Elsevier

Public Health

Volume 139, October 2016, Pages 13-21
Public Health

Review Paper
Systematic review and meta-analysis of hepatitis C virus infection in the Democratic Republic of Congo

https://doi.org/10.1016/j.puhe.2016.06.017Get rights and content

Highlights

  • Hepatitis C virus (HCV) is endemic in the Democratic Republic of Congo (DRC).

  • We carried out a systematic review and meta-analysis to provide updated information on HCV infection in the DRC.

  • HCV remains an issue of public concern in the DRC.

  • HCV infection might spread in the DRC through unsafe medical procedures including blood transfusions.

  • Our results suggest a rolling out of adequate hepatitis control programs in the DRC.

Abstract

Objectives

Hepatitis C virus (HCV) infection is endemic in the Democratic Republic of the Congo (DRC), where the prevalence of HCV antibodies (anti-HCV) is reported to range from 0.2% to 13.7%. However, the reported prevalence rates have been inconsistent. Therefore, a meta-analysis of observational studies was conducted to provide updates on the prevalence of HCV infection in the DRC.

Study design

Systematic review and meta-analysis.

Methods

Medline, EMBASE and Google Scholar were searched for publications reporting on HCV infection in the DRC up to autumn 2015. In addition, a manual search was undertaken to detect relevant papers. Studies performed in groups at low risk of HCV (blood donors and pregnant women) were used for the meta-analysis. The random effects model was used to estimate the pooled prevalence of anti-HCV.

Results

Sixteen studies with 13,799 participants (aged 6 months–71 years) met the inclusion criteria. The studies were performed in blood donors, pregnant women, military personnel, individuals with human immunodeficiency virus, children, commercial sex workers, Congolese patients living in Canada, patients with sickle cell disease and hospitalized patients. The reviewed studies revealed the presence of anti-HCV in almost all studied age groups and did not differ between sexes. The pooled prevalence of anti-HCV was 2.9% [95% confidence interval 1.5–4.3%]. Subgroup analyses revealed that the prevalence rates of anti-HCV in blood donors and pregnant women were 2.7% (95% confidence interval: 1.1–4.4%) and 3.3% (1.4–5.1%), respectively.

Conclusions

HCV infection remains an issue of public concern in the DRC, demonstrating a need for adequate hepatitis control programmes. Efforts must be made to virtually eliminate transfusion-transmitted HCV throughout the country.

Introduction

Hepatitis C virus (HCV) infection is one of the most challenging health problems to face humanity for decades, especially in developing countries where the disease remains highly endemic. HCV is considered to be endemic in the Democratic Republic of the Congo (DRC). It is estimated that HCV affects approximately 647,000 Congolese1 and 130–150 million people throughout the world.2

HCV infection is usually self-limited in the initial stages, but failure of the immune system to clear the virus leads to chronicity. Chronic hepatitis C is often clinically insidious but develops progressively and persistently over years or decades. Chronic infection with HCV is a serious public health concern as it is linked to hepatic cirrhosis and hepatocellular carcinoma3, 4 and can ultimately cause premature death.5

Despite being one of the most common bloodborne infections endemic in the DRC, little attention has been paid to HCV-related health issues. Hepatitis virus screening is not yet implemented routinely, and the lack of effective care and treatment programmes make matters worse.6, 7 Furthermore, the DRC is not currently listed in the HCV synthesis project.8 Some medical institutions in the DRC fail to perform HCV screening on donated blood.9 Therefore, patients undergoing blood transfusions are at high risk of HCV infection. As an example, a 2013 study in transfused children reported that the prevalence of anti-HCV was 13.5%.10

Different studies have reported inconsistent prevalence rates of HCV in the DRC. The prevalence of HCV antibodies (anti-HCV) has been estimated to vary from 0.2%11–13.7%.12 Published reviews have not focused specifically on the DRC.1, 13, 14 In addition, these reviews reported heterogeneous results. In 2015, a meta-analysis of two observational studies reported that the prevalence of anti-HCV was 2.1%,1 whereas this had previously been estimated to be 4.3%14 and 5.5%.13 In light of the above discrepancies in the literature, a meta-analysis of available data would be scientifically relevant.

To help inform policy identifies the appropriate intervention in a given country, it is advised that the number of people with undiagnosed HCV infection in the general population should be estimated.15, 16 In order to conduct similar studies in the DRC, it is crucial to estimate the magnitude of the problem. Therefore, this study was designed to summarize epidemiological studies on HCV infection in the DRC. The potential relevance of this study in epidemiology is that it provides valuable insights in planning future studies in order to help promote prevention and enhance community advocacy in the country.

Section snippets

Study design

A systematic review and meta-analysis was undertaken.

Search strategy and selection criteria

The preferred reporting items for systematic reviews and meta-analysis17 and meta-analysis of observational studies in epidemiology guidelines were followed.18 Medline, EMBASE and Google Scholar were searched to identify articles on HCV infection in the DRC. The search was based on literature published up to September 2015 using the following keywords: ‘hepatitis C, prevalence, Democratic Republic of Congo’, and ‘hepatitis C, incidence,

Search outcomes

The selection process is displayed in Fig. 1. The search identified 318 potentially relevant publications. After the exclusion of 197 duplicate publications, 121 titles and abstracts were screened. Of these, 15 articles were excluded because they were not pertinent to the study. Further evaluation excluded 90 publications because they were deemed to be irrelevant, leaving 16 unique publications with 13,799 individuals for inclusion in the qualitative synthesis. Twelve publications were written

Discussion

The overall prevalence of anti-HCV in the reviewed studies was estimated to be 2.9% (95% CI: 1.5–4.3%). This prevalence confirms that HCV infection remains a significant public health problem in the DRC. The results suggest the need for a strong commitment from Congolese policy makers, including adequate hepatitis control programmes.

It is possible that the prevalence reported in this study could have been underestimated as studies included in the meta-analysis were performed in low-risk groups

Acknowledgements

The authors gratefully acknowledge Dr. Keiko Katayama and Miss Mansongi Biyela Carine for their support and advice during the preparation of this article.

Ethical approval

None sought.

Funding

None declared.

Competing interests

None declared.

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