Review PaperSystematic review and meta-analysis of hepatitis C virus infection in the Democratic Republic of Congo
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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Seroprevalence of viral hepatitis B and C in two populations: blood donors and patients with suspected hepatic cirrhosis in Kwilu province, Democratic Republic of Congo
2021, International Journal of Infectious DiseasesCitation Excerpt :In the Democratic Republic of Congo (DRC), in a systematic review of 28 published studies between 2000 and 2016, HBsAg seroprevalence was estimated at 5% in blood donors and pregnant women (Shindano et al, 2018). Regarding HCV infection, a meta-analysis published in 2016 found an overall pooled prevalence of anti-HCV antibodies of 2.9% (Muzembo et al, 2016). A study carried out in 2012, looking at people aged >70 years in Kinshasa, found a seroprevalence for HCV of 25.9% (Hogan et al, 2016).
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