Parasitology, Poverty and Prevention: is there any relationship between the three P? Is it possible to eradicate Parasitic diseases without eliminating Poverty?

Context Talking about Poverty is not obvious without examples, I would like to understand the link between Parasitology, Poverty and Prevention (the three P). I explain the three P by saying that there is four level of knowledge in Parasitology and the fourth level is the integration with other disciplines including virology with preventive measures, nutrition aspects with denutrition leading by some parasites as Ascaris, economy involving patient’s income and Poverty. As a reminder, the first level in Parasitology is the knowledge of the parasitic cycle with an emphasis on the mode of contamination, the second level is that of the implementation of technical or diagnostic means to identify the parasite in the laboratory or the bench and the third level is that of treating infected cases diagnosed in the laboratory. Objective The objective of this work is to contribute to reach the first sustainable development goal i.e. no Poverty. Specifically, this manuscript aimed to evaluate poverty with the protective measures against the harmful effects of mosquitoes that contribute to the quality of care given to patients of the University Hospital of Kinshasa (UHK). Findings Residual mosquito capture, carried out in 31 randomly selected rooms per block and per level in hospital departments, presented the number of 1,144 female mosquitoes (845 Culex, 207 Anopheles and 62 Aedes). Overall considered, the Mean Mosquito Density (MMD) was 36.2 / mosquito per room (6.9 Anopheles / room, 29.1 Culex / room and 2.1 Aedes / room with an extreme between 0 and 144 mosquitoes / room. The lowest MMD (6.2 mosquitoes / room) was observed in Block II (clinical biology and microbiology laboratories, delivery and private hospitalization rooms) compared to other hospital blocks that had the highest MMD and statistically identical (ranging between 29.2 and 45.5 mosquitoes / room). Our observations give a good idea of Poverty inside this hospital and where to concentrate in the prevention of malaria transmission within the hospital. Regardless of the block considered, it was the ground floor with an MMD of 52.8 mosquitoes / room which were the most dangerous places compared with the first and second floors with MMD respectively 17.6 and 25.6 mosquitoes / room. Conclusion In conclusion, the insufficiency of the UHK anti-mosquito measures was obvious. These should be applied without delay to prevent the risk of infection transmission by mosquitoes, even within the hospital, of hepatitis B virus and strains of Plasmodium falciparum, sometimes highly virulent, which may be concentrated there. Limits We were on the right track and this study needs more research because of its limitations: we investigate and did not find if any of the mosquitoes collected were infected; we did not investigate if the hospital had any patients with a mosquito transmitted disease in the rooms where the mosquitoes were collected. Recommendation The recommendation is if it is not possible to eradicate parasitic diseases as malaria without eliminating poverty, then we need to eliminate them both.

Nous étions sur la bonne voie avec la notion de risque qui n'était pas confirmé donc cette étude La recommandation est la suivante: s'il n'est pas possible d'éradiquer les maladies parasitaires 1 1 5 comme le paludisme sans éliminer la pauvreté, nous devons éliminer tous les deux. southern suburbs of the city of Kinshasa, that occupies the top of the health system of the environments are a real reactor that concentrates most pathogens at a very high-density level. As nuisance, when they should. This work set itself the objective of assessing the level of mosquito's 1 3 5 nuisance that reigns in this important care institution in the Democratic Republic of the Congo. To be eligible, a block should be accessible to the survey in all its parts. At each level of the condition. Block III, which has at the last level a hospitalization service, was not retained because  Showing the documents authorized by the UHK authorities, we proceeded with the identification 1 5 0 of the places and the census of the premises in which the mosquitoes capture was to take place. Out of a total of 343 local respondents considered eligible for our survey, one in ten rooms was 1 5 2 selected using the random number table by level and block. Some additional premises were The capture of mosquitoes, carried out in 6 sessions, took place in 31 premises instead of 34 1 5 7 expected. We used insecticide bombs charged permethrin spray, a synthetic pyrethroid. Before spraying insecticide into some rooms, the following precautions were taken: the occupants were 1 5 9 asked to leave, taking away their valuables, all the windows were closed, dishes, food and drinks, 1 6 0 were evacuated. Furniture and tiles were covered with white sheets. we close behind us while progressing on the bottom of the room to spray every possible corner. Spraying a room, depending on its size, lasted from 20 to 40 seconds. We left the room closing 1 6 4 the door behind us. After waiting 10 minutes, the door and windows were opened again for 5 1 6 5 minutes to ventilate the treated room. Then, using pliers, we proceeded to collect mosquitoes  Captured mosquitoes were brought back to the laboratory for identification. After exclusion of 1 6 9 males, females were sorted and enumerated by genus. Given the large variability of the data (mean-proportional dispersion), this analysis was 1 7 6 performed on the logarithms of the data to which "1" was added to account for zeros. In this  The significance of the results was assessed at the 5% probability level of significance. MMD per local was 6.9 for Anopheles and 29.1 for Culex and 2.1 for Aedes (Table 1).

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The comparison of the MMD between the blocks did not show a significant difference (p = 1 8 6 0.327). However, orthogonal contrast analysis showed that Block II had the lowest MMD   Overall, there was no significant difference between levels (p = 0.437). However, orthogonal 1 9 1 contrast analysis showed that the ground floors had a significantly higher MMD than those 1 9 2 observed in the floors (p = 0.047). Between floors, the difference was not significant (p = 0.091); 1 9 3 (Table 4) The ground floor with an average of 52.8 mosquitoes / local, while the first and second 1 9 4 level had respective values: 17.6 and 25.6 mosquitoes / local. The interaction analysis showed 1 9 5 that the difference in MMD between the levels was the same from one block to another (p = 1 9 6 0.425). Overall, there was no significant difference in MMD between premises (p = 0.926). However, the 1 9 9 study of interactions showed the difference between premises was not the same, nor from one 2 0 0 block to another (p <0.0001) nor from one level to another (p = 0.0001). The difference observed 2 0 1 between the species was identical whatever the place (p = 0.712), but not from one block to 2 0 2 another (p = 0.001) ( Table 3). The work reports findings with implications for public health. Given the implication for patient 2 0 5 care or public health, among many causes, I think poor countries deserve to be affected by 2 0 6 parasitic diseases because of illiteracy, health negligence. It is observed that parasitology- [1], those least able to afford preventative measures and medical treatment and those living in where when the international aid stops, disease prevalence become more prevalent as the case of 2 1 5

Mosquitoes' bites nuisance and the risk of infection transmission
trypanosomiasis [4]. In this context, MMD at CUK was 36.2 female / local with extremes 2 1 6 mosquitoes ranging from 0 to 144 mosquitoes / local. This number represents potentially as many 2 1 7 bites to which all people sharing the same premises were exposed.

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If we consider, for example, an average of 10 people per room (patients and nurses included), 2 1 9 each of them will be exposed to receive an average of 3.6 bites per person per night (PPN), or 2 2 0 5,114 PPN annually. This nuisance was mainly due to Culex, which alone accounted for 75.9% of 2 2 1 the mosquito population caught. Compared with Anopheles, Culex was 4.1 times more numerous. The average number of PPN due to Anopheles would be 0.7 per local. This number should be  itself can not be neglected [5]. Of course, we investigated our capture, and we did not find any of 2 2 6 the mosquitoes collected were infected; but ethically we had not the right to investigate if the 2 2 7 hospital had any patients with a mosquito-transmitted disease in the rooms where the mosquitoes 2 2 8 were collected. We know that the risk of transmission of parasitic infections (HIV, yellow fever, 2 2 9 dengue fever, Japanese encephalitis, viral hepatitis, and filariasis), is very real for some patients, 2 3 0 this study highlighted that the risk of infection remains for others purely theoretical [5].

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As mosquitoes can transmit yellow fever, dengue fever and Japanese encephalitis, there is no 2 3 2 evidence that they are capable of transmitting HIV. Indeed, it is established experimentally, by 2 3 3 gene amplification techniques, that this virus disappears from the body of the mosquito after 1 to 2 3 4 2 days, time required for digestion of the blood meal. Consequently, since the virus can not particles. Due to a hypothetical inoculation of 10 copies of viral RNA per sting, it would take 1 2 4 5 million bites that can be expected to receive an individual during his stay, even extended to 2 4 6 several years, UHK.

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Regarding yellow fever, the mere presence of Aedes aegypti, which accounts for 5.6% of CUK's 2 4 8 culicidae fauna, is not enough to ensure the transmission of this disease. Indeed, the cycle of the 2 4 9 yellow fever virus requires the interlocking of three cycles to pass the virus from the forest 2 5 0 (monkeys) to the city (man). The biotope of Kinshasa, far away from the forests, is not conducive 2 5 1 for the development of such a chain of transmission. On the other hand, the intrusion of a single 2 5 2 case of yellow fever into the hospital is potentially dangerous for all the people who live there.

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Given the presence of the potential vector, draconian biosecurity measures must be taken without 2 5 4 delay. Blow et al [8] showed that this virus could be transmitted to humans through the droppings of 2 5 8