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* Infant infection rate higher than in the West African epidemic
* More than two out of three infected children have died
* Transmission in health facilities, main factor of infection
By Alessandra Prentice
BUTEMBO, Democratic Republic of Congo, May 30 (Reuters) – Kennedy Muhindo, 8, had a high fever, stomach pain and diarrhea.
Health workers told him that he had Ebola, but he first thought about his sister fighting the virus.
"How's my older sister?" he repeatedly asked health workers at an Ebola treatment center on the outskirts of Butembo, a trading hub in the middle of volcanic hills in the eastern Democratic Republic of Congo .
The staff said that they did not have the heart to tell him that Lareine, 9, had died.
"His sister was his best friend," said Desy Shabani, who provides psychosocial support to patients. "To have lost the most expensive person of his life … I asked myself:" What will this child do? "
The Ebola epidemic in Congo – the second largest – has made unusually heavy casualties. More than a quarter of the confirmed and probable cases identified in early April were children under 15 years of age, compared with 18% in the last major West Africa epidemic in 2013-2016, according to figures compiled by the United States. ;World Health Organization.
The disease can progress rapidly, paralyzing the immune system and blocking vital organs.
Young children and babies are particularly vulnerable. Their smaller bodies are less well equipped to cope with extreme fluid loss from common symptoms such as diarrhea, vomiting, fever and bleeding, said Daniel Bausch, infectious disease specialist at the London School of Hygiene and Tropical Medicine.
More than two out of every three children infected by this epidemic have died, compared with just over half of adults, the WHO said. As of May 26, the death toll was 1,281, of whom at least 541 were under 18 years of age.
According to a study published in the New England Journal of Medicine in 2015, mortality rates are highest among children under age 4 who died at a rate of about 80% in West Africa. Https://www.nejm.org/doi/full/ 10.1056 / NEJMc1415318
In total, more than 11,000 people died in this epidemic.
The contents of the storage room at the Butembo treatment center reflect the age of many patients. Next to the blankets and change of clothes, you will find shelves filled with baby formula and neon-colored plastic rattles in the shape of a little bear.
In the city center, coffins wrapped in flowery plastic were stacked in front of a carpentry shop. An employee lamented the frequency of orders.
GLOVES AND BODILY FLUIDS
Ebola cases would generally be more or less equally divided between men and women. But in this epidemic, women and girls account for 58% of cases, compared with 62% in December, said WHO.
The reason why more women and children have fallen ill remains a mystery. But experts may suspect it because the region of Beni, where the epidemic began in August, was also fighting malaria at the time.
Malaria can cause serious complications in pregnant women and children, requiring treatment in medical centers where they risk exposure of undiagnosed Ebola patients, said Mike Ryan, who runs the program of WHO health emergencies.
"Transmission as part of health care has been a major factor in this epidemic," Ryan said. "Unfortunately, women and children have been the unintended victims of this reality."
Health care standards in Congo vary widely because of the lack of surveillance of a system of many unregistered private clinics and traditional home-based healers.
The virus is transmitted by contact with infected body fluids. However, according to the Congolese Ministry of Health, health workers operating outside public hospitals do not always follow the guidelines to prevent cross-contamination.
"This means that they sometimes do not change gloves, that they do not use single-use gloves or that they do not wear gloves at all," said Jessica Ilunga. , spokesman for the ministry. "They do not sterilize their equipment, they do not decontaminate the beds and do not change sheets."
Anselme Mungwayitheka said that he and two other health workers from a private clinic in Beni had caught the Ebola virus from an infected woman and her newborn while they were being cared for by a traditional healer.
"We did not have a lot of equipment in this facility," said Mungwayitheka, who is now working in an Ebola treatment center in Beni. He feels that he saved his life. "When we received patients, we just had to put on protective gloves, and after having treated them, we had to remove the gloves, but the patient had touched almost every door."
A key element of the Ebola response is to decontaminate health facilities, educate health workers on how to protect themselves and their patients, and persuade residents to seek treatment in specialized centers. But these efforts have been hampered by outbreaks of violence and deep mistrust of foreigners.
This is the tenth Ebola epidemic in Congo, but it is the first in the densely populated provinces of North Kivu and Ituri, where militias have been conducting sporadic raids for decades. fortresses hidden in the rainforest. Women and children are often the first to be displaced by the bloodshed.
"ALL COULD HAVE DEATH"
At the Ebola Treatment Center in Beni, a city of several hundred thousand people closely linked to neighboring Uganda, five members of the same family of farmers were treated for Ebola at the end of March. Three were children.
Marcela Kaswera, 45, said that she had sent her children to their older brother in the village of Biakatu after the attack on their hometown of Oicha by members of a militia Islamist.
"On March 20, it was a Wednesday, my son called me," Kaswera recalls. He said: "Mom, I'm coming back to Oicha because Ebola touched Biakatu and that a lot of people are dying."
When they returned, his 7-year-old son was feverish. He died in his arms in a hospital, where he pbaded a positive posthumous test for Ebola.
Successively, Kaswera's son, 2-year-old daughter, adult son, daughter-in-law and grandson all developed symptoms of the virus and were transferred to the treatment center run by the Alliance for International. . Medical action.
"Now, I can thank God because they are stable," said Kaswera, who had traveled 30 kilometers behind a motorcycle taxi with her husband to visit members of their family. sick family. "If I only had doctors, I think they could all have died."
On the evening of February 27, unknown badailants attacked Butembo's center where Kennedy was being treated, setting fire to structures and vehicles. Hearing gunshots, one of the other patients took the boy away and ran across open fields to get to town. They spent the night at the man 's house and came back the next day.
"He was really scared," recalls Shabani, standing on a walkway in front of a row of tented cabins, where people suspected of having Ebola were waiting for the test results.
Kennedy was released less than a week later. He is now back at school and playing football with a group of kids on the steep, muddy streets near his home, lining lush farmland.
(Additional reports by Djaffar Al Katanty in Butembo and Beni, Stephanie Nebehay in Geneva, Kate Kelland in London and Giulia Paravicini in Brussels Edited by Alexandra Zavis and Anna Willard)
Our standards: The principles of Thomson Reuters Trust.
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