An original strategy to promote Sleeping Sickness diagnostic participation in Guinea: How did the Football World Cup 2022 help to target the refractory young male population during an active screening Door-to-Door survey?

An original strategy to promote Sleeping Sickness diagnostic participation in Guinea: How did the Football World Cup 2022 help to target the refractory young male population during an active screening Door-to-Door survey? | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article An original strategy to promote Sleeping Sickness diagnostic participation in Guinea: How did the Football World Cup 2022 help to target the refractory young male population during an active screening Door-to-Door survey? Mohamed Gassama, Oumou Camara, Aissata Soumah, Moise Kagbadouno, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5395219/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background . The study aimed to evaluate the effectiveness of sensitization events targeting young males to improve their participation in active screening campaigns for Human African Trypanosomiasis (HAT), also known as sleeping sickness, in Guinea. Despite progress towards eliminating HAT as a public health problem, challenges remain in detecting the last remaining cases, particularly among individuals, especially young men, who work in mangroves and are highly exposed to the tsetse fly vector. Method . During the 2022 Football World Cup, coinciding with a door-to-door screening campaign in the Boffa focus of Guinea, football matches were used as an opportunity to sensitize the population. Twenty-seven villages were selected for screening, and four villages with recently diagnosed HAT cases were chosen to broadcast World Cup matches followed by a 30-minute sensitization movie about HAT in the local language. Demographic data were collected using an Open Data Kit system. Results . The results indicated significant interest in the sensitization events, with over 500 attendees at all during the four days of broadcasting. A comparison of participation rates between World Cup villages (WCV) and non-WCV villages showed a higher proportion of males aged 8 to 27 participating in the WCV (17.7%) compared to non-WCV villages (14.6%). This difference was not observed for females of the same age group. Furthermore, compared to data from the previous year, there was an increase in the relative participation of young males from 16.4% to 19.6%. Conclusion . Innovative strategies, such as using football matches for sensitization, are essential for reaching at-risk populations and identifying remaining HAT cases. Football holds significant cultural and social importance in Guinean villages, making it an effective platform for HAT sensitization efforts. Scaling up such strategies could further enhance awareness and participation in screening campaigns, ultimately aiding in the elimination of HAT transmission. Sleeping Sickness Sensitization Football World-Cup Guinea Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Background In Guinea, for 20 years, the National Control Program of Human African Trypanosomiasis (HAT-NCP), has been responsible for the program to eliminate sleeping sickness. The strategy for identifying the remaining cases and eliminating transmission in the three main HAT foci (in the districts of Boffa, Dubreka and Forecariah) is based on the combination of both medical (for case diagnosis and treatment) and vector (to limit human tsetse fly contacts) control [ 1 ]. This strategy has proven its efficacy, despite the recent sanitary problems (Ebola outbreak in 2013–2016 and Sars-Cov2 pandemic in 2020–2021) [ 2 ]. During the last 5 years (2018 to 2022), the number of cases fell below one case for 10,000 habitants in each of the three HAT foci of coastal Guinea [ 3 ]. From the 235 HAT cases detected and treated during this period, half were detected by active screening (n = 120), and half by passive detection (n = 115), stressing the complementarity of both approaches. Active screening consists of proactively searching for HAT cases in the exposed population, by performing systematic serological tests by CATT (Card Agglutination Test for Trypanosomiasis) or/and RDT (Rapid Diagnostic Test) methods, followed by parasitological confirmation [ 4 ]. This approach requires previous sensitization activities aimed at informing and convincing the population to participate in the HAT screening activities. In Guinea, due to the peculiar epidemiology of the disease and the ecology of the tsetse fly, the transmission risks are mostly linked to activities that are undertaken in the mangroves, an ecosystem where tsetse fly proliferate [ 5 ]. Some of these activities (fishing and wood cutting especially) are led preferentially by the young male active population. It is known thanks to the historic data collected by the HAT-NCP that this population represents a high percentage of the reported HAT cases [ 6 ]. Paradoxically, this exposed population is often hesitant to participate in the screening campaign. Three main reasons can be advanced to explain such situation: (i) the lack of relevant information, (ii) the feeling of invulnerability explained by the asymptomatic phase of the disease at the early stage and (iii) the fear of the blood finger-puncture. Consequently, all the strategies able to convince this at-risk population should be promoted. From November 20th to December 18th 2022, the Football World Cup took place in Qatar. At the same period, an active screening door-to-door (D2D) survey, aiming the detection of HAT cases, was organized in 27 villages of the Boffa HAT focus. To encourage the participation of the population, and in particular of the young males, the HAT-NPC decided to complement the traditional sensitization activities by broadcasting, once per day, a Football World Cup match in some of the most affected villages. To do so, a specific team was empowered to project such programs during 4 days in four different villages, out of the 27 targeted for the D2D survey. The aim of this trial was to evaluate new strategies based on Football, a very popular sport in Guinea, to better reach a reluctant population. The impact on participation was measured using the pre-existing Open Data Kit (ODK) system [ 7 ], an open-source mobile data collection platform routinely used by the HAT mobile teams in Guinea since 2021. Data collected were analysed comparing the demographical features of the screened population from the villages where the Football World Cup was proposed (WCV) with the villages where the Football World Cup was not proposed (no-WCV), during the same D2D survey. In addition, the impact of the activity was also evaluated by comparing the age and sex distribution observed in the same villages during 2021 (no-WC) and 2022 (WC) in the screened population of these 4 villages. Methods Ethics statements The data presented here was collected as part of the HAT elimination program in coastal Guinea (ElimTrypGui), which was approved by the Ministry of Health of the Republic of Guinea (234/MSHP/CAB/2013). All HAT patients whose data were used in this work were diagnosed and treated in agreement with the national health policy and WHO guidelines. This work was carried out in conformity with the Declaration of Helsinki [2]. Door-to-Door survey From 29 h of November to 4 th of December 2022, 27 villages were visited by 7 mobile teams of the NCP-HAT in the Boffa-West focus. Each mobile team was composed of two Health agents responsible for performing the RDTs and one Community agent. D2D consists into a proactive process where the mobile team goes from house to house to test all the voluntary population. All the RDT positive suspects were sent to the confirmatory laboratory to perform clinical examination using CATT and mini-anion exchange centrifugation technique (mAECT) (REF). HAT is only confirmed if the presence of trypanosomes is detected by microscopic observation, then the patient is referred for treatment. Football World Cup matches broadcast During the D2D period, Football World Cup group-stage matches took place. For technical reasons, only night-session matches (7pm UGT) were broadcasted with a big screen. From 29 h of November to 4 th of December 2022, Wales vs England, Costa-Rica vs Germany, Poland vs Argentina and Cameroon vs Brazil were projected in Poukhoun, Walia, Lakhata and Thia Tanéné respectively ( Figure 1 ). Previously to the session, a Health worker and/or a Community agent explained in Soussou, the local language, the reason of such activity. After the match, a 30-min HAT-sensitization movie recorded from a humoristic play was shown in all these 4 villages (https://www.youtube.com/watch?v=5pi2ZgxdEZM). All these activities were performed prior to the D2D survey. During this survey, four Football World Cup matches were broadcast in four villages (Poukhoun, Lakhata, Walia and Thia) ( Figure 2 ). These villages were targeted as HAT cases were detected there during the years prior to screening. Before and after the broadcast of the match, sensitization messages were broadcast locally and a previously recorded play on HAT prevention was shown. High rates of participation were observed, from 50 persons (Poukhoun) to 200 (Lakhata and Thia) persons for every night session, with all ages represented. At this point a visit from the mobile screening team was scheduled for the day following sensitisation. Data collection Epidemiological and demographical data were collected during the D2D survey using ODK based tools that was used in all D2D activities since 2021. Every night, all the data collected during the day were checked, confirmed and sent to a local server. Demographical data on Guinean population was collected from the www.populationpyramid.net website, augmented by specific data for the Boffa focus by (Courtin et al., 2015), we treat these data with caution because they were collected from 2009, since when the life expectancy nationally has increased from 56 to 59 and the proportion aged 15-65 to 0-14 from 1.15 to 1.33 (World Bank; https://data.worldbank.org/indicator/). Two villages (Thia and Walia) were also visited and screened using the same ODK system in 2021 and we used these as a basis for comparison to the 2022 data. Statistical analysis To test significance of different groups we divided the data into the groups of key interest and compared the groups in 2x2 tables using a Pearson’s Chi-square test and age structures were compared using the Wilcoxon rank sum test. In self-reported ages there was a tendency to round to the nearest 5 or 10, so to allow for this in bracketing ages for analysis we cut the ages at 7, 17, 27 etc, these analyses were done in R [8]. Results The young male population: A highly HAT at risk population difficult to early detect In Guinea, after the Ebola outbreak that adversely impacted HAT control activities from 2013 to 2016 resulting in a re-emergence of the disease [2], a constant decrease of the HAT cases has been observed since 2018 ( Figure 3A ). Since 2020, the majority of the cases are detected by passive screening thanks to a network of 105 health centres. When looking at sex and age distribution of the 235 HAT cases that occurred during the last 5 years, we observed that half of the cases was detected in individuals aged from 18 to 36 years old with an apparent balanced sex ratio ( Figure 3B ). However, this sex ratio varied greatly when we analysed the repartition according to the screening method. During active screening activities, the number of 16-39 y/o females detected positive for HAT is higher than males (61% of female vs 39% of male) while this proportion is inverted (65% of male, p=0.002) for the HAT cases detected through passive screening ( Figure 3C ). These data suggest that the young male population is reluctant and/or less sensitized to take part to the active screening and mainly go to health centres when the disease is already in a late stage 2 characterized by high WBC count ( Figure 3D ). The overrepresentation among the HAT cases among males aged 18-27 is highlighted by Figure 4 with individuals aged 0-17 underrepresented among cases, and over represented in older groups. The proportion of cases among males aged 18-27 is over 12% greater than the proportion of that age group in the population, conversely for males aged 0-7 the proportion of cases is over 10% lower than the proportion of that age group in the population. Demographics from the D2D activities Data collected using the HAT-NCP ODK system were analysed to compare the demographical data (n=3,761) obtained from the D2D survey performed in Boffa from November 29 th to December 4 th 2022 with demographical data from the Boffa census population from 2009 (n=27,989). From Figure 5 , we can observe strong deviations of our diagnosed group in comparison to the general population. Nationally the proportion of the population that is aged 0-14 has been decreasing (World Bank), so the difference in the 0-y years bar should be increasing since this 2009 census. Therefore, when combining these data of over-exposure to HAT and under-diagnosis during the D2D surveys, the NPC-HAT program decided to elaborate more effective strategies to better sensitize the young male population to improve the HAT cases detection. Using the Football World Cup as sensitization tool during the Boffa D2D survey From November 29 th to December 4 th , 3,761 persons living in 27 villages of the active HAT focus of Boffa-West were tested by 7 mobiles teams, using the SD Bioline HAT 2.0 RDT. A total of 151 (4.0%) serosuspects (RDT positive) have been detected. After confirmation, 8 exhibited a CATT titration >1/4 and a 40 y/o male from Lakhata was confirmed as a case with detection of T. b. gambiense thanks to the mAECT. During this survey, four Football World Cup matches were broadcast in four villages (Poukhoun, Lakhata, Walia and Thia) ( Figures 1 and 2 ). These villages were targeted as HAT cases were detected there during the years prior to screening. Before and after the broadcast of the match, sensitization messages were broadcast locally and a previously recorded play on HAT prevention was shown. High rates of participation were observed, from 50 persons (Poukhoun) to 200 (Lakhata and Thia) persons for every night session, with all ages represented. At this point a visit from the mobile screening team was scheduled for the day following sensitisation. Quantitative analysis was first performed by comparing the data collected after the D2D survey in the four villages (n=1,157) with the data collected in the 23 remaining villages (n=2,604). Comparing the proportion of the 8-27 years old males that were screened as part of WCV, we observed a statistically significant increase from 14.57% (no-WCV) to 17.71% (WCV) (χ 2 = 5.77, p = 0.016) ( Table 1 and Figure 6A ). This difference was not observed for the female population of the same age. A second analysis compared ODK data collected during a survey in 2021 (n=7,928), with the 2022 data (n=1,021). A very different population structure was observed ( Table 2 and Figure 6B ), not significant when considering the 8-27 age bracket, but significant in the 8-17 bracket (χ 2 = 4.21, p = 0.04). Discussion Elimination of a neglected tropical disease is a challenge that many countries in Africa will face. With less than 1 HAT case for 10,000 people from 2018 to 2022, in the three active sleeping sickness foci (Boffa, Dubreka and Forecariah), Guinea is on the track for HAT elimination as public health problem [ 3 ]. Efforts should be done now to reach the elimination of transmission (EoT) goal. Flushing out the last remaining cases requires improvements to the communication strategies in order to reach the most exposed populations. From analysis of demographic, epidemiological and medical data collected during the past 5 years, evidences of a strong bias in the targeted population has been observed. Whereas no apparent unbalanced sex ratio is observed among the HAT cases, suggesting equal risk of exposition between males and females, this ratio gets out of balance when examining the data according to the screening (passive vs active) methods. The 16–39 y/o male population that represents 32% of the total HAT cases (77/235), does not greatly participate to the active screening campaigns. So, when members of this population are infected they are not typically detected for months or years following infection when severe disease develops and the patient presents to a health centre. In the meantime, infected people continue their activities in areas where tsetse flies are present potentially resulting in transmission. Thanks to the vector control implemented in 2012 in Boffa, part of these at-risk areas is protected with reduced tsetse fly numbers tsetse flies, but an exhaustive coverage through tiny targets deployment is impossible to ensure [ 9 ]. In such situations, strong efforts should be conducted to inform and convince this highly exposed population to participate in HAT screening activities at a regular interval (ideally once per year). In the recent past, original initiatives including sensitization messages divulgation through interactive broadcast or theatre performances, have been developed by the Guinean HAT-NCP. Unfortunately, despite their success in the villages, their downstream impact on the participation of the targeted people has not been properly evaluated. In 2021, through TrypaNo2! Initiative, a BMGF granted program aiming to eliminate HAT in several endemic countries [ 1 ], an ODK system was developed. It enables the HAT-NCP to collect and analyse in a real time manner, relevant epidemiological data during the screening activities. In addition to all the recent innovations that have improved HAT control tools (diagnosis, treatment, VC, etc.), it should not be forgotten that it is also thanks to work with communities that the last cases can be detected. As we have seen, the epidemiology of HAT in Guinea is strongly linked to the exposure of young men to the bites of flies during their activities in the mangroves. Raising awareness among this population is therefore essential for success. For the prevention, diagnosis or treatment of infectious diseases, community-based awareness-raising strategies to increase the engagement of young men have been studied, particularly in the case of HIV. In sub-Saharan Africa, men have been shown to be less likely than women to engage in HIV services across the care cascade, resulting in poorer clinical outcomes [ 10 , 11 ]. A way that can be chosen to apply these strategies can rely on sport. Sports-based interventions for improving health knowledge and behaviours among youth in Africa have been recently reviewed [ 12 ]. On the 28 studies the authors analysed, the most common specific health concerns addressed by the interventions were related to HIV. And given that football is considered the most popular sport in Africa, half of the interventions used football to engage youth in health education. However, even if some efforts have been conducted during the last decade, some authors underlined that very few interventions have been assessed for effectiveness in a quantitative manner [ 13 ]. Aware that an objective evaluation is an essential prerequisite to assess the success or failure of the activities, the HAT-NCP of Guinea used the ODK-based system during a D2D survey for evaluating the impact of a sport-based intervention. This intervention benefited from the 2022 Football World Cup, a planetary event particularly followed in Africa, to target the young male population. During a week, the HAT-NCP team broadcast a Football World Cup game in villages particularly exposed to the HAT. Beyond the social event, that was highly appreciated by people who has no frequent occasion to watch TV/Movies, HAT-NCP took advantage of the situation to diffuse sensitization messages toward HAT to promote HAT screening participation. Through analysis of the ODK data, the impact of such sensitization on the targeted population (young male community) was assessed. In a statistically significant manner, when HAT screenings were done in villages were world cup matches were displayed, we observed a participation increase of the young male groups, in comparison with villages where no matches were shown. Interestingly, when comparing with 2021 epidemiological data taken from the same “World Cup” villages, the same positive impact was also observed, suggesting that the ODK-measured effect was strong. Conclusions This study will encourage the Guinean NCP to disseminate such innovative strategies in all 3 endemic foci. Ludic activities such as organising local football tournaments, theatre workshops for children or a lottery during the medical prospection are planned for the next actions. In parallel, we can expect that the next arrival of acoziborole [14] in the treatment toolbox will facilitate care management, especially when the "test and treat" strategy is applied. This single-dose, oral treatment will allow patients to be cured at home. This will help to avoid the stigma associated with hospitalisation, which often prevents patients from accepting diagnosis and/or treatment. Abbreviations CATT: Card Agglutination Test for Trypanosomiasis; EoT: Elimination of Transmission; gHAT: gambiense Human African trypanosomiasis; ODK: Open Data Kit; mAECT: mini anion exchange centrifugation technique; RDT: Rapid diagnostic test; T.b.gambiense : Trypanosoma brucei gambiense ; WCV: World Cup villages; WHO: World Health Organization Declarations Ethics approval and consent to participate All the prospective work done in the field in the HAT focus was performed during the medical surveillance campaigns conducted routinely by the HAT National Control Program (HAT-NCP) of the Republic of Guinea that was established by the Ministry of Health in 2002. An open authorization for anonymous blood sampling and conservation, as well as analysis of diagnostic screening results for epidemiological surveillance was provided to the HAT-NCP by the Ministry of Health of Guinea in the framework of the ElimTryGui roadmap of the HAT-NCP which was approved by the Ministry of Health of the Republic of Guinea (234/MSHP/CAB/2013). Consent for publication Not applicable Availability of data and materials Data are available on request from the authors. Competing interests The authors declare that they have no competing interests Funding This work was supported by the Bill and Melinda Gates Foundation (www.gatesfoundation.org) through the Trypa-NO! Project (grants number INV-001785, OPP1033712, OPP1154033) and by the RECIT-JEAI (2022-2024) granted by IRD. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Authors' contributions Conceptualization: MC, BB, PB, JMB; Data Curation: BB, PB, JMB; Formal Analysis: BB, PB, JMB; Funding Acquisition: MC, BB, PB, JMB; Investigation: MG, OC, AS, FXBV, BB, PB, JMB; Methodology: BB, PB, JMB; Project Administration: BB, PB, JMB; Resources: MC, BB, PB, JMB; Software: MG, MK BB, PB; Supervision: MC, BB, PB, JMB ; Validation: MG, OC, MK, AS, FXBV, MC, BB, PB, JMB ; Visualization: MG, OC, MK, AS, FXBV, MC, BB, PB, JMB; Writing – Original Draft Preparation: BB, PB, JMB; Writing – Review & Editing: MG, OC, MK, AS, FXBV, MC, BB, PB, JMB Acknowledgements We would like to thank all the Health Agents of Boffa who took part of the Door-to-Door activities. References Ndung’u JM, Boulangé A, Picado A, Mugenyi A, Mortensen A, Hope A, Mollo BG, Bucheton B, Wamboga C, Waiswa C, Kaba D, Matovu E, Courtin F, Garrod G, Gimonneau G, Bingham G V, Hassane HM, Tirados I, Saldanha I, Kabore J, Rayaisse JB, Bart JM, Lingley J, Esterhuizen J, Longbottom J, Pulford J, Kouakou L, Sanogo L, Cunningham L, Camara M, Koffi M, Stanton M, Lehane M, Kagbadouno MS, Camara O, Bessell P, Mallaye P, Solano P, Selby R, Dunkley S, Torr S, Biéler S, Lejon V, Jamonneau V, Yoni W, Katz Z (2020) Trypa-no! contributes to the elimination of gambiense human african trypanosomiasis by combining tsetse control with “screen, diagnose and treat” using innovative tools and strategies. PLoS Negl Trop Dis 14:1–9. https://doi.org/10.1371/journal.pntd.0008738 Camara O, Biéler S, Bucheton B, Kagbadouno M, Mathu Ndung’u J, Solano P, Camara M (2021) Accelerating elimination of sleeping sickness from the Guinean littoral through enhanced screening in the post-Ebola context: A retrospective analysis. PLoS Negl Trop Dis 15:e0009163. https://doi.org/10.1371/journal.pntd.0009163 Franco JR, Priotto G, Paone M, Cecchi G, Ebeja AK, Simarro PP, Sankara D, Metwally SBA, Argaw DD (2024) The elimination of human African trypanosomiasis: Monitoring progress towards the 2021–2030 WHO road map targets. PLoS Negl Trop Dis 18:e0012111. https://doi.org/10.1371/journal.pntd.0012111 Camara O, Kaboré JW, Soumah A, Leno M, Bangoura MS, N’Diaye D, Belem AMG, Biéler S, Camara M, Bart J-M, Rotureau B, Bucheton B (2024) Conducting active screening for human African trypanosomiasis with rapid diagnostic tests: The Guinean experience (2016–2021). PLoS Negl Trop Dis 18:e0011985. https://doi.org/10.1371/journal.pntd.0011985 Kagbadouno MS, Séré M, Ségard A, Camara AD, Camara M, Bucheton B, Bart J-M, Courtin F, De Meeûs T, Ravel S (2024) Population genetics of Glossina palpalis gambiensis in the sleeping sickness focus of Boffa (Guinea) before and after eight years of vector control: no effect of control despite a significant decrease of human exposure to the disease. Peer Community Journal 4:e21. https://doi.org/10.24072/pcjournal.383 Camara M, Kaba D, Kagbadouno M, Sanon Jr, Ouendeno Ff, Solano P (2005) La Trypanosomose humaine africaine en zone de mangrove en république de guinée : caractéristiques épidémiologiques et cliniques de deux foyers voisins. Med Trop 65:155–161 Hartung C, Lerer A, Anokwa Y, Tseng C, Brunette W, Borriello G (2010) Open data kit. In: Proceedings of the 4th ACM/IEEE International Conference on Information and Communication Technologies and Development. ACM, New York, NY, USA, pp 1–12 R Core Team (2022) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria Courtin F, Camara M, Rayaisse JB, Kagbadouno M, Dama E, Camara O, Traoré IS, Rouamba J, Peylhard M, Somda MB, Leno M, Lehane MJ, Torr SJ, Solano P, Jamonneau V, Bucheton B (2015) Reducing human-tsetse contact significantly enhances the efficacy of sleeping sickness active screening campaigns: A promising result in the context of elimination. PLoS Negl Trop Dis 9:1–12. https://doi.org/10.1371/journal.pntd.0003727 Sharma M, Barnabas R V., Celum C (2017) Community-based strategies to strengthen men’s engagement in the HIV care cascade in sub-Saharan Africa. PLoS Med 14:e1002262. https://doi.org/10.1371/journal.pmed.1002262 Mills EJ, Beyrer C, Birungi J, Dybul MR (2012) Engaging Men in Prevention and Care for HIV/AIDS in Africa. PLoS Med 9:e1001167. https://doi.org/10.1371/journal.pmed.1001167 Hansell AH, Giacobbi PR, Voelker DK (2021) A Scoping Review of Sport-Based Health Promotion Interventions With Youth in Africa. Health Promot Pract 22:31–40. https://doi.org/10.1177/1524839920914916 Fuller CW, Junge A, DeCelles J, Donald J, Jankelowitz R, Dvorak J (2010) ’Football for Health’--a football-based health-promotion programme for children in South Africa: a parallel cohort study. Br J Sports Med 44:546–554. https://doi.org/10.1136/bjsm.2010.072223 Betu Kumeso VK, Kalonji WM, Rembry S, Valverde Mordt O, Ngolo Tete D, Prêtre A, Delhomme S, Ilunga Wa Kyhi M, Camara M, Catusse J, Schneitter S, Nusbaumer M, Mwamba Miaka E, Mahenzi Mbembo H, Makaya Mayawula J, Layba Camara M, Akwaso Massa F, Kaninda Badibabi L, Kasongo Bonama A, Kavunga Lukula P, Mutanda Kalonji S, Mariero Philemon P, Mokilifi Nganyonyi R, Embana Mankiara H, Asuka Akongo Nguba A, Kobo Muanza V, Mulenge Nasandhel E, Fifi Nzeza Bambuwu A, Scherrer B, Strub-Wourgaft N, Tarral A (2023) Efficacy and safety of acoziborole in patients with human African trypanosomiasis caused by Trypanosoma brucei gambiense: a multicentre, open-label, single-arm, phase 2/3 trial. Lancet Infect Dis 23:463–470. https://doi.org/10.1016/S1473-3099(22)00660-0 Tables Table 1 and 2 are available in the Supplementary Files section. 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Four villages (Poukhoun, Lakhata, Walia and Thia) were chosen to broadcast the world cup matches.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5395219/v1/073e9b46acfe42a043d98969.png"},{"id":70926514,"identity":"caf3edfe-e5d6-45fa-9f15-5f021480eb52","added_by":"auto","created_at":"2024-12-09 09:12:12","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1118450,"visible":true,"origin":"","legend":"\u003cp\u003ePhotos taken in two of the villages: Poukhoun (A) and Lakhata (B) where Football World Cup matches were broadcasted.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5395219/v1/a7d33ce366ec5fcc877ea091.png"},{"id":70926516,"identity":"81b2f75c-82a5-4c3a-acca-82a3eeb3962d","added_by":"auto","created_at":"2024-12-09 09:12:12","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":195897,"visible":true,"origin":"","legend":"\u003cp\u003eEpidemiological and biological characteristics of the HAT cases detected from 2018 to 2022 in Guinea, according to the medical screening method (active vs passive). (A) Evolution of the number of HAT cases according to the detection methods (active vs passive) from 2018 to 2022. (B) Distribution of the HAT cases according to the sex and age of the patients detected from 2018 to 2022. (C) Proportion of HAT cases detected in male according to the age and the screening mode. (D) Distribution of the number of WBC according to the screening mode and the sex.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5395219/v1/6255c4ec9a1b078442d587f6.png"},{"id":70926513,"identity":"ea6825ae-634c-4f3e-854d-325756096310","added_by":"auto","created_at":"2024-12-09 09:12:11","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":89443,"visible":true,"origin":"","legend":"\u003cp\u003eBar plots showing the difference between the proportions of cases in different age/sex groups and the population screened in active screening. Positive values indicate relative overrepresentation at screening, negative indicate underrepresentation.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5395219/v1/0cad79cdd805b9e8a20ae042.png"},{"id":70926515,"identity":"8ba77eff-c724-40c1-a2bb-84e6360b7664","added_by":"auto","created_at":"2024-12-09 09:12:12","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":284112,"visible":true,"origin":"","legend":"\u003cp\u003eDifferences measured between the data obtained during D2D in Boffa in 2022 (n=3,761) and the Boffa population from prior censuses from 2009, the solid bars represent the census, and hatched area is the population from the door-to-door screenings.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-5395219/v1/af953ddcefae2479d3cfff62.png"},{"id":70926517,"identity":"6b64bf10-f59f-4a67-b459-1ae4add93923","added_by":"auto","created_at":"2024-12-09 09:12:12","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":306700,"visible":true,"origin":"","legend":"\u003cp\u003e(A) WCV versus non-WCV. Population pyramid showing the population screened in non-WVC villages (solid bars) with the population screened in WCV villages (hatched bars). (B) Same villages 2021 versus 2022. Population pyramid showing the population screened in the WCV during 2021 (solid bars) with the population screened in WCV villages during 2022 (hatched bars).\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-5395219/v1/7cd718807cf1a530392dd54c.png"},{"id":77028883,"identity":"02cf8fa5-2523-46c2-908f-9f404ed1691f","added_by":"auto","created_at":"2025-02-24 12:01:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3628943,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5395219/v1/f1dcd16e-5c7c-4b74-b183-c7d7f35738a2.pdf"},{"id":70926512,"identity":"c2c6a524-13da-4588-97aa-45d9c60dd952","added_by":"auto","created_at":"2024-12-09 09:12:11","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18512,"visible":true,"origin":"","legend":"","description":"","filename":"Table1and2.docx","url":"https://assets-eu.researchsquare.com/files/rs-5395219/v1/d68b2f32183ddaa30774a2f3.docx"}],"financialInterests":"","formattedTitle":"An original strategy to promote Sleeping Sickness diagnostic participation in Guinea: How did the Football World Cup 2022 help to target the refractory young male population during an active screening Door-to-Door survey?","fulltext":[{"header":"Background","content":"\u003cp\u003eIn Guinea, for 20 years, the National Control Program of Human African Trypanosomiasis (HAT-NCP), has been responsible for the program to eliminate sleeping sickness. The strategy for identifying the remaining cases and eliminating transmission in the three main HAT foci (in the districts of Boffa, Dubreka and Forecariah) is based on the combination of both medical (for case diagnosis and treatment) and vector (to limit human tsetse fly contacts) control [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This strategy has proven its efficacy, despite the recent sanitary problems (Ebola outbreak in 2013\u0026ndash;2016 and Sars-Cov2 pandemic in 2020\u0026ndash;2021) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. During the last 5 years (2018 to 2022), the number of cases fell below one case for 10,000 habitants in each of the three HAT foci of coastal Guinea [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. From the 235 HAT cases detected and treated during this period, half were detected by active screening (n\u0026thinsp;=\u0026thinsp;120), and half by passive detection (n\u0026thinsp;=\u0026thinsp;115), stressing the complementarity of both approaches. Active screening consists of proactively searching for HAT cases in the exposed population, by performing systematic serological tests by CATT (Card Agglutination Test for Trypanosomiasis) or/and RDT (Rapid Diagnostic Test) methods, followed by parasitological confirmation [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This approach requires previous sensitization activities aimed at informing and convincing the population to participate in the HAT screening activities. In Guinea, due to the peculiar epidemiology of the disease and the ecology of the tsetse fly, the transmission risks are mostly linked to activities that are undertaken in the mangroves, an ecosystem where tsetse fly proliferate [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Some of these activities (fishing and wood cutting especially) are led preferentially by the young male active population. It is known thanks to the historic data collected by the HAT-NCP that this population represents a high percentage of the reported HAT cases [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Paradoxically, this exposed population is often hesitant to participate in the screening campaign. Three main reasons can be advanced to explain such situation: (i) the lack of relevant information, (ii) the feeling of invulnerability explained by the asymptomatic phase of the disease at the early stage and (iii) the fear of the blood finger-puncture. Consequently, all the strategies able to convince this at-risk population should be promoted.\u003c/p\u003e \u003cp\u003eFrom November 20th to December 18th 2022, the Football World Cup took place in Qatar. At the same period, an active screening door-to-door (D2D) survey, aiming the detection of HAT cases, was organized in 27 villages of the Boffa HAT focus. To encourage the participation of the population, and in particular of the young males, the HAT-NPC decided to complement the traditional sensitization activities by broadcasting, once per day, a Football World Cup match in some of the most affected villages. To do so, a specific team was empowered to project such programs during 4 days in four different villages, out of the 27 targeted for the D2D survey. The aim of this trial was to evaluate new strategies based on Football, a very popular sport in Guinea, to better reach a reluctant population. The impact on participation was measured using the pre-existing Open Data Kit (ODK) system [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], an open-source mobile data collection platform routinely used by the HAT mobile teams in Guinea since 2021. Data collected were analysed comparing the demographical features of the screened population from the villages where the Football World Cup was proposed (WCV) with the villages where the Football World Cup was not proposed (no-WCV), during the same D2D survey. In addition, the impact of the activity was also evaluated by comparing the age and sex distribution observed in the same villages during 2021 (no-WC) and 2022 (WC) in the screened population of these 4 villages.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eEthics statements\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe data presented here was collected as part of the HAT elimination program in coastal Guinea (ElimTrypGui), which was approved by the Ministry of Health of the Republic of Guinea (234/MSHP/CAB/2013). All HAT patients whose data were used in this work were diagnosed and treated in agreement with the national health policy and WHO guidelines. This work was carried out in conformity with the Declaration of Helsinki [2].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDoor-to-Door survey\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFrom 29\u003csup\u003eh\u003c/sup\u003e of November to 4\u003csup\u003eth\u003c/sup\u003e of December 2022, 27 villages were visited by 7 mobile teams of the NCP-HAT in the Boffa-West focus. Each mobile team was composed of two Health agents responsible for performing the RDTs and one Community agent. D2D consists into a proactive process where the mobile team goes from house to house to test all the voluntary population. All the RDT positive suspects were sent to the confirmatory laboratory to perform clinical examination using CATT and mini-anion exchange centrifugation technique (mAECT) (REF). HAT is only confirmed if the presence of trypanosomes is detected by microscopic observation, then the patient is referred for treatment. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFootball World Cup matches broadcast\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDuring the D2D period, Football World Cup group-stage matches took place. For technical reasons, only night-session matches (7pm UGT) were broadcasted with a big screen. From 29\u003csup\u003eh\u003c/sup\u003e of November to 4\u003csup\u003eth\u003c/sup\u003e of December 2022, Wales \u003cem\u003evs\u003c/em\u003e England, Costa-Rica \u003cem\u003evs\u003c/em\u003e Germany, Poland \u003cem\u003evs\u003c/em\u003e Argentina and Cameroon \u003cem\u003evs\u003c/em\u003e Brazil were projected in Poukhoun, Walia, Lakhata and Thia Tan\u0026eacute;n\u0026eacute; respectively (\u003cstrong\u003eFigure 1\u003c/strong\u003e). Previously to the session, a Health worker and/or a Community agent explained in Soussou, the local language, the reason of such activity. After the match, a 30-min HAT-sensitization movie recorded from a humoristic play was shown in all these 4 villages (https://www.youtube.com/watch?v=5pi2ZgxdEZM). All these activities were performed prior to the D2D survey.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDuring this survey, four Football World Cup matches were broadcast in four villages (Poukhoun, Lakhata, Walia and Thia) (\u003cstrong\u003eFigure 2\u003c/strong\u003e). These villages were targeted as HAT cases were detected there during the years prior to screening. Before and after the broadcast of the match, sensitization messages were broadcast locally and a previously recorded play on HAT prevention was shown. High rates of participation were observed, from 50 persons (Poukhoun) to 200 (Lakhata and Thia) persons for every night session, with all ages represented. At this point a visit from the mobile screening team was scheduled for the day following sensitisation.\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData collection\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEpidemiological and demographical data were collected during the D2D survey using ODK based tools that was used in all D2D activities since 2021. Every night, all the data collected during the day were checked, confirmed and sent to a local server. Demographical data on Guinean population was collected from the www.populationpyramid.net website, augmented by specific data for the Boffa focus by (Courtin et al., 2015), we treat these data with caution because they were collected from 2009, since when the life expectancy nationally has increased from 56 to 59 and the proportion aged 15-65 to 0-14 from 1.15 to 1.33 (World Bank; https://data.worldbank.org/indicator/). Two villages (Thia and Walia) were also visited and screened using the same ODK system in 2021 and we used these as a basis for comparison to the 2022 data.\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTo test significance of different groups we divided the data into the groups of key interest and compared the groups in 2x2 tables using a Pearson\u0026rsquo;s Chi-square test and age structures were compared using the Wilcoxon rank sum test. In self-reported ages there was a tendency to round to the nearest 5 or 10, so to allow for this in bracketing ages for analysis we cut the ages at 7, 17, 27 etc, these analyses were done in R [8].\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eThe young male population: A highly HAT at risk population difficult to early detect\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn Guinea, after the Ebola outbreak that adversely impacted HAT control activities from 2013 to 2016 resulting in a re-emergence of the disease [2], a constant decrease of the HAT cases has been observed since 2018 (\u003cstrong\u003eFigure 3A\u003c/strong\u003e). Since 2020, the majority of the cases are detected by passive screening thanks to a network of 105 health centres. When looking at sex and age distribution of the 235 HAT cases that occurred during the last 5 years, we observed that half of the cases was detected in individuals aged from 18 to 36 years old with an apparent balanced sex ratio (\u003cstrong\u003eFigure 3B\u003c/strong\u003e). However, this sex ratio varied greatly when we analysed the repartition according to the screening method. During active screening activities, the number of 16-39 y/o females detected positive for HAT is higher than males (61% of female vs 39% of male) while this proportion is inverted (65% of male, p=0.002) for the HAT cases detected through passive screening (\u003cstrong\u003eFigure 3C\u003c/strong\u003e). These data suggest that the young male population is reluctant and/or less sensitized to take part to the active screening and mainly go to health centres when the disease is already in a late stage 2 characterized by high WBC count (\u003cstrong\u003eFigure 3D\u003c/strong\u003e). \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe overrepresentation among the HAT cases among males aged 18-27 is highlighted by \u003cstrong\u003eFigure 4\u003c/strong\u003e with individuals aged 0-17 underrepresented among cases, and over represented in older groups. The proportion of cases among males aged 18-27 is over 12% greater than the proportion of that age group in the population, conversely for males aged 0-7 the proportion of cases is over 10% lower than the proportion of that age group in the population. \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDemographics from the D2D activities\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eData collected using the HAT-NCP ODK system were analysed to compare the demographical data (n=3,761) obtained from the D2D survey performed in Boffa from November 29\u003csup\u003eth\u003c/sup\u003e to December 4\u003csup\u003eth\u003c/sup\u003e 2022 with demographical data from the Boffa census population from 2009 (n=27,989). From \u003cstrong\u003eFigure 5\u003c/strong\u003e, we can observe strong deviations of our diagnosed group in comparison to the general population. Nationally the proportion of the population that is aged 0-14 has been decreasing (World Bank), so the difference in the 0-y years bar should be increasing since this 2009 census. Therefore, when combining these data of over-exposure to HAT and under-diagnosis during the D2D surveys, the NPC-HAT program decided to elaborate more effective strategies to better sensitize the young male population to improve the HAT cases detection. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eUsing the Football World Cup as sensitization tool during the Boffa D2D survey\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFrom November 29\u003csup\u003eth\u003c/sup\u003e to December 4\u003csup\u003eth\u003c/sup\u003e, 3,761 persons living in 27 villages of the active HAT focus of Boffa-West were tested by 7 mobiles teams, using the SD Bioline HAT 2.0 RDT. A total of 151 (4.0%) serosuspects (RDT positive) have been detected. After confirmation, 8 exhibited a CATT titration \u0026gt;1/4 and a 40 y/o male from Lakhata was confirmed as a case with detection of \u003cem\u003eT. b. gambiense\u003c/em\u003e thanks to the mAECT.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDuring this survey, four Football World Cup matches were broadcast in four villages (Poukhoun, Lakhata, Walia and Thia) (\u003cstrong\u003eFigures 1 and 2\u003c/strong\u003e). These villages were targeted as HAT cases were detected there during the years prior to screening. Before and after the broadcast of the match, sensitization messages were broadcast locally and a previously recorded play on HAT prevention was shown. High rates of participation were observed, from 50 persons (Poukhoun) to 200 (Lakhata and Thia) persons for every night session, with all ages represented. At this point a visit from the mobile screening team was scheduled for the day following sensitisation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eQuantitative analysis was first performed by comparing the data collected after the D2D survey in the four villages (n=1,157) with the data collected in the 23 remaining villages (n=2,604). Comparing the proportion of the 8-27 years old males that were screened as part of WCV, we observed a statistically significant increase from 14.57% (no-WCV) to 17.71% (WCV) (\u0026chi;\u003csup\u003e2\u003c/sup\u003e = 5.77, p = 0.016) (\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003eand\u003cstrong\u003e\u0026nbsp;Figure 6A\u003c/strong\u003e). This difference was not observed for the female population of the same age. A second analysis compared ODK data collected during a survey in 2021 (n=7,928), with the 2022 data (n=1,021). A very different population structure was observed (\u003cstrong\u003eTable 2\u0026nbsp;\u003c/strong\u003eand\u003cstrong\u003e\u0026nbsp;Figure 6B\u003c/strong\u003e), not significant when considering the 8-27 age bracket, but significant in the 8-17 bracket (\u0026chi;\u003csup\u003e2\u003c/sup\u003e = 4.21, p = 0.04).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eElimination of a neglected tropical disease is a challenge that many countries in Africa will face. With less than 1 HAT case for 10,000 people from 2018 to 2022, in the three active sleeping sickness foci (Boffa, Dubreka and Forecariah), Guinea is on the track for HAT elimination as public health problem [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Efforts should be done now to reach the elimination of transmission (EoT) goal. Flushing out the last remaining cases requires improvements to the communication strategies in order to reach the most exposed populations. From analysis of demographic, epidemiological and medical data collected during the past 5 years, evidences of a strong bias in the targeted population has been observed. Whereas no apparent unbalanced sex ratio is observed among the HAT cases, suggesting equal risk of exposition between males and females, this ratio gets out of balance when examining the data according to the screening (passive vs active) methods. The 16\u0026ndash;39 y/o male population that represents 32% of the total HAT cases (77/235), does not greatly participate to the active screening campaigns. So, when members of this population are infected they are not typically detected for months or years following infection when severe disease develops and the patient presents to a health centre. In the meantime, infected people continue their activities in areas where tsetse flies are present potentially resulting in transmission. Thanks to the vector control implemented in 2012 in Boffa, part of these at-risk areas is protected with reduced tsetse fly numbers tsetse flies, but an exhaustive coverage through tiny targets deployment is impossible to ensure [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In such situations, strong efforts should be conducted to inform and convince this highly exposed population to participate in HAT screening activities at a regular interval (ideally once per year).\u003c/p\u003e \u003cp\u003eIn the recent past, original initiatives including sensitization messages divulgation through interactive broadcast or theatre performances, have been developed by the Guinean HAT-NCP. Unfortunately, despite their success in the villages, their downstream impact on the participation of the targeted people has not been properly evaluated. In 2021, through TrypaNo2! Initiative, a BMGF granted program aiming to eliminate HAT in several endemic countries [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], an ODK system was developed. It enables the HAT-NCP to collect and analyse in a real time manner, relevant epidemiological data during the screening activities.\u003c/p\u003e \u003cp\u003eIn addition to all the recent innovations that have improved HAT control tools (diagnosis, treatment, VC, etc.), it should not be forgotten that it is also thanks to work with communities that the last cases can be detected. As we have seen, the epidemiology of HAT in Guinea is strongly linked to the exposure of young men to the bites of flies during their activities in the mangroves. Raising awareness among this population is therefore essential for success. For the prevention, diagnosis or treatment of infectious diseases, community-based awareness-raising strategies to increase the engagement of young men have been studied, particularly in the case of HIV. In sub-Saharan Africa, men have been shown to be less likely than women to engage in HIV services across the care cascade, resulting in poorer clinical outcomes [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. A way that can be chosen to apply these strategies can rely on sport. Sports-based interventions for improving health knowledge and behaviours among youth in Africa have been recently reviewed [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. On the 28 studies the authors analysed, the most common specific health concerns addressed by the interventions were related to HIV. And given that football is considered the most popular sport in Africa, half of the interventions used football to engage youth in health education. However, even if some efforts have been conducted during the last decade, some authors underlined that very few interventions have been assessed for effectiveness in a quantitative manner [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Aware that an objective evaluation is an essential prerequisite to assess the success or failure of the activities, the HAT-NCP of Guinea used the ODK-based system during a D2D survey for evaluating the impact of a sport-based intervention. This intervention benefited from the 2022 Football World Cup, a planetary event particularly followed in Africa, to target the young male population. During a week, the HAT-NCP team broadcast a Football World Cup game in villages particularly exposed to the HAT. Beyond the social event, that was highly appreciated by people who has no frequent occasion to watch TV/Movies, HAT-NCP took advantage of the situation to diffuse sensitization messages toward HAT to promote HAT screening participation. Through analysis of the ODK data, the impact of such sensitization on the targeted population (young male community) was assessed. In a statistically significant manner, when HAT screenings were done in villages were world cup matches were displayed, we observed a participation increase of the young male groups, in comparison with villages where no matches were shown. Interestingly, when comparing with 2021 epidemiological data taken from the same \u0026ldquo;World Cup\u0026rdquo; villages, the same positive impact was also observed, suggesting that the ODK-measured effect was strong.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study will encourage the Guinean NCP to disseminate such innovative strategies in all 3 endemic foci. Ludic activities such as organising local football tournaments, theatre workshops for children or a lottery during the medical prospection are planned for the next actions. In parallel, we can expect that the next arrival of acoziborole [14] in the treatment toolbox will facilitate care management, especially when the \u0026quot;test and treat\u0026quot; strategy is applied. This single-dose, oral treatment will allow patients to be cured at home. This will help to avoid the stigma associated with hospitalisation, which often prevents patients from accepting diagnosis and/or treatment.\u0026nbsp;\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCATT: Card Agglutination Test for Trypanosomiasis; EoT: Elimination of Transmission; gHAT: gambiense Human African trypanosomiasis; ODK: Open Data Kit;\u0026nbsp;mAECT: mini anion exchange centrifugation technique; RDT: Rapid diagnostic test; \u003cem\u003eT.b.gambiense\u003c/em\u003e :\u0026nbsp;\u003cem\u003eTrypanosoma brucei gambiense\u003c/em\u003e; WCV: World Cup villages; WHO: World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the prospective work done in the field in the HAT focus was performed during the medical surveillance campaigns conducted routinely by the HAT National Control Program (HAT-NCP) of the Republic of Guinea that was established by the Ministry of Health in 2002. An open authorization for anonymous blood sampling and conservation, as well as analysis of diagnostic screening results for epidemiological surveillance was provided to the HAT-NCP by the Ministry of Health of Guinea in the framework of the ElimTryGui roadmap of the HAT-NCP which was approved by the Ministry of Health of the Republic of Guinea (234/MSHP/CAB/2013).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are available on request from the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Bill and Melinda Gates Foundation (www.gatesfoundation.org) through the Trypa-NO! Project (grants number INV-001785, OPP1033712, OPP1154033) and by the RECIT-JEAI (2022-2024) granted by IRD. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: MC, BB, PB, JMB; Data Curation: BB, PB, JMB; Formal Analysis: BB, PB, JMB; Funding Acquisition: MC, BB, PB, JMB; Investigation: MG, OC, AS, FXBV, BB, PB, JMB; Methodology: BB, PB, JMB; Project Administration: BB, PB, JMB; Resources: MC, BB, PB, JMB; Software: MG, MK BB, PB; Supervision: MC, BB, PB, JMB ; Validation: MG, OC, MK, AS, FXBV, MC, BB, PB, JMB ; Visualization: MG, OC, MK, AS, FXBV, MC, BB, PB, JMB; Writing \u0026ndash; Original Draft Preparation: BB, PB, JMB; Writing \u0026ndash; Review \u0026amp; Editing: MG, OC, MK, AS, FXBV, MC, BB, PB, JMB \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all the Health Agents of Boffa who took part of the Door-to-Door activities.\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNdung\u0026rsquo;u JM, Boulang\u0026eacute; A, Picado A, Mugenyi A, Mortensen A, Hope A, Mollo BG, Bucheton B, Wamboga C, Waiswa C, Kaba D, Matovu E, Courtin F, Garrod G, Gimonneau G, Bingham G V, Hassane HM, Tirados I, Saldanha I, Kabore J, Rayaisse JB, Bart JM, Lingley J, Esterhuizen J, Longbottom J, Pulford J, Kouakou L, Sanogo L, Cunningham L, Camara M, Koffi M, Stanton M, Lehane M, Kagbadouno MS, Camara O, Bessell P, Mallaye P, Solano P, Selby R, Dunkley S, Torr S, Bi\u0026eacute;ler S, Lejon V, Jamonneau V, Yoni W, Katz Z (2020) Trypa-no! contributes to the elimination of gambiense human african trypanosomiasis by combining tsetse control with \u0026ldquo;screen, diagnose and treat\u0026rdquo; using innovative tools and strategies. PLoS Negl Trop Dis 14:1\u0026ndash;9. https://doi.org/10.1371/journal.pntd.0008738\u003c/li\u003e\n\u003cli\u003eCamara O, Bi\u0026eacute;ler S, Bucheton B, Kagbadouno M, Mathu Ndung\u0026rsquo;u J, Solano P, Camara M (2021) Accelerating elimination of sleeping sickness from the Guinean littoral through enhanced screening in the post-Ebola context: A retrospective analysis. PLoS Negl Trop Dis 15:e0009163. https://doi.org/10.1371/journal.pntd.0009163\u003c/li\u003e\n\u003cli\u003eFranco JR, Priotto G, Paone M, Cecchi G, Ebeja AK, Simarro PP, Sankara D, Metwally SBA, Argaw DD (2024) The elimination of human African trypanosomiasis: Monitoring progress towards the 2021\u0026ndash;2030 WHO road map targets. PLoS Negl Trop Dis 18:e0012111. https://doi.org/10.1371/journal.pntd.0012111\u003c/li\u003e\n\u003cli\u003eCamara O, Kabor\u0026eacute; JW, Soumah A, Leno M, Bangoura MS, N\u0026rsquo;Diaye D, Belem AMG, Bi\u0026eacute;ler S, Camara M, Bart J-M, Rotureau B, Bucheton B (2024) Conducting active screening for human African trypanosomiasis with rapid diagnostic tests: The Guinean experience (2016\u0026ndash;2021). PLoS Negl Trop Dis 18:e0011985. https://doi.org/10.1371/journal.pntd.0011985\u003c/li\u003e\n\u003cli\u003eKagbadouno MS, S\u0026eacute;r\u0026eacute; M, S\u0026eacute;gard A, Camara AD, Camara M, Bucheton B, Bart J-M, Courtin F, De Mee\u0026ucirc;s T, Ravel S (2024) Population genetics of Glossina palpalis gambiensis in the sleeping sickness focus of Boffa (Guinea) before and after eight years of vector control: no effect of control despite a significant decrease of human exposure to the disease. Peer Community Journal 4:e21. https://doi.org/10.24072/pcjournal.383\u003c/li\u003e\n\u003cli\u003eCamara M, Kaba D, Kagbadouno M, Sanon Jr, Ouendeno Ff, Solano P (2005) La Trypanosomose humaine africaine en zone de mangrove en r\u0026eacute;publique de guin\u0026eacute;e : caract\u0026eacute;ristiques \u0026eacute;pid\u0026eacute;miologiques et cliniques de deux foyers voisins. Med Trop 65:155\u0026ndash;161\u003c/li\u003e\n\u003cli\u003eHartung C, Lerer A, Anokwa Y, Tseng C, Brunette W, Borriello G (2010) Open data kit. In: Proceedings of the 4th ACM/IEEE International Conference on Information and Communication Technologies and Development. ACM, New York, NY, USA, pp 1\u0026ndash;12\u003c/li\u003e\n\u003cli\u003eR Core Team (2022) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria\u003c/li\u003e\n\u003cli\u003eCourtin F, Camara M, Rayaisse JB, Kagbadouno M, Dama E, Camara O, Traor\u0026eacute; IS, Rouamba J, Peylhard M, Somda MB, Leno M, Lehane MJ, Torr SJ, Solano P, Jamonneau V, Bucheton B (2015) Reducing human-tsetse contact significantly enhances the efficacy of sleeping sickness active screening campaigns: A promising result in the context of elimination. PLoS Negl Trop Dis 9:1\u0026ndash;12. https://doi.org/10.1371/journal.pntd.0003727\u003c/li\u003e\n\u003cli\u003eSharma M, Barnabas R V., Celum C (2017) Community-based strategies to strengthen men\u0026rsquo;s engagement in the HIV care cascade in sub-Saharan Africa. PLoS Med 14:e1002262. https://doi.org/10.1371/journal.pmed.1002262\u003c/li\u003e\n\u003cli\u003eMills EJ, Beyrer C, Birungi J, Dybul MR (2012) Engaging Men in Prevention and Care for HIV/AIDS in Africa. PLoS Med 9:e1001167. https://doi.org/10.1371/journal.pmed.1001167\u003c/li\u003e\n\u003cli\u003eHansell AH, Giacobbi PR, Voelker DK (2021) A Scoping Review of Sport-Based Health Promotion Interventions With Youth in Africa. Health Promot Pract 22:31\u0026ndash;40. https://doi.org/10.1177/1524839920914916\u003c/li\u003e\n\u003cli\u003eFuller CW, Junge A, DeCelles J, Donald J, Jankelowitz R, Dvorak J (2010) \u0026rsquo;Football for Health\u0026rsquo;--a football-based health-promotion programme for children in South Africa: a parallel cohort study. Br J Sports Med 44:546\u0026ndash;554. https://doi.org/10.1136/bjsm.2010.072223\u003c/li\u003e\n\u003cli\u003eBetu Kumeso VK, Kalonji WM, Rembry S, Valverde Mordt O, Ngolo Tete D, Pr\u0026ecirc;tre A, Delhomme S, Ilunga Wa Kyhi M, Camara M, Catusse J, Schneitter S, Nusbaumer M, Mwamba Miaka E, Mahenzi Mbembo H, Makaya Mayawula J, Layba Camara M, Akwaso Massa F, Kaninda Badibabi L, Kasongo Bonama A, Kavunga Lukula P, Mutanda Kalonji S, Mariero Philemon P, Mokilifi Nganyonyi R, Embana Mankiara H, Asuka Akongo Nguba A, Kobo Muanza V, Mulenge Nasandhel E, Fifi Nzeza Bambuwu A, Scherrer B, Strub-Wourgaft N, Tarral A (2023) Efficacy and safety of acoziborole in patients with human African trypanosomiasis caused by Trypanosoma brucei gambiense: a multicentre, open-label, single-arm, phase 2/3 trial. Lancet Infect Dis 23:463\u0026ndash;470. https://doi.org/10.1016/S1473-3099(22)00660-0\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 and 2 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Sleeping Sickness, Sensitization, Football World-Cup, Guinea","lastPublishedDoi":"10.21203/rs.3.rs-5395219/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5395219/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e. The study aimed to evaluate the effectiveness of sensitization events targeting young males to improve their participation in active screening campaigns for Human African Trypanosomiasis (HAT), also known as sleeping sickness, in Guinea. Despite progress towards eliminating HAT as a public health problem, challenges remain in detecting the last remaining cases, particularly among individuals, especially young men, who work in mangroves and are highly exposed to the tsetse fly vector.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e. During the 2022 Football World Cup, coinciding with a door-to-door screening campaign in the Boffa focus of Guinea, football matches were used as an opportunity to sensitize the population. Twenty-seven villages were selected for screening, and four villages with recently diagnosed HAT cases were chosen to broadcast World Cup matches followed by a 30-minute sensitization movie about HAT in the local language. Demographic data were collected using an Open Data Kit system.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e. The results indicated significant interest in the sensitization events, with over 500 attendees at all during the four days of broadcasting. A comparison of participation rates between World Cup villages (WCV) and non-WCV villages showed a higher proportion of males aged 8 to 27 participating in the WCV (17.7%) compared to non-WCV villages (14.6%). This difference was not observed for females of the same age group. Furthermore, compared to data from the previous year, there was an increase in the relative participation of young males from 16.4% to 19.6%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e. Innovative strategies, such as using football matches for sensitization, are essential for reaching at-risk populations and identifying remaining HAT cases. Football holds significant cultural and social importance in Guinean villages, making it an effective platform for HAT sensitization efforts. Scaling up such strategies could further enhance awareness and participation in screening campaigns, ultimately aiding in the elimination of HAT transmission.\u003c/p\u003e","manuscriptTitle":"An original strategy to promote Sleeping Sickness diagnostic participation in Guinea: How did the Football World Cup 2022 help to target the refractory young male population during an active screening Door-to-Door survey?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-09 09:12:07","doi":"10.21203/rs.3.rs-5395219/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ea00ec8d-5036-4622-8695-1a1917fdbb52","owner":[],"postedDate":"December 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-24T11:53:07+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-09 09:12:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5395219","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5395219","identity":"rs-5395219","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}