Magnitude and factors associated with sexual re-victimization among adolescent girls and young women in Kinshasa, Democratic Republic of the Congo: a retrospective multicenter study.

BACKGROUND: Adolescent girls and young women are more exposed to sexual violence. A significant proportion of victims of sexual abuse are victims of sexual re-victimization. However, information on the burden of sexual re-victimization among AGYW in contexts other than conflict-affected areas in the Democratic Republic of the Congo (DRC) is limited. The aim of this study was to assess the magnitude of sexual re-victimization among AGYW and to identify associated risk factors in the capital, Kinshasa. METHODS: We conducted a retrospective multicenter cohort study in which sexual violence records between 2015 and 2020 were used to extract and analyze victims' sociodemographic and behavioral characteristics and profiles of sexual violence perpetrated. Multivariate logistic regression models were employed to identify factors associated with sexual re-victimization using the adjusted odds ratio (AOR) with its 95% confidence interval (95% CI) and p value < 0.05. RESULTS: We found that 74 (31%) of the 241 AGYW included in this study had experienced sexual re-victimization. Sexual re-victimization was associated with being older (> 19 years), sexually active, and living in a single-parent family, and with perpetrator types, particularly intimate partners and family members. CONCLUSIONS: Our findings provide tools for developing and implementing targeted prevention and intervention programs to reduce sexual violence in general and sexual re-victimization in particular.

Vaccination dropout rates among children aged 12-23 months in Democratic Republic of the Congo: a cross-sectional study.

BACKGROUND: Overall, 1.8 million children fail to receive the 3-dose series for diphtheria, tetanus and pertussis each year in the Democratic Republic of the Congo (DRC). Currently, an emergency plan targeting 9 provinces including Kinshasa, the capital of the DRC, is launched to reinforce routine immunization. Mont Ngafula II was the only health district that experienced high vaccination dropout rates for nearly five consecutive years. This study aimed to identify factors predicting high immunization dropout rates among children aged 12-23 months in the Mont Ngafula II health district. METHODS: A cross-sectional household survey was conducted among 418 children in June-July 2019 using a two-stage sampling design. Socio-demographic and perception data were collected through a structured interviewer-administered questionnaire. The distribution of 2017-2018 immunization coverage and dropout rate was extracted from the local health district authority and mapped. Logistic random effects regression models were used to identify predictors of high vaccination dropout rates. RESULTS: Of the 14 health areas in the Mont Ngafula II health district, four reported high vaccine coverage, only one recorded low vaccine coverage, and three reported both low vaccine coverage and high dropout rate. In the final multivariate logistic random effects regression model, the predictors of immunization dropout among children aged 12-23 months were: living in rural areas, unavailability of seats, non-compliance with the order of arrival during vaccination in health facilities, and lack of a reminder system on days before the scheduled vaccination. CONCLUSIONS: Our results advocate for prioritizing targeted interventions and programs to strengthen interpersonal communication between immunization service providers and users during vaccination in health facilities and to implement an SMS reminder system on days before the scheduled vaccination.

An overview of bacterial meningitis epidemics in Africa from 1928 to 2018 with a focus on epidemics "outside-the-belt".

BACKGROUND: Bacterial meningitis occurs worldwide but Africa remains the most affected continent, especially in the "Meningitis belt" that extends from Senegal to Ethiopia. Three main bacteria are responsible for causing bacterial meningitis, i.e., N. meningitidis (Nm), S. pneumoniae and H. influenzae type b. Among Nm, serogroup A used to be responsible for up to 80 to 85% of meningococcal meningitis cases in Africa. Since 2000, other Nm serogroups including W, X and C have also been responsible for causing epidemics. This overview aims to describe the main patterns of meningitis disease cases and pathogens from 1928 to 2018 in Africa with a special focus on disease conditions "out-of-the-belt" area that is still usually unexplored. Based on basic spatio-temporal methods, and a 90-years database of reported suspected meningitis cases and death from the World Health Organization, we used both geographic information system and spatio-temporal statistics to identify the major localizations of meningitis epidemics over this period in Africa. RESULTS: Bacterial meningitis extends today outside its historical limits of the meningitis belt. Since the introduction of MenAfrivac vaccine in 2010, there has been a dramatic decrease in NmA cases while other pathogen species and Nm variants including NmW, NmC and Streptococcus pneumoniae have become more prevalent reflecting a greater diversity of bacterial strains causing meningitis epidemics in Africa today. CONCLUSION: Bacterial meningitis remains a major public health problem in Africa today. Formerly concentrated in the region of the meningitis belt with Sub-Saharan and Sudanian environmental conditions, the disease extends now outside these historical limits to reach more forested regions in the central parts of the continent. With global environmental changes and massive vaccination targeting a unique serogroup, an epidemiological transition of bacterial meningitis is ongoing, requiring both a better consideration of the etiological nature of the responsible agents and of their proximal and distal determinants.

Impact of COVID-19 on admission due to diarrhea to the emergency department of the largest specialized Pediatric Hospital, Kinshasa, the Democratic Republic of the Congo: A retrospective analysis

Context and objective. The COVID-19's lockdown effect on pediatric healthcare utilization has been demonstrated. However, little is known about this impact on the burden of diarrheal diseases among children in sub-Saharan Africa. This study aimed at studying the impact of the COVID-19 pandemic on admissions due to diarrhea into the largest specialized Pediatric Hospital in the city of Kinshasa. Methods. A retrospective study was conducted on diarrhea cases admitted into the emergency department of the Kalembe-Lembe Pediatric Hospital between January 1st and July 31st of 2019 and 2020. Variables were compared during the pandemic's lockdown period in 2020 to the equivalent period in 2019. Results. Overall, 422 medical records were examined. A 45% drop in diarrhea cases was observed in the pediatric emergency department between the study periods in 2019 and 2020. Daily admissions were significantly higher in 2019 than in 2020 (p < 0.001). The majority of patients were admitted with moderate dehydration in 2019 than in 2020 (p < 0.001) but an increase in proportion of patients with mild and severe dehydration was observed in 2020 than in 2019 (p < 0.001). The hospitalization rate was significantly higher in 2019 than in 2020 (p < 0.001). Conclusions; The COVID- 19's restrictions led to a substantial decrease in admissions due to diarrhea among children to the pediatric emergency department. Public health interventions are needed to promote an ambulatory healthcare system during future crises.

Contexte et objectif. L'effet de confinement dû à la COVID-19 sur l'utilisation des soins pédiatriques a été démontré sous d'autres cieux. Cependant, on en sait peu concernant cet impact sur le fardeau des maladies diarrhéiques chez les enfants en Afrique subsaharienne. Cette étude visait à rechercher l'impact de la pandémie à COVID-19 sur les admissions dues à la diarrhée dans un hôpital pédiatrique. Méthodes. Etude documentaire des cas de diarrhées recensés, au service des urgences de l'hôpital pédiatrique de Kalembe-Lembe, entre les 1er janvier et 31 juillet 2019 et 2020. Les variables ont été comparées, entre la période du confinement de la pandémie en 2020 et la période équivalente en 2019. Résultats. Au total 442 dossiers médicaux ont été colligés. Une baisse de 45 % d'admissions des cas de diarrhée a été observée, aux urgences pédiatriques pendant le confinement. Les admissions quotidiennes étaient significativement plus élevées en 2019 qu'en 2020 (p <0,001). La majorité des patients ont été admis avec une déshydratation modérée en 2019 qu'en 2020 (p <0,001) mais une augmentation de la proportion de patients avec une déshydratation légère et sévère a été observée en 2020 par rapport à 2019 (p <0,001). Le taux d'hospitalisation était significativement plus élevé en 2019 qu'en 2020 (p <0,001). Conclusion. Les restrictions dues à la COVID-19 ont conduit à une diminution substantielle des admissions dues à la diarrhée chez les enfants aux urgences pédiatriques. Des interventions de santé publique sont nécessaires pour promouvoir un système de santé ambulatoire lors d'une telle crise dans un proche avenir.