Family planning knowledge and use among women in camps for internally displaced people in the Democratic Republic of the Congo.

OBJECTIVE: To describe family planning awareness and needs among internally displaced women residing in the Mugunga camps in North Kivu, eastern Democratic Republic of the Congo. METHODS: A cross-sectional survey of women aged 14-45 years residing in the Mugunga camps was conducted during March 2014. The verbally administered survey assessed participants' obstetric history and their family planning knowledge, interest, and use. Descriptive statistics were obtained. RESULTS: Of the 155 participants, 145 (93.5%) had been camp residents for 2 years or less. Previous receipt of information on contraception was reported by 130 (83.9%) women, of whom 65 (50.0%) had received information during prenatal care. Fifty-four (34.8%) women knew at least two contraceptive methods. Overall, 47 (30.5%) of 154 women reported ever using contraception. Women who never used contraception cited lack of interest (66/107 [61.7%]) or knowledge (22/107 [20.6%]) and religious opposition (13/107 [12.1%]) as reasons. In the cohort overall, 33 (21.3%) women reported having had an induced abortion; 20 (60.6%) of these abortions were self-induced. CONCLUSION: Contraceptive knowledge among female camp residents was moderate, actual usage was low, and a considerable proportion reported a history of induced abortion. Efforts must be made to improve access to contraception to prevent unintended pregnancy, and to provide safe abortions and postabortion care.

Fistula after attended delivery and the challenge of obstetric care capacity in the eastern Democratic Republic of Congo.

OBJECTIVE: To analyze the history of women with fistula in the eastern Democratic Republic of Congo (DRC) to understand the determinants of fistula development. METHODS: In a retrospective observational study, data were analyzed from a survey of all women who underwent surgical fistula repair at HEAL Africa Hospital, Goma, between April 1, 2009, and March 1, 2012. Characteristics and obstetric histories were obtained by self-report. RESULTS: The mean age of the 202 participants at treatment was 30.7 years (range 5-69). The mean duration of fistula was 45.6 months (range 0-600). In total, 171 (91.4%) fistulas were caused by obstructed labor, and 147 (86.5%) were vesicovaginal. Most women (129/175 [73.8%]) reported having received care during early labor under the supervision of a nurse or doctor in a healthcare facility. Among 176 women for whom delivery data were available, 102 (57.9%) delivered at a hospital, 42 (23.8%) at a health center, and 32 (18.2%) at home. Only 46 (26.3%) of 175 women were transferred to a higher level of care during labor. CONCLUSIONS: In the eastern DRC, efforts to enable transport to a healthcare facility and to encourage attended births must be accompanied by improvements in the capacity of existing facilities and in the training of staff to enable the timely diagnosis of labor abnormalities and appropriate intervention.

Fertility desires and the feasibility of contraception counseling among genital fistula patients in eastern Democratic Republic of the Congo.

OBJECTIVE: To determine the fertility and contraceptive desires of genital fistula patients in eastern Democratic Republic of the Congo (DRC) and to evaluate the impact of contraceptive counseling and its effect on contraceptive knowledge and use. METHODS: Group contraceptive counseling was offered to fistula patients at HEAL Africa Hospital between February and May 2010. Fertility desires and contraceptive knowledge were assessed via verbally administered questionnaires before and after counseling, and use of modern contraceptive methods was tracked. RESULTS: Of the 61 participants, 22/34 (64.7%) of those who desired children wanted to wait at least 1 year after repair before attempting pregnancy. Overall, 31/58 (53.4%) women had heard of birth control, although only 15 (24.6%) knew any specific methods, and none had ever used contraception. After counseling, all participants could recall 1 or more methods. Of the 25 participants discharged over the subsequent 3 months, 5 (20.0%) and 3 additional fistula patients selected a modern method of contraception. CONCLUSION: Desire for contraception and birth spacing among women with fistula is significant. Basic group contraception counseling and access are feasible and lead to increased contraceptive knowledge and use.

Sexual violence toward children and youth in war-torn eastern Democratic Republic of Congo.

BACKGROUND: The epidemic of gender-based violence in the Democratic Republic of the Congo (DRC) has garnered popular media attention, but is incompletely described in the medical literature to date. In particular, the relative importance of militarized compared to civilian rape and the impact on vulnerable populations merits further study. We describe a retrospective case series of sexual abuse among children and youth in eastern DRC. METHODS: Medical records of patients treated for sexual assault at HEAL Africa Hospital, Goma, DRC between 2006 and 2008 were reviewed. Information extracted from the chart record was summarized using descriptive statistics, with comparative statistics to examine differences between pediatric (≤ 18 yrs) and adult patients. FINDINGS: 440 pediatric and 54 adult sexual abuse cases were identified. Children and youth were more often assaulted by someone known to the family (74% vs 30%, OR 6.7 [95%CI 3.6-12], p<0.001), and less frequently by military personnel (13% vs 48%, OR 0.14 [95%CI 0.075-0.26], p<0.001). Delayed presentation for medical care (>72 hours after the assault) was more common in pediatric patients (53% vs 33%, OR 2.2 [95%CI 1.2-4.0], p = 0.007). Physical signs of sexual abuse, including lesions of the posterior fourchette, hymeneal tears, and anal lesions, were more commonly observed in children and youth (84% vs 69%, OR 2.3 [95%CI 1.3-4.4], p = 0.006). Nine (2.9%) pediatrics patients were HIV-positive at presentation, compared to 5.3% of adults (p = 0.34). INTERPRETATION: World media attention has focused on violent rape as a weapon of war in the DRC. Our data highlight some neglected but important and distinct aspects of the ongoing epidemic of sexual violence: sexual abuse of children and youth.