Determinants of the use of contraceptive methods by adolescents in the Democratic Republic of the Congo: results of a cross-sectional survey.

BACKGROUND: Family planning (FP) is an effective strategy to prevent unintended pregnancies of adolescents. We aimed at identifying the socio-demographic factors underlying the low use of contraceptive methods by teenage girls in the Democratic Republic of the Congo (DRC). METHODS: A secondary analysis targeting teenage girls aged 15-19 was carried out on the Performance, Monitoring and Accountability project 2020 (PMA 2020) round 7 data, collected in Kinshasa and Kongo Central provinces. The dependent variable was the "use of contraceptive methods by sexually active teenage girls", calculated as the proportion of teenagers using modern, traditional or any contraceptive methods. Independent variables were: level of education, age, province, religion, marital status, number of children, knowledge of contraceptive methods and household income. Pearson's chi-square and logistic regression tests helped to measure the relationship between variables at the alpha significance cut point of 0.05. RESULTS: A total of 943 teenagers were interviewed; of which 22.6, 18.1 and 19.9% ​​used any contraceptive method respectively in Kinshasa, Kongo Central and overall. The use of modern contraceptive methods was estimated at 9.9, 13.4 and 12.0% respectively in Kinshasa, Kongo Central and overall. However, the use of traditional methods estimated at 8.0% overall, was higher in Kinshasa (12.7%) and lower (4.7%) in Kongo Central (p < .001). Some factors such as poor knowledge of contraceptive methods (aOR = 8.868; 95% CI, 2.997-26.240; p < .001); belonging to low-income households (aOR = 1.797; 95% CI, 1.099-2.940; p = .020); and living in Kongo central (aOR = 3.170; 95% CI, 1.974-5.091; p < .001) made teenagers more likely not to use any contraceptive method. CONCLUSION: The progress in the use of contraceptive methods by adolescent girls is not yet sufficient in the DRC. Socio-demographic factors, such as living in rural areas, poor knowledge of FP, and low-income are preventing teenagers from using FP methods. These findings highlight the need to fight against such barriers; and to make contraceptive services available, accessible, and affordable for teenagers.

The use of contraceptive methods remains low among adolescents aged 15 to 19 in the Democratic Republic of the Congo. However, family planning (FP) methods can help to prevent unintended pregnancies. This study aimed at identifying the socio-demographic factors that prevent teenage girls from using FP methods. We analyzed the data from the Performance, Monitoring and Accountability project (PMA 2020), seventh round, collected in Kinshasa and Kongo Central provinces. The use of contraceptive methods by sexually active adolescents was measured according to the level of education, age, province, religion, marital status, number of children, knowledge of contraceptive methods and household income. For the 943 adolescent girls interviewed, the use of any contraceptive method was calculated at 22.6, 18.1 and 19.9%, respectively in Kinshasa, Kongo Central and overall. The use of traditional methods was estimated at 8.0% overall, higher in Kinshasa (12.7%) and lower (4.7%) in Kongo Central. However, the use of modern contraceptive methods was estimated at 9.9, 13.4 and 12.0% respectively in Kinshasa, Kongo Central and overall. Poor knowledge of contraceptive methods; low-income and living in Kongo central province were the factors associated with the low use of any contraceptive method. In conclusion, the progress in the use of contraceptive methods by adolescent girls is not yet sufficient, due to some socio-demographic barriers. These results suggest to fight against such factors; and to make contraceptive services available, accessible, and affordable for teenagers.

Distribution and quality of emergency obstetric care service delivery in the Democratic Republic of the Congo: it is time to improve regulatory mechanisms.

BACKGROUND: The Demographic and Health Survey 2013-14 indicated that the Democratic Republic of the Congo (DRC) is still challenged by high maternal and neonatal mortality. The aim of this study was to assess the availability, quality and equity of emergency obstetric care (EmOC) in the DRC. METHODS: A cross-sectional survey of 1,568 health facilities selected by multistage random sampling in 11 provinces of the DRC was conducted in 2014. Data were collected through interviews, document reviews, and direct observation of service delivery. Collected data included availability, quality, and equity of EmOC depending on the location (urban vs. rural), administrative identity, type of facility, and province. Associations between variables were tested by Pearson's chi-squared test using an alpha significance level of 0.05. RESULTS: A total of 1,555 health facilities (99.2%) were surveyed. Of these, 9.1% provided basic EmOC and 2.9% provided comprehensive EmOC. The care was unequally distributed across the provinces and urban vs. rural areas; it was more available in urban areas, with the provinces of Kinshasa and Nord-Kivu being favored compared to other provinces. Caesarean section and blood transfusions were provided by health centers (6.5 and 9.0%, respectively) and health posts (2.3 and 2.3%, respectively), despite current guidelines disallowing the practice. None of the facilities provided quality EmOC, mainly due to the lack of proper standards and guidelines. CONCLUSIONS: The distribution and quality of EmOC are problematic. The lack of regulation and monitoring appears to be a key contributing factor. We recommend the Ministry of Health go beyond merely granting funds, and also ensure the establishment and monitoring of appropriate standard operating procedures for providers.

Task shifting in the management of hypertension in Kinshasa, Democratic Republic of Congo: a cross-sectional study.

BACKGROUND: The Democratic Republic of the Congo (DRC) is characterized by a high prevalence of hypertension (HTN) and a high proportion of uncontrolled HTN, which is indicative of poor HTN management. Effective management of HTN in the African region is challenging due to limited resources, particularly human resources for health. To address the shortage of health workers, the World Health Organization (WHO) recommends task shifting for better disease management and treatment. Although task shifting from doctors to nurses is being implemented in the DRC, there are no studies, to the best of our knowledge, that document the association between task shifting and HTN control. The aim of this study was to investigate the association between task shifting and HTN control in Kinshasa, DRC. METHODS: We conducted a cross-sectional study in Kinshasa from December 2015 to January 2016 in five general referral hospitals (GRHs) and nine health centers (HCs). A total of 260 hypertensive patients participated in the study. Sociodemographic, clinical, health care costs and perceived health care quality assessment data were collected using a structured questionnaire. To examine the association between task shifting and HTN control, we assessed differences between GRH and HC patients using bivariate and multivariate analyses. RESULTS: Almost half the patients were female (53.1%), patients' mean age was 59.5 ± 11.4 years. Over three-fourths of patients had uncontrolled HTN. There was no significant difference in the proportion of GRH and HC patients with uncontrolled HTN (76.2% vs 77.7%, p = 0.771). Uncontrolled HTN was associated with co-morbidity (OR = 10.3; 95% CI: 3.8-28.3) and the type of antihypertensive drug used (OR = 4.6; 95% CI: 1.3-16.1). The mean healthcare costs in the GRHs were significantly higher than costs in the HCs (US$ 34.2 ± US$3.34 versus US$ 7.7 ± US$ 0.6, respectively). CONCLUSION: Uncontrolled HTN was not associated with the type of health facility. This finding suggests that the management of HTN at primary healthcare level might be just as effective as at secondary level. However, the high proportion of patients with uncontrolled HTN underscores the need for HTN management guidelines at all healthcare levels.

Prevalence and determinants of use of complementary and alternative medicine by hypertensive patients attending primary health care facilities in Kinshasa, Democratic Republic of the Congo: a cross-sectional study.

BACKGROUND: In the Democratic Republic of the Congo the control of hypertension is poor, characterized by an increasing number of reported cases of hypertension related complications. Poor control of hypertension is associated with non-adherence to antihypertensive medication. It is well established that the use of complementary and alternative medicine is one of the main factors of non-adherence to antihypertensive medication. The aim of this study is to determine the prevalence and factors associated with the use of complementary and alternative medicine. METHODS: A cross-sectional study was carried out at the Kinshasa Primary Health-care (KPHC) facilities network in November 2014. A structured interview questionnaire was administrated to a total of 280hypertensive patients. Complementary and alternative medicine were defined according to the National Institute of Health classification as a group of diverse medical and healthcare systems, practices, and products that are not presently considered to be part of conventional medicine. Data were summarized using proportion and mean (with standard deviation). The student's t test and χ2 test were used respectively for mean and proportion comparison. Logistic regression analysis identified determinants of the use of complementary and alternative medicine. RESULTS: The prevalence of use of complementary and alternative medicine was 26.1% (95% CI: 20.7% - 31.8%).Determinants of use of complementary and alternative medicine included misperception about hypertension curability (OR = 2.1; 95%CI: 1.1-3.7) and experience of medication side effects (OR = 2.9; 95%CI: 1.7-5.1). CONCLUSION: The use of CAM for hypertensive patients is a major problem; antihypertensives with fewer side effects must be emphasized. Religious leaders must become involved in the communication for behavioral change activities to improve the quality of life for hypertensive patients.

Assessment of hypertension management in primary health care settings in Kinshasa, Democratic Republic of Congo.

BACKGROUND: Hypertension-related complications have become more diagnosed at secondary and tertiary care levels, in the Democratic Republic of the Congo (DRC), probably indicative of poor management of hypertensive patients at primary health care level. This study aimed to assess the management of hypertension in primary health care settings by using guidelines of the International Forum for Prevention and Control of HTN in Africa (IFHA). METHODS: A multi-center cross-sectional study was carried out in primary health care settings. A total of 102 nurses were surveyed using a structured interview. Mean and proportion comparisons were performed using the t Student test and the Chi-square test respectively. The Kinshasa Primary Health Care network facilities were compared with non-Kinshasa Primary Health Care network facilities. RESULTS: From the 102 nurses surveyed; 52.9% were female with a mean age of 41.1, (SD = 10) years, merely 9.5% benefited from in-job training on cardiovascular diseases or their risk factors, and 51.7% had guidelines on the management of hypertension. Less than a quarter of the nurses knew the cut-off values of hypertension, diabetes and obesity. Merely 14.7% knew the therapeutic goals for uncomplicated hypertension. Several of the indicators for immediate referral recommended by IFHA were unmentioned. The content of patient education was lacking, avoiding stress being the best advice provided to hypertensive patients. The antihypertensive most used were unlikely to be recommended by the IFHA. CONCLUSIONS: This study showed a considerable gap of knowledge and practices in the management of hypertensive patients at primary health care facilities in Kinshasa pertaining to the IFHA guidelines. We think that task-shifting for management of hypertension is feasible if appropriate guidelines are provided and nurses trained.

Predictors of non-adherence to antihypertensive medication in Kinshasa, Democratic Republic of Congo: a cross-sectional study.

BACKGROUND: Hypertension remains a public health challenge worldwide. In the Democratic Republic of Congo, its prevalence has increased in the past three decades. Higher prevalence of poor blood pressure control and an increasing number of reported cases of complications due to hypertension have also been observed. It is well established that non-adherence to antihypertensive medication contributes to poor control of blood pressure. The aim of this study is to measure non-adherence to antihypertensive medication and to identify its predictors. METHODS: A cross-sectional study was conducted at Kinshasa Primary Health-care network facilities from October to November 2013. A total of 395 hypertensive patients were included in the study. A structured interview was used to collect data. Adherence to medication was assessed using the Morisky Medication Scale. Covariates were defined according to the framework of the World Health Organization. Logistic regression was used to identify predictors of non-adherence. RESULTS: A total of 395 patients participated in this study. The prevalence of non-adherence to antihypertensive medication and blood pressure control was 54.2 % (95 % CI 47.3-61.8) and 15.6 % (95 % CI 12.1-20.0), respectively. Poor knowledge of complications of hypertension (OR = 2.4; 95 % CI 1.4-4.4), unavailability of antihypertensive drugs in the healthcare facilities (OR = 2.8; 95 % CI 1.4-5.5), lack of hypertensive patients education in the healthcare facilities (OR = 1.7; 95 % CI 1.1-2.7), prior experience of medication side effects (OR = 2.2; 95 % CI 1.4-3.3), uncontrolled blood pressure (OR = 2.0; 95 % CI 1.1-3.9), and taking non-prescribed medications (OR = 2.2; 95 % CI 1.2-3.8) were associated with non-adherence to antihypertensive medication. CONCLUSION: This study identified predictors of non-adherence to antihypertensive medication. All predictors identified were modifiable. Interventional studies targeting these predictors for improving adherence are needed.

Health-seeking behaviour in the city of Lubumbashi, Democratic Republic of the Congo: results from a cross-sectional household survey.

BACKGROUND: Concerns about the occurrence of disease among household members generally initiate treatment-seeking actions. This study aims to identify the various treatment-seeking options of patients in Lubumbashi, analyze their health-seeking behaviour, identify determinants for the use of formal care, and analyze direct health care expenditure. METHODS: A cross-sectional survey of households in Lubumbashi was conducted in July 2010. Information was collected from a randomly selected sample of 251 households with at least one member who had been ill in the 2 weeks preceding the survey. RESULTS: Frequently used initial treatment-seeking options consist of self-medication based on modern medicines (54.6%), the use of first-line health services (23.1%) and hospitals (11.9%), with a perceived effectiveness of 51%, 83% and 91% respectively. If people go for a second option, then formal health care services are most often preferred. The majority (60%) of patients' spontaneous itineraries reflect the expected functioning of a local health care system, with a patient flow characterised by the use of a first line health facility prior to the use of hospital-based services. Chronicity of the disease is the main determinant of seeking formal care. Analysis of care expenditure reveals that drugs are the only line of expenditure in the informal system and the main source of expenditure in the formal system; costs do not discriminate between first-line health services and hospitals, and the payment system is regressive since the poorest patients pay the same amounts as the richest. CONCLUSIONS: This study points to the importance of self-medication as the first therapeutic option for the majority of patients in Lubumbashi, whatever the nature of the health problem. There is a lot of room to rationalise this practice. Although formal care is not common initial therapeutic option, it is the source of care most patients turn to, especially when they believe having a chronic disease. Patients' itineraries in this urban environment are complex; health managers should try and deal with this reality. Finally, our study indicates that poor patients face the same level of out-of-pocket payments as the more wealthy ones, hence the need for more equitable health care financing arrangements.

Estimating prevalence of diabetes in a Congolese town was feasible.

OBJECTIVES: To study prevalence, determinants, and complications at diagnosis of diabetes and intermediate hyperglycemia (IH) in Kisantu, a semirural town in Bas-Congo province, Democratic Republic of Congo. STUDY DESIGN AND SETTING: A large-scale analytical cross-sectional population-based survey was performed in 2007 in Kisantu. After extensive sensitization, the study sample was collected using a modified World Health Organization (WHO) STEPwise strategy, taking subsequently a random sample of streets, households within streets, and inhabitants aged 20 years and older within households. After informed consent, subjects were invited to fixed sites for interview, anthropometry, clinical examination (blood pressure, monofilament, and ophthalmology), and biochemical tests (fasting capillary glucose, serum creatinine, and albuminuria). Fasting glycemia was repeated or 2-hour postload glycemia was measured the next day in subjects with an initial glycemia of 126-199 mg/dL (7.0-11.1 mmol/L) or 100-125 mg/dL (5.6-6.9 mmol/L), respectively. Hence, prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance according to both 2006 WHO/International Diabetes Federation and 2003 American Diabetes Association criteria could be evaluated. Bivariate and multivariate analyses were used for statistical analyses. RESULTS: Response rate was 93.7% (1,898 of 2,025). Complete data were available in 1,866 (92.1%) subjects. CONCLUSION: Estimating the prevalence of diabetes and IH in a small Congolese town was proven to be feasible.

Knowledge of HIV, sexual behavior and correlates of risky sex among street children in Kinshasa, Democratic Republic of Congo.

CONTEXT: Homeless children are at risk of getting many diseases, including sexually transmitted infections (STI). The number of street children is on the rise in the Democratic Republic of Congo (DRC), while very little is known about their health problems. OBJECTIVES: To determine knowledge of HIV (transmission and prevention means), sexual activity, exposure to HIV-prevention services, and to identify correlates of risky sexual behaviour (not having used a condom at first or last sexual encounter and/or having multiple sexual partners over a 12-month period) among street children in Kinshasa. RESULTS: At the time of the survey, most participants (85.8%, 95% CI = 83.5-88.1) were sexually experienced and 55.8% had their first sexual intercourse when they were already living on the streets. The median age at first sexual activity was 14.3 years for males and 13.5 years for females. Compared to males (median number of sexual partners = 1), females tended to be more involved with multiple sexual partners (median = 12). Condoms were used less at the fist sexual encounter (20.2%; 95% CI = 17.3-23.1) and the pattern of condom use depended on the type of sexual partners (61.1% at last sexual encounter with a paid/paying partner and 23.1% at last sexual encounter with a non-paid/non-paying partner). In males, sleeping in a NGO-provided night shelter (OR = 0.47; 95% CI = 0.27-0.79), and having had the first sexual intercourse while living on the streets (OR = 0.55; 95% CI = 0.35-0.88) were protective of risky sexual behaviour, while a history of drug use (OR = 3.00; 95% CI = 1.46-6.18), and being aged 20 to 24 years (OR = 1.59; 95% 1.00-2.55) increased the likelihood of displaying risky sexual behaviour. In females, not knowing where to get a condom (OR = 0.04; 95% CI = 0.005-0.29), having started sexual activity when living on the streets (OR = 0.10; 95% CI = 0.01-0.73) and not having an income-generating activity (OR = 0.09; 95% CI = 0.01-0.44) were protective of risky sexual behaviour. CONCLUSION: Street children need to be regarded as a high-risk group for acquiring HIV. The potential benefit of providing homeless youth with night-shelters should be explored more since this could be an opportunity to integrate risk-reduction programmes that take into account all problematic behaviors such as risky sexual behaviour and drug use.