Perinatal mortality and its predictors in Beni City, Democratic Republic of Congo: a cross-sectional study.

BACKGROUND: Globally, perinatal mortality rates have decreased considerably in the last 30 years. However, in sub-Saharan African countries perinatal mortality remains a public health burden. Therefore, this study aimed to determine the Perinatal Mortality Rate and the factors associated with perinatal mortality in Beni City, Northeastern Democratic Republic of Congo. METHODS: A hospital-based retrospective cross-sectional study was conducted among 1394 deliveries that were documented in Beni General Referral Hospital from 2 January to May 31, 2022. The study was done in the conflict-ridden Beni city of the North Kivu Province. Analysis was done using Open Epi and SPSS version 22. Binary and Multivariate logistic regression analyses were performed. Odds ratio with 95% confidence interval was used to measure strength of association. RESULTS: Findings indicate that 60.7% of 1394 participants were below the age of 21 years, and 95.1% (1325) Beni residents. The Perinatal Mortality Rate was 42.3 per 1000 live births. Majority (51) of the postpartum women who experienced perinatal mortality didn`t have a history of perinatal mortality as compared to their counterparts. Multivariable analysis revealed that birth weight (AoR = 0.082, 95% CI 0.014-0.449, p < 0.05) and Apgar score in the 10th minute (AoR = 0.082, 95% CI 0.000- 0.043, p < 0.05) were significantly associated with Perinatal mortality. CONCLUSION: The high perinatal mortality rate in Beni General Referral Hospital, approximately four in every 100 births remains a disturbing public health concern of which is attributable to low birth weight and Apgar score. This study may help policy-makers and healthcare providers to design preventive interventions.

Correlates of fertility desires in women with urogenital fistula in the Democratic Republic of Congo: a cross-sectional study of 1,646 women.

BACKGROUND: Studies on fertility desires among fistula patients in the Democratic Republic of Congo (DRC) have been conducted on fewer patients. Furthermore, these studies have adopted a univariate descriptive approach. This study aims to examine the determinants of fertility desires among patients with fistula in the DRC. METHODS: This cross-sectional study included women aged 15-49 whose fistulas were repaired by the Panzi Hospital mobile team in seven DRC regions between 2013 and 2018. Univariate and bivariate descriptive analyses were performed using the frequency distribution table and the chi-square test. Adjusted odds ratios with their 95 confidence intervals from logistic regression were used to analyze factors associated with fertility desire after fistula repair. All analyses were stratified by parity level for all women aged 15-49 and 20-34 years. RESULTS: Of the 1,646 women aged 15-49 and 808 aged 20-34, 948 (57.6%) and 597 (73.8%), respectively, wanted to have children after fistula repair. Among women aged 15-49 and 20-34 years, the desire to have children was parity-specific. It was negatively associated with age at all parity levels. In women with low parity, the desire for children was significantly negatively associated with a high number of surgeries, abortions, and fistula duration. It tended to decrease with time, but was particularly high in 2014 and 2017. It was high among the Protestant women. Among medium-parity women, it was significantly lower in urban areas and among widows, but higher among women who had more than two abortions. Among high-parity women, it was negatively associated with education level. CONCLUSION: To help women with fistula achieve or approach their desired number of children, our findings suggest that (1) counseling is needed for women with a high desire for children; (2) the human, material, and financial resources needed to eliminate fistula in the DRC should be made available; and (3) medical and nursing staff should be sufficiently and effectively trained to minimize the number of unsuccessful surgeries performed on women with fistula.

Association of comprehensiveness of antiretroviral care and detectable HIV viral load suppression among pregnant and postpartum women in the Democratic Republic of the Congo: a cross-sectional study.

Introduction: Worldwide, over two-thirds of people living with HIV are on antiretroviral therapy (ART). Despite increased ART access, high virological suppression prevalence remains out of reach. Few studies consider the quality of ART services and their impact on recipients' viral suppression. We assessed the association between ART service readiness and HIV viral load suppression among pregnant and breastfeeding women living with HIV (WLH) receiving ART in maternal and child health (MCH) clinics in Kinshasa, Democratic Republic of Congo. Methods: We performed a cross-sectional analysis leveraging data from a continuous quality improvement intervention on WLH's long-term ART outcomes. From November 2016 to May 2020, we enrolled WLH from the three largest clinics in each of Kinshasa'Ls 35 health zones. We measured clinic's readiness using three WHO-identified ART care quality indicators: relevant guidelines in ART service area, stocks of essential ART medicines, and relevant staff training in ≥24 months, scoring clinics 0-3 based on observed indicators. We defined viral load suppression as ≤1,000 cp/ml. Multilevel mixed-effect logistic models were used to estimate prevalence odds ratios (ORs) measuring the strength of the association between ART service readiness and viral suppression. Results: Of 2,295 WLH, only 1.9% received care from a clinic with a score of 3, 24.1% received care from a 0-scoring clinic, and overall, 66.5% achieved virologically suppression. Suppression increased from 65% among WLH receiving care in 0-scoring clinics to 66.9% in 1-scoring clinics, 65.8% in 2-scoring clinics, and 76.1% in 3-scoring clinics. We did not observe a statistically significant association between ART service readiness score and increased viral suppression prevalence, however we did find associations between other factors, such as the location of the health center and pharmacist availability with suppressed viral load. Discussion: A lack of comprehensive ART care underscores the need for enhanced structural and organizational support to improve virological suppression and overall health outcomes for women living with HIV..

COVID-19 seroprevalence cohort survey among health care workers and their household members in Kinshasa, DR Congo, 2020-2022.

INTRODUCTION: Serological surveys offer the most direct measurement to define the immunity status for numerous infectious diseases, such as COVID-19, and can provide valuable insights into understanding transmission patterns. This study describes seroprevalence changes over time in the context of the Democratic Republic of Congo, where COVID-19 case presentation was apparently largely oligo- or asymptomatic, and vaccination coverage remained extremely low. METHODS: A cohort of 635 health care workers (HCW) from 5 health zones of Kinshasa and 670 of their household members was interviewed and sampled in 6 rounds between July 2020 and January 2022. At each round, information on risk exposure and a blood sample were collected. Serology was defined as positive when binding antibodies against SARS-CoV-2 spike and nucleocapsid proteins were simultaneously present. RESULTS: The SARS-CoV-2 antibody seroprevalence was high at baseline, 17.3% (95% CI 14.4-20.6) and 7.8% (95% CI 5.5-10.8) for HCW and household members, respectively, and fluctuated over time, between 9% and 62.1%. Seropositivity was heterogeneously distributed over the health zones (p < 0.001), ranging from 12.5% (95% CI 6.6-20.8) in N'djili to 33.7% (95% CI 24.6-43.8) in Bandalungwa at baseline for HCW. Seropositivity was associated with increasing rounds adjusted Odds Ratio (aOR) 1.75 (95% CI 1.66-1.85), with increasing age aOR 1.11 (95% CI 1.02-1.20), being a female aOR 1.35 (95% CI 1.10-1.66) and being a HCW aOR 2.38 (95% CI 1.80-3.14). There was no evidence that HCW brought the COVID-19 infection back home, with an aOR of 0.64 (95% CI 0.46-0.91) of seropositivity risk among household members in subsequent surveys. There was seroreversion and seroconversion over time, and HCW had a lower risk of seroreverting than household members (aOR 0.60 (95% CI 0.42-0.86)). CONCLUSION: SARS-CoV-2 IgG antibody levels were high and dynamic over time in this African setting with low clinical case rates. The absence of association with health profession or general risk behaviors and with HCW positivity in subsequent rounds in HH members, shows the importance of the time-dependent, and not work-related, force of infection. Cohort seroprevalence estimates in a 'new disease' epidemic seem insufficient to guide policy makers for defining control strategies.

Individual and contextual determinants of early access to post-rape care: A retrospective cohort study of 4048 women in the Democratic Republic of Congo from 2014 to 2019.

BACKGROUND: Armed conflict in the eastern Democratic Republic of Congo (DRC) has significantly increased the incidence of sexual violence against women. Victims who manage to access health care within 72 h of experiencing rape can receive critical preventive care to mitigate the consequences of such violence. Despite this, a disproportionately small number of victims are able to obtain medical care within this crucial time frame. This study aimed to identify both individual and contextual factors that influence the likelihood of accessing post-rape care within 72 h in the eastern DRC. METHODS: This retrospective cohort study utilized patient records from Panzi Hospital along with contextual data provided by the South Kivu Provincial Ministry of Health. It encompassed rape victims residing in South Kivu province who sought post-rape care between 2014 and 2019. To identify individual and contextual factors influencing timely access to care (within 72 h), multilevel logistic regression analysis was employed. RESULTS: The study included a total of 4,048 women, with 30 % being under 18 years old and 40 % married. Around 13 % accessed care within 72 h of rape. Multivariate analysis revealed that timely access to care (within 72 h) was negatively influenced by factors such as the isolation of the victim's health zone of residence (aOR = 0.29 [0.14-0.63], p = 0.002), the distance between the home health zone and the hospital (aOR = 0.75 [0.54-0.99], p = 0.041), instances of rape occurring in 2015 or earlier (aOR = 0.44 [0.34-0.57], p < 0.001), and referrals to the hospital from other health facilities or organizations (aOR = 0.78 [0.61-1.00], p = 0.049). Conversely, being single was positively associated with access to care within this critical period (aOR = 1.29 [1.03-1.61], p = 0.024). Furthermore, statistical trends indicate that the presence of Panzi partner NGOs in the victim's health zone might facilitate access to care (aOR = 1.33 [0.99-1.80], p = 0.057), highlighting an area of interest, while being internally displaced at the time of rape was associated with a trend towards reduced access to care (aOR = 0.78 [0.59-1.02], p = 0.068), underscoring the need for further research and targeted interventions. CONCLUSION: To enhance access to post-rape care, our study highlights the need for strengthened collaboration with all partnering organizations and focused efforts on raising awareness, particularly among married women and their husbands. Enhancing security measures, constructing or upgrading roads to better connect major cities with currently inaccessible or isolated areas, bolstering the efforts of both local and international NGOs, and offering comprehensive reproductive health services to internally displaced women and those residing in the victims' health zones, are crucial steps toward ensuring access to post-rape care within the critical 72-hour window.

The Bacterial Meningitis Epidemic in Banalia in the Democratic Republic of Congo in 2021.

BACKGROUND: The Banalia health zone in the Democratic Republic of Congo reported a meningitis epidemic in 2021 that evolved outside the epidemic season. We assessed the effects of the meningitis epidemic response. METHODS: The standard case definition was used to identify cases. Care was provided to 2651 in-patients, with 8% of them laboratory tested, and reactive vaccination was conducted. To assess the effects of reactive vaccination and treatment with ceftriaxone, a statistical analysis was performed. RESULTS: Overall, 2662 suspected cases of meningitis with 205 deaths were reported. The highest number of cases occurred in the 30-39 years age group (927; 38.5%). Ceftriaxone contributed to preventing deaths with a case fatality rate that decreased from 70.4% before to 7.7% after ceftriaxone was introduced (p = 0.001). Neisseria meningitidis W was isolated, accounting for 47/57 (82%), of which 92% of the strains belonged to the clonal complex 11. Reactive vaccination of individuals in Banalia aged 1-19 years with a meningococcal multivalent conjugate (ACWY) vaccine (Menactra®) coverage of 104.6% resulted in an 82% decline in suspected meningitis cases (incidence rate ratio, 0.18; 95% confidence interval, 0.02-0.80; p = 0.041). CONCLUSION: Despite late detection (two months) and reactive vaccination four months after crossing the epidemic threshold, interventions implemented in Banalia contributed to the control of the epidemic.

Evaluation of resuscitation systems in the Democratic Republic of Congo: A narrative review.

Introduction: Limited data exists regarding cardiovascular diseases (CVDs) and related emergencies such as out-of-hospital cardiac arrest (OHCA) in low- and middle-income countries (LMICs). The recent burden of disease report indicates a rising prevalence of CVDs in these settings like the Democratic Republic of Congo (DRC), likely associated with acute complications. Achieving improved outcomes necessitates resilient healthcare systems, including adequate emergency care and resuscitation systems. This study aims to characterize the current state of resuscitation systems in the DRC, contributing to the discourse on the burden of CVDs in LMICs and advocating for context-appropriate interventions to develop and reinforce these systems. Methods: A narrative review utilizing the modified survival framework of the Global Resuscitation Alliance was conducted. It encompassed the country's CVD epidemiological data, healthcare components, and emergency care system. Results: Analysis of limited available data revealed an underdeveloped and inadequately resourced healthcare system in the country, particularly its early-stage emergency care component. While specific data on out-of-hospital cardiac arrests were lacking, crucial components of the survival chain necessary for improved post-arrest outcomes were found to be largely deficient. Community-based first aid knowledge and practice were inadequate, the availability of automated external defibrillators (AEDs) and integrated ambulance services were either absent or insufficiently developed, and facility-based resuscitation capacity was predominantly in its infancy. Nonetheless, optimism is warranted due to recent government decisions to increase total health expenditure and progressively implement Universal Health Coverage. Conclusion: Resuscitation systems in the DRC are largely non-existent, reflecting the country's underdeveloped healthcare system, particularly in emergency care. Urgent action is needed to develop and reinforce context-appropriate resuscitation systems to address the growing burden of CVD-related emergencies in LMICs.

Presidents and vaccines: head of state inoculation as a tool for vaccine promotion.

Introduction: Vaccine hesitancy, an important threat to global health, has increased since the onset of the COVID-19 pandemic. The public vaccination of high-profile figures, such as heads of state, has been touted as a potential tool for increasing vaccine acceptance among the general population. However, systematic information on such role modelling is lacking and existing studies focus on a small number of high-income countries. We take advantage of the COVID-19 pandemic to fill this gap. Methods: Through a systematic search of internet sources, we first document that most global leaders supported the vaccination campaign and actively communicated their vaccination status to the public. We then turn to a case study to provide experimental evidence on vaccine role modelling for a country in Africa - the region that is most lagging behind in achieving universal immunization coverage. We rely on a randomized survey experiment with 600 citizens in the Democratic Republic of Congo and take advantage of the fact that the Congolese President publicly received a COVID-19 vaccine during the survey period. Results and discussion: Our findings demonstrate that the impact of political leader's role modelling is moderated by trust and depends on media outreach and access. When trust in leaders is lacking, or news on their actions is inaccessible, alternative ambassadors and effective communication methods become crucial in motivating and informing the public. This may be especially relevant in fragile states and remote regions.

Association between bacterial vaginosis, Chlamydia trachomatis infection and tubal factor infertility in Bukavu, Democratic Republic of Congo.

BACKGROUND: Tubal factor infertility (TFI) is common in sub-Saharan Africa and often secondary to pelvic inflammatory disease (PID). Anaerobes associated with bacterial vaginosis (BV) are also found in PIDs widely dominated by Chlamydia trachomatis (C. trachomatis), whose role in TFI is better demonstrated than that of BV. OBJECTIVES: To determine the prevalence of BV and C. trachomatis and to investigate the association between BV, C. trachomatis and TFI. METHODS: We included 137 patients treated for infertility between January 2020 and November 2021. Cases were defined as women with infertility aged 18-45 years presenting with TFI (n = 52), and controls as infertile women in the same age groups without TFI (n = 85). Data on social habits, life style and infertility parameters were collected, and we performed screening for BV and C. trachomatis. Multiple regression was used to measure associations. RESULTS: The prevalence of BV and C. trachomatis was 42.3% (58/137) and 23.4% (32/137), respectively. BV (61.5% vs 30.6%, p<0.001) and C. trachomatis (48.1 vs 8.2%, p<0.001) were more frequent in cases of TFI. BV and C. trachomatis increased the risk of TFI approximately 4-fold [aOR: 3.77 (1.61-8.83), p=0.002] and 14-fold [aOR: 13.77 (4.59-41.27), p<0.001], respectively. CONCLUSION: BV and C. trachomatis infection are strongly associated with TFI in Bukavu. Prevention and screening should be implemented to reduce the risk of TFI.

Provincial Intra-Action Review of the COVID-19 Vaccination Programme: Opportunities to Improve Vaccine Response in North Kivu, Democratic Republic of Congo.

Background: Low levels of COVID-19 vaccination coverage in many countries prompted the use of rapid assessments to characterize barriers to vaccination and identify corrective measures. The World Health Organization recommended the use of intra-action reviews (IARs) to identify best practices, gaps, and lessons learned to make real-time improvements to the COVID-19 vaccination response. Objective: The Democratic Republic of the Congo (DRC) implemented a national IAR in July 2021 that was poorly attended by the provincial health level, where vaccination activities are planned and implemented. To bridge this gap, we proposed sub-national IARs focused on COVID-19 vaccine program implementation at the provincial level. Methods: Using the WHO methodology, we organized a four-day provincial IAR workshop and invited national, provincial and health zone Ministry of Health (MoH) representatives and private and non-governmental organizations involved in the provincial COVID-19 vaccination response. Participants were divided into six groups based on their expertise, affiliation, and role within the health system to assess and identify lessons learned, challenges and the solutions within each of the six technical areas: (1) coordination, planning and monitoring; (2) service delivery; (3) risk communication and community engagement; (4) adverse effects following immunization (AEFI); (5) logistics; (6) and data management, monitoring and evaluation. Results: The first provincial COVID-19 IAR was conducted in Goma, North Kivu, from January 19-22, 2022. A total of 56 participants came from provincial and health zone offices, and non-governmental organizations. Through work group discussions, they identified best practices, challenges, and lessons learned, and made recommendations to improve implementation of vaccination activities and reach coverage targets. Activities were proposed to operationalize recommendations and address challenges to improve the provincial response. Conclusion: This provincial IAR was a useful tool for reviewing progress and areas of improvement, while evaluating aspects of the COVID-19 vaccine rollout. It provided a means to share information with vaccination partners on areas of intervention, tailored to the local context.

Prioritization of maternal and newborn health policies and their implementation in the eastern conflict affected areas of the Democratic Republic of Congo: a political economy analysis.

BACKGROUND: Maternal and neonatal mortality remains a major concern in the Democratic Republic of Congo (DRC), and the country's protracted crisis context exacerbates the problem. This political economy analysis examines the maternal and newborn health (MNH) prioritization in the DRC, focussing specifically on the conflict-affected regions of North and South Kivu. The aim is to understand the factors that facilitate or hinder the prioritization of MNH policy development and implementation by the Congolese government and other key actors at national level and in the provinces of North and South Kivu. METHODS: Using a health policy triangle framework, data collection consisted of in-depth interviews with key actors at different levels of the health system, combined with a desk review. Qualitative data were analysed using inductive and then deductive approaches, exploring the content, process, actor dynamics, contextual factors and gender-related factors influencing MNH policy development and implementation. RESULTS: The study highlighted the challenges of prioritizing policies in the face of competing health and security emergencies, limited resources and governance issues. The universal health coverage policy seems to offer hope for improving access to MNH services. Results also revealed the importance of international partnerships and global financial mechanisms in the development of MNH strategies. They reveal huge gender disparities in the MNH sector at all levels, and the need to consider cultural factors that can positively or negatively impact the success of MNH policies in crisis zones. CONCLUSIONS: MNH is a high priority in DRC, yet implementation faces hurdles due to financial constraints, political influences, conflicts and gender disparities. Addressing these challenges requires tailored community-based strategies, political engagement, support for health personnel and empowerment of women in crisis areas for better MNH outcomes.

Sensitivity of the African neuropsychology battery memory subtests and learning slopes in discriminating APOE 4 and amyloid pathology in adult individuals in the Democratic Republic of Congo.

Background: The current study examined the sensitivity of two memory subtests and their corresponding learning slope metrics derived from the African Neuropsychology Battery (ANB) to detect amyloid pathology and APOEε4 status in adults from Kinshasa, the Democratic Republic of the Congo. Methods: 85 participants were classified for the presence of ß-amyloid pathology and based on allelic presence of APOEε4 using Simoa. All participants were screened using CSID and AQ, underwent verbal and visuospatial memory testing from ANB, and provided blood samples for plasma Aß42, Aß40, and APOE proteotype. Pearson correlation, linear and logistic regression were conducted to compare amyloid pathology and APOEε4 status with derived learning scores, including initial learning, raw learning score, learning over trials, and learning ratio. Results: Our sample included 35 amyloid positive and 44 amyloid negative individuals as well as 42 without and 39 with APOEε4. All ROC AUC ranges for the prediction of amyloid pathology based on learning scores were low, ranging between 0.56-0.70 (95% CI ranging from 0.44-0.82). The sensitivity of all the scores ranged between 54.3-88.6, with some learning metrics demonstrating good sensitivity. Regarding APOEε4 prediction, all AUC values ranged between 0.60-0.69, with all sensitivity measures ranging between 53.8-89.7. There were minimal differences in the AUC values across learning slope metrics, largely due to the lack of ceiling effects in this sample. Discussion: This study demonstrates that some ANB memory subtests and learning slope metrics can discriminate those that are normal from those with amyloid pathology and those with and without APOEε4, consistent with findings reported in Western populations.

Economic analysis of a health system strengthening program in the Democratic Republic of the Congo / Analyse économique d'un programme de renforcement du système de santé en République démocratique du Congo.

INTRODUCTION: Due to the Democratic Republic of the Congo's (DRC) precarious health system that provides only limited access to health care, the European Union, via Memisa Belgium, implemented a program to strengthen provision of and access to health care (known as PRO DS) in the provinces of Kongo Central and Ituri. This program took a holistic approach, seeking to improve equitable access and combat malnutrition. METHODS: To measure the program's social return on investment and to estimate the cost per capita and effectiveness per euro invested (efficiency), a 61-month (1 July 2017 to 31 July 2022) cost-effectiveness evaluation with a societal perspective was carried out. The double-difference method was used to compare the results of PRO DS and non-PRO DS zones. The social return on investment was assessed via the ratio of effectiveness to costs. RESULTS: Analyses revealed the program cost between 3.72 and 3.96 euros per capita per year (2022) in Kongo Central, and between 3.12 and 3.36 euros in Ituri. Importantly, it was cost-effective in the areas of reproductive health, nutrition, and the use of health and nutrition services. CONCLUSIONS: The program's strong nutritional component and overall holistic vision may explain why it was so efficient. PRO DS stands out from other programs that focus solely on one specific problem or population. Although the program has some limitations, it would be worthwhile for the government to invest in it.

Introduction: Face à l'accès limité aux soins et à la précarité des structures sanitaires en République démocratique du Congo, l'Union européenne par l'intermédiaire de Memisa Belgique avait mis en œuvre le Programme de renforcement de l'offre et développement de l'accès aux soins de santé (PRO DS) dans les provinces du Kongo-Central et de l'Ituri. Ce programme se caractérisait par une approche holistique d'équité d'accès et de lutte contre la malnutrition. Méthodes: Pour mesurer le retour social sur investissement du programme et estimer son coût par habitant et son efficacité par euros investis (efficience), une évaluation coûts-efficacité avec une perspective sociétale de 61 mois (1er juillet 2017 au 31 juillet 2022) a été réalisée. La méthode de double différence, qui compare les résultats des zones PRO DS et des zones non PRO DS, a été utilisée. Le retour social sur investissement a été évalué par le biais du rapport entre l'efficacité et les coûts. Résultats: Les analyses ont montré que le programme coûtait par année et par habitant entre 3,72 et 3,96 euros (2022) au Kongo-Central, et entre 3,12 et 3,36 euros en Ituri. De plus, il était coût-efficace dans plusieurs domaines, telles la santé de la reproduction, la nutrition, l'utilisation des services de santé et nutritionnels. Conclusions: L'efficience du programme pourrait s'expliquer par sa vision holistique avec un fort volet « Nutrition ¼. PRO DS se démarque d'autres programmes qui agissent uniquement sur une problématique ou population spécifique. Malgré ses quelques imperfections, le gouvernement mériterait d'y investir.

Pelvic organ prolapse: a cross-sectional study during mass campaign in two hospitals in the city of Kananga in the Democratic Republic of Congo.

Introduction: pelvic organ prolapse is a dynamic pathology that can worsen or regress especially postpartum and is the basis of several disorders that bother the patient and alter her quality of life. This study aims to determine the epidemiological, clinical, and therapeutic profile of pelvic organ prolapse in the town of Kananga. Methods: this is a cross-sectional study of cases of pelvic organ prolapse recorded during the mass campaign organized in the Bon-Berger Hospital of Tshikaji and Saint Georges Hospital of Katoka in the town of Kananga, from January 1 to July 31, 2023. Non-probability convenience sampling was used to select cases. Results: we recorded 138 cases of prolapse out of 572 patients. The prevalence of pelvic organ prolapse is 24.12% with an average monthly incidence of 19.71 (SD: 4.23) cases per month. The prevalence of recurrence of pelvic organ prolapse is 8.69%. The average age of patients is 54.86 (SD: 11.36) years with an average parity of 7.62 (SD: 1.8) deliveries. Its preoperative symptomatology consists of the intravaginal mass associated with digestive and urinary disorders in 97.00% (n=130), stage III hysterocele predominates in 68.70% (n=92), surgical treatment is the most practiced in 91.79% (n=123) and hysterectomy associated with the treatment of cystocele and rectocele by vaginal surgical access is the most practiced in 80.60% (n=108). Conclusion: pelvic organ prolapse is a real public health problem in the city of Kananga, its symptoms are classic and its treatment is surgical via the vaginal route.

Efficacy and tolerability of Helicobacter pylori eradication regimes in South Kivu, Eastern of the Democratic Republic of Congo: A single center observational study.

Background and Aims: Treating Helicobacter pylori infections has become a major challenge due to increased antibiotic resistance. The aim of this study was to investigate the efficacy and tolerability of the main standard regimens recommended for H. pylori eradication in Bukavu, Eastern of the Democratic Republic of Congo. Methods: The study enrolled patients with evidence of H. pylori infection in histological examination or serology testing combined with a positive fecal antigen test. As first-line treatment, patients were randomized to either a 10-days (OAC-10) or a 14-days (OAC-14) regimen, employing a combination of omeprazole 20 mg, amoxicillin 1 g, and clarithromycin 500 mg twice daily. In case of failure, a second line regimen was evaluated and included two others protocols: OAC-10 regimen + levofloxacin 500 mg (OAC-10+) and the bismuth-based therapy (pantoprazole + bismuth salt + metronidazole + tetracycline) during 10 days. Our primary endpoint was H. pylori eradication and secondarily, the compliance and adverse effects were also evaluated. Results: A total of 179 patients were enrolled. The eradication rate was 79.2% and 80.5% with the OAC-10 and OAC-14 regimen, respectively (p = 0.796). Adverse effects were significant higher in the OAC-14 group than in the OAC-10 group (36.5% vs. 57.8%; p < 0.001). On the other hand, the compliance rate was slightly higher in the OAC-10 group (97.9% vs. 91.6%, p = 0.052) while clinical improvement was almost similar in both groups. Regarding the second line regimen, the bismuth-based therapy (n = 18) seemed to show a better response with 100% of eradication rate and 100% of clinical improvement. Conclusion: The classic 10-days triple therapy seems to be as effective as the 14-days regimen while having in addition a good tolerance. Apart from cost issues, the bismuth-based therapy seems to be a very good alternative in case of first-line treatment failure.

Malaria infection among adults residing in a highly endemic region from the Democratic Republic of the Congo.

BACKGROUND: Adults infected with Plasmodium spp. in endemic areas need to be re-evaluated in light of global malaria elimination goals. They potentially undermine malaria interventions but remain an overlooked aspect of public health strategies. METHODS: This study aimed to estimate the prevalence of Plasmodium spp. infections, to identify underlying parasite species, and to assess predicting factors among adults residing in an endemic area from the Democratic Republic of Congo (DRC). A community-based cross-sectional survey in subjects aged 18 years and above was therefore carried out. Study participants were interviewed using a standard questionnaire and tested for Plasmodium spp. using a rapid diagnostic test and a nested polymerase chain reaction assay. Logistic regression models were fitted to assess the effect of potential predictive factors for infections with different Plasmodium spp. RESULTS: Overall, 420 adults with an estimated prevalence of Plasmodium spp. infections of 60.2% [95% CI 55.5; 64.8] were included. Non-falciparum species infected 26.2% [95% CI 22.2; 30.5] of the study population. Among infected participants, three parasite species were identified, including Plasmodium falciparum (88.5%), Plasmodium malariae (39.9%), and Plasmodium ovale (7.5%) but no Plasmodium vivax. Mixed species accounted for 42.3% of infections while single-species infections predominated with P. falciparum (56.5%) among infected participants. All infected participants were asymptomatic at the time of the survey. Adults belonging to the "most economically disadvantaged" households had increased risks of infections with any Plasmodium spp. (adjusted odds ratio, aOR = 2.87 [95% CI 1.66, 20.07]; p < 0.001), compared to those from the "less economically disadvantaged" households. Conversely, each 1 year increase in age reduced the risk of infections with any Plasmodium spp. (aOR = 0.99 [95% CI 0.97, 0.99]; p = 0.048). Specifically for non-falciparum spp., males had increased risks of infection than females (aOR = 1.83 [95% CI 1.13, 2.96]; p = 0.014). CONCLUSION: Adults infected with malaria constitute a potentially important latent reservoir for the transmission of the disease in the study setting. They should specifically be taken into account in public health measures and translational research.

Plant use and perceptions in the context of sexual health among people of Congolese descent in Belgium.

BACKGROUND: The use of medicinal plants is integral to global healthcare systems, with Sub-Saharan Africa maintaining a robust tradition of herbal medicine alongside Western-oriented healthcare. As migrant communities tend to continue traditional herbal practices after migration, documenting this use is vital to develop culturally sensitive healthcare. This study investigates plant usage and perspectives in the context of sexual and reproductive health among the Congolese community in Belgium, particularly in the Matongé quarter of Brussels. Our research questions were: (1) What is the current knowledge of medicinal plants among the Congolese community in Belgium in the context of sexual health, and what are the applications and commonly employed administration methods of these plants? (2) What role does herbal medicine play in the context of sexual health for people of Congolese descent in Belgium and how this is influenced by perceptions of sexuality? and (3) Is there a gender bias in the use of medicinal plants, and if so, can this be related to perceived gender norms? METHODS: We conducted 22 semi-structured interviews with people of Congolese descent currently living in Belgium. Participants were selected using both snowball sampling and purposive sampling. Plant use in the context of sexual health was recorded through freelisting. Data on narratives, ideas, and perceptions of this plant use in the context of sexual health were collected. Interview transcripts were analyzed using thematic analysis. RESULTS: We identified 17 plant species used for sexual health. Three overarching themes emerged from our data. Plants were used with a notable gender bias favoring male sexual potency enhancement. Men used these plants for both remedying potency issues and enhancing sexual prowess. In contrast, knowledge about plants for female sexual health was limited. Gender norms reinforced the importance of male sexual potency, while stigmatizing open discussions of female sexuality. CONCLUSIONS: The use of medicinal plants for sexual health raises health, social, and conservation concerns, underscoring the need for further research in this area. This study contributes to understanding medicinal plant use within the Congolese community in Belgium and highlights the necessity for future research on herbal practices for female sexual health in this context.

Epidemiological, clinical and prognosis aspects of acute generalized peritonitis in South-Kivu Province: descriptive observational study of 278 cases.

Introduction: the aim was to determine epidemiological, clinical, therapeutic, and prognostic aspects of acute generalized peritonitis (AGP). Methods: we conducted an observational, cross-sectional and multicentre study over 2 years of 278 cases of acute generalized peritonitis operated in semi-urban and urban hospitals in South-Kivu Province, Democratic Republic of Congo. Results: the population of this study was young with a mean age was 28.9 ± 16.1 years with extremes of 1.3 years to 80 years with a sex ratio M: F of 0.8. Peritonitis aetiology was dominated by intestinal perforation 132 cases (47.4%), the admission time in 65, 5% was more than 72 hours. Acute abdominal pain was the most reason for consultation in 93.2% of cases, 11.9% of patients were in hypovolemic shock. In 40.6%, the treatment of patients consisted in intestinal resection with terminal anastomosis, or ileostomy in 32.7%. About the outcomes, 32.4% of the patients had a surgical reoperation and 15.8% of the digestive fistulas were reported. The average duration of the hospitalization was 23.4 ± 20.3 days. Morbidity rate was 14.7%. Conclusion: the AGP remains one of the abdominal emergencies observed in different semi-urban and urban hospitals of the province of South-Kivu, causing some problems of medical and surgical management, starting from the delay of admission, the severity of the symptoms related to the etiology of the intestinal perforation. In all cases, AGP requires a well-executed resuscitation procedure and surgical technique to improve the prognosis and reduce mortality, which seems to be high in this study.

The role of provincial health administration in supporting district health management teams in the Democratic Republic of Congo: eliciting an initial programme theory of a realist evaluation.

BACKGROUND: In 2006, the Ministry of Health in the Democratic Republic of Congo designed a strategy to strengthen the health system by developing health districts. This strategy included a reform of the provincial health administration to provide effective technical support to district health management teams in terms of leadership and management. The provincial health teams were set up in 2014, but few studies have been done on how, for whom, and under what circumstances their support to the districts works. We report on the development of an initial programme theory that is the first step of a realist evaluation seeking to address this knowledge gap. METHODS: To inform the initial programme theory, we collected data through a scoping review of primary studies on leadership or management capacity building of district health managers in sub-Saharan Africa, a review of policy documents and interviews with the programme designers. We then conducted a two-step data analysis: first, identification of intervention features, context, actors, mechanisms and outcomes through thematic content analysis, and second, formulation of intervention-context-actor-mechanism-outcome (ICAMO) configurations using a retroductive approach. RESULTS: We identified six ICAMO configurations explaining how effective technical support (i.e. personalised, problem-solving centred and reflection-stimulating) may improve the competencies of the members of district health management teams by activating a series of mechanisms (including positive perceived relevance of the support, positive perceived credibility of provincial health administration staff, trust in provincial health administration staff, psychological safety, reflexivity, self-efficacy and perceived autonomy) under specific contextual conditions (including enabling learning environment, integration of vertical programmes, competent public health administration staff, optimal decision space, supportive work conditions, availability of resources and absence of negative political influences). CONCLUSIONS: We identified initial ICAMO configurations that explain how provincial health administration technical support for district health management teams is expected to work, for whom and under what conditions. These ICAMO configurations will be tested in subsequent empirical studies.