Abstract
BackgroundThe eastern Democratic Republic of Congo (DRC) has experienced decades-long armed conflicts which have had a negative impact on population’s health. Most research in public health explores measures that focus on a specific health problem rather than overall population health status. The aim of this study was to assess the health status of the population and its predictors in conflict settings of South Kivu province, using the World Health Organization Disability Assessment Schedule (WHODAS).MethodsBetween May and June 2019, we conducted a community-based cross-sectional survey among 1440 adults in six health zones (HZ), classified according to their level of armed conflict intensity and chronicity in four types (accessible and stable, remote and stable, intermediate and unstable). The data were collected by a questionnaire including socio-demographic data and the WHODAS 2.0 tool with 12 items. The main variable of the study was the WHODAS summary score measuring individual’s health status and synthesize in six domains of disability (household, cognitive, mobility, self-care, social and society). Univariate analysis, correlation and comparison tests as well as hierarchical multiple linear regression were performed.ResultsThe median WHODAS score in the accessible and stable (AS), remote and stable (RS), intermediate (I) and unstable (U) HZ was 6.3 (0–28.6); 25 (6.3–41.7); 22.9 (12.5–33.3) and 39.6 (22.9–54.2), respectively. Four of the six WHODAS domain scores (household, cognitive, mobility and society) were the most altered in the UHZs. The RSHZ and IHZ had statistically comparable global WHODAS scores. The stable HZs (accessible and remote) had statistically lower scores than the UHZ on all items. In regression analysis, the factors significantly associated with an overall poor health status (or higher WHODAS score) were advanced age, being woman, being membership of an association; being divorced, separated or widower and living in an unstable HZ.ConclusionsArmed conflicts have a significantly negative impact on people’s perceived health, particularly in crisis health zones. In this area, we must accentuate actions aiming to strengthen people’s psychosocial well-being.
Highlights
The eastern Democratic Republic of Congo (DRC) has experienced decades-long armed conflicts which have had a negative impact on population’s health
The factors significantly associated with an overall poor health status were; advanced age (B = 0.356; p < 0.001), being woman (B = 5.776; p < 0.001), being membership of an association (B = 5.944; p < 0.001), being divorced, separated or widower (B = 2.147; p = 0.003) and living in an unstable health zone (B = 6.780; p < 0.001)
Our study found that the overall World Health Organization Disability Assessment Schedule (WHODAS) score in our population was high, mostly in unstable health zones (HZ) [Med (IQR) = 39.6 (22.9–54.2)] indicating an overall low health status for the population in this area
Summary
The eastern Democratic Republic of Congo (DRC) has experienced decades-long armed conflicts which have had a negative impact on population’s health. Conflicts has an impact on the socio-economic life of people, the education of citizens and contributes to the impoverishment of communities [5,6,7,8,9]. All these factors create conditions that interfere with strategies for control and response to communicable diseases. As a result of these conflicts, the national crude death rate rose from 1.3 deaths per 1000 population per month in 1997 to 2.2 deaths per 1000 population per month in 2002 [13]. This rate would exceed by 40% (for the whole country) and 60% (in the East of the country) the African average in 2013 [14]
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