Democratic Republic Of Congo Research Articles

A Call to Action for Global Solutions to Air Quality Crisis: Urgent Actions and Innovative Solutions Needed

ABSTRACT Air pollution, specifically smog, has become a prevalent concern worldwide due to its association with various health risks including stroke, heart disease, lung disease, lower respiratory disorders, and cancer. The excessive use of fossil fuels and the rapidly increasing population have led to the rise in air pollution, which also increases the risk of other ailments such as diabetes and negatively impacts cognitive development in children as well as mental health. According to the World Health Organization, almost 7 million people die each year due to air pollution. According to the recent reports by the Swiss organization (IQAir) on October 22nd, 2024, accessed at (https://www.iqair.com) Lahore in Pakistan, Delhi in India, Kinshasa in Democratic Republic of the Congo, Milano in Italy, Belgrade in Serbia, Jakarta in Indonesia and Karachi in Pakistan have been identified as the top seven cities with the highest US Air Quality Index (AQI). The rising levels of air pollution pose significant health risks globally, necessitating immediate action from governments and communities. Implementing effective policies, investing in clean technologies, and fostering international collaboration are essential to mitigate the impacts of air quality deterioration on public health and the environment.

Household Food Insecurity During the COVID-19 Pandemic Between Slum and Non-Slum Areas in Kinshasa, DR Congo: A Cross-Sectional Study

Introduction: Food insecurity is a vital issue, especially in places such as Kinshasa. Additionally, food insecurity has been worsened by the COVID-19 pandemic, particularly in low- and middle-income countries. Thus, this study examined food insecurity in Kinshasa after the peak of the pandemic to understand the impact of post-pandemic recovery efforts as well as the heterogeneity of this problem according to the residence of respondent (slum vs. non-slum areas). Methods: Grounded in the four key dimensions of food security (availability, access, vulnerability, and utilization), this cross-sectional study was conducted in Kinshasa with a representative sample of 2170 households selected from 62 enumeration areas. We used a questionnaire to interview participants about their food situations. Interviews were conducted with the head of each household or their designated representative by 150 master’s students using tablets powered by the SurveyCTO application. Household food security status was evaluated using the Household Food Insecurity Access Scale. A logistic regression model was developed to assess household risk factors associated with food insecurity. Results: Most people we talked to were over 40 years old, and many lived in households with fewer than six people. About a third of the households were overcrowded. The prevalence of food insecurity was 76.5% (95%CI: 74.6–78.3). Factors associated with food insecurity included being a household head aged over 50 years, insufficient living space, lower socioeconomic status, and residing in slum areas (AOR: 1.38; 95% CI: 1.06–1.79). Conclusions: Vulnerable groups, such as slum residents, older adults, and informal workers are more likely to be affected by food insecurity. Addressing these challenges requires the government to develop targeted strategies that bolster resilience and mitigate household vulnerability during crises.

Exploring the genomic basis of Mpox virus-host transmission and pathogenesis.

Mpox disease, caused by the monkeypox virus (MPXV), was recently classified as a public health emergency of international concern due to its high lethality and pandemic potential. MPXV is a zoonotic disease that emerged and is primarily spread by small rodents. Historically, it was considered mainly zoonotic and not likely to sustain human-to-human transmission. However, the worldwide outbreak of Clade IIb MPXV from 2020 to 2022 and ongoing Clade I MPXV epidemics in the Democratic Republic of the Congo and surrounding areas are a warning that human-adapted MPXVs will continually arise. Understanding the viral genetic determinants of host range, pathogenesis, and immune evasion is imperative for developing control strategies and predicting the future of Mpox. Here, we delve into the MPXV genome to detail genes involved in host immune evasion strategies for this zoonotic rodent-borne and human-circulating virus. We compare MPXV gene content to related Orthopoxviruses, which have narrow host ranges, to identify potential genes involved in species-specific pathogenesis and host tropism. In addition, we cover the key virulence factor differences that distinguish the MPXV clade lineages. Finally, we dissect how genomic reduction of Orthopoxviruses, through various molecular mechanisms, is contributing to the generation of novel MPXV lineages with increased human adaptation. This review aims to highlight gene content that defines the MPXV species, MPXV clades, and novel MPXV lineages that have culminated in this virus being elevated to a public health emergency of national concern.

Caregivers’ hesitancy and outright refusal toward children’s COVID-19 vaccination in the Democratic Republic of Congo: A community-based cross-sectional study

ABSTRACT Data from the global South show higher COVID-19-related mortality in children compared to the North. Parents’ willingness to vaccinate their children once COVID-19 vaccines are available is poorly documented. We assessed parents’ willingness to vaccinate their children in the DRC. A year after the vaccination program started, we conducted a population and online-based cross-sectional study, using the WHO modified Behavior and Social Drivers questionnaire among parents and caregivers in the eastern DRC. We performed Modified Poisson regressions to determine factors associated with vaccine hesitancy and outright refusal, focusing on the intention to vaccinate one’s children as our primary outcome. Of the 1709 respondents aged 38 years, 82.56% were unwilling to vaccinate their children, of which 26.80% were hesitant and 55.76% were outright refusals. Drivers of hesitancy were religious refusal of vaccine, non-healthcare status, and caregiver beliefs about vaccine unsafety. Independent predictors of refusal were religious refusal of vaccine, neither healthcare nor student status and belief about vaccine effectiveness, unsafety, and distrust. In addition, both hesitancy and refusal to vaccinate one’s children were driven by not being ready to get vaccinated if recommended or mandated. In contrast, parents’ and caregivers’ trust in the government and readiness to vaccinate themselves reduced hesitancy and outright refusal to vaccinate one’s children, respectively. Briefly, COVID-19 vaccine hesitancy and outright refusal in eastern DRC are influenced by individual (subjective convictions) and system-level factors (government confidence, mandate trust). It is important to address these issues to improve vaccine coverage during disease outbreaks and mitigate public health risks.

Land degradation vulnerability modelling for landscape restoration planning in Eastern DR Congo using the analytical hierarchy process (AHP) and geospatial techniques

Land degradation is a major issue for attainment of sustainable development in Eastern DR Congo. This study aims to assess and model the spatial pattern of land degradation vulnerability (LDV) in this region through the application of the Analytical Hierarchy Process (AHP) and geospatial techniques by using the Kalehe territory as a case study. LDV has been defined as the resultant of three components: the exposure to erosion risk, the sensitivity associated with biophysical factors, and the adaptability associated with socioeconomic factors of vulnerability. These factors were weighted using the EasyAHP plugin and multisource open spatial data to obtain the LDV model. This model was validated using the frequency ratio of physical land degradation features. The LDV map was obtained through the application of the weighted overlay technique in QGIS. The results indicated that about 32% of the territory is prone to high to very high vulnerability, representing the hotspot of LDV. The developed model has an overall accuracy of 77.8% in predicting the area with high to very high LDV. Thus, it can be used during land conservation planning to identify the priority areas for implementation of landscape restoration initiatives at the territorial level in Eastern DR Congo.

Geospatial Analysis of Malaria and Typhoid Prevalence Due to Waste Dumpsite Exposure in Kinshasa Districts with and without Waste Services: A Case Study of Bandalungwa and Bumbu, Democratic Republic of Congo

Municipal solid waste (MSW) management poses substantial challenges in rapidly urbanizing areas, with implications for both the environment and public health. This study focuses on the city of Kinshasa in the Democratic Republic of Congo, investigating whether the presence or absence of solid waste collection services results in varying health and economic impacts, and additionally, seeking to establish a correlation between residing in proximity to dumpsites and the prevalence of diseases like malaria and typhoid, thereby providing a comprehensive understanding of the health implications tied to waste exposure. Health data were collected through survey questionnaires, and the geospatial distribution of 19 dumpsites was analyzed using Google Earth Pro 7.3.1 for satellite imagery and GIS software 10.3.1 to map dumpsites and define 1 km buffer zones around the largest dumpsites for household sampling. Statistical analyses were conducted using R Version 4.2.3, employing Chi-square tests for disease prevalence and logistic regression to assess associations between waste management practices and health outcomes. A multivariate regression was used to evaluate correlations between discomfort symptoms (e.g., nasal and eye irritation) and waste activities. The geospatial analysis revealed significant variation in dumpsite size and location, with larger dumpsites near water bodies and flood-prone areas. The study contributes valuable insights into waste-related health risks, emphasizing the need for improved waste management policies in rapidly urbanizing areas like Kinshasa. The socio-demographic analysis reveals distinct traits within the surveyed populations of two communes, Bandalungwa (Bandal) and Bumbu. Bumbu, characterized by larger open dumpsites and limited waste collection services, exhibits a higher prevalence of certain diseases, particularly typhoid fever, and malaria. This discrepancy is statistically significant (p < 2.2 × 10−16), suggesting a potential link between waste exposure and disease prevalence. In Bandal, self-waste collection is a high risk of exposure to typhoid (OR = 4.834 and p = 0.00001), but the implementation of a waste collection service shows protective effect (OR = 0.206 and p = 0.00001). The lack of waste collection services in Bumbu increases the risk of exposure, although not significantly (OR = 2.268 and p = 0.08). Key findings indicate that waste disposal methods significantly differ between Bandal and Bumbu. Bumbu’s reliance on burning and dumping creates environments conducive to disease vectors, contributing to elevated disease transmission risks. However, an in-depth correlation analysis reveals that specific waste management practices, such as burning, burying, and open dumping, do not exhibit statistically significant associations with disease prevalence, underlining the complexity of disease dynamics. This study contributes valuable insights into the importance for urban public health, particularly in rapidly urbanizing cities like Kinshasa, where inadequate waste management exacerbates health risks. By investigating the correlation between proximity to unregulated dumpsites and the prevalence of diseases such as malaria and typhoid fever, the research underscores the urgent need for targeted waste management policies. The stark health disparities between Bandal, with better waste services, and Bumbu, where services are lacking, highlight the protective effect of organized waste collection. These findings suggest that expanding public waste services and enforcing stricter regulations on waste disposal could reduce disease prevalence in vulnerable areas. Additionally, the study supports integrating waste management into urban planning as a critical public health measure. Its evidence-based approach offers valuable insights for policymakers in Kinshasa and other cities facing similar challenges, emphasizing the broader health implications of environmental governance in urban settings.

Bridging the gap: opportunities, challenges, and future directions for teleradiology in rural healthcare

Teleradiology, the electronic transmission of radiological images and data for diagnostic purposes, holds significant promise for improving healthcare access in rural and underserved regions. This review explores the opportunities and challenges of implementing teleradiology in rural settings, where limited access to radiology services exacerbates healthcare disparities. Teleradiology offers multiple benefits, including improved access to timely diagnostics, enhanced decision-making, and cost savings for rural patients who would otherwise need to travel to urban centers for radiology services. It has shown positive outcomes globally, with examples in India, Mali, the Democratic Republic of Congo, and Brazil, demonstrating its feasibility and potential to reduce geographic health inequities. However, implementing teleradiology in these settings faces several challenges, such as technological limitations, workforce shortages, regulatory and legal barriers, data security concerns, and cultural acceptance issues. Solutions and recommendations include investments in infrastructure, workforce training, supportive regulatory frameworks, secure data management, and adaptable telehealth models that consider socioeconomic factors in rural areas. By addressing these challenges, stakeholders can enhance the impact of teleradiology in rural healthcare systems, ultimately contributing to reduced disparities and improved healthcare outcomes. This review provides a comprehensive overview of the current landscape and suggests actionable pathways for advancing teleradiology in rural settings worldwide.

Household Wealth is Associated With Perceived Trustworthiness in a Diverse Set of Countries

Interpersonal trust impacts societal and individual outcomes, affecting economic growth, democracy, and well-being. Trust levels vary both within and across countries, raising the question of what factors influence interpersonal trust. Existing research indicates that an individual’s socioeconomic status influences their level of trust, with wealthier individuals tending to be more trusting. This article examines a further effect of wealth on interpersonal trust, namely whether people perceive wealthier individuals as more trustworthy. Using a novel method for uncovering stereotypes while avoiding social desirability bias, we investigate whether wealth cues are associated with the perceived trustworthiness of targets. Our study, conducted with diverse participants across different cultures (Brazil, Colombia, Democratic Republic of Congo, India, France, Nigeria, Philippines, and the United Kingdom), consistently demonstrates that wealthier targets are seen as more trustworthy. This culturally widespread negative stereotyping of poorer individuals may contribute to observed patterns of interpersonal trust.

Prevalence of syphilis among men serving in the militaries of Sub-Saharan Africa.

The 2030 United Nations Agenda for Sustainable Development includes targets to end sexually transmitted infections (STIs) as a major public health threat. STI prevalence data to inform strategies towards this goal are lacking in middle and low-income countries, especially among men. Data from Seroprevalence and Behavioral Epidemiology Risk Surveys (SABERS) conducted among militaries in Cameroon, Chad, Democratic Republic of the Congo (DRC), Ethiopia, Liberia, Malawi, Republic of the Congo (ROC), and Sierra Leone during 2013-2018 were used to estimate the prevalence of presumed active syphilis among active-duty military men. Associations of active syphilis infection with age, education, marital status, and rank for each country were assessed. The prevalence of active syphilis was less than 1% among men in Cameroon (2018), Ethiopia (2018), Liberia (2018), Malawi (2013), ROC (2014), and Sierra Leone (2013). In Chad (2014), 6.2% (95% CI 5.2%-7.4%; n = 121/1949) of men tested positive for active syphilis. In DRC (2014), the prevalence of active syphilis was 15.5% (95% CI 14.1%-16.9%; n = 404/2611) among men. Active syphilis was associated with older age in DRC (p < 0.01), with less education in Chad (p = 0.03) and DRC (p < 0.01), and with rank in DRC (p = 0.048). These data help address a paucity of information on STI prevalence in sub-Saharan Africa and demonstrate the need for improved surveillance among men.

Cost- effectiveness of a simplified acute malnutrition program: a secondary analysis of the OptiMA randomized clinical trial in the Democratic Republic of the Congo.

Acute malnutrition (AM) causes large loss of life and disability in children in Africa. Researchers are testing innovative approaches to increase efficiency of treatment programs. This paper presents results of a cost-effectiveness analysis of one such program in the Democratic Republic of the Congo (DRC) based on a secondary analysis of a randomized controlled trial Optimizing Treatment for Acute Malnutrition (OptiMA), conducted in DRC in 2018-20. 896 children aged 6-59 months with a mid-upper arm circumference (MUAC) <125 mm or with oedema were treated and followed for six months. Cost-effectiveness of OptiMA using ready-to-use therapeutic food (RUTF) at a tapered dose was compared with the standard national program in which severe cases (SAM) received RUTF proportional to weight, and moderate cases (MAM) were referred to another clinic for a fixed dose regimen of ready-to-use supplementary food. Cost analysis from provider perspective used data collected during the trial and from administrative records. Statistical differences were derived using t-tests. The mean cost per enrolled child under OptiMA was $123 [95%CI: 114-132], not statistically different from the standard group ($127 [95%CI: 118-136], p=0.549), while treatment success (i.e. recovery to MUAC > 125mm and no relapse for 6 months) under OptiMA was 9 percentage points higher (72% vs 63%, p=0.004). Among children with SAM at enrollment, there was no significant difference in treatment success between OptiMA and standard (70% vs 62%, p=0.12) but OptiMA's mean cost per enrolled child was 23% lower ($128 vs $166, p<0.0001). OptiMA was more effective at preventing progression to SAM among those enrolled with MAM (5% vs 16%, p<0.0001) with an incremental cost-effectiveness ratio (ICER) of $234 per progression to SAM prevented. Overall, OptiMA had significantly better outcomes and was no more expensive than standard care. Its adoption could enable more children to be successfully treated in contexts where therapeutic food products are scarce.

Changing Rainfall Patterns in the Northeastern South Kivu Region, Democratic Republic of the Congo: A Detailed Analysis Using CHIRPS Rainfall Data (1981–2023)

AbstractUnderstanding changes in rainfall patterns is vital for effective water resource management and agricultural planning in climate-sensitive regions. In Northeastern South Kivu, Democratic Republic of the Congo, limited knowledge of rainfall dynamics poses challenges for local climate assessments. This study analyzed rainfall patterns using the Climate Hazards Group InfraRed Precipitation with Stations (CHIRPS) dataset from 1981 to 2023 to fill this knowledge gap. The findings revealed significant spatial and temporal changes in rainfall across the regions of Kabare, Bukavu, Kalehe, and Idjwi. Mean annual rainfall ranged from 1136.92 mm to 2048.85 mm, with coefficients of variation between 8.23% and 8.45%. Monthly rainfall fluctuations were substantial, ranging from 16 to 56.35%. Standardized rainfall anomalies indicated a shift from predominantly wet conditions in the 1980s to drier conditions in later decades, with over half the years from 1990 to 2023 recording below-average rainfall. Mann-Kendall trend analysis, supported by Innovative Trend Analysis (ITA), confirmed significant decreases in annual rainfall, with rates between − 3.53 to -5.72 mm/year. Additionally, rainfall intensity indices highlighted a decline in total annual precipitation, suggested fewer extreme events. Spatial variability was observed, with regions like Kalehe and Bukavu showed higher values for indices such as R95P and RX1day compared to Kabare and Idjwi. These results underscored the urgent need for adaptive strategies to mitigate water scarcity and manage changing rainfall patterns in the region.

Lessons from Recent Measles Post-Campaign Coverage Surveys Worldwide

Background: Measles elimination strategies include supplementary immunization activities (SIAs) to rapidly fill immunity gaps. Post-campaign coverage surveys (PCCSs) are recommended to assess SIA coverage. We characterized selected PCCSs performed following recent SIAs, highlighting specific challenges and strengths, and provide recommendations for improvement. Methods: We extracted national SIA data from the global measles/MR SIA database for the period of 2020–2023 and reviewed PCCS reports available at the World Health Organization headquarters. We extracted selected information on PCCS implementation, including information about the implementer, sampling, and main results. Results: Only 15 of 66 countries (23%) with a national-level SIA performed since 2020 had a PCCS report available. We reviewed those reports, plus six more, following three 2019 SIAs with a delayed PCCS and two PCCSs following large subnational SIAs (Kenya 2021 and Yemen 2023). All 24 PCCS reports available were from Gavi-eligible countries, with 15 from South Saharan Africa (Cameroon, the Democratic Republic of the Congo, and Ethiopia had two PCCSs). Eleven (45.8%) PCCSs were conducted within three months of the end of the SIA. All included sampling information and most had percentage of participation. Description of the interviewers’ profiles varied but was limited. PCCS coverage was lower than administrative data in all but two instances. All PCCSs collected data on previous measles vaccination status that would allow exploring indicators on the SIA reaching previously measles zero-dose children. Of the 12 PCCSs reporting coverage among previously measles zero-dose children, nine reported coverage among this group of more than 50% (range: 12% and 91.6%). Conclusion: Even though a PCCS following an SIA is recommended and a requirement in Gavi-supported countries, most SIAs are not followed by a PCCS and, when performed, the timeliness of survey implementation needs improvement. Recent PCCSs were independently conducted and reports included basic survey information, but analysis and presentation of survey results vary particularly for measles zero-dose-related indicators. More guidance and technical support on how to implement PCCSs, including standardization of reports and more in-depth PCCS analyses, may help improve reporting and use of available PCCS data.

Using spatial video and deep learning for automated mapping of ground-level context in relief camps

BackgroundThe creation of relief camps following a disaster, conflict or other form of externality often generates additional health problems. The density of people in a highly stressed environment with questionable safe food and water access presents the potential for infectious disease outbreaks. These camps are also not static data events but rather fluctuate in size, composition, and level and quality of service provision. While contextualized geospatial data collection and mapping are vital for understanding the nature of these camps, various challenges, including a lack of data at the required spatial or temporal granularity, as well as the issue of sustainability, can act as major impediments. Here, we present the first steps toward a deep learning-based solution for dynamic mapping using spatial video (SV).MethodsWe trained a convolutional neural network (CNN) model on a SV dataset collected from Goma, Democratic Republic of Congo (DRC) to identify relief camps from video imagery. We developed a spatial filtering approach to tackle the challenges associated with spatially tagging objects such as the accuracy of global positioning system and positioning of camera. The spatial filtering approach generates smooth surfaces of detection, which can further be used to capture changes in microenvironments by applying techniques such as raster math.ResultsThe initial results suggest that our model can detect temporary physical dwellings from SV imagery with a high level of precision, recall, and object localization. The spatial filtering approach helps to identify areas with higher concentrations of camps and the web-based tool helps to explore these areas. The longitudinal analysis based on applying raster math on the detection surfaces revealed locations, which had a considerable change in the distribution of tents over space and time.ConclusionsThe results lay the groundwork for automated mapping of spatial features from imagery data. We anticipate that this work is the building block for a future combination of SV, object identification and automatic mapping that could provide sustainable data generation possibilities for challenging environments such as relief camps or other informal settlements.

Conflict, Displacement and Overlapping Vulnerabilities: Understanding Risk Factors for Gender Based Violence Among Displaced Women in Eastern Democratic Republic of Congo

Eastern Democratic Republic of Congo (DRC) has been embroiled in decades-long conflict that has resulted in the forced displacement of millions of people and extremely high rates of gender-based violence (GBV). While much attention has understandably focused on conflict-related sexual violence, intimate partner violence (IPV) is in fact one of the most pervasive forms of GBV, including in conflict settings. This paper presents results of a large, randomised survey looking at both sexual and intimate partner violence. Formerly displaced women had 11 per cent greater odds of reporting past-year IPV (p < 0.05), and currently displaced women reported 20 per cent greater odds of IPV in the past-year (p < 0.001). Women who reported ever being displaced also reported 8.5 per cent greater odds (p < 0.001) of past-year sexual violence. Both displacement and war-related experiences are highly and significantly associated with lifetime and past-year IPV and sexual violence. By acknowledging and creating programs that explicitly address the high risk of violence faced by displaced women, we may more effectively break the cycles of violence in fragile settings.

Monkeypox 2024 outbreak: Fifty essential questions and answers.

As the world still vividly recalls the previous monkeypox (mpox) outbreak that impacted over 120 countries worldwide with more than 99,000 cases in 2022, we are now facing a second wave of infections from the monkeypox virus (MPXV), characterized by an exponential increase in cases. The current 2024 outbreak has already recorded more than 20,000 cases in Africa, marking a dramatic escalation compared to previous outbreaks. The predominance of the newly identified clade Ib variant, first detected in the Democratic Republic of the Congo (DRC) and now identified across multiple African nations and beyond, underscores its enhanced transmissibility and potential for international spread, evidenced by cases in Sweden and Thailand. The World Health Organization (WHO) declared on August 14, 2024, the current mpox outbreak a Public Health Emergency of International Concern (PHEIC), calling for heightened global public health measures. The ongoing pattern of unusual, frequent, and extensive outbreaks of mpox with potential global implications poses significant questions. This review addresses, in the format of 50 questions and answers, the 2024 mpox outbreak, detailing its characteristics, epidemiological data, and impact compared to previous outbreaks. It comprehensively explores critical questions related to MPXV virological characteristics, immunological response, clinical manifestations, epidemiology, diagnostics, and available treatments. The review also documents the significant and evolving challenges posed by the current mpox outbreak, highlighting its scale, spread, and public health response.

Compellence by denial against armed groups: UN peacekeeping in Ituri, the Democratic Republic of the Congo

Abstract Peace operations are often deployed to countries where conflicts are effectively ongoing, with mandates to protect civilians and provide security. With the authorisation to use force beyond self-defence, peacekeepers are expected to exert military pressure on armed groups to induce them to abandon violence and join peace processes. Such an approach falls in the domain of compellence. Given that peace operations struggle to adapt to this new expectation, it is imperative to find effective ways of compelling armed groups. While studies on compellence agree on the effectiveness of denial-type pressure, its specific forms are highly context-dependent. What is the most effective way to achieve denial against armed groups in the context of peace operations? There are four such approaches: attrition, stronghold neutralisation, decapitation, and counter-coercion negation. A case study of peacekeeping by the United Nation in Ituri reveals that stronghold neutralisation and counter-coercion negation were especially important for compelling rebels to disarm. As existing studies have not examined the effectiveness of specific forms of denial in peace operations, the finding contributes significantly to the literature on compellence and peace operations.

Introduction to the Symposium “The monusco Intervention Brigade at Ten” Ten Years of the monusco Intervention Brigade: International Law Concerns on the Future of Peacekeeping and the Protection of Civilians

Abstract This is an introduction on a special issue on ‘The monusco Intervention Brigade at Ten’. The special issue includes three articles that discuss the impact of ten years of practice of the monusco Intervention Brigade on peacekeeping in general and the protection of civilians in the Democratic Republic of the Congo in particular.

Diversity and availability of edible caterpillar host plants in the Luki biosphere reserve landscape in the Democratic Republic of the Congo

Edible caterpillars are an important food and economic resource for rural African people. However, they are subject to a number of threats; in particular, their host plants are threatened. The Luki Biosphere Reserve landscape is a region of the Democratic Republic of Congo where the practice of eating caterpillars is a recent phenomenon; however, rural communities have reported their scarcity. This study assessed the diversity and availability of host plants of the edible caterpillars in the Luki Biosphere Reserve (LBR) landscape. Botanical inventories were conducted in eleven ha plots of each of the following habitats: forest, savannah under protection, fallow, and inhabited areas, covering an area of 44 ha. The coverage-based rarefaction and extrapolation method and the iNEXT online software were used to calculate the true diversity of edible caterpillar host plants. The diameter structure of the edible caterpillar host plant species was assessed by counting the number of individuals in each diameter class. The results revealed that in the Luki Biosphere Reserve landscape, edible caterpillars rely on 15 main plant host species (Spondias mombin L., Petersianthus macrocarpus (P.Beauv.) Liben, Croton sylvaticus Hochst. ex Krauss, Hymenocardia acida Tul., Lannea welwitschii (Hiern) Engl., Macaranga spinosa Müll.Arg., Celtis mildbraedii Engl., Coelocaryon botryoïdes Vermoesen, Albizia gummifera (J.F.Gmel.) C. A. Sm, Bridelia atroviridis Müll.Arg, Ficus mucuso Welw. ex Ficalho, Funtumia elastica (P.Preuss) Stapf, Lannea welwitschii (Hiern) Engl., Milicia excelsa (Welw.) C.C. Berg., and Terminalia superba Engl. & Diels). The habitats exhibited low species diversity of the edible caterpillar host plants. Moreover, several of these species are becoming scarce or are locally threatened with extinction. The trend in the diametric structure is similar to species evolving in a disturbed environment.The results of this study suggest potential habitat instability linked to human activities that could lead to biodiversity loss and, thus, a decline in edible caterpillars in the LBR landscape. A better understanding of the unfavourable conditions that influence the nutritional support for the edible caterpillars would help promote appropriate strategies that can be applied in local development plans for community lands at a landscape scale.

“With an unwanted pregnancy, we are looking for midwives in the neighbourhood to show us what to do.” Stakeholder perceptions of midwife-led woman-centred comprehensive abortion care in the province of Kinshasa, Democratic Republic of Congo: a qualitative descriptive study

ProblemMidwives are an essential yet underutilised health human resource for improving unsafe abortion outcomes and increasing abortion access and contraceptive care. BackgroundIn Democratic Republic of Congo (DRC), morbidity and mortality resulting from unsafe abortions are alarmingly high. The recent ratification of the Maputo Protocol in 2018 has made safe abortion accessible. National implementation strategies recognise midwives as providers of comprehensive abortion care (CAC), yet there is little understanding of their current role in its provision. AimTo understand the obstacles and facilitators in integrating the midwifery model of CAC in DRC's health system. MethodsA qualitative descriptive design was used to explore health system stakeholders' perceptions regarding the midwifery model of CAC in Kinshasa, DRC. Data sources included n=43 key informant interviews and n=2 FGDs. Results were member-checked with DRC Midwives’ Association (SCOSAF) members. FindingsFindings highlight midwives provided all aspects of CAC, with attention to the psycho-social well-being of their clients and acted as health service navigators in the community. Appropriate midwifery legislation, scope of practice that includes CAC, administrative support and remuneration, and better access to continuing education are facilitating health system factors for the midwifery model of CAC. Finally, SCOSAF, the Midwives’ Association, played an influential role in the implementation, positively supporting CAC integration by midwives. DiscussionUnderstanding health system levers and the involvement of Midwives’ Associations are important considerations when integrating and sustaining the midwifery model of CAC. Gender transformative approaches are appropriate given systemic gender inequities inherent in midwifery. ConclusionFurther research is needed to understand the impact of the midwifery model of CAC in DRC.

Mpox Vaccine Acceptance, Democratic Republic of the Congo.

We report general acceptance (61.0%) of an mpox vaccine in the Democratic Republic of the Congo among 5,226 survey respondents. Healthcare workers and respondents in historic mpox-endemic regions had higher acceptance rates. These data highlight the need for increased community engagement and sensitization before widespread deployment of mpox vaccines.