Health Zone Research Articles

Determinants of Access to Essential Surgery in the Democratic Republic of Congo

IntroductionIn the Democratic Republic of Congo (DRC), the determinants and barriers of essential surgical care are not well described, hindering efforts to improve national surgical programs and access. MethodsA cross-sectional study evaluated access to essential surgery in the Butembo and Katwa health zones in the North Kivu province of DRC. A double-clustered random sample of community members was surveyed using questions derived from the Surgeons OverSeas Surgical Needs Assessment Survey, a validated tool to determine the reasons for not seeking, reaching, or receiving a Bellwether surgery (i.e., caesarean delivery, laparotomy, and external fixation of a fracture) when needed. ResultsOverall, 887 households comprising 5944 community members were surveyed from April to August 2022. Six percent (n = 363/5944) of the study population involving 35% (n = 309/887) households needed a Bellwether surgery in the previous year, 30% (n = 108/363) of whom died. Of those who needed surgery, 25% (n = 78) did not go to the hospital to seek care and were more likely to find transportation unaffordable (P = 0.042). The most common reasons for not seeking care were lack of funds for hospitalization, prior poor hospital experience, and fear of hospital care. ConclusionsAccess and delivery of essential surgery are drastically limited in the North Kivu province of the DRC, such that a quarter of households needing surgery fails to seek surgical care. Poor access was predominantly driven by households’ inability to pay for surgery and community distrust of the hospital system.

Ebola vaccine uptake and attitudes among healthcare workers in North Kivu, Democratic Republic of the Congo, 2021.

During the 2018-2020 Ebola virus disease (EVD) outbreak in the eastern part of the Democratic Republic of the Congo (DRC), prevention and control measures, such as Ebola vaccination were challenging by community mistrust. We aimed to understand perceptions regarding Ebola vaccination and identify determinants of Ebola vaccine uptake among HCWs. In March 2021, we conducted a cross-sectional survey among 438 HCWs from 100 randomly selected health facilities in three health zones (Butembo, Beni, Mabalako) affected by the 10th EVD outbreak in North Kivu, DRC. HCWs were eligible if they were ≥ 18 years and were working in a health facility during the outbreak. We used survey logistic regression to assess correlates of first-offer uptake (i.e., having received the vaccine the first time it was offered vs. after subsequent offers). Of the 438 HCWs enrolled in the study, 420 (95.8%) reported that they were eligible and offered an Ebola vaccine. Among those offered vaccination, self-reported uptake of the Ebola vaccine was 99.0% (95% confidence interval (CI) [98.5-99.4]), but first-offer uptake was 70.2% (95% CI [67.1, 73.5]). Nearly all HCWs (94.3%; 95% CI [92.7-95.5]) perceived themselves to be at risk of contracting EVD. The most common concern was that the vaccine would cause side effects (65.7%; 95% CI [61.4-69.7]). In the multivariable analysis, mistrust of the vaccine source or how the vaccine was produced decreased the odds of first-time uptake. Overall uptake of the Ebola vaccine was high among HCWs, but uptake at the first offer was substantially lower, which was associated with mistrust of the vaccine source. Future Ebola vaccination efforts should plan to make repeated vaccination offers to HCWs and address their underlying mistrust in the vaccines, which can, in turn, improve community uptake.

Post-Endoscopy Care for Patients Presenting with Esophageal Food Bolus Impaction: A Population-Based Multicenter Cohort Study.

Esophageal food bolus impactions (FBIs) are a common gastrointestinal emergency. Appropriate management includes not only index endoscopy for disimpaction, but also medical follow-up and treatment for the underlying esophageal pathology. We evaluated the appropriateness of post-endoscopy care for patients with FBIs, and assessed patient-, physician- and system-related factors that may contribute to loss to follow-up. We conducted a retrospective, population-based, multi-center cohort study of all adult patients undergoing endoscopy for FBI in the Calgary Health Zone, Canada from 2016-2018. Appropriate post-endoscopy care was defined by a composite of a clinical or endoscopic follow-up visit, appropriate investigations (e.g., manometry), or therapy (e.g., proton pump inhibitors, endoscopic dilation). Predictors of inappropriate care were assessed using multivariable logistic regression. A total of 519 patients underwent endoscopy for FBI: 25.2% (131/519) did not receive appropriate post-endoscopy care. Half of patients (55.3%, 287/519) underwent follow-up endoscopy or attended clinic, and amongst this group, 22.3% (64/287) had a change in their initial diagnosis after follow-up, including three new cases of esophageal cancer. Patients in whom a suspected underlying esophageal pathology was not identified at the index endoscopy were 7-fold (adjusted odds ratio 7.28 [95% CI: 4.49-11.78], p<0.001) more likely to receive inappropriate post-endoscopy follow-up and treatment, even after adjusting age, sex, rural residence, timing of endoscopy, weekend presentation, and endoscopic interventions. One quarter of patients presenting with an FBI do not receive appropriate post-endoscopy care. This is strongly associated with failure to identify a potential underlying pathology at index presentation.

Use of Mpox Multiplex Serology in the Identification of Cases and Outbreak Investigations in the Democratic Republic of the Congo (DRC).

Human Mpox cases are increasingly reported in Africa, with the highest burden in the Democratic Republic of Congo (DRC). While case reporting on a clinical basis can overestimate infection rates, laboratory confirmation by PCR can underestimate them, especially on suboptimal samples like blood, commonly used in DRC. Here we used a Luminex-based assay to evaluate whether antibody testing can be complementary to confirm cases and to identify human transmission chains during outbreak investigations. We used left-over blood samples from 463 patients, collected during 174 outbreaks between 2013 and 2022, with corresponding Mpox and VZV PCR results. In total, 157 (33.9%) samples were orthopox-PCR positive and classified as Mpox+; 124 (26.8%) had antibodies to at least one of the three Mpox peptides. The proportion of antibody positive samples was significantly higher in Mpox positive samples (36.9%) versus negative (21.6%) (p < 0.001). By combining PCR and serology, 66 additional patients were identified, leading to an Mpox infection rate of 48.2% (223/463) versus 33.9% when only PCR positivity is considered. Mpox infections were as such identified in 14 additional health zones and 23 additional outbreaks (111/174 (63.8%) versus 88/174 (50.6%)). Our findings highlight the urgent need of rapid on-site diagnostics to circumvent Mpox spread.

Mapping, profile and training of immunization stakeholders, Benin, 2020

The Benin Immunization and Logistic Directorate commissioned this study to provide evidence-based data to improve the performance of the Expanded Programme on Immunization. The objectives were to identify immunization stakeholders, describe their profile, their geographical distribution and determine their training needs. In December 2020, we conducted a census of Benin's immunization stakeholders via their administrative files and telephone interviews. The data were collected in each departmental directorate and health zone by focal points using an Excel® grid. The authorizations of the ethics and personal data protection committees were obtained. We identified 3, 893 immunization workers, 39 years old on average, 66% of whom were women, 53% were health care assistants, 77% were vaccinators, and 56% were government contract workers. About 96% of them worked in peripheral centers. Approximately 56% were untrained and 14% had been untrained for more than 5 years. More than half of the actors were not trained for their function. The proportion of actors needing training was estimated at 70%. The training needs were at least 72% in the departmental hospitals, zone hospitals and health centers. 98% of actors reported a need for training, including immunization (74%), vaccine management (69%), cold chain (61%), monitoring (61%), and maintenance (47%). The predominance of nurses' aides and women and the low proportion of trained personnel among immunization workers were also observed in other sub-Saharan African countries. Benin's Immunization and Logistics Directorate should mobilize sufficient resources to strengthen the technical capacities of the majority of immunization stakeholders.

Evaluation of the effect of the Momentum project on family planning outcomes among first-time mothers aged 15–24 years in Kinshasa, DRC

ObjectivesThis article presents the effect of Momentum, a nursing student-led community-based service delivery project, on postpartum family planning (FP) outcomes among first-time mothers in Kinshasa, Democratic Republic of the Congo. Study designWe employed a quasi-experimental design, with three intervention and three comparison health zones (HZ). Data were collected through interviewer-administered questionnaires in 2018 and 2020. The sample consisted of 1927 nulliparous women aged 15–24 years who were 6 months pregnant at baseline. Random effects and treatment effects models were used to assess the effect of Momentum on 14 postpartum FP outcomes. ResultsThe intervention group was associated with a unit increase of 0.6 (95% confidence interval [CI]: 0.4, 0.8)) in contraceptive knowledge and personal agency (95% CI: 0.3, 0.9), a unit decrease of 0.9 (95% CI: −1.2, −0.5) in the number of FP myths/misconceptions endorsed, and percentage point increases of 23.4 (95% CI: 0.2, 0.3) in FP discussion with a health worker, 13.0 (95% CI: 0.1, 0.2) in obtaining a contraceptive method within 6 weeks of delivery, and 13.3 (95% CI: 0.1, 0.2) in modern contraceptive use within 12 months of delivery. Intervention effects included percentage point increases of 5.4 (95% CI: 0.0, 0.1) in partner discussion and 15.4 (95% CI: 0.1, 0.2) in perceived community support for postpartum FP use. The level of exposure to Momentum was significantly associated with all behavioral outcomes. ConclusionsThe study demonstrated the effect of Momentum on increased postpartum FP-related knowledge, perceived norms, personal agency, partner discussion, and modern contraceptive use. ImplicationsCommunity-based service delivery by nursing students can potentially lead to improved postpartum FP outcomes among urban adolescent and young first-time mothers in other provinces of the Democratic Republic of the Congo and other African countries.

Assessment of cyanide intake through consumption of cassava‐based diets in the Democratic Republic of Congo

AbstractBackgroundKonzo is attributed to inadequate cassava processing and consumption of cassava meals with little protein, which is characterized by a neurological disorder that causes paralysis of the lower limbs. However, the exposure to cyanide in the Mwana health zone is still unknown while the prevalence of konzo is assumed to be high compared with other areas in the Democratic Republic of Congo (DRC).ResultsThe results showed that women are the most affected (56.7%), followed by young people under the age of 10 (27%), and people from low socioeconomic class at 93.4%. The prevalence of konzo in Burhinyi is 0.06%. Cyanide intake by the population of Burhinyi ranged from 26 to 271 mg/kg bw/day at the 95th percentile through consumption of cassava‐based ugali. Margin of exposure was around 0.271 and 0.393 g/person/day.ConclusionPoor people, women, and children are more at risk for konzo disease due to a diet dominated by under processed food made from cassava. However, since 2011, the study area's konzo prevalence has remained constant.

Cell wall response of field grown Populus to Septoria infection.

Due to its ability to spread quickly and result in tree mortality, Sphaerulina musiva (Septoria) is one of the most severe diseases impacting Populus. Previous studies have identified that Septoria infection induces differential expression of phenylpropanoid biosynthesis genes. However, more extensive characterization of changes to lignin in response to Septoria infection is lacking. To study the changes of lignin due to Septoria infection, four field grown, naturally variant Populus trichocarpa exhibiting visible signs of Septoria infection were sampled at health, infected, and reaction zone regions for cell wall characterization. Fourier transform infrared spectroscopy (FTIR), nuclear magnetic resonance (NMR), and acid hydrolysis were applied to identify changes to the cell wall, and especially lignin. FTIR and subsequent principal component analysis revealed that infected and reaction zone regions were similar and could be distinguished from the non-infected (healthy) region. NMR results indicated the general trend that infected region had a higher syringyl:guaiacyl ratio and lower p-hydroxybenzoate content than the healthy regions from the same genotype. Finally, Klason lignin content in the infected and/or reaction zone regions was shown to be higher than healthy region, which is consistent with previous observations of periderm development and metabolite profiling. These results provide insights on the response of Populus wood characteristics to Septoria infection, especially between healthy and infected region within the same genotype.

Exploring The Experiments of Mass Distributions of Bed Nets in The Community to Prevent Malaria in Kisantu Health Zone, Democratic Republic of Congo: A Qualitative Study

Despite its discovery more than a century, malaria remains a of public health problem. One of the pillars in the strategy to fighting it is the use of the mosquito net, which remains the only significant tool of prevention. This study is to evaluate the knowledge, perception and experiments of the mass campaign distribution of the mosquito nets in the community one year after the distribution. A qualitative study, centered on households, was carried out in the community of Kisantu Health Zone (KHZ) in the end of clinical trial in 2019. The semi-structured interviews with community leaders and individual focus groups with women having at least one child, were selected in six villages of the of KHZ. Among the respondents, the all had a good level of knowledge of mosquito nets, namely the proper definition of a mosquito net, the correct mode of installation in a sleeping space and that the occurrence of such holes in a mosquito net could be repaired but that was grounds for its inefficiency. The minority either cleaned the mosquito net with powdered laundry soap, and spread out to dry under the sun. The undesirable events related to the use of long-lasting insecticide-treated nets (LLINs) as well as occurrence of holes was quoted by a minority of the respondents as grounds of the weak use of LLINs in households. After one year of distribution, majority possession and the minority gave up use because of attrition or an adverse effect allotted to the use of LLINs.

A community-based contact isolation strategy to reduce the spread of Ebola virus disease: an analysis of the 2018–2020 outbreak in the Democratic Republic of the Congo

IntroductionDespite tremendous progress in the development of diagnostics, vaccines and therapeutics for Ebola virus disease (EVD), challenges remain in the implementation of holistic strategies to rapidly curtail outbreaks. We investigated...

HIV testing and knowledge on mother-to-child transmission among pregnant women attending antenatal care at Vanga Hospital, Democratic Republic of Congo.

Human immunodeficiency virus (HIV) causes an infectious disease that can be transmitted from an infected mother to her child. Prevention of Mother-to-Child Transmission (PMTCT) programs provide a range of services to women and children that can reduce the risk of vertical transmission of HIV. Unfortunately, PMTCT programs face many challenges in the rural Democratic Republic of Congo (DRC). A cross-sectional study was conducted among 460 pregnant women attending antenatal care at Vanga Hospital in the Vanga health zone, DRC from March 11th to June 25th, 2019. Serological tests were performed and a pre-tested questionnaire regarding HIV knowledge was given to all participants. Data were analyzed with STATA 13.0. Descriptive statistics of key variables were computed and logistic regression was used to assess the association between participant's characteristics and knowledge of MTCT. Among the participants, 95.4% (439/460) reported that they have heard about HIV, 82.4% (378/460) indicated sexual intercourse as one of the routes of HIV transmission but only 30.4% (139/460) mentioned MTCT as one of the routes. In addition, only 10.1% (46/460) had knowledge of the existence of PMTCT. Participants' age (>29 years), education level, previous antenatal care, and previous HIV tests were significantly associated with knowledge of MTCT. Also, age (>29 years) and education level were significantly associated with previous HIV test uptake. Most pregnant women 82.3% (376/460) reported that they have never been tested in the past for HIV infection and the prevalence was at 0.9% (4/460). Knowledge of MTCT of HIV, previous uptake of HIV testing, and prevalence was low. The rural setting of Vanga and insufficient HIV sensitization activities are considered contributors to this. While the low prevalence is a positive finding, much needs to be done to improve the uptake of HIV testing and knowledge of HIV MTCT.

Evaluación de una intervención comunitaria para incrementar la cobertura vacunal de la gripe en mujeres embarazadas

ObjectiveTo know the impact of the educational intervention carried out on the professionals of a basic health area and their community participation group, which make up the intervention group (IG), and to analyze its repercussion on the vaccination coverage achieved for influenza in the risk group (pregnant and puerperal women) comparing it with its neighboring basic zone, which makes up the control group (CG), during the 2019/20 vaccination season. DesignQuasi-experimental study of community intervention. SiteTwo basic health zones belonging to the Elche-Crevillente health department, Spain. ParticipantsPregnant and postpartum women from 2 basic health areas and the community participation group. Health professionals directly related to the flu vaccination campaign. InterventionsTraining session for the IG prior to the 2019/20 flu campaign. Main measurementsAttitudes towards influenza vaccination in health professionals through the validated CAPSVA questionnaire and the vaccination coverage of pregnant and postpartum women through the Nominal Vaccine Registry and their acceptance of the vaccine in the midwife's office. ResultsThe influenza vaccination coverage data recorded in Nominal Vaccine Registry for pregnant and puerperal women was 26.4% (n=207) in the IG and 19.7% (n=144) in the CG (p=0.001), with an incidence ratio of 1.34, thus achieving 34% more vaccination in the IG. Acceptance for vaccination in the midwife's office was also high, with 96.5% immunization in IG vs. 89.0% in CG, with a RR=1.09 (95% CI 1.01-1.62). ConclusionsJoint training strategies for professionals and community assets improve the results of vaccination coverage.

Community-based COVID-19 active case finding and rapid response in the Democratic Republic of the Congo: Improving case detection and response.

A community-based coronavirus disease (COVID-19) active case-finding strategy using an antigen-detecting rapid diagnostic test (Ag-RDT) was implemented in the Democratic Republic of Congo (DRC) to enhance COVID-19 case detection. With this pilot community-based active case finding and response program that was designed as a clinical, prospective testing performance, and implementation study, we aimed to identify insights to improve community diagnosis and rapid response to COVID-19. This pilot study was modeled on the DRC's National COVID-19 Response Plan and the COVID-19 Ag-RDT screening algorithm defined by the World Health Organization (WHO), with case findings implemented in 259 health areas, 39 health zones, and 9 provinces. In each health area, a 7-member interdisciplinary field team tested the close contacts (ring strategy) and applied preventive and control measures to each confirmed case. The COVID-19 testing capacity increased from 0.3 tests per 10,000 inhabitants per week in the first wave to 0.4, 1.6, and 2.2 in the second, third, and fourth waves, respectively. From January to November 2021, this capacity increase contributed to an average of 10.5% of COVID-19 tests in the DRC, with 7,110 positive Ag-RDT results for 40,226 suspected cases and close contacts who were tested (53.6% female, median age: 37 years [interquartile range: 26.0-50.0)]. Overall, 79.7% (n = 32,071) of the participants were symptomatic and 7.6% (n = 3,073) had comorbidities. The Ag-RDT sensitivity and specificity were 55.5% and 99.0%, respectively, based on reverse transcription polymerase chain reaction analysis, and there was substantial agreement between the tests (k = 0.63). Despite its limited sensitivity, the Ag-RDT has improved COVID-19 testing capacity, enabling earlier detection, isolation, and treatment of COVID-19 cases. Our findings support the community testing of suspected cases and asymptomatic close contacts of confirmed cases to reduce disease spread and virus transmission.

Epidemic Response amidst Insecurity: Addressing the Ebola Virus Epidemic in the Provinces of North Kivu and Ituri.

This paper examines the impact of insecurity on the management of the Ebola virus disease epidemic in the Democratic Republic of the Congo provinces of North Kivu and Ituri. In these provinces, insecurity has been one of the biggest obstacles in the response to the Ebola outbreak. When the epidemic began, these provinces were already insecure-creating unfavorable circumstances for implementing epidemic response activities. While the ninth epidemic in the Equateur province was brought under control in record time, the same was not true for the tenth epidemic in North Kivu and Ituri. Since the epidemic began, teams were organized to address all aspects of the response. These response teams conducted extensive fieldwork, including epidemiological surveillance, risk communication and community involvement, infection prevention and control, vaccination, dignified and safe burials, care at transit centers and Ebola treatment centers, and medical and psychosocial care for the recovered. They faced confrontational reactions from the communities, which jeopardized their security. The insecure state of the provinces led to the destruction and damage of infrastructure, including healthcare facilities, which affected the ability of rescue teams to access people needing care as well as the resources they needed to care for the ill. Worse yet, the insecurity took other forms, including threatening and kidnapping members of the response teams, lodging protests against the response activities in towns or health zones, committing violence against teams responsible for safe and dignified burials, instigating altercations between community members and members of the response team, and encouraging general resistance by the population. This level of insecurity interrupted or even halted response activities in some areas-sometimes for more than two weeks, decreasing the efficiency of the response teams, particularly in monitoring contacts due to the inability to access certain communities. Additionally, certain acts of protest, such as community members handling bodies as a demonstration of their opposition to safe and dignified burials, likely intensified disease spread. However, the involvement of community leaders, at least, made dialogue and negotiation possible between the response teams and community members, as such efforts led to communities contributing to the security of personnel involved in the fight against the Ebola epidemic in North Kivu and Ituri provinces.

Epidemic Response amidst Insecurity: Addressing the Ebola Virus Epidemic in the Provinces of North Kivu and Ituri

This paper examines the impact of insecurity on the management of the Ebola virus disease epidemic in the Democratic Republic of the Congo provinces of North Kivu and Ituri. In these provinces, insecurity has been one of the biggest obstacles in the response to the Ebola outbreak. When the epidemic began, these provinces were already insecure—creating unfavorable circumstances for implementing epidemic response activities. While the ninth epidemic in the Equateur province was brought under control in record time, the same was not true for the tenth epidemic in North Kivu and Ituri. Since the epidemic began, teams were organized to address all aspects of the response. These response teams conducted extensive fieldwork, including epidemiological surveillance, risk communication and community involvement, infection prevention and control, vaccination, dignified and safe burials, care at transit centers and Ebola treatment centers, and medical and psychosocial care for the recovered. They faced confrontational reactions from the communities, which jeopardized their security. The insecure state of the provinces led to the destruction and damage of infrastructure, including healthcare facilities, which affected the ability of rescue teams to access people needing care as well as the resources they needed to care for the ill. Worse yet, the insecurity took other forms, including threatening and kidnapping members of the response teams, lodging protests against the response activities in towns or health zones, committing violence against teams responsible for safe and dignified burials, instigating altercations between community members and members of the response team, and encouraging general resistance by the population. This level of insecurity interrupted or even halted response activities in some areas—sometimes for more than two weeks, decreasing the efficiency of the response teams, particularly in monitoring contacts due to the inability to access certain communities. Additionally, certain acts of protest, such as community members handling bodies as a demonstration of their opposition to safe and dignified burials, likely intensified disease spread. However, the involvement of community leaders, at least, made dialogue and negotiation possible between the response teams and community members, as such efforts led to communities contributing to the security of personnel involved in the fight against the Ebola epidemic in North Kivu and Ituri provinces.

Potential threats of cholera amidst COVID pandemic in the Democratic Republic of Congo; bridging the gaps: a review.

Cholera, being a global health issue has remarkably affected the wellness of the people, especially in the Democratic Republic of Congo (DRC). This has worsened during the COVID-19 pandemic, and it could be more if no concrete Intervention is done to curtail the outbreak. The authors reviewed past and present literatures on cholera and COVID-19 from the year 2013-2023 in well renowned scientific journals such as PUBMED, ResearchGate, Google Scholar. Database servers of these journals were accessed based on their permissions. From this search the authors found that, cholera is at its peak amidst COVID in DRC. Between the 10 March 2020 to the 10 March 2022, DRC reported a total of 86462 cases of COVID-19 in 314 health zones in all 26 provinces of the country, with 1335 deaths recorded. And since the beginning of 2022, 6692 suspected cholera cases including 107 deaths have been reported in 54 health zones in 11 provinces of DRC, compared with 3681 suspected cases and 91 deaths reported during the same period in 2021 in 67 health zones in 14 provinces in the country. The authors realized that despite all efforts to mitigate the spread of cholera in DRC by the Congolese government and the non-governmental organizations in the country, there are still some gaps required to be filled, such as; limited community mobilizations and awareness campaigns about the signs and symptoms of cholera and COVID-19, unavailability of free cholera and COVID-19 vaccines to all the Congolese populations as well as association of witchcraft to diseases. etc. Hence, to mitigate this menace, the authors urge the Congolese government to utilize research implementation strategies such as increase mass awareness campaigns on cholera and COVID among the Congolese populations as well as training workshops for the religious and traditional leaders as well as the healthcare providers in the country for a better diagnosis and treatment of these diseases.

Leadership Approach in a Complex Disease Outbreak Management: The Case of the Tenth Ebola Virus Disease Outbreak in the Democratic Republic of the Congo

Introduction:The world's second largest Ebola virus disease outbreak in DRC (August 2018-June 2020) caused 3,481 cases in 29 health zones, 2,299 deaths and about 250,000 contacts traced. It occurred in densely populated vast areas, with insecurity, ongoing humanitarian crisis and community reluctancy. Four hubs, sixteen sub-coordinations were set up with hundreds of experts to support local inexperienced health workers. Five health coordinators were deployed to lead more than 600 people at national and field level coordinations. This work aimed at reviewing coordinators’ leadership styles using leadership theories. Recommendations were made for future complex health operations.Method:The leadership styles of the five coordinators were reviewed retrospectively using different leadership theories. Three groups of theories: (1) Leader’s traits, characteristics, and skills; (2) Leader’s behaviors: behavioral, transformational, and situational; (3) Authentic and servant leadership.Results:Analysis with the three groups of leadership theory highlighted that leaders had mixed leadership approaches.1) Self-confident, calm, determined, extravert (one a bit shy), conscientious, motivators; Sociable and empathic while dealing with staffs affected by incidents; Few strong characters affecting interpersonal relations; Strong negotiation skills while dealing with local stakeholders; Experienced and knowledgeable in analyzing, making judgment and decisions.2) A participative approach when supporting nationals and partners; Using transformational leadership when coaching national counterparts and mobilizing partners, Directive when teams were to comply with rules or act quickly.3) Compassion; building trust, confidence and capacity; empowering and coaching.Conclusion:The complex disease outbreak imposed a mixed leadership style. Leaders had specific traits and technical skills. Servant leadership style was often used to trigger participation and build capacity in support of national and international experts. Directive approaches were used to trigger urgent actions. Findings could help in selecting and training leaders for public health emergencies. It may require further empirical and operational research in emergency contexts.

A modelling assessment of short- and medium-term risks of programme interruptions for gambiense human African trypanosomiasis in the DRC.

Gambiense human African trypanosomiasis (gHAT) is a deadly vector-borne, neglected tropical disease found in West and Central Africa targeted for elimination of transmission (EoT) by 2030. The recent pandemic has illustrated how it can be important to quantify the impact that unplanned disruption to programme activities may have in achieving EoT. We used a previously developed model of gHAT fitted to data from the Democratic Republic of the Congo, the country with the highest global case burden, to explore how interruptions to intervention activities, due to e.g. COVID-19, Ebola or political instability, could impact progress towards EoT and gHAT burden. We simulated transmission and reporting dynamics in 38 regions within Kwilu, Mai Ndombe and Kwango provinces under six interruption scenarios lasting for nine or twenty-one months. Included in the interruption scenarios are the cessation of active screening in all scenarios and a reduction in passive detection rates and a delay or suspension of vector control deployments in some scenarios. Our results indicate that, even under the most extreme 21-month interruption scenario, EoT is not predicted to be delayed by more than one additional year compared to the length of the interruption. If existing vector control deployments continue, we predict no delay in achieving EoT even when both active and passive screening activities are interrupted. If passive screening remains as functional as in 2019, we expect a marginal negative impact on transmission, however this depends on the strength of passive screening in each health zone. We predict a pronounced increase in additional gHAT disease burden (morbidity and mortality) in many health zones if both active and passive screening were interrupted compared to the interruption of active screening alone. The ability to continue existing vector control during medical activity interruption is also predicted to avert a moderate proportion of disease burden.

Profile of health care workers in a context of instability: a cross-sectional study of four rural health zones in eastern DR Congo (lessons learned)

BackgroundThe crisis in human resources for health is observed worldwide, particularly in sub-Saharan Africa. Many studies have demonstrated the importance of human resources for health as a major pillar for the proper functioning of the health system, especially in fragile and conflict-affected contexts such as DR Congo. However, the aspects relating to human resources profile in relation to the level of performance of the health districts in a particular context of conflicts and multiform crises have not yet been described.ObjectiveThis study aims to describe the profile of staff working in rural health districts in a context of crisis and conflicts.MethodsA cross-sectional study was carried out from May 15, 2017 to May 30, 2019 on 1090 health care workers (HCW) exhaustively chosen from four health districts in Eastern Democratic Republic of Congo (Idjwi, Katana, Mulungu and Walungu). Data were collected using a survey questionnaire. The Chi2 test was used for comparison of proportions and the Kruskal–Wallis test for medians. As measures of association, we calculated the odds ratios (OR) along with their 95% confidence interval. The α-error cut-off was set at 5%.ResultsIn all the health districts the number of medical doctors was very insufficient with an average of 0.35 medical doctors per 10,000 inhabitants. However, the number of nurses was sufficient, with an average of 3 nurses per 5000 inhabitants; the nursing / medical staff (47%) were less represented than the administrative staff (53%). The median (Min–Max) age of all HCW was 46 (20–84) years and 32% of them were female. This was the same for the registration of staff in the civil service (obtaining a registration number). The mechanism of remuneration and payment of benefits, although a national responsibility, also suffered more in unstable districts. Twenty-one percent of the HCW had a monthly income of 151USD and above in the stable district; 9.2% in the intermediate and 0.9% in the unstable districts. Ninety-six percent of HCW do not receive Government’ salary and 64% of them do not receive the Government bonus.ConclusionThe context of instability compromises the performance of the health system by depriving it of competent personnel. This is the consequence of the weakening of the mechanisms for implementing the practices and policies related to its management. DR Congo authorities should develop incentive mechanisms to motivate young and trained HCW to work in unstable and intermediate health districts by improving their living and working conditions.

Knowledge of Obstetric Danger Signs among Pregnant Women in the Eastern Democratic Republic of the Congo.

A lack of awareness regarding obstetric danger signs (ODS) is one of the factors that delay a pregnant woman's decision to seek emergency obstetric care. In developing countries, this delay can lead to high morbidity and mortality among pregnant women. In eastern Democratic Republic of Congo (DRC), very few studies have been conducted to assess the level of knowledge of pregnant women about ODS. Therefore, this study aimed to assess the knowledge of pregnant women about ODS in health facilities in eastern DRC. This quantitative cross-sectional, descriptive, and analytical study was conducted in 19 health facilities in the Kasongo health zone in the south Maniema Province of eastern DRC. A total of 624 pregnant women aged 12-49 years were interviewed in this study. Of these, 60.6% were secondary school graduates, >99% were married, 85.5% were cultivators, and 67.9% were Muslims. The knowledge of ODS among pregnant women was low (21.9%). The most cited danger signs during pregnancy, labor/delivery, and postpartum included severe abdominal pain and severe vaginal bleeding. Additionally, pregnant women aged 30-39 years (p = 0.015) and those who had given birth once (p = 0.049), twice (p = 0.003), 3-5 times (p = 0.004), and >5 times (p = 0.009) were more likely to be aware of ODS than others. Our findings indicated that pregnant women have little knowledge of ODS, which makes it difficult for them to take prompt decisions to seek emergency obstetric care. Thus, strategies to increase the knowledge of pregnant women about obstetrical danger signs by healthcare providers during prenatal consultations (antenatal care) must be developed to improve their rapid decision-making skills during pregnancy, labor, and postpartum.