Kivu Province Research Articles

Prognostic value of chest computed tomography in adult inpatients with coronavirus disease 2019 pneumonia in Goma, in the Democratic Republic of the Congo

Objectives: Chest computed tomography (CT) plays a crucial role in evaluating patients with coronavirus disease 2019 (COVID-19) pneumonia. This study aimed to assess the association between initial chest CT findings and mortality in adult inpatients with COVID-19 in the city of Goma, North Kivu province, the Democratic Republic of the Congo. Materials and Methods: This was a multicenter retrospective study of patients hospitalized in Goma with COVID-19 pneumonia who underwent chest CT from January 1, 2021, to December 31, 2022. For each patient included, two experienced radiologists independently reviewed the initial chest CT. A multivariate logistic regression was performed to identify chest CT findings associated with mortality at the 5% significance level. Results: Of 76 patients included in the study, 26 (34.2%) died. The degree of lung parenchymal involvement >25% (adjusted odds ratio [aOR] = 16.27 [3.30–80.16]) and the presence of consolidations (aOR = 3.33 [1.00–11.47]) were predictive of mortality with an area under the receiver operating characteristic curve of 0.8392. Sensitivity was 73.08%, specificity was 82%, positive predictive value was 67.86%, and negative predictive value was 85.42%. Conclusion: Lung involvement >25% and consolidations on chest CT appear to predict death in adult inpatients with COVID-19 pneumonia.

Detection of Artemisinin Resistance Marker Kelch-13 469Y in Plasmodium falciparum, South Kivu, Democratic Republic of the Congo, 2022.

Partial artemisinin resistance has emerged in East Africa, posing a threat to malaria control across the continent. The Democratic Republic of the Congo carries one of the heaviest malaria burdens globally, and the South Kivu province directly borders current artemisinin resistance hot spots, but indications of such resistance have not been observed so far. We assessed molecular markers of antimalarial drug resistance in 256 Plasmodium falciparum isolates collected in 2022 in South Kivu, Democratic Republic of the Congo. One isolate carried the P. falciparum Kelch-13 469Y variant, a marker associated with partial artemisinin resistance and decreased lumefantrine susceptibility in Uganda. In addition, the multidrug resistance-1 mutation pattern suggested increased lumefantrine tolerance.

Attitudes and perceptions of rural youth towards agribusiness as a profession in a post-conflict context. Evidence from South-Kivu in the Democratic Republic of Congo

The global demographic dynamics with increasing numbers of young people will have varying socio-economic effects on low-income countries. The extreme poverty of young people, particularly in rural areas, is still much higher compared to the global average. Creating more and better jobs for young people is therefore an urgent priority of the century. Despite the recognized driving role of the agribusiness in economic growth, job creation and poverty reduction, there is evidence of a disengagement/disinterest of young people towards agribusiness. This study aimed to analyze the attitudes and perceptions of rural youth towards agribusiness as a profession career in South Kivu province. To deeply understand the complexity and cross-cutting nature of this issue, a systemic approach was used. A Likert-type questionnaire with a 5-points scale was used to conduct the survey among 456 rural youth aged 15 to 35 randomly selected using the Bernoulli Urn technique in Kabare, Walungu and Uvira territories. The study revealed that 53.5% of young people have a negative attitude towards agribusiness, 29.8% display a neutral attitude and only 16.7% of them show a positive attitude. 76.3% confirmed that they can only engage in agriculture when they have no other job. 77.6% declared that agribusiness cannot enable them to meet all their basic needs. After verifying the normality of the data, the Mann-Whitney and Kruskal-Wallis tests, were used to compare the perception scores of the different groups analyzed. The study revealed a statistically significant difference in personal and societal perceptions scores between different age groups, between men and women, as well as between different education level groups. A statistically significant difference in the economic perceptions scores was observed only between the different survey areas.

Vulnerability and adaptation of maize smallholder farmers to climate change: a Sub-Saharan African context

This study analyzed smallholder maize farmers' perceptions of climate change vulnerability and adaptation strategies in the eastern Democratic Republic of the Congo. The study used a cross-sectional quantitative approach, with smallholder farmers selected based on farm size (less than 10 hectares). Using simple random sampling techniques, 210 smallholder farmers in South Kivu Province was selected from October and November 2021. The data were analyzed using frequency analysis, non-parametric Mann–Whitney U-tests, Tobit regression model and structural equations modeling, which demonstrated that demographic and socioeconomic factors influenced smallholder farmers' perceptions and adaptation strategies to climate change. The findings revealed that the level of education, size of the field, and activities of smallholder farmers had significant effects on climate change perception and adaptation strategies. Smallholder farmers' perceptions had a negative (p < 1%) influence on maize smallholder farmers' adaptation to climate change. Common efforts should be made to encourage smallholder farmers to feel committed enough to implement climate change adaptation measures that are effective in mitigating or preventing climate change risk. The results of this study would have implications for policies to support maize smallholder farmers in their efforts to mitigate and resilient to climate change in sub-Saharan Africa. Firstly, the promotion of climate literacy must be sufficient to provide farmers with information on climate and forecasting. Secondly, to empower smallholder farmers with means and resources to prevent and reduce the effects of climate change. Lastly, enhancing the current environment for the agriculture sector will advance community inclusivity and food security.

Essential surgery delivery in the Northern Kivu Province of the Democratic Republic of the Congo

IntroductionSurgical services are an essential part of a functional healthcare system, but the Lancet Commission of Global Surgery (LCoGS) indicators of surgical capacity such as perioperative workforce and surgical volume are unknown in many low- and middle-income countries (LMICs) including the Democratic Republic of Congo (DRC). We aimed to determine the surgical capacity and its associated factors within the DRC.MethodsHospitals were assessed in the North Kivu province of the DRC. Hospital characteristics and surgical rates were determined using the WHO-PGSSC hospital assessment tool and operating room (OR) registries. The primary outcome of interest was the number of Bellwether operations (i.e. Caesarean sections, laparotomies, and external fixation for bone fractures) per 100,000 people. Univariate and multiple linear regressions were performed. Primary predictors were the number of trained surgeons, anaesthesiologists, and obstetricians (SAOs) and the number of perioperative providers (including clinical officers and nurse anaesthetists) per 100,000 people.ResultsTwenty-eight hospitals in North Kivu were assessed over one year in 2021; 24 (86%) were first-level referral health centres while 4 (14%) were second-level referral hospitals. In total, 11,176 Bellwether procedures were performed in the region in one year. Rates per 100,000 people were 1,461 Bellwether surgical interventions, 1.05 SAOs, and 13.1 perioperative providers. In univariate linear regression analysis, each additional SAO added 239 additional cases annually (p = 0.023), while each additional perioperative provider added 110 cases annually (p < 0.001). In our multiple regression analysis adjusting for other hospital services, the association between workforce and Bellwether surgeries was no longer significant.ConclusionsThe surgical workforce in DRC did not meet the LCoGS benchmark of 20 SAOs per 100,000 people but was not an independent predictor of surgical capacity. Major investment is needed to simultaneously bolster healthcare facilities and increase surgical workforce training.

Exploring different health care providers´ perceptions on the management of diarrhoea in cholera hotspots in the Democratic Republic of Congo: A qualitative content analysis.

Global cholera guidelines support wider healthcare system strengthening interventions, alongside vertical outbreak responses, to end cholera. Well-trained healthcare providers are essential for a resilient health system and can create synergies with childhood diarrhoea, which has higher mortality. We explored how the main provider groups for diarrhoea in cholera hotspots interact, decide on treatment, and reflect on possible limiting factors and opportunities to improve prevention and treatment. We conducted focus group discussions in September 2022 with different healthcare provider types in two urban and two rural cholera hotspots in the North Kivu and Tanganyika provinces in the Eastern Democratic Republic of Congo. Content analysis was used with the same coding applied to all providers. In total 15 focus group discussions with medical doctors (n = 3), nurses (n = 4), drug shop vendors (n = 4), and traditional health practitioners (n = 4) were performed. Four categories were derived from the analysis. (i) Provider dynamics: scepticism between all cadres was prominent, whilst also acknowledging the important role all provider groups have in current case management. (ii) Choice of treatment: affordability and strong caregiver demands shaped by cultural beliefs strongly affected choice. (iii) Financial consideration on access: empathy was strong, with providers finding innovative ways to create access to treatment. Concurrently, financial incentives were important, and providers asked for this to be considered when subsiding treatment. (iv) How to improve: the current cholera outbreak response approach was appreciated however there was a strong wish for broader long-term interventions targeting root causes, particularly community access to potable water. Drug shops and traditional health practitioners should be considered for inclusion in health policies for cholera and other diarrhoeal diseases. Financial incentives for the provider to improve access to low-cost treatment and investment in access to potable water should furthermore be considered.

Ongoing mpox outbreak in Kamituga, South Kivu province, associated with monkeypox virus of a novel Clade I sub-lineage, Democratic Republic of the Congo, 2024.

Since the beginning of 2023, the number of people with suspected monkeypox virus (MPXV) infection have sharply increased in the Democratic Republic of the Congo (DRC). We report near-to-complete MPXV genome sequences derived from six cases from the South Kivu province. Phylogenetic analyses reveal that the MPXV affecting the cases belongs to a novel Clade I sub-lineage. The outbreak strain genome lacks the target sequence of the probe and primers of a commonly used Clade I-specific real-time PCR.

Facility capacity and provider knowledge for cholera surveillance and diarrhoea case management in cholera hotspots in the Democratic Republic of Congo – a mixed-methods study

ABSTRACT Background Wider healthcare-strengthening interventions are recommended in cholera hotspots and could benefit other types of diarrhoeal diseases which contribute to greater mortality than cholera. Objective Describe facility capacity and provider knowledge for case management of diarrhoea and cholera surveillance in cholera hotspots in the Democratic Republic of Congo (DRC) among health facilities, drug shops, and traditional health practitioners. Methods We conducted a sequential exploratory mixed-method study, using focus group discussions, facility audits, and provider knowledge questionnaires during September and October 2022 in North Kivu and Tanganyika provinces, Eastern DRC. Content analysis was used for qualitative data. Quantitative data were summarised by facility level and healthcare provider type. Audit and knowledge scores (range 0–100) were generated. Multivariable linear regression estimated association between scores and explanatory factors. Qualitative and quantitative data were triangulated during interpretation. Results Overall, 244 facilities and 308 providers were included. The mean audit score for health facilities was 51/100 (SD: 17). Private facilities had an −11.6 (95% CI, −16.7 to −6.6) lower adjusted mean score compared to public. Mean knowledge score was 59/100 (95% CI, 57 to 60) for health facility personnel, 46/100 (95% CI, 43 to 48) for drug shop vendors and 37/100 (95% CI, 34 to 39) for traditional health practitioners. Providers had particularly low knowledge concerning when to check for low blood sugar, use of nasogastric tubes, and dosing schedules. Knowledge about case definitions for cholera was similar between groups (range 41–58%) except for traditional health practitioners for the definition during an outbreak 15/73 (21%). Conclusions Increasing awareness of cholera case definitions in this context could help improve cholera surveillance and control. Increased support and supervision, especially for private providers, could help ensure facilities are equipped to provide safe care. More nuanced aspects of case management should be emphasised in provider training.

Rule of Law and Sustainable Peace in North Kivu Province, in Democratic Republic of Congo (DRC)

Rule of Law and Sustainable Peace in North Kivu Province, in Democratic Republic of Congo (DRC)

Effect of early vitamin D supplementation on the incidence of preeclampsia in primigravid women: a randomised clinical trial in Eastern Democratic Republic of the Congo

BackgroundPrevious studies have reported the association between maternal vitamin D deficiency and preeclampsia. However, the efficacy of vitamin D supplementation in reducing the occurrence of preeclampsia remains unclear. The objective of this study was to evaluate the effect of cholecalciferol supplementation on the incidence of preeclampsia in primigravid women and its related maternal and foetal outcomes.MethodsA single-blinded clinical trial was conducted in fourteen antenatal care health facilities in the North (Goma, Mwesso, Nyiragongo) and South Kivu (Bukavu-Panzi) provinces of the Democratic Republic of Congo from March 1, 2020, to June 30, 2021. A total of 1300 primigravid women not exceeding 16 weeks of gestation were randomised with a 1:1 ratio to either the supplemented (A) or control (B) group. Each pregnant woman (A) presenting for antenatal care received a single monthly dose of cholecalciferol (60,000 IU) orally for 6 months. The control group received no vitamin D supplementation or placebo. Serum 25(OH)D was measured at recruitment and at 34 weeks of gestation. Outcomes were assessed monthly until delivery.ResultsThe median maternal age was 21 years (14–40), while the median gestational age was 15 weeks (5.4–29.0). A significant reduction in the risk of preeclampsia [RR = 0.36 (0.19–0.69); p = 0.001] and preterm delivery [RR = 0.5 (0.32–0.78); p = 0.002] was observed in the intervention group. An RR of 0.43 [(0.27–0.67); p < 0.001] was found for low birth weight. The RR for caesarean section was 0.63 [(0.52–0.75); p < 0.001]. The APGAR score at the 5th minute (p = 0.021) and the size of the newborn were significantly higher in the supplemented group (p = 0.005).ConclusionA single monthly dose (60,000 IU) of vitamin D supplementation, started in earlypregnancy, significantly reduced the incidence of preeclampsia and its maternal and foetal complications.Trial registrationISRCTN Register with ISRCTN46539495 on 17 November 2020.

Factors associated with COVID-19 vaccine uptake and hesitancy among healthcare workers in the Democratic Republic of the Congo.

Vaccination is a critical intervention to reduce morbidity and mortality and limit strain on health systems caused by COVID-19. The slow pace of COVID-19 vaccination uptake observed in some settings raises concerns about COVID-19 vaccine hesitancy. The Democratic Republic of the Congo experienced logistical challenges and low uptake at the start of vaccine distribution, leading to one of the lowest overall COVID-19 vaccine coverage rates in the world in 2021. This study assessed the magnitude and associated factors of COVID-19 vaccine uptake among healthcare workers (HCWs) in seven provinces in DRC. We implemented a cross-sectional Knowledge, Attitudes, and Practices (KAP) questionnaire targeting HCWs, administered by trained data collectors in Haut-Katanga, Kasaï Orientale, Kinshasa, Kongo Centrale, Lualaba, North Kivu, and South Kivu provinces. Data were summarized and statistical tests were performed to assess factors associated with vaccine uptake. HCWs across the seven provinces completed the questionnaire (N = 5,102), of whom 46.3% had received at least one dose of COVID-19 vaccine. Older age, being married, being a medical doctor, being a rural resident, and having access to or having previously worked in a COVID-19 vaccination site were all strongly associated with vaccination uptake. Vaccinated individuals most frequently cited protection of themselves, their families, and their communities as motivations for being vaccinated, whereas unvaccinated individuals were most concerned about safety, effectiveness, and risk of severe side effects. The findings suggest an opinion divide between vaccine-willing and vaccine-hesitant HCWs. A multidimensional approach may be needed to increase the acceptability of the COVID-19 vaccine for HCWs. Future vaccine campaign messaging could center around the positive impact of vaccination on protecting friends, family, and the community, and also emphasize the safety and very low risk of adverse effects. These types of messages may further be useful when planning future immunization campaigns with new vaccines.

Predictors of mortality among inpatients in COVID-19 treatment centers in the city of Butembo, North Kivu, Democratic Republic of Congo.

Determining the risk factors for severe disease and death among hospitalized Covid-19 patients is critical to optimize health outcomes and health services efficiency, especially in resource-constrained and humanitarian settings. This study aimed to identify the predictors of mortality of Covid-19 patients in North Kivu province in the Democratic Republic of Congo.A retrospective cohort study was conducted in 6 Covid-19 treatment centers in the city of Butembo from 1 January to 31 December 2021. The time to event (death), the outcome variable, was visualized by Kaplan-Meier curves and the log-rank test was used to confirm differences in trends. Cox regression was used for all the predictors in the bivariate analysis and multivariate analysis was done using predictors found statistically significant in the bivariate analysis. The following variables were considered for inclusion to the Cox regression model: Age, Sex, Disease length, Treatment site, History of at least one co-morbidity, Body mass index, Stage according to SpO2 and the NEWS-modified score.Among the 303 participants (mean age of 53 years), the fatality rate was 33.8 deaths per 1000 patient-days. Four predictors were independently associated with inpatient death: age category (≥ 60 years) (adjusted HR: 9.90; 95% CI: 2.68-36.27), presence of at least one comorbidity (adjusted HR: 11.39; 95% CI: 3.19-40.71); duration of illness of > 5 days before hospitalization (adjusted HR:1.70, 95% CI: 1.04-2.79) and peripheral capillary oxygen saturation (SpO2) < 90% (adjusted HR = 14.02, 95% CI: 2.23-88.32). In addition to advanced age, comorbidity, and length of disease before hospitalization, ambient air SpO2 measured by healthcare providers using low-tech, affordable and relatively accessible pulse oximetry could inform the care pathways of Covid-19 inpatients in resource-challenged health systems in humanitarian settings.

Challenging Gender Equality: An Examination of Gender Egalitarianism in the South Kivu Province, Democratic Republic of Congo

Challenging Gender Equality: An Examination of Gender Egalitarianism in the South Kivu Province, Democratic Republic of Congo

Adapting the informed push model to the last mile of the contraceptive supply chain in South Kivu in the Democratic Republic of Congo.

In the Democratic Republic of Congo (DRC), contraceptive security is one of the largest barriers to improving access to family planning. This article presents findings from a pilot study that adapted an informed push distribution model to the last mile of the contraceptive supply chain, between the health zone pharmacy and health facilities, in the eastern region of DRC. The intervention consisted of three changes in the supply chain: organization of more efficient transportation routes, in-depth involvement of the community in supply chain management and bundling of contraceptives with other essential medications for efficient delivery. The intervention was implemented from October 2017 to October 2018 in the Katana health zone of the South Kivu province. Although there was not a statistically significant difference in availability of contraceptives during the pilot study period, there were sharp declines in the mean length of stockouts at health facilities and the monthly transportation costs of delivering contraceptives. Overall, the pilot study demonstrated it is feasible to adapt the IPM to a new location with complex geographical, political and socioeconomical influences. Future studies will be required to evaluate whether the adapted informed push model is more effective than the existing pull supply chain system for contraceptives in the DRC.

The Suitability of the Mandate Used by the United Nations Humanitarian Military Intervention in North Kivu Province, Eastern Democratic Republic of Congo, 2004-2022

North Kivu is one of the provinces in Eastern Democratic Republic of the Congo (DRC) where conflict seems to defy the multiple interventions by a number of national, regional and international organizations. It hosts several United Nations Humanitarian Military Intervention (UNHMI) bases and has shown a humanitarian crisis resulting from the conflict in Eastern DRC including hostilities by the armed groups. This study interrogated the suitability of the mandate used by the UNHMI through the United Nations Organization Stabilization Mission in the Democratic Republic of the Congo (MONUSCO) between 2004 and 2022. This study was informed by two complementary theories namely; Realism and New Institutionalism. Realism argued that that humanitarian military intervention by the UN in Eastern DRC was motivated by the need to promote the geopolitical interests of powerful states. New Institutionalism on the other hand contended that North Kivu province was characterized by weak institutions and there was lack of trust between the different actors. This study took the form of an exploratory research design employing the use of both primary and secondary sources. Purposive and snow ball sampling techniques were used to select 99 respondents who included 19 representatives from international humanitarian organizations in North Kivu, 20 representatives from the civil society, 10 government officials, 15 experts in conflict management, 15 security specialists, and 20 Congolese nationals. Questionnaires and interview schedules were the main research instruments. The study concluded that in as much as the UNHMI was suitable in the context of conflict management, the operation faced a number of setbacks. The study recommended that the government of DRC, taking advantage of the suitability of the Mandate of UNHMI, should cooperate with and provide more support to MONUSCO in addressing the conflict.

Seroprevalence of anti-SARS-CoV-2 antibodies and risk of viral exposure among healthcare workers in the South Kivu province, eastern Democratic Republic of the Congo: a cross-sectional study

ObjectivesHealthcare workers (HCWs) are on the frontline of combating COVID-19, hence are at elevated risk of contracting an infection with SARS-CoV-2. The present study aims to measure the impact of...

Informal Sector Workers&amp;#8217; Perceptions of Health Insurance Coverage in South Kivu Province, Democratic Republic of Congo

Informal Sector Workers&amp;#8217; Perceptions of Health Insurance Coverage in South Kivu Province, Democratic Republic of Congo

Cervical precancerous and cancerous lesions screening using Pap smear test at Provincial Referral Hospital of Bukavu, Eastern DR Congo: profile and recommendations to stakeholders.

cervical cancer is a health concern worldwide. The South Kivu Province in the Eastern DR Congo is facing many cases of this disease but poorly screened and reported. The objective of this was to determine the prevalence of cell abnormalities at cervical cytology in a tertiary teaching hospital in Bukavu and their association with common risk factors of cervical cancer. a cross-sectional study was conducted on 142 women attending the Provincial Referral Hospital of Bukavu (HPGRB) from February to December 2021. Quantitative variables were described by their median following their asymmetric distributions and the qualitative variables in absolute and relative frequencies. Then the Chi-square test was used for the comparison of proportion. forty-five percent of the participants had between three and five children. Twenty-two (15.5%) of the 142 patients reported to have two or more sexual partners and 17.5% reported the use of hormonal contraception. The prevalence of cell abnormalities at cervical cytology was 17% of which Low- Grade Squamous Intraepithelial Lesion (LSIL) was the most representative (12.9%). There was no statistically significant association between the common cervical risk factors and the occurrence of cell abnormalities. cervical pre-cancerous lesions are frequent in South Kivu province. The Pap smear test remains an early and affordable screening method and constitutes a secondary prevention strategy in women of 18 years and older in a low-income country such as DR Congo where vaccination against HPV is still hypothetic.

A new species of the genus Paranataretus El-Sonbati, 2023 (Hemiptera: Cicadellidae: Deltocephalinae) from the continental Africa.

A new species of the leafhopper genus Paranataretus El-Sonbati, 2023, P. albertinus sp. n., is described from North Kivu Province of the Democratic Republic of Congo which is first record of the genus from Africa. New records from Madagascar is given for Paranataretus brevis (Gnezdilov, 2020). Relationships of the species within the genus Paranataretus are discussed.

Adaptation to land scarcity among small-scale farming households in South Kivu in the Democratic Republic of the Congo

Rural farming households in Sub-Saharan Africa, facing limited land access, engage in land purchase, rental, and other land access practices. However, the highly unregulated land markets expose these farmers to wide-ranging vulnerabilities. In this study, we investigated the land access mechanisms and the related constraints among the small-scale farmers in the densely populated Eastern part of The Democratic Republic of the Congo (DRC). We randomly selected 240 consenting farmers for inclusion in the study and collected data using semi-structured interviews to obtain data on land access characteristics. Then, the data was subjected to descriptive statistics to obtain measures of central tendency and dispersion on the responses and correlation statistics to understand the patterns and relations of factors affecting the land access and strategies used to cope with the limited land situation in the South Kivu province of DRC. Our results showed an insecure land tenure system among smallholder farmers. Most of the farmers in the study purchased and leased land to cope with poor land access and, in so doing, faced high price-related limitations that were unsustainable to these farmers; they also faced highly restrictive leasehold contracts. Given the limited access to financial resources and support, improving regulations of land markets and resource support interventions could promote land access among these smallholder farmers. We conclude that the challenges of land access and the current methods farmers use to obtain additional land among the smallholder farming households in the south Kivu province of DRC are precarious and unsustainable and continue to pose a food insecurity and poverty risk among these farmers. We recommend developing and implementing measures to support resource access by these farmers, such as finance, farmer-focused cooperative societies, and better land policy reforms and tenure systems to improve access to land among these farmers and farmers facing similar scenarios in other parts of sub-Saharan Africa.