South Kivu Province Research Articles

Clade I mpox virus genomic diversity in the Democratic Republic of the Congo, 2018–2024: Predominance of zoonotic transmission

Recent reports raise concerns on the changing epidemiology of mpox in the Democratic Republic of the Congo (DRC). High-quality genomes were generated for 337 patients from 14/26 provinces to document whether the increase in number of cases is due to zoonotic spillover events or viral evolution, with enrichment of APOBEC3 mutations linked to human adaptation. Our study highlights two patterns of transmission contributing to the source of human cases. All new sequences from the eastern South Kivu province (n= 17; 4.8%) corresponded to the recently described clade Ib, associated with sexual contact and sustainedhuman-to-human transmission. By contrast, all other genomes are clade Ia, which exhibits high genetic diversity with low numbers of APOBEC3 mutations compared with clade Ib, suggesting multiplezoonotic introductions. The presence of multiple clade I variants in urban areas highlights the need for coordinated international response efforts and more studies on the transmission and the reservoir of mpox.

Epidemiologic Quantities for Monkeypox Virus Clade I from Historical Data with Implications for Current Outbreaks, Democratic Republic of the Congo.

We used published data from outbreak investigations of monkeypox virus clade I in the Democratic Republic of the Congo to estimate the distributions of critical epidemiological parameters. We estimated a mean incubation period of 9.9 days (95% credible interval [CrI] 8.5-11.5 days) and a mean generation time of 17.2 days (95% CrI 14.1-20.9 days) or 11.3 days (95% CrI 9.4-14.0 days), depending on the considered dataset. Presymptomatic transmission was limited. Those estimates suggest generally slower transmission dynamics in clade I than in clade IIb. The time-varying reproduction number for clade I in the Democratic Republic of the Congo was estimated to be below the epidemic threshold in the first half of 2024. However, in the South Kivu Province, where the newly identified subclade Ib has been associated with sustained human-to-human transmission, we estimated an effective reproduction number above the epidemic threshold (95% CrI 0.96-1.27).

First imported Cases of MPXV Clade Ib in Goma, Democratic Republic of the Congo: Implications for Global Surveillance and Transmission Dynamics.

The ongoing national mpox outbreak in the Democratic Republic of the Congo has resulted in more >30,000 suspected cases in the country from January 2023 to August 2024. While these historic case totals have been driven by primarily by zoonosis, the emergence of Clade Ib monkeypox virus (MPXV), which is connected to more sustained human-to-human transmission, has been associated with increasing public health impacts in eastern DRC. First identified in South Kivu province, Clade Ib MPXV has been identified in multiple non-endemic East African countries for the first time. In DRC, there have been concerns over broader Clade Ib expansion in the country that could further complicate containment and mitigation responses. Here, we report the first introductions of Clade Ib into North Kivu province, including within internal displacement camps, with suspected close contact transmission that includes non-intimate contacts and children. These findings demonstrate that mpox case investigations and community messaging campaigns should include considerations for non-sexual contact-mediated transmission of Clade Ib that includes children <15 years.

Determinants of membership to agricultural cooperatives in eastern Democratic Republic of Congo: An exploratory study of the coffee sector in South Kivu province

Determinants of membership to agricultural cooperatives in eastern Democratic Republic of Congo: An exploratory study of the coffee sector in South Kivu province

Maternal mortality in Eastern Democratic Republic of Congo: a 10-year multi-zonal institutional death review

BackgroundMaternal mortality (MM) remains a real scourge that hits hardest in the poorest regions of the world, particularly those affected by conflict. However, despite this worrying reality, few studies have been conducted about MM ratio in the Democratic Republic of Congo (DRC). The study aimed to describe the trends as well as the epidemiological profile and causes of reported institutional maternal deaths between 2013 and 2022 in Eastern DRC.MethodsA retrospective descriptive study was conducted between March 2023 and August 2023 in eight Health Zones (HZ), five in South Kivu Province (Mwana, Minova, Miti-Murhesa, Kamituga and Idjwi) and three in North Kivu Province (Kirotshe, Karisimbi and Kayna) in the eastern region of the DRC. Our study covers 242 health facilities: 168 health centers (HC), 16 referral health centers (RHCs),50 referral hospitals (RH) and 8 general referral hospitals (GRHs). Data from registers and medical records of maternal deaths recorded in these zones from 2013–2022 were extracted along with information on the number of deliveries and live births. Sociodemographic, clinical parameters, blood and ultrasound tests and suspected causes of death between provinces were assessed.ResultsIn total, we obtained 177 files on deceased women. Of these, 143 (80.8%) were retained for the present study, including 75 in the 3 HZs of North Kivu and 68 in the 5 HZs of South Kivu. From 2013 to 2022, study sites experienced two significant drops in maternal mortality ratio (MMR) (in 2015 and 2018), and a spike in 2016–2017. Nonetheless, the combined MMR (across study sites) started and ended the 10-year study period at approximately the same level (53 and 57 deaths per 100,000 live births in 2013 and 2022 respectively). Overall, 62,6% of the deaths were reported from secondary hospital. Most deaths were of married women in their thirties (93.5%). Almost half (47.8%) had not completed four antenatal consultations. The main direct causes of death were, in decreasing order of frequency: post-partum haemorrhage (55.2%), uterine rupture (14.0), hypertensive disorders (8.4%), abortion (7.7%) puerperal infections (2.8%) and placental abruption (0.7%). When comparing among provinces, reported abortion-related maternal mortality (14.1% vs 0%) was more frequent in North Kivu than in South Kivu.ConclusionThis study imperatively highlights the need for targeted interventions to reduce maternal mortality. By emphasizing the crucial importance of antenatal consultations, intrapartum/immediate post-partum care and quality of care, significant progress can be made in guaranteeing maternal health and reducing many avoidable deaths.

Typology of smallholder maize farmers in South-Kivu, Eastern D.R. Congo: implications in improving farming practices and markets

Understanding the typology of smallholder maize farmers is crucial to elucidate the diversity in local farming systems, and therefore, devise effective interventions and policies that maximize the impact of agricultural innovations in South-Kivu province, eastern Democratic Republic of Congo (DRC). This study aimed at characterizing maize farmers in South-Kivu province and clustering them based on various socioeconomic and agronomic factors to identify specific production constraints and devise more effective interventions. A household survey among 300 South-Kivu maize farmers allowed to identify four distinct clusters based on farm size, land use, income, and agricultural technology adoption. The clusters ranged from resource-poor smallholder (Types 1 and 2) to medium-resource semi-innovative producers (Type 3) and highly equipped innovative farmers (Type 4). Key discriminative factors included total farm size, maize farm size, farming experience, access to agricultural credit, income, and innovation adoption rate. This study revealed specific constraints for each cluster, including low soil fertility, poor weed management, low market access, and labor scarcity. This study’s findings demonstrate the value of farm typology in guiding targeted interventions to address specific constraints and improve maize productivity, and suggest specific strategic directions for research and development projects in rural areas of the South-Kivu province.

High Rates of Miscarriage and Stillbirth among Pregnant Women with Clade I Mpox (Monkeypox) Are Confirmed during 2023-2024 DR Congo Outbreak in South Kivu Province.

Mpox (monkeypox) is a neglected tropical disease that has received increased attention since the multi-nation outbreak that began in 2022. The virus is endemic in West and Central Africa, where the Democratic Republic of the Congo (DRC) is the most affected country. Clade I monkeypox virus (MPXV) infection is endemic in the DRC and has an overall case fatality rate of 10.6% among children and adults. A study conducted in Sankuru Province, DRC, from 2007 to 2011 demonstrated that 75% of pregnant women with mpox had miscarriages or stillbirth. Further analysis of a stillborn fetus showed that MPXV could infect both the placenta and fetus, causing congenital infection. No additional cases of Clade I MPXV in pregnant women were reported until a new outbreak occurred in South Kivu Province during 2023 and 2024. Eight pregnant women having Clade I MPXV infection were identified, of whom four had either miscarriages or stillbirth, representing a 50% fetal mortality rate. These reports confirm previous data from the DRC that indicate the capability of Clade I MPXV to affect the fetus, causing congenital infection and fetal loss in a high percentage of cases. In this article, we review both past and new data from the DRC on the effects of Clade I MPXV during pregnancy and discuss the association of mpox with fetal loss.

An agricultural field, a dangerous place for women: survivors of sexual violence’s experience ineastern democratic republic of Congo

ABSTRACT This study investigates Congolese girls’ and women’s experience in the eastern Democratic Republic of Congo concerning the rape they face during field activities. A qualitative approach was employed to collect data from 40 single young women and married women aged 18–45 years old. Four focus group discussions and 28 individual interviews were conducted among women survivors of sexual violence from the South and North Kivu provinces. Findings indicate that the agricultural fields in remote areas represent a sexually hostile work environment where militias or attackers gang-rape women and girls. According to the participants, they occasionally avoid going to the fields due to pain, fear, and illness resulting from rape. It is believed that the enemy is using such brutal rape as a tactic to instil fear in the community and families in order to force them to starve. Greater efforts are needed from the government to ensure the protection of traumatized population, girls and women living in rural areas.

High prevalence of hepatitis B and HIV among women survivors of sexual violence in South Kivu province, eastern Democratic Republic of Congo.

Limited data are available on the prevalence rates of hepatitis B and acquired immunodeficiency syndrome (AIDS) among women survivors of sexual violence (WSSV) in South Kivu province, in the eastern part of the Democratic Republic of Congo (DRC), where armed conflicts persist. Here, we aimed to assess the prevalence of these two infections in this vulnerable local population. A total of 1002 WSSV, aged from 18 to 70 years old were enrolled from May 2018 to May 2020 at three healthcare facilities (Panzi, Mulamba and Bulenga hospitals), which are called "The One-Stop Centre Care Model" for the management of sexual violence in South Kivu. Blood samples were collected and tested for hepatitis B virus (HBV) and human immunodeficiency virus (HIV) antigens and antibodies using enzyme-linked immunoassay (ELISA) methods. Subsequently, viral load quantification for HBV and HIV were performed using the GeneXpert. Univariate and multivariate logistic regression models were used to assess factors associated with HIV-positive and HBV-positive status. For HBV, overall prevalence was 8.9% (95% CI; 7.2-10.8%), 32.1% (95% CI; 29.3-35.0%), and 14.5% (95% CI; 12.3-16.8%) for HBsAg, anti-HBc and anti-HBs antibodies, respectively. Among the 89 HBsAg-positive patients, 17 (19.1%) were HBeAg-positive. The median age of individuals with a positive HBsAg test was higher than those with a negative test (median: 40 years (IQR 30-52) compared to 36 years (IQR 24-48)). Risk factors for HBV infection were age (≥35 years) (AOR = 1.83 [1.02-3.32]; p = 0.041), having no schooling (AOR = 4.14 [1.35-12.62]; p = 0.012) or only primary school-level (AOR = 4.88 [1.61-14.75]; p = 0.005), and multiple aggressors (AOR = 1.76 [1.09-2.84], p = 0.019). The prevalence of HIV was 4.3% [95% CI: 3.1-5.7%]. HIV/HBV co-infection occurred only in 5 individuals (0.5%). The HBV viral load was detectable (> 1 log10 UI/mL) in 61.8% of HBsAg-positive subjects and 64.8% HIV-positive subjects had a high viral load (≥ 3 log10 copies/mL). This study revealed a high prevalence of HBV and HIV infections among WSSV in South Kivu. The results generated highlight the urgent need for systematic screening of HBV and HIV by integrating fourth-generation ELISA tests in HIV and HBV control programs.

Potential of Dried Edible Caterpillars (Lepidoptera: Saturniidae) Vending on Local Markets to Improve Mineral Suitability in the Diet of the Population in Democratic Republic of the Congo

Insects, a traditional food in many parts of the world, are highly nutritious and especially rich in proteins and thus represent a potential food and protein source. They are rich in essential amino acids and unsaturated fatty acids and provide ample quantities of minerals such as Fe, Zn, Mn, Ca, and P essential for human health. The objective of this study was to assess the nutritional value of dried edible caterpillars with an exclusive focus on mineral content. Quantitative analysis of seven essential minerals for humans was analyzed for two dried edible caterpillars currently commercialized in Bukavu town, South Kivu province (eastern DR Congo) central market including Bunaeopsis aurantiaca (Lepidoptera: Saturniidae) and Imbrasia oyemensis (Lepidoptera: Saturniidae). Mineral content analysis of Ca, Mg, Na, Fe, Zn, and Mn were carried out using the Atomic Absorption Spectrophotometer (AAS) while the P content was analyzed using the Colorimetric method, then the mineral content was compared to the recommended daily intakes (mg/day). On a dry weight basis, we find that mineral content differed with type of caterpillar. I. oyemensis had the highest concentrations of most minerals tested compared to B. aurantiaca, which nevertheless had the greatest amount of phosphorus (P). P was significantly the most abundant mineral detected (605.70 ± 6.08 mg/100g; p &lt; 0.001), followed by Mg and Na in I. oyemensis with 220.11 ± 6.10 mg/100g and 216.43 ± 1.08 mg/100g respectively. Oligo-minerals Zn and Fe, were the lowest in the caterpillar samples. All the edible caterpillars analyzed met the recommended daily mineral intake. The consumption of &lt; 28 g and &lt; 8 g of these caterpillars covers daily RNI in adults for Fe and Mn respectively. Thus, edible caterpillars in this study have shown that they can be excellent contributors to people's mineral requirements and should be sustainably utilized. Aside from direct consumption, there is a huge potential for using these caterpillars as raw material and food fortification. The mineral content of commonly eaten caterpillars was analyzed to inform consumers among indigenous populations in the Democratic Republic of Congo about the micro-nutritional quality of the insects.

Effect of a Water, Sanitation, and Hygiene Program on Handwashing with a Cleansing Agent among Diarrhea Patients and Attendants in Healthcare Facilities in the Democratic Republic of the Congo: A Randomized Pilot of the PICHA7 Program.

Healthcare-acquired infections are a major problem in healthcare facility settings around the world. The Democratic Republic of the Congo (DRC) has over 2 million diarrhea patients hospitalized each year. These healthcare settings become high-risk environments for spreading diarrheal illnesses such as cholera. The objective of the Preventative Intervention for Cholera for 7 Days (PICHA7) program is to develop evidence-based water, sanitation, and hygiene (WASH) interventions to reduce cholera and other severe diarrheal diseases in the DRC. The study objective was to evaluate the effectiveness of PICHA7 program delivery in increasing handwashing with a cleansing agent at stool/vomit- and food-related events in a healthcare facility setting among diarrhea patients and patient attendants. A pilot of the PICHA7 program was conducted among 284 participants in 27 healthcare facilities from March 2020 to November 2021 in urban Bukavu in the South Kivu Province of the DRC. The standard arm received the standard message provided in the DRC to diarrhea patients on the use of oral rehydration solution and a basic WASH message at healthcare facility discharge. The PICHA7 arm received the PICHA7 WASH pictorial module delivered by a health promoter focused on handwashing with a cleansing agent at the bedside of the diarrhea patient in the healthcare facility and provision of a soapy water bottle (water and detergent powder). Within 24 h of intervention delivery, a three-hour structured observation of handwashing practices at stool/vomit- and food-related events (key events) was conducted in healthcare facilities of diarrhea patients and their attendants. Compared to the standard arm, there was significantly more handwashing with a cleansing agent at key events in the PICHA7 arm (40% vs. 15%) (odds ratio: 5.04; (95% confidence interval (CI): 2.01, 12.7)). These findings demonstrate that delivery of the PICHA7 WASH pictorial module and provision of a soapy water bottle to diarrhea patients and their attendants presents a promising approach to increase handwashing with a cleansing agent among this high-risk population in healthcare facilities in the eastern DRC.

The Contribution of Subsistence Agriculture to the Livelihoods of the Smallholder Farmers in South Kivu Province, Democratic Republic of Congo

Subsistence agriculture in most cases is practiced on a limited space of land by farmers and it is dependent on human power that results into production of food consumed at household level, with little or no surplus for sale. A study about the contribution of subsistence agriculture to the livelihoods of the smallholder farmers in south Kivu province was carried out. A total of 303 smallholder farmers were randomly selected and interviewed to examine the effects of practicing subsistence agriculture on the socioeconomic status of the farmers. How the socioeconomic status attained by the farmers influenced their sustainable livelihoods was also assessed. Data were analyzed using means, frequency distribution, correlation, ANOVA and Chi square test. Thematic analysis was done on qualitative data. The farmers practiced shifting and primitive agriculture, intensive subsistence, and nomadic herding. There was a significant difference in the yields of crops grown (F = 0.0088; P = 0.05), while education and income status significantly affected the farmer’s socioeconomic status by practicing subsistence agriculture (P &lt; 0.05). An average mean value of 3.12 for the components of the farmers’ livelihoods were exhibited, with the human capital mean value being highest (4.16) compared to natural, social and financial capital. The socioeconomic status attained had a significant effect on sustainable livelihoods of the farmers at P &lt; 0.05. This implies that the smallholder farmers need to be trained by the agricultural extension workers better and sustainable methods of farming for higher crop yields. In addition, the Central Government though the Ministry of Agriculture, should avail improved seed inputs to the local community for better crop yields. All these will enable the smallholder farmers improve their socioeconomic status and at the same time attain higher sustainable livelihoods.

Complete Genome Sequencing, Annotation, and Mutational Profiling of the Novel Clade I Human Mpox Virus, Kamituga Strain.

Human Mpox (formerly monkeypox) infection is an emerging zoonotic disease caused by the Mpox virus (MPXV). We describe the complete genome annotation, phylogeny, and mutational profile of a novel, sustained Clade I Mpox outbreak in the city of Kamituga in Eastern Democratic Republic of the Congo (DRC). A cross-sectional, observational, cohort study was performed among patients of all ages admitted to the Kamituga Hospital with Mpox infection symptoms between late September 2023 and late January 2024. DNA was isolated from Mpox swabbed lesions and sequenced followed by phylogenetic analysis, genome annotation, and mutational profiling. We describe an ongoing Clade I Mpox outbreak in the city of Kamituga, South Kivu Province, Democratic Republic of Congo. Whole-genome sequencing of the viral RNA samples revealed, on average, 201.5 snps, 28 insertions, 81 deletions, 2 indels, 312.5 total variants, 158.3 amino acid changes, 81.66 intergenic variants, 72.16 synonymous mutations, 106 missense variants, 41.16 frameshift variants, and 3.33 inframe deletions across six samples. By assigning mutations at the proteome level for Kamituga MPXV sequences, we observed that seven proteins, namely, C9L (OPG047), I4L (OPG080), L6R (OPG105), A17L (OPG143), A25R (OPG151), A28L (OPG153), and B21R (OPG210) have emerged as hot spot mutations based on the consensuses inframe deletions, frameshift variants, synonymous variants, and amino acids substitutions. Based on the outcome of the annotation, we found a deletion of the D14L (OPG032) gene in all six samples. Following phylogenetic analysis and whole genome assembly, we determined that this cluster of Mpox infections is genetically distinct from previously reported Clade I outbreaks, and thus propose that the Kamituga Mpox outbreak represents a novel subgroup (subgroup VI) of Clade I MPXV. Here we report the complete viral genome for the ongoing Clade I Mpox Kamituga outbreak for the first time. This outbreak presents a distinct mutational profile from previously sequenced Clade I MPXV oubtreaks, suggesting that this cluster of infections is a novel subgroup (we term this subgroup VI). These findings underscore the need for ongoing vigilance and continued sequencing of novel Mpox threats in endemic regions.

The Contribution of Subsistence Agriculture to the Livelihoods of the Smallholder Farmers in South Kivu Province, Democratic Republic of Congo

Subsistence agriculture is practiced in most parts of the world on a limited space of land by farmers. It is mainly dependent on human power that results into production of food consumed at household level, with little or no surplus for sale. A study about the contribution of subsistence agriculture to the livelihoods of the smallholder farmers in south Kivu province was carried out. A total of 303 smallholder farmers were randomly selected and interviewed to examine the effects of practicing subsistence agriculture on the socioeconomic status of the farmers. How the socioeconomic status attained by the farmers influenced their sustainable livelihoods was also assessed. Data were analyzed using means, frequency distribution, correlation, ANOVA and Chi square test. Thematic analysis was done on qualitative data. The farmers practiced shifting and primitive agriculture, intensive subsistence, and nomadic herding. There was a significant difference in the yields of crops grown (F = 0.0088; P = 0.05), while education and income status significantly affected the farmer’s socioeconomic status by practicing subsistence agriculture (P &lt; 0.05). An average mean value of 3.12 for the components of the farmers’ livelihoods were exhibited, with the human capital mean value being highest (4.16) compared to natural, social and financial capital. The socioeconomic status attained had a significant effect on sustainable livelihoods of the farmers at P &lt; 0.05. This implies that the smallholder farmers need to be trained by the agricultural extension workers better and sustainable methods of farming for higher crop yields. In addition, the Central Government though the Ministry of Agriculture, should avail improved seed inputs to the local community for better crop yields. All these will enable the smallholder farmers improve their socioeconomic status and at the same time attain higher sustainable livelihoods.

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.

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.

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.