South Kivu Province Research Articles

Fatty Acid Composition of Lebrunia bushiae Staner and Tephrosia vogelii Hook.f. Seed Oils

Aim: The nutritive and medicinal values of vegetable oils rely on the nature of their fatty acids (FAs). This study aimed to determine the nature and content of FAs in Lebrunia bushiae Staner and Tephrosia vogelii seed oils which are used by the local population of South Kivu province in DRC mainly for medical purposes. Materials and Methods: The seeds were harvested from Bunyakiri, zone close to the National Parc Kahuzi-Biega, in South-Kivu province/DRC. The oils were manually expressed, and the FAs composition characterized by gas chromatography (GCMS). Results: Ten major FAs were detected in Lebrunia bushiae seed oil comprising of 4 saturated and 6 unsaturated of which oleic acid (18:0;43.0%), linoleic acid (18:1;11.74%) and erucic acid (22.1;14.07%) predominate. In the Tephrosia vogelii oil, 5 saturated and 5 unsaturated FAs were detected comprising in majority of linoleic acid (40.34%), oleic acid (19.97%), alpha linolenic acid (7.62%), palmitic acid (13.98%) and stearic acid (5.78%).

Knowledge, Attitudes and Practices of Medical and Paramedical Staff in Blood Transfusion in the Democratic Republic of Congo

Objective: To assess the knowledge, attitudes and practices of providers in blood transfusion, HIV infections and hepatitis B and C in the province of South Kivu (eastern DRC). Methods: This study is comparative cross-sectional. It covered all the staff care. Our sample was composed by doctors, nurses, midwives, and agents’ rapid training in activity in health sector in South Kivu between 1 December 2011 and 30 December 2011. Those medical and paramedical staffs came from 12 general reference hospitals, 11 hospitals and 65 health centers in the province of South Kivu. Three hundred and ninety three people were interviewed including 6.5% of physicians, 87.4% of nurses and 5.1% of midwives. Among them, 25.5% had received training in blood transfusion. Results: Overall, 11.7% of providers responded correctly to questions on knowledge and attitude on blood safety. The proportion of correct answers on the knowledge and attitude on exposure accidents was 53.8%. The frequency of caregivers who responded well to the basics of HIV and hepatitis B and C was 15.5%. Notions about the type of donor blood and the risk of blood transfusion received an overall rating of 17.8% and the proportion of correct answers on the knowledge and practice base of blood transfusion was 16.7%. During the six months following the survey, 54.4% of providers have experienced accidental exposure to blood. Conclusion: The lack of knowledge of the medical staff in transfusion is obvious. We must therefore have the possibility of organizing regular training and follow-up activities.

Intensive TB Case Finding in Unsafe Settings: Testing an Outreach Peer Education Intervention for Increased TB Case Detection among Displaced Populations and Host Communities in South-Kivu Province, Democratic Republic of Congo

Introduction: The Democratic Republic of Congo (DRC) is one of the high-burden TB countries in the world. The most affected provinces were North and South Kivu where displacements of the population favor transmission of infections. Delays in diagnosis are often causes for excessive mortality among TB patients. Aim of the Study: The study aimed to test an intervention designed to increase detection of TB cases in internally displaced persons and their host communities in South Kivu province. Methods: The project used a quasi-experimental method, with prospective data collection every six months. Two peri-urban districts were selected and designated as intervention and control districts respectively. Twenty peer educators were selected among prospective TB suspects who sought care in health facilities. The peer educators were trained and encouraged to actively influence, identify and refer potential TB suspects to health centers. The data on new TB suspects seen and cases diagnosed in both districts were collected and compared over two and a half years period. Results: This pilot study has demonstrated that the intervention has had some positive effects on both the number of persons suspected with TB who were diagnosed using either microscopy or clinical assessment. Even in terms of case detection, the study demonstrated that the number of cases detected in the intervention district was at least twice the number of cases detected in the control district. Conclusion: Nonprofessional educators can influence TB case detection even in unstable settings, but their effectiveness is dependent on the security situation. National TB control programs need to adapt community mobilization strategies to local developments even in unsafe settings.

Prevalence and Correlates of Experience of Physical and Sexual Intimate Partner Violence among Men and Women in Eastern DRC

This manuscript uses large-scale survey data to examine the prevalence and correlates of intimate partner violence (IPV) in the eastern part of the Democratic Republic of the Congo (DRC), namely in North Kivu and South Kivu provinces. We examine two form of IPV: physical and sexual. The data show that two of every five women and more than one quarter of men had reportedly ever experienced physical IPV while one quarter of women and 15.7 percent of men reported ever experiencing sexual IPV. The correlates of IPV differ for men and women and depend on the type of IPV. For men, the strongest correlates of physical IPV include current employment, education and recent experience of sexual IPV. The strongest correlates for experiencing sexual violence among men were young age, problematic use of alcohol, gender-equitable attitudes, province of residence, and recent experience of physical IPV. For women, young age, low education, gender-equitable attitudes, partner problematic use of alcohol, partner controlling behaviors, recent experience of sexual IPV, and recent experience of public humiliation were the correlates of physical IPV. The strongest correlates of sexual IPV for women include province of residence, partner problematic use of alcohol, partner controlling behaviors, and recent experience of physical IPV. The programmatic implications of the findings are discussed.

Impact of Income Generating Projects on Family Income and Expenditure in South Kivu, Democratic Republic of Congo

Grassroots development projects in rural and suburban areas in Africa tend nowadays to focus on the fight against poverty. Many projects are developed based on the assumption that providing families with opportunities to increase their income through income-generating activities is an effective way of empowering them to sustainably improve their living conditions. This research was conducted in South Kivu Province, in the Democratic Republic of Congo (DRC), to gauge impact of project-supported income generating activities on family income and expenditures. The research compares family income and expenditures before 2006 and the situation 5 years later for families that have received support for income generating activities. Based on case studies, interviews and participant observation, the research confirms that introduction of institutional loan has created new employment opportunities, which in turn has boosted the income level of the grass roots households at present. There is significant contribution to the changes from additional external assistance received, infrastructural facilities developed, socio-political and cultural influence and the physical and mental capacities improved during the present period. It is quite clear here that the outlook of the present period households has been changed to handle the everyday kind of family problems to build up their future plans.

Factors for viral infection in blood donors of South Kivu in the Democratic Republic of Congo

IntroductionAssessing the knowledge, attitudes, practices and behaviors among blood donors in South Kivu and identify risk factors for viral markers.MethodsA descriptive and analytical cross-sectional study involved 595 blood donors in the city of Bukavu (Head city of the province of South Kivu) in the eastern Democratic Republic of Congo.ResultsOur sample consisted of 70.3% men with a median age of 23 and 77% of young people fewer than 30 years. The score of knowledge and attitude of blood donor's volunteer on blood safety were assessed at 23.5% and 79.1%. A statistically significant difference was observed between the loyal and new blood donors volunteer (25.1% vs 64.6% p < 0.001); between blood donors volunteer of low and high education level (p = 0.04). Motivation to donate blood in 95.9% of cases respect ethical rules of donation. The prevalence of viral markers in blood donors is as follows: 4.8% hepatitis B, 3.9% hepatitis C, 1.6% HIV. For HIV, the low level of education and replacement blood donors are most at risk, the antigen of hepatitis B is observed in blood donors over 30 years, blood donors living couple.ConclusionGeneral knowledge on blood safety is very low in the first link in the chain transfusion (blood donors). A good education of this population conducted by the transfusion service reinforced building (training and support) is needed.

Assessing Post-Conflict Challenges and Opportunities of the Animal-Agriculture System in the Alpine Region of Uvira District in Sud-Kivu Province, D. R. Congo

The Alpine region of Uvira District in South-Kivu Province faces low agricultural productivity challenges largely due to human population pressure on the natural resource base. During the dry season, conflicts between crop farmers and livestock breeders are common. This region is located 2500 - 3020 m a.s.l. and is almost inaccessible due to poor road infrastructure. To understand the interactions between natural resources (forests, pastures, soils) and sedentary agriculture, and to propose solutions for sustainable natural resource management, Participatory Rural Appraisal (PRA) sessions covering three farmer group interviews were conducted in July 2010 in Marungu, Kitembe and Kahololo location. The livelihoods of the Banyamulenge have been transformed from pastoralism to a sedentary system with the introduction of crop cultivation after 1980. Maize, bush beans and Irish potatoes are cultivated with limited success because of late crop maturity under the prevailing climatic conditions. Livestock, mainly cattle, sheep and goats is managed under extensive system, relying on natural pasture far from the human settlements. Livestock plays an important role to define people’s wealth and is mainly managed by men. There is a real need of forages during the dry season; however, cultivation of forages is unknown. On the other hand, pastures appear to be degenerating due to overgrazing. Access by farmers to efficient and effective agricultural extension services is fundamental in order to promote locally adapted and profitable crop and livestock production while at the same time, sustaining the productive resource base and security.

The Banyamulenge of South Kivu: The ‘Nationality Question’

My aim in this article is to address the question of the relationship between the ethnogenesis of the Banyamulenge in South Kivu province of the Democratic Republic of Congo (DRC) and their status as nationals and citizens of that country. I do not intend to present a history of the Banyamulenge, aspects of which have been thoroughly researched by several noted scholars. Nor do I undertake an account of developments following the first Congo war of 1996/7 to the present day. Rather, I will focus on three principal questions that have impacted on the formative relationship between the ‘Banyamulenge’ of South Kivu province and the broader Congolese society; namely, the diverse historical forms and stages of regional migration of Kinyarwanda speakers into pre-colonial, colonial and post-colonial Congo-Zaire; the nature of the post-independence Zairian state and its role in the manipulation and instrumentalisation of group identifications in the Kivu provinces; and the import of the discourses of nationalism and ‘nation-statism’ in the postcolony.

An analysis of the determinants of household level production and marketing of beans in Eastern Congo

Legumes and especially beans provide some of the most widely grown crops in the East and Central Africa region. The question of whether certain crops, specifically beans, are more beneficial to women than to men in relation to cash crops and other cereals, has been raised from time to time. In the central Africa region and in particular in the Democratic Republic of Congo (DRC), bean production has been promoted in the recent years. Beans contribute to better nutrition and soil fertility improvement in the region. The economic benefits and costs associated with beans production has not received adequate attention at the household level while taking into consideration male and female farm actors. Based on beans, this paper examines the differentiated profitabilities and costs of production for beans at the household level, among male and female farmers in the South Kivu Province of the DRC. The paper uses results obtained from a survey of 160 farmers in 10 villages in the South Kivu Province of DRC. Data was collected on household characteristics, costs, prices and quantities associated with bean production. Regression analysis was used to assess factors that influence the observedbean gross margins and production costs among the households. The results indicate the average age of bean farmers is relatively low and that there is no significant difference between the profits received by men and women farmers in spite of men incurring relatively higher production costs than women farmers. the results also indicate that larger surfaces put under beans do not necessarily lead to higher gross margins. Market access had factors such as physical location of the farmers vis a vis markets influenced to raise the costs incurred in bean production for those farmers located much farther away from major markets. Farmers located in remote areas suffer higher production costs in acquiring inputs, usually at higher costs than those located in optimal locations. Interventions that would enable such farmers to affordably access productive inputs are likely to impact positively on the farmers’ economic welfare.

Dispossession, displacement and resistance: Artisanal miners in a gold concession in South-Kivu, Democratic Republic of Congo

This article reports on an empirical study of the relationship between artisanal and industrial mining at the Twangiza gold concession in South Kivu Province, Democratic Republic of Congo (DRC). The setting is a post-conflict context where artisanal mining activities have supported livelihoods for several decades, but where the arrival of a multinational company, with explicit backing from the national government, has caused dispossession and displacement and altered local power relations, leaving former artisanal miners with few alternatives for making a living. Although Congolese law recognizes artisanal mining and policies have been proposed to formalize and support this sector, reality is often very different and artisanal miners frequently clash with industrial enterprises. This article argues that, in order to understand the dynamics underlying these clashes, closer attention needs to be paid to the practices and discourses of the artisanal miners themselves: how do they conceptualize notions such as property, legitimacy and livelihood, and what is their outlook on development? The empirical analysis shows how miners in Twangiza resist dispossession by the multinational corporation in both words and actions.

Demographics and Care-Seeking Behaviors of Sexual Violence Survivors in South Kivu Province, Democratic Republic of Congo

One of the most striking features of the ongoing conflict in the Democratic Republic of Congo (DRC) is the use of sexual violence. In spite of the brutality of these crimes, the experiences of women affected by sexual violence in Eastern DRC remain poorly characterized. This analysis aimed to (1) provide detailed demographics of sexual violence survivors presenting to Panzi Hospital; (2) examine how demographic factors might impact patterns of sexual violence; and (3) describe care-seeking behavior among sexual violence survivors. The demographics and care-seeking behavior of sexual violence survivors in South Kivu Province were described from a retrospective registry-based study of sexual violence survivors presenting to Panzi Hospital (2004-2008). A total of 4311 records were reviewed. The mean age of survivors was 35 years. Most women (53%) were married, self-identified with the Bashi tribe (65%), and reported agriculture as their livelihood (74%). The mean time delay between sexual assault and seeking care was 10.4 months. Five reasons were identified to help explain the lengthy delays to seeking care: waiting for physical symptoms to develop or worsen before seeking medical attention, lack of means to access medical care, concerns that family would find out about the sexual assault, stigma surrounding sexual violence, and being abducted into sexual slavery for prolonged periods of time. Many sexual assault survivors have very delayed presentations to medical attention. Promoting timely access of medical care may best be facilitated by reducing stigma and by educating women about the benefits of early medical care, even in the absence of injuries or symptoms.

Sexual violence and HIV transmission: summary proceedings of a scientific research planning meeting.

This summarizes proceedings of a Scientific Research Planning Meeting on Sexual Violence and HIV transmission, convened by the Social Science Research Council on 19–20 March 2012 at the Greentree Foundation in New York. The Meeting brought together an interdisciplinary group of basic, clinical, epidemiological and social science researchers and policy makers with the aim of: (1) examining what is known about the physiology of sexual violence and its role in HIV transmission, acquisition and pathogenesis; (2) specifying factors that distinguish risks throughout the maturation of the female genital tract, the reproductive cycle and among post-menopausal women; and (3) developing a research agenda to explore unanswered questions. The Meeting resulted in a consensus Research Agenda and White Paper that identify priorities for HIV research, policy and practice as it pertains to the role of sexual violence and genital injury in HIV transmission, acquisition and pathogenesis, particularly among women and girls.

Estimating human rights violations in South Kivu Province, Democratic Republic of the Congo: A population-based survey

UN Resolution 1612 requires that annual tends in the rate of grave violations of children's rights be reported to the Security Council for countries of interest such as the Democratic Republic of Congo. We conducted a population-based three-staged cluster survey from May to August 2010 to measure the occurrence of military recruitment, abduction, killing and maiming, and attacks against education occurring in the population in South Kivu during 2010. In addition, key informants were interviewed with a semi-structured questionnaire to examine their ability to report any of the grave violations perpetrated in their village. The findings indicated that among the 4471 members of respondent households, abduction was the most frequently reported violation and it is estimated that 5.7% of the population (95% confidence interval [CI]: 3.9–7.5, design effect [DE]: 4.06) were abducted annually. It is estimated that 44,898 children (1.5%) (95% CI: 23,679–66,118, DE: 2.90) throughout South Kivu Province (excluding the cities of Bukavu and Uvira) experienced one of the four grave violations (recruitment, abduction, killing or maiming, and attacks against education) in the first 6.5 months of 2010. The majority of all violation episodes were perpetrated by government Forces Armées de la République Démocratique du Congo soldiers. In the majority of villages where at least one household reported a member experiencing a violation, the key informants reported that no violations had occurred in their village. This survey suggests the UN's Monitoring and Reporting Mechanism was less than 1% complete in South Kivu. These results beckon population-based non-UN, nongovernmental rights monitoring systems be developed to complement the UN effort.

A Congolese community-based health program for survivors of sexual violence.

Many survivors of gender based violence (GBV) in the Democratic Republic of Congo (DRC) report barriers to access health services including, distance, cost, lack of trained providers and fear of stigma. In 2004, Foundation RamaLevina (FORAL), a Congolese health and social non-governmental organization, started a mobile health program for vulnerable women and men to address the barriers to access identified by GBV survivors and their families in rural South Kivu province, Eastern DRC. FORAL conducted a case study of the implementation of this program between July 2010-June 2011 in 6 rural villages. The case study engaged FORAL staff, partner health care providers, community leaders and survivors in developing and implementing a revised strategy with the goal of improving and sustaining health services. The case study focused on: (1) Expansion of mobile clinic services and visit schedule; (2) Clinical monitoring and evaluation system; and (3) Recognition, documentation and brief psychosocial support for symptoms suggestive of anxiety, depression and PTSD. During this period, FORAL treated 772 women of which 85% reported being survivors of sexual violence. Almost half of the women (45%) reported never receiving health services after the last sexual assault. The majority of survivors reported symptoms consistent with STI. Male partner adherence to STI treatment was low (41%). The case study demonstrated areas of strengths in FORAL’s program, including improved access to health care by survivors and their male partner, enhanced quality of health education and facilitated regular monitoring, follow-up care and referrals. In addition, three critical areas were identified by FORAL that needed further development: provision of health services to young, unmarried women in a way that reduces possibility of future stigma, engaging male partners in health education and clinical care and strengthening linkages for referral of survivors and their partners to psychosocial support and mental health services. FORAL’s model of offering health education to all community members, partnering with local providers to leverage resources and their principal of avoiding labeling the clinic as one for survivors will help women and their families in the DRC and other conflict settings to comfortably and safely access needed health care services.

Randomized controlled trial of the effectiveness of a soybean-maize-sorghum–based ready-to-use complementary food paste on infant growth in South Kivu, Democratic Republic of Congo

Evidence of the effectiveness of lipid-based ready-to-use complementary foods (RUCF) at improving linear growth among infants aged 6-12 mo is scarce, and further work is warranted. The objective was to assess the effectiveness of a fortified soybean-maize-sorghum RUCF paste compared with a fortified corn soy blend (UNIMIX) porridge on the prevalence of underweight and stunting among infants in South Kivu Province, Democratic Republic of Congo. Infants were randomly assigned at 6 mo of age to receive either RUCF (n = 691) or UNIMIX (n = 692) for 6 mo. In addition to admission and monthly anthropometric measurements, hemoglobin, triglyceride, and cholesterol were measured at enrollment and at the end of the study. No significant differences in the prevalence of stunting (RUCF: 48.6%; UNIMIX: 46.4%; P = 0.31), the prevalence of underweight (RUCF: 20.4%; UNIMIX: 18.2%; P = 0.42), or weight gain (RUCF: 1.2 ± 0.7 kg; UNIMIX: 1.3 ± 0.7 kg; P = 0.08) were found. A small but statistically significant difference in length gain (RUCF: 5.2 ± 2.0; UNIMIX: 5.4 ± 2.0; P = 0.03) was found. No significant differences in the concentrations of hemoglobin, serum triglyceride, and serum cholesterol were found between the 2 groups. No significant differences were found between the RUCF and UNIMIX in the reduction of the prevalence of stunting and underweight at 12 mo of age among rural Congolese infants. This trial was registered at controlled-trials.com as ISRCTN20267635.

Challenges and opportunities for smallholder livestock production in post-conflict South Kivu, eastern DR Congo

A survey on smallholder livestock production with emphasis on monogastric animals was conducted in 20 villages of seven so-called ‘groupements’ of South Kivu province in DR Congo, situated along a north to south-west axis with the town of Bukavu in the center. This land adjacent to Lake Kivu is located at elevations ranging around 900–1900 m asl, experiencing tropical highland climate. A diagnostic survey helped to rapidly obtain in-depth knowledge of constraints and opportunities in this environment. Correspondence analysis and multiple regression analysis were used to investigate the association of production constraints with particular livestock species and to understand the factors that govern the number of livestock that people owned (converted to tropical livestock units [TLU]), respectively. Responses of 112 informants demonstrated that livestock is an integral part of the region’s mixed farming systems. Low livestock numbers per household at present reflect the poverty as a consequence of recent violent conflicts. Currently, farmers focus on small livestock, like poultry, swine, cavies (i.e., Guinea pigs) and rabbits. Families keep livestock to accumulate household reserves that are strongly invested in children’s education. Major issues of animal husbandry were related to animal diseases and lack of feed resources, particularly in the dry season. Lack of feed or forages were unrelated to a particular livestock species. Livestock holdings depended on animal diversity, location, land size available and respondents’ education level. The potential introduction of improved forages is challenged by their dry-season tolerance, compatibility with cropping on small farms; and people’s readiness to cultivate forages.

Sexual Violence Trends between 2004 and 2008 in South Kivu, Democratic Republic of Congo

For more than a decade, conflict in the Eastern Democratic Republic of Congo (DRC) has been claiming lives. Within that conflict, sexual violence has been used by militia groups to intimidate and punish communities, and to control territory. This study aimed to: (1) investigate overall frequency in number of Eastern DRC sexual assaults from 2004 to 2008 inclusive; (2) determine if peaks in sexual violence coincide with known military campaigns in Eastern DRC; and (3) study the types of violence and types of perpetrators as a function of time. This study was a retrospective, descriptive, registry-based evaluation of sexual violence survivors presenting to Panzi Hospital between 2004 and 2008. A total of 4,311 records were reviewed. Throughout the five-year study period, the highest number of reported sexual assaults occurred in 2004, with a steady decrease in the total number of incidents reported at Panzi Hospital from 2004 through 2008. The highest peak of reported sexual assaults coincided with a known militant attack on the city of Bukavu. A smaller sexual violence peak in April 2004 coincided with a known military clash near Bukavu. Over the five-year period, the number of sexual assaults reportedly perpetrated by armed combatants decreased by 77% (p = 0.086) and the number of assaults reportedly perpetrated by non-specified perpetrators decreased by 92% (p < 0.0001). At the same time, according to the hospital registry, the number of sexual assaults reportedly perpetrated by civilians increased 17-fold (p < 0.0001). This study was limited by its retrospective nature, by the inherent selection bias of studying only survivors presenting to Panzi Hospital, and by the use of a convenience sample within Panzi Hospital. After years of military rape in South Kivu Province, civilian adoption of sexual violence may be a growing phenomenon. If this is the case, the social mechanisms that prevent sexual violence will have to be rebuilt and sexual violence laws will have to be fully enforced to bring all perpetrators to justice. Proper rehabilitation and reintegration of ex-combatants may also be an important step towards reducing civilian rape in Eastern DRC.

Sexual and gender based violence against men in the Democratic Republic of Congo: effects on survivors, their families and the community

Media and service provider reports of sexual and gender based violence (SGBV) perpetrated against men in armed conflicts have increased. However, response to these reports has been limited, as existing evidence and programs have primarily focused on prevention and response to women and girl survivors of SGBV. This study aims to contribute to the evidence of SGBV experienced by males by advancing our understanding of the definition and characteristics of male SGBV and the overlap of health, social and economic consequences on the male survivor, his family and community in conflict and post-conflict settings. The qualitative study using purposive sampling was conducted from June–August 2010 in the South Kivu province of Eastern DRC, an area that has experienced over a decade of armed conflict. Semi structured individual interviews and focus group discussions were conducted with adult male survivors of SGBV, the survivors' wife and/or friend, health care and service providers, community members and leaders. This study found that SGBV against men, as for women, is multi-dimensional and has significant negative physical, mental, social and economic consequences for the male survivor and his family. SGBV perpetrated against men and boys is likely common within a conflict-affected region but often goes unreported by survivors and others due to cultural and social factors associated with sexual assaults, including survivor shame, fear of retaliation by perpetrators and stigma by community members. All key stakeholders in our study advocated for improvements and programs in several areas: (1) health care services, including capacity to identify survivors and increased access to clinical care and psychosocial support for male survivors; (2) economic development initiatives, including microfinance programs, for men and their families to assist them to regain their productive role in the family; (3) community awareness and education of SGBV against men to reduce stigma and discrimination and increase acceptance of survivors by family and larger community.

Evaluation of medical supplies essential for the care of survivors of sex- and gender-based violence in post-conflict Eastern Democratic Republic of Congo

The fundamental concepts set forth in the formal Post-Conflict Needs Assessment (PCNA) initiative created by the United Nations Development Group have the potential to be adapted to assist local groups in documenting the needs of and the provision of health care to survivors of sex- and gender-based violence (SGBV) in Eastern Democratic Republic of Congo (DRC). In partnership with Congolese health care providers, we took the first step in advocating for a locally-adapted and focused needs assessment through the development and administration of surveys to providers in the South Kivu Province, DRC. The content of the surveys was largely based on lists of medical supplies deemed essential for reproductive health and for the care of survivors by the Reproductive Health Response in Crises Consortium. The providers in both urban and rural settings considered many of the supplies identified on the surveys necessary for the care of survivors (84%; p < 0.05) but considered few accessible (26%; p < 0.05) in their particular clinical settings. Providers also felt that the existing list of supplies was inadequate to meet the needs of survivors, and also that providers needed ongoing training to improve supply procurement and management, more knowledge of the needs of male survivors of SGBV, and more educational opportunities to improve the quality of care to survivors. Given the deficiencies expressed by providers in the surveys, this study demonstrated a critical need for a locally-adapted and focused needs assessment to improve health services to survivors.

A Congolese–US participatory action research partnership to rebuild the lives of rape survivors and their families in eastern Democratic Republic of Congo

The Democratic Republic of Congo (DRC) remains an all-too-potent reminder of how war, human rights violations and their related health and economic impacts can devastate a society. The last decade has seen the use of rape as a weapon of war in the DRC, where rebels and soldiers subject women and girls to brutalising attacks, rape, torture and mutilation. Survivors of sexual and gender-based violence (SGBV) are often further traumatised by infections, disease, poverty, stigma and social isolation. Substantial evidence exists showing an association between social determinants (e.g., poverty, stress and trauma, stigma, lack of access to health care) and health; however, limited research has been conducted to elucidate these relationships or to develop and test interventions to change social determinants of health, especially in conflict and post-conflict settings such as the DRC. The purpose of this article is to present a Congolese–US community-academic research partnership to obtain evidence to develop and implement a sustainable intervention to begin to address the social determinants of health, including poverty and traumatic stress for survivors of SGBV and their families in the South Kivu province of eastern DRC.