Search

This study evaluated the effect of Momentum-an integrated family planning, maternal and newborn health, and nutrition intervention-on postpartum family planning norms and behaviors among ever married and never-married first-time mothers age 15-24 in Kinshasa, Democratic Republic of the Congo. Using data collected in 2018 and 2020, we conducted an intent-to-treat analysis among 1,927 first-time mothers who were about six-months pregnant at enrollment. Difference-in-differences models were run for panel data and treatment effects models with inverse-probability weighting for endline-only outcomes. Average treatment effects (ATE) were estimated. Momentum had positive effects on partner discussion of family planning in the early postpartum period (ever married 15-19: ATE = 0.179, 95% CI = 0.098, 0.261; never married 15-19: ATE = 0.131, 95% CI = 0.029, 0.232; ever married 20-24: ATE = 0.233, 95% CI = 0.164, 0.302; never married 20-24: ATE = 0.241, 95% CI = 0.121, 0.362) and discussion with a health worker, and on obtaining a contraceptive method in the early postpartum period, except among never married adolescents. Among adolescents, intervention effects on modern contraceptive use within 12 months of childbirth/pregnancy loss were larger for the never married (ATE = 0.251, 95% CI = 0.122, 0.380) than the ever married (ATE = 0.114, 95% CI = 0.020, 0.208). Full intervention exposure had consistently larger effects on contraceptive behaviors than partial exposure, except among ever married adolescents. Momentum had no effect on normative expectations about postpartum family planning use among adolescents, and on descriptive norms and personal agency among those who were never married. Results for normative outcomes and personal agency underscored the intersectionality between young maternal age and marital status. Future programs should improve personal agency and foster normative change in support of postpartum family planning uptake and tailor interventions to different age and marital status subsets of first-time mothers.

Objective To compare coverage of key child health policy indicators across provinces and to explore their association with under-five mortality and level of conflict in the Democratic Republic of the Congo. Methods We made a secondary analysis of nationally representative data from 1380 health facilities and 20 792 households in 2017-2018. We analysed provincial-level data on coverage of 23 different indicators for improving common causes of childhood mortality, combined into mean scores for: newborn health, pneumonia, diarrhoea, malaria and safe environment. Using negative binomial regression we compared the scores with provincial-level under-five mortality. With binary logistic regression at the individual level we compared indicators (outcome) with living in a conflict-affected province (exposure). Findings All grouped coverage scores demonstrated large ranges across the 26 provinces: newborn health: 20% to 61%; pneumonia: 26% to 86%; diarrhoea: 25% to 63%; malaria: 22% to 53%; and safe environment: 4% to 53%. The diarrhoea score demonstrated the strongest association with under-five mortality (adjusted coefficient: -0.026; 95% confidence interval: -0.045 to -0.007). Conflict-affected provinces had both the highest as well as the lowest mortality rates and indicator coverages. The odds of coverage were higher in conflict-affected provinces for 13 out of 23 indicators, whereas in provinces unaffected by conflict only one indicator had higher odds of coverage. Conclusion Conflict alone is a poor predictor for child health. Ensuring that children in unaffected provinces are not neglected while addressing the needs of the most vulnerable in conflict settings is important. Prevent, protect and treat strategies for diarrhoeal disease could help improve equity in child survival. Objectif Comparer le degre de couverture des principaux indicateurs propres a la politique de sante infantile dans les provinces, puis examiner leurs liens avec la mortalite chez les moins de cinq ans et le niveau de conflit en Republique democratique du Congo. Methodes Nous avons effectue une analyse secondaire des donnees representatives a l'echelle nationale provenant de 1380 etablissements de sante et 20 792 menages en 2017-2018. Cette analyse portait sur des donnees a l'echelle provinciale sur la couverture de 23 indicateurs relatifs a Amelioration des causes courantes de mortalite infantile, combinees sous forme de scores moyens en matiere de sante des nouveau-nes, pneumonie, diarrhee, malaria et environnement sur. A l'aide d'une regression binomiale negative, nous avons confronte les scores avec la mortalite chez les moins de cinq ans, observee a l'echelle provinciale. Enfin, nous avons utilise une regression logistique binaire a l'echelle individuelle pour comparer les indicateurs (resultats) avec le fait de vivre dans une province en conflit (exposition). Resultats Tous les scores ont montre de grandes disparites entre les 26 provinces: sante des nouveau-nes: 20% a 61%; pneumonie: 26% a 86%; diarrhee: 25% a 63%; malaria: 22% a 53%; et environnement sur: 4% a 53%. Le score le plus souvent associe a la mortalite chez les moins de cinq ans etait celui de la diarrhee (coefficient ajuste: -0,026; IC de 95%: -0,045 a -0,007). Les provinces touchees par des conflits possedaient a la fois les taux les plus bas et les plus eleves en matiere de mortalite et de couverture des indicateurs. Les probabilites de couverture etaient plus elevees dans les provinces en conflit pour 13 indicateurs sur 23, tandis que, dans les provinces epargnees, seul un indicateur affichait de meilleures probabilites de couverture. Conclusion La sante infantile ne depend pas uniquement de la presence ou non d'un conflit. Il faut donc imperativement veiller a ce que les enfants des provinces epargnees ne soient pas negliges au moment de repondre aux besoins des plus vulnerables dans les regions en conflit. Des strategies de prevention, de protection et de traitement contre les maladies diarrheiques pourraient contribuer a renforcer l'equite dans la survie infantile. Objetivo Comparar la cobertura de los indicadores clave de la politica de salud infantil entre las provincias y explorar su asociacion con la mortalidad de menores de cinco anos y el nivel de conflicto en la Republica Democratica del Congo. Metodos Se realizo un analisis secundario de los datos representativos a nivel nacional de 1380 centros de salud y 20 792 hogares entre 2017 y 2018. Se analizaron los datos a nivel provincial sobre la cobertura de 23 indicadores para mejorar las causas comunes de mortalidad infantil, combinados en puntuaciones medias para: la salud del recien nacido, la neumonia, la diarrea, la malaria (o paludismo) y el entorno seguro. Mediante una regresion binomial negativa, se compararon las puntuaciones con la mortalidad de menores de cinco anos a nivel provincial. A traves de una regresion logistica binaria a nivel individual, se compararon los indicadores (desenlace) con el hecho de vivir en una provincia afectada por el conflicto (exposicion). Resultados Todas las puntuaciones de cobertura agrupadas mostraron grandes rangos en las 26 provincias: salud del recien nacido: 20 % a 61 %; neumonia: 26 % a 86 %; diarrea: 25 % a 63 %; malaria: 22 % a 53 %; y entorno seguro: 4 % a 53 %. La puntuacion de la diarrea demostro la mayor asociacion con la mortalidad de menores de cinco anos (coeficiente ajustado: -0,026; IC del 95 %: -0,045 a -0,007). Las provincias afectadas por el conflicto tenian tanto las tasas de mortalidad como las coberturas de los indicadores mas altas y mas bajas. Las probabilidades de cobertura eran mayores en las provincias afectadas por el conflicto para 13 de los 23 indicadores, mientras que en las provincias no afectadas por el conflicto solo un indicador tenia mayores probabilidades de cobertura. Conclusion El conflicto por si solo no es un buen factor de prediccion de la salud infantil. Es importante asegurar que los ninos de las provincias no afectadas no sean desatendidos mientras se atienden las necesidades de los mas vulnerables en las situaciones de conflicto. Las estrategias de prevencion, proteccion y tratamiento de las enfermedades diarreicas podrian contribuir a mejorar la equidad en la supervivencia infantil., Introduction The main contributors to mortality in children younger than 5 years in sub-Saharan Africa are lower respiratory infections, diarrhoea, malaria and neonatal conditions, (1) all of which are targeted [...]

Introduction: There is a high incidence of unsafe abortion among women in Nigeria and the DRC. Low knowledge of recommended abortion methods [i.e., surgical and medication abortion (MA) pills] is a barrier for women accessing safe abortions. Women often rely on friends for information about abortion methods. Understanding characteristics of women with knowledge of recommended abortion methods, and MA specifically, and how it is influenced by close female friendships may help identify women most at risk of relying on unsafe abortion. Methods: We used survey data from Performance Monitoring for Action from 11,106 women of reproductive age in Nigeria (April–May 2018) and 3,697 women in Kinshasa and Kongo Central, DRC, (December 2021–April 2022) to produce representative estimates of knowledge of abortion methods at the national and province levels, respectively. We performed bivariate and multivariate logistic regression to determine which characteristics were independently associated with knowing a recommended abortion method, with knowing of MA pills specifically, and to assess our hypothesis that having at least one female confidante would increase one's odds of knowing about these methods. Results: A minority (26.9%) of women in Nigeria and the majority in Kinshasa (76.7%) and Kongo Central (58.1%) reported having knowledge of at least one recommended abortion method, while knowledge of MA pills was low in all sites. Having at least one close female confidante was associated with increased odds of knowing a recommend abortion method in Nigeria (aOR = 1.50, 95% CI 1.25–1.79) and in Kongo Central (aOR = 2.66, 95% CI 1.40–5.40), and with increased odds of knowing about MA specifically in Kinshasa (aOR = 1.44, 95% CI 1.08–1.93) and Kongo Central (aOR = 3.61, 95% CI 1.28–10.22), but not Nigeria. Discussion: In legally restrictive contexts where knowledge of recommended abortion methods (particularly medication abortion) is low, having close female friends is related to increased knowledge of recommended abortion methods. [ABSTRACT FROM AUTHOR]

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

Introduction: The Democratic Republic of Congo (DRC) does not have national prevalence data for arterial hypertension (HTN) or diabetes (type I and II combined) to aid evidence-based decision-making, despite the assumption of epidemiological transition in low- and middle-income countries. The aim of this study was to estimate a proxy of prevalence for HTN and diabetes. Methodology: This study used routine monthly reported data pertaining to HTN and diabetes from the District Health Information Software 2 (DHIS2), spanning 2019–2023. Data underwent quality assessment and adjustments using standardization before analysis. Equity analyses were carried out at the national and sub-national levels. Epidemiological curves and maps were produced to analyze trends in the prevalence of HTN and diabetes among adults aged 18 and over. Permission to use the data was obtained from the regulatory authority. Results: Over five years, incidence of HTN increased from 13.23% (CI 95%: 13.22–13.24) to 15.23% (CI 95%: 15.22–15.24) (+15.1% relative increase), and diabetes rose from 2.73% (CI 95%: 2.72–2.74) to 3.345% (CI 95%: 3.34–3.35) (+16.3% relative increase), with provincial variations observed. Conclusions: In the DRC, hypertension and diabetes are advancing rapidly. Primary and preventative healthcare services and public health interventions must prioritize these diseases. [ABSTRACT FROM AUTHOR]

STUDY QUESTION What is the nature of women's care-seeking for difficulties conceiving in sub-Saharan Africa (SSA), including the correlates of seeking biomedical infertility care at a health facility? SUMMARY ANSWER Care-seeking for difficulties getting pregnant was low, much of which involved traditional or religious sources of care, with evidence of sociodemographic disparities in receipt of biomedical care. WHAT IS KNOWN ALREADY Nearly all research on infertility care-seeking patterns in SSA is limited to clinic-based studies among the minority of people in these settings who obtain facility-based services. In the absence of population-based data on infertility care-seeking, we are unable to determine the demand for services and disparities in the use of more effective biomedical sources of care. STUDY DESIGN, SIZE, DURATION We used cross-sectional, population-based data from the Performance Monitoring for Action (PMA) female survey in eight geographies in SSA, including nationally representative data from Burkina Faso, Côte d'Ivoire, Kenya, and Uganda and regionally representative data from two provinces in the Democratic Republic of the Congo (DRC) (Kinshasa and Kongo Central) and two states in Nigeria (Kano and Lagos). We employed a multi-stage cluster random sampling design with probability proportional to size selection of clusters within each geography to produce representative samples of women aged 15–49. Samples ranged from 1144 in Kano, Nigeria, to 9489 in Kenya. PMA collected these data between November 2021 and December 2022. PARTICIPANTS/MATERIALS, SETTING, METHODS We restricted the sample to women who had ever had sex, with analytic samples ranging from 854 in Kano to 8,059 in Kenya, then conducted descriptive and bivariable analyses to examine characteristics of those who sought care for difficulties getting pregnant. Among those who reported seeking care, we conducted bivariable and multivariable logistic regression analyses to determine factors associated with receipt of biomedical services from a health facility. All analyses were conducted separately by geography. MAIN RESULTS AND THE ROLE OF CHANCE Our study found low levels of care-seeking for difficulties getting pregnant among sexually active women in eight geographies in SSA, ranging from 3.7% (Kenya) to 15.3% (Côte d'Ivoire). Of this, 51.8% (Burkina Faso) to 86.7% (Kinshasa) involved receipt of biomedical services in health facilities. While many factors were consistently associated with infertility care-seeking from any source across geographies, factors associated with receipt of biomedical care specifically were less pronounced. This may be a result of the highly limited sources of infertility services in SSA; thus, even privileged groups may struggle to obtain effective treatment for difficulties getting pregnant. However, we did observe disparities in biomedical care-seeking in our bivariable results in several geographies, with the wealthiest women, those with more education, and those residing in urban areas generally more likely to have sought biomedical care for difficulties getting pregnant. LIMITATIONS, REASONS FOR CAUTION Our data lacked details on the nature of the services received and outcomes, and we do not have information on reasons why women chose the sources they did. Small samples of women who sought care limited our power to detect significant differences in care-seeking by women's characteristics in several geographies. WIDER IMPLICATIONS OF THE FINDINGS Infertility and access to appropriate treatment are issues of reproductive health and human rights. While our results do not indicate to what extent use of non-biomedical sources of care is driven by preferences, cost, or lack of accessible services, it is clear from our results and existing literature that more needs to be done to ensure access to affordable, quality, cost-effective infertility services in SSA. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by grants from the Bill & Melinda Gates Foundation (INV009639) and the National Institute of Child Health and Human Development (K01HD107172). The funders were not involved in the study design, analyses, manuscript writing, or the decision to publish. The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]

Recent evidence suggests that women in high‐income countries desired to delay or forgo childbearing due to COVID‐19, yet there remains insufficient evidence of COVID‐19's impact on fertility desires in low‐ and middle‐income countries, particularly in sub‐Saharan Africa (SSA). We examined how quantum and tempo of fertility intentions changed in the first year of COVID‐19 and assessed the impact of economic insecurity and sociodemographic characteristics on these changes in SSA. We used longitudinal data collected among 14,053 women from Kenya, Burkina Faso, two provinces in the Democratic Republic of Congo (Kinshasa and Kongo Central), and two states in Nigeria (Kano and Lagos). Descriptive analyses and logistic regression examined overall changes and economic and sociodemographic factors associated with quantum and tempo shifts. At the population‐level, most women remained stable in their fertility intentions throughout the first year of COVID‐19. Despite widespread income loss, few women reported that COVID‐19 influenced their near‐term childbearing intentions. However, among women who changed their intentions in Burkina Faso and Kenya, income loss was associated with transitions toward wanting to delay or limit childbearing, particularly among the poorest women. These findings underscore the importance of accounting for context when anticipating the consequences of public health emergencies on fertility. [ABSTRACT FROM AUTHOR]

Vaccination against COVID-19 has been the main strategy used by most countries to limit the spread of the virus. However, vaccine uptake has been low in Africa, leading to the implementation of several interventions in order to improve vaccine coverage. This study was conducted due to the lack of information about COVID-19 vaccine coverage and the factors associated with vaccine hesitancy. This cross-sectional study was carried out in Kinshasa city using multi-stage random sampling. A total of 2160 households were included in this study. The data were analyzed using Stata 17 software. The means and standard deviations were computed for continuous data that followed a normal distribution, whereas proportions together with their 95% confidence intervals (CIs) were computed for categorical variables. The connections between dependent variables and each independent variable were tested using either Pearson's chi-square test or Fisher's exact test. The logistic regression method was employed to determine the factors that are linked to hesitation in obtaining the COVID-19 immunization. The majority of respondents were aged between 25 and 34 and 35 and 49 (28.9%). During this study, 15% (95% CI [13.25–17.9]) of respondents had received at least one dose of the COVID-19 vaccine. The prevalence of vaccine hesitancy was 67% (CI95%:64.9–69.1). Among the reasons given for refusing to be vaccinated, most respondents cited concerns about the vaccine being unsafe or causing adverse reactions (45%). Among the reasons given for accepting the vaccine, 26% thought that the vaccine prevented superinfection. The factors associated with hesitancy toward the COVID-19 vaccine were female gender, an age of less than 35 years, and living in non-slum households. Despite the interventions implemented across the country, the reluctance to be vaccinated remains a problem; this could lead to poor health outcomes, especially among the elderly and those with pre-existing conditions. It is important to step up awareness-raising campaigns in the community in order to increase the uptake of vaccination. [ABSTRACT FROM AUTHOR]