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Abstract 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

Introduction: 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). Methodology: 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. Results: We describe an ongoing Clade I Mpox outbreak in the city of Kamituga, South Kivu Province, Democratic Republic of Congo. Wholegenome 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. Conclusions: 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. [ABSTRACT FROM AUTHOR]

COVID-19 vaccine hesitancy and its enablers shape community uptake of non-covid vaccines such as the oral cholera vaccine (OCV) in the post-COVID-19 era. This study assessed the impact of COVID-19 vaccine hesitancy and its drivers on OCV hesitancy in a cholera-endemic region of the Democratic Republic of Congo. We conducted a community-based survey in Bukavu. The survey included demographics, intention to take OCV and COVID-19 vaccines, reasons for COVID-19 hesitancy, and thoughts and feelings about COVID-19 vaccines. Poisson regression analyses were performed. Of the 1708 respondents, 84.66% and 77.57% were hesitant to OCV alone and to both OCV and COVID-19, respectively. Hesitancy to COVID-19 vaccines rose OCV hesitancy by 12% (crude prevalence ratio, [cPR] = 1.12, 95%CI [1.03–1.21]). Independent predictors of OCV hesitancy were living in a semi-urban area (adjusted prevalence ratio [aPR] = 1.10, 95%CI [1.03–1.12]), religious refusal of vaccines (aPR = 1.06, 95%CI [1.02–1.12]), concerns about vaccine safety (aPR = 1.05, 95%CI [1.01–1.11]) and adverse effects (aPR = 1.06, 95%CI [1.01–1.12]), as well as poor vaccine literacy (aPR = 1.07, 95%CI [1.01–1.14]). Interestingly, the belief in COVID-19 vaccine effectiveness reduced OCV hesitancy by 24% (aPR = 0.76, 95%CI [0.62–0.93]). COVID-19 vaccine hesitancy and its drivers exhibited a significant domino effect on OCV uptake. Addressing vaccine hesitancy through community-based health literacy and trust-building interventions would likely improve the introduction of novel non-COVID-19 vaccines in the post-COVID-19 era. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract Background The World Health Organization’s (WHO) 2030 goal of eradicating Hepatitis B and C viruses must also include HIV co-infected children. However, data on the prevalence of this condition are lacking in the Democratic Republic of Congo (DRC), which is considered as one of the countries with high-prevalence of these viruses. The need to assess the extent of this co-infection in the children of this country is therefore important in order to capitalize on efforts to improve prevention and management of both infections. Methodology This is a comparative cross-sectional study conducted from February 04, 2015 to September 03, 2019 at 14 General Reference Hospitals with a pediatric HIV management programme in South Kivu province. The study compared the frequency of hepatitis B (HBV) and C (HCV) markers and factors associated with these two viruses in two equal groups: HIV-positive and HIV-negative children. The data were analyzed using the SPSS version 20.0 software and the significance level was set at p-value less than 0.05. Results The study involved a total of 594 children, 297 of whom were HIV-positive and 297 negative. HBsAg was found in 8.7% of HIV-positive patients and 0.7% for HCV antibodies. On the other hand, among the HIV-negative patients, the proportion of HBsAg was 0.7% but no cases with anti-HCV antibodies were detected. HIV status increases by 14 times the risk of co-occurring with HBV [OR 14.1 (95% CI: 3.33–60.2); p

Background: The World Health Organization's (WHO) 2030 goal of eradicating Hepatitis B and C viruses must also include HIV co-infected children. However, data on the prevalence of this condition are lacking in the Democratic Republic of Congo (DRC), which is considered as one of the countries with high-prevalence of these viruses. The need to assess the extent of this co-infection in the children of this country is therefore important in order to capitalize on efforts to improve prevention and management of both infections. Methodology: This is a comparative cross-sectional study conducted from February 04, 2015 to September 03, 2019 at 14 General Reference Hospitals with a pediatric HIV management programme in South Kivu province. The study compared the frequency of hepatitis B (HBV) and C (HCV) markers and factors associated with these two viruses in two equal groups: HIV-positive and HIV-negative children. The data were analyzed using the SPSS version 20.0 software and the significance level was set at p-value less than 0.05. Results: The study involved a total of 594 children, 297 of whom were HIV-positive and 297 negative. HBsAg was found in 8.7% of HIV-positive patients and 0.7% for HCV antibodies. On the other hand, among the HIV-negative patients, the proportion of HBsAg was 0.7% but no cases with anti-HCV antibodies were detected. HIV status increases by 14 times the risk of co-occurring with HBV [OR 14.1 (95% CI: 3.33–60.2); p < 0.001] and this risk is not apparent for HCV (p = 0.297). Multivariate logistic regression showed that history of jaundice in the family (aOR:4.19;95% CI: 2.12–11.59), recent hospitalization (aOR:10.7;95% CI: 6.69–17.2), surgery (aOR: 3.24;95% CI: 1.18–8.92), piercing (aOR: 4.26;95% CI: 1.70–10.7) and transfusion in the last 6 months (aOR: 2.69;95% CI: 1.55–4.67) were significantly associated with higher risk of being HBV- HIV co-infected. Conclusion: This study investigated the importance of hepatitis viral co-infections in HIV-positive children in South Kivu. Particular attention should be paid to prevention and early detection of these co-infections in this population. [ABSTRACT FROM AUTHOR]

COVID-19 vaccine hesitancy and its enablers shape community uptake of non-covid vaccines such as the oral cholera vaccine (OCV) in the post-COVID-19 era. This study assessed the impact of COVID-19 vaccine hesitancy and its drivers on OCV hesitancy in a cholera-endemic region of the Democratic Republic of Congo. We conducted a community-based survey in Bukavu. The survey included demographics, intention to take OCV and COVID-19 vaccines, reasons for COVID-19 hesitancy, and thoughts and feelings about COVID-19 vaccines. Poisson regression analyses were performed. Of the 1708 respondents, 84.66% and 77.57% were hesitant to OCV alone and to both OCV and COVID-19, respectively. Hesitancy to COVID-19 vaccines rose OCV hesitancy by 12% (crude prevalence ratio, [cPR] = 1.12, 95%CI [1.03–1.21]). Independent predictors of OCV hesitancy were living in a semi-urban area (adjusted prevalence ratio [aPR] = 1.10, 95%CI [1.03–1.12]), religious refusal of vaccines (aPR = 1.06, 95%CI [1.02–1.12]), concerns about vaccine safety (aPR = 1.05, 95%CI [1.01–1.11]) and adverse effects (aPR = 1.06, 95%CI [1.01–1.12]), as well as poor vaccine literacy (aPR = 1.07, 95%CI [1.01–1.14]). Interestingly, the belief in COVID-19 vaccine effectiveness reduced OCV hesitancy by 24% (aPR = 0.76, 95%CI [0.62–0.93]). COVID-19 vaccine hesitancy and its drivers exhibited a significant domino effect on OCV uptake. Addressing vaccine hesitancy through community-based health literacy and trust-building interventions would likely improve the introduction of novel non-COVID-19 vaccines in the post-COVID-19 era.

ABSTRACT: Objectives: We used whole-genome sequencing of SARS-CoV-2 to identify variants circulating in the Democratic Republic of the Congo and obtain molecular information useful for diagnosis, improving treatment, and general pandemic control strategies. Methods: A total of 74 SARS-CoV-2 isolates were sequenced using Oxford Nanopore platforms. Generated reads were processed to obtain consensus genome sequences. Sequences with more than 80% genome coverage were used for variant calling, phylogenetic analysis, and classification using Pangolin lineage annotation nomenclature. Results: Phylogenetic analysis based on Pangolin classification clustered South Kivu sequences into seven lineages (A.23.1, B.1.1.6, B.1.214, B.1.617.2, B.1.351, C.16, and P.1). The Delta (B.1.617.2) variant was the most dominant and responsible for outbreaks during the third wave. Based on the Wuhan reference genome, 289 distinct mutations were detected, including 141 missenses, 123 synonymous, and 25 insertions/deletions when our isolates were mapped to the Wuhan reference strain. Most of these point mutations were located within the coding sequences of the SARS-CoV-2 genome that includes spike, ORF1ab, ORF3, and nucleocapsid protein genes. The most common mutation was D614G (1841A>G) observed in 61 sequences, followed by L4715L (14143 C>T) found in 60 sequences. Conclusion: Our findings highlight multiple introductions of SARS-CoV-2 into South Kivu through different sources and subsequent circulation of variants in the province. These results emphasize the importance of timely monitoring of genetic variation and its effect on disease severity. This work set a foundation for the use of genomic surveillance as a tool for future global pandemic management and control.

BackgroundFew studies have assessed the relationship between weight-for-height (WHZ) and mid-upper arm circumference (MUAC) with hospital mortality considering confounders. The particularity of MUAC for age (MUACZ) is less documented.ObjectiveThis study aims to investigate this relationship in a region endemic for severe acute malnutrition (SAM).MethodsThis is a retrospective cohort based on a database of children admitted from 1987 to 2008 in South Kivu, eastern DRC. Our outcome was hospital mortality. To estimate the strength of the association between mortality and nutritional indices, the relative risk (RR) with its 95% confidence interval (95% CI) was calculated. In addition to univariate analyses, we constructed multivariate models from binomial regression.ResultsA total of 9,969 children aged 6 to 59 months were selected with a median age of 23 months. 40.9% had SAM (according to the criteria WHZ

• The Pangolin classification clustered the South Kivu sequences into seven lineages. • The Delta variant is responsible for COVID-19 outbreaks during the third wave. • D614G is the most frequent mutation observed, followed by L4715L. • There are multiple introductions of SARS-CoV-2 and subsequent circulating variants. We used whole-genome sequencing of SARS-CoV-2 to identify variants circulating in the Democratic Republic of the Congo and obtain molecular information useful for diagnosis, improving treatment, and general pandemic control strategies. A total of 74 SARS-CoV-2 isolates were sequenced using Oxford Nanopore platforms. Generated reads were processed to obtain consensus genome sequences. Sequences with more than 80% genome coverage were used for variant calling, phylogenetic analysis, and classification using Pangolin lineage annotation nomenclature. Phylogenetic analysis based on Pangolin classification clustered South Kivu sequences into seven lineages (A.23.1, B.1.1.6, B.1.214, B.1.617.2, B.1.351, C.16, and P.1). The Delta (B.1.617.2) variant was the most dominant and responsible for outbreaks during the third wave. Based on the Wuhan reference genome, 289 distinct mutations were detected, including 141 missenses, 123 synonymous, and 25 insertions/deletions when our isolates were mapped to the Wuhan reference strain. Most of these point mutations were located within the coding sequences of the SARS-CoV-2 genome that includes spike, ORF1ab, ORF3, and nucleocapsid protein genes. The most common mutation was D614G (1841A>G) observed in 61 sequences, followed by L4715L (14143 C>T) found in 60 sequences. Our findings highlight multiple introductions of SARS-CoV-2 into South Kivu through different sources and subsequent circulation of variants in the province. These results emphasize the importance of timely monitoring of genetic variation and its effect on disease severity. This work set a foundation for the use of genomic surveillance as a tool for future global pandemic management and control. [ABSTRACT FROM AUTHOR]

Recent warfare in Eastern DRC, especially since 2015, is marked by violence inspired by 'race' narratives. Identity politics around 'race' is used to legitimise 'expressive' or reprisal-oriented violence against 'Hamitic' or 'Tutsi' minorities. The case of the Banyamulenge of South Kivu is examined in this article. Following Autesserre, we show that one-dimensional narratives – in this case of 'race' – tend to over-simplify the dynamics of political violence. Anti-Hamitic racism is derived from colonial ideas around race hierarchies, and has resulted in systematic killings of Banyamulenge civilians in what resembles a 'slow genocide'. Expressive violence has, in turn, produced a lack of concern for the plight of Banyamulenge civilians among the military, humanitarians, media, scholars and NGOs. Given armed alliances between local Maimai forces, Burundian and Rwandan opposition and the DRC army, such 'race' narratives cruelly legitimise violence against civilians from 'Tutsi' communities, associated by neighbouring communities with Rwanda. Resultant displacement, starvation and killing of Banyamulenge civilians in this context amount to an on-going, slow-moving genocide. As the COVID-19 crisis unrolls, the decolonisation of identity politics in Eastern DRC, and in South Kivu in particular still seems very remote. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the relationship of iron and zinc deficiencies and anemia in children aged under 5 years living in malaria endemic area of South Kivu/DRC. We conducted a cross-sectional study in the health zone of Miti Murhesa in South Kivu/DRC. A total of 1088 children in good general health were included in this study. Almost 40% of children were anemic. The prevalence of iron deficiency (ID) was found in 34.9% and 49.1% children based on ferritin or free erythrocyte protoporphyrin (FEP), respectively. If anemia is present, we found iron deficiency anemia (IDA) according to the WHO-criteria (ferritin) in 31%, and according to FEP in 66% of children. The overall prevalence of zinc deficiency was 17.6%. If anemia is present, zinc deficiency was found in 24.4% of children. Inflammation/infection, based upon CRP, was present in 39.7% children. The independent factors associated with anemia were recent illness, middle upper arm circumference, weight-for-height, ID according to FEP, zinc deficiency, and submicroscopic Plasmodium infection. A high prevalence of ID was observed in children in South Kivu according to FEP. Ferritin as acute phase protein was less suited in this population due to a high frequency of infection/inflammation. Iron and zinc deficiencies were found to be significantly associated with anemia in this population. [ABSTRACT FROM AUTHOR]

Abstract Background The eastern Democratic Republic of Congo (DRC) has experienced decades-long armed conflicts which have had a negative impact on population’s health. Most research in public health explores measures that focus on a specific health problem rather than overall population health status. The aim of this study was to assess the health status of the population and its predictors in conflict settings of South Kivu province, using the World Health Organization Disability Assessment Schedule (WHODAS). Methods Between May and June 2019, we conducted a community-based cross-sectional survey among 1440 adults in six health zones (HZ), classified according to their level of armed conflict intensity and chronicity in four types (accessible and stable, remote and stable, intermediate and unstable). The data were collected by a questionnaire including socio-demographic data and the WHODAS 2.0 tool with 12 items. The main variable of the study was the WHODAS summary score measuring individual’s health status and synthesize in six domains of disability (household, cognitive, mobility, self-care, social and society). Univariate analysis, correlation and comparison tests as well as hierarchical multiple linear regression were performed. Results The median WHODAS score in the accessible and stable (AS), remote and stable (RS), intermediate (I) and unstable (U) HZ was 6.3 (0–28.6); 25 (6.3–41.7); 22.9 (12.5–33.3) and 39.6 (22.9–54.2), respectively. Four of the six WHODAS domain scores (household, cognitive, mobility and society) were the most altered in the UHZs. The RSHZ and IHZ had statistically comparable global WHODAS scores. The stable HZs (accessible and remote) had statistically lower scores than the UHZ on all items. In regression analysis, the factors significantly associated with an overall poor health status (or higher WHODAS score) were advanced age, being woman, being membership of an association; being divorced, separated or widower and living in an unstable HZ. Conclusions Armed conflicts have a significantly negative impact on people’s perceived health, particularly in crisis health zones. In this area, we must accentuate actions aiming to strengthen people’s psychosocial well-being.

Abstract Background Suboptimal child nutrition remains the main factor underlying child undernutrition in Democratic Republic of Congo (DRC). This study aimed to assess the prevalence of minimum acceptable diet and associated factors among children aged 6–23 months old. Methods Community-based cross-sectional study including 742 mothers with children aged 6–23 months old was conducted in 2 Health Zones of South Kivu, Eastern DRC. WHO indicators of Infant and Young Child Feeding (IYCF) regarding complementary feeding practices were used. Logistic regression analysis was used to quantify the association between sociodemographic indicators and adequate minimum acceptable diet for both univariate and multivariate analysis. Results Overall, 33% of infants had minimum acceptable diet. After controlling for a wide range of covariates, residence urban area (AOR 2.39; 95% CI 1.43, 3.85), attendance postnatal care (AOR 1.68; 95% CI 1.12, 2.97), education status of mother (AOR 1.83; 95% CI 1.20, 2.77) and household socioeconomic status (AOR 1.72; 95% CI 1.14, 2.59) were factors positively associated with minimum acceptable diet. Conclusion Actions targeting these factors are expected to improve infant feeding practices in South Kivu.

Objective: The outbreak of coronavirus disease 2019 (COVID-19) in South Kivu, Democratic Republic of Congo raised concerns regarding additional morbidity and mortality. Updating these indicators before a second wave is essential in order to prepare for additional help. Methods: From mid-May to mid-December 2020, weekly surveys were undertaken in sampled streets from 10 health areas to quantify the use of barrier measures, and interview pedestrians about sickness and deaths in their households. Crude death rates (CDRs) were estimated. Results: Minimal use or no use of face masks was observed in at least half of the streets. From May to December 2020, the number of suspected cases of COVID-19 increased six-fold (P < 0.05). Of deaths within 30 days preceding the interviews, 20% were considered to be related to COVID-19. The monthly CDRs at the beginning and end of the study were approximately 5 and 25 per 1000 population, respectively (P < 0.05); that is, annual CDRs of 60 and 260 per 1000 population, respectively. Thus, during the first wave, the estimated mortality rate increased by 50% compared with previous years, and increased at least four-fold by the end of 2020. Conclusion: Despite possible overestimations, the excess mortality in South Kivu is extremely concerning. This crisis calls for a rapid response and increased humanitarian assistance.

Abstract Background African swine fever (ASF), a highly contagious hemorrhagic disease, affects domestic pigs in the Democratic Republic of Congo (DRC) where regular outbreaks are reported leading to high mortality rates approaching 100% in the affected regions. No study on the characteristics of the complete genome of strains responsible for ASF outbreaks in the South Kivu province of DRC is available, limited a better understanding of molecular evolution and spread of this virus within the country. The present study aimed at determining the complete genome sequence of ASFV strains genotype X involved in 2018–2019 ASF disease outbreaks in South Kivu province of DRC. Materials and methods Genomic DNA of a spleen sample from an ASFV genotype X-positive domestic pig in Uvira, during the 2018–2019 outbreaks in South Kivu, was sequenced using the Illumina HiSeq X platform. Obtained trimmed reads using Geneious Prime 2020.0.4 were blasted against a pig reference genome then contigs were generated from the unmapped reads enriched in ASFV DNA using Spades implemented in Geneious 2020.0.4. The assembly of the complete genome sequence of ASFV was achieved from the longest overlapping contigs. The new genome was annotated with the genome annotation transfer utility (GATU) software and the CLC Genomics Workbench 8 software was further used to search for any ORFs that failed to be identified by GATU. Subsequent analyses of the newly determined Uvira ASFV genotype X genome were done using BLAST for databases search, CLUSTAL W for multiple sequences alignments and MEGA X for phylogeny. Results 42 Gbp paired-end reads of 150 bp long were obtained containing about 0.1% of ASFV DNA. The assembled Uvira ASFV genome, termed Uvira B53, was 180,916 bp long that could be assembled in 2 contigs. The Uvira B53genome had a GC content of 38.5%, encoded 168 open reading frames (ORFs) and had 98.8% nucleotide identity with the reference ASFV genotype X Kenya 1950. The phylogenetic relationship with selected representative genomes clustered the Uvira B53 strain together with ASFV genotype X reported to date (Kenya 1950 and Ken05/Tk1). Multiple genome sequences comparison with the two reference ASFV genotype X strains showed that 130 of the 168 ORFs were fully conserved in the Uvira B53. The other 38 ORFs were divergent mainly due to SNPs and indels (deletions and insertions). Most of 46 multigene family (MGF) genes identified were affected by various genetic variations. However, 8 MGF ORFs present in Kenya 1950 and Ken05/Tk1 were absent from the Uvira B53 genome including three members of MGF 360, four of MGF 110 and one of MGF 100 while one MGF ORF (MGF 360-1L) at the left end of the genome was truncated in Uvira B53. Moreover, ORFs DP96R and p285L were also absent in the Uvira B53 genome. In contrast, the ORF MGF 110-5L present in Uvira B53 and Ken05/Tk1 was missing in Kenya 1950. The analysis of the intergenic region between the I73R and I329L genes also revealed sequence variations between the three genotype X strains mainly characterized by a deletion of 69 bp in Uvira B53 and 36 bp in Kenya 1950, compared to Ken05/Tk1. Assessment of the CD2v (EP402R) antigen unveiled the presence of SNPs and indels particularly in the PPPKPY tandem repeat region between selected variants representing the eight serogroups reported to date. Uvira B53 had identical CD2v variable region to the Uganda (KM609361) strain, the only other ASFV serogroup 7 reported to date. Conclusion We report the first complete genome sequence of an African swine fever virus (ASFV) p72 genotype X and CD2v serogroup 7, termed Uvira B53. This study provides additional insights on genetic characteristics and evolution of ASFV useful for tracing the geographical spread of ASF and essential for improved design of control and management strategies against ASF.

A survey has been conducted in Bukavu on bovines imported in Democratic Republic of Congo from Rwanda to the public slaughterhouse of Bukavu, with the aim of identifying the Ixodidae ticks on their body. Thus, 1024 ticks have been collected on 300 cows for the entomological identification. Four species have been identified whose Boophilus decoloratus (44.4 %), Rhipicephalus appendiculatus (43.9 %), Amblyomma variegatum (11 %) and Ixodes thomasai (2 %). This last species being a new among those recognized in South Kivu. A charge to ticks of 6.5 has been observed at those bovines and the infestation rate has been significantly different in the 4 races, the Friesland (41.1 %) and Ankolé presented the superior values. The importation of cows in this part of the country from Rwanda is a real factor which conducts to the introduction of ticks and also diseases in Democratic Republic of Congo. Then being measures of heath control in the border must be sustained and reinforced for minimizing real risks.

Background: One third of patients in the Democratic Republic of Congo (DRC) do not use the formal health system to access healthcare. Aim: In this manuscript we analyse the therapeutic decisions of hypertensive and diabetic patients in rural eastern DRC and the reasons for these decisions. Setting: The study was conduct in two health zones (HZ) in South Kivu (Bagira and Walungu), DRC. Methods: A mixed-methods convergent study was conducted from November 2018 to December 2018. Quantitative data were collected using a questionnaire and qualitative data were collected using focus groups. The quantitative data were analysed using descriptive statistics and a Fischer exact test, while the qualitative data were analysed using thematic analysis. Results: Out of 382 subjects declaring a chronic pathology, hypertensives and diabetics represented 21.5% and 7.9%, respectively. Health facilities were the first therapeutic choice of the chronically affected persons. The alternative therapeutic choices found were the use of prayer rooms, consultation with traditional healers and self-medication. Poverty, ignorance, the pharmaceutical business, and the socio-cultural dimension of the disease are the main causes of alternative therapeutic choices for hypertensives and diabetics. Conclusion: To ensure appropriate care for patients with chronic diseases in rural areas, it is important to establish a bridge of regulated collaboration between the formal and informal health sector. [ABSTRACT FROM AUTHOR]

Abstract Background Insecurity has characterized the Eastern regions of the Democratic Republic of Congo for decades. Providing health services to sustain women’s and children’s health during protracted conflict is challenging. This mixed-methods case study aimed to describe how reproductive, maternal, newborn, child, adolescent health and nutrition (RMNCAH+N) services have been offered in North and South Kivu since 2000 and how successful they were. Methods We conducted a case study using a desk review of publicly available literature, secondary analysis of survey and health information system data, and primary qualitative interviews. The qualitative component provides insights on factors shaping RMNCAH+N design and implementation. We conducted 49 interviews with government officials, humanitarian agency staff and facility-based healthcare providers, and focus group discussions with community health workers in four health zones (Minova, Walungu, Ruanguba, Mweso). We applied framework analysis to investigate key themes across informants. The quantitative component used secondary data from nationwide surveys and the national health facility information system to estimate coverage of RMNCAH+N interventions at provincial and sub-provincial level. The association between insecurity on service provision was examined with random effects generalized least square models using health facility data from South Kivu. Results Coverage of selected preventive RMNCAH+N interventions seems high in North and South Kivu, often higher than the national level. Health facility data show a small negative association of insecurity and preventive service coverage within provinces. However, health outcomes are poorer in conflict-affected territories than in stable ones. The main challenges to service provisions identified by study respondents are the availability and retention of skilled personnel, the lack of basic materials and equipment as well as the insufficient financial resources to ensure health workers’ regular payment, medicaments’ availability and facilities’ running costs. Insecurity exacerbates pre-existing challenges, but do not seem to represent the main barrier to service provision in North and South Kivu. Conclusions Provision of preventive schedulable RMNCAH+N services has continued during intermittent conflict in North and South Kivu. The prolonged effort by non-governmental organizations and UN agencies to respond to humanitarian needs was likely key in maintaining intervention coverage despite conflict. Health actors and communities appear to have adapted to changing levels and nature of insecurity and developed strategies to ensure preventive services are provided and accessed. However, emergency non-schedulable RMNCAH+N interventions do not appear to be readily accessible. Achieving the Sustainable Development Goals will require increased access to life-saving interventions, especially for newborn and pregnant women.

Background: The eastern Democratic Republic of Congo (DRC) has experienced decades-long armed conflicts which have had a negative impact on population's health. Most research in public health explores measures that focus on a specific health problem rather than overall population health status. The aim of this study was to assess the health status of the population and its predictors in conflict settings of South Kivu province, using the World Health Organization Disability Assessment Schedule (WHODAS). Methods: Between May and June 2019, we conducted a community-based cross-sectional survey among 1440 adults in six health zones (HZ), classified according to their level of armed conflict intensity and chronicity in four types (accessible and stable, remote and stable, intermediate and unstable). The data were collected by a questionnaire including socio-demographic data and the WHODAS 2.0 tool with 12 items. The main variable of the study was the WHODAS summary score measuring individual's health status and synthesize in six domains of disability (household, cognitive, mobility, self-care, social and society). Univariate analysis, correlation and comparison tests as well as hierarchical multiple linear regression were performed. Results: The median WHODAS score in the accessible and stable (AS), remote and stable (RS), intermediate (I) and unstable (U) HZ was 6.3 (0–28.6); 25 (6.3–41.7); 22.9 (12.5–33.3) and 39.6 (22.9–54.2), respectively. Four of the six WHODAS domain scores (household, cognitive, mobility and society) were the most altered in the UHZs. The RSHZ and IHZ had statistically comparable global WHODAS scores. The stable HZs (accessible and remote) had statistically lower scores than the UHZ on all items. In regression analysis, the factors significantly associated with an overall poor health status (or higher WHODAS score) were advanced age, being woman, being membership of an association; being divorced, separated or widower and living in an unstable HZ. Conclusions: Armed conflicts have a significantly negative impact on people's perceived health, particularly in crisis health zones. In this area, we must accentuate actions aiming to strengthen people's psychosocial well-being. [ABSTRACT FROM AUTHOR]

Background: Suboptimal child nutrition remains the main factor underlying child undernutrition in Democratic Republic of Congo (DRC). This study aimed to assess the prevalence of minimum acceptable diet and associated factors among children aged 6-23 months old.Methods: Community-based cross-sectional study including 742 mothers with children aged 6-23 months old was conducted in 2 Health Zones of South Kivu, Eastern DRC. WHO indicators of Infant and Young Child Feeding (IYCF) regarding complementary feeding practices were used. Logistic regression analysis was used to quantify the association between sociodemographic indicators and adequate minimum acceptable diet for both univariate and multivariate analysis.Results: Overall, 33% of infants had minimum acceptable diet. After controlling for a wide range of covariates, residence urban area (AOR 2.39; 95% CI 1.43, 3.85), attendance postnatal care (AOR 1.68; 95% CI 1.12, 2.97), education status of mother (AOR 1.83; 95% CI 1.20, 2.77) and household socioeconomic status (AOR 1.72; 95% CI 1.14, 2.59) were factors positively associated with minimum acceptable diet.Conclusion: Actions targeting these factors are expected to improve infant feeding practices in South Kivu. [ABSTRACT FROM AUTHOR]

Aim: This study was conducted to assess the prevalence of calf fetal wastage and its economic implications at ELAKAT slaughterhouse, Bukavu, Democratic Republic of Congo (DR Congo) to fill the research gap in relationship with this thematic. The study investigations took place from May to September 2018. Materials and Methods: A cross-sectional survey was carried at the slaughterhouse. For each visit, the number of cattle slaughtered, the number of pregnant cows slaughtered, and gestational ages (stage of pregnancy of the dam, and estimated by crown-rump length) of the fetuses were recorded. Results: Out of the 1035 cattle slaughtered during the study period, 970 were females. A total of 255 fetuses were recovered, representing a fetal recovery rate of 26.28%. The study established that one fetus was lost out of 4.5 cows slaughtered, and most of fetuses recovered (58.1%) were in the first trimester of gestation while 29.1% and 12.8% were, respectively, in the second and third trimester. Their age varied from 1.2 to 8.6 months, with body length ranging from 14 cm to 92 cm while their weight varied from 1.0 kg to 23.0 kg. The economic loss associated with the total cattle fetal wastages was estimated at Congo Democratic Francs (CDF) 29,906,400 ($15,787.5) with a monthly average of CDF 5,981,280 ($3,157.5). Conclusion: These results attested that slaughtering pregnant cows constitute a strong constraint on cattle industry development in DR Congo. Urgent measures, such as adequate enforcement of legislations on routine veterinary examinations at slaughterhouses as well as livestock owner's sensitization, are required to avoid selling pregnant cows during calving season.

• The outbreak of COVID-19 in South Kivu raised concern about increased morbidity and mortality. • Little or no use of face masks was noted in at least half of the streets observed. • The number of suspected cases of COVID-19 increased six-fold. • The estimated mortality rate increased at least four-fold by the end of 2020 compared with the first wave. • The excess mortality in South Kivu is extremely concerning. The outbreak of coronavirus disease 2019 (COVID-19) in South Kivu, Democratic Republic of Congo raised concerns regarding additional morbidity and mortality. Updating these indicators before a second wave is essential in order to prepare for additional help. From mid-May to mid-December 2020, weekly surveys were undertaken in sampled streets from 10 health areas to quantify the use of barrier measures, and interview pedestrians about sickness and deaths in their households. Crude death rates (CDRs) were estimated. Minimal use or no use of face masks was observed in at least half of the streets. From May to December 2020, the number of suspected cases of COVID-19 increased six-fold (P < 0.05). Of deaths within 30 days preceding the interviews, 20% were considered to be related to COVID-19. The monthly CDRs at the beginning and end of the study were approximately 5 and 25 per 1000 population, respectively (P < 0.05); that is, annual CDRs of 60 and 260 per 1000 population, respectively. Thus, during the first wave, the estimated mortality rate increased by 50% compared with previous years, and increased at least four-fold by the end of 2020. Despite possible overestimations, the excess mortality in South Kivu is extremely concerning. This crisis calls for a rapid response and increased humanitarian assistance. [ABSTRACT FROM AUTHOR]

This paper sets out to explore sexual violence in armed conflict from the perspective of the combatants themselves. We interviewed combatants in South Kivu in eastern DRC about their experiences with sexual violence, what they think causes it, and how it might be mitigated. Although respondents in this study strongly believe that sexual violence is a serious crime and an immoral act which should be avoided in their ranks, they sometimes perpetrate it systematically, suggesting a disconnect between their good soldiering ideals and own actions. Combatants report that they want to protect women and men in armed conflicts, but the contexts in which they operate lead them, contrary to their wishes, to behave violently against the civilians they are supposed to protect. To mitigate sexual violence in armed conflicts they propose improving their socioeconomic conditions, getting rid of militias and uniting the Congolese army, punishing perpetrators and adequately training new soldiers joining the united army. [ABSTRACT FROM AUTHOR]

Reform and Performance of the Provincial Health Inspectorate and the Provincial Division of Health of South Kivu in the Democratic Republic of Congo. Background: The intermediate level incorporated both the Provincial Health Inspectorate (IPS) and the Provincial Health Division (DPS) of Health. The new constitution of 2006 gave impetus to decentralisation, which became effective in 2015. The reform introduced at the intermediate level clearly separated the IPS and the DPS. This article assesses the effect of this reform on the performance of IPS and DPS in South Kivu, Democratic Republic of Congo. Methodology: The study is evaluative before and after and covers the period from 2012 to 2017. It uses mixed methods: three techniques were used to collect data including observation, document review and individual interviews. The analysis of the quantitative data concerned the evolution of the indicators; that of qualitative data was carried out by themes from two theoretical models: the ministerial functional framework and the ‘Strengths, Weaknesses, Opportunities and Threats’ analysis framework (SWOT analysis). Scores were assigned to each managerial function according to their level of performance for better comparison. Results: After the reform, a decline in the performance score of activities devolved to IPS is noted, mainly due to the low funding of activities. On the other hand, in the DPS, the evolution of the score is favorable, because of the strong support given to the reform at this level by the partners and the government. The alignment of partners to a single contract for funding DPS activities is observed. The weak financing of the health sector by the government remains a weak point, however, and the brain drain a threat to institutional sustainability. The introduction of the single financing contract constitutes an opportunity to improve the performance of the provincial management team. Discussion and Conclusion: The study shows the improvement in the performance of managerial functions of the DPS and the regression to the IPS. The low funding of IPS by the Congolese government could jeopardise the reform.

Background: The disruptive effect of protracted socio-political instability and conflict on the health systems is likely to exacerbate inequities in health service utilisation in conflict-recovering contexts. Objective: To examine whether the level of healthcare need is associated with health facility utilisation in post-conflict settings. Methods: We conducted a cross-sectional study among adults with diabetes, hypertension, mothers of infants with acute malnutrition, informal caregivers (of participants with diabetes and hypertension) and helpers of mothers of children acutely malnourished, and randomly selected neighbours in South Kivu province, eastern DR Congo. Healthcare need levels were derived from a combination, summary and categorisation of the World Health Organisation Disability Assessment Schedule 2.0. Health facility utilisation was defined as having utilised in the first resort a health post, a health centre or a hospital as opposed to self-medication, traditional herbs or prayer homes during illness in the past 30 days. We used mixed-effects Poisson regression models with robust variance to identify the factors associated with health facility utilisation. Results: Overall, 82% (n = 413) of the participants (N = 504) utilised modern health facilities. Health facility utilisation likelihood was higher by 27% [adjusted prevalence ratio (aPR): 1.27; 95% CI: 1.13–1.43; p

Background: African swine fever (ASF), a highly contagious hemorrhagic disease, affects domestic pigs in the Democratic Republic of Congo (DRC) where regular outbreaks are reported leading to high mortality rates approaching 100% in the affected regions. No study on the characteristics of the complete genome of strains responsible for ASF outbreaks in the South Kivu province of DRC is available, limited a better understanding of molecular evolution and spread of this virus within the country. The present study aimed at determining the complete genome sequence of ASFV strains genotype X involved in 2018–2019 ASF disease outbreaks in South Kivu province of DRC. Materials and methods: Genomic DNA of a spleen sample from an ASFV genotype X-positive domestic pig in Uvira, during the 2018–2019 outbreaks in South Kivu, was sequenced using the Illumina HiSeq X platform. Obtained trimmed reads using Geneious Prime 2020.0.4 were blasted against a pig reference genome then contigs were generated from the unmapped reads enriched in ASFV DNA using Spades implemented in Geneious 2020.0.4. The assembly of the complete genome sequence of ASFV was achieved from the longest overlapping contigs. The new genome was annotated with the genome annotation transfer utility (GATU) software and the CLC Genomics Workbench 8 software was further used to search for any ORFs that failed to be identified by GATU. Subsequent analyses of the newly determined Uvira ASFV genotype X genome were done using BLAST for databases search, CLUSTAL W for multiple sequences alignments and MEGA X for phylogeny. Results: 42 Gbp paired-end reads of 150 bp long were obtained containing about 0.1% of ASFV DNA. The assembled Uvira ASFV genome, termed Uvira B53, was 180,916 bp long that could be assembled in 2 contigs. The Uvira B53genome had a GC content of 38.5%, encoded 168 open reading frames (ORFs) and had 98.8% nucleotide identity with the reference ASFV genotype X Kenya 1950. The phylogenetic relationship with selected representative genomes clustered the Uvira B53 strain together with ASFV genotype X reported to date (Kenya 1950 and Ken05/Tk1). Multiple genome sequences comparison with the two reference ASFV genotype X strains showed that 130 of the 168 ORFs were fully conserved in the Uvira B53. The other 38 ORFs were divergent mainly due to SNPs and indels (deletions and insertions). Most of 46 multigene family (MGF) genes identified were affected by various genetic variations. However, 8 MGF ORFs present in Kenya 1950 and Ken05/Tk1 were absent from the Uvira B53 genome including three members of MGF 360, four of MGF 110 and one of MGF 100 while one MGF ORF (MGF 360-1L) at the left end of the genome was truncated in Uvira B53. Moreover, ORFs DP96R and p285L were also absent in the Uvira B53 genome. In contrast, the ORF MGF 110-5L present in Uvira B53 and Ken05/Tk1 was missing in Kenya 1950. The analysis of the intergenic region between the I73R and I329L genes also revealed sequence variations between the three genotype X strains mainly characterized by a deletion of 69 bp in Uvira B53 and 36 bp in Kenya 1950, compared to Ken05/Tk1. Assessment of the CD2v (EP402R) antigen unveiled the presence of SNPs and indels particularly in the PPPKPY tandem repeat region between selected variants representing the eight serogroups reported to date. Uvira B53 had identical CD2v variable region to the Uganda (KM609361) strain, the only other ASFV serogroup 7 reported to date. Conclusion: We report the first complete genome sequence of an African swine fever virus (ASFV) p72 genotype X and CD2v serogroup 7, termed Uvira B53. This study provides additional insights on genetic characteristics and evolution of ASFV useful for tracing the geographical spread of ASF and essential for improved design of control and management strategies against ASF. [ABSTRACT FROM AUTHOR]

Background: Insecurity has characterized the Eastern regions of the Democratic Republic of Congo for decades. Providing health services to sustain women's and children's health during protracted conflict is challenging. This mixed-methods case study aimed to describe how reproductive, maternal, newborn, child, adolescent health and nutrition (RMNCAH+N) services have been offered in North and South Kivu since 2000 and how successful they were. Methods: We conducted a case study using a desk review of publicly available literature, secondary analysis of survey and health information system data, and primary qualitative interviews. The qualitative component provides insights on factors shaping RMNCAH+N design and implementation. We conducted 49 interviews with government officials, humanitarian agency staff and facility-based healthcare providers, and focus group discussions with community health workers in four health zones (Minova, Walungu, Ruanguba, Mweso). We applied framework analysis to investigate key themes across informants. The quantitative component used secondary data from nationwide surveys and the national health facility information system to estimate coverage of RMNCAH+N interventions at provincial and sub-provincial level. The association between insecurity on service provision was examined with random effects generalized least square models using health facility data from South Kivu. Results: Coverage of selected preventive RMNCAH+N interventions seems high in North and South Kivu, often higher than the national level. Health facility data show a small negative association of insecurity and preventive service coverage within provinces. However, health outcomes are poorer in conflict-affected territories than in stable ones. The main challenges to service provisions identified by study respondents are the availability and retention of skilled personnel, the lack of basic materials and equipment as well as the insufficient financial resources to ensure health workers' regular payment, medicaments' availability and facilities' running costs. Insecurity exacerbates pre-existing challenges, but do not seem to represent the main barrier to service provision in North and South Kivu. Conclusions: Provision of preventive schedulable RMNCAH+N services has continued during intermittent conflict in North and South Kivu. The prolonged effort by non-governmental organizations and UN agencies to respond to humanitarian needs was likely key in maintaining intervention coverage despite conflict. Health actors and communities appear to have adapted to changing levels and nature of insecurity and developed strategies to ensure preventive services are provided and accessed. However, emergency non-schedulable RMNCAH+N interventions do not appear to be readily accessible. Achieving the Sustainable Development Goals will require increased access to life-saving interventions, especially for newborn and pregnant women. [ABSTRACT FROM AUTHOR]

Prospective, community‐based surveillance systems for measuring birth, death, and population movement rates may have advantages over the 'gold‐standard' retrospective household survey in humanitarian contexts. A community‐based, monthly surveillance system was established in South Kivu, Democratic Republic of the Congo, in partnership with a local implementing partner and the national ministry of health. Data were collected on the occurrence of births, deaths, arrivals, and departures over the course of one year, and a retrospective survey was conducted at the end of the period to validate the information. Discrepancies between the two approaches were resolved by a third visit to the households with discordant records. The study found that the surveillance system was superior in terms of its specificity and sensitivity in measuring crude mortality and birth rates as compared to the survey, demonstrating the method's potential to measure accurately important population‐level health metrics in an insecure setting in a timely, community‐acceptable manner. [ABSTRACT FROM AUTHOR]

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Background: The disruptive effect of protracted socio-political instability and conflict on the health systems is likely to exacerbate inequities in health service utilisation in conflict-recovering contexts. Objective: To examine whether the level of healthcare need is associated with health facility utilisation in post-conflict settings. Methods: We conducted a cross-sectional study among adults with diabetes, hypertension, mothers of infants with acute malnutrition, informal caregivers (of participants with diabetes and hypertension) and helpers of mothers of children acutely malnourished, and randomly selected neighbours in South Kivu province, eastern DR Congo. Healthcare need levels were derived from a combination, summary and categorisation of the World Health Organisation Disability Assessment Schedule 2.0. Health facility utilisation was defined as having utilised in the first resort a health post, a health centre or a hospital as opposed to self-medication, traditional herbs or prayer homes during illness in the past 30 days. We used mixed-effects Poisson regression models with robust variance to identify the factors associated with health facility utilisation. Results: Overall, 82% (n = 413) of the participants (N = 504) utilised modern health facilities. Health facility utilisation likelihood was higher by 27% [adjusted prevalence ratio (aPR): 1.27; 95% CI: 1.13–1.43; p < 0.001] and 18% (aPR: 1.18; 95% CI: 1.06–1.30; p = 0.002) among participants with middle and higher health needs, respectively, compared to those with low healthcare needs. Using the lowest health need cluster as a reference, participants in the middle healthcare need cluster tended to have a higher hospital utilisation level. Conclusion: Greater reported healthcare need was significantly associated with health facility utilisation. Primary healthcare facilities were the first resort for a vast majority of respondents. Improving the availability and quality of health service packages at the primary healthcare level is necessary to ensure the universal health coverage goal advocating quality health for all can be achieved in post-conflict settings. [ABSTRACT FROM AUTHOR]

Reform and Performance of the Provincial Health Inspectorate and the Provincial Division of Health of South Kivu in the Democratic Republic of Congo. Background: The intermediate level incorporated both the Provincial Health Inspectorate (IPS) and the Provincial Health Division (DPS) of Health. The new constitution of 2006 gave impetus to decentralisation, which became effective in 2015. The reform introduced at the intermediate level clearly separated the IPS and the DPS. This article assesses the effect of this reform on the performance of IPS and DPS in South Kivu, Democratic Republic of Congo. Methodology: The study is evaluative before and after and covers the period from 2012 to 2017. It uses mixed methods: three techniques were used to collect data including observation, document review and individual interviews. The analysis of the quantitative data concerned the evolution of the indicators; that of qualitative data was carried out by themes from two theoretical models: the ministerial functional framework and the 'Strengths, Weaknesses, Opportunities and Threats' analysis framework (SWOT analysis). Scores were assigned to each managerial function according to their level of performance for better comparison. Results: After the reform, a decline in the performance score of activities devolved to IPS is noted, mainly due to the low funding of activities. On the other hand, in the DPS, the evolution of the score is favorable, because of the strong support given to the reform at this level by the partners and the government. The alignment of partners to a single contract for funding DPS activities is observed. The weak financing of the health sector by the government remains a weak point, however, and the brain drain a threat to institutional sustainability. The introduction of the single financing contract constitutes an opportunity to improve the performance of the provincial management team. Discussion and Conclusion: The study shows the improvement in the performance of managerial functions of the DPS and the regression to the IPS. The low funding of IPS by the Congolese government could jeopardise the reform. [ABSTRACT FROM AUTHOR]

Cassava mosaic disease (CMD) is reported as the most important constraint on cassava production in Sub­Saharan Africa. Yield losses of 25­95% are reported. The use of resistant genotypes is one of the components for its integrated management. However its impact on genotype behavior depends on infection period, age of the infected plants, environment and virus species or strain. This study was carried out to assess its impact in farmers' fields and the behavior of 14 genotypes under high epidemic pressure in the Sud­Kivu province, in the East of Democratic Republic of Congo (DRC). Early infections have induced 77.5% to 97.3% of yield losses whereas 44.9 to 80% were recorded for cassava plants infected during thirteenth to twenty­fourth weeks after planting. The highest yield losses were recorded in low altitude where more EACMV­UG and dual infections were reported. Improved resistant genotypes MM96/002, MM96/0157 and MM96/1920 allowed harvesting more than 30 T/ha and didn't show any symptoms whereas MM96/6967 and Mvuama have developed symptoms at harvest. Local landraces were susceptible to CMD and developed symptoms during the whole season until harvest. However two of them, Pharmakina and Cizinduka yielded more than 50 T/ha of tubers and associated symptoms were moderate. Two improved and two local cassava genotypes are recommended in this area always making sure to use healthy cuttings.

In the eastern Democratic Republic of the Congo there are several support programmes for sexual violence survivors, but their impacts are rarely systematically assessed. We investigated the effects for women from two support programmes that include both survivors of sexual and gender-based violence (SGBV) and others. Specifically, we estimated (1) the effect of SGBV on social exclusion and economic well-being, and (2) the effects of support programmes on social exclusion and economic well-being, as well as differential effects for SGBV survivors and others. Based on an original survey of 1,203 women, we found that survivors felt less included across various social settings, but their economic well-being was no different than that of other women. We also found that support programmes significantly improve both perceived social inclusion and economic well-being for survivors and non-survivors. The effects on economic well-being were larger for survivors. In conclusion, these support programmes brought important benefits to survivors and non-survivors alike, although there is potential for improvement, particularly on social inclusion for SGBV survivors. [ABSTRACT FROM AUTHOR]

Summary Savings group (SG) models are praised for achieving financial inclusion for the poorest at a very low cost. Promoted by international NGOs, SG models are inspired by indigenous savings and credit associations (ROSCAs). SG models however differ in that they prescribe lending the pooled savings to group members for an interest. The interest rate aims to (1) boost capital accumulation, (2) allocate scarce capital efficiently, and (3) remunerate and incentivize savers. This paper builds on a six-month fieldwork conducted in DR Congo consisting of direct observations of SG meetings and interviews with SG participants and practitioners. We study the gaps between SG practitioners’ objectives and SG participants’ perceptions and practices related to the interest rate. Our research pays particular attention to the local context and local norms that interfere with SG practitioners’ objectives. Our analysis highlights three gaps. First, SG participants turn savings into credit for security purposes rather for rapid capital accumulation. Second, credit allocation decisions are guided by fairness and security concerns rather than efficiency. Third, SG participants often regard the accumulated interest as belonging to the group and to active borrowers rather than to passive savers. Our results invite development actors to pay greater attention to the potential risks of the SG approach for its participants. Despite the common appellation “savings groups”, this microfinance innovation builds upon credit and strongly encourages its members to go into debt. [ABSTRACT FROM AUTHOR]

Introduction: Prolonged waiting times for medical consultations become a factor in patient dissatisfaction. This study aimed to measure the waiting times for medical consultation and to identify the causes and the consequences from the perspective of improvement of the organisation of medical services. Methods: We conducted a cross-sectional descriptive study at the General Provincial Reference hospital in Bukavu and at the Biopharm Hospital Center. Data were collected using a literature review, the monitoring of the waiting times and individual interviews of patients and care providers. Quantitative data analysis was accomplished using Epi Info 7.2.0.1.software. Qualitative data were analyzed searching for themes. Results: More than 70% of patients in 3 major Departments at the General Provincial Reference Hospital in Bukavu waited more than 30 minutes before being seen. More than 40% of patients in the 4 major Departments at the Biopharm Hospital Center waited between 0 and 15 minutes. In the Department of Gynecology and Obstetrics at the General Provincial Reference hospital in Bukavu 56% of patients had shorter waiting times (0-15 minutes). The two main causes of prolonged wait times included administrative burden of medical services and physicians delay. Serious implications included a reduction in attendance, in medicinal recipes as well as patients' fatigue. The availability of qualified health staff, the computerization of hospital services and continuous staff training are priorities to reduce waiting times. Conclusion: Waiting times vary from one hospital to another and from one department to another within the same hospital, depending on several factors. This study describes possible measures for improvement of waiting times for medical consultations. [ABSTRACT FROM AUTHOR]