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BACKGROUND: Malnutrition is identified as a risk-factor for insufficient polioseroconversion in the context of a vaccine-derived polio virus (VDPV) outbreak prone region. To assess the prevalence of malnutrition and its link to poliovirus insufficient immunity, a cross-sectional household survey was conducted in the regions of Haut- Lomami and Tanganyika, DRC. METHODS: In March 2018, we included 968 healthy children aged 6 to 59 months from eight out of 27 districts. Selection of study locations within these districts was done using a stratified random sampling method, where villages were chosen based on habitat characteristics identified from satellite images. Consent was obtained verbally in the preferred language of the participant (French or Swahili) by interviewers who received specific training for this task. Furthermore, participants contributed a dried blood spot sample, collected via finger prick. To assess malnutrition, we measured height and weight, applying WHO criteria to determine rates of underweight, wasting, and stunting. The assessment of immunity to poliovirus types 1, 2, and 3 through the detection of neutralizing antibodies was carried out at the CDC in Atlanta, USA. RESULTS: Of the study population, we found 24.7% underweight, 54.8% stunted, and 15.4% wasted. With IC95%, underweight (OR=1.50; [1.11-2.03]), and the non-administration of vitamin A (OR=1.96; [1.52-2.54]) were significantly associated with seronegativity to polioserotype 1. Underweight (OR=1.64; [1.20-2.24]) and the non-administration of vitamin A (OR=1.55; [1.20-2.01]) were significantly associated with seronegativity to polioserotype 2. Underweight (OR=1.50; [1.11-2.03]), and the non-administration of vitamin A (OR=1.80. [1.38-2.35]) were significantly associated with seronegativity to polioserotype 3. Underweight (OR=1.68; IC95% [1.10-2.57]) and the non-administration of vitamin A (OR=1.82; IC95% [1.30-2.55]) were significantly associated with seronegativity to all polioserotypes. CONCLUSION: This study reveals a significant association between underweight and polioseronegativity in children. In order to reduce vaccine failures in high-risk areas, an integrated approach by vaccination and nutrition programs should be adopted.

Purpose: This study aims to identify the main challenges to achieving humanitarian logistics in the context of United Nations peace missions in sub-Saharan Africa and to present suggestions for overcoming the logistical gaps encountered. Design/methodology/approach: The methodological approach of the work focuses on the comparative case study of the United Nations Mission in South Sudan, the United Nations Multidimensional Integrated Stabilisation Mission in the Central African Republic and The United Nations Organisation Stabilisation Mission in the Democratic Republic of Congo from 2014 to 2021. The approach combined a systematic literature review with the authors' empirical experience as participant observers in each mission, combining theory and practice. Findings: As a result, six common challenges were identified for carrying out humanitarian logistics in the three peace missions. Each challenge revealed a logistical gap for which an appropriate solution was suggested based on the best practices found in the case study of each mission. Research limitations/implications: This paper presents limitations when addressing the logistical analysis based on only three countries under the UN mission as a case study, as well as conceiving that certain flaws in the system, in the observed period, are already in the process of correction with the adoption of the 2016–2021 strategy by the UN Global Logistic Cluster. The authors suggest that further studies can be carried out by expanding the number of cases or using countries where other bodies (AU, NATO or EU) work. Originality/value: To the best of the authors' knowledge, this study is the first comparative case study of humanitarian logistics on the three principal missions of the UN conducted by academics and practitioners. [ABSTRACT FROM AUTHOR]

Benthic macroinvertebrate abundance and taxa richness associated with environmental variables were monitored monthly from September 2015 to August 2016 in the Nyamuhinga River. The benthic macroinvertebrate samples were collected using a D-frame aquatic net employing the man-time method. Environmental variables including pH, temperature, conductivity, and total dissolved solids (TDS) were measured using a Combo HI 98129 and GREISIN-GER 020 multimeters, and water flow was assessed using the Float Method procedure. The Shannon–Wiener and equitability indices were then calculated to assess diversity and richness, facilitating the comparison of diversity within sites or stations. A total of 35,142 macroinvertebrate individuals were collected from the 12 sampling sites belonging to 29 genera, 27 families, and 9 orders. Diptera were the most abundant (71.83%) followed by Odonata (9.13%) and Ephemeroptera (7.11%). The findings showed that taxa richness decreased from upstream to downstream. At the same time, absolute abundance increased from downstream to upstream due to riparian vegetation, substrate type, plant debris, and organic matter which are habitats for benthic macroinvertebrates in the river. Environmental variables such as flow, pH, temperature, conductivity, and TDS varied between sites and stations because of habitat disturbances, contaminant discharges into the catchment, and inflow of tributary waters into the river. The canonical correspondence analysis (CCA) results displayed that Eristalis and Chironomus were strongly associated with the flow, conductivity, TDS, temperature, and pH at the downstream sites related to anthropogenic activities from the catchment. From our results, the Nyamuhinga River needs conservation master plan/guidelines and increased awareness to reduce environmental impacts in Bukavu River catchments in the Lake Kivu basin. [ABSTRACT FROM AUTHOR]

Copyright of Cahiers d'Études Africaines is the property of Editions EHESS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The study describes the distribution of fish farming activities, identifies and characterizes the stakeholders involved, and assesses their level of knowledge and the techniques used for fish farming in the Territory of Mbanza-Ngungu. Furthermore, it proposes avenues to improve the sustainability and profitability of the sector. The methodology relied on a snowball approach to recruit a representative sample of 350 fish farmers. Field visits allowed for detailed data collection through a specially designed questionnaire. The data were analyzed using statistical methods (chi-square test of independence) to identify trends and challenges across the sectors of the territory of Mbanza-Ngungu. The findings revealed that fish farming activities are distributed across the territory of Mbanza-Ngungu, with a male predominance (96%) among fish farmers and a growing trend of this activity among older individuals over 40 years old (48%). Additionally, the results demonstrate that aquaculture is mainly a secondary activity for 97% of respondents, yet it could play a pivotal role in household economic diversification. The study identifies predominant practices, such as extensive farming (89%) and monoculture (92%), while highlighting gaps in pond management and fish farmers' general knowledge. Challenges are mainly related to feed access (28%), financing (27%), training (23%), and water quality monitoring (100%). The commercial orientation of production towards sales (94%) rather than self-consumption offers an opportunity to improve this sector in this territory. Finally, recommendations are made to enhance the sustainability and profitability of aquaculture in the region, including promoting integrated practices, more efficient pond management practices, and aquaculture product processing. [ABSTRACT FROM AUTHOR]

BACKGROUND: Low immunization coverage rates in the Democratic Republic of Congo (DRC) have been reflective of challenges with vaccine access, support and delivery in the country. Motivated by measles and vaccine-derived polio virus (VDPV) outbreaks in 2016-17 and low vaccination rates, the provinces of Haut Lomami and Tanganyika were identified as pilot locations for an innovative approach focused on establishing a consortium of partners supporting local government. This approach was formalized through Memorandums of Understanding (MoUs) between the Bill and Melinda Gates Foundation and Provincial governments in 2018. A third province, Lualaba, established an MoU in 2021. MOU IMPLEMENTATION: These MoUs were 5-year partnerships designed to aid provinces in meeting four key objectives: 80 % immunization coverage, management/elimination of polio/cVDPV outbreaks, improvement of vaccine accessibility, and transfer of immunization service management to provincial leadership. OUTCOMES: During the MoU period, Haut-Lomami saw an increase in full immunization coverage, from 35.7 % (MICS 2018) to 88.9 % (VCS 2021-22), the highest in country. A sharp drop in percentage of zero-dose children was observed in the 3 provinces, confirming improved access to immunization services. Tanganyika saw initial improvement in full immunization coverage, followed by a drop in the VCS 2021-22 due to COVID-19 and healthcare worker strikes. Coverage improved in Tanganyika in the 2023 VCS. The 3 provinces increased their financial contributions to routine immunization and are now the top contributing provinces. While no cVDPV cases were recorded in 2020 and 2021, cVDPV1 and cVDPV2 outbreaks are afflicting the 3 provinces since 2022. CONCLUSIONS: Ultimately, the provincial MoUs were successful in bolstering provincial autonomy and capacity building with the biggest success being a drop in zero-dose children. While not all objectives have been met, the MoU approach served as an innovative program for key aspects of strengthening routine immunization in the DRC.

Purpose: This study describes the experience with common neonatal surgical conditions and their outcomes at a single center in the Eastern Democratic Republic of the Congo (DRC) over a period of 7 years (2016–2022). Methods: A retrospective review of neonatal surgical admissions and their outcomes was performed for patient admitted between January 2016 and December 2022 at HEAL Africa teaching hospital. Data were collected from the neonatal admission and discharge registry for all patients with a potential surgical condition. Results: 107 neonates potentially requiring surgery were identified. 81.3% were referred from facilities within 10 km of HEAL Africa. The most common diagnosis was myelomeningocele/meningocele (27.1%). 68.2% of patients had an operation. The overall mortality was 29% for all patients and mean length of stay 9.9 days. Operated patients had a lower mortality at 16.4% (p-value < 0.001, OR 0.155, CI 0.062–0.389) while patients with a birth weight of less than 2500 g were more likely to die (p-value < 0.001, OR 5.333, CI 2.062–13.79). Conclusion: The neonatal mortality rate for patients presenting with a potential surgical condition is extremely high. This is multifactorial and largely related to patient selection inherent to resource limitations. [ABSTRACT FROM AUTHOR]

During the 2018–2020 Ebola virus disease outbreak in Democratic Republic of the Congo, a phase 3 trial of the Ad26.ZEBOV, MVA-BN-Filo Ebola vaccine (DRC-EB-001) commenced in Goma, with participants being offered the two-dose regimen given 56 days apart. Suspension of trial activities in 2020 due to the COVID-19 pandemic led to some participants receiving a late dose 2 outside the planned interval. Blood samples were collected from adults, adolescents, and children prior to their delayed dose 2 vaccination and 21 days after, and tested for IgG binding antibodies against Ebola virus glycoprotein using the Filovirus Animal Nonclinical Group (FANG) ELISA. Results from 133 participants showed a median two-dose interval of 9.3 months. The pre-dose 2 antibody geometric mean concentration (GMC) was 217 ELISA Units (EU)/mL (95% CI 157; 301) in adults, 378 EU/mL (281; 510) in adolescents, and 558 EU/mL (471; 661) in children. At 21 days post-dose 2, the GMC increased to 22,194 EU/mL (16,726; 29,449) in adults, 37,896 EU/mL (29,985; 47,893) in adolescents, and 34,652 EU/mL (27,906; 43,028) in children. Participants receiving a delayed dose 2 had a higher GMC at 21 days post-dose 2 than those who received a standard 56-day regimen in other African trials, but similar to those who received the regimen with an extended interval. [ABSTRACT FROM AUTHOR]

During the 2018–2020 Ebola virus disease (EVD) outbreak, residents in Goma, Democratic Republic of the Congo, were offered a two-dose prophylactic EVD vaccine. This was the first study to evaluate the safety of this vaccine in pregnant women. Adults, including pregnant women, and children aged ≥1 year old were offered the Ad26.ZEBOV (day 0; dose 1), MVA-BN-Filo (day 56; dose 2) EVD vaccine through an open-label clinical trial. In total, 20,408 participants, including 6635 (32.5%) children, received dose 1. Fewer than 1% of non-pregnant participants experienced a serious adverse event (SAE) following dose 1; one SAE was possibly related to the Ad26.ZEBOV vaccine. Of the 1221 pregnant women, 371 (30.4%) experienced an SAE, with caesarean section being the most common event. No SAEs in pregnant women were considered related to vaccination. Of 1169 pregnancies with a known outcome, 55 (4.7%) ended in a miscarriage, and 30 (2.6%) in a stillbirth. Eleven (1.0%) live births ended in early neonatal death, and five (0.4%) had a congenital abnormality. Overall, 188/891 (21.1%) were preterm births and 79/1032 (7.6%) had low birth weight. The uptake of the two-dose regimen was high: 15,328/20,408 (75.1%). The vaccine regimen was well-tolerated among the study participants, including pregnant women, although further data, ideally from controlled trials, are needed in this crucial group. [ABSTRACT FROM AUTHOR]

Background: Patients living with HIV (PLHIV) often face challenges that contribute to missed clinical care which can impact their health outcomes. Methods: This retrospective quantitative study comprised 5338 adults living with HIV who received antiretroviral treatment (ART) for 12 months, from July 2018 to June 2019 in Kinshasa and Haut-Katanga provinces of the Democratic Republic of Congo. Descriptive statistics were computed to show the level of missed appointments for ART. Multivariable associations of clinical and sociodemographic factors with a tendency to miss scheduled visits after adjusting for the covariates were examined using multivariable logistic regression analysis. Results: Six percent of PLHIV experienced at least one missed visit while 94% did not miss any visits. A small proportion (20%) of PLHIV had a viral load ≥1000 copies/mL. PLHIV receiving ART from urban clinics showed significantly higher odds of missed visits compared to those from rural areas (AOR = 4.18, 95% CI [1.84–9.511]; p < 0.0001). Similarly, patients from semi-rural/semi-urban clinics showed significantly higher odds of missed visits compared to those from rural areas. (AOR = 2.57, 95% CI [1.08–6.141]; p = 0.03). Additionally, older PLHIV (18–34 years old) demonstrated increased odds of missed visits (AOR= 1.71, 95% CI [1.0078–2.697]; p = 0.02) compared to those under 18 years old. Conclusions: The findings from this study strongly suggest that there is a significant association between certain demographic factors, such as age and rurality-urbanicity, and missed visits. The study findings have implications for policy and interventions targeting PLHIV at higher risk of missed visits. [ABSTRACT FROM AUTHOR]

This study critically examines the impact of indoor air quality (IAQ) on occupant health in two critical care units (ICUs) at Jason Sendwe Hospital (JSH) and General Carrier de Mine Hospital (GCMH) within the Southern DRC metropolitan area, focusing on their impact on occupant health and well-being. Utilizing a mixed methods approach that includes health questionnaires, continuous environmental monitoring (monitoring CO2, VOCs, PM2.5, PM10, temperature, and relative humidity), and computational fluid dynamics (CFD) analysis, this research aims to identify correlations between environmental factors and the health of hospital staff and patients. The investigation was conducted across both the rainy and dry seasons, revealing significant seasonal variations in IEQ parameters and exploring the incidence of symptoms commonly associated with sick building syndrome among hospital staff. Higher CO2, VOCs, and particulate matter levels during the dry season indicated the inadequacy of current ventilation strategies to maintain optimal air quality. This study proposes the implementation of air filtration and purification systems and the refurbishment of natural ventilation systems as effective measures to improve IAQ. Additionally, alternative ventilation strategies, including occupancy reduction and the integration of supply and exhaust ventilation, were explored to address the challenges of inadequate ventilation. The findings reveal the urgent need for hospitals to adopt ventilation strategies that ensure the health and well-being of occupants, highlighting the importance of continuous IAQ monitoring, community engagement, and the integration of advanced ventilation technologies in healthcare settings. This comprehensive exploration offers valuable insights for improving ventilation in ICUs, contributing to creating healthier indoor environments in hospital settings, especially in regions facing unique environmental challenges. [ABSTRACT FROM AUTHOR]

Introduction: Traditional, complementary and alternative medicine (TCAM) providers are central for many when seeking healthcare. Internally Displaced Persons (IDPs) are no exception. This paper seeks to better understand the use of TCAM by IDPs and its connection with the local integration of IDPs into the social fabric of the communities where they have taken refuge. We compare IDPs and non-IDPs access to TCAM providers and their level of confidence in having their healthcare needs met by these sources in Uvira and Kabare territories of South Kivu, Democratic Republic of Congo (DRC). Methods: We draw from a mixed method, social connections design comprised of participatory workshops with 111 participants; a survey with 847 participants capturing exploring access and trust of TCAM and other wealth and demographic indicators; 24 interviews with traditional healthcare providers; and 56 in-depth life history interviews with IDPs. Collected data were analysed using both qualitative and quantitative approaches. Descriptive statistics (mean, percentage, and standard deviation) and statistical tests (proportions test and t test) were used as quantitative analysis tools whereas thematic content analysis was used for qualitative data. Results: We show that IDPs use TCAM more than non IDPs. Access to and trust in traditional healers seems dependent on the exact nature of the services they offer, which varies across our sample. As such, processes of recognition and integration of both IDPs and TCAM providers into formal healthcare systems should be treated cautiously with an understanding of the socio-economic rationales that displaced people and TCAM providers operate under. While many of these TCAM providers are not highly trusted sources in South Kivu, their highly valued treatment of certain conditions such as what is locally known as "mulonge" (and bears similarities with the Buruli ulcer) suggest there may be potential specific areas where collaboration could be successful between biomedical health workers and TCAM providers. [ABSTRACT FROM AUTHOR]

This article presents a critical analysis on the interrelated yet distinctive approaches of various peace processes, namely: peace mediation, peacekeeping and peacebuilding. The critique aims to broaden the understanding of the extent to which peace processes adapt to complex environments marked by cycles of violence, and the extent to which these adaptations align. This understanding is particularly critical given the complexities of current peace processes, which often involve overlapping interventions in persistently violent settings. To address this need, the article draws on the concept of adaptive alignment, which views peace processes as dynamic and interconnected systems that continuously adapt to the evolving nature of complex conflict-affected situations. Adaptive alignment focuses on maintaining peace through adaptability, offering a nuanced understanding of how peace initiatives collectively engage to mitigate violence and achieve sustainable peace. The concept is further illustrated through examination of the specific cases of the Democratic Republic of Congo and Mali. [ABSTRACT FROM AUTHOR]

The UN may sanction peacekeeping operations (POs) to neutralize armed groups and promote democratization. This research presents perceptions from beneficiaries of assistance related to POs and relations between local women/girls and peacekeepers within two post-colonial contexts: the DRC and Haiti. Using cross-sectional, mixed-methods data collected in Haiti (2017) and the DRC (2018), we performed a comparative secondary analysis to better understand similarities and differences by country and gender in how participants perceived peacekeepers. Congolese participants were more likely to perceive foreign UN personnel as 'able to offer financial support', compared to Haitian participants who were more likely to perceive the UN personnel as 'in a position of authority' and 'able to offer protection'. Overall response patterns indicated that both Haitian and Congolese perceived the peacekeeper as responsible for initiating interactions with local women/girls. However, some variations were noted: Congolese male participants were most likely to perceive UN personnel as the initiators of interactions with local women and girls, compared to Haitians and Congolese females, who were more likely to perceive local women and girls as the initiators. Our research presents a locally grounded understanding of how locals perceive POs and peacekeepers relative to their communities and women and girls. [ABSTRACT FROM AUTHOR]

Scientific manuring, by adopting balanced nutrition in perennial plantations is the need of hour for increased productivity and addressing global warming by adopting 4 R nutrient stewardship. Continuous use of NPK in perennial crops can lead to deficiency of micronutrients. Therefore, a study was carried out to understand nutrient status of major rubber growing tracts and to formulate a customized nutrient mixture for rubber. A detailed soil fertility assessment and leaf tissue analysis of mature rubber plantations of age group 11-15 years in five agro ecological units (AEU) in Thiruvananthapuram were conducted during the study. Based on this, a multi micronutrient mixture was formulated for rubber and the composition of the mixture was Zn -3.64 %, B -8.04 %, Fe- 2.01 %, Cu- 2.55 % and Mn-3.25 %. For accessing the effect of the mixture, a field experiment was conducted in existing rubber plantation of RRII 105 replanted in 2005 at Aryanad (AEU 14) in randomized block design with seven treatments and three replications, namely general recommendation of NPK at 30:30:30 kg ha-1year-1, soil test based recommendation of NPK at 22:8:21 kg ha-1 year-1, application of multi micronutrient mixture along with soil test based recommendation of NPK at varying levels from 5 to 15 kg ha-1year-1. The treatments had a significant effect on dry rubber content (DRC). For the post monsoon, summer, and annual period, the highest DRC was noticed in 15 kg ha-1 of the mixture applied plot which was on par with 7.5 kg ha-1 applied plot. Application of micronutrient mixture resulted in enhancement of different micronutrient pools and enriched nutrient storehouse. It was also observed that available micronutrients were within sufficiency level even after application of the mixture. Multi micronutrient mixture application at 7.5 kg ha-1 along with soil test based recommendation of NPK can be considered for future studies. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to assess quality of life (QoL) using the WHOQOL-BREF questionnaire among obstetric fistula (OF) patients before and after surgical repair of OF (SROF). Methods: A longitudinal cohort study was conducted between November 2022 and October 2023 in the Democratic Republic of the Congo (DRC) among OF patients to assess their QoL before and after SROF. A systematic sampling technique was used to recruit a total of 158 OF patients. The WHOQOL-BREF questionnaire assessed general health, life experience, as well as physical, social, psychological, and environmental domains. Results: The mean age among the 158 respondents was 33.51 ± 9.63 years, and 77.85% of them lived in rural areas. In terms of surgical outcomes, 80.38% had closure of the OF with regained continence, 5.7% had closure of the OF with persistent incontinence, and 13.9% had a failed surgical repair. Overall mean QoL scores were higher after OF surgical repair (3.83, standard deviation [SD]=0.89) in comparison to pre-operative (1.58, SD=0.63) (p< 0.001). These QoL improvements included physical (mean score 66.32 post-surgery versus 28.37 before, p< 0.001), social (mean score 64.92 post-surgery versus 27.90 before, p< 0.001), psychological (mean score 68.09 post-surgery versus 21.28 before, p< 0.001), environmental (mean score 48.41 post-surgery versus 16.91 before p< 0.001), and general domains. Patients with a successful OF repair had a better QoL score than those with a closed fistula but ongoing incontinence or those for whom surgery failed to close the fistula. Conclusion: The present study showed that among OF patients, all QoL domains were impaired before surgical repair and significantly improved after surgery. Successful OF closure alleviates the consequences of OF and helps to restore patients' wellbeing. Our findings call for improved access to high-quality surgical repair services as a fundamental right for OF patients. [ABSTRACT FROM AUTHOR]

Copyright of Environmental & Social Management Journal / Revista de Gestão Social e Ambiental is the property of Environmental & Social Management Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Research on conflict and fisheries has largely focused on conflict between resource users, rather than on how fisheries are affected by external conflict, including civil war. Knowledge that does exist does not fully engage with the specific characteristics of conflicts, how those characteristics affect fisheries, and how fishers respond. This article identifies how the characteristics of conflict in the Democratic Republic of the Congo (DRC) affect the fisheries of the transboundary Lake Tanganyika and how those dependent on small-scale fisheries have responded to those characteristics. Data was collected at three fish landing sites through remote interviews in 2017 and 2018. The results show that the primary characteristic of the DRC conflict is the sporadic and unpredictable nature of the violence generating insecurity, loss of equipment and increase in fishing pressure. Increasing fishing pressure is associated with newcomers, who turn to fishing as a safety net, yet do not abide by local norms and beliefs. A reported increase in illegal fishing and corruption further present challenges to the weakly managed fisheries. The research concludes that the experience of civil war brings multiple and contrasting sources and experiences of vulnerability for fishers. The significant influence that conflict has on fisherfolk and fisheries supports calls for greater recognition of how the wider political and economic environment of natural resources affects how they are used and governed. [ABSTRACT FROM AUTHOR]

Development of effective therapies against SARS-CoV-2 infections relies on mechanistic knowledge of virus-host interface. Abundant physical interactions between viral and host proteins have been identified, but few have been functionally characterized. Harnessing the power of fly genetics, we develop a comprehensive Drosophila COVID-19 resource (DCR) consisting of publicly available strains for conditional tissue-specific expression of all SARS-CoV-2 encoded proteins, UAS-human cDNA transgenic lines encoding established host-viral interacting factors, and GAL4 insertion lines disrupting fly homologs of SARS-CoV-2 human interacting proteins. We demonstrate the utility of the DCR to functionally assess SARS-CoV-2 genes and candidate human binding partners. We show that NSP8 engages in strong genetic interactions with several human candidates, most prominently with the ATE1 arginyltransferase to induce actin arginylation and cytoskeletal disorganization, and that two ATE1 inhibitors can reverse NSP8 phenotypes. The DCR enables parallel global-scale functional analysis of SARS-CoV-2 components in a prime genetic model system.

Introduction Neonatal mortality rates remain a significant concern in resource-limited settings, where effective interventions are crucial. The Kangaroo Mother Care (KMC) method has emerged as a promising strategy to improve neonatal survival through skin-to-skin contact and mother-centered care. Purpose This study aims to assess the impact of the KMC method on neonatal survival and to explore the perceptions of healthcare professionals and mothers regarding this approach at the General Reference Hospital in Buta, Democratic Republic of the Congo. Methods This quasi-experimental retrospective study, conducted over a 60-month period (2015–2020) at the General Reference Hospital in Buta, DRC, used a mixed-methods approach to compare neonatal survival rates and complications in preterm and low-birth-weight newborns before and after the introduction of the Kangaroo Mother Care method. Quantitative data were analyzed from 650 preterm newborns, while qualitative experiences and satisfaction levels were gathered from 20 mothers and 15 healthcare professionals. Results Quantitative analysis showed a significant increase in neonatal survival rates, rising from 32.6% before the introduction of KMC to 63.4% afterward (p < 0.01). Additionally, the rate of neonatal complications decreased from 26.7% to 8.6% following the method’s implementation. Qualitative findings revealed that 85% of mothers and 90% of healthcare professionals expressed favorable opinions regarding the execution of KMC. Conclusion The study demonstrates that implementing the Kangaroo Mother Care method at the General Reference Hospital in Buta significantly improved neonatal survival rates, with positive perceptions from both mothers and healthcare professionals. These findings suggest that KMC could be a key strategy for improving neonatal survival in the Democratic Republic of the Congo and similar settings, underscoring the need for continuous training of healthcare staff and the integration of this approach into neonatal health policies.

The Democratic Republic of Congo (DRC) is a country with many public health challenges, including those related to the prevention and management of viral hepatitis B. Healthcare workers, who are at the frontline of patient care, are particularly at risk of contracting and spreading this virus, especially given its high prevalence in the general population. This paper examines the level of awareness and preventive measures among Congolese healthcare workers. Overall, the data show that health workers are under-immunized and lack formal training in hepatitis B prevention and management. In addition to limited awareness, health facilities are insufficiently involved in the implementation of standardized infection control protocols, the provision of personal protective equipment and routine hepatitis B vaccination programmes. There also appears to be a lack of clear and effective national policies outlining the main axes of infection control targets by 2030. This calls for urgent policy implementation focusing on mandatory vaccination, training, resource availability, adherence to infection control practices and comprehensive post-exposure management.

Seven samples were selected from various facies of geological formations intersected by the drill holes for petrographic analysis, supplemented by diffractometry. The goal was to identify the mineralogical composition of Banded Iron Formations (BIFs), the associated parageneses, and elements deleterious to the metallurgical processing of iron ore. Field tests, based on geophysical maps, were conducted to identify high-prospectivity sites characterized by low magnetic susceptibility and hematite richness, followed by sampling and drilling to confirm mineralization. Selected samples from characteristic facies in contact with iron ores underwent petrographic analysis using optical and scanning electron microscopy, supported by diffractometric analyses to ensure accurate mineralogical identification. The study revealed the presence of hematitic BIF, predominantly composed of weakly aggregated euhedral and subhedral martite grains, with evidence of some leaching. Magnetite, identified as the protore mineral, has been oxidized by fluid influence into martite (hematite), with a low presence of secondary supergene minerals. Variscite, kaolinite, and gibbsite were the main secondary minerals identified in both petrographic and diffractometric analyses, and are considered sources of phosphorus, aluminum, and silica—elements recognized as harmful in the metallurgical processing of iron and its alloys. These secondary minerals were precipitated within interstitial cavities leached between martite and hematite aggregates, forming a botryoidal texture. The BIFs of the Zatua Hills are primarily composed of hematitic iron ores associated with goethite, microplaty hematite, and secondary supergene minerals, likely formed through fluid circulation along fracture zones, shearing, and folding. Geochemical studies are recommended to complete the analysis, aiming to determine the content of these iron oxides, secondary minerals, and the degree of hydration through loss on ignition.

Abstract Introduction Surgical repair of obstetric fistula aims to restore the anatomical and functional integrity of the urinary tract, enabling affected women to regain their dignity and quality of life. However, such repairs can end in a failure. The aim of this study is to develop a predictive score to identify factors influencing failure of surgical repair of obstetric vesico-vaginal fistula (FSROVVF) in the Democratic Republic of the Congo. Methods This was an analytical cross-sectional study of 318 women with obstetric vesico-vaginal fistula (OVVF) who had undergone surgical management. A bivariate and then a multivariate analysis were performed. Score discrimination was assessed using the ROC curve and C-index, and score calibration using the Hosmer–Lemeshow test. Results Surgical repair of OVVF was unsuccessful in 16.98% of cases (54/318). After logistic modeling, six criteria emerged as predictive factors for FSROVVF: the presence of fibrosis (AOR = 5.01; 95% CI:1.73–14.49), the presence of 2 or more fistulas (AOR = 9.04; 95% CI:3.01–27.13), the association of OVVF with another anatomoclinical entity of fistula (AOR = 3.16; 95% CI:1.09–9.13), the fistula size > 3 cm (AOR = 3.65; 95% CI:1.36–9.76), the peri-operative hemorrhage (AOR = 7.01; 95% CI:2.33–21.03), and the post-operative infection (AOR = 178.89; 95% CI:26.09–1226.64). A score ranging from 0 to 13 points was obtained, of which a value ≤ 5 points defines a low risk of FSROVVF, a value between 6 and 8 points defines a moderate risk and value ≥ 9 points corresponds to a high risk of FSROVVF. The area under the ROC curve of the score is 0.925 with a sensitivity of 61.11%, a specificity of 96.59%, a positive predictive value of 78.57% and a negative predictive value of 92.39%. Conclusion This study demonstrated that the number of fistulas ≥ 2, fistula size > 3 cm, fibrosis, association of OVVF with other types of fistulas, peri-operative hemorrhage, and post-operative infection are factors predictive of FSROVVF. These six factors are key contributors to the score used to predict FSROVVF. Once validated, this score will inform and enable preoperative counseling regarding the prognosis and the chances of a successful outcome of surgical repair of OVVF.

Guillaume N Mwamba,1,2 Michel Kabamba Nzaji,1,2 Nicole A Hoff,3 Patrick K Mukadi,4 Kamy Kaminye Musene,5 Sue K Gerber,6 Megan Halbrook,3 Cyrus Sinai,3 Trevon Fuller,3 Oscar Luboya Numbi,7 Emile Okitolonda Wemakoy,8 Jean Jacques Muyembe Tamfum,4 Dalau Nkamba Mukadi,8 Mala Ali Mapatano,8,9,&ast; Anne W Rimoin,3,&ast; Paul-Samson Lusamba Dikassa8,&ast; 1Department of Public Health, Faculty of Medicine, University of Kamina, Kamina, Democratic Republic of the Congo; 2Expanded Program on Immunization, Ministry of Health, Kinshasa, Democratic Republic of the Congo; 3Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA; 4National Institute of Biomedical Research (INRB), Ministry of Health, Kinshasa, Democratic Republic of the Congo; 5UCLA-DRC Health Research and Training Program, UCLA-DRC, Kinshasa, Democratic Republic of the Congo; 6Polio Eradication program, The Bill and Melinda Gates Foundation, Seattle, WA, 98109, USA; 7Faculty of Medicine, University of Lubumbashi, Lubumbashi, 1825, Democratic Republic of the Congo; 8Department of Epidemiology and Biostatistics, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo; 9Department of Nutrition, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo&ast;These authors contributed equally to this workCorrespondence: Nicole A Hoff, Field Director for UCLA-DRC Research Program and Researcher at UCLA Fielding School of Public Health, 5345 Av De la Démocratie (Ex Av. Des huileries), Kinshasa, Democratic Republic of the Congo, Tel +1 (240) 409-0578, Email nhoff84@ucla.edu Guillaume N Mwamba, Expanded Program on Immunization, 32 Av De la Justice, Kinshasa-Gombe, Democratic Republic of the Congo, Tel +243817975023, Email guillaumengoiemwamba@gmail.comBackground: Malnutrition is identified as a risk-factor for insufficient polioseroconversion in the context of a vaccine-derived polio virus (VDPV) outbreak prone region. To assess the prevalence of malnutrition and its link to poliovirus insufficient immunity, a cross-sectional household survey was conducted in the regions of Haut- Lomami and Tanganyika, DRC.Methods: In March 2018, we included 968 healthy children aged 6 to 59 months from eight out of 27 districts. Selection of study locations within these districts was done using a stratified random sampling method, where villages were chosen based on habitat characteristics identified from satellite images. Consent was obtained verbally in the preferred language of the participant (French or Swahili) by interviewers who received specific training for this task. Furthermore, participants contributed a dried blood spot sample, collected via finger prick. To assess malnutrition, we measured height and weight, applying WHO criteria to determine rates of underweight, wasting, and stunting. The assessment of immunity to poliovirus types 1, 2, and 3 through the detection of neutralizing antibodies was carried out at the CDC in Atlanta, USA.Results: Of the study population, we found 24.7% underweight, 54.8% stunted, and 15.4% wasted. With IC95%, underweight (OR=1.50; [1.11– 2.03]), and the non-administration of vitamin A (OR=1.96; [1.52– 2.54]) were significantly associated with seronegativity to polioserotype 1. Underweight (OR=1.64; [1.20– 2.24]) and the non-administration of vitamin A (OR=1.55; [1.20– 2.01]) were significantly associated with seronegativity to polioserotype 2. Underweight (OR=1.50; [1.11– 2.03]), and the non-administration of vitamin A (OR=1.80. [1.38– 2.35]) were significantly associated with seronegativity to polioserotype 3. Underweight (OR=1.68; IC95% [1.10– 2.57]) and the non-administration of vitamin A (OR=1.82; IC95% [1.30– 2.55]) were significantly associated with seronegativity to all polioserotypes.Conclusion: This study reveals a significant association between underweight and polioseronegativity in children. In order to reduce vaccine failures in high-risk areas, an integrated approach by vaccination and nutrition programs should be adopted.Keywords: children, underweight, polioserotype, malnutrition, seronegativity, DRC

Sahra Ibrahimi,1– 3 Bamba Youssouf,4 Christine Potts,1 Alexandre Dumouza,1 Rani Duff,1 Landry-Serges Malaba,1 Bettina Brunner1 1International Development Division, Abt Associates, Rockville, MD, USA; 2Department of Global Health, Denison University, Granville, OH, USA; 3Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA; 4Matchboxology, Johannesburg, Gauteng, province, South AfricaCorrespondence: Sahra Ibrahimi, Global Development Group, Abt Associates, 6130 Executive Blvd, Rockville, MD, USA, Tel +1 413-406-4401, Email ibrahimi.sahra3@gmail.comBackground: In response to limited contraception availability and a lack of knowledge about family planning (FP) in the Democratic Republic of the Congo (DRC), the United States Agency for International Development (USAID) Integrated Health Program (IHP) in the DRC has been providing FP services, including outreach programs in the DRC. Our study aims to assess the FP outreach program by understanding the participants’ perception of the campaign, its impact on their behavior, and their feedback regarding the campaign. Additionally, we draw insights from lessons learned and provide recommendations.Methods: Between July and August 2022, we conducted 47 in-person participant interviews with women of reproductive age who used the outreach services provided by USAID IHP. Participants were randomly selected from Sud-Kivu, Kasai-Oriental, Haut-Katanga, and Tanganyika provinces. Consent and confidentiality were assured, and responses were recorded and transcribed in a Word document. We used Excel for data coding and analysis.Results: The campaign reached 95.7% of women interviewed; however, some participants could not recall specific message details. Most respondents (89.3%) reported that the campaign motivated them to make FP decisions and change their behaviors. While 14.8% of women reported making FP decisions independently, 85.1% reported making the decision jointly with their partners. Our analysis resulted in three emerging themes: 1) Increased FP outreach and improved perception of FP, 2) Improved perceived behavioral changes due to FP outreach, and 3) The need for program improvement by including men and providing additional information about possible FP side effects.Implications: Our study provides insights into how women receive information and whether they find it useful and share it with other women in their community. In particular, women’s feedback about the FP outreach program and our recommendations can inform future policies and interventions.Keywords: DRC, family planning, reproductive health, community outreach, USAID

Between 2018 and 2024, we conducted systematic whole-genome sequencing and phylogenomic analysis on 263 V. cholerae O1 isolates from cholera patients across four provinces in the Democratic Republic of Congo (North-Kivu, South-Kivu, Tanganyika, and Kasai Oriental). These isolates were classified into the AFR10d and AFR10e sublineages of AFR10 lineage, originating from the third wave of the seventh El Tor cholera pandemic (7PET). Compared to the strains analysed between 2014 and 2017, both sublineages had few genetic changes in the core genome but recent isolates (2022-2024) had significant CTX prophage rearrangement. AFR10e spread across all four provinces, while AFR10d appeared to be extinct by the end of 2020. Since 2022, most V. cholerae O1 isolates exhibited significant CTX prophage rearrangements, including a tandem repeat of an environmental satellite phage RS1 downstream the ctxB toxin gene of the CTX-Φ-3 prophage on the large chromosome, as well as two or more arrayed copies of an environmental pre-CTX-Φ prophage precursor on the small chromosome. We used Illumina data for mapping and coverage estimation to identify isolates with unique CTX-Φ genomic features. Gene localization was then determined on MinION-derived assemblies, revealing an organization similar to that of non-O1 V. cholerae isolates found in Asia (O139 VC1374, and environmental O4 VCE232), but never described in V. cholerae O1 El Tor from the third wave. In conclusion, while the core genome of AFR10d and AFR10e showed minimal changes, significant alterations in the CTX-Φ and pre-CTX-Φ prophage content and organization were identified in AFR10e from 2022 onwards.

ABSTRACTThe COVID-19 booster dose is considered an important adjunct for the control of the COVID-19 pandemic due to reports of reduced immunity in fully vaccinated individuals. The aims of this study were to assess healthcare workers’ intention to receive the booster dose of COVID-19 vaccine and to identify predictive factors among healthcare workers. A cross-sectional study was conducted among healthcare workers selected in two provinces, Kasai Oriental, and Haut-Lomami. Data were collected using a questionnaire administered through structured face-to-face interviews, with respondents using a pre-tested questionnaire set up on the Open Data Kit (ODK Collect). All data were analyzed using SPSS v26.0 (IBM Corporation, Armonk, NY, USA). Vaccination coverage for COVID-19, considering declarations by health workers, is around 85.9% for the province of Kasai Oriental and 85.8% for Haut-Lomami. A total of 975 responses were collected, 71.4% of health workers at Kasai Oriental and 66.4% from Haut-Lomami declared a definite willingness to receive a COVID-19 vaccine booster. The duration of protection was the main reason for accepting a booster COVID-19 dose for 64.6% of the respondents. Logistic regression analysis showed that having chronic diseases (aOR = 2.95 [1.65–5.28]), having already received one of the COVID-19 vaccines (aOR = 2.72 [1.43–5. 19]); the belief that only high-risk individuals, such as healthcare professionals and elderly people suffering from other illnesses, needed a booster dose (aOR = 1.75 [1.10–2.81]). Considering the burden of COVID-19, a high acceptance rate for booster doses could be essential to control the pandemic. Our results are novel and could help policymakers design and implement specific COVID-19 vaccination programs to reduce reluctance to seek booster vaccination.

BACKGROUND: Malnutrition is identified as a risk factor for insufficient polio seroconversion in the context of a vaccine-derived poliovirus (VDPV) outbreak-prone region. In the Democratic Republic of Congo (DRC), underweight decreased from 31% (in 2001) to 26% (in 2018). Since 2004, VDPV serotype 2 outbreaks (cVDPV2) have been documented and were geographically limited around the Haut-Lomami and Tanganyika Provinces. METHODS: To develop and validate a predictive model for poliomyelitis vaccine response in malnourished infants, a cross-sectional household study was carried out in the Haut-Lomami and Tanganyika provinces. Healthy children aged 6 to 59 months (n=968) were enrolled from eight health zones (HZ) out of 27, in March 2018. We performed a bivariate and multivariate logistics analysis. Final models were selected using a stepwise Wald method, and variables were selected based on the criterion p < 0.05. The association between nutritional variables, explaining polio seronegativity for the three serotypes, was assessed using the receiver operating characteristic curve (ROC curve). RESULTS: Factors significantly associated with seronegativity to the three polio serotypes were underweight, non-administration of vitamin A, and the age group of 12 to 59 months. The sensitivity was 10.5%, and its specificity was 96.4% while the positive predictive values (PPV) and negative (PNV) were 62.7% and 65.3%, respectively. We found a convergence of the curves of the initial sample and two split samples. Based on the comparison of the overlapping confidence intervals of the ROC curve, we concluded that our prediction model is valid. CONCLUSION: This study proposed the first tool which variables are easy to collect by any health worker in charge of vaccination or in charge of nutrition. It will bring on top, the collaboration between the Immunization and the Nutritional programs in DRC integration policy, and its replicability in other low- and middle-income countries with endemic poliovirus.

Introduction: Surgical repair of obstetric fistula aims to restore the anatomical and functional integrity of the urinary tract, enabling affected women to regain their dignity and quality of life. However, such repairs can end in a failure. The aim of this study is to develop a predictive score to identify factors influencing failure of surgical repair of obstetric vesico-vaginal fistula (FSROVVF) in the Democratic Republic of the Congo. Methods: This was an analytical cross-sectional study of 318 women with obstetric vesico-vaginal fistula (OVVF) who had undergone surgical management. A bivariate and then a multivariate analysis were performed. Score discrimination was assessed using the ROC curve and C-index, and score calibration using the Hosmer–Lemeshow test. Results: Surgical repair of OVVF was unsuccessful in 16.98% of cases (54/318). After logistic modeling, six criteria emerged as predictive factors for FSROVVF: the presence of fibrosis (AOR = 5.01; 95% CI:1.73–14.49), the presence of 2 or more fistulas (AOR = 9.04; 95% CI:3.01–27.13), the association of OVVF with another anatomoclinical entity of fistula (AOR = 3.16; 95% CI:1.09–9.13), the fistula size > 3 cm (AOR = 3.65; 95% CI:1.36–9.76), the peri-operative hemorrhage (AOR = 7.01; 95% CI:2.33–21.03), and the post-operative infection (AOR = 178.89; 95% CI:26.09–1226.64). A score ranging from 0 to 13 points was obtained, of which a value ≤ 5 points defines a low risk of FSROVVF, a value between 6 and 8 points defines a moderate risk and value ≥ 9 points corresponds to a high risk of FSROVVF. The area under the ROC curve of the score is 0.925 with a sensitivity of 61.11%, a specificity of 96.59%, a positive predictive value of 78.57% and a negative predictive value of 92.39%. Conclusion: This study demonstrated that the number of fistulas ≥ 2, fistula size > 3 cm, fibrosis, association of OVVF with other types of fistulas, peri-operative hemorrhage, and post-operative infection are factors predictive of FSROVVF. These six factors are key contributors to the score used to predict FSROVVF. Once validated, this score will inform and enable preoperative counseling regarding the prognosis and the chances of a successful outcome of surgical repair of OVVF. [ABSTRACT FROM AUTHOR]

Objective: Our aim is to describe the epidemiological, anatomoclinical and therapeutic profile of obstetric fistula (OF) in the Democratic Republic of the Congo (DRC). Methodology: This was a descriptive retrospective study that collected 1416 obstetric fistulas in 1267 patients in seven provinces of the DRC, treated between January 2017 and December 2022. The variables studied were epidemiological, anatomoclinical and therapeutic. Results: The mean age of patients at the time of surgical repair was 33.2 years (range: 15 and 77 years) and 32.8% of patients were aged between 20 and 29 years. The mean age of the fistula at repair was 10 years (range: 3.5 months and 56 years). At the time of fistula, 61.7% of patients had delivered vaginally and 28.7% by caesarean section and 8.2% of patients had a haemostasis hysterectomy. Labour lasted at least 3 days in 47.3% of these patients for the fistula birth. Deliveries took place either at home (27.4%) or in a health facility (72.6%); 83.6% of newborns resulting from these births had died. Taken as a whole, urogenital fistulas are more common than genito‐digestive fistulas. Urethro‐vaginal (26.2%) and vesico‐uterine (24.7%) anatomoclinical entities were predominant among urogenital fistulas. A total of 1416 fistulas were surgically repaired in 1267 patients. These repairs were successful for 1226 (86.6%) fistulas. The main surgical route used was transvaginal (68.8%). Conclusion: In the DRC, obstetric fistula is common in young adult women. It often results from vaginal delivery, after prolonged labour. Fistula births often result in the death of newborns. Uro‐genital obstetric fistulas are the most frequent with predominance of urethro‐vaginal and vesico‐uterine anatomoclinical entities. Fistulas remain untreated for a long time. Mostly done transvaginally, surgical repair gives a good result. [ABSTRACT FROM AUTHOR]

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]

Researchers have shown how UN stabilization peace operations mix liberal and illiberal goals and strategies. Yet, further research is needed to theorize and comprehend illiberal peacebuilding features of stabilization operations. This article fills this gap by demonstrating how UN stabilization operations wield illiberal peacebuilding practices. Building upon previous scholarship, we understand illiberal peacebuilding both as an approach and outcome which is oriented by and helps diffuse illiberal norms in the societies where illiberal peacebuilding is instrumentalized by local, regional and international actors. We frame UN stabilization operations in the CAR, the DRC, and Mali as illiberal peacebuilding processes infused with illiberal strategies and show that liberal actors can engage with illiberal strategies for peace promotion. We also analyse peace agreements that accompany these missions as illiberal peacebuilding outcomes and show how these are shaped by illiberal norms. Our key finding is that a set of illiberal norms – exclusion, violence, power inequality and authoritarianism – are central for both UN stabilization operations and peace agreements signed in CAR, DRC and Mali. Therefore, we challenge the UN discourse that stabilization is a needed first step towards liberal and inclusive peace agreements. [ABSTRACT FROM AUTHOR]

COVID-19 vaccination in the Democratic Republic of the Congo (DRC) began in April 2021. A month later, most COVID-19 vaccine doses were reallocated to other African countries, due to low vaccine uptake and the realization that the doses would expire before use. Based on data available on 13 August 2022, 2.76% of the DRC population had been fully vaccinated with last dose of primary series of COVID-19 vaccine, placing the country second to last in Africa and in the last five in global COVID-19 vaccination coverage. The DRC's reliance on vaccine donations requires continuous adaptation of the vaccine deployment plan to match incoming COVID-19 vaccines shipments. Challenges in planning vaccine deployments, vaccinating priority populations, coordinating, and implementing the communications plan, disbursing funds, and conducting supervision of vaccination activities have contributed to low COVID-19 vaccine coverage. In addition, the spread of rumors through social media and by various community and religious leaders resulted in high levels of vaccine hesitancy. A strong risk communication and community engagement plan, coupled with innovative efforts to target the highest-risk populations are critical to increase vaccine uptake during the next phase of COVID-19 vaccine introduction.

Abstract This article contributes to the stock of scientific knowledge by showing the effect of orphan status on child labour and school attendance in the Democratic Republic of the Congo (DRC). While the abolition of child labour is undeniably one of the major tasks assigned to the International Labour Organization (ILO) when it was founded, child labour remains a severe problem worldwide. In many parts of the world, especially in developing countries, children do not have access to school. Instead of ending up in school, millions of children are forced to engage in child labour in income-generating and non-income-generating activities. Little researchers have yet made it possible to obtain simultaneous information on child labour, school attendance and orphaned children. This paper describes the research that tries to make such a connection. Data used is from the out-of-school children and adolescents (OOSC-DRC-2012) survey organised by the Ministry of Primary, secondary and Vocational Education. Using a bivariate probit econometric model and testing the endogeneity with an instrumental variables approach, funding of the analysis supports the assumption of a significant negative relationship between child labour and school attendance. The result shows also that being orphaned reduces a child's likelihood of school attendance and increases the probability of entering the labour market. It is underlined that most children are present in non-income-generating than income-generating activities.

Abstract Introduction Obstetric fistula (OF) repair surgery aims to restore the anatomical and functional integrity of the urinary tract, allowing affected women to regain their dignity and quality of life. However, in some cases, this surgical repair may fail. The objective of this study was to develop a predictive score to identify factors associated with the failure of surgical repair of obstetric urethro-vaginal fistula (FSROUVF) in the Democratic Republic of the Congo (DRC). Methods This is an analytical cross-sectional study of 358 patients with obstetric urethro-vaginal fistula (OUVF) who received surgical repair. We conducted bivariate and multivariate analyses. Score discrimination was assessed using the receiver operating characteristic (ROC) curve, C-index, and score calibration according to the Hosmer-Lemeshow test. Results Surgical repair of OUVF failed in 24.86% of cases (89/358). After logistic modelling, 6 criteria predicted FSROUVF: the use of intravaginal indigenous products (AOR = 3.59; 95% CI: 1.51–8.53), the presence of fibrosis (AOR = 6.37; 95% CI: 1.70–23.82), the presence of 2 or more fistulas in the same patient (AOR = 7.03; 95% CI: 3.14–15.72), the total urethral damage (AOR = 3.29; 95% CI: 1.36–7.95), the fistula size > 3 cm (AOR = 5.65; 95% CI: 2.12–15.01), and the postoperative infection (AOR = 351.10; 95% CI: 51.15–2409.81). A score of 0 to 14 was obtained, with a value ≤5 points indicating a low risk of FSROUVF, a value between 6 and 8 indicating a moderate risk, and a value ≥9 points corresponding to a high risk of FSROUVF. The area under the ROC curve of the score is 0.938 with a sensitivity of 60.67%, a specificity of 96.28%, a positive predictive value of 84.38%, and a negative predictive value of 88.10%. Conclusion We report a FSROUVF rate in the DRC approaching a quarter of operative patients. Predictors of failure included fibrosis, presence of 2 or more fistulas, total urethral involvement, fistula size greater than 3 cm, postoperative infection, and use of intravaginal indigenous products. These factors are constitutive of the HEAL Africa score, which once validated, may have value in pre-operative counselling of patients. This study could be valuable for policy and strategies to address the problem of OUVF in the DRC and in resource limited settings more generally.

Abstract Background This study examines how leadership is provided at the operational level of a health system in a protracted crisis context. Despite advances in medical science and technology, health systems in low- and middle-income countries struggle to deliver quality care to all their citizens. The role of leadership in fostering resilience and positive transformation of a health system is established. However, there is little literature on this issue in Democratic Republic of the Congo (DRC). This study describes leadership as experienced and perceived by health managers in crisis affected health districts in Eastern DRC. Methods A qualitative cross-sectional study was conducted in eight rural health districts (corresponding to health zones, in DRC’s health system organization), in 2021. Data were collected through in-depth interviews and non-participatory observations. Participants were key health actors in each district. The study deductively explored six themes related to leadership, using an adapted version of the Leadership Framework conceptual approach to leadership from the United Kingdom National Health Service’s Leadership Academy. From these themes, a secondary analysis extracted emerging subthemes. Results The study has revealed deficiencies regarding management and organization of the health zones, internal collaboration within their management teams as well as collaboration between these teams and the health zone’s external partners. Communication and clinical and managerial capacities were identified as key factors to be strengthened in improving leadership within the districts. The findings have also highlighted the detrimental influence of vertical interventions from external partners and hierarchical supervisors in health zones on planning, human resource management and decision-making autonomy of district leaders, weakening their leadership. Conclusions Despite their decentralized basic operating structure, which has withstood decades of crisis and insufficient government investment in healthcare, the districts still struggle to assert their leadership and autonomy. The authors suggest greater support for personal and professional development of the health workforce, coupled with increased government investment, to further strengthen health system capacities in these settings.

Introduction: Prehospital care in many low- and middle-income countries is underdeveloped and needs strengthening for improved outcomes. Where formal prehospital care systems are under development, integration of a layperson first responder programme may help improve access for those in need. The World Health Organization recently developed the Community First Aid Responder (CFAR) learning program in support of this system, providing that it may require adaptation to be contextually suitable and sustainably implemented at country level. This study assesses a pilot WHO CFAR course in Kinshasa, Democratic Republic of Congo, to inform future rollouts and related research. Methods: We conducted a 3-day in-person pilot CFAR training with 42 purposively selected community health workers. Data collection involved quantitative and qualitative phases. The first consisted of structured pre- and post-training surveys, and a course evaluation by participants. The second consisted of two focus group discussions involving purposively selected community health workers in one group, and a convenience sample of course instructors and organisers in the other. Perceptions regarding course content, perceived knowledge acquisition and self-confidence gain were analysed using descriptive statistics for the quantitative data and content analysis for qualitative data. Results: Course participants were predominantly male (76.3 %) with a median age of 42 years and most (80.5 %) had no prior first aid training. Most were satisfied that the learning objectives were reached, the logistics were adequate, and that the content and teaching language were appropriately tailored to local context. The majority (94.7 %) found the 3-day duration insufficient. There was a significant self-confidence gain regarding first aid skills (average 17.9 % in pre- to 95.3 % in post-training, p

Agricultural productivity in the Great Lakes Countries of Central Africa, including Burundi, Rwanda, and the Democratic Republic of Congo, is affected by a wide range of diseases and pests which are mainly controlled by chemical pesticides. However, more than 30% of the pesticides used in the region are banned in European Union due to their high toxicity. Globally available safe and ecofriendly biological alternatives to chemicals are virtually non-existent in the region. Bacillus PGPR-based biocontrol products are the most dominant in the market and have proven their efficacy in controlling major plant diseases reported in the region. With this review, we present the current situation of disease and pest management and urge the need to utilize Bacillus-based control as a possible sustainable alternative to chemical pesticides. A repertoire of strains from the Bacillus subtilis group that have shown great potential to antagonize local pathogens is provided, and efforts to promote their use, as well as the search for indigenous and more adapted Bacillus strains to local agroecological conditions, should be undertaken to make sustainable agriculture a reality in the region. [ABSTRACT FROM AUTHOR]

Introduction: Obstetric fistula (OF) repair surgery aims to restore the anatomical and functional integrity of the urinary tract, allowing affected women to regain their dignity and quality of life. However, in some cases, this surgical repair may fail. The objective of this study was to develop a predictive score to identify factors associated with the failure of surgical repair of obstetric urethro-vaginal fistula (FSROUVF) in the Democratic Republic of the Congo (DRC). Methods: This is an analytical cross-sectional study of 358 patients with obstetric urethro-vaginal fistula (OUVF) who received surgical repair. We conducted bivariate and multivariate analyses. Score discrimination was assessed using the receiver operating characteristic (ROC) curve, C-index, and score calibration according to the Hosmer-Lemeshow test. Results: Surgical repair of OUVF failed in 24.86% of cases (89/358). After logistic modelling, 6 criteria predicted FSROUVF: the use of intravaginal indigenous products (AOR = 3.59; 95% CI: 1.51–8.53), the presence of fibrosis (AOR = 6.37; 95% CI: 1.70–23.82), the presence of 2 or more fistulas in the same patient (AOR = 7.03; 95% CI: 3.14–15.72), the total urethral damage (AOR = 3.29; 95% CI: 1.36–7.95), the fistula size > 3 cm (AOR = 5.65; 95% CI: 2.12–15.01), and the postoperative infection (AOR = 351.10; 95% CI: 51.15–2409.81). A score of 0 to 14 was obtained, with a value ≤5 points indicating a low risk of FSROUVF, a value between 6 and 8 indicating a moderate risk, and a value ≥9 points corresponding to a high risk of FSROUVF. The area under the ROC curve of the score is 0.938 with a sensitivity of 60.67%, a specificity of 96.28%, a positive predictive value of 84.38%, and a negative predictive value of 88.10%. Conclusion: We report a FSROUVF rate in the DRC approaching a quarter of operative patients. Predictors of failure included fibrosis, presence of 2 or more fistulas, total urethral involvement, fistula size greater than 3 cm, postoperative infection, and use of intravaginal indigenous products. These factors are constitutive of the HEAL Africa score, which once validated, may have value in pre-operative counselling of patients. This study could be valuable for policy and strategies to address the problem of OUVF in the DRC and in resource limited settings more generally. [ABSTRACT FROM AUTHOR]

This article contributes to the stock of scientific knowledge by showing the effect of orphan status on child labour and school attendance in the Democratic Republic of the Congo (DRC). While the abolition of child labour is undeniably one of the major tasks assigned to the International Labour Organization (ILO) when it was founded, child labour remains a severe problem worldwide. In many parts of the world, especially in developing countries, children do not have access to school. Instead of ending up in school, millions of children are forced to engage in child labour in income-generating and non-income-generating activities. Little researchers have yet made it possible to obtain simultaneous information on child labour, school attendance and orphaned children. This paper describes the research that tries to make such a connection. Data used is from the out-of-school children and adolescents (OOSC-DRC-2012) survey organised by the Ministry of Primary, secondary and Vocational Education. Using a bivariate probit econometric model and testing the endogeneity with an instrumental variables approach, funding of the analysis supports the assumption of a significant negative relationship between child labour and school attendance. The result shows also that being orphaned reduces a child's likelihood of school attendance and increases the probability of entering the labour market. It is underlined that most children are present in non-income-generating than income-generating activities. [ABSTRACT FROM AUTHOR]

Background: Little is known about isoniazid preventive therapy (IPT) completion rates among children or adolescents compared to adults living with HIV in Kinshasa, Democratic Republic of the Congo (DRC). Methods: We conducted a retrospective cohort analysis including children, adolescents, and adults living with HIV who were treated at FHI360 and partners‐implemented HIV care programs at six health zones in Kinshasa, DRC, from 2004 to 2020. The primary outcome was the proportion of children, adolescents versus adults who did complete 6 months of daily self‐administered IPT. Log‐binomial regression assessed independent predictors of IPT non‐completion and Kaplan–Meier technique for survival analysis. Results: Of 11,691 eligible patients on ART who initiated IPT, 429 were children (<11 years), 804 adolescents (11–19 years), and 10,458 adults (≥20 years). The median age was 7 (IQR: 3–9) years for children, 15 (IQR: 13–17) years for adolescents, and 43 (35–51) years for adults. Among those who were initiated on IPT, 5625 out of 11,691 people living with HIV (PLHIV) had IPT completion outcome results, and an overall 3457/5625 (61.5%) completion rate was documented. Compared to adults, children and adolescents were less likely to complete IPT [104/199 (52.3%) and 268/525 (51.0%), respectively, vs. 3085/4901 (62.9%)]. After adjustment, the only independent predictors for IPT non‐completion were health zone of residence and type of ART regimen. Kaplan–Meier analysis showed comparable poor survival among patients who completed IPT versus those who did not (p‐value for log‐rank test, 0.15). Conclusions: The overall sub‐optimal IPT completion rate in adults as well as children/adolescents in this setting is of great concern. Prospective studies are needed to elucidate the specific barriers to IPT completion among children, adolescents, and adults in DRC as well as the scale‐up of evidence‐informed interventions to improve IPT completion, such as adoption of shorter TB preventive regimens. [ABSTRACT FROM AUTHOR]

This study sought to generate, evaluate, and recommend possible national policies for the government of the Democratic Republic of the Congo (DRC) to implement to most effectively boost growth and investment in renewable energy technologies (RETs) through 2065 using Open Source Energy Modelling System (OSeMOSYS). The novelty of this study stems in-part from the scarcity of RET modelling completed for specific West African countries rather than for broader regions. Market-based instruments were identified as the policy type most practical for DRC. From modelling the resulting energy systems for policy pathways involving a 16% RET subsidy, a 70% fossil fuel tax, and both in combination relative to no-policy baseline scenarios, the scenarios including the tax had the lowest net costs (USD304–306 B) and the highest proportion of RETs (above 90%). Additionally, despite the current reliance on hydropower to fulfil 98% of its energy needs, hydropower played a very minor role in all of a modelled scenarios (no future investment beyond residual capacity). Finally, a post-modelling market potential assessment was performed on the technology that dominated off-grid supply across policy pathways: a 0.3 kW small solar home system (SHS). Based on learning rates for solar photovoltaics (PV), demand for a small SHS in DRC (>160 million units in total) was found to be sufficient to substantially reduce the unit cost as deployment scales. Ultimately, this study yielded four recommendations for the DRC government: (1) Pursue financial incentives to catalyse DRC's renewable energy supply. (2) Tax fossil fuel energy production. (3) Re-evaluate focus on hydropower. (4) Promote DRC as a healthy market for solar home systems. [ABSTRACT FROM AUTHOR]

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