BackgroundWasting is a public health problem affecting 47 million children under 5 years of age and causing 1 million deaths. Its prevalence is 7% in the Democratic Republic of the Congo. Vaccination in the DRC is suboptimal, with approximately 20% of children aged 12-23 months classified as zero-dose. This study aims to measure the association between wasting and zero-dose vaccination status in the DRC.MethodsThis is a secondary data analysis based on national data from the Immunization Coverage Survey conducted across 26 provinces for the 2023 cohort. The survey used a three-stage sampling method. The dependent variable was wasting, defined as a mid-upper arm circumference (MUAC) less than 125 mm. The independent variable was zero-dose vaccination status, defined by GAVI as the absence of having received the first dose of the pentavalent vaccine. A weighted descriptive analysis and multivariate logistic regression were performed to estimate the crude (COR) and adjusted odds ratios (AOR).ResultsA total of 48,332 children were included in the study, of whom 19.5% were zero-dose. The prevalence of wasting was 10.2%. The prevalence of wasting was higher among the zero-dose group (13.8%) than among those who were not zero-dose (9.4%). After multiple regression and adjustment for confounding factors, the zero-dose group had higher odds of having wasting than the non-zero-dose group (AOR=1.35, 95% CI=1.23-1.47).ConclusionZero-dose vaccination status was significantly associated with wasting. This underscores the need for integrated vaccination-nutrition interventions for comprehensive care, especially during Periodic Intensification of Systematic Immunization (PIVS), mass campaigns, or recuperation activities.

Despite significant immunization achievements, including polio-free certification and neonatal tetanus elimination, the Democratic Republic of the Congo (DRC) continues to face persistent challenges in its Expanded Programme on Immunization (EPI), particularly in governance, structure, and performance. This study aimed to evaluate the institutional and functional capacities of the DRC’s EPI to guide reforms in line with the WHO Immunization Agenda 2030 and the evolving health system context. A qualitative exploratory case study was conducted between November 2024 and February 2025. The audit employed an adapted version of the Participatory Institutional Capacity Assessment and Learning (PICAL) tool to evaluate six critical dimensions of organizational capacity across related indicators. Data were collected through 74 in-depth interviews, six focus group discussions, and a documentary review of over 40 official documents. Fieldwork was conducted at the national level and in three provinces. Thematic qualitative analysis was carried out using NVivo 15, with a hybrid inductive-deductive coding approach. This study revealed systemic and cross-cutting organizational deficits across all six capacity dimensions. Consensus scores from the adapted PICAL tool averaged 54

Background Universal access to sexual and reproductive health and rights (SRHR) is fundamental to achieving the Sustainable Development Goals due to its impact on gender equality as well as women’s health and survival. In the Democratic Republic of Congo, there are many civil society organizations (CSOs) that are involved in raising awareness of SRHR issues and providing SRHR services to young people. Objective: The aim of this study was to explore the challenges and enabling factors CSOs experience regarding the delivery of SRHR services to young people. Methods We conducted a qualitative study via focus group discussions with CSOs in Kinshasa. Two focus groups comprising women and two comprising men, with approximately 10 participants in each group, were held. The interview transcripts were subjected to an inductive thematic analysis. Results Young people’s barriers to SRHR information and services were described as multi-layered, linked to individual, community, societal, institutional, and health system levels. The most common barrier in delivering SRHR information was the widespread view of sexuality as a taboo subject in communities and churches as well as in young people’s families. Despite the obstacles that CSOs faced, the results also demonstrate that CSOs have found creative ways to reach out and offer SRHR information to young people. Conclusion It is essential to acknowledge the role of CSOs in the advancement of gender equality, and it is important to put policies into place that can overcome cultural, religious, and familial barriers to young people’s access to SRHR information.

Background Pelvic organ prolapse is a common debilitating condition worldwide. Despite surgical treatment, its recurrence can reach up to 30%. It has multiple risk factors, some of which are particular for a low-resource settings. The identification these factors would help to devise risk models allowing the development of prevention policies. The objective of this study was to explore risk factors for pelvic organ prolapse in a population in eastern Democratic Republic of Congo (DRC). Methods This was an unmatched case-control study conducted between January 2021 and January 2022. The sample size was estimated to be a total of 434 women (217 with prolapse as cases and 217 without prolapse as controls). Data comparisons were made using the Chi-Square and Student T tests. Binary and multivariate logistic regressions were used to determine associated factors. A p < 0.05 was considered significant. Results Variables identified as definitive predictors of pelvic organ prolapse included low BMI (aOR 2.991; CI 1.419–6.307; p = 0.004), home birth (aOR 6.102; CI 3.526–10.561; p < 0.001), family history of POP (aOR 2.085; CI 1.107–3.924; p = 0.023), history of birth without an episiotomy (aOR 3.504; CI 2.031–6.048; p = 0), height ≤ 150 cm (aOR 5.328; CI 2.942–9.648; p < 0.001) and history of giving birth to a macrosomic baby (aOR 1.929; IC 1.121–3.321; p = 0.018). Conclusions This study identified that Body Mass Index and birth-related factors are definitive predictors of pelvic organ prolapse in a low-resource setting. These factors are potentially modifiable and should be targeted in any future pelvic organ prolapse prevention policy. Additionally, there seems to be a genetic predisposition for prolapse, which warrants further assessment in specifically designed large scale studies.

Empowering women and promoting gender equality is crucial for accelerating sustainable development in fragile countries, including the Democratic Republic of Congo (DRC). However, there is scarce existing knowledge or understanding of the factors determining women’s empowerment in these contexts. We aimed to assess women’s empowerment and determine its associated factors in Kinshasa, DRC. We analyzed data from the 2021 Performance Monitoring Assessment (PMA) survey. A sample of 1365 women of childbearing age was retained for this study. Twenty empowerment items related to household decision-making, contraception use, and husband/partner influence were considered. We calculated the average women’s empowerment index (aWEI), identified the women’s empowerment variables using principal component analysis (PCA), and determined the associated factors for the first three principal components through the performance of multivariate binary logistic regression. In Kinshasa, the overall aWEI was estimated at 0.65. It was low for household decision-making (0.34) and high for husband/partner influence domains (0.93). Three principal components were identified and named, including the absence of threats, control of sexuality, and participation in decision-making. The factors associated with these components were having internet access, being in free union with a partner, being aged 40–49 years, and residing in a non-slum area. Increasing access to information would enable women in Kinshasa to make strategic decisions about their lives, benefiting themselves and others.

Aflatoxins B1 (AFB1) are fungi-produced toxins found in crops like peanuts, maize, and tree nuts. They constitute a public health concern due to their genotoxic and carcinogenic effects. A deterministic exposure risk assessment to AFB1 through the consumption of peanuts was conducted on children using the Margin of Exposure (MOE) and the liver cancer risk approaches. Data on AFB1 concentrations in peanuts, quantities of peanut consumption, and the weights of the children were obtained from the literature. Generally, MOE values were below the safe margin of 10,000, ranging between 3.68 and 0.14, 754.34 and 27.33, and 11,428.57 and 419.05 for the high (0.0466 ng/kg), median (0.00023 ng/kg), and low (0.000015 ng/kg) AFB1 concentration levels, respectively. The liver cancer risk upon lifetime exposure to highly AFB1-contaminated peanuts (0.0466 ng/kg) ranged between 1 and 23 (95% lower bound) and 2 and 50 (95% upper bound) cases in a million individuals: a public health concern. A low liver cancer risk (≤1 case in a billion individuals upon lifetime exposure) was shown at median and low AFB1 concentrations. However, the risk of AFB1 should be a priority for risk management since its harmful effects could be potentiated by poor diet, high malnutrition levels, and other disease burdens in Zambia's children.

Abstract Background An Ebola Virus Disease (EVD) outbreak occurred in North Kivu between 2018 and 2020. This eastern province of the Democratic Republic of Congo was also grappling with insecurity caused by several armed groups. This study aimed to explore the barriers and facilitators to utilizing Healthcare Facilities (HCFs) by non-Ebola patients during the crisis. Methods A qualitative case study was conducted in Beni and Butembo with 24 relatives of 15 deceased non-EVD patients, 47 key informants from healthcare workers (HCWs), as well as community leaders. Semi-structured interviews were conducted to explore three key areas: (i) the participants’ illness history, care pathway, care, and social support; (ii) their perceptions of how EVD affected the care outcome; and (iii) their opinions on the preparedness, supply, use, and quality of healthcare before and during the outbreak. All interviews were recorded, transcribed verbatim, and thematically analysed using Atlas-ti 8.0. Results Nine of the 15 deaths were female and their ages ranged from 7 to 79 years. The causes of death were non-communicable (13) or infectious (2) diseases. Conspiracy theories, failure to establish security, and the concept of the ''Ebola business'' were associated with misinformation and lower levels of trust in government and HCFs. The negative perceptions, fear of being identified as an Ebola case, apprehension about the triage unit, and inadequacy of personal protective equipment resulted in a preference for private or informal HCFs. For half of the deceased’s relatives, the Ebola outbreak hastened their death. Conversely, community involvement, employing familiar, neutral, and credible HCWs, and implementing a free care policy increased the number of visits. These results were observable despite a lack of funds, overstretched HCWs, and long waiting time. Conclusions Our findings can inform policies before and during future outbreaks to enhance the resilience of routine HCFs by maintaining dialogue between HCWs and patients, and rebuilding confidence in HCFs. Quantitative studies including context analysis are essential to identify the determinants of care-seeking during such a crisis.

Despite efforts to increase childhood vaccination coverage in the Democratic Republic of the Congo (DRC), approximately 20% of infants have not started their routine immunization schedule (zero-dose). The present study aims to evaluate the relative influence of geospatial access to health facilities and caregiver perceptions of vaccines on the vaccination status of children in rural DRC. Pooled data from two consecutive nationwide immunization surveys conducted in 2022 and 2023 were used. Geographic accessibility was assessed based on travel time from households to their nearest health facility using the AccessMod 5 model. Caregiver attitudes to vaccination were assessed using the survey question “How good do you think vaccines are for your child?” We used logistic regression to assess the relationship between geographic accessibility, caregiver attitudes toward vaccination, and their child’s vaccination status. Geographic accessibility to health facilities was high in rural DRC, with 88% of the population living within an hour’s walk to a health facility. Responding that vaccines are “Bad, Very Bad, or Don’t Know” relative to “Very Good” for children was associated with a many-fold increased odds of a zero-dose status (ORs 69.3 [95%CI: 63.4–75.8]) compared to the odds for those living 60+ min from a health facility, relative to <5 min (1.3 [95%CI: 1.1–1.4]). Similar proportions of the population fell into these two at-risk categories. We did not find evidence of an interaction between caregiver attitude toward vaccination and travel time to care. While geographic access to health facilities is crucial, caregiver demand appears to be a more important driver in improving vaccination rates in rural DRC.

Background: Several trace minerals have been shown to be associated with thyroid cancer. However, there is a paucity of data on the characteristics of thyroid nodules in different mineral rich regions of the Democratic Republic of Congo (DRC). The objective of this study is to establish the spectrum of thyroid nodules in different regions of the most mineral wealthy country in the world. Method: We conducted a cross-sectional study, performing descriptive statistics and logistic regression with a p value < 0.05 deemed of statistical significance. We enrolled 529 patients diagnosed with thyroid nodules between 2005 and 2019 in two of the richest provinces in minerals (Katanga and South Kivu) and the capital city, Kinshasa. Results: The mean age was 44.2±14.6 years with a female predominance, with a female to male ratio of 5.4. 66.5% of patients had a family history of thyroid disease. 74 patients had simple nodules, whereas 455 had multiple nodules. 87.7% of patients with nodules were euthyroid. The nodules mostly presented a solid structure (72.2%), hypoechogenicity (84.5%), a macronodule (59.8%), calcification (14.4%) and lymphadenopathy (15.5%). 22.3% of these nodules had a malignant character. The independent factors associated with this malignancy were age ≥60 years (aOR=2.81), Katanga as province of origin (aOR=8.19), solid echostructure (aOR=7.69), hypoechogenicity (aOR=14.19), macronodule (aOR=9.13), calcification (aOR=2.6) and the presence of adenopathy (aOR=6.94). Conclusion: By the way of this first of its kind study, we demonstrated that thyroid nodules were more likely to be malignant if found in patients originating from mineral rich region of Katanga. This high frequency of malignancy in mineral rich regions requires measures aimed at early detection in this population, lower threshold for suspicion of malignancy and adequate training of doctors involved in the management of these patients. This study paves the way for future, more extensive and well-funded studies to better understand the relationship of heavy metals and thyroid cancer incidence in the richest country in heavy metals in the world.

The Coronavirus disease (COVID-19) pandemic caused significant morbidity and mortality in Africa, in addition to other socio-economic consequences. Across the continent, Schools of Public Health (SPHs) played several roles in supporting national, regional, and global response to the pandemic. Following a published and grey literature search, this paper reviews and analyses the contribution of SPHs in Africa during the COVID-19 pandemic. SPH faculty in most countries contributed their expertise through COVID-19 task forces and advisory committees where they guided and supported decision-making. Faculty also supported the identification, review, and synthesis of rapidly evolving global and local evidence, adapting it to the local context to guide policy decisions. Through research, SPHs contributed to a better understanding of the disease epidemiology, response interventions, as well as prevention and control measures. SPHs engaged in training field epidemiologists, frontline health workers, and district response teams. SPH staff, students and field epidemiology trainees also supported field activities including surveillance, contact tracing, as well as managing quarantine facilities and points of entry. SPHs engaged in public education and awareness-raising initiatives to share information and dispel misinformation. In partnership with other stakeholders, SPHs also developed important innovations and technologies. SPHs are a critical pillar for pandemic prevention, preparedness, and response, that support health systems with important functions. To further enhance their capacity, efforts to improve coordination of SPHs, strengthen collaboration among schools, harmonize training and curricula, and enhance capacity for advanced research are needed. There is also a need to bridge the inequities in capacity and resources that exist among SPHs across regions and countries.

Introduction : Transthoracic Doppler echocardiography (TDE) is an essential tool in the diagnosis of left ventricular hypertrophy (LVH), alongside the Gold standard which is magnetic resonance imaging (MRI), which is much more expensive. TDE is an easily accessible tool in developed countries but remains difficult to access in most rural areas of sub-Saharan African countries, making the diagnosis of LVH difficult. However, it is a predictive factor of cardiovascular events in hypertensive patients. The electrocardiogram being more accessible in these environments, we evaluated its performance in the diagnosis of LVH and especially sought to predict left ventricular mass from the most sensitive and specific electrocardiographic score in our study, the Romhilt-Estes. Method This is an analytical study of a consecutive series of cases, which covered the period from July to September 2018, in five hospital facilities in Kinshasa. Socio-demographic parameters, ECG, and TDE were studied. Spearman's Rho correlation coefficient and Bland Altman concordance test were used for numerical values. And multiple linear regression modeling was used for the entire workforce and in each sex separately. Results The area below the ROC curve of the Romhilt-Estes score was significantly greater than that of the other ECG indices (X²=4.78; p = 0.0289); the most important correlation coefficient was observed between the MVG and the Romhilt-Estes score (0.436) with better alignment and dispersion (95% CI) and finally in the multiple linear regression, age and the score of Romhilt-Estes emerged in both sexes as independent determinants of LVM. Conclusion Age and sex are variables that influence the modeling of LVM based on the Romhilt-Estes score. But the mathematical models found have a weak prediction.

A systematic and contextualized assessment of the interactions between the Sustainable Development Goals and health in the Democratic Republic of Congo is currently lacking. This study aimed to characterize and classify the linkages between the Sustainable Development Goals in the DRC with a focus on health and well-being. In this semi-qualitative participatory study, 35 experts assessed 240 interactions between 16 of the 17 SDGs during a two-day workshop in Kinshasa, Democratic Republic of the Congo, using a scale from +3 (strongly promoting) to −3 (strongly restricting). SDG 16 (Peace, justice, and strong institutions) had the strongest promoting influence on other goals and was identified as a key priority for the DRC to attain the SDGs. Progress on SDG 3 (good health and well-being) was perceived as promoting progress on most SDGs, and through second-order interactions, a positive feedback loop was identified. Furthermore, progress on the other SDGs was deemed to promote progress on SDG 3, with SDG 16 having the greatest positive potential when second-order interactions were taken into account. Our results show the importance of recognizing synergies and trade-offs concerning the interactions between health and other SDGs and that it is imperative to set up structures bringing together different sectors to accelerate work towards achieving the 2030 Agenda.

Background Food insecurity is alarming in all four dimensions—availability, access, utilization, and stability—in Popokabaka, DR Congo. In such cases, a unique indicator may not help to develop adapted and local long-term actions. A comprehensive analysis of food insecurity is needed. We aimed to examine the burden and extent of food insecurity and suggest integrative pathways using a mixed approach for transformative actions at the local level. Methods We designed a convergent parallel mixed-methods study with four-level data sources collected in Popokabaka: (1) a household food survey (using the Household Food Insecurity Access Scale (HFIAS), a Household Dietary Diversity Score (HDDS) and the Food Consumption Score (FCS), (2) a market food census (assessing food availability and cost per 100 g), and (3) an exit food market survey (assessing buyers' food choices and client satisfaction), and (4) on-farm qualitative study among food producers (exploring challenges and opportunities). Descriptive statistics from our quantitative data were triangulated with themes emerging from qualitative data. Results Popokabaka experienced severe food access insecurity (89%), poor food consumption (40.7%), and low dietary diversity (30.2%) at the household level. The quantitative findings at the household level were linked to market characteristics and farmer-reported themes under three pathways: poor diet quality , culturally grounded diet , and risk perception . Conclusions The focus should be on improving livestock development, developing adapted communications about nutrition to change established dietary habits, and engaging the government and all stakeholders to empower local communities for improved food security.

Background Catastrophic health expenditures are direct healthcare expenses that exceed 10% or 25% of total household income. The present study aims to measure the proportion of households that fall into catastrophic health expenditure, their socio-demographic and economic characteristics and the factors associated with catastrophic health expenditures. Methods We conducted a secondary data analysis of 205 households from a cross-sectional study in seven health zones in 2022 in DRC. A Clustered Lot Quality Assurance Sampling (LQAS) was used through a 3-stage sampling process. Data were entered into SPSS version 26 and analyzed using the same software. Descriptive analyses included frequencies and percentages, bivariate analyses were performed to see the association between catastrophic health expenditure at 10% and 25% and the independent variables (location, household size, household head occupation, health insurance coverage, and economic well-being). Binary logistic regressions were performed respectively at the 10% and 25% thresholds of income. The association was statistically significant if the p-value was strictly less than 0.05. Results Overall, the extent of catastrophic expenditure at the 10% threshold was 72%, and 47% at the 25% threshold of the monthly household income. Poor households were 1.87 (95% confidence interval, CI=1.06-3.28) times more exposed to catastrophic expenditure than rich households. Conclusions In Kongo Central’s port area, catastrophic health expenditure prevalence is significantly higher than in Sub-Saharan Africa. This exposes the majority to further poverty, highlighting the need for a healthcare coverage system in the country. Registration: ESP/CE/118/2022 of September 12, 2022

BACKGROUND:Cancer diagnosis is increasing around the world and in the Democratic Republic of the Congo (DRC). The proportion of thyroid cancer has increased over the past three decades. There are very few studies on cancer epidemiology, and in particular on thyroid cancer in the DRC.AIM:To establish the most recent proportion of thyroid cancer in the DRC compared to other cancers.METHODS:This is a retrospective and descriptive study of 6106 consecutive cancer cases listed in the pathological registers of 4 Laboratories in the city of Kinshasa. This study included all cancer cases recorded in the registers between 2005 and 2019.RESULTS:From a sample of 6106 patients, including all cancer types, 68.3% cases were female and 31.7% were male. Breast and cervical cancer were the most common types of cancer in women and, prostate and skin cancer were the most common types in men. Thyroid cancer was sixth in proportion in women and eleventh in men compared to all cancers. Papillary carcinoma was the most common of thyroid cancers. Rare cancers such as anaplastic and medullary thyroid carcinomas had a proportion of 7% and 2%, respectively.CONCLUSION:Newer diagnostic tools led to a surge in cancer diagnoses in the DRC. Thyroid cancer has more than doubled its proportion over the last several decades in the country.

Background: The prevalence of stunting in the Democratic Republic of the Congo (DRC) is one of the highest globally. However, only a few studies have attempted to measure the association between stunting and vegetation, which is an important food source. The leaf area index (LAI) is an excellent measure for the vegetation state. Objective: This paper intended to measure the association between the LAI and stunting among children under five years of age in the DRC. Its aim was to better understand the boundary conditions of stunting and explore potential links to climate and environmental change. Methods: This paper adopts a secondary data analysis approach. We used data on 5241 children from the DRC Demographic Health Survey (DHS) 2013–2014, which was collected from a nationally representative cross-sectional survey. We used the satellite-derived LAI as a measure for the state of vegetation and created a 10-km buffer to extract each DHS cluster centroid’s corresponding mean leaf-area value. We used a generalised mixed-effect logistic regression to measure the association between LAI and stunting, adjusting the model for mother’s education, occupation and birth interval, as well as child’s age and national wealth quintile. A height-for-age Z-score (HAZ) was calculated and classified according to WHO guidelines. Results: Children in communities surrounded by high LAI values have lower odds of being stunted (OR [odds ratio] = 0.63; 95% CI [confidence interval] = 0.47–0.86) than those exposed to low LAI values. The association still holds when the exposure is analysed as a continuous variable (OR = 0.84; 95% CI = 0.74–0.95).When stratified in rural and urban areas, a significant association was only observed in rural areas (OR = 0.6; 95% CI = 0.39–0.81), but not in urban areas (OR = 0.9; 95% CI = 0.5−0.5). Furthermore, the study showed that these associations were robust to LAI buffer variations under 25 km. Conclusions: Good vegetation conditions have a protective effect against stunting in children under five years of age. Further advanced study designs are needed to confirm these findings.

The thyroid imaging reporting and data systems by the European Thyroid Association (EU-TIRADS) has been widely used in malignancy risk stratification of thyroid nodules. However, there is a paucity of data in developing countries, especially in Africa, to validate the use of this scoring system. The aim of the study was to assess the diagnostic value of the EU-TIRADS score in Congolese hospitals, using pathological examination after surgery as the gold standard in Congolese hospitals. This retrospective and analytical study examined clinical, ultrasound and pathological data of 549 patients aged 45 ± 14 years, including 468 females (85.2%), operated for thyroid nodule between January 2005 and January 2019. In the present study, only the highest graded nodule according to the EU-TIRADS score in each patient was taken into account for the statistical analyses. So 549 nodules were considered. Nodules classified EU-TIRADS 2 and 3 on the one hand, and, on the other hand, 4 and 5, were considered respectively at low and high risk of malignancy. The sensitivity and specificity of the EU-TIRADS score were calculated. The significance level was set at 5%. Of all patients, 21.7% had malignant nodules. They made 48.4% of the nodules in patients younger than and at 20 years old, and 31.1% in those aged 60 or over. Malignant nodules were more frequent in men than in women (30.9% vs. 20.1%; p = 0.024). Papillary carcinoma (67.2%) and follicular carcinoma (21.8%) were the main types. The malignancy rate was 39.7% and 1.5% among nodules rated EU-TIRADS 4 and 5, and those with EU-TIRADS score 2 and 3, respectively (p < 0.001). The EU-TIRADS score had a sensitivity of 96.6% and a specificity of 59.3%. The ROC curve indicated an area under the curve of 0.862. In a low-income country, a well performed thyroid ultrasound, using the EU-TIRADS score, could be an important tool in the selection of thyroid nodules suspected of malignancy and requiring histopathological examination in the Congolese hospital setting.Trial registration: The research protocol had obtained the favorable opinion of the DRC national health ethics committee no. 197/CNES/BN/PMMF/2020. The data was collected and analyzed anonymously.