Home-based records (HBRs) are often considered the "gold-standard" for determining vaccination status - especially for vaccination coverage surveys (VCS). However, data on the quality and usability of HBRs when collected at the source (household) as opposed to photos for recording at a central level is scarce. This study explores the usability of HBR photographs taken during the 2022 VCS of the Democratic Republic of the Congo (DRC). It compares results from analyses of HBR transcribed in the field and those entered from corresponding photos sent to a central server in the assessment of vaccine coverage. This analysis included a random sample of 2768 children aged 12-23 months who had both HBR data entered at the time of the survey and a corresponding photo. Using the card photo, a team of 6 independent researchers transcribed the cards and assessed HBR characteristics based on a predefined set of criteria related to data quality, entry and HBR quality. Data were summarized using proportions; agreement was assessed using concordance and Kappa-Cohen statistics. Over 90 % of selected children had photos considered adequate. Most HBRs met the set quality criteria in terms of physical condition and legibility. The majority (84.6 %) included the Ministry of Health logo and listed all the vaccines in the routine immunization schedule. Concordance and the Kappa-Cohen statistic showed high levels of variability of agreement by vaccine between the two sources of data. This study illustrates that entering vaccine data using photos of HBR at a central level versus at the time of survey is feasible and can provide accurate results with moderate agreement. Further, this approach can also reduce the time per survey in the field, if interviewers are only required to take a photograph. Additionally, having an HBR photo available can be useful for secondary analyses and further training.

In the Democratic Republic of the Congo (DRC), estimating vaccine coverage (VC) has traditionally relied on large-scale surveys such as the Demographic and Health Surveys (DHS) and the Multiple Indicator Cluster Surveys (MICS). However, these surveys are infrequent, costly, and lack the granularity needed for decision-making at the health district or zone (HZ) level. This paper describes the development by the Kinshasa School of Public Health (KSPH), and technical partners of a Vaccine Coverage Survey (KSPH VCS), adapted from the World Health Organization (WHO) guidelines, which aims to provides timely, cost-effective, and representative estimates of VC at the HZ level. The KSPH VCS adopted a cross-sectional design and a multi-stage sampling approach to sample households at the HZ level. It uses Health Area as cluster in spite of Enumeration Area, and extends the eligibility age range from 12 -23 months to 6-23 months. The sample size for each HZ was calculated using vaccine coverage provided in MICS-2018. It integrates assessments of barriers and enablers to vaccination. Since 2023, it has included malaria indicators. Since its inception in 2018, it has expanded nationwide, covering all 26 provinces of the DRC by 2022. Findings from the KSPH VCS provides estimates at the HZ level that could be combined to provincial and national estimates. Results have been instrumental in evaluating national immunization strategies, including the Mashako Plan and informing Presidential Forums on immunization. They have informed resource allocation, operational planning, and policy decisions at both national and provincial levels as they provided granularity needed for operational decision-making at the HZ level. Its results have also contributed to global immunization estimates, including the WHO/UNICEF Estimates of National Immunization Coverage (WUENIC). The KSPH VCS demonstrates the feasibility of a locally led, cost-effective, and adaptable VC survey in a low-resource setting. Its success highlights the potential for similar methodologies to be implemented in other low- and middle-income countries seeking to improve immunization monitoring and health system performance.

Democratic Republic of the Congo (DRC) is among the countries that have a high malaria incidence. In an effort to combat this public health challenge, innovative tools and strategies are being developed and evaluated. Among the new generation of nets with improved effectiveness of insecticides, those treated with a combination of piperonyl butoxide (PBO) and pyrethroids appear to be a promising malaria control tool. This study evaluated the effectiveness of this combination under community conditions of use in the DRC. A quasi-experimental study was carried out from January to December 2018, in Kisantu Health Zone. Thirty villages were randomly allocated as clusters (1:1) to receive one of two types of long-lasting insecticidal nets (LLIN) treated with deltamethrin alone, or PBO with deltamethrin. After the intervention, the assessments were conducted monthly, quarterly, and every six months for malaria infection, mosquito density, and LLIN durability, respectively. Comparison of changes in different indices between the two groups was made using generalized linear models to correct for non-linear effects. A total of 1790 children were included. There was a significant non-linear effect of time (months) on the malaria infection incidence. The malaria infection incidence was higher in January-March, May-June, and November. It remained higher in the control group compared to the intervention group over time. Similarly, there was a significant non-linear effect of time on the density of both Anopheles funestus s.l. and Anopheles gambiae s.l. These densities decreased after the first month following the intervention and increased after 6 months. Twelve months later, a cohort follow-up showed that the bio-efficacy of LLINs was better in the intervention group. The nets treated with the combination of PBO and deltamethrin appear to be more effective for malaria control under community conditions in the DRC, but a loss of chemical durability is noted after the first year of use.

Background Malaria morbidity and mortality increase in the Democratic Republic of the Congo (DRC) may be the consequence of the low utilization rate of long-lasting insecticidal nets (LLINs) resulting from poor compliance due to adverse events (AEs). This study aimed at determining the prevalence and predictors of AEs following the mass distribution of LLINs in the Kisantu Health Zone (KHZ), a high malaria-endemic region in the DRC. Methods A community-based cross-sectional study embedded was conducted within a randomized controlled trial (RCT) after the mass distribution of LLINs in 30 villages located in DRC KHZ. A three-stage sampling method was used without replacement to select 1790 children. Data was collected on adverse events (AEs) using a reporting form and information on demographics, nutritional status, and house characteristics. This was done using a structured questionnaire administered to household heads. Logistic regression models were used to identify predictors of AEs following the mass distribution of LLINs. Result In a total of 1790 children enrolled, 17.8% (95% CI 16.1–19.7) experienced AEs. The most common AEs were respiratory-related (61%). Around 60% of AEs occurred within 24 h of use, and 51% were resolved without treatment. Sleeping under deltamethrin LLINs (Adjusted OR, 95% CI 5.5 [3.8–8.0]) and zinc roofing (Adjusted OR, 95% CI 1.98 [1.1–3.57]) were associated with the risk of reporting an AE following the mass distribution of LLINs. Conclusion Approximately 1 out of 5 children had an AE within 24 h following LLIN use. These adverse events were often respiratory-related. LLINs and roofing types were associated with a higher risk of reporting AEs. However, further research using a robust study design is needed to confirm these findings. Future studies should design and implement interventions aiming to reduce AEs and improve compliance with LLINs.

Background:There has been increasing awareness about the importance of type 1 diabetes (T1D) globally. Diabetic ketoacidosis (DKA) is a life-threatening complication of T1D in low-income settings. Little is known about health system capacity to manage DKA in low- and lower-middle income countries (LLMICs). As such, we describe health system capacity to diagnose and manage DKA across nine LLMICs using data from Service Provision Assessments. Methods:In this cross-sectional study, we used data from Service Provision Assessment (SPA) surveys, which are part of the Demographic and Health Survey (DHS) Program. We defined an item set to diagnose and manage DKA in higher-level (tertiary or secondary) facilities, and a set to assess and refer patients presenting to lower-level (primary) facilities. We quantified each item's availability by service level in Bangladesh (Survey 1: May 22 2014-Jul 20 2014; Survey 2: Jul 2017-Oct 2017), the Democratic Republic of the Congo (DRC) (Oct 16 2017-Nov 24 2017 in Kinshasha; Aug 08 2018-Apr 20 2018 in rest of country), Haiti (Survey 1: Mar 05 2013-Jul 2013; Survey 2: Dec 16 2017-May 09 2018), Ethiopia (Feb 06 2014-Mar 09 2014), Malawi (Phase 1: Jun 11 2013-Aug 20 2013; Phase 2: Nov 13 2013-Feb 7 2014), Nepal (Phase 1: Apr 20 2015-Apr 25 2015; Phase 2: Jun 04 2015-Nov 05 2015), Senegal (Survey 1: Jan 2014-Oct 2014; Survey 2: Feb 09 2015-Nov 10 2015; Survey 3: Feb 2016-Nov 2016; Survey 4: Mar 13 2017-Dec 15 2017; Survey 5: Apr 15 2018-Dec 31 2018; Survey 6: Apr 15 2019-Feb 28 2020), Tanzania (Oct 20 2014-Feb 21 2015), and Afghanistan (Nov 1 2018-Jan 20 2019). Variation in secondary facilities' capacity and trends over time were also explored. Findings:We examined data from 2028 higher-level and 7534 lower-level facilities. Of these, 1874 higher-level and 6636 lower-level facilities' data were eligible for analysis. Availability of all item sets were low at higher-level facilities, where less than 50% had the minimal set of supplies, less than 20% had the full minimal set, and less than 15% had the ideal set needed to diagnose and manage DKA. Across countries in lower-level facilities, less than 14% had the minimal set of supplies and less than 9% the full set of supplies for diagnosis and transfer of DKA patients. No country had more than 20% of facilities with the minimal set of items needed to assess or manage DKA. Where data were available for more than one survey (Bangladesh, Senegal, and Haiti), changes in availability of the minimal set and ideal set of items did not exceed 15%. Tertiary facilities performed best in Haiti, Ethiopia, Malawi, Nepal, Senegal, Tanzania, and Afghanistan. Secondary facilities that were rural, public, and had fewer staff had lower capacity. Interpretation:Health system capacity to manage DKA was low across these nine LLMICs. Although efforts are underway to strengthen health systems, a specific focus on DKA management is still needed. Funding:Leona M. and Harry B. Helmsley Charitable Trust, and Juvenile Diabetes Research Foundation Ltd.

Early adolescents (ages 10-14) living in low- and middle-income countries have heightened vulnerability to psychosocial risks, but available evidence from these settings is limited. This study used data from the Global Early Adolescent Study to characterize prototypical patterns of emotional and behavioral problems among 10,437 early adolescents (51% female) living in the Democratic Republic of Congo (DRC), Malawi, Indonesia, and China, and explore the extent to which these patterns varied by country and sex. LCA was used to identify and classify patterns of emotional and behavioral problems separately by country. Within each country, measurement invariance by sex was evaluated. LCA supported a four-class solution in DRC, Malawi, and Indonesia, and a three-class solution in China. Across countries, early adolescents fell into the following subgroups: Well-Adjusted (40-62%), Emotional Problems (14-29%), Behavioral Problems (15-22%; not present in China), and Maladjusted (4-15%). Despite the consistency of these patterns, there were notable contextual differences. Further, tests of measurement invariance indicated that the prevalence and nature of these classes differed by sex. Findings can be used to support the tailoring of interventions targeting psychosocial adjustment, and suggest that such programs may have utility across diverse cross-national settings.

Early adolescence (ages 10-14) is a critical period for psychosocial development. With a substantial proportion of lifetime mental health problems manifesting by age 14, poor psychosocial adjustment in early adolescence can set the stage for impairment throughout the life course. Youth living in low- and middle-income countries (LMICs) are at particular risk of experiencing emotional and behavioral problems, but little research on adolescent psychosocial development has been conducted in these settings. The aim of this study was to characterize prototypical patterns of emotional and behavioral problems among early adolescents living in four LMICs, and to explore the extent to which these patterns varied by country and sex.

Context and objectives Non-communicable diseases and injuries (NCDIs) comprise a large share of mortality and morbidity in low-income countries (LICs), many of which occur earlier in life and with greater severity than in higher income settings. Our objective was to assess availability of essential equipment and medications required for a broad range of acute and chronic NCDI conditions. Design Secondary analysis of existing cross-sectional survey data. Setting We used data from Service Provision Assessment surveys in Bangladesh, the Democratic Republic of the Congo, Ethiopia, Haiti, Malawi, Nepal, Senegal and Tanzania, focusing on public first-referral level hospitals in each country. Outcome measures We defined sets of equipment and medications required for diagnosis and management of four acute and nine chronic NCDI conditions and determined availability of these items at the health facilities. Results Overall, 797 hospitals were included. Medication and equipment availability was highest for acute epilepsy (country estimates ranging from 40% to 95%) and stage 1–2 hypertension (28%–83%). Availability was low for type 1 diabetes (1%–70%), type 2 diabetes (3%–57%), asthma (0%–7%) and acute presentations of diabetes (0%–26%) and asthma (0%–4%). Few hospitals had equipment or medications for heart failure (0%–32%), rheumatic heart disease (0%–23%), hypertensive emergencies (0%–64%) or acute minor surgical conditions (0%–5%). Data for chronic pain were limited to only two countries. Availability of essential medications and equipment was lower than previous facility-reported service availability. Conclusions Our findings demonstrate low availability of essential equipment and medications for diverse NCDIs at first-referral level hospitals in eight LICs. There is a need for decentralisation and integration of NCDI services in existing care platforms and improved assessment and monitoring to fully achieve universal health coverage.

Health care workers (HCW) are the most to be affected by Ebola virus disease (EVD), majority of this transmission is nosocomial because they treat patients with EVD, this occurs through close contact with patients when infection prevention and control (IPC) measures are not strictly practiced. This study aimed to assess knowledge and challenges to implement the IPC by the HCWs in northeastern regions in Democratic Republic of Congo (DRC).

The Democratic Republic of the Congo (DRC) is characterized by a high prevalence of hypertension (HTN) and a high proportion of uncontrolled HTN, which is indicative of poor HTN management. Effective management of HTN in the African region is challenging due to limited resources, particularly human resources for health. To address the shortage of health workers, the World Health Organization (WHO) recommends task shifting for better disease management and treatment. Although task shifting from doctors to nurses is being implemented in the DRC, there are no studies, to the best of our knowledge, that document the association between task shifting and HTN control. The aim of this study was to investigate the association between task shifting and HTN control in Kinshasa, DRC.

In the Democratic Republic of the Congo the control of hypertension is poor, characterized by an increasing number of reported cases of hypertension related complications. Poor control of hypertension is associated with non-adherence to antihypertensive medication. It is well established that the use of complementary and alternative medicine is one of the main factors of non-adherence to antihypertensive medication. The aim of this study is to determine the prevalence and factors associated with the use of complementary and alternative medicine.

Obesity is one of the main risk factors of non-communicable diseases (NCDs) worldwide, especially in sub-Saharan Africa. The use of Cyproheptadine increases body weight and the risk of becoming obese. The aim of this study is to determine the prevalence of Cyproheptadine misuse in the Kinshasa population and to describe its characteristics.

Hypertension remains a public health challenge worldwide. In the Democratic Republic of Congo, its prevalence has increased in the past three decades. Higher prevalence of poor blood pressure control and an increasing number of reported cases of complications due to hypertension have also been observed. It is well established that non-adherence to antihypertensive medication contributes to poor control of blood pressure. The aim of this study is to measure non-adherence to antihypertensive medication and to identify its predictors.

Background: Hypertension-related complications have become more diagnosed at secondary and tertiary care levels, in the Democratic Republic of the Congo (DRC), probably indicative of poor management of hypertensive patients at primary health care level. This study aimed to assess the management of hypertension in primary health care settings by using guidelines of the International Forum for Prevention and Control of HTN in Africa (IFHA).Methods: A multi-center cross-sectional study was carried out in primary health care settings. A total of 102 nurses were surveyed using a structured interview. Mean and proportion comparisons were performed using the t Student test and the Chi-square test respectively. The Kinshasa Primary Health Care network facilities were compared with non-Kinshasa Primary Health Care network facilities.Results: From the 102 nurses surveyed; 52.9 % were female with a mean age of 41.1, (SD = 10) years, merely 9.5 % benefited from in-job training on cardiovascular diseases or their risk factors, and 51.7 % had guidelines on the management of hypertension. Less than a quarter of the nurses knew the cut-off values of hypertension, diabetes and obesity. Merely 14.7 % knew the therapeutic goals for uncomplicated hypertension. Several of the indicators for immediate referral recommended by IFHA were unmentioned. The content of patient education was lacking, avoiding stress being the best advice provided to hypertensive patients. The antihypertensive most used were unlikely to be recommended by the IFHA.Conclusions: This study showed a considerable gap of knowledge and practices in the management of hypertensive patients at primary health care facilities in Kinshasa pertaining to the IFHA guidelines. We think that task-shifting for management of hypertension is feasible if appropriate guidelines are provided and nurses trained.

Background: Democratic Republic of the Congo (DRC) is experiencing an increase in the morbi-mortality related to Non Communicable Diseases (NCD). The reform of DRC health system, based on Health District model, is needed in order to tackle this public issue. This article used 2006 International Diabetes Federation (IDF)'s guidelines to assess the capacities of health facilities belonging to Kinshasa Primary Health Care Network (KPHCN) in terms of equipments, as well as the knowledge, and the practice of their health providers related to type 2 diabetes care.Methods: A multicentric cross-sectional study was carried in 18 Health Facilities (HF) of KPHCN in charge of the follow-up of diabetic patients. The presence of IDF recommended materials and equipment was checked and 28 health providers were interviewed about their theoretical knowledge about patients' management and therapeutic objectives during recommended visits. Chi square test or Fisher exact test was used to compare proportions and the Student t-test to compare means.Results: The integration of NCD healthcare in the KPHC network is feasible. The majority of HF possessed IDF recommended materials except for the clinical practice guidelines, urinary test strips, and monofilament, available in only one, two and four HF, respectively. KPHCN referral facilities had required materials for biochemical analyses, the ECG and for the fundus oculi test. Patients' management is characterized by a lack of attention on the impairment of renal function during the first visits and a poor respect of recommended practices during quarterly and annual visits. A poor knowledge of the reduction of cardiovascular risk factors-related therapeutic objectives has been also reported.Conclusion: The capacities, knowledge, and practice of T2D care were poor among HF of KPHCN. The lack of equipment and training of healthcare professionals should be supplied even to those who are not medical doctors. Special attention must to be put on the clinical practice guidelines formulation and sensitization and on supervision.

Background. - Despite numerous advantages of breastfeeding, in Democratic Republic of the Congo, the rate of children exclusively breastfed up to six months remains low. The lack of breastfeeding support received by mothers from health care providers is an important factor of early cessation of breastfeeding. This study aimed to evaluate the effect of the training of health care providers, in the Baby Friendly Hospital Initiative, on the duration of exclusive breastfeeding (EBF) in Kinshasa.Methods. - A total of 422 mothers, recruited during the first antenatal care visit in 12 maternities and followed up to six months after delivery, were included in a cluster randomized trial. In the experimental group, health care providers were trained using the "20-Hour Course For Maternity Staff''. Cox proportional hazards model was used to determine the effect of the intervention on the duration of EBF.Results. - The rate of EBF at six months was 2.8%; the median duration of EBF was 10.9 weeks (IQR 4.3 to 14.9). The hazard of discontinuing EBF before six month was 1.4 times higher in the control group (adjusted HR [95% CI] = 1.40 (1.10-1.78), P = 0.007).Conclusion. - In this study, training of health care providers in the Baby Friendly Hospital Initiative was associated with a significant improvement in the duration of EBF. Extending this training to different maternities could improve the coverage of EBF in Kinshasa. (C) 2015 Elsevier Masson SAS. All rights reserved.

Contexte : En communauté française de Belgique, l'enseignement de la médecine est organisé en deux cursus.Le premier -baccalauréat -étudie l'homme normal.Le deuxième cursus -mastersétudie les pathologies avec, pour les 1 e et 2 e masters, une faible exploitation clinique.Les 3 e et 4 e masters bénéficient de pratiques cliniques hospitalières tout au long de l'année académique.Celles-ci sont réparties en dix mois de stages obligatoires dont un mois de gynécologie-obstétrique délimitant le cadre du projet pédagogique que nous travaillons avec les étudiants de 3 e master et avec les assistants-pilotes qui les accompagnent.Problématique : Bien que les étudiants de 1 e master reçoivent dix heures d'un cours de psychologie médicale assorti de douze heures de « travaux pratiques », les assistants-pilotes observent de profonds malaises chez les stagiaires de 3 e master.Ainsi, posons nous la question de l'acquisition et de la mobilisation de la compétence professionnelle « communication clinique » lors du parcours clinique de gynécologie-obstétrique. Finalité : Mobilisation, progression, co-évaluation et régulation de cette compétence.Dispositif : Deux familles de situations sont définies afin de mieux cerner l'appropriation de cette compétence professionnelle dans le cadre des stages.La première s'intitule « Lors d'une consultation de base.».La deuxième s'intitule « Lors d'une consultation incluant une annonce difficile.».Dès le début du stage, nous proposons aux étudiants une grille fondée sur la première famille de situations.À dessein non certificatif, cet outil intègre les paramètres à évaluer et leurs indicateurs de développement.Lorsque l'étudiant en fait la demande, son auto-évaluation est discutée avec l'assistant-pilote.Au terme du parcours, suite à l'organisation d'un atelier encadré par un médecin formé à la communication clinique (jeux de rôle et exercices de simulation) intitulé « Lors d'une consultation de base.», l'étudiant évalue sa compétence avant et après la formation.S'ensuit une confrontation des jugements et une prise de conscience par l'étudiant de son niveau de développement.La deuxième famille de situations est abordée à mi-parcours lors d'un atelier intitulé « Lors d'une consultation incluant une annonce difficile.».L'analyse de cas vécus par les apprenants, la métacognition, la conceptualisation (carte conceptuelle), l'évaluation et la régulation sont organisées et gérées grâce à l'intervention d'un psychologue clinicien.Impacts anticipés : Ce processus devrait faciliter la régulation des activités mentales ainsi qu'une anticipation adéquate de la communication clinique avec les patientes dans ces deux familles de situations.Dans l'avenir, si les résultats de cette recherche-action s'avèrent positifs, la faculté propose d'installer cette pratique dans d'autres départements cliniques.Les résultats seront évalués à l'aide de focus-groups avec les stagiaires afin d'évaluer leurs perceptions de l'aspect formatif des ateliers.