Patterns of Congenital Malformations and Barriers to Care in Eastern Democratic Republic of Congo.

An increase of congenital anomalies in the eastern Democratic Republic of the Congo (DRC) has been reported. Congenital malformations (CMs) are not uncommon among newborns and, if left untreated, can contribute to increased neonate morbidity and mortality.Medical records of all individuals admitted with a diagnosed CM to HEAL Africa Teaching Hospital (Goma, DRC) from 2002 to 2014 (n=1301) were reviewed. Data were analysed using descriptive statistics to summarize chart records, and inferential statistics to investigate significant barriers to earlier treatment.Since 2012, the number of patients treated each year for CMs has increased by over 200% compared to the average annual number of cases treated from 2002-2011. Though delayed presentation of patients to HEAL Hospital was very obvious, with an average age of 8.2 years. We find that patient age has been significantly decreasing (p=0.037) over time. The average distance separating patients from HEAL Hospital was 178 km, with approximately one third living 350 km or further from the treatment center. Distance is the most significant (p=3.33x10(-6)) barrier to earlier treatment. When controlling for an interaction between gender and the use of mercy funds, we also find that female patients are at a significant (p=1.04x10(-3)) disadvantage to undergo earlier corrective surgery. This disadvantage is further illustrated by our finding that 89% of women and girls, and over 81% of all patients, required mercy funds to cover the cost of surgery in 2014. Lastly, the mortality rate for surgery was low and averaged less than 1.0%.Despite a formal end to the war in 2009, and an overall increase in individuals undergoing corrective surgery, distance, poverty, and gender are still massive barriers to CM care at HEAL Hospital, Goma, DRC. We find that patients have been successfully treated earlier by HEAL, although the average age of CM correction in 2014 (4.9 years) is still above average for Sub-Saharan Africa. Thus, we advocate for further funding from the National Government and international health agencies to enable continued treatment of CMs in rural residents of the eastern DRC. Distance, the most significant barrier to care can be mitigated by the implementation of additional mobile clinics and the construction of regional surgery centers along with the associated hiring of surgeons trained in CM repair

Number of surgeons in the DRC, demonstrating the shortage of specialists in the country.

<p>DRC is ranked 187th out of 187 countries on the planet as per the Human Development Index calculated by the United Nations.</p

R output summarizing the significant (p = 0.05) predictors of age at time of surgery in our best-fit model.

<p>Individual significant diagnoses were not included in this table but can be found in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0132362#pone.0132362.s002" target="_blank">S2 Table</a>. The model had AIC of 774.0, and an adjusted R² value of 0.41.</p

Boxplots depicting the yearly age distributions of patients treated for congenital malformations at HEAL Africa Training Hospital from 2002–2014.

<p>The overall average age at time of presentation decreased significantly (p = 0.04) over time, even when controlling for distance from HEAL, payment type, diagnosis, and sex. Boxes indicate interquartile (IQR) variation in age each year; bold lines the median age. Whiskers demonstrate data within the third and quartile +/- 1.5 IQR respectively; dots indicate outliers. Number of individuals treated each year is indicated within parentheses.</p

Patient Characteristics.

<p>Patient Characteristics.</p

Demographics, mean distance to HEAL, payment type, and surgery location of patients treated by HEAL Africa Training Hospital from 2002 to 2014.

<p>Demographics, mean distance to HEAL, payment type, and surgery location of patients treated by HEAL Africa Training Hospital from 2002 to 2014.</p