Prevention against malaria before the first antenatal visit and absence of anaemia at the first visit were protective from low birth weight: results from a South Kivu cohort, Democratic Republic of the Congo.

Background: There is little information on the causes of low birth weight (LBW, <2500 g) in South Kivu. The authors determined the prevalence of LBW among full-term newborns, and its relationship with malaria and anaemia at the first antenatal visit (ANV1) in the rural health zone of Miti-Murhesa, in the eastern Democratic Republic of the Congo. Methods: Four-hundred-and-seventy-eight pregnant women in the second trimester attending their first antenatal clinic were recruited between November 2010 and July 2011, and followed-up until delivery. Besides information on use of preventive measures and malaria morbidity, anthropometric measures and a blood sample were collected. Results: Women's mean age (SD) at enrolment, was 26 (6.5) years (n=434); prevalence of malaria was 9.5% (43/453) and that of anaemia 32.2% (141/439). The latter was significantly more frequent in malaria-infected women and in those who had not been dewormed. At delivery, prevalence of LBW was 6.5% (23/355) and was independently associated with not sleeping under insecticide-treated bed net (p=0.030), mother's height <150 cm (p=0.001) and anaemia at the ANV1 (p=0.006). Conclusion: In South Kivu, malaria and anaemia are important risk factors for LBW, and should be prevented among all women of reproductive age

Are people most in need utilising health facilities in post-conflict settings? A cross-sectional study from South Kivu, eastern DR Congo

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

Ensuring leadership at the operational level of a health system in protracted crisis context: a cross-sectional qualitative study covering 8 health districts in Eastern Democratic Republic of Congo

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

Violence against health care workers in a crisis context: a mixed cross-sectional study in Eastern Democratic Republic of Congo

Abstract Background Health Care Workers (HCWs) in conflict zones face high levels of violence while also playing a crucial role in assisting the population in distress. For more than two decades, the eastern provinces of the Democratic Republic of the Congo (DRC), have been wracked by conflict. This study aims to describe the state of violence against HCWs and the potential prevention mechanisms in eastern DRC. Methods In North and South Kivu, between February 5 and 21, 2021, we conducted a mixed cross-sectional convergent study in health facilities (health centers and hospitals). An anonymized self-administered questionnaire was sent to HCWs about their experience of violence in the 12 months prior to the study. In-depth individual interviews with HCWs, present on the day of the investigation, were also done to explore their experience of violence. A descriptive analysis of the quantitative data and a thematic analysis of the qualitative data was carried out. Results Of a total of 590 participants, 276 (45.9%) reported having experienced violence in the 12 months before the study. In North Kivu, aggressors were more frequently the patients (43.7% vs. 26.5%) and armed group members (14.3% vs. 7.9%) than in South Kivu. Most respondents (93.5%) reported verbal aggression (insults, intimidation, death threats). Other forms of physical aggression including with bare hands (11.2%), firearm (1.81%), and stabbing (4.7%). Only nearly one-tenth of the attacks were officially reported, and among those reported a higher proportion of sanctions was observed in South Kivu (8.5%) than in North Kivu (2.4%). The mechanisms proposed to prevent violence against HCWs were community initiatives and actions to strength the health system. Conclusions In Eastern DRC, HCWs face multiple and severe forms of aggression from a variety of individuals. The effects of such levels violence on HCWs and the communities they served could be devastating on the already pressured health system. Policy framework that defines the roles and responsibilities for the protection of HCWs and for the development and implementation of preparedness measures such as training on management of violence are possible solutions to this problem