Barriers to family planning use in the Eastern Democratic Republic of the Congo: an application of the theory of planned behaviour using a longitudinal survey

OBJECTIVE: In the Democratic Republic of the Congo, there is a low adherence of the population to the use of family planning (FP) due to various social barriers. This study aimed to understand the drives from social barriers to the use of FP in women in the Kivu, a region particularly affected by poverty and many years of conflicts. A theory of planned behaviour (TPB) using a generalised structural equation modelling has been applied to understand the complex sociocultural drivers to the intention and the ultimate decision to use FP. DESIGN: Longitudinal study. SETTING: A community-based approach was used to investigate FP use in the North and South-Kivu regions. PARTICIPANTS: Overall, 1812 women 15 years and older were enrolled in the baseline study and 1055 were retrieved during the follow-up. PRIMARY AND SECONDARY OUTCOMES: FP use and intention to use FP. RESULTS: The mean age was 36+/-12.9 years, with a minimum of 15 years old and a maximum of 94 years old. Among sexually active participants, more than 40% used a modern contraceptive method at the last sexual intercourse. Education was positively and significantly associated with intention to use FP (beta=0.367; p=0.008). Being married was positively and marginally significantly associated with intention to use FP (beta=0.524: p=0.050). Subjective norms were negatively and significantly associated with intention to use FP (beta=-0.572; p=0.003) while perceived control was positively associated with intention to use FP (beta=0.578; p<0.0001). Education and perceived control were positively and significantly associated with the use of FP (respectively, beta=0.422, p=0.017; and beta=0.374; p=0.017), while Intention to use FP was positively and marginally significantly associated with the use of FP (beta=0.583; p=0.052). CONCLUSION: TPB helped understand sociocultural barriers to FP use and it can be useful to define adapted strategies in different contexts

The effectiveness of community volunteers in counting populations and assessing their nutritional vulnerability during armed conflict: district health in D.R. Congo, Central Africa

The study assessed the ability of community volunteers, working with district health officials, to conduct a local census to count the population in their villages and assess their nutritional vulnerability. The study involved organizing community volunteers in village nutrition committee and assigning them to count the village population in a Kivu rural health district (D.R.Congo) and assess their vulnerability in terms of nutrition. The study took place in March and April 2003, during armed conflict in the region. Community volunteers supervised by district health officials collected data, presented here as median proportions (with their Max and Min), by age category. The results show that community volunteers were able to conduct this census with reliable results. The population distribution by age category was similar to the national model from a survey by experts. The community volunteers estimated a median of 22.2 % (6.2-100 %) of households in each village in the eastern DR Congo were vulnerable and required foreign aid. Community volunteers can contribute accurately to the collection of demographic data to be used in health programme planning, thus allowing these data to be followed even during instability and armed conflicts.Objectif : Evaluer la capacité des relais communautaires opérant dans le domaine de la nutrition à contribuer au dénombrement de la population de leurs villages respectifs sous la coordination du district sanitaire. Méthodologie : Une étude quasi expérimentale, consistant à organiser les relais communautaires en comités villageois de nutrition et à les responsabiliser dans le dénombrement de la population de leurs villages respectifs, a été mise sur pied dans un district sanitaire rural du Kivu (RD Congo). L’étude a été réalisée de mars à avril 2003 dans une situation de conflit armé. La collecte des données de la population a été assuée par les relais communautaires. Les médianes (minimum et maximum) des proportions observées par catégories d’âge ont été présentées. Résultats : Les relais ont été capables de faire un dénombrement de la population avec des résultats fiables. Les proportions de la population par catégorie d’âge observées se sont révélées similaires à celles du modèle national issu d’une enquête réalisée par des experts. Pour les relais communautaires, un pourcentage médian de 22,2 % (6,2-100 %) des ménages par village a été considéré comme vulnérables dans le contexte de l’Est de la RD Congo, nécessitant par conséquent une aide extérieure. Conclusion : Les relais communautaires peuvent contribuer à la récolte de données démographiques fiables pouvant permettre de planifier des programmes de santé publique, et le suivi de l’évolution démographique même dans une situation d’instabilité et de conflit armé

Protein-energy malnutrition and malaria-related morbidity in children under 59 months in the Kivu region of the Democratic Republic of the Congo

In the Kivu region located in east of the Democratic Republic of the Congo, malnutrition and malaria is a major cause of morbidity and mortality. The relationship between malaria and malnutrition is unclear and has never been studied in the Kivu region. This report presents an analysis of data from 5695 children aged 0 to 5 years, admitted to the paediatric ward of Lwiro hospital between November 1992 and February 2004. The weight/age (W/A) index and weight/height (W/H) index expressed with standard deviation in relation to the reference median were calculated (Z score). The association between protein-energetic malnutrition and malaria infection and nutritional indicators was measured based on prevalence ratios determined by univariate analysis and adjusted Odds Ratio (OR) derived using a multivariate model. The prevalence of malaria at the time of admission was 35.8 % (n=5695). The W/A and W/H indexes and serum albumin level were correlated with malaria-related morbidity. Logistic regression showed that high malaria OR was associated with both anthropometric nutritional indicators [WHZ > -2: OR (CI 95 %) 1.7 (1.4-2.2)] [WAZ > -2: OR (CI 95 %) 1.3 (1.1-1.6)] and biological nutritional indicators [serum albumin > or = 23 g/L: OR (CI 95 %) 1.6 (1.2-2.1)]. Our findings indicate that malnourished children at admission have a lower risk of malaria infection

Prevalence of gastro-intestinal helminths in slaughtered cattle in Walungu territory, South Kivu Province, Eastern Democratic Republic of Congo

Austin Journal of Veterinary Science & Animal Husbandry; 2018; Vol. 5(1): 1039An abattoir cross sectional survey was carried out to determine the prevalence of gastrointestinal parasitic helminths in slaughtered cattle at Kankinda and Mugogo Municipal abattoirs located in Walungu territory, South Kivu province, eastern Democratic Republic of Congo. Using qualitative and quantitative coprological examination, 200 fecal samples were tested. Gastrointestinal helminths’ eggs were detected in only 148 samples tested giving an overall prevalence of 74%. The most diversity class was nematodes with four species, followed by trematode and cestode with two species in each, both representing species abundances of 44.4%, 22.2% and 22.2% respectively and only one protozoan species was identified (11.1%). However, the prevalence of helminths in relation to sex and age group revealed no statistical difference at P value >0.05. The exotic breed presented the highest infection rate of 72.5% (OR=4.6, 95% CI: 1.9–11.1; p=0.0004) compared to the local breed. Similarly high prevalence of helminthes was found in slaughtered cattle from local farms 90.6% (OR=4.1; 95% CI: 1.9–9.5; p=0.0001) compared to cattle imported from Rwanda. The prevalent helminthes species identified were Eimeria bovis (74%), followed by Schistosoma bovis (41%); Hymenolepis diminuta (39%); Toxocara vitulorum (32.5%) and the least species observed were Fasciola gigantica (18%); Strongyloides papillosus (11.5%); Trichonstrongylus sp (7%); Haemonchus spp (6.5%); and Moniezia spp (6%). These findings reflect a growing burden of gastrointestinal parasite infections at abattoir level. Therefore, a proper management, improved hygiene and regular deworming practices should be institutionalized for prevention and control of parasitic infections in livestock

Association between post-traumatic stress disorder and hypertension in Congolese exposed to violence: a case-control study.

Numerous risk factors have been involved in the pathogenesis of hypertension. The contribution of psychological factors, including post-traumatic stress disorder, remains largely underexplored, despite their potential role in hypertension. We compared the prevalence of trauma, post-traumatic stress and other psychological disorders between hypertensive and normotensive patients from Bukavu (Democratic Republic of Congo), a 25-year war-exposed city. In this case-control study, we assessed past traumatic events with the Stressful-Events-Scale, post-traumatic stress disorder through the post-traumatic diagnostic scale, depression and alcohol use disorder through the MINI-International-Neuropsychiatric-Interview, and emotion regulation through the Emotion-Regulation-Questionnaire in 106 hypertensive and 106 normotensive patients, enrolled at the Bukavu General Hospital. Compared with normotensive controls (73% women, age: 43 ± 14 years, BP: 121 ± 10/75 ± 8 mmHg), hypertensive patients (57% women, age: 42 ± 13 years, BP: 141 ± 12/82 ± 7 mmHg, on a median of two antihypertensive drugs) were exposed to more man-made traumas (61 vs. 13%, P &lt; 0.001), used more expressive suppression (P = 0.05) and less cognitive reappraisal (P = 0.02) as emotional regulation strategies. They developed more frequent post-traumatic stress disorder (36 vs. 7%, P &lt; 0.001) and major depressive disorder (37 vs. 13%, P = 0.001), often in association with alcohol use disorder (23 vs. 4%, P &lt; 0.001). In multivariate logistic regression, post-traumatic stress disorder [OR = 3.52 (1.23-6.54)], man-made trauma [OR = 2.24 (1.15-4.12)], family history of hypertension [OR = 2.24 (1.06-4.44)], fasting blood glucose [OR = 1.85 (1.07-3.08)], BMI [OR = 1.28 (1.12-2.92)], expressive suppression [OR = 1.23 (1.11-2.23)] and cognitive reappraisal [OR = 0.76 (0.63-0.98)] were independent predictors of hypertension. In Congolese populations exposed to war, man-made trauma exposure and post-traumatic stress disorder appear to be more tightly related to hypertension than classical hypertension risk factors

Prevalence of gastro-intestinal helminths in slaughtered cattle in Walungu territory, South Kivu Province, Eastern Democratic Republic of Congo

Austin Journal of Veterinary Science & Animal Husbandry; 2018; Vol. 5(1): 1039An abattoir cross sectional survey was carried out to determine the prevalence of gastrointestinal parasitic helminths in slaughtered cattle at Kankinda and Mugogo Municipal abattoirs located in Walungu territory, South Kivu province, eastern Democratic Republic of Congo. Using qualitative and quantitative coprological examination, 200 fecal samples were tested. Gastrointestinal helminths’ eggs were detected in only 148 samples tested giving an overall prevalence of 74%. The most diversity class was nematodes with four species, followed by trematode and cestode with two species in each, both representing species abundances of 44.4%, 22.2% and 22.2% respectively and only one protozoan species was identified (11.1%). However, the prevalence of helminths in relation to sex and age group revealed no statistical difference at P value >0.05. The exotic breed presented the highest infection rate of 72.5% (OR=4.6, 95% CI: 1.9–11.1; p=0.0004) compared to the local breed. Similarly high prevalence of helminthes was found in slaughtered cattle from local farms 90.6% (OR=4.1; 95% CI: 1.9–9.5; p=0.0001) compared to cattle imported from Rwanda. The prevalent helminthes species identified were Eimeria bovis (74%), followed by Schistosoma bovis (41%); Hymenolepis diminuta (39%); Toxocara vitulorum (32.5%) and the least species observed were Fasciola gigantica (18%); Strongyloides papillosus (11.5%); Trichonstrongylus sp (7%); Haemonchus spp (6.5%); and Moniezia spp (6%). These findings reflect a growing burden of gastrointestinal parasite infections at abattoir level. Therefore, a proper management, improved hygiene and regular deworming practices should be institutionalized for prevention and control of parasitic infections in livestock

Malaria infection and nutritional status: results from a cohort survey of children from 6-59 months old in the Kivu province, Democratic Republic of the Congo

BACKGROUND: Despite a reduction in the magnitude of endemic malaria reported in recent years, malaria and protein-energy malnutrition (PEM) still remain major causes of morbidity and mortality in sub-Saharan Africa among children under five. The relationship between malaria and malnutrition remains a topic of controversy. We aimed to investigate malaria infection according to nutritional status in a community-based survey. METHODS: A cohort of 790 children aged 6 to 59 months and residing in eastern Democratic Republic of the Congo was followed-up from April 2009 to March 2010 with monthly visits. Data on nutritional status, morbidity between visits, use of insecticide-treated nets and malaria parasitemia were collected at each visit. The Z scores height for age, weight for age and weight for height were computed using the reference population defined by the WHO in 2006. Thresholds for Z scores were defined at -3 and -2. A binary logistic model of the generalized estimating equation (GEE) was used to quantify the association between PEM indicators and malaria parasitemia. Odds ratio (OR) and their 95% confidence interval (95% CI) were computed. RESULTS: After adjustment for season, children with severe stunting (height for age Z score<-3) were at lower risk of malaria parasitemia greater or equal to 5000 trophozoits/μL of blood as compared to those in with a better nutritional status (height for age Z score≥-2) (OR=0.48, 95% CI: 0.25-0.91). CONCLUSION: Severely stunted children are at a lower risk of high-level malaria parasitemia