Determinants of Neonatal Mortality in Referral Facilities of the Health Districts in North Kivu, Democratic Republic of Congo

Over the last two decades, several countries that implemented strategies for reaching the Millennium Development Goals (MDGs), have reduced their infant mortality by more than half.  In spite of global decrease in infant mortality, in 2015, on the point of completion of the MDGs, Sub-Saharan Africa countries among them Democratic Republic of Congo (DRC), remained with highest infant mortality rate. Although making progress, neonatal mortality rate is declining less rapidly than the under-five mortality rate.In order to accelerate reaching infant mortality rate target, several countries among them DRC, have implemented strategies to substantially reduce neonatal mortality.In order to target actions, a descriptive cross-sectional study of neonatal deaths occurred between January 1st, 2009 and June 30th, 2014 was performed in referral health facilities of 6 North Kivu province health zones in DRC. Acute fetal distress, premature birth and infection were found to be the causes of 83.4% (n = 235) of newborn deaths. Inadequate staff capacities and / or poor management were implicated in the occurrence of 52.9% (n = 225) deaths, linked to a set made of acute fetal distress, premature birth and infection including sepsis and pneumonia.   Results show that implementation of sophisticated structures such as neonatal intensive care units are not necessary to reduce neonatal mortality in the context of health facilities in DRC. A rational organization of care management including staff training, application of effective interventions and targeted low cost strategies to fight effectively against neonatal mortality would contribute significantly to reduce infant mortality

Supporting the intermediate level of health care in urban health areas in Kinshasa (1995-2005), DR Congo

As a result of the decentralization of health systems, some countries have introduced intermediate (provincial) levels in their public health system. This paper presents the results of a case study conducted in Kinshasa on health system decentralization. The study identified a shift from a focus on regulation compliance assessment to an emphasis on health system coordination and health district support. It also highlighted the emergence of a?managerial (as opposed to a bureaucratic) approach to health district support. The performance of health districts in terms of health care coverage and health service use were also found to have improved. The results highlight the importance of intermediate levels in?the health care system and the value of a more organic and managerial rationality in supporting health districts faced with the complexity of urban environments and the integration of specialized multi-partner programs and interventions.Dans un contexte de décentralisation des systèmes de santé, l’objectif de cette étude était d’analyser le soutien du niveau intermédiaire (provincial) du système sanitaire au district de santé en milieu urbain en RD Congo. La méthode est une étude de cas exploratoire dans la ville de Kinshasa, analyse par triangulation des données documentaires, d’entretiens et des données sanitaires de routine de 1995 à 2005. Cette étude a mis en évidence une évolution des fonctions de contrôle du respect des normes vers des fonctions de coordination de l’action sanitaire et de soutien au développement des districts sanitaires. Cette émergence d’une logique plus managériale que bureaucratique s’est accompagnée d’une amélioration des performances des districts de santé en termes de couverture sanitaire et d’utilisation des services. Ces résultats mettent en exergue l’importance du niveau intermédiaire dans le système de santé. Ils plaident en faveur d’une logique managériale dans le soutien au district de santé, qui est confronté à la complexité du milieu urbain et à l’intégration de programmes verticaux et d’interventions de nombreux partenaires

Urbanisation and health services: developing a new model of primary health care in Goma (Democratic Republic of Congo)

info:eu-repo/semantics/publishe

Urbanisation and health services: developing a new model of primary health care in Goma (Democratic Republic of Congo)

In this article, we present the process leading to the pilot test of a new primary health care services model in Goma (DRC). This new model proposes the introduction of a multidisciplinary team in the urban health centres to offer comprehensive and better-quality patient care. Our contribution highlights the importance of an in-depth analysis of the urban context for the implementation of a new model of care, and the usefulness of a constructive dialogue and active participation of all relevant stakeholders. Our analysis informs launches new research perspectives on the improvement of health care services access in the urban areas

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peer reviewed[en] INTRODUCTION: Nord-Kivu is facing a high prevalence of hypoxemia diseases requiring the use of oxygen concentrators. PURPOSE OF RESEARCH: This article describes the level of functionality of oxygen concentrators in 31 hospital structures, in North Kivu province of Democratic Republic of Congo (DRC). METHODS: This descriptive cross-sectional study carried out a survey of managerial and maintenance personnel and the removal of parameters on the operation of oxygen concentrators from 31 hospitals handling Covid19 cases in North Kivu. The collected data was encoded and analyzed using SPSS version 26 software. RESULTS: The oxygen concentrators were of 28 different brands, and in 65.8% of cases with a 5-liter capacity. They were used in 70% of cases in 4 departments (Intensive care, operating room, emergency room, internal medicine). They were donated in 66.2% of cases (n=225), without accessory equipment in33.6% of cases and without training of maintenance technician in three of five cases or users in one in two cases. In 45% of cases, maintenance was provided. In 67.6% of cases oxygen concentrators were not functional (n=225), with impaired volume flow in 54.9% of cases and oxygen levels in 34,6% of cases. The oxygen deficit was variable depending on the type of hospital structures (p=0,005) but not the volume flow (P>0.05). CONCLUSIONS: Low functionality of oxygen concentrators increases patient risk and shows the interest to implement a provincial strategy for the management and maintenance of bio-medical equipment and its integration into regional health development plan

Recherche-action sur les centres de santé médicalisés urbains dans la ville de Goma (Est de la RDC): Bassin d’attraction et profil de la patientèle

peer reviewedIntroduction: Le phénomène croissant d’urbanisation observé en République Démocratique du Congo (RDC) oblige une adaptation dans l’organisation des services de santé urbains. Dans cette perspective, cette étude décrit le bassin d’attraction et le profil de la patientèle ayant fréquenté les deux Centres de Santé Médicalisés Urbains(CSMU) mis en place dans ville de Goma à l’Est de la RDC dans le cadre d’une recherche-action. Méthodologie: Il s’est agi d’une étude basée sur l’analyse des données des registres et des dossiers des patients ayant fréquenté les deux CSMU pendantla période allant d’avril 2019 à décembre 2021. Résultats: Un total de 14433 patients a fréquenté les deux CSMU pendant la période. Les deux CSMU avaient connu une attraction au-delà des aires de santé d’implantation (26,7%). Le profil de la patientèle avait été de prédominance féminine (62,3%), instruite (70,5%), adulte (44,9% âgés de 18 à 49 ans), et issue des ménages inscrits au CSMU dans 19,6% des cas. Le motif de prise en charge était ominépar des pathologiesinfectieuses (55,2%) et parasitaires (10,6%), suivies des maladies chroniques (26,9%) et des traumatismes (2,6%)(p <0,001). Dans plus de 90% des cas, la prise en charge avait fait intervenir à la fois trois compétences différentes (médicales, infirmières et assistant social) de l’équipe pluridisciplinaire. Discussion et conclusion: Le bassin d’attraction et le profil de la patientèle trouvés montrent l’intérêt de repenser le mode d’organisation des services de santé urbains en vue de mieux répondre aux attentes des populations urbaines

Prevalence of anti-SARS-CoV-2 antibodies in people attending the two main Goma markets in the eastern Democratic Republic of the Congo.

The Democratic Republic of the Congo (DRC) officially reports low coronavirus disease 19 (COVID-19) prevalence. This cross-sectional study, conducted between September and November 2021, assessed the COVID-19 seroprevalence in people attending Goma's two largest markets, Kituku and Virunga. A similar study in a slum of Bukavu overlapped for 1 month using identical methods. COVID-19-unvaccinated participants (n = 796 including 454 vendors and 342 customers, 60% of whom were women) were surveyed. The median age of vendors and customers was 34.2 and 30.1 years, respectively. The crude and adjusted anti-SARS-CoV-2 antibody seroprevalence rates were 70.2% (95% CI 66.9-73.4%) and 98.8% (95% CI 94.1-100%), respectively, with no difference between vendors and customers. COVID-19 symptoms reported by survey participants in the previous 6 months were mild or absent in 58.9% and 41.1% of participants with anti-SARS-CoV-2 antibodies, respectively. No COVID-19-seropositive participants reported hospitalisation in the last 6 months. These findings are consistent with those reported in Bukavu. They confirm that SARS-CoV-2 spread without causing severe symptoms in densely populated settlements and markets and suggest that many COVID-19 cases went unreported. Based on these results, the relevance of an untargeted hypothetical vaccination programme in these communities should be questioned