Utilisation De La Consultation Prénatale Dans Les Structures De Soins De L’Armée Du Salut A Kinshasa De 2020 A 2022

Malgré des forts investissements faits pour les soins prénatals dans les pays en développement comme en RDC, les femmes n’utilisent pas toujours de façon optimale les services qui leur sont offerts. En effet, le taux d’utilisation de la consultation prénatale (CPN) reste très faible : seulement 35,93% des femmes ont réalisé au moins les 4 visites prénatales en 2022(DHS2). Il est donc de bonne politique, plusieurs temps après, que des états de lieux soient faits pour estimer contribuer à l’amélioration de la santé maternelle.Ainsi, dans cette recherche théorique, qui vise à vérifier et décrire le niveau d’utilisation de la CPN dans les structures de soins salutistes de 2019 à 2022 ; il se dégage que l’utilisation de la CPN dans le réseau sanitaire salutiste, partenaire important du système national de santé, reste encore faible avec un taux moyen de CPN 4 allant de 14 à 22% entre 2019 et 2022. Il faut reconnaître que les structures qui disposent d’une maternité sont mieux utilisées en CPN, soit La maternité de BOMOI avec plus de 150% et CS AMBA avec plus de 26% de taux d’utilisation de CPN4. En outre, les conditions socio-économiques des femmes seraient une condition indispensable de l'utilisation de la CPN

How countries cope with competing demands and expectations: perspectives of different stakeholders on priority setting and resource allocation for health in the era of HIV and AIDS

Background: Health systems have experienced unprecedented stress in recent years, and as yet no consensus has emerged as to how to deal with the multiple burden of disease in the context of HIV and AIDS and other competing health priorities. Priority setting is essential, yet this is a complex, multifaceted process. Drawing on a study conducted in five African countries, this paper explores different stakeholders′ perceptions of health priorities, how priorities are defined in practice, the process of resource allocation for HIV and Health and how different stakeholders perceive this. Methods: A sub-analysis was conducted of selected data from a wider qualitative study that explored the interactions between health systems and HIV and AIDS responses in five sub-Saharan countries (Burkina Faso, the Democratic Republic of Congo, Ghana, Madagascar and Malawi). Key background documents were analysed and semi-structured interviews (n = 258) and focus group discussions (n = 45) were held with representatives of communities, health personnel, decision makers, civil society representatives and development partners at both national and district level. Results: Health priorities were expressed either in terms of specific health problems and diseases or gaps in service delivery requiring a strengthening of the overall health system. In all five countries study respondents (with the exception of community members in Ghana) identified malaria and HIV as the two top health priorities. Community representatives were more likely to report concerns about accessibility of services and quality of care. National level respondents often referred to wider systemic challenges in relation to achieving the Millennium Development Goals (MDGs). Indeed, actual priority setting was heavily influenced by international agendas (e.g. MDGs) and by the ways in which development partners were supporting national strategic planning processes. At the same time, multi-stakeholder processes were increasingly used to identify priorities and inform sector-wide planning, whereby health service statistics were used to rank the burden of disease. However, many respondents remarked that health system challenges are not captured by such statistics. In all countries funding for health was reported to fall short of requirements and a need for further priority setting to match actual resource availability was identified. Pooled health sector funds have been established to some extent, but development partners′ lack of flexibility in the allocation of funds according to country-generated priorities was identified as a major constraint. Conclusions Although we found consensus on health priorities across all levels in the study countries, current funding falls short of addressing these identified areas. The nature of external funding, as well as programme-specific investment, was found to distort priority setting. There are signs that existing interventions have had limited effects beyond meeting the needs of disease-specific programmes. A need for more comprehensive health system strengthening (HSS) was identified, which requires a strong vision as to what the term means, coupled with a clear strategy and commitment from national and international decision makers in order to achieve stated goals. Prospective studies and action research, accompanied by pilot programmes, are recommended as deliberate strategies for HSS

Low-Cost Investigation into Sources of PM2.5 in Kinshasa, Democratic Republic of the Congo

peer reviewe

Field Assessment of a Novel Household-Based Water Filtration Device: A Randomised, Placebo-Controlled Trial in the Democratic Republic of Congo

BACKGROUND: Household water treatment can improve the microbiological quality of drinking water and may prevent diarrheal diseases. However, current methods of treating water at home have certain shortcomings, and there is evidence of bias in the reported health impact of the intervention in open trial designs. METHODS AND FINDINGS: We undertook a randomised, double-blinded, placebo-controlled trial among 240 households (1,144 persons) in rural Democratic Republic of Congo to assess the field performance, use and effectiveness of a novel filtration device in preventing diarrhea. Households were followed up monthly for 12 months. Filters and placebos were monitored for longevity and for microbiological performance by comparing thermotolerant coliform (TTC) levels in influent and effluent water samples. Mean longitudinal prevalence of diarrhea was estimated among participants of all ages. Compliance was assessed through self-reported use and presence of water in the top vessel of the device at the time of visit. Over the 12-month follow-up period, data were collected for 11,236 person-weeks of observation (81.8% total possible). After adjusting for clustering within the household, the longitudinal prevalence ratio of diarrhoea was 0.85 (95% confidence interval: 0.61-1.20). The filters achieved a 2.98 log reduction in TTC levels while, for reasons that are unclear, the placebos achieved a 1.05 log reduction (p<0.0001). After 8 months, 68% of intervention households met the study's definition of current users, though most (73% of adults and 95% of children) also reported drinking untreated water the previous day. The filter maintained a constant flow rate over time, though 12.4% of filters were damaged during the course of the study. CONCLUSIONS: While the filter was effective in improving water quality, our results provide little evidence that it was protective against diarrhea. The moderate reduction observed nevertheless supports the need for larger studies that measure impact against a neutral placebo. TRIAL REGISTRATION: Current Controlled Trials ISRCTN03844341

L'éducation à l'antibiothérapie à domicile: alternative pragmatique et éthique de la gestion thérapeutique des IST chez les jeunes de la rue à Kinshasa

Tout prestataire de soins « décide à la place de ». Ce faisant, ne prend-il pas part à une longue tradition, celle du paternalisme médical ? Le malade est traité comme un enfant, un être structurellement incapable de prendre les décisions qui le concernent. Mais que faire face à des malades comme les enfants des rues, en République démocratique du Congo, qui, loin d’adhérer à notre système de santé, refusent soins et prescriptions ? Ce refus du rôle du soignant nous force à rechercher des stratégies pour dissiper les conflits, à nous adapter au contexte (automédication, vente de médicaments en dehors des officines, etc.), mais surtout à repenser la relation soignant/malade. Il ne s’agit pas d’abandonner le modèle patriarcal autoritaire au profit d’un relativisme total – l’emploi de médicaments comme les antibiotiques est et doit rester encadré de toutes les précautions nécessaires, pour éviter que les résistances ne se renforcent – \; il s’agit de former et d’informer. La tâche qui s’offre à nous est celle d’une éducation thérapeutique, un processus long et continu, centré sur le malade et intégré aux soins qu’il reçoit, qui vise à le rendre capable de gérer au mieux sa maladie. Cette démarche s’intègre dans une approche pragmatique : au-delà de l’asymétrie constitutive de toute relation de pouvoir, il faut rétablir une confiance éclairée, rechercher l’adhésion et non la contrainte. Seul ce pragmatisme peut inciter, en cas d’infections sexuellement transmissibles, des jeunes gens des rues à recourir à la médication moderne et à respecter les posologies. Une gestion thérapeutique efficace des IST n’est-elle pas, selon l’OMS, un des leviers les plus puissants de lutte contre la transmission du sida