Applying the Robson classification to routine facility data to understand the Caesarean section practice in conflict settings of South Kivu, eastern DR Congo

Introduction: Sub-Saharan Africa has low Caesarean (CS) levels, despite a global increase in CS use. In conflict settings, the pattern of CS use is unclear because of scanty data. We aimed to examine the opportunity of using routine facility data to describe the CS use in conflict settings. Methods: We conducted a facility-based cross-sectional study in 8 health zones (HZ) of South Kivu province in eastern DR Congo. We reviewed patient hospital records, maternity registers and operative protocol books, from January to December 2018. Data on direct conflict fatalities were obtained from the Uppsala Conflict Data Program. Based on conflict intensity and chronicity (expressed as a 6-year cumulative conflict death rate), HZ were classified as unstable (higher conflict death rate), intermediate and stable (lower conflict death rate). To describe the Caesarean section practice, we used the Robson classification system. Based on parity, history of previous CS, onset of labour, foetal lie and presentation, number of neonates and gestational age, the Robson classification categorises deliveries into 10 mutually exclusive groups. We performed a descriptive analysis of the relative contribution of each Robson group to the overall CS rate in the conflict stratum. Results: Among the 29,600 deliveries reported by health facilities, 5,520 (18.6%) were by CS; 5,325 (96.5%) records were reviewed, of which 2,883 (54.1%) could be classified. The overall estimated population CS rate was 6.9%. The proportion of health facility deliveries that occurred in secondary hospitals was much smaller in unstable health zones (22.4%) than in intermediate (40.25) or stable health zones (43.0%). Robson groups 5 (previous CS, single cephalic, ≥ 37 weeks), 1 (nulliparous, single cephalic, ≥ 37 weeks, spontaneous labour) and 3 (multiparous, no previous CS, single cephalic, ≥ 37 weeks, spontaneous labour) were the leading contributors to the overall CS rate; and represented 75% of all CS deliveries. In unstable zones, previous CS (27.1%) and abnormal position of the fetus (breech, transverse lie, 3.3%) were much less frequent than in unstable and intermediate (44.3% and 6.0% respectively) and stable (46.7%and 6.2% respectively). Premature delivery and multiple pregnancy were more prominent Robson groups in unstable zones. Conclusion: In South Kivu province, conflict exposure is linked with an uneven estimated CS rate at HZ level with at high-risks women in conflict affected settings likely to have lower access to CS compared to low-risk mothers in stable health zones

Onchocerciasis in the Democratic Republic of Congo: Survey of knowledge, attitude and perception in Bandundu province.

A community-directed treatment with ivermectin (CDTI) for fighting onchocerciasis was started in 2003 in the hyperendemic province of Bandundu, Democratic Republic of Congo (DRC); such initiative was supported by the African Programme for Onchocerciasis Control (APOC). As the APOC stopped at the end of 2015, there was an urgent need to assess the sustainability of an ivermectin treatment. A cross-sectional survey of knowledge, attitude and perception was conducted to determine the awareness level of local population regarding the disease. A multi-stage random sampling technique allowed the selection of 450 heads of households. Most respondents (96.9%) knew about onchocerciasis as a disease. The black-fly was viewed as the causing agent of onchocerciasis by 49.9% of respondents. The most commonly cited clinical manifestations were nodules (34.4%) and pruritus (31.1%), while blindness was the most frequently reported complication (90.7%). Approximately 55.1% of respondents had a good knowledge of onchocerciasis and CDTI. Overall, only 37% of participants had a favourable attitude and 46% a positive perception. Good knowledge was associated with school attendance (adjusted OR=1.9, 95%CI: 1.3-2.8, p=0.001), while education and continuation of treatment were related with good attitude (adjusted OR=9.7, 95%CI:4.8-19.5 and adjusted OR=19.8, 95%CI: 9.7-40.6, respectively, both with p<0.001). Good perception was associated with being at least 46 years old, non-Catholic and continuing the treatment (adjusted OR=3.2, 95%CI:1.2-9.1; adjusted OR=29.6, 95%CI:14.1-62.2 and adjusted OR=5.1, 95%CI:1.6-16.0 respectively, all with p<0.001). A good level of knowledge, attitude and perception is needed for a massive adherence of population to onchocerciasis control programmes. In the area of study (Moanza, DRC), good attitude and perception motivated the continuation of treatment in the population. In the future, different plans should focus on educational strategies to maintain a massive adherence and reduce onchocerciasis prevalence.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Untreated villages and factors associated with the absence of Community-Directed Treatment with Ivermectin (CDTI) in DRC

Introduction: The African Programme for Onchocerciasis Control (APOC), the main objective of which was the Community-Directed Treatment with Ivermectin (CDTI), was closed by the end of 2015. The purpose of this study was to describe untreated villages in DRC and to assess the factors associated with the absence of CDTI in endemic villages, between 2001 and 2014. Methodology: This retrospective study was descriptive. Several annual technical reports of the National Onchocerciasis Task Force (NOTF) and national technical reports of CDTI projects were analysed; 21 projects implemented to control the disease were considered, representing the coverage of 42,778 endemic villages. Data were collected over a 3 month-period, between October and December 2016. Results: Only 15,700 endemic villages were not treated through an annual CDT with Mectizan, i.e. 36.7%. The population at risk totalled 29,712,381 individuals and 7,681,995 of them were not treated, i.e. 25.9%. Eight projects recorded high proportions of untreated villages, i.e. 7,100 endemic entities (16.6%). Factors independently associated with non-treatment were the fear of serious side effects (adjusted OR: 10.6; 95% CI: 4.5-27.7), supply impaired by insecurity (adjusted OR: 15.9; 95% CI: 6.7-41.4) and geographical inaccessibility (adjusted OR: 19; 95% CI: 6.9-63.9). Conclusion: After 15 CDTI-cycles in DRC, the mean geographical coverage and therapeutic coverage rates reached 63.3% and 74.1%, respectively. The 2025 target of onchocerciasis eradication, as advocated by APOC, will not be reached. Untreated areas are partly responsible for such results. Many weaknesses persist in the National Program for Onchocerciasis Control (NPOC) and new strategies of disease control should be investigated.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Onchocerciasis control in the Democratic Republic of Congo (DRC): challenges in a post-war environment

0info:eu-repo/semantics/nonPublishe