Humanitarian sector (international non-governmental organisations) support to the community in Goma city/DRC during the COVID-19 pandemic period: Expectations and reality.

COVID-19 was the largest public health emergency to disrupt social life and health systems worldwide. The pandemic affected all world continents creating fear and stress in many aspects of social life. The pandemic spread from China to Europe, then to Africa carrying with it all the negative impacts affecting population wellbeing. The COVID-19 pandemic was declared in the Democratic Republic of Congo (DRC) in March 2020 and created huge shock and stress countrywide. Goma city accommodates more than 30 international non-governmental humanitarian organisations (HO) who have sought to support local communities to help them overcome COVID-19 stress. Few studies to date have considered the role of these HO from the perspective of the beneficiary populations. This is a descriptive, analytical study, reporting data collected from a survey questionnaire to 100 community members (including 21 healthcare professionals) in Karisimbi health zone in Goma city in DRC. The study's main aim was to explore how community members viewed the contribution and impact of HO actions during COVID-19 in Goma city. We identified some important mis-matches between community expectations and HO actions which must be addressed in future outbreaks. First, community members had big expectations of HO in terms of practice support to tackle the pandemic (including providing handwashing devices and mobile support teams), yet the vast majority of respondents reported seeing little or no such actions. This can create resentment against HO and it is critically important that they rapidly engage with communities at the start of any outbreak to understand their needs and concerns and develop strategies to directly respond to these. Second, HO played a very limited role in dissemination of information about COVID-19 and were not trusted messengers. Our findings showed that most people's preferred source of information about COVID-19, specifically vaccines, was local healthcare workers-particularly those who were known well and therefore trusted. HO (and national responders) should therefore map trusted spokespersons (including healthcare professionals) in the targeted communities and involve them in the planning and implementation of interventions as essential steps in the response. Among our respondents, social media played a large role in information sharing. Further research is needed to understand the role that social media (particularly Facebook and WhatsApp which were most frequently used) could play in sharing messages from trusted sources, including official government communications. Collectively, these actions could help create a positive attitude towards COVID-19 vaccine and similar interventions in future outbreaks

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Data for: "Humanitarian sector (international non-governmental organisations) support to the community in Goma city/DRC during the COVID-19 pandemic period: expectations and reality"

These data were collected in Goma city/DRC by a team from Hope Medical Centre in support of LSHTM team (Dr Mateus Kambale Sahani and prof Susannah Mayhew). Collection was done by an administered survey questionnaire to the community members to explore how humanitarian international organizations operating in Goma city have engaged with the community members to support them coping with the COVID-19 pandemic. The dataset has 16 variables which are all categorical except the participant ID. It contains both independent variables which are the participants' general characteristics (such age group, social group, sex, level of education), and dependent variables which are directly related to interventions from humanitarian organisations or judgement by the community members

Community expectations from HO by categories of educational levels and healthcare professional status.

Community expectations from HO by categories of educational levels and healthcare professional status.</p

Readiness for COVID-19 vaccine uptake.

COVID-19 was the largest public health emergency to disrupt social life and health systems worldwide. The pandemic affected all world continents creating fear and stress in many aspects of social life. The pandemic spread from China to Europe, then to Africa carrying with it all the negative impacts affecting population wellbeing. The COVID-19 pandemic was declared in the Democratic Republic of Congo (DRC) in March 2020 and created huge shock and stress countrywide. Goma city accommodates more than 30 international non-governmental humanitarian organisations (HO) who have sought to support local communities to help them overcome COVID-19 stress. Few studies to date have considered the role of these HO from the perspective of the beneficiary populations. This is a descriptive, analytical study, reporting data collected from a survey questionnaire to 100 community members (including 21 healthcare professionals) in Karisimbi health zone in Goma city in DRC. The study’s main aim was to explore how community members viewed the contribution and impact of HO actions during COVID-19 in Goma city. We identified some important mis-matches between community expectations and HO actions which must be addressed in future outbreaks. First, community members had big expectations of HO in terms of practice support to tackle the pandemic (including providing handwashing devices and mobile support teams), yet the vast majority of respondents reported seeing little or no such actions. This can create resentment against HO and it is critically important that they rapidly engage with communities at the start of any outbreak to understand their needs and concerns and develop strategies to directly respond to these. Second, HO played a very limited role in dissemination of information about COVID-19 and were not trusted messengers. Our findings showed that most people’s preferred source of information about COVID-19, specifically vaccines, was local healthcare workers–particularly those who were known well and therefore trusted. HO (and national responders) should therefore map trusted spokespersons (including healthcare professionals) in the targeted communities and involve them in the planning and implementation of interventions as essential steps in the response. Among our respondents, social media played a large role in information sharing. Further research is needed to understand the role that social media (particularly Facebook and WhatsApp which were most frequently used) could play in sharing messages from trusted sources, including official government communications. Collectively, these actions could help create a positive attitude towards COVID-19 vaccine and similar interventions in future outbreaks.</div