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253 result(s)
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253 result(s)
Journal Article > ResearchFull Text

Using an analogue-digital hybrid clinical data management platform during a two-dose preventive Ebola virus vaccine trial in Goma, the Democratic Republic of the Congo

PLOS Glob Public Health. 2 May 2025; Volume 5 (Issue 5); e0004487.; DOI:10.1371/journal.pgph.0004487
Brindle HE, Tetsa-Tata D, Edwards T, Choi EML, Kasonia K,  et al.
PLOS Glob Public Health. 2 May 2025; Volume 5 (Issue 5); e0004487.; DOI:10.1371/journal.pgph.0004487

Clinical trials in settings with intermittent or non-existent internet and power connectivity, for example during humanitarian emergencies, present challenges in the synchronisation of data across different sites, in addition to accessing a centralised database in real-time. To overcome these, we designed a novel hybrid analogue/digital data management system which was deployed during the rapid implementation of a Phase III evaluation of a two-dose preventative vaccine for Ebola virus disease in Goma, Democratic Republic of the Congo, from 2019 to 2022. We provided study participants with an Enhanced Participant Record Card (EPRC) that served as eligibility for, and confirmation of, vaccination and was used in combination with Open Data Kit (ODK) electronic case report forms to create an off-grid study participant management system. To understand the utility of the EPRC, we analysed data from 15,327 study participants who received both vaccines and various types of prompts or reminders to return for dose 2, including home visits, telephone calls, or short messaging service (SMS). A total of 53% participants referred to the date on the EPRC as a prompt to return for dose 2 and 36.1% mentioned this as the only prompt. A multivariable generalised linear mixed-effects model showed that those who were not working, those aged 45–64 years or who had a chronic medical condition identified prior to receiving dose 2 were more likely to use the date on the EPRC as a prompt. Our findings demonstrate the utility of this system in the facilitation of decentralised data collection in off-grid locations that may be useful for future trials in complex humanitarian settings.

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Journal Article > ResearchFull Text

Community perceptions about factors influencing access to care after sexual violence in North Kivu, Democratic Republic of the Congo: a qualitative study

Confl Health. 5 April 2025; Volume 19 (Issue 1); DOI:10.1186/s13031-025-00662-4
Reinholdz H, Palmieri J, Frielingsdorf H, Katungu Kalere E, Nteziryayo Heritier G,  et al.
Confl Health. 5 April 2025; Volume 19 (Issue 1); DOI:10.1186/s13031-025-00662-4

BACKGROUND

Sexual violence is widespread in the eastern parts of the Democratic Republic of the Congo, including in the North Kivu province. Moreover, in this region survivors of sexual violence often have limited access to care and encounter a variety of barriers when seeking care and support. The aim of this study was to explore community perceptions about access to care, barriers, enablers and possible actions to improve access to care for survivors of sexual violence in North Kivu. A deeper understanding of community perceptions about access to care can guide ongoing efforts to overcome barriers and increase access to care for survivors of sexual violence.


METHODS

The study utilised a qualitative design, based on focus group discussions with male and female adult community members in the study area. Previous experience of sexual violence was not a requirement. The transcripts from the discussions were analysed using manifest and latent qualitative content analysis.


RESULTS

A total of 18 focus group discussions were carried out. The analysis resulted in three main themes; Knowledge and misconceptions around medical consequences crucial for care seeking, Community and family attitudes playing a dual role in care seeking behaviours and Care seeking dependent on optimised healthcare facilities and sensitive staff.


CONCLUSIONS

Lack of correct knowledge, harmful attitudes from community and healthcare staff, and poorly adapted healthcare services constitute barriers to accessing care. Improved awareness raising around sexual violence is needed to address both lack of knowledge and misconceptions. Efforts should be made to build upon the community support models and actively work to improve community attitudes towards survivors of sexual violence. In addition, there is a need for better adapted healthcare services with improved proximity, access for different groups of survivors and respectful and well-trained healthcare staff.

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Journal Article > LetterFull Text

DR Congo's conflict and cholera: a call for ring vaccination

Lancet Infect Dis. 4 April 2025; Online ahead of print; DOI:10.1016/S1473-3099(25)00229-4
Al-Rabeeah AA, Ebrahim SH, Mwamba D, Ditekemena J, Christou C,  et al.
Lancet Infect Dis. 4 April 2025; Online ahead of print; DOI:10.1016/S1473-3099(25)00229-4
Journal Article > ResearchFull Text

Evaluation of a decentralised model of care on case isolation and patient outcomes during the 2018–20 Ebola outbreak in the Democratic Republic of the Congo: a retrospective observational study

Lancet Global Health. 25 March 2025; Online ahead of print; DOI:10.1016/S2214-109X(25)00011-7
Barks PM, Camacho A, Newport T, Ribeiro F, Ahuka-Mundeke S,  et al.
Lancet Global Health. 25 March 2025; Online ahead of print; DOI:10.1016/S2214-109X(25)00011-7
Journal Article > ResearchFull Text

Understanding the medical challenges for the diagnosis and treatment of bilateral pitting oedema in children: a qualitative study

PLOS Glob Public Health. 18 March 2025; Volume 5 (Issue 3); e0004125.; DOI:10.1371/journal.pgph.0004125
Scarpa G, Sagara J, Mambula C, Koudika MH, Loddo F,  et al.
PLOS Glob Public Health. 18 March 2025; Volume 5 (Issue 3); e0004125.; DOI:10.1371/journal.pgph.0004125

Severely malnourished patients can present with bilateral pitting oedema, which is a common sign of Kwashiorkor. However, bilateral pitting oedema can also be an expression of other pathologies. In Mali and DRC, the number of children presenting with bilateral pitting oedema at MSF (Médecins Sans Frontiers/Doctors Without Borders) hospitals are up to 30% (Mali) and 49% (DRC) higher than in other countries, however, the reasons underlying this trend are unknown. Through this qualitative study, we aimed to explore the perspectives and lived experiences of health professionals on the diagnosis and management of children with bilateral pitting oedema. Using a participatory approach, we conducted 21 in-depth interviews, and 2 focus groups with health professionals at MSF health facilities who had worked in the settings of Koutiala (Mali) and Rutshuru (DRC) for at least 6 months. The understanding of the bilateral pitting oedema phenomenon is complex. Health workers described clinical obstacles to reducing mortality, including: i) difficulties making the diagnosis due to a lack of specialized staff and insufficient resources, ii) challenges treating complications that may arise due to the complexity of the diseases associated with bilateral pitting oedema, and iii) lack of scientific evidence in the literature explaining the physiopathology of bilateral pitting oedema. Study participants shared several key recommendations for reducing mortality among children presenting with bilateral pitting oedema, including prevention of bilateral pitting oedema at the community level, standardization of the diagnostic process, strengthening of medical training, and better collaboration both within the medical teams and between teams and the children’s families.

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Journal Article > ResearchFull Text

Impact of a multi-pronged cholera intervention in an endemic setting

PLoS Negl Trop Dis. 19 February 2025; Volume 19 (Issue 2); e0012867.; DOI:10.1371/journal.pntd.0012867
Blake A, Walder A, Hanks EM, Welo PO, Luquero F,  et al.
PLoS Negl Trop Dis. 19 February 2025; Volume 19 (Issue 2); e0012867.; DOI:10.1371/journal.pntd.0012867

Cholera is a bacterial water-borne diarrheal disease transmitted via the fecal-oral route that causes high morbidity in sub-Saharan Africa and Asia. It is preventable with vaccination, and Water, Sanitation, and Hygiene (WASH) improvements. However, the impact of vaccination in endemic settings remains unclear. Cholera is endemic in the city of Kalemie, on the shore of Lake Tanganyika, in the Democratic Republic of Congo, where both seasonal mobility and the lake, a potential environmental reservoir, may promote transmission. Kalemie received a vaccination campaign and WASH improvements in 2013–2016. We assessed the impact of this intervention to inform future control strategies in endemic settings. We fit compartmental models considering seasonal mobility and environmentally-based transmission. We estimated the number of cases the intervention avoided, and the relative contributions of the elements promoting local cholera transmission. We estimated the intervention avoided 5,259 cases (95% credible interval: 1,576.6–11,337.8) over 118 weeks. Transmission did not rely on seasonal mobility and was primarily environmentally-driven. Removing environmental exposure or contamination could control local transmission. Repeated environmental exposure could maintain high population immunity and decrease the impact of vaccination in similar endemic areas. Addressing environmental exposure and contamination should be the primary target of interventions in such settings.

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Journal Article > ResearchFull Text

Pregnancy and neonatal outcomes in Eastern Democratic Republic of the Congo: a systematic review

Front Glob Womens Health. 5 December 2024; Volume 5; 1412403.; DOI:10.3389/fgwh.2024.1412403
Kasonia K, Brindle H, Manno D, Edwards T, Gardais S,  et al.
Front Glob Womens Health. 5 December 2024; Volume 5; 1412403.; DOI:10.3389/fgwh.2024.1412403

BACKGROUND

Conflict is known to impact maternal and neonatal health in Eastern Democratic Republic of the Congo (DRC), an area of longstanding insecurity. We conducted a systematic review on pregnancy and neonatal outcomes in this region to provide a comprehensive overview of maternal and neonatal outcomes over a 20-year period.


METHODS

We systematically searched databases, such as Medline, EMBASE, Global Health, ClinicalTrials.gov and the Cochrane Library, along with grey literature, for articles published between 2001 and 2021. These articles provided quantitative data on selected pregnancy and neonatal outcomes in the provinces of Ituri, Maniema and North and South Kivu, Eastern DRC. We conducted a descriptive analysis, combining results from different data sources and comparing incidence of outcomes in North Kivu with those in other provinces in Eastern DRC.


RESULTS

A total of 1,065 abstracts from peer-reviewed publications and 196 articles from the grey literature were screened, resulting in the inclusion of 14 scientific articles in the review. The most frequently reported pregnancy complications were caesarean sections (11.6%–48.3% of deliveries) and miscarriage (1.2%–30.0% of deliveries). The most common neonatal outcomes were low birth weight (3.8%–21.9% of live births), preterm birth (0.9%–74.0%) and neonatal death (0.2%–43.3%).


CONCLUSION

Our review provides data on pregnancy and neonatal outcomes in Eastern DRC, which will be valuable for future studies. Despite the area's ongoing armed conflict, the percentages of complications we noted in Eastern DRC are comparable with those observed in other countries in the region.

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Journal Article > ResearchFull Text

Oral cholera vaccine coverage in Goma, Democratic Republic of the Congo, 2022, following 2019–2020 targeted preventative mass campaigns

Vaccine: X. 1 October 2024; Volume 20; 100555.; DOI:10.1016/j.jvacx.2024.100555
Briskin E, Bateyi Mustafa SH, Mahamba R, Kabunga D, Kubuya J,  et al.
Vaccine: X. 1 October 2024; Volume 20; 100555.; DOI:10.1016/j.jvacx.2024.100555

BACKGROUND

In 2019–2020, preventative Oral Cholera Vaccine campaigns were conducted in 24/32 non-contiguous health areas of Goma, DR Congo. In August 2022, we measured coverage and factors potentially influencing success of the delivery strategy.


METHODS

We used random geo-sampled stratified cluster survey to estimate OCV coverage and assess population movement, diarrhea history, and reasons for non-vaccination.


RESULTS

603 households were visited. Coverage with at least one dose was 46.4 % (95 %CI: 41.8–51.0), and 50.1 % (95 %CI: 45.4–54.8) in areas targeted by vaccination compared to 26.3 % (95 %CI: 19.2–34.9) in non-targeted areas. Additionally, 7.0 % of participants reported moving from outside Goma since 2019, and 5.4 % reported history of severe diarrhea. Absence and unawareness were the main reasons for non-vaccination.


CONCLUSION

Results suggest that targeting non-contiguous urban areas had a coverage-diluting effect. Targeting entire geographically contiguous areas, adapted distribution, and regular catch-up campaigns are operational recommendations to reach higher coverages arising from the study.


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Journal Article > ResearchFull Text

How did the COVID-19 pandemic affect antibiotic consumption within humanitarian emergencies? Results from five humanitarian contexts

Infection Prevention in Practice. 1 September 2024; Volume 6 (Issue 3); 100385.; DOI:10.1016/j.infpip.2024.100385
Yavuz T, Clezy K, Skender K, Goldberg J, Vallieres F
Infection Prevention in Practice. 1 September 2024; Volume 6 (Issue 3); 100385.; DOI:10.1016/j.infpip.2024.100385

INTRODUCTION

Both high- and low-income countries reported increased antibiotic consumption among COVID-19 patients during the first months of the pandemic. To date, however, no studies have examined changes in antibiotic consumption during the COVID-19 pandemic within humanitarian emergency contexts.


METHODS

Data was collected by Médecins Sans Frontières (MSF) for the years 2018-2021 across the following humanitarian settings: Afghanistan (Lashkar Gah), Bangladesh (Kutupalong), the Democratic Republic of Congo (Mweso and Baraka), and South Sudan (Bentiu). Inpatient and outpatient antibiotic consumption was calculated as Daily Defined Dose (DDD) per 1000 inhabitants per day, as per the World Health Organisation's (WHO) Collaborating Centre for Drug Statistics Methodology. Interrupted time series (ITS) analysis, using an autoregressive integrated moving average (ARIMA) model was used to analyse retrospective monthly antibiotic consumption. The impact of COVID-19 pandemic was evaluated as total antibiotic consumption and according to WHO Access, Watch, Reserve (AWaRe) group classifications within each humanitarian setting.


RESULTS

The COVID-19 pandemic had no statistically significant impact on total antibiotic consumption in South Sudan (Bentiu) and Bangladesh (Kutupalong). Similarly, the pandemic had no impact on total antibiotic consumption in DR Congo (Baraka), despite an initial 0.27% (estimate=.274, p-value=0.006) increase in March 2020 driven by Access group antibiotics. Meanwhile, total antibiotic consumption in DR Congo (Mweso) and Afghanistan (Lashkar Gah) declined by 0.74% (estimate = -.744, p = 0.003) and 0.26% (estimate = -.26, p < 0.001), respectively with the COVID-19 pandemic.


CONCLUSION

Further studies are required to investigate what may have contributed to these results.

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Journal Article > Short ReportFull Text

Evaluation of centralised and decentralised models of care during the 2020 Ebola Virus Disease outbreak in Equateur Province, Democratic Republic of the Congo: A brief report

F1000Research. 28 August 2024; Volume 13 (Issue 642); DOI:10.12688/f1000research.150755.2
Lampaert E, Nsio JM, Nair D, Mashako M, De Weggheleire A,  et al.
F1000Research. 28 August 2024; Volume 13 (Issue 642); DOI:10.12688/f1000research.150755.2

BACKGROUND

Traditionally in the Democratic Republic of the Congo (DRC), centralised Ebola treatment centres (ETCs) have been set exclusively for Ebola virus disease (EVD) case management during outbreaks. During the 2020 EVD outbreak in DRC’s Equateur Province, existing health centres were equipped as decentralised treatment centres (DTC) to improve access for patients with suspected EVD. Between ETCs and DTCs, we compared the time from symptom onset to admission and diagnosis among patients with suspected EVD.

METHODS

This was a cohort study based on analysis of a line-list containing demographic and clinical information of patients with suspected EVD admitted to any EVD health facility during the outbreak.

RESULTS

Of 2359 patients with suspected EVD, 363 (15%) were first admitted to a DTC. Of 1996 EVD-suspected patients initially admitted to an ETC, 72 (4%) were confirmed as EVD-positive. Of 363 EVD-suspected patients initially admitted to a DTC, 6 (2%) were confirmed and managed as EVD-positive in the DTC. Among all EVD-suspected patients, the median (interquartile range) duration between symptom onset and admission was 2 (1-4) days in a DTC compared to 4 (2-7) days in an ETC (p<0.001). Similarly, time from symptom onset to admission was significantly shorter among EVD-suspected patients ultimately diagnosed as EVD-negative.

CONCLUSIONS

Since <5% of the EVD-suspected patients admitted were eventually diagnosed with EVD, there is a need for better screening to optimise resource utilization and outbreak control. Only one in seven EVD-suspected patients were admitted to a DTC first, as the DTCs were piloted in a limited and phased manner. However, there is a case to be made for considering decentralized care especially in remote and hard-to-reach areas in places like the DRC to facilitate early access to care, contain viral shedding by patients with EVD and ensure no disrupted provision of non-EVD services.

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