Investigating Non-Compliance with COVID-19 Vaccination through Hesitancy, Refusal, and Access Limitation: A Community-Based Survey from the Democratic Republic of the Congo

Introduction: Vaccination plays a pivotal role in mitigating the repercussions of the COVID-19 pandemic. However, vaccination campaigns encounter obstacles, especially in developing countries like the Democratic Republic of the Congo (DRC). This study aimed at investigating the roles of vaccine hesitancy, refusal, and access barriers, while identifying individual-level factors associated with non-vaccination in Mbujimayi, DRC. Methods: A community-based cross-sectional survey was conducted in three health districts and included 1496 residents. Attitudes and behaviors related to seeking COVID-19 vaccination were assessed using a standardized questionnaire. Hierarchical logistic regression modeling was used to assess factors potentially affecting non-compliance with vaccination. Results: Among participants (median age = 33, IQR = 23.3, M/F sex ratio = 0.7), 60% displayed misconceptions about COVID-19 or its vaccine, while only 35.2% perceived COVID-19 as a significant health threat. Vaccination coverage was estimated at 49.1% (95% CI: 47.5;52.6), with 71.8% of vaccinated individuals having received one dose. Among the unvaccinated individuals, 50.9% expressed no intention to be vaccinated in the future, citing hesitation (30.4%) or refusal (39.6%) mainly due to side effects or distrust of vaccines. Conversely, 32.7% of the unvaccinated persons expressed access barriers despite willingness to be vaccinated. Misconceptions about COVID-19 and its vaccines were the main drivers of vaccination non-compliance. Conclusion: These findings demonstrate significant vaccine non-compliance driven by hesitancy, refusal, and access barriers. Strategies to enhance vaccination coverage and pandemic preparedness should address misconceptions, sociodemographic barriers, and geographic disparities.

Evaluation of Clinical Laboratory Tests’ Turnaround Time in a Tertiary Hospital in Democratic Republic of the Congo

The delay in the delivery of laboratory results can be fatal and can even lead to the death of patients. This study was conducted at the clinical laboratory of the University Hospital of Kinshasa (UHK) from October 2020 to April 2021, aimed to evaluate the laboratory tests’ turnaround time (TAT) and to identify reasons for delay. TAT was quantified using a time and motion analysis approach. The evaluation of TAT consisted of comparing the overall intra-lab TAT with the suggested TAT using student t-test at 95% confidence intervals. Brainstorming was the root cause analysis tool used for identifying reasons for delay. In this study, the laboratory tests’ TATs were significantly higher (p < 0.001) comparing to international guidelines (60 minutes) and customers’ suggested TAT (120 minutes). Only 0.98% of the samples were reported within 60 minutes of patient reception and 1.47% within 120 minutes, i.e. an outlier rate of 98.5%. Root causes of delay related to Machinery, Management, Manpower, Materials, Method and Milieu. Because of many reasons, the laboratory is not meeting the established TAT. Preventive and curative measures must be undertaken to reduce the delay and improve the TAT.

A Case-Control Study of Obstetric Fistula Risk Factors in the Democratic Republic of the Congo

Background: Pregnant women in the Democratic Republic of Congo (DRC) are at increased risk for developing obstetric fistulas (OFs) as a result of obstructed labor, in conditions similar to many other African countries. No case-control study of biological and social risk factors for OF has been reported from the DRC. This study aimed to identify factors that would aid in prevention and early identification of women who are at risk of developing OF. Methods: Participants were enrolled in a case-control study at four obstetric clinics in the central DRC. Cases of OF were evaluated as they presented, then a control participant was enrolled among women presenting subsequently to the same clinic, seeking to match parity at the time of the fistula and tribe of the case. A questionnaire was administered to elicit physical, obstetric, demographic, socioeconomic, religion, geographic, and delivery attributes of the participants. Case-control comparisons sought to identify independent risk factors for OF in the total case-control pairs and in subgroups of the participants. Logistic regression was utilized to identify independent risk factors for OF in the total case-control study group and in selected subgroups of the participants, and linear regression was utilized to estimate the variation explained between case and control outcomes from the variables independently significant in the logistic regression models. Results: A total of 177 case-control pairs were enrolled. Among all pairs, shorter height of the case (odds ratio = 1.06, 95% Confidence Limits 1.02 - 1.12);more kilometers travelled to the delivery site (1.02, 1.01 - 1.02);her village, not town, residence (OR = 5.52, 2.72 - 11.2), and her lower professional status (2.95, 1.53 - 5.72) were statistically independent factors associated with OF development. When applied in linear regression comparison of the pairs, these variables yielded an r2 = 0.48, imputing 48% of the difference in delivery outcome between the pairs was explained by these variables. Among the 38 pairs who were primigravida, the independent variables were more kilometers travelled to the delivery site (1.02, 1.00 - 1.05), village, not town, residence (50.0, 10.2 - 248.7), and facility intended for lower patient acuity (3.7 s, 1.01 - 13.6, r2 = 0.66) patients who were matched on parity and tribe, the significant risk factors were professional status (OR = 0.29), greater distance travelled to the clinic (OR = 1.02, 1.01 - 1.02), village, not town, residence (5.52, 2.72 - 11.2), and mother’s lower professional status (2.95, 1.53 - 5.72) when the OF occurred. Conclusions: Our study showed biological and social factors associated with the development of OF. Shorter height was the only biological risk factor found to be statistically significant in the study population. Other factors were related to limited resources and limited access to medical care.

Improving Clinical Laboratory Quality through Reduction of Tests’ Turnaround Time in Democratic Republic of the Congo: Key Strategies

In Democratic Republic of the Congo (DRC), the laboratory TAT is significantly very long and do not comply with either international standards or the suggestions of customers. However, there is neither a national nor a local strategy to improve the laboratory TAT. The aim of the present study is to develop practical management strategies to shorten clinical laboratory tests’ TAT. This was a qualitative study conducted in Kinshasa. Focus groups and Lean tools were used respectively to generate a wide range of views from a variety of laboratory staff and to eliminate several form of waste in the laboratory flow process. Based on the identified root causes of delay, focus groups participants reported that there is a lot of scope for the improvement of TAT in DRC. Consistent attendance and punctuality are essential. The hospital management should implement the Laboratory Information Systems (LIS) and install Middleware. Total laboratory automation, inventory system for all reagents and supplies used in the laboratory, expansion of the sampling area, sufficient number of high-power machine and a clear job description are indispensable. LIS, 3.5 mL BD vacutainer BarricorTM tube and point-of-care testing (POCT) are necessary for workflow improvement. A reduction of 312 minutes was achieved by eliminating or decreasing non-value-added activities. Applying the suggested key strategies, and particularly the new workflow process, is a basis for improving the laboratory tests’ TAT. The algorithm presented can be easily implemented in other laboratories that face this type of problem.

Vitamin D Status and the Determinants of Preeclampsia in Pregnant Women in Goma (Democratic Republic of the Congo)

Background: Preeclampsia (PE) is a common condition, causing maternal and perinatal morbidity and mortality worldwide. In the absence of fully satisfactory treatment, screening remains one of the pillars of management. Low vitamin D status has been identified as a risk factor for PE. But, data on vitamin D status and risk factors for PE in the Democratic Republic of the Congo (DRC) is scanty. The aim of this study is to determine the level of Vitamin D and risk factors in preeclamptic patients in our environment. Methods: To fill this gap, we conducted a multicenter incident case control study on 190 pregnant women, 95 cases and 95 controls, receiving care from seven hospitals in Goma, in the eastern DRC, from April 1 to December 31, 2019. Socioeconomic, diet habits, clinical data, urinalysis and serum 25-hydroxy vitamin D [25(OH)D] levels were analyzed. Vitamin D deficiency was defined as serum 25(OH)D < 30 ng/ml. Bivariate and multivariate analysis were used to assess risk factors of PE. Results: The median vitamin D level in preeclamptic women was lower than in the control group (21.7 [Interquartile Range (IQR) = 19.2 - 24.1] ng/ml versus 28.5 [IQR = 24.9 - 31.4] ng/ml;(p < 0.001). PE was associated with: 1) vitamin D deficiency, Odds Ratio (OR) = 2.77 at 95% Confidence Interval-CI of [1.22 - 6.31];p = 0.015; 2) previous history of PE (OR = 12.30;95% CI [1.92 - 18.98];p = 0.008) and 3) high BMI (OR = 2.82;95% CI [1.28 - 6.21];p = 0.010). Smoking (OR = 0.33;95% CI [0.22 - 0.98];p = 0.015) and consumption of dairy products (OR = 0.39;95% CI [0.17 - 0.92];p = 0.032) were protective. Conclusion: The odds of PE were 3-fold in pregnant women with vitamin D deficiency. Vitamin D supplementation during pregnancy might reduce the risk of developing PE and ultimately reduce the consequences on maternal and perinatal advert outcomes.

Contributions of the Measles Follow-Up Vaccination Campaign to Improving the Vaccination Coverage of Children Aged 6 - 59 Months in the Democratic Republic of the Congo in 2019

Background: In accordance with its measles elimination strategic plan 2012-2020, the Democratic Republic of the Congo (DRC) organized a follow-up vaccination campaign against measles from October to December 2019 in 26 provinces. This study aims to establish the contribution of this supplementary vaccination campaign to protecting children against measles. Methods: The survey was carried out in November 2020 among households of the DRC, according to the 2018 revised version of the World Health Organization’s stratified cluster sampling method, using multiple stage sampling. It targeted 280 children aged 6 - 59 months per stratum or province, with 10 children in each of the 28 selected clusters. Data collection using tablets with centralized and real-time data processing was preceded by enumeration to refine the household sampling frame. Clusters and households were selected by random draw. Data collected with CS Pro 7 software were analyzed with SPSS, Epi info 7 and Excel software to determine indicators and make before-after comparisons using the McNemar test, at a precision threshold of 5%. Results: Of the 8535 surveyed children, 89.5% were vaccinatedduring the follow-up campaign and 81.6% were vaccinated before. Only 3.7% had correctly completed campaign vaccination cards. Estimated vaccination coverage increased from 80.8% before the campaign to 92.6% after the campaign (p 0.001). Vaccination coverage after campaign against measles improved in all provinces (p < 0.001) except Bas-Uele and Maniema. Thirteen provinces reached the national coverage target of 95%, compared to five before the campaign. The proportion of zero-dose children dropped significantly after this campaign from 19.2% to 7.4% (p 0.001), and even fell below 1% in six provinces. Conclusion: This measles vaccination campaign improved overall vaccination coverage by 10% and reached more unvaccinated children. Efforts must continue to improve the retention of vaccination card, the adherence of unvaccinated children and the effectiveness of routine vaccination.

Childhood immunization uptake determinants in Kinshasa,Democratic Republic of the Congo:ordered regressions to assess timely infant vaccines administered at birth and 6-weeks

Background Despite global efforts to reduce preventable childhood illness by distributing infant vaccines,immunization coverage in sub-Saharan African settings remains low.Further,timely administration of vaccines at birth—tuberculosis(Bacille Calmette-Guerin[BCG])and polio(OPV0)—remains inconsistent.As countries such as Democratic Republic of the Congo(DRC)prepare to add yet another birth-dose vaccine to their immunization schedule,this study aims to improve current and future birth-dose immunization coverage by understanding the determinants of infants receiving vaccinations within the national timeframe.Methods The study used two ordered regression models to assess barriers to timely BCG and first round of the hepatitis B(HepB3)immunization series across multiple time points using the Andersen Behavioral Model to conceptualize determinants at various levels.The assessment leveraged survey data collected during a continuous quality improvement study(NCT03048669)conducted in 105 maternity centers throughout Kinshasa Province,DRC.The final sample included 2398(BCG analysis)and 2268(HepB3 analysis)women-infant dyads living with HIV.Results Between 2016 and 2020,1981 infants(82.6%)received the BCG vaccine,and 1551(68.4%)received the first dose of HepB3 vaccine.Of those who received the BCG vaccine,26.3%,43.5%,and 12.8%received BCG within 24 h,between one and seven days,and between one and 14 weeks,respectively.Of infants who received the HepB3 vaccine,22.4%received it within six weeks,and 46%between six and 14 weeks of life.Many factors were positively associated with BCG uptake,including higher maternal education,household wealth,higher facility general readiness score,and religious-affiliated facility ownership.The factors influencing HepB3 uptake included older maternal age,higher education level,household wealth,transport by taxi to a facility,higher facility general and immunization readiness scores,and religious-affiliated facility ownership.Conclusions This study demonstrated that the study participants’uptake of vaccines was consistent with the country average,but not in a timely manner.Various factors were associated with timely uptake of BCG and HepB3 vaccines.These findings suggest that investment to strengthen the vaccine delivery system might improve timely vaccine uptake and equity in vaccine coverage.

Floristic Inventory and Evaluation of Carbon Sequestration Potential of the Misomuni Forest Massif,Kikwit City (Democratic Republic of the Congo)

The aim of this study was to inventory plant biodiversity and to evaluate the carbon sequestration potential of the Misomuni forest massif.An inventory of all trees with diameter at breast height(dbh)≥10 cm measured at 1.30 m height was performed.The aerial biomass(AGB)was used for estimating the stored CO2 and its carbon equivalent.88 plant species belonging to 71 genera and 32 families were inventoried.Fabaceae family displayed the highest number of species and genera.The highest basal area values were displayed by Scorodophloeus zenkeri(7.34±2.45 m2/ha),Brachystegia laurentii(5.82±1.94 m2/ha),Entandrophragma utile(5.28±1.94 m2/ha),Pentadesma butyracea(4.53±1.51 m2/ha).The highest values of stored carbon and their carbon equivalent were observed in Pentadesma butyracea(15.13±5.00 and 50.55±16.85 t/ha),Picralima nitida(7.02±2.34 and 23.66±7.88 t/ha),Strombosia tetandra(6.56±2.18 and 22.10±7.36 t/ha).The Misomuni forest massif is thus much floristically diversified and plays a significant role in the sequestration of CO2.The total AGB of the inventoried trees is 183.78±61.26 t/ha corresponding to stored carbon and carbon equivalent of 96.63±32.21 t/ha and 289.92±96.64 t/ha respectively.The protection of this ecosystem is highly needed for combatting climatic changes at local,national and regional scales and for the conservation biodiversity habitat.

Blood Safety in the Democratic Republic of the Congo: Literature Review

Background: The Democratic Republic of the Congo (DRC) faces severe malaria, postpartum haemorrhage, malnutrition and sickle cell disease that require transfusion. The latter poses immunological, infectious, metabolic and hemodynamic risks to recipients. Objective: To present transfusion safety in the DRC through data from the literature. Methods: This review consists of listing the various articles and abstracts published online and presented in scientific conferences having as a subject of interest transfusion safety in the DRC. Results: The review is dominated by articles from eastern DRC and blood mobilization is around 0.5% of the general population. All screening tests are serological with a proven residual risk. The prevalence of HIV, HBV, HCV and syphilis infections is documented at more than 80% and represents respectively 1.9%, 2.96%, 1.89% and 1.21%. The prevalence of other pathogens, the immunological and haemodynamic risk are very poorly documented (12.5% to 25%). The prevalence of Parvovirus B19 infection is 5.3% and that of bacterial contamination at 1.4%, that of malaria infestations between 0.3% and 28.3%, that of trypanosomiasis at 1.3%, that of babebiosis at 0.17% in blood donors. Allo-immunization represents 47.8%, adverse reactions 3.4%, iron deficiency 63.2, iron deficiency anemia 25.9% and anemia 36.5%. Pediatrics is the biggest user of this blood. Conclusion: The prevalence of HIV, HBV, HCV and Syphilis infections is within the range of sub-Saharan African countries. The serological test is systematic and involves the residual risk, it is necessary to introduce the molecular tests. The prevalence of other pathogens (emerging viruses, bacteria and hemoparasites), the immunological and metabolic risk is poorly documented. The search for these pathogens, irregular antibodies and the determination of ferritin in blood donations is not systematic.

Patients with severe schistosomiasis mansoni in Ituri Province, Democratic Republic of the Congo

Background:Severe hepatosplenic complications arise in patients with chronic Schistosoma mansoni infection after heavy exposure to disease agents in endemic areas.These complications are rarely reported and,hence,underestimated.Case presentation:We report on eight patients with severe morbidity associated with S.mansoni infection in Ituri Province,northeastern Democratic Republic of Congo(DRC).The patients were identified during a community-based survey in 2017;one patient was seen at the district hospital.After taking the patients'history,a clinical examination and an abdominal ultrasonographical examination were performed.S.mansoni infection was diagnosed in fecal(Kato-Katz technique)and urine(point-of-case circulating cathodic antigen test)samples.These eight patients with severe intestinal and hepatosplenic complications were identified from four villages with high 5.mansoni infection prevalence and related morbidity.The patients'ages ranged from 19 to 57 years;four patients were women.Three patients reported hematemesis.Two patients were severely anemic.All patients reported non-specific abdominal symptoms,such as diarrhea(six patients),abdominal pain(seven patients),and blood in the stool(five patients),as well as weight loss(two patients).Abdominal ultrasonography revealed ascites in four patients.All patients had portal hypertension with hepatomegaly(seven patients)or splenomegaly(five patients).Of the six patients with a discernable liver parenchyma pattern,five displayed pattern F and three patient displayed pattern E.Liver parenchyma was not visible for two patients with severe ascites.An 5.mansoni infection was confirmed in six patients,with infection intensity ranging from light to heavy.All S.mansoni positive patients were treated with praziquantel(40 mg/kg body weight)and referred to the district hospital for follow-up.One patient with severe ascites died two weeks after we saw her.Due to security and accessibility reasons,the villages could not be visited again and the patients were lost to follow-up.Conclusions:Our observations of patients with severe schistosomiasis document the severe degree of endemicity of S.mansoni in the province and suggest an urgent need for adequate schistosomiasis control measures that target vulnerable population groups and address severe complications.

Sustainable strategies for Ebola virus disease outbreak preparedness in Africa:a case study on lessons learnt in countries neighbouring the Democratic Republic of the Congo

Background: From May 2018 to September 2022, the Democratic Republic of Congo (DRC) experienced seven Ebola virus disease (EVD) outbreaks within its borders. During the 10th EVD outbreak (2018–2020), the largest experienced in the DRC and the second largest and most prolonged EVD outbreak recorded globally, a WHO risk assessment identified nine countries bordering the DRC as moderate to high risk from cross border importation. These countries implemented varying levels of Ebola virus disease preparedness interventions. This case study highlights the gains and shortfalls with the Ebola virus disease preparedness interventions within the various contexts of these countries against the background of a renewed and growing commitment for global epidemic preparedness highlighted during recent World Health Assembly events.Main text: Several positive impacts from preparedness support to countries bordering the affected provinces in the DRC were identified, including development of sustained capacities which were leveraged upon to respond to the subsequent coronavirus disease 2019 (COVID-19) pandemic. Shortfalls such as lost opportunities for operationalizing cross-border regional preparedness collaboration and better integration of multidisciplinary perspectives, vertical approaches to response pillars such as surveillance, over dependence on external support and duplication of efforts especially in areas of capacity building were also identified. A recurrent theme that emerged from this case study is the propensity towards implementing short-term interventions during active Ebola virus disease outbreaks for preparedness rather than sustainable investment into strengthening systems for improved health security in alignment with IHR obligations, the Sustainable Development Goals and advocating global policy for addressing the larger structural determinants underscoring these outbreaks.Conclusions: Despite several international frameworks established at the global level for emergency preparedness, a shortfall exists between global policy and practice in countries at high risk of cross border transmission from persistent Ebola virus disease outbreaks in the Democratic Republic of Congo. With renewed global health commitment for country emergency preparedness resulting from the COVID-19 pandemic and cumulating in a resolution for a pandemic preparedness treaty, the time to review and address these gaps and provide recommendations for more sustainable and integrative approaches to emergency preparedness towards achieving global health security is now.

Proportion of thyroid cancer and other cancers in the democratic republic of Congo

BACKGROUND Cancer diagnosis is increasing around the world and in the Democratic Republic of the Congo(DRC).The proportion of thyroid cancer has increased over the past three decades.There are very few studies on cancer epidemiology,and in particular on thyroid cancer in the DRC.AIM To establish the most recent proportion of thyroid cancer in the DRC compared to other cancers.METHODS This is a retrospective and descriptive study of 6106 consecutive cancer cases listed in the pathological registers of 4 Laboratories in the city of Kinshasa.This study included all cancer cases recorded in the registers between 2005 and 2019.RESULTS From a sample of 6106 patients,including all cancer types,68.3%cases were female and 31.7%were male.Breast and cervical cancer were the most common types of cancer in women and,prostate and skin cancer were the most common types in men.Thyroid cancer was sixth in proportion in women and eleventh in men compared to all cancers.Papillary carcinoma was the most common of thyroid cancers.Rare cancers such as anaplastic and medullary thyroid carcinomas had a proportion of 7%and 2%,respectively.CONCLUSION Newer diagnostic tools led to a surge in cancer diagnoses in the DRC.Thyroid cancer has more than doubled its proportion over the last several decades in the country.

Large-Scale Investment of Chinese Enterprises in the Copper Industry in the Democratic Republic of the Congo

In recent years,with China’s accelerated implementation of the'going out'strategy and promotion of the'Belt and Road'construction and development,Chinese enterprises have grown rapidly and achieved breakthroughs in terms of overseas investment in copper industries and overseas development of copper resources that are in short supply in China.