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.

Abdominoplasty, Liposuction and Brazilian Butt Lift (BBL) in Kinshasa in the Democratic Republic of Congo. My Experience in This Aesthetic Plastic Surgery with Black African Women in a Low-Income Country

Background: In low-income African countries, the demand and use of plastic surgery operations including abdominoplasty, liposuction and Brazilian butt lift (BBL) are increasing. The goal of this work is to present my experience and the challenges of this aesthetic plastic surgery among black African women. Material and Methods: A retrospective study was conducted about the abdominoplasties, liposuctions and Brazilian butt lift (BBL) which I operated in public and private hospitals at Kinshasa (Democratic Republic of Congo) in black African women. It covers a period of 13 years, going from December 1, 2010 to December 1, 2023. For this study, I had at least 6 months period (to Juin 1, 2024) to assess the occurrence of early and late postoperative complications. Results: I performed 84 abdominoplasties, 144 liposuctions and 23 Brazilian butt lifts (BBL). The average age at the time of abdominoplasty was 44 years with extremes ranging from 26 to 55 years and a concentration of cases (60.7%) in the age group of 40 to 49 years. The age group of 20 to 29 years old represented the lowest rate of requests for abdominoplasty (4.7%). Patients with a BMI of 30 to 2 were the majority (61.9%), followed by those between 25 to 2 (29.7%). 67.8% of patients were obese (BMI ≥ 30 kg/m2). The average age at the time of liposuction was 41 years with extremes ranging from 21 years to 69 years;and more than half of cases (68%) in the age group between 30 and 49 years. As for Brazilian butt lift (BBL), the average age was 33 years with extremes ranging from 24 to 42 years and a concentration of patients (91.3%) between 20 and 39 years. The immediate postoperative complications of abdominoplasties observed were: seroma in 7% of cases, hematoma and partial infection of the surgical site in 5% of cases. Pathological scars (hypertrophic, keloid) after abdominoplasties were observed in 9% of cases. The most common complication of liposuction was contour deformity. I observed 16 patients (11.1%) with soft-tissue depressions or elevations, skin panniculus or folds. For Brazalian Butt Lift (BBL), complications like asymmetry for 2 patients (8.9%), contour irregularities for 2 patients (8.9%), and excessive fat removal for 6 patients (26%), had observed. I have not recorded any cases of death or pulmonary embolism. Conclusion: I perform aesthetic plastic surgery procedures in black African women with a high socioeconomic standard of living compared to the average of the general population. The renunciation of planned surgery is motivated by the impossibility of paying the cost of the operation as well as by popular and religious perceptions regarding cosmetic surgery. The results of these aesthetic plastic surgery procedures carried out are very satisfactory for them. The challenges to overcome are mainly threefold: the unforeseeable complications of these cosmetic plastic surgery procedures, popular and religious perceptions of cosmetic surgery as well as the poverty of the population.

Occurrence and Distribution of <i>Banana bunchy top virus</i>Related Agro-Ecosystem in South Western, Democratic Republic of Congo

Banana bunchy top virus (BBTV) is one of the most severe and widespread virus limiting production and distribution of planting material of banana (Musa spp.) crops in the world. In Democratic Republic of Congo (DRC), these crops play a major role in daily life of almost 70% of citizen. Many factors influence banana production negatively such as Banana bunchy top disease. Epidemiological survey was conducted in experimental stations and farmers’ fields for two consecutive seasons covering 72 sites in five provinces of south western of RDC. The objective of this study was to evaluate the presence and distribution of the Banana bunchy top virus in five provinces of South Western of DRC, with emphasis on the agro-ecological factors. A total of 174 Musa spp. leaves samples were collected and analyzed by PCR. The results revealed the presence of BBTV in all provinces investigated. The frequency of BBTV was 6.3% in Bandundu, 12.1% in Kasa?Oriental, 17.8% Bas Congo, 1.1% in Katanga and 7.5% Kinshasa Urban and Peri-urban. Results also revealed that BBTV occurred in experimental station and farmers’ fields, both having all cooking and dessert bananas. The high prevalence of BBTV seemed to be linked to multiple introductions of planting materials in the Bas Congo province during 1990 and 2002. However, the province of Katanga had not experienced the introduction of planting material. This factor would explain the lowest prevalence of Banana bunchy top virus in this province. The results indicated that there was a real need to facilitate access to genetically improved and healthy certified planting material in these provinces.

The Debate on Democratic Revolution in Japan in the 1920s

Anti-hegemonic movements in Japan had occurred frequently since the early 20th century,and democratic revolution debate in the 1920s was the first significant domestic debate on future development strategy.Various discussions on it from Japanese academia involved state power,absolutism,agrarian revolution,and revolutionary strategy,etc.An analysis of early Japanese scholars’perspectives on the democratic revolution helps to know about the social milieu in Japan at that time,and is of positive significance to comprehend the development process of the current Japanese democratic revolution.

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.

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.

A Pilot Study about the First Cases of Coronary Angioplasty in Democratic Republic of Congo/Kinshasa: Patient Profile

Background: The objective of this pilot study was to describe clinical profile, electric, echocardiographic and angiographic caracteristics with procedural outcome of congolease patients undergoing coronarography in the first and only one cardiac catheterization center opened in Kinshasa. Methods: An analytical cross-sectional study was carried out over a period from October 2019 (date of establishment of the first coronary angiography unit in DR Congo) to March 2021. We proceeded to a serial sampling of the consecutive cases of all the patients who have an angiographic exploration of coronary arteries. Clinical, ECG and cardiac ultrasound data were collected in all patients. The indications for the coronary angiography examination were set by differents cardiologists on the basis of repolarization troubles in the electrocardiogram, cinetic troubles in echocardiography, positive stress test and chest pain in patients with cardiovascular risq factors. Results: The serie (47 patients) was predominantly male with a sex ratio M/W of 2.6. The average age was 59.8 ± 10.5 years. Arterial hypertension (HBP) was the main risk factor (89.4%);followed by diabetes mellitus (14.9%). Chest pain was the main functional sign with an atypical character in 44.7%. The ECG showed ST segment depression (17%) and T wave inversion (17%), the anterior region being the most affected. Hypokinesia was the most common echocardiographic abnormality (34%), followed by akinesia (10.6%). The anteroseptal and apical territories were affected in 12.8%. Dilated myocardiopathy (DMC) was significantly predominant in the male sex (29.4% vs 7.7%;p = 0.011). With radial puncture as the main approach, coronary angiography was pathological in 44% revealing mono-truncal lesions. The left coronary network was the most affected: the middle inter ventricular artery (12.8%), the proximal interventricular artery (10.6%) and the proximal circonflex artery (10.6%). In multivariate logistic regression analysis, age (for age > 50 years for men and >60 years for women), arterial hypertension and dilated cardiomyopathy emerged as independent determinants of pathological coronary angiography. Transluminal angioplasty was performed in 27.7% of patients. The bypass indication was retained in 4.3% of cases and medical treatment in 68%. Conclusion: Coronary angiography was used to diagnose lesions responsible for ischemic heart disease and to treat 27.7% of patients locally. The young age of patients and limited financial resources encourage the strengthening of preventive measures against cardio vascular risq factors.

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.

Research on the Role of Democratic Parties in Colleges and Universities in Building Morality and Cultivating People: Taking the General Branch of the Democratic League of Huizhou College as an Example

This article takes the general branch of the Huizhou College of the Democratic League of Huizhou College in recent years as an example. Through literature review, field research, case analysis, and other research methods, it summarized how the Democratic League of Huizhou College made good use of various activity carriers in ideological and political education. It combined discipline construction, scientific research platforms, school-government-enterprise, and other cooperation platforms. From educational methods to subject transformation and integration, and from daily teaching to social practice, it promoted the role of college teachers in the alliance to play the role of cultivating people in the era of college education reform. The aim was to put forward that in educating others, they should first educate themselves, teachers had two-way morality in terms of teacher ethics and professionalism, effectively integrated ideological and political courses into professional teaching and practice, and realized waiting for flowers to bloom in the “context”1 teaching environment like the cultivation effect of salt in water.

A step to the decentralized real-time timekeeping network

The composite time scale(CTS) provides an accurate and stable time-frequency reference for modern science and technology. Conventional CTS always features a centralized network topology, which means that the CTS is accompanied by a local master clock. This largely restricts the stability and reliability of the CTS. We simulate the restriction and analyze the influence of the master clock on the CTS. It proves that the CTS's long-term stability is also positively related to that of the master clock, until the region dominated by the frequency drift of the H-maser(averaging time longer than ~10~5s).Aiming at this restriction, a real-time clock network is utilized. Based on the network, a real-time CTS referenced by a stable remote master clock is achieved. The experiment comparing two real-time CTSs referenced by a local and a remote master clock respectively reveals that under open-loop steering, the stability of the CTS is improved by referencing to a remote and more stable master clock instead of a local and less stable master clock. In this way, with the help of the proposed scheme, the CTS can be referenced to the most stable master clock within the network in real time, no matter whether it is local or remote, making democratic polycentric timekeeping possible.

美国两党对台政策的差异及影响

In the context of the whole-of-government strategic approach the United States(US)currently applies toward China,the Democratic and Republican parties have reached a consensus on“using Taiwan to contain China,”compromising the integrity of the one-China policy and seriously eroding the political foundations of China–US relations.However,considerable differences persist between the two parties regarding Taiwan policy.The Republicans,as represented by Donald Trump,have appeared more radical and more straightforward,whereas the incumbent Biden administration of the Democratic Party has shown significant duplicity.Democrats in the US Congress have introduced relatively fewer Taiwan-related bills than their Republican counterparts;by comparison,some Republican lawmakers have even introduced resolutions calling for resuming“diplomatic ties”with Taiwan.The Taiwan policy gap between the Democratic and Republican parties mirrors their differences on China policy:liberal think tanks advocate for“strategic ambiguity”on Taiwan,but conservatives back“strategic clarity.”And the gap also ref lects the shifting lobbying priorities of Taiwan's Democratic Progressive Party.Looking ahead to the upcoming decade,the Democratic and Republican par ties will continue to compete to“support Taiwan,”thus rendering the Taiwan question even more dangerous.After 2024,if Democrats remain in power,they may hasten the“internationalization”of the Taiwan question;otherwise,if Republicans return to the White House and both chambers of Congress,China and the US may find their relationship even more confrontational.Although the political situation in Taiwan will very unlikely have any fundamental impact on the Taiwan Strait,it will,to a certain extent,influence the intensity of China–US rivalry.

Epidemiological and Histopathological Profile of Prostate Cancer: A Retrospective Study in the Pathology Department of the University Clinics of Kinshasa

Background: Prostate cancer, the most common male cancer, represents a real public health problem in terms of its frequency and severity in different countries around the world. It disproportionately affects people of African descent wherever they live in the world [1]. To the best of our knowledge, its extent and particularities in the African environment are not well known. Objective: To determine the epidemiological and histopathological profile of prostate cancer in the CUK anatomopathology department. Methodology: This is a retrospective study conducted at the University Clinics of Kinshasa Anapathology Department from January 1, 2015 to December 31, 2022, a period of 8 years. Word processing and tables were entered using the Hp brand computer, with Microsoft Office WORD 2016 software. Data analysis was performed with SPSS version 22.0 software. Results were presented in tables and figures. Results: Prostate was diagnosed in 132 cases, i.e. 1.58% of all CUK laboratory analyses and 8% of cancers diagnosed. The age group most affected was 66-75 years, i.e. 59% of all subjects. Adenocarcinoma was the most frequent histological type, and biopsy dominated in 111 cases (84.1%). Conclusion: Prostate cancer is a real public health problem. Worldwide, and in the Democratic Republic of Congo, it is the most frequently diagnosed cancer in men, and the leading cause of cancer-related death in men. In the DRC, because of the delay in consulting our patients and the weakness of systematic screening, patients are seen at an advanced stage of the disease. Treatment is multidisciplinary, involving surgery, radiotherapy and chemotherapy (including targeted therapies). Patient awareness and screening campaigns will help to considerably reduce the delay in diagnosis and the morbidity and mortality associated with prostate cancer.

Challenges of Vietnamese Agricultural Cooperatives in the 21st Century:The Link Between Efficiency and Legality

The article shows that the situation of agricultural cooperatives in the world in general and agricultural cooperatives in Vietnam in particular are facing certain challenges in the context of globalization in the 21st century.The article points out limitations on:the nature,principles of democratic member control and principles of surplus distribution of the International Cooperative Alliance,as well as Vietnamese law in cooperative management.

Slightly Analyze the Historical Causes of Walt. Whitman's Democratic Poems

Walt·Whitman was one of the famous poets in American literary field. He is remembered by his masterpiece-Leaves of Grass, which composes a lot of his democratic ideas. His democratic poems and his writing styles have their historical background which helped form his democratic ideas.

Profile of retinal diseases in adult patients attending two major eye clinics in Kinshasa,the Democratic Republic of Congo

AIM:To determine the frequency and types of retinal diseases and the extend of the related visual loss in adult patients attending two public eye clinics of Kinshasa,Democratic Republic of Congo.METHODS:Review of medical records of patients with retinal diseases seen in the major eye clinics in Kinshasa,the University Hospital of Kinshasa(UHK)and Saint Joseph Hospital(SJH),from January 2012 to December 2014.Demographics and diagnoses were retrieved and analyzed.Outcome measures were frequency and prevalence of retinal diseases,blindness and low vision.RESULTS:A total of 40965 patients aged 40 y or older were examined during this period in both clinics.Of these,1208 had retinal disease,giving a 3-year and an annual prevalence of 3%and 1%,respectively.Mean age was 61.7±10.7 y,and 55.8%of the patients were males.Arterial hypertension(68.1%)and diabetes(43.3%)were the most common systemic comorbidities.Hypertensive retinopathy(41.8%),diabetic retinopathy(37.9%),age-related macular degeneration(AMD;14.6%),and chorioretinitis and retinal vein occlusion(7.3%each)were the most common retinal diseases,with 3-year prevalence rates of 1.3%,1.0%,0.43%,and 0.21%respectively.Bilateral low vision and blindness were present in 26.8%and 8.4%of the patients at presentation.Major causes of low vision and blindness were diabetic retinopathy(14.8%),AMD(4.9%),retinal detachment(2.8%),and retinal vein occlusion(2.5%).The prevalence was significantly higher among males than females,and at the UHK than SJH.CONCLUSION:Retinal diseases are common among Congolese adult patients attending eye clinics in Kinshasa.They cause a significant proportion of low vision and blindness.

Emergence of H5N1 highly pathogenic avian influenza in Democratic People's Republic of Korea

In the past decade,there has been extensive global surveillance for highly pathogenic avian influenza(HPAI)infection in both animals and humans,however,few studies on epidemiology of avian influenza in Democratic People’s Republic of Korea(DPRK)were published.During the period 2013–2014,HPAI H5N1 viruses were detected with outbreaks in domestic poultry in DPRK.Phylogenetic analysis revealed that the hemagglutinin gene of all samples belonged to clade 2.3.2.1c with high homology.The HPAI H5N1 virus found in ducks at the Tudan Duck Farm in 2013 was might introduced by migratory birds and then led to the outbreaks on neighboring chicken farms in 2014.These data provide direct evidence for the transmission of avian influenza viruses from wild birds to waterfowl to terrestrial birds.Therefore,the monitoring and control of influenza virus in ducks must be given top priority,which are essential components to prevent and control HPAI.

How to Develop a Realist Evaluation to Evaluate the Effectiveness of Integrated Management of Childhood Illness Strategy in Community Care Sites in the Democratic Republic of Congo

Background: In sub-Saharan Africa, the DRC ranks among countries with high infant mortality. To solve this problem, the Health Ministry has set up a programme: the use of integrated management childhood illness (IMCI) in community care sites (CCSs) managed by non-health professional persons known as community health workers (CHW). This approach has not yet been integrated into the health pyramid. This is why we chose the Realist Evaluation Approach to evaluate the effectiveness of this programme on Universal Access to care for children under 5 years of age in the DRC. Methods/design: To conduct this exploratory study which is essentially a descriptive case study, we applied the principles of a realist evaluation by context—mechanisms—effects explained in the conceptual framework. The preliminary theory of the programme was elaborated by data collection through a literature review coupled with semi-structured interviews with key informants who were managers of the government programme and technical and financial partners of the programme. Results: IMCI has been evaluated and shown its positive contribution in the reduction of global children mortality. In the DRC, summaries of data collection through a literature review coupled with semi-structured interviews showed the same result. However, under criticism, based on the data collected during this exploratory study, it is promisingly apparent that this programme will achieve the objectives assigned to it through the preliminary theory of the programme. Conclusion: The literature review corroborated the effectiveness of the IMCI programme. The application of this programme in CCS with non-health professionals who are Community Health Workers has been shown to be effective in the DRC. Based on this reality, it was possible to define the basis for a realist evaluation of the effectiveness of the programme in CCS.

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.