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.

Health Safety of the Fish from the Luapula River in Democratic Republic of Congo

The Luapula River has received mining discharges from Lubumbashi and Kipushi Gecamines for several decades and from the CHEMAF company since 2005. It also received mining waste from SODIMICO. The Luapula River has Lake Banguelo as its source in Zambia and flows into Lake Moero, which is located on the border between Zambia and the Democratic Republic of Congo. The objective of this study is to assess the health safety of the fish from the Luapula River. Fish samples were collected in August 2015 at the site of the locality of Kasenga located downstream of the mining activities (n = 14) and presumed to be polluted. On the other hand, reference fish samples were taken upstream of any mining activity of the Panda, Kasungwe and Congo Rivers at the sections located near their sources and presumed not to be polluted by mining wastes. (n = 11). Ten Metal Trace Elements (MTE) were assayed at the laboratory of the Congolese Control Office (OCC) of Lubumbashi and at the laboratory of the Catholic University of Leuven in Belgium using ICP-OES and ICP-MS. To assess and evaluate the health safety of fish from the Luapula River, the concentrations of fish samples from the Luapula River were compared with the concentrations of the reference fish samples from the Panda Kasungwe and Congo rivers by the Wilcoxon test. The concentrations of fish samples from the Congo River were also compared with the maximum acceptable metal trace element concentrations established by the FAO, WHO, EU (European Union) and other regulatory bodies. as reported by Akoto et al. The results of this study showed that the fish from the Luapula River is contaminated in Cd, Cu, Ni and Pb, and are not fit for human consumption. The results obtained will be brought to attention of the decision-makers of the Province of Haut-Katanga, so that measures can be taken to ban metallurgical factories to drump their mining wastes into waterways.

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.

On the Hong Kong Newspaper's Role in the Democratic Revolution

Since the Cession of Hong Kong for the British since the news of speech terms is strictly limited, long-term Hong Kong residents can not participate in local politics. But to allow discussion of political affairs in China outside Hong Kong. Thus, the various historical periods in the future, the progressive intellectuals to Hong Kong newspaper, publicity revolution, the process of democratic revolution in China, plays a very important role.

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.

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.

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.

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.

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.

Human seroreactivity against Bartonella species in the Democratic Republic of Congo

Objective:To assess the presence and identity of Bartonella species in a pool of human blood samples from DRC Congo.Methods:Blood(±120μL) was collected anonymously from Congolese patients and placed on calibrated filter papers.Bartonella serology determination was performed using an indirect immun of luorescence assay(IFA) against six specific Bartonella antigens and Coxiella burnetii(C.burnetii) antigen.The end cut- of f value for Bartonella sp.was a titre greater than 1200.Results:None of the patients was positive for Bartonella elizabethae, Bartonella vinsonii subsp.vinsonii or Bartonella vinsonii subsp.arupensis nor for C.burnetti, but 4.5%of the 1SS samples were positive for either Bartonella henselae,Bartonella quintana, or Bartonella clarridgeiae.Conclusions:This preliminary study presents the first report of Bartonella species in the DR Congo and the first report of antibodies to Bartonella clarridgeiae in an African human population.Although few experimental trials have established the link between fleas and Bartonella transmission,the repeated detection of similar Bartonella species in fleas and humans in several countries suggests that Bartonellosis could be another flea-borne disease which specific reservoirs are still unknown.

The road towards sustainable control of schistosomiasis in the Democratic Republic of Congo:Pre-assessment of staff performance and material resources in endemic regions

Objective: To improve knowledge and practice of health staff as well as the availability of material resources for diagnosis and management of schistosomiasis in two endemic provinces of DRC(Kinshasa and Bas-Congo).Methods: Structured interviews were performed using questionnaires with staff from 35 healthcare facilities in 9 health zones(HZ) of Kinshasa and 2 HZ in Bas-Congo.Results: Schistosomiasis was reported to be present in all the included HZ.Health staff knew the most important symptoms of schistosomiasis, but advanced symptoms were more accurately reported in Bas-Congo.Knowledge of symptoms related to schistosomiasis such as anemia(P = 0.0 115) and pollakiuria(P = 0.0 260) was statistically different in both two provinces.Kato-Katz technique and urine filtration were unavailable in both provinces.Parasitological diagnosis was mostly performed using the direct smear method.PZQ was available in 70% of the health facilities, all situated in Bas-Congo.Diagnosis and treatment mostly relied on symptoms and cost more in urban area than in rural.Conclusions: Though knowledge on schistosomiasis among health staff appears sufficient, substantial efforts still must be made to improve the availability of diagnostic tools and treatment in the health facilities in DRC.

RETRACTED: Prevalence and Profile of Hepatitis B Virus Infection among HIV-Infected Adults at Panzi Referral Hospital, in the Post-Conflict South Kivu Province, Eastern Democratic Republic of Congo

Short Retraction Notice? The paper does not meet the standards of "World Journal of AIDS". This article has been retracted to straighten the academic record. In making this decision the Editorial Board follows COPE's Retraction Guidelines. The aim is to promote the circulation of scientific research by offering an ideal research publication platform with due consideration of internationally accepted standards on publication ethics. The Editorial Board would like to extend its sincere apologies for any inconvenience this retraction may have caused.? Editor guiding this retraction: Prof. Linda D. Moneyham (EiC of WJA) Please see the article page for more details.? The?full retraction notice in PDF is preceding the original paper which is marked "RETRACTED".

Quality of Water Adjusted Sources and Storage in the Households of the Sanitized Villages in Area of National Program of Sanitized Schools and Villages at Tshopo Province in Republic Democratic of Congo

Introduction: The present research paper aims at assessing the bacteriological water quality in households and at provisioning points, and so factors of water deterioration. Method: a transverse study has been conducted during the period starting from 11 up to 28 October 2018 within 6 Health Zones (HZ) in Tshopo Province integrated in National Program of Schools and Sanitized Villages (NPSSV). Water samples have been collected within 300 reserves of households and 30 water provisioning and analysed points in order to find out water contamination factors. The frequencies and raw OR have been estimated at (p < 0.05) valued significative. Results: fecal coliforms (80% CI95: 75% - 85%) and total (97% CI95: 95% - 99%) were significantly present in water reserves and the presence of Escherichia coli were at about 27% (IC95 22% - 32%). These proportions were correspondingly at 63%, 90% and 10% at water provisioning. The fecal coliforms were the highest in water reserves of sanitized villages (p < 0.05) and Escherichia coli were at about three times higher in traditional sources (17% vs 6%). The duration of water conservation was around 48 hours and more (OR = 4.41;IC95: 1.92 - 10.11), water classification of sanitized risk “intermedium” and the recipients of conservation with bottleneck were associated with the presence of E.coli in water (p < 0.05). Conclusion: water from provisioning sources and household reserves are severely polluted and water quality is not good at consumption point and at provisioning point. The reinforcement of safety measures at water points, reduction of conservation length and hygienic water cleaning of storage water recipients are necessary to assure quality of water.

Mass Distribution Campaign of Long-Lasting Insecticidal Nets in the Democratic Republic of Congo from 2018 to 2021 in the Context of the Emergence of COVID-19: Results and Lessons Learned

Introduction: The DRC had planned 23 mass distribution campaigns distribution of long-lasting insecticidal nets (LLIN) for the years 2018-2020, the implementation of which spanned from 2018 to July 2021. This article reviews the campaign’s planning process, the results, challenges, and lessons learned. Methods: A descriptive method was used to postpone the planning and implementation process according to the National Malaria Control Program (NMCP) standards adapted to the COVID-19 context. The changes and adaptations implemented as well as the challenges encountered are described. Results: Between January 2018 to June 2021, 23 LLIN mass distribution campaigns were organized in the DRC with the financial support of The Global Fund to Fight against Tuberculosis, AIDS and Malaria (GFTAM) and Against Malaria Foundation (AMF) allowing the distribution of 55,273,473 LLINs to 19,048,372 households at risk of malaria transmission with an average of 2.9 LLINs per household. The enumerated population (111,081,191) exceeded 7% of the micro plans projected population (102,790,391) while the number of households enumerated (19,311,629) was 3% lower compared to the micro planning projection households (19,862,417). Compared to a reported household coverage of 96% of households achieved over the expected households, the independent monitoring carried out revealed 91% of households served in the intervention areas. The main reasons for not reaching households mentioned by the respondents were absence at the time of distribution (26%) followed by the loss of vouchers (16%). Several communication channels were used among which, community workers were the most frequently mentioned (63.1%), followed by radios (18.5%) and churches (12.4%). Conclusion: Good planning, effective coordination of stakeholders, and revision of the implementing campaigns methods following the COVID-19 were factors in the success of this campaign. An effort to respect the schedules for renewing LLINs in households, coupled with good continuous distribution, is necessary to maintain the gains and hope for an impact in terms of morbidity and mortality reduction of malaria.

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.

Improving Demand for Health Services with the Involvement of Community Health Workers: A Case Study of Community Dynamics at Mosango Rural Health Zone in the Democratic Republic of Congo

Introduction: DRC is one of Sub-Saharan Africa country with high infant and maternal mortality. The major problem is the underuse of health services because of inaccessibility on all fronts and also the population under-information to the health and development problems. Community participation is one of the basic requirements and basic principles of the Primary Health Care to solve this problem. That is why we choose Mosango RHZ to assess the improvement of demand for health services with the involvement of community health workers. Methods: We conduct a cross-sectional study carried out in Mosango RHZ in 2019. The study combined a mixed method (quantitative and qualitative) based on the realist evaluation approach which takes into account the Context-Mechanisms-Effects explained in the conceptual framework model. Results: Four predictive factors determine the improvement of health indicators with the involvement of CHWS in activities of the Mosango RHZ: Having attended school (p = 0.000;OR = 0.150);Having sufficient theoretical knowledge on malaria, diarrhoea, pneumonia, malnutrition, availability of inputs to treat these diseases (p = 0.004;OR = 0.192);Having taken the training as CHWS and Having undergone more than one training as CHW (p = 0.013;OR = 0.074). This result corroborated with other studies carried in low- and middle-income countries like DRC. Conclusion: The involvement of CHWs on improving demand for health services is effective in Mosango RHZ. The improvement of health service indicators and the effectiveness of this community intervention were conditioned by capacity building of the CHWs, the availability of inputs and the involvement of the community in the activities of the health zone through the Community Action Cells.

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.

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.

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.