Tumors Registry in Low Income Countries’ Hospital: A Retrospective Study of 350 Cases in the Democratic Republic of Congo from 2007 to 2017

Abstract In low-income countries, the incidence of burns is high and severe burns are frequently managed at peripheral facilities. Outcome after burn care is poorly studied although it might help identify risk-group and improve treatment strategies. This study aimed to study factors associated with in-hospital outcomes in a burn cohort in the Democratic Republic of Congo. In this retrospective study, we included burn patients admitted to the surgical department at the Hôpital Provincial Général de Référence de Bukavu between January 2013 and December 2018. Differences between groups were tested using χ 2 test or Fisher's exact tests or Wilcoxon rank sum test, as appropriate. Multivariate logistic regression was used to analyze the effect of patients and of burn characteristics on in-hospital mortality, prolongated length of stay (=LOS ≥ 25 days), and occurrence of complications. The study population consisted of 100 patients, mainly young males with the rural origin, moderate-sized but deep burns. Of them, 46 developed complications, 12 died. Median LOS was 25 days (IQR: 15–42). In-hospital death was independently associated with Total Burn Surface Area percentage “TBSA%” (OR = 3.96; 95% CI = 1.67–9.40) and Full-thickness Burns (FTB) (10.68; 1.34–84.74); prolongated LOS with FTB (3.35; 1.07–10.49), and complication with rural origin (5.84; 1.51–22.53), TBSA% (3.96; 1.67–9.40), FTB (4.08; 1.19–14.00), and burns on multiple sites (4.38; 1.38–13.86). In-hospital death was associated with TBSA% and FTB, prolongated LOS with FTB, and complications with burns characteristics and rural origin of the patients. Additional studies are necessary to investigate the effect of provided burn care on outcomes.

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Midwives’ challenges and factors that motivate them to remain in their workplace in the Democratic Republic of Congo—an interview study

Human Resources for Health ◽

10.1186/s12960-020-00510-x ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Malin Bogren ◽

Malin Grahn ◽

Berthollet Bwira Kaboru ◽

Marie Berg

Keyword(s):

Work Environment ◽

Low Income ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

Quality Of Healthcare ◽

International Standards ◽

Low Income Countries ◽

Professional Status ◽

Republic Of Congo ◽

Main Category

Abstract Background The Democratic Republic of Congo (DRC) has high maternal mortality and a low number of midwives, which undermines the achievement of goal 3 of the Sustainable Development Goals (SDGs) for 2030, specifically the health of the mother and newborn. Scaling up the midwifery workforce in relation to number, quality of healthcare, and retention in service is therefore critical. The aim of this study was to investigate midwives’ challenges and factors that motivate them to remain in their workplace in the DRC. Methods Data were collected in two out of 26 provinces in the DRC through ten focus group discussions with a total of 63 midwives working at ten different healthcare facilities. Transcribed discussions were inductively analysed using content analysis. Results The midwives’ challenges and the factors motivating them to remain in their workplace in the DRC are summarised in one main category—Loving one’s work makes it worthwhile to remain in one’s workplace, despite a difficult work environment and low professional status—consisting of three generic categories: Midwifery is not just a profession; it’s a calling is described in the subcategories Saving lives through midwifery skills, Building relationships with the women and the community, and Professional pride; Unsupportive organisational system is expressed in the subcategories Insufficient work-related security and No equitable remuneration system, within Hierarchical management structures; and Inadequate pre-conditions in the work environment includes the subcategories Lack of resources and equipment and Insufficient competence for difficult working conditions. Conclusion Midwives in the DRC are driven by a strong professional conscience to provide the best possible care for women during childbirth, despite a difficult work environment and low professional status. To attract and retain midwives and ensure that they are working to their full scope of practice, we suggest coordinated actions at the regional and national levels in the DRC and in other low-income countries with similar challenges, including (i) conducting midwifery education programmes following international standards, (ii) prioritising and enforcing policies to include adequate remuneration for midwives, (iii) involving midwives’ associations in policy and planning about the midwifery workforce, and (iv) ensuring that midwives’ working environments are safe and well equipped.

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Midwives’ challenges and factors that motivate them to remain in their workplace in the Democratic Republic of Congo – An interview study

10.21203/rs.3.rs-41975/v2 ◽

2020 ◽

Author(s):

Malin Bogren ◽

Malin Grahn ◽

Berthollet Bwira Kaboru ◽

Marie Berg

Keyword(s):

Work Environment ◽

Low Income ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

Quality Of Healthcare ◽

International Standards ◽

Low Income Countries ◽

Professional Status ◽

Republic Of Congo ◽

Main Category

Abstract Background: The Democratic Republic of Congo (DRC) has high maternal mortality and a low number of midwives, which undermines the achievement of Goal 3 of the Sustainable Development Goals (SDGs) for 2030, specifically the health of mother and newborn. Scaling up the midwifery workforce in relation to number, quality of healthcare, and retention in service, are therefore critical. The aim of this study was to investigate midwives’ challenges and factors that motivate them to remain in their workplace in the DRC. Methods: Data were collected in two out of 26 provinces in the DRC through ten focus-group discussions with a total of 63 midwives working at ten different healthcare facilities. Transcribed discussions were inductively analysed using content analysis.Results: The midwives’ challenges and the factors motivating them to remain in their workplace in the DRC are summarised in one main category – Loving one’s work makes it worthwhile to remain in one’s workplace, despite a difficult work environment and low professional status – consisting of three generic categories: Midwifery is not just a profession; it’s a calling is described in the subcategories Saving lives through midwifery skills, Building relationships with the women and the community, and Professional pride; Unsupportive organisational system is expressed in the subcategories Insufficient work-related security and No equitable remuneration system, within Hierarchical management structures; and Inadequate pre-conditions in the work environment includes the subcategories Lack of resources and equipment and Insufficient competence for difficult working conditions. Conclusion: Midwives in the DRC are driven by a strong professional conscience to provide the best possible care for women during childbirth, despite a difficult work environment and low professional status. To attract and retain midwives and ensure that they are working to their full scope of practice, we suggest coordinated actions at the regional and national levels in the DRC and in other low-income countries with similar challenges, including: i) conducting midwifery education programmes following international standards; ii) prioritising and enforcing policies to include adequate remuneration for midwives; iii) involving midwives’ associations in policy and planning about the midwifery workforce; and iv) ensuring that midwives’ working environments are safe and well equipped.

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Challenges of ongoing Covid and Ebola epidemics amidst violence and other epidemics in DR Congo

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.841 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

A Amorim Tomaz ◽

F I P M Bastos ◽

R S Santos ◽

M Mossoko

Keyword(s):

Low Income ◽

Ebola Virus ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

Virus Disease ◽

Emerging Diseases ◽

Low Income Countries ◽

Republic Of Congo ◽

Poor Countries ◽

Conflict Zone

Abstract The world has seen outbreaks of emergency and re-emergency of infectious diseases very often in the past years, many of them with devastating consequences for low-income countries with fragile or nonexistent health system, covid-19 being by now the last of a long series of global challenges. Although it is a huge challenge for the whole world, one country is facing it together with a current Ebola outbreak plus violence and some other diseases. The Democratic Republic of Congo is facing the immediate effects of both epidemics as illness and death, however its consequences at the political and economic level are usually more complex and may be protracted. Following the debate on why poor countries remain poor, it is maybe useful to rethink poverty and inequality keeping in mind Amartya Sen's seminal concepts: development must comprise freedom and respect for human rights and institutions at the price of fostering a vicious circle of (re)emerging diseases and structural violence. Ebola epidemics, that usually face some challenges when they happen alone, now together with malaria, measles, plague and covid, on top of violence in some areas, the disease sees its protocols harmed: for covid the orientation is to stay isolated, for Ebola the response includes tracking contacts. What means coming with a team to field to do the mapping in the middle of a confinement. The surveillance for such many epidemics on top of violence and humanitarian crisis makes the Democratic Republic of Congo one of the most worrying countries in terms of consequences of the Covid outbreak. Key messages Study of the association between the Covid, Ebola virus disease outbreak and the at-risk population living in the conflict zone in Eastern Democratic Republic of Congo. The study presents the difficulties that the population encountered in the face of restrictions imposed by armed groups to reach health services during an Ebola outbreak, in a conflict zone.

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Midwives’ Challenges and Factors that Motivate them to Remain in Their Workplace in the Democratic Republic of Congo – An Interview Study

10.21203/rs.3.rs-41975/v1 ◽

2020 ◽

Author(s):

Malin Bogren ◽

Malin Grahn ◽

Berthollet Bwira Kaboru ◽

Marie Berg

Keyword(s):

Low Income ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

Qualitative Content Analysis ◽

Quality Of Healthcare ◽

International Standards ◽

Low Income Countries ◽

Professional Status ◽

Republic Of Congo ◽

Healthcare Facilities

Abstract Background: The Democratic Republic of Congo (DRC) has high maternal mortality and a low number of midwives, which undermines the achievement of Goal 3 of the Sustainable Development Goals (SDGs) for 2030, specifically the health of mother and newborn. Scaling up the midwifery workforce in relation to number, quality of healthcare, and retention in service, are therefore critical. The aim of this study was to investigate midwives’ challenges and factors that motivate them to remain in their workplace in the DRC. Methods: A qualitative content analysis method was used. Data was collected through ten focus-group discussions with a total of 63 midwives working at ten different healthcare facilities. Results: Loving one’s work made it worthwhile for the midwives to remain in the workplace. To be a midwife was not just a profession; it was a calling and made them proud, despite low professional status. The organisational system at facility level was unsupportive, with insufficient work-related security, no remuneration system, and rigid hierarchical management structures. A lack of resources and insufficient competence gave the midwives inadequate pre-conditions for carrying out their professional work.Conclusion: Midwives in the DRC are driven by a strong professional conscience to provide the best possible care for women during childbirth, despite a difficult work environment and low professional status. To attract and retain midwives and ensure that they are working to their full scope of practice, we suggest coordinated actions at the regional and national levels in the DRC and in other low-income countries with similar challenges, including: i) conducting midwifery education programmes following international standards; ii) prioritising and enforcing policies to include adequate remuneration for midwives; iii) involving midwives’ associations in policy and planning about the midwifery workforce; and iv) ensuring that midwives’ working environments are safe and well equipped.

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Using self-controlled case series to understand the relationship between conflict and cholera in Nigeria and the Democratic Republic of Congo

10.1101/2021.10.19.21265191 ◽

2021 ◽

Author(s):

Gina E C Charnley ◽

Kevin Jean ◽

Ilan Kelman ◽

Katy A M Gaythorpe ◽

Kris A Murray

Keyword(s):

Low Income ◽

Research Council ◽

Positive Relationship ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

Case Series ◽

Excess Risk ◽

Environmental Research ◽

Republic Of Congo ◽

Increased Risk

Abstract Background Cholera outbreaks contribute significantly to diarrhoeal disease mortality, especially in low-income countries. Cholera outbreaks have several social and environmental risk factors and extreme conditions can act as catalysts for outbreaks. A social extreme with known links to infectious disease outbreaks is conflict, causing disruption to services, loss of income and displacement. Methods Here, we explored this relationship in Nigeria and the Democratic Republic of Congo (DRC), by fitting publicly available cholera and conflict data to conditional logistic regression models. We used the self-controlled case series method in a novel application, to understand if an exposure period of excess risk (conflict), increased the relative incidence of cholera. We also used a sensitivity analysis to understand potential lag effects. Results We found that conflict and cholera had a strong positive relationship, especially in the first week after the event, at a national and sub-national level. Conflict increased the risk of cholera in Nigeria by 3.6 times and 2.6 times for the DRC. Conflict was attributed to 19.7% and 12.3% of cholera outbreaks in Nigeria and the DRC, respectively. This was higher for some states/provinces, with a maximum increased risk of 7.5 times. Conclusion The results found that several states/provinces with the strongest positive relationship were also areas of high reported conflict or were neighbouring states/provinces, suggesting a possible spill-over effect. Our results help highlight the importance of rapid and sufficient assistance during social extremes and the need for pre-existing vulnerabilities such as poverty and access to healthcare to be addressed. In fragile states, conflict resolution should be a top priority to avoid excess risk for both cholera and other health and social implications. Funding Natural Environmental Research Council, UK Medical Research Council, and the Department for International Development.

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Correction to: Sustained social withdrawal behavior and ‘difcult’ temperament among infants, in relation to maternal afectivity in a low-income area of Kinshasa, Democratic Republic of Congo

European Child & Adolescent Psychiatry ◽

10.1007/s00787-021-01887-3 ◽

2021 ◽

Author(s):

Daniel Okitundu-Luwa ◽

Brigitte Imbula Essam ◽

Marie-Thérèse Sombo Ayanne ◽

Ally Ndjukendi Omba ◽

Franck Otete Djamba ◽

...

Keyword(s):

Low Income ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

Social Withdrawal ◽

Republic Of Congo ◽

Withdrawal Behavior

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Economic evaluation of gambiense human African trypanosomiasis elimination campaigns in five distinct transmission settings in the Democratic Republic of Congo

10.1101/2020.08.25.20181982 ◽

2020 ◽

Cited By ~ 1

Author(s):

Marina Antillon ◽

Ching-I Huang ◽

Ron E Crump ◽

Paul E Brown ◽

Rian Snijders ◽

...

Keyword(s):

Low Income ◽

Human African Trypanosomiasis ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

Low Risk ◽

Transmission Model ◽

African Trypanosomiasis ◽

Republic Of Congo ◽

Use Of Resources ◽

Life Years

Background: Gambiense human African trypanosomiasis (gHAT) is marked for elimination of transmission (EOT) by 2030, but the disease persists in several low-income countries. We examine the cost-effectiveness of four gHAT elimination strategies in Democratic Republic of Congo (DRC), which has the highest burden of gHAT. Methods: We compared four strategies against gHAT by coupling a transmission model with a health outcomes model in five settings -- spanning low- to high-risk. Alongside passive surveillance (PS) in fixed health facilities, the strategies included active screening (AS) at average or high coverage levels, both alone or with vector control (VC). A scale-back algorithm was devised to simulate cessation of AS and VC when no cases were reported for three consecutive years. Outcomes were denominated in disability-adjusted life-years (DALYs) and costs until 2040 were denominated in 2018 US$. Results: In high or moderate-risk settings, costs of gHAT strategies are primarily driven by AS and, if used, VC. Due to the cessation of AS and VC most investments (75-80%) will be made by 2030 and VC might be cost-saving while ensuring EOT. In low-risk settings, costs are driven by PS, and minimum-cost strategies consisting of AS and PS lead to EOT by 2030 with high probability. Conclusion: In many settings, the case for EOT by 2030 is a sensible use of resources, and investments in gHAT will decelerate within this decade in moderate- and low-risk regions.

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