Aterido, Reyes; Gonzalez, Alvaro; Merotto, Dino; Petracco, Carly; Sanchez-Reaza, Javier
The economy of the Democratic Republic of Congo is not creating sufficient jobs for its young and rapidly growing workforce. Although the Congolese economy has experienced fast growth and poverty has declined, further reducing poverty will require more dynamic job creation and continued reductions in fertility rates. The current youth bulge and potential demographic dividend will open a un...
Internet Backbone in the Democratic Republic of Congo : Feasibility Study and Advocacy. During 7-10 February 2005, representatives of five francophone African countries (Cameroon, Morocco, Niger, Sénégal, and the Democratic Republic of Congo - DRC) met to consider ways and means of galvanizing the appropriation ...
Nanclares, Carolina; Kapetshi, Jimmy; Lionetto, Fanshen; de la Rosa, Olimpia; Tamfun, Jean-Jacques Muyembe; Alia, Miriam; Kobinger, Gary; Bernasconi, Andrea
During July-November 2014, the Democratic Republic of the Congo underwent its seventh Ebola virus disease (EVD) outbreak. The etiologic agent was Zaire Ebola virus; 66 cases were reported (overall case-fatality rate 74.2%). Through a retrospective observational study of confirmed EVD in 25 patients admitted to either of 2 Ebola treatment centers, we described clinical features and investigated correlates associated with death. Clinical features were mainly generic. At admission, 76% of patients had >1 gastrointestinal symptom and 28% >1 hemorrhagic symptom. The case-fatality rate in this group was 48% and was higher for female patients (67%). Cox regression analysis correlated death with initial low cycle threshold, indicating high viral load. Cycle threshold was a robust predictor of death, as were fever, hiccups, diarrhea, dyspnea, dehydration, disorientation, hematemesis, bloody feces during hospitalization, and anorexia in recent medical history. Differences from other outbreaks could suggest guidance for optimizing clinical management and disease control.
ravaged by a brutal armed conflict. In comparison to the three past presidents, Joseph Kabila has managed to restore political stability and calm to much...DEMOCRATIC REPUBLIC OF CONGO-A FERTILE GROUND FOR INSTABILITY IN THE GREAT LAKES REGION STATES A thesis presented to the Faculty of...From - To) AUG 2016 – JUNE 2017 4. TITLE AND SUBTITLE Democratic Republic of Congo-A Fertile Ground for Instability in the Great Lakes Region
Warren, Tracy A [ORNL
Each month, approximately 45,000 people die from violence, hunger, disease, and other effects of displacement as a result of war in the Democratic Republic of the Congo (DRC). The country is often said to be plagued by a 'resource curse.' During each period in history since its discovery by the West, the DRC has possessed the resources the world craves and the world has sought these without regard for the consequences to the Congolese people. The catastrophic consequences of Congo's history of natural resource exploitation are the direct and indirect death of millions of Congolese people. The current war in Congo is multi-causal in nature but explanations are often reduced to describing it as an ethic conflict based on objective grievance. Objective grievance such as inequality, ethnic tensions, land disputes, and lack of democracy do exist, but they are neither necessary nor sufficient to explain the cause of the violent conflict, and more importantly, they fall short in explaining why this conflict has continued for years. The reality is the conflict is an economic war in which the trade of conflict minerals, gold and the 3Ts (tin, tantalum, tungsten), is directly linked to the financial sustainability of the groups fighting each other in eastern DRC. Objective grievance is a by-product of the conflict, used to create a false but plausible moral justification to continue violence. This paper examines the history of conflict in the DRC and the socio-economic variables contributing to the current war fought over conflict minerals.
Luc Malemo Kalisya
Full Text Available The Democratic Republic of Congo (DRC is the second largest country on the African continent with a population of over 70 million. It is also a major crossroad through Africa as it borders nine countries. Unfortunately, the DRC has experienced recurrent political and social instability throughout its history and active fighting is still prevalent today. At least two decades of conflict have devastated the civilian population and collapsed healthcare infrastructure. Life expectancy is low and government expenditure on health per capita remains one of the lowest in the world. Emergency Medicine has not been established as a specialty in the DRC. While the vast majority of hospitals have emergency rooms or salle des urgences, this designation has no agreed upon format and is rarely staffed by doctors or nurses trained in emergency care. Presenting complaints include general and obstetric surgical emergencies as well as respiratory and diarrhoeal illnesses. Most patients present late, in advanced stages of disease or with extreme morbidity, so mortality is high. Epidemics include HIV, cholera, measles, meningitis and other diarrhoeal and respiratory illnesses. Lack of training, lack of equipment and fee-for-service are cited as barriers to care. Pre-hospital care is also not an established specialty. New initiatives to improve emergency care include training Congolese physicians in emergency medicine residencies and medic ranger training within national parks.
Full Text Available Ocular pentastomiasis is a rare infection caused by the larval stage of pentastomids, an unusual group of crustacean-related parasites. Zoonotic pentastomids have a distinct geographical distribution and utilize reptiles or canids as final hosts. Recently, an increasing number of human abdominal infections have been reported in Africa, where pentastomiasis is an emerging, though severely neglected, tropical disease. Here we describe four ocular infections caused by pentastomids from the Democratic Republic of the Congo. Two cases underwent surgery and an Armillifer grandis infection was detected by morphological and molecular approaches. Thus far, 15 other cases of ocular pentastomiasis have been reported worldwide. Twelve cases were caused by Armillifer sp., recorded almost exclusively in Africa, where such infections occur as a consequence of hunting and consuming snakes, their final hosts. Seven further cases were caused by Linguatula serrata, a cosmopolitan pentastomid whose final hosts are usually canids. Intraocular infections caused permanent visual damage in 69% and a total loss of vision in 31% of reported cases. In contrast, ocular adnexal cases had a benign clinical course. Further research is required to estimate the burden, therapeutic options and pathogenesis of this neglected disease.
Vivian Awiti Owuor
Doing business is challenging in the Democratic Republic of Congo and presents opportunities for innovative approaches to banking, especially for micro, small, and medium enterprises (MSMEs) - and particularly for women entrepreneurs. But it is getting easier, thanks to innovating banking. This SmartLesson reviews some of the early lessons learned from the ongoing implementation of a Women...
Longstanding patterns of interaction exist between state and non-state actors seeking to improve public health in Democratic Republic of Congo (DRC). DRC is a weak state, and, in many cases, private actors have stepped in to fill the void created by the lack of state health care provision. However,
E Biezakala Mudiandambu
Full Text Available In a survey among the pygmies of central Democratic Republic of Congo, the incidence of scorpion stings seemed very high with a severity greater than expected. Species responsible were not identified. Specific studies are needed to clarify the risk emerging in the equatorial African forest.
Y.A. Nur; J. Groen (Jan); H. Heuvelmans; W. Tuynman; C. Copra (Cederick); A.D.M.E. Osterhaus (Albert)
textabstractIn February 1998, an outbreak of acute febrile illness was reported from the Kapalata military camp in Kisangani, the Democratic Republic of Congo. The illness was characterized by an acute onset of fever associated with severe headache, arthralgia, backache, neurologic signs, abdominal
Y.A. Nur; J. Groen (Jan); H. Heuvelmans; W. Tuynman; C. Copra (Cederick); A.D.M.E. Osterhaus (Albert)
textabstractIn February 1998, an outbreak of acute febrile illness was reported from the Kapalata military camp in Kisangani, the Democratic Republic of Congo. The illness was characterized by an acute onset of fever associated with severe headache, arthralgia, backache, neurologic
How should resource-dependent countries respond (fiscally) to resource price volatility? This note studies what determines revenue allocation between a "spend today" strategy and a "save now-spend tomorrow" approach in the context of the Democratic Republic of Congo. It uses a three-sector model in which public infrastructure investment has tangible benefits for private production and inve...
Ombeni, Alphonse Mihigo; Crago, Anna Louise
Sex workers in the Sud-Kivu district of the Democratic Republic of Congo (DRC) are regularly subjected to sexual and other forms of violence. In this article, based on a presentation at a concurrent session at the conference, Alphonse Mihigo Ombeni and Anna Louise Crago describe the negative impacts of this violence on the sex workers' health and working conditions. Many have become HIV-positive.
... identifi ed business ethics as a way to mitigate the destructive commercial practices that ... Ethical business initiatives have peacebuilding potential; however, the ... of the Congo (DRC) and its surrounding areas by purchasing minerals that fi ...
political system as opposed to the view that it was merely a power struggle between Kabila on the .... Local actors and international mining companies built alliances exploiting Congo's minerals to gain a ... They are preparing a contingency plan for their activities in the post-Laurent Kabila era, for ... small arms in the DRC.33.
ethnic Hutu extremists who fled to Congo from Rwanda after helping to carry out the 1994 genocide there; “Mai Mai,” a term that broadly refers to a... Rwanda , Uganda, Angola, and South Africa. U.S. policymakers, including in Congress, continue to debate the relative effectiveness of various policy tools...institutions and the military progressively deteriorated, while regional civil conflicts and the genocide in neighboring Rwanda spilled over the border
acts as a form of insurance against failures in the local economy and job market , as the household is receiving income from differing locations and...E. S. (1966). A Theory of Migration. Demography, 47 - 57. 35. Lewis, W. A. (1954). Economic Development with Unlimited Supplies of Labour . The... Norway . 47. Rice, C. (2005, December 11). The Promise of Democratic Peace: Why Promoting Freedom is the Only Realistic Path to Security. The Washington
van Vliet, Nathalie; Nebesse, Casimir; Nasi, Robert
of other meat (from the wild, such as fish and caterpillars, or from domestic sources, such as beef, chicken, pork, goat and mutton) among children from Province Orientale, Democratic Republic of Congo. Our results show that urban and rural households consume more meat from the wild than from domestic...... monkeys), probably because rural households tend to consume the less marketable species or the smaller animals. We show that despite the tendency towards more urbanized population profiles and increased livelihood opportunities away from forest and farms, wildlife harvest remains a critical component...
Backiny-Yetna, Prospere; Wodon, Quentin
This paper provides a comparative assessment of the market share, reach to the poor, and performance of faith-based and public schools in the Democratic Republic of Congo using data from the 2004-2005 "123" survey. More than two thirds of primary school students attend faith-based government-assisted schools. Both types of school cater to a similar population that is overwhelmingly poor. Faith-based schools perform slightly better at least in some dimensions than government schools, but the ...
Jacob Udo-Udo Jacob
Full Text Available This paper examines the nature and impacts of two information intervention radio programmes broadcast on Radio Okapi—the radio service of the UN Mission in the Democratic Republic of Congo. A matched randomization technique was used to assign Rwandan Hutus and Congolese autochthons in South Kivu to listen to either of the two programmes within their naturalistic contexts for 13 months. At the end of the treatment, participants’ perceptions of barriers to peace; descriptive and prescriptive interventions; victimhood and villainity; opportunities for personal development and civic engagement; and knowledge of repatriation processes were assessed in 16 focus groups across four contexts. The study concludes that international media intervention programmes that provide robust information and a platform for objective analyses within a multiple narrative and participatory framework can enhance greater engagement with nascent democratic reforms, positive perception of long term opportunities for personal development and empathy with the ethnic Other.
Aimé Kazadi Lukusa
Full Text Available Background. To determine clinical profile and management of retinoblastoma among children at Kinshasa in Democratic Republic of Congo. Patients and methods. The medical records of patients with a diagnosis of retinoblastoma seen at the University Hospital of Kinshasa from January 1985 till December 2005 were retrospectively reviewed. Demographic profile, clinical data, modes of treatment and outcome were analysed. Results. A total of 49 children, of whom 40 had adequate data on record were identified as retinoblastoma (28 males and 12 females. Nine cases had bilateral disease. The median age at the first symptoms was 9 months (range, 1 month to 6 years for unilateral retinoblastoma and 18 months (range, 1 month to 3.5 years for bilateral retinoblastoma. The median age at the first oncology consultation was 2.4 years (range, 6 months to 6 years for unilateral retinoblastoma and 2.4years (range, 9 months to 4 years for bilateral disease. Leukokoria was present in 67.5% of subjects. Seventy-five percent abandoned the treatment. The mortality was 92.5%. Conclusion. In Democratic Republic of Congo, retinoblastoma remains a life threatening disease characterized by late referral to a specialized unit and affordability of chemotherapy; all leading to an extension of the disease and high mortality.
Linsuke, S.; Nundu, S.; Mupoyi, R.; Mukele, R.; Mukunda, F.; Kabongo, M.M.; Inocencio da Luz, R.; Van Geertruyden, J.P.; Van Sprundel, M.; Boelaert, M.; Polman, K.; Lutumba, P.
School-aged children suffer the most from schistosomiasis infection in sub Saharan Africa due to poverty and limited sanitary conditions. Mapping of disease burden is recommended and there is a need of updating prevalence data which is as old as 20 years in the Democratic Republic of Congo. An
Schure, J.M.; Levang, P.; Wiersum, K.F.
Woodfuel is a renewable energy source with good potential for climate change mitigation. In the Democratic Republic of Congo (DRC), the sector employs over 300,000 people for the supply of Kinshasa alone, but the benefits to the poor are often unknown. This paper analyzes the contribution of
State administrations rely on knowledge about its employees in order to ensure transparent payroll management. This thesis investigates the political economy and social dynamics around such knowledge by focusing on public school teachers in the Democratic Republic of Congo (DRC). After a calamitous
Kyamusugulwa, P.M.; Hilhorst, D.
One of the challenges of participatory development and reconstruction programs is how and where to engage with power holders. This paper analyses the dynamics of power relations within a community-driven reconstruction program in the Democratic Republic of Congo. It shows that, in some
Laudisoit, A.; Falay, D.; Amundala, N.; de Bellock, J.G.; van Houtte, N.; Breno, M.; Verheven, E.; Wilschut, Liesbeth; Parola, P.; Raoult, D.; C., Socolovschi
The prevalence and identity of Rickettsia and Bartonella in urban rat and flea populations were evaluated in Kisangani, Democratic Republic of the Congo (DRC) by molecular tools. An overall prevalence of 17% Bartonella species and 13% Rickettsia typhi, the agent of murine typhus, was found in the
Mosnier, Aline; Bocqueho, Geraldine; Mant, Rebecca; Obersteiner, Michael; Havlik, Petr; Kapos, Val; Fritz, Steffen; Botrill, Leo
The Democratic Republic of Congo (DRC) encompasses a large rainforest area which has been rather preserved up to now. However, pressure on the forests is increasing with high population growth, transition toward political stability and the abundance of minerals in the country. REDD+ is a developing mechanism under the UNFCCC that aims to support developing countries that want to make efforts to reduce their emissions from deforestation and forest degradation. The REDD+ strategy in DRC combines an independent national fund and independent REDD+ projects at the local level that are at the initial stage of implementation. The objective of this paper is to assess i) emissions reduction due to the implementation of the REDD+ pilot projects taking into account potential leakage and ii) potential co-benefits of REDD+ pilot projects in terms of biodiversity and rural income by 2030. We use the land use economic model CongoBIOM adapted from GLOBIOM which represents land-based activities and land use changes at a 50x50km resolution level. It includes domestic and international demand for agricultural products, fuel wood and minerals which are the main deforestation drivers in the Congo Basin region. Finally, we run a sensitivity analysis on emissions from land use change according to three different above and below ground living biomass estimates: downscaled FAO, NASA and WHRC.
Memvanga, Patrick B; Tona, Gaston L; Mesia, Gauthier K; Lusakibanza, Mariano M; Cimanga, Richard K
Malaria is the most prevalent parasitic disease and the foremost cause of morbidity and mortality in the Democratic Republic of Congo. For the management of this disease, a large Congolese population recourses to traditional medicinal plants. To date the efficacy and safety of many of these plants have been validated scientifically in rodent malaria models. In order to generate scientific evidence of traditional remedies used in the Democratic Republic of Congo for the management of malaria, and show the potential of Congolese plants as a major source of antimalarial drugs, this review highlights the antiplasmodial and toxicological properties of the Congolese antimalarial plants investigated during the period of 1999-2014. In doing so, a useful resource for further complementary investigations is presented. Furthermore, this review may pave the way for the research and development of several available and affordable antimalarial phytomedicines. In order to get information on the different studies, a Google Scholar and PubMed literature search was performed using keywords (malaria, Congolese, medicinal plants, antiplasmodial/antimalarial activity, and toxicity). Data from non-indexed journals, Master and Doctoral dissertations were also collected. Approximately 120 extracts and fractions obtained from Congolese medicinal plants showed pronounced or good antiplasmodial activity. A number of compounds with interesting antiplasmodial properties were also isolated and identified. Some of these compounds constituted new scaffolds for the synthesis of promising antimalarial drugs. Interestingly, most of these extracts and compounds possessed high selective activity against Plasmodium parasites compared to mammalian cells. The efficacy and safety of several plant-derived products was confirmed in mice, and a good correlation was observed between in vitro and in vivo antimalarial activity. The formulation of several plant-derived products also led to some clinical trials
Leirs, Herwig; Mills, James N.; Krebs, John W.
A 3-month ecologic investigation was done to identify the reservoir of Ebola virus following the 1995 outbreak in Kikwit, Democratic Republic of the Congo, Efforts focused on the fields where the putative primary case had worked but included other habitats near Kikwit, Samples were collected from...... 3066 vertebrates and tested for the presence of antibodies to Ebola (subtype Zaire) virus: All tests were negative, and attempts to isolate Ebola virus were unsuccessful. The investigation was hampered by a lack of information beyond the daily activities of the primary case, a lack of information...... on Ebola virus ecology, which precluded the detailed study of select groups of animals, and sample-size limitations for rare species, The epidemiology of Ebola hemorrhagic fever suggests that humans have only intermittent contact with the virus, which complicates selection of target species. Further study...
Shako, Jean-Christophe; Gaudart, Jean; Sudre, Bertrand; Ilunga, Benoit Kebela; Shamamba, Stomy Karhemere Bi; Diatta, Georges; Davoust, Bernard; Tamfum, Jean-Jacques Muyembe; Piarroux, Renaud; Piarroux, Martine
During 2004–2014, the Democratic Republic of the Congo (DRC) declared 54% of plague cases worldwide. Using national data, we characterized the epidemiology of human plague in DRC for this period. All 4,630 suspected human plague cases and 349 deaths recorded in DRC came from Orientale Province. Pneumonic plague cases (8.8% of total) occurred during 2 major outbreaks in mining camps in the equatorial forest, and some limited outbreaks occurred in the Ituri highlands. Epidemics originated in 5 health zones clustered in Ituri, where sporadic bubonic cases were recorded throughout every year. Classification and regression tree characterized this cluster by the dominance of ecosystem 40 (mountain tropical climate). In conclusion, a small, stable, endemic focus of plague in the highlands of the Ituri tropical region persisted, acting as a source of outbreaks in DRC. PMID:29350136
R. Gasigwa Sabimana
Full Text Available Prospects for the development of goat breeding in the Democratic Republic of Congo seem favorable. Knowledge of the characteristics of local goat farming by breeders is a very important factor to control and promote goat production. The objective of this study was to improve the productivity of Mbanza-Ngungu’s local goat by increasing the knowledge of its reproductive performance. To achieve this objective, data were collected by direct observation of the goats. These data were used to simulate reproductive and population dynamics parameters over a five-year period. The study showed the relevance of the model to simulate the reproduction traits of Mbanza-Ngungu’s goats and that it is useless to keep them beyond five years.
Trenholm, J E; Olsson, P; Ahlberg, B M
Rape has been used as a weapon in the conflict in eastern Democratic Republic of Congo (DRC) in unprecedented ways. Research into the phenomenon of war-rape is limited, particularly in this context. The aim of this study was to explore perceptions of local leaders in eastern DRC concerning rape and raped women in the war context. Local leaders were chosen for their ability to both reflect and influence their constituencies. Interviews were conducted with 10 local leaders and transcripts subjected to qualitative content analysis. The study suggests that mass raping and the methods of perpetration created a chaos effectively destroying communities and the entire society and that humanitarian aid was often inappropriate. Furthermore, an exclusive focus on raped women missed the extent of traumatisation entire communities suffered. More significantly, the lack of political will, corruption, greed and inappropriate aid creates a tangled web serving to intensify the war. This complexity has implications for humanitarian interventions including public health.
Full Text Available Smallholder supply chain participation remains low despite the potential welfare gains that would result from choosing a market-oriented production. Yet, studies on determinants of market participation for commodities with underdeveloped value chains are scanty. Employing a double-hurdle model, this paper examines factors determining households’ participation in cavy marketing among cavy farmers from Sud-Kivu province in the Democratic Republic of Congo. We find that wealthier households participated less in cavy marketing while those producing more cavies were more likely to participate in their marketing. Moreover, smaller households tended to sell more cavies, while households with other livestock sold fewer cavies. The findings underscore the significance of increasing the participation in the cavy supply chains by farmers through the promotion of appropriate husbandry practices that enhance cavy productivity and production and that enable farmers to participate in markets as sellers.
Full Text Available A new species of Dorstenia L. (Moraceae, D. luamensis M.E.Leal, is described from the Luama Wildlife Reserve, west of Lake Tanganyika and north of the town of Kalemie in the eastern part of the Democratic Republic of Congo (DRC. This species is endemic to the region and differs from any of the other species by its fernlike lithophytic habit and lack of latex. A description and illustration of this species is presented here. Dorstenia luamensis M.E.Leal inhabits moist and shady vertical rock faces close to small waterfalls in the forest; the species is distributed in small populations within the type locality, and merits the conservation status of endangered (EN.
Full Text Available Denis Mukwege and Marie Berg describe the One Stop Centre at Panzi Hospital in Eastern Democratic Republic of Congo that provides care for girls and women who have been raped in combination with extreme bodily harm.
Full Text Available In recent decades, civil wars in the eastern provinces of the Democratic Republic of Congo have caused massive social disruptions, which have been exacerbated by volcanic and earthquake disasters. Seismic data were gathered and analysed as part...
Mukwege, Denis; Berg, Marie
Denis Mukwege and Marie Berg describe the One Stop Centre at Panzi Hospital in Eastern Democratic Republic of Congo that provides care for girls and women who have been raped in combination with extreme bodily harm.
Full Text Available BACKGROUND: Retaining patients with HIV infection in care is still a major challenge in sub- Saharan Africa, particularly in the Democratic Republic of Congo (DRC where the antiretroviral treatment (ART coverage is low. Monitoring retention is an important tool for evaluating the quality of care. METHODS AND FINDINGS: A review of medical records of HIV-infected children was performed in three health facilities in the DRC: the Amo-Congo Health center, the Monkole Clinic in Kinshasa, and the HEAL Africa Clinic in Goma. Medical records of 720 children were included. Kaplan Meier curves were constructed with the probability of retention at 6 months, 1 year, 2 years and 3 years. Retention rates were: 88.2% (95% CI: 85.1%-90.8% at 6 months; 85% (95% CI: 81.5%-87.6% at one year; 79.4% (95%CI: 75.5%-82.8% at two years and 74.7% (95% CI: 70.5%-78.5% at 3 years. The retention varied across study sites: 88.2%, 66.6% and 92.5% at 6 months; 84%, 59% and 90% at 12 months and 75.7%, 56.3% and 85.8% at 24 months respectively for Amo-Congo/Kasavubu, Monkole facility and HEAL Africa. After multivariable Cox regression four variables remained independently associated with attrition: study site, CD4 cell count <350 cells/µL, children younger than 2 years and children whose caregivers were member of an independent church. CONCLUSIONS: Attrition remains a challenge for pediatric HIV positive patients in ART programs in DRC. In addition, the low coverage of pediatric treatment exacerbates the situation of pediatric HIV/AIDS.
Patrick May Mukonki
KOV pit (Kamoto Oliveira Virgule) is located 10 km from Kolwezi town, one of the mineral rich town in the Lualaba province of the Democratic Republic of Congo. The KOV pit is currently operating under the Katanga Mining Limited (KML), a Glencore-Gecamines (a State Owned Company) join venture. Recently, the mine optimization process provided a life of mine of approximately 10 years withnice pushbacks using the Datamine NPV Scheduler software. In previous KOV pit studies, we recently outlined t...
Full Text Available Abstract Background The war in eastern Democratic Republic of Congo has been the subject of numerous studies related to the problem of sexual violence. Historically, such violence is known to be part of strategic war plans to conquer and destroy communities, but it is now unfortunately prevalent in times of relative calm. Methods We describe the characteristics and consequences of sexual violence in Ituri province of Democratic Republic of Congo through the retrospective analysis of 2,565 patients who received medical care in the Médecins Sans Frontières sexual violence clinic in the capital of Ituri province, Bunia, between September 2005 and December 2006. Using a standardised questionnaire, we report patients' demographics, number and status of aggressor(s, forced detention and violent threats among other variables for all patients presenting for medical consultation after a sexually violent event during this period. Results Ninety-six percent of our cohort were female and 29.3% minors, 18-29 years was the most represented age group. Acts of sexual violence (n = 2,565 were reported to be mainly perpetrated by men with military affiliations (73%, although civilians were implicated in 21% of crimes. The attack was perpetrated by two or more persons in over 74% of cases and most commonly perpetrators were unknown armed males, (87.2%. Male victims accounted for 4% (n = 103 of our cohort. Forty-eight percent of our patients reported being attacked whilst performing daily domestic duties outside the home and 18% of victims being detained by their perpetrators, the majority of whom were held for less than 2 weeks (61.6%. Conclusions The characteristics of sexually violent acts in Ituri province during this period cannot be simply explained as a 'weapon of war' as described in the literature, meaning the use of sexual violence within a military strategy where it is employed under the orders of a commander to harm a particular community. Whilst the
Shapiro, Aurelie; Saatchi, Sassan
With the support of the International Climate Initiative (ICI) of the Federal Ministry of the Environment, Conservation, and Nuclear Security, the implementation of the German Development Bank KfW, the World Wide Fund for Nature (WWF) Germany, the University of California Los Angeles (UCLA) and local DRC partners will produce a national scale biomass map for the entire forest coverage of the Democratic Republic of Congo (DRC) along with feasibility assessments of different forest protection measures within a framework of a REDD+ model project. The « Carbon Map and Model (CO2M&M) » project will produce a national forest biomass map for the DRC, which will enable quantitative assessments of carbon stocks and emissions in the largest forest of the Congo Basin. This effort will support the national REDD (Reducing Emissions from Deforestation and Degradation) program in DRC, which plays a major role in sustainable development and poverty alleviation. This map will be developed from field data, complemented by airborne LiDAR (Light Detection and Ranging) and aerial photos, systematically sampled throughout the forests of the DRC and up-scaled to satellite images to accurately estimate carbon content in all forested areas. The second component of the project is to develop specific approaches for model REDD projects in key landscapes. This project represents the largest LiDAR-derived mapping effort in Africa, under unprecedented logistical constraints, which will provide one of the poorest nations in the world with the richest airborne and satellites derived datasets for analyzing forest structure, biomass and biodiversity.
Bennouna, Cyril; van Boetzelaer, Elburg; Rojas, Lina; Richard, Kinyera; Karume, Gang; Nshombo, Marius; Roberts, Leslie; Boothby, Neil
The United Nations' Monitoring and Reporting Mechanism is charged with documenting six grave violations against children in a time of conflict, including attacks on schools. Many of these incidents, however, remain unreported across the globe. This study explores whether or not a local knowledge base of education and child protection actors in North and South Kivu Provinces, Democratic Republic of the Congo, and in Mogadishu, Somalia, could contribute to a more complete record of attacks on education in those areas. Hundreds of semi-structured interviews were conducted with key informants across the three settings, and in total 432 attacks on education were documented. Purposive samples of these reports were verified and a large majority was confirmed. Local non-governmental organisations and education institutions were most knowledgeable about these incidents, but most never reported them to a monitoring authority. The study concludes that attack surveillance and response were largely insufficient, and recommends investing in mechanisms that utilise local knowledge to address these shortcomings. © 2018 The Author(s). Disasters © Overseas Development Institute, 2018.
Onsrud, Mathias; Sjøveian, Solbjørg; Luhiriri, Roger; Mukwege, Dennis
To determine the magnitude of traumatic gynecologic fistulas caused by sexual violence in the Democratic Republic of Congo. A retrospective analysis of hospital records from 604 consecutive patients who received treatment for gynecologic fistulas at Panzi Hospital between November 2005 and November 2007. Of the 604 patients, 24 (4%) reported that their fistulas had been caused by sexual violence; of these, 5 (0.8%) had developed fistulas as a direct result of forced penetration with foreign objects and/or gang rapes. Of the remaining patients, 6 had a fistula before they were raped, 9 developed iatrogenic fistulas following inappropriate instrumentation to manage rape-induced spontaneous abortion or stillbirth, or after abdominal hysterectomy, and 4 developed fistulas after prolonged and obstructed labor. Traumatic fistulas are rare compared to obstetric fistulas. Fistulas indirectly related to sexual violence are likely to be more common than those directly related. All fistulas resulting from sexual violence, whether direct or indirect, should be considered traumatic and special care should be given to these women.
Nsakala, Gabriel Vodiena; Coppieters, Yves
This paper describes a review of the possibilities of improving HIV/AIDS prevention and reproductive health of teenagers and adolescents in the Democratic Republic of Congo (DRC). This approach was based on compilation of institutional, political, legislative and national strategy data. The document review was completed by information collected from 15 key informants and by direct observation of the work of peer educators and community workers, allowing evaluation of the possibilities of development of the priority domains of the Ottawa Charter for Health Promotion in young adolescents. Health promotion interventions for adolescents are globally ensured institutionally by three specialized programmes of the Ministry of Health, in collaboration with numerous national and international partners. Organized operationally outside of the primary health care circuit, strategic actions are more specifically directed towards acquisition of knowledge than individual skills by means of IEC (information, education and communication) and (BCC) (behaviour change communication) approaches, but with disappointing results. Although traces of these five priority domains of the Ottawa Charter are perceptible in the national response to the health problems of adolescents, the work of the various actors is not coordinated and organized in compliance with health promotion guidelines. The training of health workers appears to be a major determinant to structure this response around a dynamic federating the actions of all stakeholders to orient them towards the options of the health promotion approach.
Hernandez, Julie H; Muanda, Mbadu; Garcia, Mélissa; Matawa, Grace
Despite the commitment of the Democratic Republic of the Congo (DRC) to expand the family planning method mix and increase access to services, awareness of emergency contraception is low among women, and the method remains underused and poorly integrated in family planning programming. Data from 15 focus group discussions conducted in 2016 among women aged 15-35 were used to examine awareness and perceptions of, and attitudes toward, emergency contraceptives. After facilitators explained emergency contraceptive pills' mechanism of action and other characteristics, participants were asked about the potential benefits and risks of making the method more widely available. Transcripts were analyzed using an iterative approach. Women reported employing a wide range of postcoital contraceptive behaviors, albeit often using inappropriate products, and generally agreed that emergency contraceptive pills seemed to be a potentially effective solution to their family planning needs. Perceived benefits and limitations of the method were almost always framed in reference to other, better-known contraceptives, and women expressed strong preferences for pharmacy-based provision that aligned with their usual behaviors for obtaining contraceptives. Participants were reluctant to see the method available for free. Emergency contraceptive pills have the potential to address gaps in the family planning method mix in the DRC. Assessing whether women have incomplete or erroneous information about family planning methods can provide better understanding of women's contraceptive choices in low-income countries.
Full Text Available A structural study has been undertaken on a cobaltoan dolomite, with chemical formula CaMg0.83Co0.17(CO32 (calcium magnesium cobalt dicarbonate, from Kolwezi, Democratic Republic of Congo. Pale-pink euhedral cobaltoan dolomite was associated with kolwezite [(Cu1.33Co0.67(CO3(OH2] and cobaltoan malachite [(Cu,Co2(CO3(OH2]. A crystal with a Co:Mg ratio of 1:5.6 (SEM/EDAX measurement, twinned on (11 -2 0 was used for crystal structural refinement. The refinement of the structural model of Reeder & Wenk [Am. Mineral. (1983, 68, 769–776; Ca at site 3a with site symmetry -3; Mg site at site 3b with site symmetry -3; C at site 6c with site symmetry 3; O at site 18f with site symmetry 1] showed that Co is totally incorporated in the Mg site, with refined occupancy Mg0.83Co0.17, which compares with Mg0.85Co0.15 from chemical data. The Co substitution reflects in the expansion of the cell volume, with a pronounced increasing of the c cell parameter.
Akilimali, P Z; Mutombo, P B; Kayembe, P K; Kaba, D K; Mapatano, M A
The study aimed to identify factors associated with the survival of patients receiving antiretroviral therapy. A historic cohort of HIV patients from two major hospitals in Goma (Democratic Republic of Congo) was followed from 2004 to 2012. The Kaplan-Meier method was used to describe the probability of survival as a function of time since inclusion into the cohort. The log-rank test was used to compare survival curves based on determinants. The Cox regression model identified the determinants of survival since treatment induction. The median follow-up time was 3.56 years (IQR=2.22-5.39). The mortality rate was 40 deaths per 1000 person-years. Male gender (RR: 2.56; 95 %CI 1.66-4.83), advanced clinical stage (RR: 2.12; 95 %CI 1.15-3.90), low CD4 count (CD4 < 50) (RR: 2.05; 95 %CI : 1.22-3.45), anemia (RR: 3.95; 95 %CI 2.60-6.01), chemoprophylaxis with cotrimoxazole (RR: 4.29, 95 % CI 2.69-6.86) and period of treatment initiation (2010-2011) (RR: 3.34; 95 %CI 1.24-8.98) were statistically associated with short survival. Initiation of treatment at an early stage of the disease with use of less toxic molecules and an increased surveillance especially of male patients are recommended to reduce mortality. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
Claire A Quiner
Full Text Available Monkeypox virus (MPXV, a close relative of Variola virus, is a zoonotic virus with an unknown reservoir. Interaction with infected wildlife, bites from peri-domestic animals, and bushmeat hunting are hypothesized routes of infection from wildlife to humans. Using a Risk Questionnaire, performed in monkeypox-affected areas of rural Democratic Republic of the Congo, we describe the lifestyles and demographics associated with presumptive risk factors for MPXV infection. We generated two indices to assess risk: Household Materials Index (HMI, a proxy for socioeconomic status of households and Risk Activity Index (RAI, which describes presumptive risk for animal-to-human transmission of MPXV. Based on participant self-reported activity patterns, we found that people in this population are more likely to visit the forest than a market to fulfill material needs, and that the reported occupation is limited in describing behavior of individuals may participate. Being bitten by rodents in the home was commonly reported, and this was significantly associated with a low HMI. The highest scoring RAI sub-groups were 'hunters' and males aged ≥ 18 years; however, several activities involving MPXV-implicated animals were distributed across all sub-groups. The current analysis may be useful in identifying at-risk groups and help to direct education, outreach and prevention efforts more efficiently.
Ribesse, Nathalie; Iyeti, Alain; Macq, Jean
Technical assistance (TA) is a common component of health system strengthening interventions. This type of intervention is too often designed and evaluated according to a logic that fails to take into account social complexity. Actors' perceptions are one element of this complexity. This article presents a study conducted in the Democratic Republic of Congo designed to identify perceptions concerning two types of technical support providers for health system strengthening: long-term technical assistants (agents of development agencies) and provincial technical advisors (agents of the Ministry of Health). Interviews were conducted with an innovative tool inspired by the principles of systems thinking. Interviewees were actors involved in a TA intervention in the province of Bandundu. Their expectations regarding TA providers were identified in terms of personal characteristics (knowledge, know-how and interpersonal skills), roles, and styles of interaction for capacity building ("interventionist/ prescriptive axes"). Interviewees emphasized the importance of mutual learning and the quality of interactions, which depends on TA provider's interpersonal skills and mutual willingness. Perceptions of TA provider's characteristics tend to be similar, but several differences were observed concerning the expectations about the roles of TAs, and the style that should be adopted for capacity building. Ignoring these differences in expectations may be a threat to the effectiveness of TA.
Voorman, Arend; Hoff, Nicole A; Doshi, Reena H; Alfonso, Vivian; Mukadi, Patrick; Muyembe-Tamfum, Jean-Jacques; Wemakoy, Emile Okitolonda; Bwaka, Ado; Weldon, William; Gerber, Sue; Rimoin, Anne W
In order to prevent outbreaks from wild and vaccine-derived poliovirus, maintenance of population immunity in non-endemic countries is critical. We estimated population seroprevalence using dried blood spots collected from 4893 children 6-59months olds in the 2013-2014 Demographic and Health Survey in the Democratic Republic of the Congo (DRC). Population immunity was 81%, 90%, and 70% for poliovirus types 1, 2, and 3, respectively. Among 6-59-month-old children, 78% reported at least one dose of polio in routine immunization, while only 15% had three doses documented on vaccination cards. All children in the study had been eligible for at least two trivalent oral polio vaccine campaigns at the time of enrollment; additional immunization campaigns seroconverted 5.0%, 14%, and 5.5% of non-immune children per-campaign for types 1, 2, and 3, respectively, averaged over relevant campaigns for each serotype. Overall polio immunity was high at the time of the study, though pockets of low immunity cannot be ruled out. The DRC still relies on supplementary immunization campaigns, and this report stresses the importance of the quality and coverage of those campaigns over their quantity, as well as the importance of routine immunization. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.
Cairo, Sarah B; Kalisya, Luc Malemo; Bigabwa, Richard; Rothstein, David H
Characterize pediatric surgical capacity in the eastern Democratic Republic of Congo (DRC) to identify areas of potential improvement. The Pediatric Personnel, Infrastructure, Procedures, Equipment, and Supplies (PediPIPES) survey was used in two representative eastern DRC provinces to assess existing surgical infrastructure and capacity. We compared our results to previously published reports from other sub-Saharan African countries. Fourteen hospitals in the eastern DRC and 37 in 19 sub-Saharan African (SSA) countries were compared. The average PediPIPES index for the DRC was 7.7 compared to 13.5 for SSAs. The greatest disparities existed in the areas of personnel and infrastructure. Running water was reportedly available to 57.1% of the hospitals in the DRC, and the majority of hospitals (78.6%) were dependent on generators and solar panels for electricity. Only two hospitals in the DRC (14.3%) reported a pediatric surgeon equivalent on staff, compared to 86.5% of facilities sampled in SSA reporting ≥ 1 pediatric surgeon. Significant barriers in personnel, infrastructure, procedures, equipment, and supplies impede the provision of adequate surgical care to children. Further work is needed to assess allocation and utilization of existing resources, and to enhance training of personnel with specific attention to pediatric surgery.
Baraka, Vito; Delgado-Ratto, Christopher; Nag, Sidsel
Sulfadoxine/pyrimethamine (SP) is still used for malaria control in sub-Saharan Africa; however, widespread resistance is a major concern. This study aimed to determine the dispersal and origin of sulfadoxine resistance lineages in the Democratic Republic of the Congo compared with East African.......3 and 7.7 kb) flanking the Pfdhps gene were assayed. Evolutionary analysis revealed a shared origin of Pfdhps haplotypes in East Africa, with a distinct population clustering in DR Congo. Furthermore, in Tanzania there was an independent distinct origin of Pfdhps SGEGA resistant haplotype. In Uganda...... and Tanzania, gene flow patterns contribute to the dispersal and shared origin of parasites carrying double- and triple-mutant Pfdhps haplotypes associated with poor outcomes of intermittent preventive treatment during pregnancy using SP (IPTp-SP). However, the origins of the Pfdhps haplotypes in DR Congo...
Ali, Engy; Bergh, Rafael Van Den; D'hondt, Rob; Kuma-Kuma, Donat; Weggheleire, Anja De; Baudot, Yves; Lambert, Vincent; Hunter, Paul; Zachariah, Rony; Maes, Peter
In a semi-urban setting in the Democratic Republic of Congo, this study aims to understand the dynamic of a typhoid fever (TF) outbreak and to assess: a) the existence of hot spots for TF transmission and b) the difference between typhoid cases identified within those hot spots and the general population in relation to socio-demographic characteristics, sanitation practice, and sources of drinking water. This was a retrospective analysis of TF outbreaks in 2011 in Kikwit, DRC using microbiological analysis of water sources and a structured interview questionnaire. There were a total of 1430 reported TF cases. The outbreak's epidemic curve shows earliest and highest peak attack rates (AR) in three military camps located in Kikwit (Ebeya 3.2%; Ngubu 3.0%; and Nsinga 2.2%) compared to an average peak AR of 0.6% in other affected areas. A total 320 cases from the military camps and the high burden health areas were interviewed. Typhoid cases in the military camps shared a latrine with more than one family (P<0.02). All tap water sources in both the military camps and general population were found to be highly contaminated with faecal coliforms. The role of military camps in Kikwit as early hotspots of TF transmission was likely associated with lower sanitary and hygiene conditions. The proximity of camps to the general population might have been responsible for disseminating TF to the general population. Mapping of cases during an outbreak could be crucial to identify hot spots for transmission and institute corrective measures.
Otshudiema, John O; Ndakala, Nestor G; Mawanda, Elande-Taty K; Tshapenda, Gaston P; Kimfuta, Jacques M; Nsibu, Loupy-Régence N; Gueye, Abdou S; Dee, Jacob; Philen, Rossanne M; Giese, Coralie; Murrill, Christopher S; Arthur, Ray R; Kebela, Benoit I
On April 23, 2016, the Democratic Republic of the Congo's (DRC's) Ministry of Health declared a yellow fever outbreak. As of May 24, 2016, approximately 90% of suspected yellow fever cases (n = 459) and deaths (45) were reported in a single province, Kongo Central Province, that borders Angola, where a large yellow fever outbreak had begun in December 2015. Two yellow fever mass vaccination campaigns were conducted in Kongo Central Province during May 25-June 7, 2016 and August 17-28, 2016. In June 2016, the DRC Ministry of Health requested assistance from CDC to control the outbreak. As of August 18, 2016, a total of 410 suspected yellow fever cases and 42 deaths were reported in Kongo Central Province. Thirty seven of the 393 specimens tested in the laboratory were confirmed as positive for yellow fever virus (local outbreak threshold is one laboratory-confirmed case of yellow fever). Although not well-documented for this outbreak, malaria, viral hepatitis, and typhoid fever are common differential diagnoses among suspected yellow fever cases in this region. Other possible diagnoses include Zika, West Nile, or dengue viruses; however, no laboratory-confirmed cases of these viruses were reported. Thirty five of the 37 cases of yellow fever were imported from Angola. Two-thirds of confirmed cases occurred in persons who crossed the DRC-Angola border at one market city on the DRC side, where ≤40,000 travelers cross the border each week on market day. Strategies to improve coordination between health surveillance and cross-border trade activities at land borders and to enhance laboratory and case-based surveillance and health border screening capacity are needed to prevent and control future yellow fever outbreaks.
Scobie, Heather Melissa; Ilunga, Benoît Kebela; Mulumba, Audry; Shidi, Calixte; Coulibaly, Tiekoura; Obama, Ricardo; Tamfum, Jean-Jacques Muyembe; Simbu, Elisabeth Pukuta; Smit, Sheilagh Brigitte; Masresha, Balcha; Perry, Robert Tyrrell; Alleman, Mary Margaret; Kretsinger, Katrina; Goodson, James
Introduction Despite accelerated measles control efforts, a massive measles resurgence occurred in the Democratic Republic of the Congo (DRC) starting in mid-2010, prompting an investigation into likely causes. Methods We conducted a descriptive epidemiological analysis using measles immunization and surveillance data to understand the causes of the measles resurgence and to develop recommendations for elimination efforts in DRC. Results During 2004-2012, performance indicator targets for case-based surveillance and routine measles vaccination were not met. Estimated coverage with the routine first dose of measles-containing vaccine (MCV1) increased from 57% to 73%. Phased supplementary immunization activities (SIAs) were conducted starting in 2002, in some cases with sub-optimal coverage (≤95%). In 2010, SIAs in five of 11 provinces were not implemented as planned, resulting in a prolonged interval between SIAs, and a missed birth cohort in one province. During July 1, 2010-December 30, 2012, high measles attack rates (>100 cases per 100,000 population) occurred in provinces that had estimated MCV1 coverage lower than the national estimate and did not implement planned 2010 SIAs. The majority of confirmed case-patients were aged measles virus strains that were previously identified in the region. Conclusion The resurgence was likely caused by an accumulation of unvaccinated, measles-susceptible children due to low MCV1 coverage and suboptimal SIA implementation. To achieve the regional goal of measles elimination by 2020, efforts are needed in DRC to improve case-based surveillance and increase two-dose measles vaccination coverage through routine services and SIAs. PMID:26401224
Alleman, Mary M; Chitale, Rohit; Burns, Cara C; Iber, Jane; Dybdahl-Sissoko, Naomi; Chen, Qi; Van Koko, Djo-Roy; Ewetola, Raimi; Riziki, Yogolelo; Kavunga-Membo, Hugo; Dah, Cheikh; Andriamihantanirina, Rija
The last confirmed wild poliovirus (WPV) case in Democratic Republic of the Congo (DRC) had paralysis onset in December 2011 (1). DRC has had cases of vaccine-derived polioviruses (VDPVs) documented since 2004 (Table 1) (1-6). After an outbreak of 30 circulating VDPV type 2 (cVDPV2) cases during 2011-2012, only five VDPV2 cases were reported during 2013-2016 (Table 1) (1-6). VDPVs can emerge from oral poliovirus vaccine (OPV types 1, 2, or 3; Sabin) polioviruses that have genetically mutated resulting in reversion to neurovirulence. This process occurs during extensive person-to-person transmission in populations with low immunity or after extended replication in the intestines of immune-deficient persons following vaccination (1-6). During 2017 (as of March 8, 2018), 25 VDPV cases were reported in three provinces in DRC: in Tanganyika province, an emergence with one VDPV2 case (pending final classification) in Kabalo health zone and an emergence with one ambiguous VDPV type 1 (aVDPV1) case in Ankoro health zone; in Maniema province, an emergence with two cVDPV2 cases; and in Haut Lomami province, an emergence with 20 cVDPV2 cases that originated in Haut Lomami province and later spread to Tanganyika province (hereafter referred to as the Haut Lomami outbreak area) and an emergence with one aVDPV type 2 (aVDPV2) case in Lwamba health zone (Table 1) (Figure) (6). Outbreak response supplementary immunization activities (SIAs) were conducted during June-December 2017 (Table 2) (6). Because of limitations in surveillance and suboptimal SIA quality and geographic scope, cVDPV2 circulation is likely continuing in 2018, requiring additional SIAs. DRC health officials and Global Polio Eradication Initiative (GPEI) partners are increasing human and financial resources to improve all aspects of outbreak response.
Syavulisembo, A. M.; Havenith, H.-B.; Smets, B.; d'Oreye, N.; Marti, J.
Assessment and management of volcanic risk are important scientific, economic, and political issues, especially in densely populated areas threatened by volcanoes. The Virunga area in the Democratic Republic of Congo, with over 1 million inhabitants, has to cope permanently with the threat posed by the active Nyamulagira and Nyiragongo volcanoes. During the past century, Nyamulagira erupted at intervals of 1-4 years - mostly in the form of lava flows - at least 30 times. Its summit and flank eruptions lasted for periods of a few days up to more than two years, and produced lava flows sometimes reaching distances of over 20 km from the volcano, thereby affecting very large areas and having a serious impact on the region of Virunga. In order to identify a useful tool for lava flow hazard assessment at the Goma Volcano Observatory (GVO), we tested VORIS 2.0.1 (Felpeto et al., 2007), a freely available software (http://www.gvb-csic.es) based on a probabilistic model that considers topography as the main parameter controlling lava flow propagation. We tested different Digital Elevation Models (DEM) - SRTM1, SRTM3, and ASTER GDEM - to analyze the sensibility of the input parameters of VORIS 2.0.1 in simulation of recent historical lava-flow for which the pre-eruption topography is known. The results obtained show that VORIS 2.0.1 is a quick, easy-to-use tool for simulating lava-flow eruptions and replicates to a high degree of accuracy the eruptions tested. In practice, these results will be used by GVO to calibrate VORIS model for lava flow path forecasting during new eruptions, hence contributing to a better volcanic crisis management.
Background In regions where access to clean water and the provision of a sanitary infrastructure has not been sustainable, cholera continues to pose an important public health burden. Although oral cholera vaccines (OCV) are effective means to complement classical cholera control efforts, still relatively little is known about their acceptability in targeted communities. Clarification of vaccine acceptability prior to the introduction of a new vaccine provides important information for future policy and planning. Methods In a cross-sectional study in Katanga province, Democratic Republic of Congo (DRC), local perceptions of cholera and anticipated acceptance of an OCV were investigated. A random sample of 360 unaffected adults from a rural town and a remote fishing island was interviewed in 2010. In-depth interviews with a purposive sample of key informants and focus-group discussions provided contextual information. Socio-cultural determinants of anticipated OCV acceptance were assessed with logistic regression. Results Most respondents perceived contaminated water (63%) and food (61%) as main causes of cholera. Vaccines (28%), health education (18%) and the provision of clean water (15%) were considered the most effective measures of cholera control. Anticipated vaccine acceptance reached 97% if an OCV would be provided for free. Cholera-specific knowledge of hygiene and self-help in form of praying for healing were positively associated with anticipated OCV acceptance if costs of USD 5 were assumed. Conversely, respondents who feared negative social implications of cholera were less likely to anticipate acceptance of OCVs. These fears were especially prominent among respondents who generated their income through fishing. With an increase of assumed costs to USD 10.5, fear of financial constraints was negatively associated with anticipated vaccine acceptance as well. Conclusions Results suggest a high motivation to use an OCV as long as it seems affordable. The
Kabinda Maotela, J; Ramazani, S Y; Misingi, P; Dramaix-Wilmet, M
The authors trace the history of blood transfusion in the Democratic Republic of Congo, as inherited through the colonial organization of the health system. The current configuration of transfusion system begins with the drafting of the national blood transfusion policy and the establishment of a national technical office within the Ministry of Health to coordinate transfusion activities and of its agents in each province. Despite countless difficulties, several positive points were noted. These involve essentially the drafting of all the necessary documents and standards and the integration of the blood safety system into the country's health system. Initially, the blood transfusion system applied a vertical approach, but with the reform of the country's health system, the performance of blood safety became transversal. In the 12 years from 2001 to 2012, it mobilized 112,882 volunteer blood donors; more than 80% of blood products were checked for safety and covered all blood needs; and 81,806 HIV infections were avoided by routine testing of blood products. During the same period, 7560 people were trained in blood transfusion. The prevalence of viral markers among donors has diminished sharply. Thus, HIV prevalence decreased from 4.7% to 2.1% between 2001 and 2012 that of hepatitis B dropped from 7.1% to 3.5% during the same period, and hepatitis C from 11.8% to 2.3% from 2004 to 2012. Despite this performance, enormous efforts are still required, for the organization of blood safety monitoring, the establishment of a safe supply of reagents and supplies, for sustaining the dynamics of voluntary associations of blood donors, and finally for providing stable funding for these blood safety activities.
Le Gargasson, Jean-Bernard; Mibulumukini, Benoît; Gessner, Bradford D; Colombini, Anaïs
In Democratic Republic of the Congo (DRC), the availability of domestic resources for the immunization program is limited and relies mostly on external donor support. DRC has introduced a series of reforms to move the country toward performance-based management and program budgets. The objectives of the study were to: (i) describe the budget process norm, (ii) analyze the budget process in practice and associated bottlenecks at each of its phases, and (iii) collect suggestions made by the actors involved to improve the situation. Quantitative and qualitative data were collected through: a review of published and gray literature, and individual interviews. Bottlenecks in the budget process and disbursement of funds for immunization are one of the causes of limited domestic resources for the program. Critical bottlenecks include: excessive use of off-budget procedures; limited human resources and capacity; lack of motivation; interference from ministries with the standard budget process; dependency toward the development partner's disbursements schedule; and lack of budget implementation tracking. Results show that the health sector's mobilization rate was 59% in 2011. For the credit line specific to immunization program activities, the mobilization rate for the national Expanded Program for Immunization (EPI) was 26% in 2011 and 43% for vaccines (2010). The main bottleneck for the EPI budget line (2011) and vaccine budget line (2011) occurs at the authorization phase. Budget process bottlenecks identified in the analysis lead to a low mobilization rate for the immunization program. The bottlenecks identified show that a poor flow of funds causes an insufficient percentage of already allocated resources to reach various health system levels. Copyright © 2014 Elsevier Ltd. All rights reserved.
Luc Malemo Kalisya
Full Text Available BACKGROUND: The epidemic of gender-based violence in the Democratic Republic of the Congo (DRC has garnered popular media attention, but is incompletely described in the medical literature to date. In particular, the relative importance of militarized compared to civilian rape and the impact on vulnerable populations merits further study. We describe a retrospective case series of sexual abuse among children and youth in eastern DRC. METHODS: Medical records of patients treated for sexual assault at HEAL Africa Hospital, Goma, DRC between 2006 and 2008 were reviewed. Information extracted from the chart record was summarized using descriptive statistics, with comparative statistics to examine differences between pediatric (≤ 18 yrs and adult patients. FINDINGS: 440 pediatric and 54 adult sexual abuse cases were identified. Children and youth were more often assaulted by someone known to the family (74% vs 30%, OR 6.7 [95%CI 3.6-12], p72 hours after the assault was more common in pediatric patients (53% vs 33%, OR 2.2 [95%CI 1.2-4.0], p = 0.007. Physical signs of sexual abuse, including lesions of the posterior fourchette, hymeneal tears, and anal lesions, were more commonly observed in children and youth (84% vs 69%, OR 2.3 [95%CI 1.3-4.4], p = 0.006. Nine (2.9% pediatrics patients were HIV-positive at presentation, compared to 5.3% of adults (p = 0.34. INTERPRETATION: World media attention has focused on violent rape as a weapon of war in the DRC. Our data highlight some neglected but important and distinct aspects of the ongoing epidemic of sexual violence: sexual abuse of children and youth.
Full Text Available Background: Contraception is often necessary in order to plan for children and without it there is a risk of unplanned pregnancies. In the Democratic Republic of Congo, this often results in abortions by untrained persons with resultant morbidity and mortality. Aim: To investigate the factors that influence contraceptive use amongst women of childbearing age in the Vanga health zone. Methods: Cross-sectional survey using interviewer-administered questionnaires. Results: Of the 384 women recruited, a majority (46.1% were in the 31–40 year age group;52% had reached primary school and 88% did not have formal employment. One hundredand forty of the participants reported current use of contraception, with 60% of them using modern methods of contraception; 36.1% of them had begun using contraception before the age of 20; and the most common methods were oral contraceptive pills and injection, each accounting for 22.9%. There was variation in the duration of contraceptive use and the main reason for using contraception was to space children. Of the participants, 20.7% had been using contraception for more than two years. Seventy-seven (31.5% of the women reported they did not use contraception because of a fear of side effects. Forty-four (18% reported that they are unable to afford contraception, 38 (15.6% had husbands who disapproved of contraceptive usage, 26 (10.6% had a fear of infertility, 18 (7.4% practised a religion that did not allow them to use contraception and 12 of the women (4.9% did not use contraception because it was unavailable to them. Conclusion: Barriers to contraception in our study were fears of side effects and infertility, cost, male partner’s objection, unavailability of contraception and religious beliefs.
Doudou, Yobi; Renaud, Piarroux; Coralie, L'Ollivier; Jacqueline, Franck; Hypolite, Situakibanza; Hypolite, Muhindo; Patrick, Mitashi; Andreia, Inocêncio da Luz Raquel; Van Sprundel, Marc; Marleen, Boelaert; Van Geertruyden, Jean-Pierre; Pascal, Lutumba
To determine the seroprevalence of toxoplasmosis in pregnant women, as well as the proportion of acutely infected and risk factors in the Democratic Republic of Congo. Thirty maternities in Kinshasa were randomly selected and women attending antenatal consultation were invited to participate. They were interviewed with a structured questionnaire about known risk factors (age, meat consumption, contact with soil, and presence of cat) and a venous blood sample was taken. Sera were analysed for total immunoglobulins (Ig) by VIDAS Toxo Competition using Enzyme Linked Fluorescent Assay. IgM was determined by VIDIA Toxo IgM and IgG avidity by VIDAS Toxo IgG avidity. A total of 781 women were included. Median age was 28 years old (IQR: 8.5). And 627 women (80.3%; 95% CI: 77.5-83.1) were found to be positive to total Ig and 17 out of 387 (4.4%; 95% CI: 2.3-6.4) were positive to IgM. IgG avidity was low for 2 (11.8%) women, intermediate for 2 (11.8%) and high for 13 women (76.4%). There was no statistically significant association between Toxoplasma gondii infection and any risk factors assessed. In Kinshasa, toxoplasmosis endemicity is highly prevalent. One woman out of twenty five had a recent toxoplasmosis infection and 20% were not protected against primo-infection, indicating a need for measures to prevent and control toxoplasmosis during pregnancy. Copyright © 2014 Asian Pacific Tropical Biomedical Magazine. Published by Elsevier B.V. All rights reserved.
Makenga Bof, J-C; Maketa, V; Bakajika, D K; Ntumba, F; Mpunga, D; Murdoch, M E; Hopkins, A; Noma, M M; Zouré, H; Tekle, A H; Katabarwa, M N; Lutumba, P
To evaluate onchocerciasis control activities in the Democratic Republic of Congo (DRC) in the first 12 years of community-directed treatment with ivermectin (CDTI). Data from the National Programme for Onchocerciasis (NPO) provided by the National Onchocerciasis Task Force (NOTF) through the annual reports of the 21 CDTI projects for the years 2001-2012 were reviewed retrospectively. A hypothetical-inputs-process-outputs-outcomes table was constructed. Community-directed treatment with ivermectin expanded from 1968 communities in 2001 to 39 100 communities by 2012 while the number of community-directed distributors (CDD) and health workers (HW) multiplied. By 2012, there were ratios of 1 CDD per 262 persons and 1 HW per 2318 persons at risk. More than 80% of the funding came from the fiduciary funds of the African Programme for Onchocerciasis Control. The cost of treatment per person treated fell from US$ 1.1 in 2001 to US$ 0.1 in 2012. The therapeutic coverage increased from 2.7% (2001) to 74.2% (2012); the geographical coverage, from 4.7% (2001) to 93.9% (2012). Geographical coverage fell in 2005 due to deaths in loiasis co-endemic areas, and the therapeutic coverage fell in 2008 due to insecurity. Challenges to CDTI in DRC have been serious adverse reactions to ivermectin in loiasis co-endemic areas and political conflict. Targets for personnel or therapeutic and geographical coverages were not met. Longer term funding and renewed efforts are required to achieve control and elimination of onchocerciasis in DRC. © 2014 John Wiley & Sons Ltd.
Carrel, Margaret; Patel, Jaymin; Taylor, Steve M.; Janko, Mark; Mwandagalirwa, Melchior Kashamuka; Tshefu, Antoinette K.; Escalante, Ananias A.; McCollum, Andrea; Alam, Md Tauqeer; Udhayakumar, Venkatachalam; Meshnick, Steven; Emch, Michael
Understanding how malaria parasites move between populations is important, particularly given the potential for malaria to be reintroduced into areas where it was previously eliminated. We examine the distribution of malaria genetics across seven sites within the Democratic Republic of Congo (DRC) and two nearby countries, Ghana and Kenya, in order to understand how the relatedness of malaria parasites varies across space, and whether there are barriers to the flow of malaria parasites within the DRC or across borders. Parasite DNA was retrieved from dried blood spots from 7 Demographic and Health Survey sample clusters in the DRC. Malaria genetic characteristics of parasites from Ghana and Kenya were also obtained. For each of 9 geographic sites (7 DRC, 1 Ghana and 1 Kenya), a pair-wise RST statistic was calculated, indicating the genetic distance between malaria parasites found in those locations. Mapping genetics across the spatial extent of the study area indicates a complex genetic landscape, where relatedness between two proximal sites may be relatively high (RST > 0.64) or low (RST < 0.05), and where distal sites also exhibit both high and low genetic similarity. Mantel’s tests suggest that malaria genetics differ as geographic distances increase. Principal Coordinate Analysis suggests that genetically related samples are not co-located. Barrier analysis reveals no significant barriers to gene flow between locations. Malaria genetics in the DRC have a complex and fragmented landscape. Limited exchange of genes across space is reflected in greater genetic distance between malaria parasites isolated at greater geographic distances. There is, however, evidence for close genetic ties between distally located sample locations, indicating that movement of malaria parasites and flow of genes is being driven by factors other than distance decay. This research demonstrates the contributions that spatial disease ecology and landscape genetics can make to
RENNIE, STUART; MUPENDA, BAVON
Despite decades of prevention efforts, millions of persons worldwide continue to become infected by the human immunodeficiency virus (HIV) every year. This urgent problem of global epidemic control has recently lead to significant changes in HIV testing policies. Provider-initiated approaches to HIV testing have been embraced by the Centers for Disease Control and Prevention and the World Health Organization, such as those that routinely inform persons that they will be tested for HIV unless they explicitly refuse (‘opt out’). While these policies appear to increase uptake of testing, they raise a number of ethical concerns that have been debated in journals and at international AIDS conferences. However, one special form of ‘provider-initiated’ testing is being practiced and promoted in various parts of the world, and has advocates within international health agencies, but has received little attention in the bioethical literature: mandatory premarital HIV testing. This article analyses some of the key ethical issues related to mandatory premarital HIV testing in resource-poor settings with generalized HIV epidemics. We will first briefly mention some mandatory HIV premarital testing proposals, policies and practices worldwide, and offer a number of conceptual and factual distinctions to help distinguish different types of mandatory testing policies. Using premarital testing in Goma (Democratic Republic of Congo) as a point of departure, we will use influential public health ethics principles to evaluate different forms of mandatory testing. We conclude by making concrete recommendations concerning the place of mandatory premarital testing in the struggle against HIV/AIDS. PMID:19143089
Beaumont, Benjamin; Bouvy, Alban; Stephenne, Nathalie; Mathoux, Pierre; Bastin, Jean-François; Baudot, Yves; Akkermans, Tom
Monitoring tropical forest carbon stocks changes has been a rising topic in the recent years as a result of REDD+ mechanisms negotiations. Such monitoring will be mandatory for each project/country willing to benefit from these financial incentives in the future. Aerial and satellite remote sensing technologies offer cost advantages in implementing large scale forest inventories. Despite the recent progress made in the use of airborne LiDAR for carbon stocks estimation, no widely operational and cost effective method has yet been delivered for central Africa forest monitoring. Within the Maï Ndombe region of Democratic Republic of Congo, the EO4REDD project develops a method combining satellite, aerial and ground measurements. This combination is done in three steps:  mapping and quantifying forest cover changes using an object-based semi-automatic change detection (deforestation and forest degradation) methodology based on very high resolution satellite imagery (RapidEye),  developing an allometric linear model for above ground biomass measurements based on dendrometric parameters (tree crown areas and heights) extracted from airborne stereoscopic image pairs and calibrated using ground measurements of individual trees on a data set of 18 one hectare plots and  relating these two products to assess carbon stocks changes at a regional scale. Given the high accuracies obtained in  (> 80% for deforestation and 77% for forest degradation) and the suitable, but still to be improved with a larger calibrating sample, model (R² of 0.7) obtained in , EO4REDD products can be seen as a valid and replicable option for carbon stocks monitoring in tropical forests. Further improvements are planned to strengthen the cost effectiveness value and the REDD+ suitability in the second phase of EO4REDD. This second phase will include [A] specific model developments per forest type; [B] measurements of afforestation, reforestation and natural regeneration processes and
Full Text Available Human monkeypox (MPX occurs at appreciable rates in the Democratic Republic of Congo (DRC. Infection with varicella zoster virus (VZV has a similar presentation to that of MPX, and in areas where MPX is endemic these two illnesses are commonly mistaken. This study evaluated the diagnostic utility of two surveillance case definitions for MPX and specific clinical characteristics associated with laboratory-confirmed MPX cases.Data from a cohort of suspect MPX cases (identified by surveillance over the course of a 42 month period during 2009-2014 from DRC were used; real-time PCR diagnostic test results were used to establish MPX and VZV diagnoses. A total of 333 laboratory-confirmed MPX cases, 383 laboratory-confirmed VZV cases, and 36 cases that were determined to not be either MPX or VZV were included in the analyses. Significant (p<0.05 differences between laboratory-confirmed MPX and VZV cases were noted for several signs/symptoms including key rash characteristics. Both surveillance case definitions had high sensitivity and low specificities for individuals that had suspected MPX virus infections. Using 12 signs/symptoms with high sensitivity and/or specificity values, a receiver operator characteristic analysis showed that models for MPX cases that had the presence of 'fever before rash' plus at least 7 or 8 of the 12 signs/symptoms demonstrated a more balanced performance between sensitivity and specificity.Laboratory-confirmed MPX and VZV cases presented with many of the same signs and symptoms, and the analysis here emphasized the utility of including 12 specific signs/symptoms when investigating MPX cases. In order to document and detect endemic human MPX cases, a surveillance case definition with more specificity is needed for accurate case detection. In the absence of a more specific case definition, continued emphasis on confirmatory laboratory-based diagnostics is warranted.
Alfonso, Vivian H; Doshi, Reena H; Mukadi, Patrick; Higgins, Stephen G; Hoff, Nicole A; Bwaka, Ado; Mwamba, Guillaume Ngoie; Okitolonda, Emile; Muyembe, Jean-Jacques; Gerber, Sue; Rimoin, Anne W
While generally mild in children, rubella infection in early pregnancy can lead to miscarriage, fetal death or congenital rubella syndrome. Rubella vaccination is not yet available as a part of routine immunization in the Democratic Republic of the Congo (DRC), and the burden of infection is unknown. In collaboration with the 2013-2014 DRC Demographic and Health Survey, a serosurvey was carried out to assess population immunity to vaccine-preventable diseases. Dry blood spot samples collected from children 6-59 months of age were processed using the Dynex Technologies Multiplier FLEX chemiluminescent immunoassay platform (Dynex Technologies, Chantilly, VA). Among the 7195 6- to 59-month-old children, 33% were positive and <1% indeterminate for rubella antibodies in weighted analyses. Seroprevalence was positively associated with age of the child and province, with seropositivity highest in Bandundu (53%) and lowest in Kasai-Oriental (20%). In multivariate analyses, serologic evidence of infection was associated with age of the mother and child, socioeconomic status and geographic location. Rubella infection is prevalent among children in the DRC, and while most seroconversion occurs in young children, a significant proportion of children remain at risk and may enter reproductive age susceptible to rubella infection. While not currently in place, implementation of a surveillance program will provide improved estimates of both rubella virus circulation and the burden of congenital rubella syndrome. Such information will play an important role in future policy decisions, vaccine delivery strategies and may provide a basis upon which the effectiveness of rubella antigen introduction may be assessed.
Dhakal, Sarita; Song, Jin Sung; Shin, Dong Eun; Lee, Tae Ho; So, Ae Young; Nam, Eun Woo
Unintended pregnancy is an important reproductive health problem in both developed and developing countries and is most prominent in low-middle income countries. In the Democratic Republic of the Congo, the total fertility rate is high at 5.9 births per women, and a mother's probabily of dying at an age between 15-49 years is also high (53 %). Women with unintended pregnancies are less likely to utilize available necessary services for their own health and the health of their children. Therefore, unintended pregnancy is a crucial factor of maternal health in the Democratic Republic of the Congo. This study aims to identify the prevalence of unintended pregnancy and its associated factors in the Democratic Republic of the Congo. Data were collected from June 20 to 29, 2014 among women aged 15-49 years who had children younger than 5 years old. The women were from a representative sample of 602 households. Multiple logistic regression analysis was performed to evaluate the associations between the dependent variable and the explanatory variables. Unintended pregnancy was reported in 51.4 % of the respondents. Multivariate logistic regression showed an association between education status (AOR, 3.4; CI, 1.21-9.90) and age of the last child (AOR, 5.17; CI, 1.23-21.70) with an unintended pregnancy. Unintended pregnancies were low among women who owner a cell phone (AOR, 0.18; CI, 0.47-0.73) and those who were aware of family planning method (AOR 0.20; CI, 0.06-0.60). The unintended pregnancy rate high and was significantly associated with female education, previous use of family planning methods, ownership of cell phone, and age of the last child. Maternal health interventions should focus on increasing family planning service utilization, awareness of family planning, and access to communication and income.
Vandenberg, Olivier; Nyarukweba, Deo Z.; Ndeba, Prudence M.
Background: The morbidity of Salmonella bloodstream infections is unacceptably high in Africa. In 2000, the WHO Global Salmonella-Surveillance (GSS) program was founded to reduce the health burden of foodborne diseases. The incorporation, in 2002, of the Democratic Republic of Congo (DRC......) in this program allowed the improvement of laboratory capacities. In this retrospective study, we describe the first signs of impact the GSS program has had in DRC in the management of bacteremia. Methods: Between 2002 and 2006, we evaluated, in one pediatric hospital, the microbiologic and clinical features...
effects .8 In addition to these deaths, the UN reports 2.9 million 7 The eleven nations: DRC, Republic of Congo , Uganda, Rwanda , Burundi, Angola, Namibia...Lakes region of Central Africa on land that is easy to exploit but difficult to control. Since the 1994 genocide in Rwanda , which prompted massive...incumbent Hutu government in neighboring Rwanda initiated a genocide of the Tutsi population. The Tutsi Rwanda Patriotic Front (RPF) capitalized on the
Binanga, Arsene; Bertrand, Jane T
ABSTRACT In the Democratic Republic of the Congo (DRC), the Ministry of Health authorizes only physicians and nurses to give injections, with one exception—medical and nursing students may also give injections if supervised by a clinical instructor. The emergence of the injectable contraceptive Sayana Press in some African countries prompted the DRC to test the acceptability and feasibility of distributing Sayana Press and other contraceptive methods at the community level through medical and nursing students. Sayana Press is similar in formulation to the injectable contraceptive Depo-Provera but contains a lower dose and is administered subcutaneously using a single-use syringe with a short needle called the Uniject system. The Uniject system allows Sayana Press to be administered by community health workers without clinical training or by self-injection. In this pilot, the advocacy objective was to obtain approval from the Ministry of Health to allow medical and nursing students to inject Sayana Press, as a first step toward authorization for community health workers to provide the method. The pilot described in this article documents a process whereby an innovative approach moved from concept to implementation to replication in less than 2 years. It also paved the way for testing additional progressive strategies to increase access to contraception at the community level. Because the pilot project included a research component designed to assess benefits and challenges, it provided the means to introduce the new task-shifting approach, which might not have been approved otherwise. Key pilot activities included: (1) increasing awareness of Sayana Press among family planning stakeholders at a national conference on family planning, (2) enlisting the support of key decision makers in designing the pilot, (3) obtaining marketing authorization to distribute Sayana Press in the DRC, (4) implementing the pilot from July to December 2015, (5) conducting quantitative
Binanga, Arsene; Bertrand, Jane T
In the Democratic Republic of the Congo (DRC), the Ministry of Health authorizes only physicians and nurses to give injections, with one exception-medical and nursing students may also give injections if supervised by a clinical instructor. The emergence of the injectable contraceptive Sayana Press in some African countries prompted the DRC to test the acceptability and feasibility of distributing Sayana Press and other contraceptive methods at the community level through medical and nursing students. Sayana Press is similar in formulation to the injectable contraceptive Depo-Provera but contains a lower dose and is administered subcutaneously using a single-use syringe with a short needle called the Uniject system. The Uniject system allows Sayana Press to be administered by community health workers without clinical training or by self-injection. In this pilot, the advocacy objective was to obtain approval from the Ministry of Health to allow medical and nursing students to inject Sayana Press, as a first step toward authorization for community health workers to provide the method. The pilot described in this article documents a process whereby an innovative approach moved from concept to implementation to replication in less than 2 years. It also paved the way for testing additional progressive strategies to increase access to contraception at the community level. Because the pilot project included a research component designed to assess benefits and challenges, it provided the means to introduce the new task-shifting approach, which might not have been approved otherwise. Key pilot activities included: (1) increasing awareness of Sayana Press among family planning stakeholders at a national conference on family planning, (2) enlisting the support of key decision makers in designing the pilot, (3) obtaining marketing authorization to distribute Sayana Press in the DRC, (4) implementing the pilot from July to December 2015, (5) conducting quantitative and
Longstanding patterns of interaction exist between state and non-state actors seeking to improve public health in Democratic Republic of Congo (DRC). DRC is a weak state, and, in many cases, private actors have stepped in to fill the void created by the lack of state health care provision. However, the role of these interactions in creating a governance network in the health sector has been underexplored. Using data from 18 months of qualitative field research, this study aimed to explore governance networks in DRC's health sector, examining how multiple stakeholders work to manage the health system and how the resulting governance network has been relevant for the state-building process. The findings demonstrate that the health sector in South Kivu is emerging as an arena of networked governance based on active partnerships between state institutions and non-state actors. Interactions between state and non-state actors account for the persistence of the health sector in a setting characterized by state weakness. However, networked governance does not function optimally, because, although non-state interventions fill the void where the state falls short, the DRC state has faced the challenge of interacting with partners with fragmented and horizontally competing agendas. Although weak, the shadow of state authority is present in the arena of stakeholders' interactions, as the state plays a determining role by providing a regulatory framework. Overall, the findings show that the interactive engagement of non-state actors contributes to improving institutional capacity through these actors' engagement with state institutions for health system management and institutional development. However, although networked health sector governance does contribute to state capacity, it is difficult to assess the real influence of these interactions on the state-building process in a context of critical fragility, where coordination and alignment have been problematic. © The
Bazira, L; Coulibaly, T; Mayenga, M; Ncharre, C; Yogolelo, R; Mbule, A; Moudzeo, H; Lwamba, P; Mulumba, A W; Cabore, J
According to the WHO records of 2013, the incidence of poliomyelitis was reduced by more than 99%, the number of endemic countries decreased from 125 in 1988 to 3 in 2013 and over 10 million cases were prevented from poliomyelitis thanks to the intensive use of Oral polio vaccine (OPV). However, the emergence of circulating vaccine-derived poliovirus strains (cVDPV), causing serious epidemics like the wild poliovirus, is a major challenge on the final straight towards the goal of eradication and OPV cessation. This paper describes the cVDPVoutbreak that occurred in the Democratic Republic of Congo (DRC) from November 2011 to April 2012. All children under 15 years of age with acute flaccid paralysis (AFP) and confirmed presence of cVDPV in the stool samples were included. Thirty (30) children, all from the administrative territories of Bukama and Malemba Nkulu in the Katanga Province (south-east DRC), were reported. The virus responsible was the cVDPV type 2 (0.7% -3.5% divergent from the reference Sabin 2 strain) in 29 children (97%) and the ambiguous vaccine-derived poliovirus strain (0.7% divergent) was confirmed in one case (3%), a boy seventeen months old and already vaccinated four times with OPV. Twentyfive children (83%) were protected by any of the routine EPI vaccines and 3 children (10%) had never received any dose of OPV. In reaction, DRC has conducted five local campaigns over a period of 10 months (from January to October 2012) and the epidemic was stopped after the second round performed in March 2012. As elsewhere in similar conditions, low immunization coverage, poor sanitation conditions and the stop of the use of OPV2 have favoured the emergence of the third cVDPV epidemic in DRC. The implementation of the Strategic Plan for Polio eradication and endgame strategic plan 2013-2018 will prevent the emergence of cVDPV and set up the conditions for a coordinated OPV phase out.
Kwete, Dieudonné; Binanga, Arsene; Mukaba, Thibaut; Nemuandjare, Théophile; Mbadu, Muanda Fidele; Kyungu, Marie-Thérèse; Sutton, Perri; Bertrand, Jane T
Momentum for family planning in the Democratic Republic of the Congo (DRC) is evident in multiple ways: strong political will, increasing donor support, a growing number of implementing organizations, innovative family planning programming, and a cohesive family planning stakeholder group. Between 2013 and 2017, the modern contraceptive prevalence rate (mCPR) in the capital city of Kinshasa increased from 18.5% to 26.7% among married women, but as of 2013–14, it was only 7.8% at the national level. The National Multisectoral Strategic Plan for Family Planning: 2014–2020 calls for achieving an mCPR of 19.0% by 2020, an ambitious goal in light of formidable challenges to family planning in the DRC. Of the 16,465 health facilities reporting to the national health information system in 2017, only 40% offer family planning services. Key challenges include uncertainty over the political situation, difficulties of ensuring access to family planning services in a vast country with a weak transportation infrastructure, funding shortfalls for procuring adequate quantities of contraceptives, weak contraceptive logistics and supply chain management, strong cultural norms that favor large families, and low capacity of the population to pay for contraceptive services. This article describes promising initiatives designed to address these barriers, consistent with the World Health Organization's framework for health systems strengthening. For example, the national family planning coordinating mechanism is being replicated at the provincial level to oversee the expansion of family planning service delivery. Promising initiatives are being implemented to improve the supply and quality of services and generate demand for family planning, including social marketing of subsidized contraceptives at both traditional and non-traditional channels and strengthening of services in military health facilities. To expand contraceptive access, family planning is being institutionalized in
Lumbala, Crispin; Simarro, Pere P; Cecchi, Giuliano; Paone, Massimo; Franco, José R; Kande Betu Ku Mesu, Victor; Makabuza, Jacquies; Diarra, Abdoulaye; Chansy, Shampa; Priotto, Gerardo; Mattioli, Raffaele C; Jannin, Jean G
For the past three decades, the Democratic Republic of the Congo (DRC) has been the country reporting the highest number of cases of human African trypanosomiasis (HAT). In 2012, DRC continued to bear the heaviest burden of gambiense HAT, accounting for 84 % of all cases reported at the continental level (i.e., 5,968/7,106). This paper reviews the status of sleeping sickness in DRC between 2000 and 2012, with a focus on spatio-temporal patterns. Epidemiological trends at the national and provincial level are presented. The number of HAT cases reported yearly from DRC decreased by 65 % from 2000 to 2012, i.e., from 16,951 to 5,968. At the provincial level a more complex picture emerges. Whilst HAT control in the Equateur province has had a spectacular impact on the number of cases (97 % reduction), the disease has proved more difficult to tackle in other provinces, most notably in Bandundu and Kasai, where, despite substantial progress, HAT remains entrenched. HAT prevalence presents its highest values in the northern part of the Province Orientale, where a number of constraints hinder surveillance and control. Significant coordinated efforts by the National Sleeping Sickness Control Programme and the World Health Organization in data collection, reporting, management and mapping, culminating in the Atlas of HAT, have enabled HAT distribution and risk in DRC to be known with more accuracy than ever before. Over 18,000 locations of epidemiological interest have been geo-referenced (average accuracy ≈ 1.7 km), corresponding to 93.6 % of reported cases (period 2000-2012). The population at risk of contracting sleeping sickness has been calculated for two five-year periods (2003-2007 and 2008-2012), resulting in estimates of 33 and 37 million people respectively. The progressive decrease in HAT cases reported since 2000 in DRC is likely to reflect a real decline in disease incidence. If this result is to be sustained, and if further progress is to be made
G. M. Sidorova
Full Text Available The research focuses on the problem of military-political instability in the Democratic Republic of the Congo experiencing continued armed conflict for a long time. Dozens of illegal armed groups both Congolese and foreign origin continue to destabilize situation in the eastern part of the country causing humanitarian disasters. Due to governmental weakness, economic backwardness, chronical lack of finance resources, interethnic conflicts, all-round and widely spread corruption of the authorities, the Congolese government at the moment is not able to overcome scores of problems including the problem of security. Assistanceprovided to the DRC by itspartnerssuch as, first of all, the former metropolitan country Belgium, as well as the USA, Great Britain, the Europe Union and China works only in favourof these country-donors. They are attracted by rich Congolese natural resources which the DRC remaining one of the poorest countries in the world cannot turn to advantage to the full extent because of its economic backwardness. In exchange for so-calleddevelopment programmes, expensive strategic raw material (such as coltan, wolfram, casseterit, cooper, gold, niobium, and other is being extracted and exported from the country, in addition, often on the inequivalent basis. This is taking place for the reason that numerous mines and open-cast mines are being controlled by different illegal armed groups and not by the central government. Therefore, it turns out that in the context of a military-political crisis, for so-called partners it is more beneficial to pursue their own interests. Furthermore, western ideologists arouse "separatism-oriented" theories similar to "balkanization", in other words, a breakdown of this giant country into several independent states. The Congolese are tremulous to this issue, they try to counter such approachs and defend the territorial integrity of the DRC. However, it is not an easy task. The impediment is unsettled
Luc Malemo Kalisya
Full Text Available An increase of congenital anomalies in the eastern Democratic Republic of the Congo (DRC has been reported. Congenital malformations (CMs are not uncommon among newborns and, if left untreated, can contribute to increased neonate morbidity and mortality.Medical records of all individuals admitted with a diagnosed CM to HEAL Africa Teaching Hospital (Goma, DRC from 2002 to 2014 (n=1301 were reviewed. Data were analysed using descriptive statistics to summarize chart records, and inferential statistics to investigate significant barriers to earlier treatment.Since 2012, the number of patients treated each year for CMs has increased by over 200% compared to the average annual number of cases treated from 2002-2011. Though delayed presentation of patients to HEAL Hospital was very obvious, with an average age of 8.2 years. We find that patient age has been significantly decreasing (p=0.037 over time. The average distance separating patients from HEAL Hospital was 178 km, with approximately one third living 350 km or further from the treatment center. Distance is the most significant (p=3.33x10(-6 barrier to earlier treatment. When controlling for an interaction between gender and the use of mercy funds, we also find that female patients are at a significant (p=1.04x10(-3 disadvantage to undergo earlier corrective surgery. This disadvantage is further illustrated by our finding that 89% of women and girls, and over 81% of all patients, required mercy funds to cover the cost of surgery in 2014. Lastly, the mortality rate for surgery was low and averaged less than 1.0%.Despite a formal end to the war in 2009, and an overall increase in individuals undergoing corrective surgery, distance, poverty, and gender are still massive barriers to CM care at HEAL Hospital, Goma, DRC. We find that patients have been successfully treated earlier by HEAL, although the average age of CM correction in 2014 (4.9 years is still above average for Sub-Saharan Africa. Thus
Full Text Available Orientation: The modern workplace, which is characterised by increasing turbulence and debilitating uncertainty, has led to renewed focus on whether employees experience satisfaction and how they commit themselves to the organisation. Research purpose: The aim of this study was to measure the nature of the relationship between employees’ levels of job satisfaction (JS and organisational commitment (OC in a public railway organisation in the Democratic Republic of Congo (DRC. Motivation for the study: Although previous researchers have found evidence of the relationship between JS and OC in Western countries, there seems to be a paucity of research on the relationship between JS and OC in a developing country context such as that of the DRC. The results could make a valuable contribution to the current literature debate on these two constructs (JS and OC and possibly employees’ intention to stay in their present organisation. Research design, approach and method: A cross-sectional survey design was used employing the Job Satisfaction Questionnaire and the Organisational Commitment Scale. The sample (n = 839 comprised permanently employed staff. Correlations and regression analyses were conducted. The results indicated that employees’ JS related positively to their level of OC and that JS predicted OC. Practical and managerial implications: The results should also have interesting implications for top management and human resource practitioners. They could use this information to study how organisational psychological attachment is fostered in order to potentially master other organisational dynamics. The information could also be used to create positive working conditions with a view to reinforcing OC. JS manifested as a critical driver of OC, which could result in superior business performance. Management could use the results to create a working environment that actively fosters satisfaction and boosts employees’ level of
Kwete, Dieudonné; Binanga, Arsene; Mukaba, Thibaut; Nemuandjare, Théophile; Mbadu, Muanda Fidele; Kyungu, Marie-Thérèse; Sutton, Perri; Bertrand, Jane T
Momentum for family planning in the Democratic Republic of the Congo (DRC) is evident in multiple ways: strong political will, increasing donor support, a growing number of implementing organizations, innovative family planning programming, and a cohesive family planning stakeholder group. Between 2013 and 2017, the modern contraceptive prevalence rate (mCPR) in the capital city of Kinshasa increased from 18.5% to 26.7% among married women, but as of 2013-14, it was only 7.8% at the national level. The National Multisectoral Strategic Plan for Family Planning: 2014-2020 calls for achieving an mCPR of 19.0% by 2020, an ambitious goal in light of formidable challenges to family planning in the DRC. Of the 16,465 health facilities reporting to the national health information system in 2017, only 40% offer family planning services. Key challenges include uncertainty over the political situation, difficulties of ensuring access to family planning services in a vast country with a weak transportation infrastructure, funding shortfalls for procuring adequate quantities of contraceptives, weak contraceptive logistics and supply chain management, strong cultural norms that favor large families, and low capacity of the population to pay for contraceptive services. This article describes promising initiatives designed to address these barriers, consistent with the World Health Organization's framework for health systems strengthening. For example, the national family planning coordinating mechanism is being replicated at the provincial level to oversee the expansion of family planning service delivery. Promising initiatives are being implemented to improve the supply and quality of services and generate demand for family planning, including social marketing of subsidized contraceptives at both traditional and non-traditional channels and strengthening of services in military health facilities. To expand contraceptive access, family planning is being institutionalized in
As a sequel to the assistance which the Agency provided to the Government of the Democratic Republic of the Congo in connection with a research reactor project, a Second Supply Agreement has been concluded between the Agency and the Governments of the Congo and the United States of America. This Agreement entered into force on 15 April 1971, and the text is reproduced herein for the information of all Members.
As a sequel to the assistance which the Agency provided to the Government of the Democratic Republic of the Congo in connection with a research reactor project, a Second Supply Agreement has been concluded between the Agency and the Governments of the Congo and the United States of America. This Agreement entered into force on 15 April 1971, and the text is reproduced herein for the information of all Members
John A Hart
Full Text Available In June 2007, a previously undescribed monkey known locally as "lesula" was found in the forests of the middle Lomami Basin in central Democratic Republic of Congo (DRC. We describe this new species as Cercopithecus lomamiensis sp. nov., and provide data on its distribution, morphology, genetics, ecology and behavior. C. lomamiensis is restricted to the lowland rain forests of central DRC between the middle Lomami and the upper Tshuapa Rivers. Morphological and molecular data confirm that C. lomamiensis is distinct from its nearest congener, C. hamlyni, from which it is separated geographically by both the Congo (Lualaba and the Lomami Rivers. C. lomamiensis, like C. hamlyni, is semi-terrestrial with a diet containing terrestrial herbaceous vegetation. The discovery of C. lomamiensis highlights the biogeographic significance and importance for conservation of central Congo's interfluvial TL2 region, defined from the upper Tshuapa River through the Lomami Basin to the Congo (Lualaba River. The TL2 region has been found to contain a high diversity of anthropoid primates including three forms, in addition to C. lomamiensis, that are endemic to the area. We recommend the common name, lesula, for this new species, as it is the vernacular name used over most of its known range.
Parker, L.; Maman, S.; Pettifor, A.; Chalachala, J. L.; Edmonds, A.; Golin, C. E.; Moracco, K.; Behets, F.
We evaluated the feasibility of a Positive Prevention intervention adapted for youth living with HIV/AIDS (YLWH) ages 15-24 in Kinshasa, Democratic Republic of the Congo. We conducted in-depth interviews and focus group discussions with intervention facilitators and YLWH participants on the following four areas of a feasibility framework:…
The text of the Project Extension Agreement between the Agency and the Government of the Democratic Republic of the Congo in connection with the Agency's additional assistance to that Government in continuing a research reactor project is reproduced in this document for the information of all Members. This Agreement entered into force on 27 September 1966.
Cabral, A. R.; Skála, Roman; Vymazalová, A.; Kallistová, Anna; Lehmann, B.; Jedwab, J.; Sidorinová, T.
Roč. 78, č. 3 (2014), s. 739-745 ISSN 0026-461X Institutional support: RVO:67985831 Keywords : kitagohaite * Pt 7 Cu * Lubero * North Kivu * Democratic Republic of the Congo Subject RIV: DB - Geology ; Mineralogy Impact factor: 2.026, year: 2014
Mwanamoki, Paola M; Devarajan, Naresh; Niane, Birane; Ngelinkoto, Patience; Thevenon, Florian; Nlandu, José W; Mpiana, Pius T; Prabakar, Kandasamy; Mubedi, Josué I; Kabele, Christophe G; Wildi, Walter; Poté, John
The contamination of drinking water resources by toxic metals is a major problem in many parts of the world, particularly in dense populated areas of developing countries that lack wastewater treatment facilities. The present study characterizes the recent evolution with time of some contaminants deposited in the Congo River and Lake Ma Vallée, both located in the vicinity of the large city of Kinshasa, capital of Democratic Republic of Congo (DRC). Physicochemical parameters including grain size distribution, organic matter and trace element concentrations were measured in sediment cores sampled from Congo River (n = 3) and Lake Ma Vallée (n = 2). The maximum concentration of trace elements in sediment profiles was found in the samples from the sites of Pool Malebo, with the values of 107.2, 111.7, 88.6, 39.3, 15.4, 6.1 and 4.7 mg kg(-1) for Cr, Ni, Zn, Cu, Pb, As and Hg, respectively. This site, which is characterized by intense human activities, is especially well known for the construction of numerous boats that are used for regular navigation on Congo River. Concerning Lake Ma Vallée, the concentration of all metals are generally low, with maximum values of 26.3, 53.6, 16.1, 15.3, 6.5 and 1.8 mg kg(-1) for Cr, Ni, Zn, Cu, Pb and As, respectively. However, the comparison of the metal profiles retrieved from the different sampled cores also reveals specific variations. The results of this study point out the sediment pollution by toxic metals in the Congo River Basin. This research presents useful tools for the evaluation of sediment contamination of river-reservoir systems.
Drazo, Nicaise Amundala; Kennis, Jan; Leirs, Herwig
We conducted a survey on rodent crop damage among farmers in the hinterland of Kisangani (Democratic Republic of Congo). We studied the amount of crop damage, the rodent groups causing crop damage, the growth stages affected and the control techniques used. We conducted this survey in three...... municipalities using a standard questionnaire form translated into local languages, between November 2005 and June 2006 and during July 2007. We used the Quotas method and interviewed 70 households per municipality. Farmers indicated rodent groups implicated in crop damage on color photographs. Two types...... of survey techniques were used: individual and focus-group surveys. The sugar cane rat, Thryonomys sp. and Lemniscomys striatus caused most damage to crops, but inside granaries, Rattus rattus was the primary pest species eating stored food supplies and causing damage to stored goods. Cassava and maize were...
Patel, Jaymin C; Taylor, Steve M; Juliao, Patricia C; Parobek, Christian M; Janko, Mark; Gonzalez, Luis Demetrio; Ortiz, Lucia; Padilla, Norma; Tshefu, Antoinette K; Emch, Michael; Udhayakumar, Venkatachalam; Lindblade, Kim; Meshnick, Steven R
Imported malaria threatens control and elimination efforts in countries that have low rates of transmission. In 2010, an outbreak of Plasmodium falciparum malaria was reported among United Nations peacekeeping soldiers from Guatemala who had recently returned from the Democratic Republic of the Congo (DRC). Epidemiologic evidence suggested that the soldiers were infected in the DRC, but local transmission could not be ruled out in all cases. We used population genetic analyses of neutral microsatellites to determine the outbreak source. Genetic relatedness was compared among parasites found in samples from the soldiers and parasite populations collected in the DRC and Guatemala; parasites identified in the soldiers were more closely related to those from the DRC. A phylogenetic clustering analysis confirms this identification with >99.9% confidence. Thus, results support the hypothesis that the soldiers likely imported malaria from the DRC. This study demonstrates the utility of molecular genotyping in outbreak investigations.
Four cases of coprophagy and two cases of fecal inspection were identified during the 1142 h of observing wild bonobos at Wamba in the Luo Scientific Reserve in the Democratic Republic of the Congo. At least 5 females in the study group practiced coprophagy and/or fecal inspection. According to our daily behavioral observations, boredom and stress, insufficient roughage, and the search for essential nutrients could not explain the coprophagy. Several episodes observed in this study indicated that bonobos might have sought and ingested certain valuable food items, such as hard Dialium seeds, in feces during relatively lean seasons. Although coprophagy occurred only rarely among wild bonobos, this practice appeared to represent a possibly adaptive feeding strategy during periods of food scarcity rather than a behavioral abnormality.
Veling, Wim; Hall, Brian J; Joosse, Petra
The Democratic Republic of Congo (DRC) has suffered from a bloody conflict for more than a decade. More than 5,400,000 people died from war-related causes since 1998 and exposure to violence was wide-spread. This study investigated the impact of posttraumatic stress disorder (PTSD) symptoms on perceived health and physical and social functioning, filling an important gap in the current literature. Data were collected from a sample of 93 adults living in Bunia, Eastern Democratic Republic of Congo. Structured in-person interviews included the PTSD section of the Composite International Diagnostic Interview and the World Health Organization Disability Assessment Scale. Additional questions were included to assess social resources. Study recruitment was balanced to achieve equal representation of both sexes and each quarter of town. Forty percent met symptom criteria for probable PTSD. Individuals with PTSD reported poor perceived general health and had high disability scores compared to those without PTSD. Of the three PTSD symptom clusters, hyperarousal was most strongly associated with disability. Individuals with PTSD were significantly more emotionally affected by their health problems than those without PTSD (85% versus 41%), had more difficulties in activities involving social contact (54% versus 16%) and in doing their daily work (54% versus 20%). The impact of war-related violence on mental health is severe in the DRC. Psychosocial interventions developed in conflict areas might be best targeted primarily to supporting social functioning and reducing hyperarousal. Implications for clinical treatment and future directions are discussed. Copyright © 2013 Elsevier Ltd. All rights reserved.
Monica Adhiambo Onyango
Full Text Available The Democratic Republic of the Congo (DRC has experienced nearly two decades of civil conflict in the Eastern regions of North and South Kivu. This conflict has been notorious for the use of sexual violence as a weapon of war, leading in many cases to pregnancy after rape. The objectives of this analysis were: 1 to describe patterns of sexual violence-related pregnancy (SVRP disclosure; 2 to consider why survivors chose to disclose to particular individuals; and 3 to examine the dialogue around SVRPs between women with SVRPs and their confidants. In South Kivu Province, Democratic Republic of Congo, two sub-groups of sexual violence survivors completed qualitative interviews, those currently raising a child from an SVRP (parenting group, N = 38 and those who had terminated an SVRP (termination group, N = 17. The findings show that a majority of SVRPs were conceived when participants were held in sexual captivity for prolonged periods of time. The SVRPs were disclosed to friends, family members, other sexual violence survivors, community members, spouses, health care providers, or perpetrators. The confidants were most often chosen because they were perceived by the participants as being discreet, trusted, and supportive. The confidants often provided advice about continuing or terminating the SVRP. Trust and discretion are the most important factors determining to whom women with SVRPs disclose their pregnancies. The vital role of confidants in giving support after disclosure cannot be overlooked. Providing opportunities for survivors to safely disclose their SVRPs, including to health care providers, is a necessary first step in allowing them to access safe and comprehensive post-assault care and services.
Yotebieng, Marcel; Chalachala, Jean Lambert; Labbok, Miriam; Behets, Frieda
Although breastfeeding is almost universally accepted in the Democratic Republic (DR) of Congo, by the age of 2 to 3 months 65% of children are receiving something other than human milk. We sought to describe the infant feeding practices and determinants of suboptimal breastfeeding behaviors in DR Congo. Survey questionnaire administered to mothers of infants aged ≤ 6 months and healthcare providers who were recruited consecutively at six selected primary health care facilities in Kinshasa, the capital. All 66 mothers interviewed were breastfeeding. Before initiating breastfeeding, 23 gave their infants something other than their milk, including: sugar water (16) or water (2). During the twenty-four hours prior to interview, 26 (39%) infants were exclusively breastfed (EBF), whereas 18 (27%), 12 (18%), and 10 (15%) received water, tea, formula, or porridge, respectively, in addition to human milk. The main reasons for water supplementation included "heat" and cultural beliefs that water is needed for proper digestion of human milk. The main reason for formula supplementation was the impression that the baby was not getting enough milk; and for porridge supplementation, the belief that the child was old enough to start complementary food. Virtually all mothers reported that breastfeeding was discussed during antenatal clinic visit and half reported receiving help regarding breastfeeding from a health provider either after birth or during well-child clinic visit. Despite a median of at least 14 years of experience in these facilities, healthcare workers surveyed had little to no formal training on how to support breastfeeding and inadequate breastfeeding-related knowledge and skills. The facilities lacked any written policy about breastfeeding. Addressing cultural beliefs, training healthcare providers adequately on breastfeeding support skills, and providing structured breastfeeding support after maternity discharge is needed to promote EBF in the DR Congo.
Delpomdor, F.; Van Vliet, N.; Devleeschouwer, X.; Tack, L.; Préat, A.
New detailed lithological, sedimentological, chemostratigraphic data were obtained from exploration drilling samples on the C5 carbonate-dominated formation of the Neoproterozoic Lukala Subgroup (former Schisto-Calcaire Subgroup) from the West Congo Belt (WCB) in the Democratic Republic of Congo. This formation records the last post-Marinoan sea-level events that occurred in the whole basin, followed by the development of the Araçuaï-West Congo Orogen between 630 and 560 Ma. The C5 Formation consists of back-reef lagoonal and peritidal/sabkha cycles of ∼2.0 m in thickness, that record a short-time marine regression, rapidly flooded by a marine transgression with deposition of organic-rich argillaceous carbonates or shales under dysoxia and anoxia conditions. These dysoxic/anoxic waters were rapidly followed by a regional-scale marine transgression, favouring mixing with well-oxygenated waters, and the development of benthic Tonian to Cambro-Ordovician Obruchevella parva-type 'seagrasses' in the nearshore zones of the lagoons. New δ13C and 87Sr/86Sr isotopic data in the C5 Formation of the Lukala Subgroup are used in the frame of a correlation with the Sete Lagoas Formation in Brazil. Relatively comparable negative to positive δ13C excursions point to marine flooding of the whole basin and allow extension of the debatable Late Ediacaran age of the uppermost Sete Lagoas and C5 formations. Sr isotope ;blind dating; failed due to low Sr concentration related to a dolomitization event close 540 Ma. Several tentative datings of the C5 Formation converge to a Late Ediacaran age ranging between 575 and 540 Ma. As the overlying Mpioka folded Subgroup, the C5 series suffered the Pan African deformation, dated at 566 ± 42 Ma. Unlike the previously generally accepted interpretation, our data suggests that the Mpioka Subgroup was deposited in the Early Cambrian.
Bakkegaard, Riyong Kim; Nielsen, Martin Reinhardt; Thorsen, Bo Jellesmark
Peri-urban pressure on the Luki Biosphere Reserve in Bas-Congo, Democratic Republic of Congo, is fuelled by growing demand in urban markets coupled with easy access. With data from 175 randomly selected households, this paper examines factors that motivate households to collect two major forest....... Greater market distance being a female-headed household and greater age of household heads negatively affected selection into eru collection, reflecting characteristics of cash harvesting activities. Low education and more local knowledge characterised more successful outcome of eru collection, whereas...... of these activities in providing a pathway out of poverty and stress the needs for better integration of conservation and development policies....
In recent years there has been growing interest in how societies and states should address past wrongdoing. Despite attention to issues of responsibility and moral reparation, however, institutional (moral) responsibility remains relatively unstudied. To this end, the article critically evaluates the UN’s moral responsibility in the world’s deadliest conflict since World War II, namely the conflict in the Democratic Republic of Congo (DRC). It argues that the UN Security Council should be hel...
Nsakala, Gabriel Vodiena; Coppieters, Yves; Kayembe, Patrick Kalambayi
Background: As teenagers have easy access to both radio programs and cell phones, the current study used these tools so that young people could anonymously identify questions about sex and other related concerns in the urban environment of the Democratic Republic of Congo. The purpose of this healthcare intervention was to identify and address concerns raised by young people, which are related to sexual health, and which promote youth health. Methods: This healthcare intervention was conducte...
Sikiminywa, K.-L.; Godeau, Jean-Marie; Nyongombe, U.-F.; Hornick, Jean-Luc
Providing animal proteins to humans requires choosing the animal species to be raised when access to land is limited. Butembo, is a refuge city of conflicts area in the east of Democratic Republic of Congo, where guinea-pig (Cavia porcellus) is considered as food. Therefore the breeding of this animal is an option to make more meat available. Genetic selection of guinea pigs and popularization of improved farming techniques can contribute to solve problems of food security in the region. The ...
Gignoux, E; Polonsky, J; Ciglenecki, I; Bichet, M; Coldiron, M; Thuambe Lwiyo, E; Akonda, I; Serafini, M; Porten, K
In 2013, a large measles epidemic occurred in the Aketi Health Zone of the Democratic Republic of Congo. We conducted a two-stage, retrospective cluster survey to estimate the attack rate, the case fatality rate, and the measles-specific mortality rate during the epidemic. 1424 households containing 7880 individuals were included. The estimated attack rate was 14.0%, (35.0% among children aged
Full Text Available Background: Comzmercialization of health care has contributed to widen inequities between the rich and the poor, especially in settings with suboptimal regulatory frameworks of the health sector. Poorly regulated fee-for-service payment systems generate inequity and initiate a vicious circle in which access to quality health care gradually deteriorates. Although the abolition of user fees is high on the international health policy agenda, the sudden removal of user fees may have disrupting effects on the health system and may not be affordable or sustainable in resource-constrained countries, such as the Democratic Republic of Congo. Methods and Results: Between 2008 and 2011, the Belgian development aid agency (BTC launched a set of reforms in the Kisantu district, in the province of Bas Congo, through an action-research process deemed appropriate for the implementation of change within open complex systems such as the Kisantu local health system. Moreover, the entire process contributed to strengthen the stewardship capacity of the Kisantu district management team. The reforms mainly comprised the rationalization of resources and the regulation of health services financing. Flat fees per episode of disease were introduced as an alternative to fee-for-service payments by patients. A financial subsidy from BTC allowed to reduce the height of the flat fees. The provision of the subsidy was made conditional upon a range of measures to rationalize the use of resources. Conclusions: The results in terms of enhancing people access to quality health care were immediate and substantial. The Kisantu experience demonstrates that a systems approach is essential in addressing complex problems. It provides useful lessons for other districts in the country.
Kabwe, Constantin; Maketa, Vivi; Lukanu, Philippe; Lutumba, Pascal; Polman, Katja; Matondo, Peter; Speybroeck, Niko; Dorny, Pierre; Sumbu, Julienne
Background Taenia solium, a zoonotic parasite that is endemic in most developing countries where pork is consumed, is recognised as the main cause of acquired epilepsy in these regions. T. solium has been reported in almost all of the neighboring countries of Democratic Republic of Congo (DRC) but data on the current prevalence of the disease in the country itself are lacking. This study, focusing on porcine cysticercosis (CC), makes part of a first initiative to assess whether cysticercosis is indeed actually present in DRC. Methods An epidemiological study on porcine CC was conducted (1) on urban markets of Kinshasa where pork is sold and (2) in villages in Bas-Congo province where pigs are traditionally reared. Tongue inspection and ELISA for the detection of circulating antigen of the larval stage of T. solium were used to assess the prevalence of active CC in both study sites. Findings The overall prevalence of pigs with active cysticercosis did not significantly differ between the market and the village study sites (38.8 [CI95%: 34–43] versus 41.2% [CI95%: 33–49], respectively). However, tongue cysticercosis was only found in the village study site together with a significantly higher intensity of infection (detected by ELISA). Interpretation Pigs reared at village level are sold for consumption on Kinshasa markets, but it seems that highly infected animals are excluded at a certain level in the pig trade chain. Indeed, preliminary informal surveys on common practices conducted in parallel revealed that pig farmers and/or buyers select the low infected animals and exclude those who are positive by tongue inspection at village level. This study provides the only recent evidence of CC presence in DRC and gives the first estimates to fill an important gap on the African taeniasis/cysticercosis distribution map. PMID:20838646
Kandala, Ngianga-Bakwin; Madungu, Tumwaka P; Emina, Jacques B O; Nzita, Kikhela P D; Cappuccio, Francesco P
Although there are inequalities in child health and survival in the Democratic Republic of Congo (DRC), the influence of distal determinants such as geographic location on children's nutritional status is still unclear. We investigate the impact of geographic location on child nutritional status by mapping the residual net effect of malnutrition while accounting for important risk factors. We examine spatial variation in under-five malnutrition with flexible geo-additive semi-parametric mixed model while simultaneously controlling for spatial dependence and possibly nonlinear effects of covariates within a simultaneous, coherent regression framework based on Markov Chain Monte Carlo techniques. Individual data records were constructed for children. Each record represents a child and consists of nutritional status information and a list of covariates. For the 8,992 children born within the last five years before the survey, 3,663 children have information on anthropometric measures.Our novel empirical approach is able to flexibly determine to what extent the substantial spatial pattern of malnutrition is driven by detectable factors such as socioeconomic factors and can be attributable to unmeasured factors such as conflicts, political, environmental and cultural factors. Although childhood malnutrition was more pronounced in all provinces of the DRC, after accounting for the location's effects, geographic differences were significant: malnutrition was significantly higher in rural areas compared to urban centres and this difference persisted after multiple adjustments. The findings suggest that models of nutritional intervention must be carefully specified with regard to residential location. Childhood malnutrition is spatially structured and rates remain very high in the provinces that rely on the mining industry and comparable to the level seen in Eastern provinces under conflicts. Even in provinces such as Bas-Congo that produce foods, childhood malnutrition is
Nzita Kikhela PD
Full Text Available Abstract Background Although there are inequalities in child health and survival in the Democratic Republic of Congo (DRC, the influence of distal determinants such as geographic location on children's nutritional status is still unclear. We investigate the impact of geographic location on child nutritional status by mapping the residual net effect of malnutrition while accounting for important risk factors. Methods We examine spatial variation in under-five malnutrition with flexible geo-additive semi-parametric mixed model while simultaneously controlling for spatial dependence and possibly nonlinear effects of covariates within a simultaneous, coherent regression framework based on Markov Chain Monte Carlo techniques. Individual data records were constructed for children. Each record represents a child and consists of nutritional status information and a list of covariates. For the 8,992 children born within the last five years before the survey, 3,663 children have information on anthropometric measures. Our novel empirical approach is able to flexibly determine to what extent the substantial spatial pattern of malnutrition is driven by detectable factors such as socioeconomic factors and can be attributable to unmeasured factors such as conflicts, political, environmental and cultural factors. Results Although childhood malnutrition was more pronounced in all provinces of the DRC, after accounting for the location's effects, geographic differences were significant: malnutrition was significantly higher in rural areas compared to urban centres and this difference persisted after multiple adjustments. The findings suggest that models of nutritional intervention must be carefully specified with regard to residential location. Conclusion Childhood malnutrition is spatially structured and rates remain very high in the provinces that rely on the mining industry and comparable to the level seen in Eastern provinces under conflicts. Even in
Full Text Available BACKGROUND: Taenia solium, a zoonotic parasite that is endemic in most developing countries where pork is consumed, is recognised as the main cause of acquired epilepsy in these regions. T. solium has been reported in almost all of the neighboring countries of Democratic Republic of Congo (DRC but data on the current prevalence of the disease in the country itself are lacking. This study, focusing on porcine cysticercosis (CC, makes part of a first initiative to assess whether cysticercosis is indeed actually present in DRC. METHODS: An epidemiological study on porcine CC was conducted (1 on urban markets of Kinshasa where pork is sold and (2 in villages in Bas-Congo province where pigs are traditionally reared. Tongue inspection and ELISA for the detection of circulating antigen of the larval stage of T. solium were used to assess the prevalence of active CC in both study sites. FINDINGS: The overall prevalence of pigs with active cysticercosis did not significantly differ between the market and the village study sites (38.8 [CI 95%: 34-43] versus 41.2% [CI 95%: 33-49], respectively. However, tongue cysticercosis was only found in the village study site together with a significantly higher intensity of infection (detected by ELISA. INTERPRETATION: Pigs reared at village level are sold for consumption on Kinshasa markets, but it seems that highly infected animals are excluded at a certain level in the pig trade chain. Indeed, preliminary informal surveys on common practices conducted in parallel revealed that pig farmers and/or buyers select the low infected animals and exclude those who are positive by tongue inspection at village level. This study provides the only recent evidence of CC presence in DRC and gives the first estimates to fill an important gap on the African taeniasis/cysticercosis distribution map.
Hilhorst, Dorothea; Douma, Nynke
The Democratic Republic of the Congo (DRC) has witnessed a high prevalence of sexual violence since the wars of the mid-1990s. The huge response to it commenced around the turn of the century, but turned to 'hype' towards 2010. The paper defines 'hypes' as phenomena characterised by a media frenzy, eagerness by non-governmental organisations, and pragmatic local responses. Interviews and analyses conducted in 2011 revealed misuse of services and misrepresentation at different levels. The paper goes on to review medical and legal assistance and to provide evidence of incremental improvements in the response since 2012. It has become better coordinated, with more engagement by the DRC government, more community-oriented, and has incorporated a broader notion of gender-based violence. Nonetheless, concern remains about its impact and its continued dependence on international resources. There is apprehension too about social reactions to the problems of corruption and impunity, seemingly adding to the confusion surrounding gender relations in the country. © 2018 The Author(s). Disasters © Overseas Development Institute, 2018.
Hawkes, Michael; Katsuva, Jean Paul; Masumbuko, Claude K
Accurate and practical malaria diagnostics, such as immunochromatographic rapid diagnostic tests (RDTs), have the potential to avert unnecessary treatments and save lives. Volunteer community health workers (CHWs) represent a potentially valuable human resource for expanding this technology to where it is most needed, remote rural communities in sub-Saharan Africa with limited health facilities and personnel. This study reports on a training programme for CHWs to incorporate RDTs into their management strategy for febrile children in the Democratic Republic of Congo, a tropical African setting ravaged by human conflict. Prospective cohort study, satisfaction questionnaire and decision analysis. Twelve CHWs were trained to safely and accurately perform and interpret RDTs, then successfully implemented rapid diagnostic testing in their remote community in a cohort of 357 febrile children. CHWs were uniformly positive in evaluating RDTs for their utility and ease of use. However, high malaria prevalence in this cohort (93% by RDTs, 88% by light microscopy) limited the cost-effectiveness of RDTs compared to presumptive treatment of all febrile children, as evidenced by findings from a simplified decision analysis. CHWs can safely and effectively use RDTs in their management of febrile children; however, cost-effectiveness of RDTs is limited in zones of high malaria prevalence.
Full Text Available Abstract Background Accurate and practical malaria diagnostics, such as immunochromatographic rapid diagnostic tests (RDTs, have the potential to avert unnecessary treatments and save lives. Volunteer community health workers (CHWs represent a potentially valuable human resource for expanding this technology to where it is most needed, remote rural communities in sub-Saharan Africa with limited health facilities and personnel. This study reports on a training programme for CHWs to incorporate RDTs into their management strategy for febrile children in the Democratic Republic of Congo, a tropical African setting ravaged by human conflict. Methods Prospective cohort study, satisfaction questionnaire and decision analysis. Results Twelve CHWs were trained to safely and accurately perform and interpret RDTs, then successfully implemented rapid diagnostic testing in their remote community in a cohort of 357 febrile children. CHWs were uniformly positive in evaluating RDTs for their utility and ease of use. However, high malaria prevalence in this cohort (93% by RDTs, 88% by light microscopy limited the cost-effectiveness of RDTs compared to presumptive treatment of all febrile children, as evidenced by findings from a simplified decision analysis. Conclusions CHWs can safely and effectively use RDTs in their management of febrile children; however, cost-effectiveness of RDTs is limited in zones of high malaria prevalence.
Young-Lin, Nichole; Namugunga, Esperance N; Lussy, Justin P; Benfield, Nerys
To understand perspectives of local health providers on the social reintegration of patients who have undergone fistula repair in the eastern Democratic Republic of Congo. In a qualitative study, semi-structured individual interviews were conducted with patient-care professionals working with women with fistula at HEAL Africa Hospital (Goma) and Panzi Hospital (Bukavu) between June and August 2011. The interviews were transcribed and themes elicited through manual coding. Overall, 41 interviews were conducted. Successful surgical repair was reported to be the most important factor contributing to patients' ability to lead a normal life by all providers. Family acceptance-especially from the husband-was deemed crucial for reintegration by 39 (95%) providers, and 29 (71%) believed this acceptance was more important than the ability to work. Forty (98%) providers felt that, on the basis of African values, future childbearing was key for family acceptance. Because of poor access and the high cost of cesarean deliveries, 28 (68%) providers were concerned about fistula recurrence. Providers view postsurgical childbearing as crucial for social reintegration after fistula repair. However, cesarean deliveries are costly and often inaccessible. More work is needed to improve reproductive health access for women after fistula repair. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Tiruneh, Fentanesh Nibret; Chuang, Kun-Yang; Ntenda, Peter A M; Chuang, Ying-Chih
The Democratic Republic of the Congo (DRC) has one of the highest rates of violence against women in the world; however, few studies have focused on this issue. In this study, we assessed the interrelationship among intimate partner violence (IPV), unintended pregnancy, pregnancy loss, and other sociodemographic factors in the DRC. Our analyses were based on data from the DRC demographic and health survey, conducted from November 2013 to February 2014. We constructed generalized estimating equation models to analyze the data from a sample of 5,120 married women. Our results showed that having a husband or partner who exhibited controlling behaviors, women who justified wife-beating, having a mother who had experienced IPV, and having a husband or partner who consumed alcohol were positively associated with IPV, whereas decision-making autonomy among women was negatively associated with IPV. In the community, the proportion of women who had experienced IPV and that of those who had completed secondary or higher education were positively and negatively associated with any IPV type, respectively. In addition, emotional IPV and any IPV type were positively associated with pregnancy loss. Our results indicate the necessity of implementing programs targeting gender equality at both individual and community levels.
Aber, J Lawrence; Tubbs, Carly; Torrente, Catalina; Halpin, Peter F; Johnston, Brian; Starkey, Leighann; Shivshanker, Anjuli; Annan, Jeannie; Seidman, Edward; Wolf, Sharon
Improving children's learning and development in conflict-affected countries is critically important for breaking the intergenerational transmission of violence and poverty. Yet there is currently a stunning lack of rigorous evidence as to whether and how programs to improve learning and development in conflict-affected countries actually work to bolster children's academic learning and socioemotional development. This study tests a theory of change derived from the fields of developmental psychopathology and social ecology about how a school-based universal socioemotional learning program, the International Rescue Committee's Learning to Read in a Healing Classroom (LRHC), impacts children's learning and development. The study was implemented in three conflict-affected provinces of the Democratic Republic of the Congo and employed a cluster-randomized waitlist control design to estimate impact. Using multilevel structural equation modeling techniques, we found support for the central pathways in the LRHC theory of change. Specifically, we found that LRHC differentially impacted dimensions of the quality of the school and classroom environment at the end of the first year of the intervention, and that in turn these dimensions of quality were differentially associated with child academic and socioemotional outcomes. Future implications and directions are discussed.
Kabengele Mpinga, Emmanuel; Koya, Mapendo; Hasselgard-Rowe, Jennifer; Jeannot, Emilien; Rehani, Sylvie B; Chastonay, Philippe
We conducted a systematic review of the scientific literature between 1996 and 2013 on rape in war-ridden Eastern Democratic Republic of Congo (DRC) in order to better understand the interest of the scientific community in describing the magnitude and characteristics of the problem. The literature search was conducted in French and English using several databases (Pubmed, PsycInfo, Sapphire, BDSP, Embase, Rero, and Web of Science) with the key words "rape and DRC" combined with several Medical Subject Headings concepts. Our systematic review yielded 2,087 references, among which only 27 are original studies, that is 20 are based on population surveys and the remaining 7 are original data based on case studies and reviews. Ten studies provided prevalence rates of rape victims, 18 provided specific information on the profile of the victims, 10 reported that most of the perpetrators of rape were military personnel, 14 referred to the negligence of the government in protecting victims, and 10 reported a lack of competent health-care facilities. The awareness of rape in conflict-ridden DRC is still limited as reported in the scientific literature: Published scientific papers are scarce. Yet more research would probably help mobilize local authorities and the international community against this basic human rights violation.
Ashbaugh, Hayley R; Kuang, Brandon; Gadoth, Adva; Alfonso, Vivian H; Mukadi, Patrick; Doshi, Reena H; Hoff, Nicole A; Sinai, Cyrus; Mossoko, Mathias; Kebela, Benoit Ilunga; Muyembe, Jean-Jacques; Wemakoy, Emile Okitolonda; Rimoin, Anne W
Ebola virus disease (EVD) can be clinically severe and highly fatal, making surveillance efforts for early disease detection of paramount importance. In areas with limited access to laboratory testing, the Integrated Disease Surveillance and Response (IDSR) strategy in the Democratic Republic of Congo (DRC) may be a vital tool in improving outbreak response. Using DRC IDSR data from the nation's four EVD outbreak periods from 2007-2014, we assessed trends of Viral Hemorrhagic Fever (VHF) and EVD differential diagnoses reportable through IDSR. With official case counts from active surveillance of EVD outbreaks, we assessed accuracy of reporting through the IDSR passive surveillance system. Although the active and passive surveillance represent distinct sets of data, the two were correlated, suggesting that passive surveillance based only on clinical evaluation may be a useful predictor of true cases prior to laboratory confirmation. There were 438 suspect VHF cases reported through the IDSR system and 416 EVD cases officially recorded across the outbreaks examined. Although collected prior to official active surveillance cases, case reporting through the IDSR during the 2007, 2008 and 2012 outbreaks coincided with official EVD epidemic curves. Additionally, all outbreak areas experienced increases in suspected cases for both malaria and typhoid fever during EVD outbreaks, underscoring the importance of training health care workers in recognising EVD differential diagnoses and the potential for co-morbidities. © 2017 John Wiley & Sons Ltd.
R. Khonde Kumbu
Full Text Available Background. Schistosomiasis is a public health problem in Democratic Republic of the Congo but estimates of its prevalence vary widely. The aim of this study was to determine prevalence of Schistosoma mansoni infection and associated risk factors among children in 4 health areas of Kisantu health zone. Methods. A cross-sectional study was carried out in 4 health areas of Kisantu health zone. 388 children randomly selected were screened for S. mansoni using Kato Katz technique and the sociodemographic data was collected. Data were entered and encoded using software EpiData version 3.1. Analysis was performed using SPSS version 21 software. Results. The prevalence of S. mansoni was 26.5% (103; almost two-thirds (63 (61.2% had light infection intensity. A significant association was found between S. mansoni infection and age (p=0.005, educational level (p=0.001, and practices of swimming/bathing (p<0.001 and using water from river/lake/stream for domestic use (p<0.001. Kipasa health area had high prevalence of schistosomiasis (64.6% (64/99; 95% CI 54.4–74.0 compared to other health areas. Conclusion. Schistosoma mansoni infection still remains a public health problem in these areas. There is a need to promote health education and promote behavioral changes in children towards schistosomiasis.
Jeffrey B. Doty
Full Text Available During 2012, 2013 and 2015, we collected small mammals within 25 km of the town of Boende in Tshuapa Province, the Democratic Republic of the Congo. The prevalence of monkeypox virus (MPXV in this area is unknown; however, cases of human infection were previously confirmed near these collection sites. Samples were collected from 353 mammals (rodents, shrews, pangolins, elephant shrews, a potamogale, and a hyrax. Some rodents and shrews were captured from houses where human monkeypox cases have recently been identified, but most were trapped in forests and agricultural areas near villages. Real-time PCR and ELISA were used to assess evidence of MPXV infection and other Orthopoxvirus (OPXV infections in these small mammals. Seven (2.0% of these animal samples were found to be anti-orthopoxvirus immunoglobulin G (IgG antibody positive (six rodents: two Funisciurus spp.; one Graphiurus lorraineus; one Cricetomys emini; one Heliosciurus sp.; one Oenomys hypoxanthus, and one elephant shrew Petrodromus tetradactylus; no individuals were found positive in PCR-based assays. These results suggest that a variety of animals can be infected with OPXVs, and that epidemiology studies and educational campaigns should focus on animals that people are regularly contacting, including larger rodents used as protein sources.
Leekitcharoenphon, Pimlapas; Friis, Carsten; Zankari, Ea; Svendsen, Christina Aaby; Price, Lance B; Rahmani, Maral; Herrero-Fresno, Ana; Fashae, Kayode; Vandenberg, Olivier; Aarestrup, Frank M; Hendriksen, Rene S
Salmonella enterica serovar Typhimurium ST313 is an invasive and phylogenetically distinct lineage present in sub-Saharan Africa. We report the presence of S. Typhimurium ST313 from patients in the Democratic Republic of Congo and Nigeria. Eighteen S. Typhimurium ST313 isolates were characterized by antimicrobial susceptibility testing, pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST). Additionally, six of the isolates were characterized by whole genome sequence typing (WGST). The presence of a putative virulence determinant was examined in 177 Salmonella isolates belonging to 57 different serovars. All S. Typhimurium ST313 isolates harbored resistant genes encoded by blaTEM1b, catA1, strA/B, sul1, and dfrA1. Additionally, aac(6')1aa gene was detected. Phylogenetic analyses revealed close genetic relationships among Congolese and Nigerian isolates from both blood and stool. Comparative genomic analyses identified a putative virulence fragment (ST313-TD) unique to S. Typhimurium ST313 and S. Dublin. We showed in a limited number of isolates that S. Typhimurium ST313 is a prevalent sequence-type causing gastrointestinal diseases and septicemia in patients from Nigeria and DRC. We found three distinct phylogenetic clusters based on the origin of isolation suggesting some spatial evolution. Comparative genomics showed an interesting putative virulence fragment (ST313-TD) unique to S. Typhimurium ST313 and invasive S. Dublin.
Full Text Available School-aged children suffer the most from schistosomiasis infection in sub Saharan Africa due to poverty and limited sanitary conditions. Mapping of disease burden is recommended and there is a need of updating prevalence data which is as old as 20 years in the Democratic Republic of Congo. An epidemiological and parasitological study was carried out in 2011 in the health zone of Kasansa. Six health areas (HA were included in the study. In each health area, one primary school was selected. School-aged children were screened for S. mansoni infection using parallel Kato-Katz and direct microscopy techniques. A total of 335 school-aged children were screened. The average prevalence was 82.7% and ranged between 59.5-94.9%. Four of the six HAs had a prevalence level over 91%. Of all infected children, about half 112 (43.2% had light parasite density. These results demonstrate that Schistosoma mansoni infection is a bigger problem than anticipated and there is an urgent need to implement effective control measures.
Doty, Jeffrey B; Malekani, Jean M; Kalemba, Lem's N; Stanley, William T; Monroe, Benjamin P; Nakazawa, Yoshinori U; Mauldin, Matthew R; Bakambana, Trésor L; Liyandja Dja Liyandja, Tobit; Braden, Zachary H; Wallace, Ryan M; Malekani, Divin V; McCollum, Andrea M; Gallardo-Romero, Nadia; Kondas, Ashley; Peterson, A Townsend; Osorio, Jorge E; Rocke, Tonie E; Karem, Kevin L; Emerson, Ginny L; Carroll, Darin S
During 2012, 2013 and 2015, we collected small mammals within 25 km of the town of Boende in Tshuapa Province, the Democratic Republic of the Congo. The prevalence of monkeypox virus (MPXV) in this area is unknown; however, cases of human infection were previously confirmed near these collection sites. Samples were collected from 353 mammals (rodents, shrews, pangolins, elephant shrews, a potamogale, and a hyrax). Some rodents and shrews were captured from houses where human monkeypox cases have recently been identified, but most were trapped in forests and agricultural areas near villages. Real-time PCR and ELISA were used to assess evidence of MPXV infection and other Orthopoxvirus (OPXV) infections in these small mammals. Seven (2.0%) of these animal samples were found to be anti-orthopoxvirus immunoglobulin G (IgG) antibody positive (six rodents: two Funisciurus spp.; one Graphiurus lorraineus ; one Cricetomys emini ; one Heliosciurus sp.; one Oenomys hypoxanthus , and one elephant shrew Petrodromus tetradactylus ); no individuals were found positive in PCR-based assays. These results suggest that a variety of animals can be infected with OPXVs, and that epidemiology studies and educational campaigns should focus on animals that people are regularly contacting, including larger rodents used as protein sources.
Noah K. Tenai
Full Text Available An ongoing armed conflict in Eastern Democratic Republic of Congo continues to impoverish and dehumanise women. Sexual violence meted on women has negative consequences that affect whole communities. Churches nationally and in the region have not done enough to respond to the challenge of armed conflict in general and the nefariousness of sexual violence towards women in particular. By utilising the sustainable livelihoods framework, churches in the region can be re-positioned for a constructive advocacy response to armed conflict(s and sexual violence(s, particularly in solidarity with the women.Intradisciplinary and/or interdisciplinary implications: This study is made feasible through extensive intradisciplinary and interdisciplinary research. The subject matter demands on the investigator the necessity to make use of the knowledge from across the socio-scientific spectrum to understand the ongoing conflict and its impact on the local people. The study entrenches an advocacy role on regional churches as a means to lend a voice to the vulnerable women, who are impoverished and dehumanised by and within the context of an armed conflict.
Katchunga, P B; Malanda, B; Mweze, M C; Dupont, B; M'Buyamba-Kabangu, J R; Kashongwe, Z; Kabinda, J M; Buysschaert, M
In the Democratic Republic of Congo (DRC), a country in a post-conflict period, high priority cannot be given to non-communicable diseases other than to emergencies. This certainly involves inadequacy in raising awareness for prevention of these diseases. To evaluate the level of knowledge of the Congolese general population on hypertension and diabetes mellitus. Responses to a questionnaire from 3% of the general population aged 15 and older in the city of Bukavu and two rural areas: Hombo and Walungu (South Kivu, eastern DRC), recruited after stratification by ward in the city of Bukavu and a group of prone villages were expected. The questions focused on identification, testing, causes, complications and treatment of hypertension and diabetes mellitus. Of the 7770 respondents, screening for hypertension and diabetes mellitus affected only 14.9% and 7.3% of subjects respectively. Knowledge of these two conditions was generally low in the general population, although better in the subgroups of patients and those with higher socioeconomic level (Pknowledge (Pknowledge about hypertension and diabetes mellitus and their testing in South Kivu is low. It is imperative that the Congolese government includes non-communicable diseases in its priorities of the millennium. Similarly, the WHO should actively contribute to screening for them in low-income countries. Copyright © 2012 Elsevier Masson SAS. All rights reserved.
Wachter, Karin; Gulbas, Lauren E
In 2016, researchers conducted a qualitative study in a mid-sized town in the United States to address gaps in research and practice related to psychosocial consequences of forced migration among women. The loss of social support and its impacts on the well-being of women are rarely addressed in refugee resettlement policy or practice overwhelmingly concerned with economic self-sufficiency. The study sought to develop theory to explain how women (n = 27) who migrated from the Democratic Republic of the Congo recreate social support post-resettlement in the United States. An interpretive approach informed by postcolonial feminist perspectives guided the grounded theory methodology. A theoretical model emerged explaining pivots in the internal and relational lives of women as social support systematically constricted over time as a result of war, displacement, and resettlement. Upon arrival to the United States, women experienced partitioned lives through changing relationships to space and time, which contributed to women being alone and impacted well-being. Converging processes propelled women towards learning to stand alone, through which women could develop a sense self-reliance, but not without internal and relational consequences. The analysis contributes to the empirical literature knowledge of how resettlement is a life altering event that sets into motion psychosocial processes with implications for well-being and health. Implications for practice and future research are discussed. Copyright © 2018 Elsevier Ltd. All rights reserved.
Raymond Achu Samndong
Full Text Available In this study we analyze gender relations legitimatized by socio-political institutions of forest governance in REDD+ pilots in Équateur Province of the Democratic Republic of Congo. Using data from interviews, focus group discussions, and field observations, we show that men and women have different knowledge and use of forests, but these differences are not given due consideration in forest governance. Women's voices are often muted in decision-making arenas and they occupy only a nominal position in both forestry and development initiatives as compared with men. This status quo is extended to the REDD+ pilot projects as well. Women have limited information about REDD+ compared with men. The mechanisms used to establish new village organization for REDD+ exclude women from decision making in the ongoing REDD+ pilot project. We show that women's bargaining power for equal inclusion in decision-making processes and for sharing benefits are constrained by existing social norms regarding local access to land and material resources, existing gender division of labor, local perceptions regarding women's roles and contributions/responsibilities, as well as men's dominant position in rural settings. For a gender transformative REDD+, we suggest that REDD+ actors should attempt to bring about institutional changes that transform gender relations and thereby increase women's bargaining power.
Kashala-Abotnes, Espérance; Mumbere, Pépé Penghele; Mishika, Jeannette Mukanya; Ndjukendi, Ally Omba; Mpaka, Davin Beya; Bumoko, Makila-Mabe Guy; Kayembe, Tharcisse Kalula; Tshala-Katumbay, Désiré; Kazadi, Théodore Kayembe; Okitundu, Daniel Luwa E-Andjafono
Childhood lead exposure remains a problem in developing countries, and little is known about its effects on early child neurodevelopment and temperament in the Democratic Republic of Congo (DRC). We, therefore, conducted this study to determine the association between lead exposure and the neurodevelopment and behaviour of children aged 12-24 months in Kinshasa, DRC. A cross-sectional study was conducted between February and June 2012, and parents of 104 children were invited to participate. Blood lead levels (BLLs) of each child were tested using the flame atomic spectrophotometry method. All children were subject to a clinical examination and assessed with two selected early child neurodevelopmental tools, the Gensini-Gavito and the baby characteristics questionnaire, to measure their neurodevelopment and temperament. Detectable BLLs ranged from 1 to 30 μg/dl with a geometric mean of 6.9 (SD 4.8) μg/dl. BLLs at 5-9 and ≥10 μg/dl were significantly associated with the child temperament (p early child neurodevelopment and temperament. Children exposed to lead were reported with more temperament difficulties at even blood lead levels <10 μg/dl, suggesting the need for preventive and intervention measures to reduce lead exposure among children in Kinshasa, DRC.
Jeandron, Aurélie; Saidi, Jaime Mufitini; Kapama, Alois; Burhole, Manu; Birembano, Freddy; Vandevelde, Thierry; Gasparrini, Antonio; Armstrong, Ben; Cairncross, Sandy; Ensink, Jeroen H. J.
Background The eastern provinces of the Democratic Republic of the Congo have been identified as endemic areas for cholera transmission, and despite continuous control efforts, they continue to experience regular cholera outbreaks that occasionally spread to the rest of the country. In a region where access to improved water sources is particularly poor, the question of which improvements in water access should be prioritized to address cholera transmission remains unresolved. This study aimed at investigating the temporal association between water supply interruptions and Cholera Treatment Centre (CTC) admissions in a medium-sized town. Methods and Findings Time-series patterns of daily incidence of suspected cholera cases admitted to the Cholera Treatment Centre in Uvira in South Kivu Province between 2009 and 2014 were examined in relation to the daily variations in volume of water supplied by the town water treatment plant. Quasi-poisson regression and distributed lag nonlinear models up to 12 d were used, adjusting for daily precipitation rates, day of the week, and seasonal variations. A total of 5,745 patients over 5 y of age with acute watery diarrhoea symptoms were admitted to the CTC over the study period of 1,946 d. Following a day without tap water supply, the suspected cholera incidence rate increased on average by 155% over the next 12 d, corresponding to a rate ratio of 2.55 (95% CI: 1.54–4.24), compared to the incidence experienced after a day with optimal production (defined as the 95th percentile—4,794 m3). Suspected cholera cases attributable to a suboptimal tap water supply reached 23.2% of total admissions (95% CI 11.4%–33.2%). Although generally reporting less admissions to the CTC, neighbourhoods with a higher consumption of tap water were more affected by water supply interruptions, with a rate ratio of 3.71 (95% CI: 1.91–7.20) and an attributable fraction of cases of 31.4% (95% CI: 17.3%–42.5%). The analysis did not suggest any
Jeandron, Aurélie; Saidi, Jaime Mufitini; Kapama, Alois; Burhole, Manu; Birembano, Freddy; Vandevelde, Thierry; Gasparrini, Antonio; Armstrong, Ben; Cairncross, Sandy; Ensink, Jeroen H J
The eastern provinces of the Democratic Republic of the Congo have been identified as endemic areas for cholera transmission, and despite continuous control efforts, they continue to experience regular cholera outbreaks that occasionally spread to the rest of the country. In a region where access to improved water sources is particularly poor, the question of which improvements in water access should be prioritized to address cholera transmission remains unresolved. This study aimed at investigating the temporal association between water supply interruptions and Cholera Treatment Centre (CTC) admissions in a medium-sized town. Time-series patterns of daily incidence of suspected cholera cases admitted to the Cholera Treatment Centre in Uvira in South Kivu Province between 2009 and 2014 were examined in relation to the daily variations in volume of water supplied by the town water treatment plant. Quasi-poisson regression and distributed lag nonlinear models up to 12 d were used, adjusting for daily precipitation rates, day of the week, and seasonal variations. A total of 5,745 patients over 5 y of age with acute watery diarrhoea symptoms were admitted to the CTC over the study period of 1,946 d. Following a day without tap water supply, the suspected cholera incidence rate increased on average by 155% over the next 12 d, corresponding to a rate ratio of 2.55 (95% CI: 1.54-4.24), compared to the incidence experienced after a day with optimal production (defined as the 95th percentile-4,794 m3). Suspected cholera cases attributable to a suboptimal tap water supply reached 23.2% of total admissions (95% CI 11.4%-33.2%). Although generally reporting less admissions to the CTC, neighbourhoods with a higher consumption of tap water were more affected by water supply interruptions, with a rate ratio of 3.71 (95% CI: 1.91-7.20) and an attributable fraction of cases of 31.4% (95% CI: 17.3%-42.5%). The analysis did not suggest any association between levels of residual
Delphin Mavinga Phanzu
Full Text Available BACKGROUND: Cutaneous infection by Mycobacterium ulcerans, also known as Buruli ulcer (BU, represents the third most common mycobacterial disease in the world after tuberculosis and leprosy. Data on the burden of BU disease in the Democratic Republic of Congo are scanty. This study aimed to estimate the prevalence rate and the distribution of BU in the Songololo Territory, and to assess the coverage of the existing hospital-based reporting system. METHODS: We conducted a cross-sectional survey (July-August 2008 using the door-to-door method simultaneously in the two rural health zones (RHZ of the Songololo Territory (RHZ of Kimpese and Nsona-Mpangu, each containing twenty health areas. Cases were defined clinically as active BU and inactive BU in accordance with WHO-case definitions. RESULTS: We detected 775 BU patients (259 active and 516 inactive in a total population of 237,418 inhabitants. The overall prevalence of BU in Songololo Territory was 3.3/1000 inhabitants, varying from 0 to 27.5/1000 between health areas. Of the 259 patients with active BU, 18 (7% had been reported in the hospital-based reporting system at Kimpese in the 6-8 months prior to the survey. CONCLUSION: The survey demonstrated a huge variation of prevalence between health areas in Songololo Territory and gross underreporting of BU cases in the hospital-based reporting system. Data obtained may contribute to better targeted and improved BU control interventions, and serve as a baseline for future assessments of the control program.
Kelly J T
Full Text Available Abstract Background The conflict in eastern Democratic Republic of the Congo (DRC is the deadliest since World War II. Over a decade of fighting amongst an array of armed groups has resulted in extensive human rights abuses, particularly the widespread use of sexual violence against women. Methods Using a mixed-methods approach, we surveyed a non-random sample of 255 women attending a referral hospital and two local non-governmental organizations to characterize their experiences of sexual and gender-based violence (SGBV. We then conducted focus groups of 48 women survivors of SGBV to elaborate on survey findings. Quantitative and qualitative data underwent thematic and statistical analysis respectively. Findings Of the women surveyed, 193 (75.7% experienced rape. Twenty-nine percent of raped women were rejected by their families and 6% by their communities. Thirteen percent of women had a child from rape. Widowhood, husband abandonment, gang rape, and having a child from rape were significant risk factors for social rejection. Mixed methods findings show rape survivors were seen as "contaminated" with HIV, contributing to their isolation and over 95% could not access prophylactic care in time. Receiving support from their husbands after rape was protective against survivors' feelings of shame and social isolation. Interpretation Rape results not only in physical and psychological trauma, but can destroy family and community structures. Women face significant obstacles in seeking services after rape. Interventions offering long-term solutions for hyper-vulnerable women are vital, but lacking; reintegration programs on SGBV for women, men, and communities are also needed.
Full Text Available BACKGROUND: Until the 1970s the prevalence of non-venereal trepanomatosis, including yaws, was greatly reduced after worldwide mass treatment. In 2005, cases were again reported in the Democratic Republic of the Congo. We carried out a survey to estimate the village-level prevalence of yaws in the region of Equator in the north of the country in order to define appropriate strategies to effectively treat the affected population. METHODOLOGY/PRINCIPAL FINDINGS: We designed a community-based survey using the Lot Quality Assurance Sampling method to classify the prevalence of active yaws in 14 groups of villages (lots. The classification into high, moderate, or low yaws prevalence corresponded to World Health Organization prevalence thresholds for identifying appropriate operational treatment strategies. Active yaws cases were defined by suggestive clinical signs and positive rapid plasma reagin and Treponema pallidum hemagglutination serological tests. The overall prevalence in the study area was 4.7% (95% confidence interval: 3.4-6.0. Two of 14 lots had high prevalence (>10%, three moderate prevalence (5-10% and nine low prevalence (<5%.. CONCLUSIONS/SIGNIFICANCE: Although yaws is no longer a World Health Organization priority disease, the presence of yaws in a region where it was supposed to be eradicated demonstrates the importance of continued surveillance and control efforts. Yaws should remain a public health priority in countries where previously it was known to be endemic. The integration of sensitive surveillance systems together with free access to effective treatment is recommended. As a consequence of our study results, more than 16,000 people received free treatment against yaws.
Makiala-Mandanda, Sheila; Le Gal, Frédéric; Ngwaka-Matsung, Nadine; Ahuka-Mundeke, Steve; Onanga, Richard; Bivigou-Mboumba, Berthold; Pukuta-Simbu, Elisabeth; Gerber, Athenaïs; Abbate, Jessica L; Mwamba, Dieudonné; Berthet, Nicolas; Leroy, Eric Maurice; Muyembe-Tamfum, Jean-Jacques; Becquart, Pierre
The majority of patients with acute febrile jaundice (>95%) identified through a yellow fever surveillance program in the Democratic Republic of Congo (DRC) test negative for antibodies against yellow fever virus. However, no etiological investigation has ever been carried out on these patients. Here, we tested for hepatitis A (HAV), hepatitis B (HBV), hepatitis C (HCV), hepatitis D (HDV), and hepatitis E (HEV) viruses, all of which can cause acute febrile jaundice, in patients included in the yellow fever surveillance program in the DRC. On a total of 498 serum samples collected from suspected cases of yellow fever from January 2003 to January 2012, enzyme-linked immunosorbent assay (ELISA) techniques were used to screen for antibodies against HAV (IgM) and HEV (IgM) and for antigens and antibodies against HBV (HBsAg and anti-hepatitis B core protein [HBc] IgM, respectively), HCV, and HDV. Viral loads and genotypes were determined for HBV and HVD. Viral hepatitis serological markers were diagnosed in 218 (43.7%) patients. The seroprevalences were 16.7% for HAV, 24.6% for HBV, 2.3% for HCV, and 10.4% for HEV, and 26.1% of HBV-positive patients were also infected with HDV. Median viral loads were 4.19 × 10 5 IU/ml for HBV (range, 769 to 9.82 × 10 9 IU/ml) and 1.4 × 10 6 IU/ml for HDV (range, 3.1 × 10 2 to 2.9 × 10 8 IU/ml). Genotypes A, E, and D of HBV and genotype 1 of HDV were detected. These high hepatitis prevalence rates highlight the necessity to include screening for hepatitis viruses in the yellow fever surveillance program in the DRC. Copyright © 2017 Makiala-Mandanda et al.
Makiala-Mandanda, Sheila; Ahuka-Mundeke, Steve; Abbate, Jessica L; Pukuta-Simbu, Elisabeth; Nsio-Mbeta, Justus; Berthet, Nicolas; Leroy, Eric Maurice; Becquart, Pierre; Muyembe-Tamfum, Jean-Jacques
For more than 95% of acute febrile jaundice cases identified through surveillance for yellow fever, a reemerging arthropod-borne viral disease, no etiological exploration is ever done. The aim of this study was to test for other arthropod-borne viruses that can induce the same symptoms in patients enrolled in the yellow fever surveillance in the Democratic Republic of the Congo (DRC). Of 652 patients included in the surveillance of yellow fever in DRC from January 2003 to January 2012, 453 patients that tested negative for yellow fever virus (YFV) immunoglobulin M (IgM) antibodies were selected for the study. Real-time polymerase chain reaction was performed for the detection of dengue, West Nile, Chikungunya, O'nyong-nyong, Rift Valley fever, Zika, and YFV. The average age of patients was 22.1 years. We reported 16 cases (3.5%; confidence interval [CI]: 0.8-5.2) of dengue (serotypes 1 and 2) and 2 cases (0.4%; CI: 0.0-1.0) of Chikungunya. Three patients were co-infected with the two serotypes of dengue virus. Three cases of dengue were found in early July 2010 from the city of Titule (Oriental province) during a laboratory-confirmed outbreak of yellow fever, suggesting simultaneous circulation of dengue and yellow fever viruses. This study showed that dengue and Chikungunya viruses are potential causes of acute febrile jaundice in the DRC and highlights the need to consider dengue and Chikungunya diagnosis in the integrated disease surveillance and response program in the DRC. A prospective study is necessary to establish the epidemiology of these diseases.
Molinario, G.; Hansen, M. C.; Potapov, P. V.; Tyukavina, A.; Stehman, S.; Barker, B.; Humber, M.
The rural complex is the inhabited agricultural land cover mosaic found along the network of rivers and roads in the forest of the Democratic Republic of Congo. It is a product of traditional small-holder shifting cultivation. To date, thanks to its distinction from primary forest, this area has been mapped as relatively homogenous, leaving the proportions of land cover heterogeneity within it unknown. However, the success of strategies for sustainable development, including land use planning and payment for ecosystem services, such as Reduced Emissions from Deforestation and Degradation, depends on the accurate characterization of the impacts of land use on natural resources, including within the rural complex. We photo-interpreted a simple random sample of 1000 points in the established rural complex, using 3106 high resolution satellite images obtained from the National Geospatial-Intelligence Agency, together with 406 images from Google Earth, spanning the period 2008-2016. Results indicate that nationally the established rural complex includes 5% clearings, 10% active fields, 26% fallows, 34% secondary forest, 2% wetland forest, 11% primary forest, 6% grasslands, 3% roads and settlements and 2% commercial plantations. Only a small proportion of sample points were plantations, while other commercial dynamics, such as logging and mining, were not detected in the sample. The area of current shifting cultivation accounts for 76% of the established rural complex. Added to primary forest (11%), this means that 87% of the rural complex is available for shifting cultivation. At the current clearing rate, it would take ~18 years for a complete rotation of the rural complex to occur. Additional pressure on land results in either the cultivation of non-preferred land types within the rural complex (such as wetland forest), or expansion of agriculture into nearby primary forests, with attendant impacts on emissions, habitat loss and other ecosystems services.
Full Text Available Abstract Background The provision of surgical assistance in conflict is often associated with care for victims of violence. However, there is an increasing appreciation that surgical care is needed for non-traumatic morbidities. In this paper we report on surgical interventions carried out by Médecins sans Frontières in Masisi, North Kivu, Democratic Republic of Congo to contribute to the scarce evidence base on surgical needs in conflict. Methods We analysed data on all surgical interventions done at Masisi district hospital between September 2007 and December 2009. Types of interventions are described, and logistic regression used to model associations with violence-related injury. Results 2869 operations were performed on 2441 patients. Obstetric emergencies accounted for over half (675, 57% of all surgical pathology and infections for another quarter (160, 14%. Trauma-related injuries accounted for only one quarter (681, 24% of all interventions; among these, 363 (13% were violence-related. Male gender (adjusted odds ratio (AOR = 20.0, p Conclusions In this study, most surgical interventions were unrelated to violent trauma and rather reflected the general surgical needs of a low-income tropical country. Programs in conflict zones in low-income countries need to be prepared to treat both the war-wounded and non-trauma related life-threatening surgical needs of the general population. Given the limited surgical workforce in these areas, training of local staff and task shifting is recommended to support broad availability of essential surgical care. Further studies into the surgical needs of the population are warranted, including population-based surveys, to improve program planning and resource allocation and the effectiveness of the humanitarian response.
Chu, Kathryn; Havet, Philippe; Ford, Nathan; Trelles, Miguel
The provision of surgical assistance in conflict is often associated with care for victims of violence. However, there is an increasing appreciation that surgical care is needed for non-traumatic morbidities. In this paper we report on surgical interventions carried out by Médecins sans Frontières in Masisi, North Kivu, Democratic Republic of Congo to contribute to the scarce evidence base on surgical needs in conflict. We analysed data on all surgical interventions done at Masisi district hospital between September 2007 and December 2009. Types of interventions are described, and logistic regression used to model associations with violence-related injury. 2869 operations were performed on 2441 patients. Obstetric emergencies accounted for over half (675, 57%) of all surgical pathology and infections for another quarter (160, 14%). Trauma-related injuries accounted for only one quarter (681, 24%) of all interventions; among these, 363 (13%) were violence-related. Male gender (adjusted odds ratio (AOR) = 20.0, p violence-related injury. Immediate peri-operative mortality was 0.2%. In this study, most surgical interventions were unrelated to violent trauma and rather reflected the general surgical needs of a low-income tropical country. Programs in conflict zones in low-income countries need to be prepared to treat both the war-wounded and non-trauma related life-threatening surgical needs of the general population. Given the limited surgical workforce in these areas, training of local staff and task shifting is recommended to support broad availability of essential surgical care. Further studies into the surgical needs of the population are warranted, including population-based surveys, to improve program planning and resource allocation and the effectiveness of the humanitarian response.
Dünser Martin W
Full Text Available Abstract Background Since 1998, the Eastern Democratic Republic of the Congo has been torn by a military conflict. A particular atrocity of the war is widespread sexual violence. Methods In this combined retrospective analysis and prospective survey, we sought to identify hospital facilities and resources available to treat victims of sexual violence in Goma, the capital city of the North Kivu province. Results Of twenty-three acute care hospitals registered in the area of Goma, four (17% regularly cared for victims of sexual violence. One hospital had all resources always available to appropriately care for victims of sexual violence. From Jan 2009 until Oct 2010, 7,048 females sought medical care because of physical or psychological sequelae from sexual violence in the four hospitals of Goma. Only half of the hospitals had physicians specialized in gynaecology or gynaecological surgery available. Similarly, anaesthetists and psychiatrists/psychologists were available in two (50% and one (25% hospital, respectively. Post-discharge care facilities, material resources, such as surgical and anaesthesiological equipment and drugs, were inconsistently available in the hospitals caring for sexually abused females. At one selected hospital, acyclovir and/or antibiotics were administered to 1,202 sexually abused females (89.5%, whereas post-exposure HIV prophylaxis and surgery because of vesico-vaginal fistula was provided to only 75 (5.6% and 121 (9% patients, respectively. Conclusions This study provides data that only few hospitals in Goma care for victims of sexual violence. In addition, these hospitals suffer from a relevant shortage of human and material resources to provide adequate care for sexually abused females. Aside from establishment of adequate protection strategies, steps must be taken to increase the availability of trained health care professionals and resources to provide adequate care for victims of sexual violence in Goma and the
Mulenga, Philippe Cilundika; Kazadi, Alex Bukasa
Penis size is a huge topic of anxiety for a lot of men. Some of them are unhappy with their penis size as shown in the study conducted by Tiggemann in 2008. There are relatively few studies on erect penis size. This may reflect cultural taboos of researchers or doctors interacting with men who are in a state of sexual arousal. On the other hand, it is important for people who announce details on penis size to give the average penis size first and then sizes suggested by the researchers. We performed a cross-sectional survey in the two major urban centres of the Democratic Republic of Congo namely Kinshasa and Lubumbashi over a period of two years from May 2014 to May 2016. A total of 21 information sources constituted our sample, 8 in Kinshasa and 13 in Lubumbashi. We found it sufficient because in our culture discussing about sexual matter is rare. The parameters studied were: the nature of the source, the accuracy of the measurement method, the presence of bibliographical reference, the announced penis size. The majority of information sources used were radio or television broadcastings (23,8%); this can be explained by the fact that there are an increasing number of radio and television stations in our country and especially in large cities. With regard to accuracy of information about penis measurement method when sharing the message about penis size, our study showed that the majority of information sources did not indicate it when they announced penis size to the public (85,7%). Several sources did not report bibliographical references (57,1%). Announced data analysis on penis size showed that the average penis size was: 14 cm (28,6%), 15 cm (23,8%) and 15-20 cm (19%). All these results are intended to offer a warning to all players responsible for diffusing information on sexual health (penis size): scientific rigor consists in seeking information from reliable sources.
Muasa Patoka Guillaume Kalonji
Full Text Available Background: In developing countries, quality of prison life remains a challenge in public health. The present study aimed at determining the quality of life as perceived by inmates during their imprisonment at the Central Prison of Mbuji-Mayi, Democratic Republic of Congo. Methods: This cross-sectional study was carried out over a 3-month period (between December 2015 and February 2016 at the Central Prison of Mbuji-Mayi. Three hundred inmates participated to the survey. The World Health Organization Quality of Life Scale (WHOQOL-BREF was used to estimate health and problems affecting inmates’ everyday life. Results: Mean age of inmates was 33 ± 10 years (range: 18-70 years and most of them were male (88.7%. The quality of life score estimated was below 50, on the WHOQOL-BREF scale weighted over 100 points (average overall score: 26 ± 7. When considering each WHOQOLBREF domain, the lowest scores (0-100 normalized scale were registered for: perception of physical health (24 ± 11, psychological health (18 ± 8, social relationship (39 ± 15 and environmental relationships (24 ± 8. Overall, inmates aged over 30 years old presented an average score slightly lower than younger inmates (25 ± 6 vs. 27 ± 7; p=0.005. Depending on the length of incarceration, the average score was lower for inmates imprisoned for more than 6 months compared to others (26 ± 6 vs. 28 ± 8; p=0.015. Correlations between domain scores were low but statistically significant; no correlation was highlighted between environment and mental health domains. Conclusion: Most inmates considered their quality of life as negative, regardless of the WHOQOL-BREF domain. Efforts to improve quality of life should remain a priority for political authorities.
Kismul, Hallgeir; Acharya, Pawan; Mapatano, Mala Ali; Hatløy, Anne
Prevalence of child stunting in the Democratic Republic of Congo (DRC) is among the highest in the world. There is a need to systematically investigate how stunting operates at different levels of determination and identify major factors contributing to the development of stunting. The aim of this study was to look for key determinants of stunting in the DRC. This study used data from the DRC Demographic Health Survey 2013-14 which included anthropometric measurement for 9030 under 5 year children. Height-for-Age Z score was calculated and classified according to the WHO guideline. The association between stunting and bio-demographic characteristics was assessed using logistic regression. Prevalence of stunting was much higher in boys than girls. There was a significant rural urban gap in the prevalence of stunting with rural areas having a larger proportion of children living with stunting than urban. Male children, older than 6 months, preceding birth interval less than 24 months, being from lower wealth quintiles had the highest odds of stunting. Several provinces had in particular high odds of stunting. Early initiation of breastfeeding, mother's age more than 20 years at the time of delivery had lower odds of stunting. The taller the mother the less likely the child was to be stunted. Similarly, mother's BMI, access to safe water, access to hygienic toilet, mother's education were found negatively correlated with child stunting in the bivariate logistic regression, but they lost statistical significance in multivariate analysis together with numbers of children in the family and place of residence. Child stunting is widespread in the DRC and increasing prevalence is worrisome. This study has identified modifiable factors determining high prevalence of stunting in the DRC. Policy implementation should in particular target provinces with high prevalence of stunting and address modifiable determinants such as reducing socioeconomic disparity. Nutrition
Vancutsem, C.; Pekel, J.-F.; Evrard, C.; Malaisse, F.; Defourny, P.
The need for quantitative and accurate information to characterize the state and evolution of vegetation types at a national scale is widely recognized. This type of information is crucial for the Democratic Republic of Congo, which contains the majority of the tropical forest cover of Central Africa and a large diversity of habitats. In spite of recent progress in earth observation capabilities, vegetation mapping and seasonality analysis in equatorial areas still represent an outstanding challenge owing to high cloud coverage and the extent and limited accessibility of the territory. On one hand, the use of coarse-resolution optical data is constrained by performance in the presence of cloud screening and by noise arising from the compositing process, which limits the spatial consistency of the composite and the temporal resolution. On the other hand, the use of high-resolution data suffers from heterogeneity of acquisition dates, images and interpretation from one scene to another. The objective of the present study was to propose and demonstrate a semi-automatic processing method for vegetation mapping and seasonality characterization based on temporal and spectral information from SPOT VEGETATION time series. A land cover map with 18 vegetation classes was produced using the proposed method that was fed by ecological knowledge gathered from botanists and reference documents. The floristic composition and physiognomy of each vegetation type are described using the Land Cover Classification System developed by the FAO. Moreover, the seasonality of each class is characterized on a monthly basis and the variation in different vegetation indicators is discussed from a phenological point of view. This mapping exercise delivers the first area estimates of seven different forest types, five different savannas characterized by specific seasonality behavior and two aquatic vegetation types. Finally, the result is compared to two recent land cover maps derived from
Mukendi, Deby; Lilo Kalo, Jean-Roger; Mpanya, Alain; Minikulu, Luigi; Kayembe, Tharcisse; Lutumba, Pascal; Barbé, Barbara; Gillet, Philippe; Jacobs, Jan; Van Loen, Harry; Yansouni, Cédric P; Chappuis, François; Ravinetto, Raffaella; Verdonck, Kristien; Boelaert, Marleen; Winkler, Andrea S; Bottieau, Emmanuel
There is little published information on the epidemiology of neurological disorders in rural Central Africa, although the burden is considered to be substantial. This study aimed to investigate the pattern, etiology, and outcome of neurological disorders in children > 5 years and adults admitted to the rural hospital of Mosango, province of Kwilu, Democratic Republic of Congo, with a focus on severe and treatable infections of the central nervous system (CNS). From September 2012 to January 2015, 351 consecutive patients hospitalized for recent and/or ongoing neurological disorder were prospectively evaluated by a neurologist, subjected to a set of reference diagnostic tests in blood or cerebrospinal fluid, and followed-up for 3-6 months after discharge. No neuroimaging was available. Severe headache (199, 56.7%), gait/walking disorders (97, 27.6%), epileptic seizure (87, 24.8%), and focal neurological deficit (86, 24.5%) were the predominant presentations, often in combination. Infections of the CNS were documented in 63 (17.9%) patients and mainly included bacterial meningitis and unspecified meningoencephalitis (33, 9.4%), second-stage human African trypanosomiasis (10, 2.8%), and human immunodeficiency virus (HIV)-related neurological disorders (10, 2.8%). Other focal/systemic infections with neurological manifestations were diagnosed in an additional 60 (17.1%) cases. The leading noncommunicable conditions were epilepsy (61, 17.3%), psychiatric disorders (56, 16.0%), and cerebrovascular accident (23, 6.6%). Overall fatality rate was 8.2% (29/351), but up to 23.8% for CNS infections. Sequelae were observed in 76 (21.6%) patients. Clinical presentations and etiologies of neurological disorders were very diverse in this rural Central African setting and caused considerable mortality and morbidity.
Bartels, Susan A; Scott, Jennifer A; Leaning, Jennifer; Kelly, Jocelyn T; Joyce, Nina R; Mukwege, Denis; Vanrooyen, Michael J
One of the most striking features of the ongoing conflict in the Democratic Republic of Congo (DRC) is the use of sexual violence. In spite of the brutality of these crimes, the experiences of women affected by sexual violence in Eastern DRC remain poorly characterized. This analysis aimed to (1) provide detailed demographics of sexual violence survivors presenting to Panzi Hospital; (2) examine how demographic factors might impact patterns of sexual violence; and (3) describe care-seeking behavior among sexual violence survivors. The demographics and care-seeking behavior of sexual violence survivors in South Kivu Province were described from a retrospective registry-based study of sexual violence survivors presenting to Panzi Hospital (2004-2008). A total of 4311 records were reviewed. The mean age of survivors was 35 years. Most women (53%) were married, self-identified with the Bashi tribe (65%), and reported agriculture as their livelihood (74%). The mean time delay between sexual assault and seeking care was 10.4 months. Five reasons were identified to help explain the lengthy delays to seeking care: waiting for physical symptoms to develop or worsen before seeking medical attention, lack of means to access medical care, concerns that family would find out about the sexual assault, stigma surrounding sexual violence, and being abducted into sexual slavery for prolonged periods of time. Many sexual assault survivors have very delayed presentations to medical attention. Promoting timely access of medical care may best be facilitated by reducing stigma and by educating women about the benefits of early medical care, even in the absence of injuries or symptoms.
Matonda-Ma-Nzuzi, Thierry; Mampunza Ma Miezi, Samuel; Mpembi, Magloire Nkosi; Mvumbi, Diane Muanza; Aloni, Michel Ntentani; Malendakana, Fanny; Mpaka Mbeya, Davin; Lelo, Gilbert Mananga; Charlier-Mikolajczak, Dominique
Behavioral problems and cognitive impairment are common in children with epilepsy (CWE). In sub-Saharan Africa, little is known about these comorbidities particularly their relationships with socioeconomic features. The goal of this study was to identify clinical and socioeconomic factors associated with behavioral problems and cognitive impairment in CWE of Kinshasa (Democratic Republic of the Congo). This cross-sectional hospital-based study had included 104 CWE aged 6 to 17years. Behavioral problems were assessed by the child behavior checklist. The Wechsler nonverbal scale of ability was used to assess cognitive impairment. At least one behavioral problem was found in 34.6% of CWE. Internalized problems were increasing with father's age (p=0.034). Externalized problems were increasing with the decreased of mother's age (p=0.009) and with a previous antiepileptic treatment (p=0.032). Total behavioral problems were increasing with a previous antiepileptic treatment (p=0.029). Cognitive impairment was present in 73.3% of CWE. It was more common in boys (p=0.013), and it was increasing with a low household daily expenses (p=0.034), with a previous antiepileptic treatment (p=0.041), with an early onset of epileptic seizures (p=0.042), and with a high frequency of epileptic seizures (p=0.011). Behavioral problems and cognitive impairment are common in CWE. Multivariate analysis has shown that behavioral problems were associated with socioeconomic features only. Contrariwise, cognitive impairment was associated with both socioeconomic factors and clinical features. There is a need of more studies to improve knowledge of these comorbidities in the sub-Saharan Africa context. Copyright © 2017 Elsevier Inc. All rights reserved.
Doshi, Reena H; Eckhoff, Philip; Cheng, Alvan; Hoff, Nicole A; Mukadi, Patrick; Shidi, Calixte; Gerber, Sue; Wemakoy, Emile Okitolonda; Muyembe-Tafum, Jean-Jacques; Kominski, Gerald F; Rimoin, Anne W
One of the goals of the Global Measles and Rubella Strategic Plan is the reduction in global measles mortality, with high measles vaccination coverage as one of its core components. While measles mortality has been reduced more than 79%, the disease remains a major cause of childhood vaccine preventable disease burden globally. Measles immunization requires a two-dose schedule and only countries with strong, stable immunization programs can rely on routine services to deliver the second dose. In the Democratic Republic of Congo (DRC), weak health infrastructure and lack of provision of the second dose of measles vaccine necessitates the use of supplementary immunization activities (SIAs) to administer the second dose. We modeled three vaccination strategies using an age-structured SIR (Susceptible-Infectious-Recovered) model to simulate natural measles dynamics along with the effect of immunization. We compared the cost-effectiveness of two different strategies for the second dose of Measles Containing Vaccine (MCV) to one dose of MCV through routine immunization services over a 15-year time period for a hypothetical birth cohort of 3 million children. Compared to strategy 1 (MCV1 only), strategy 2 (MCV2 by SIA) would prevent a total of 5,808,750 measles cases, 156,836 measles-related deaths and save U.S. $199 million. Compared to strategy 1, strategy 3 (MCV2 by RI) would prevent a total of 13,232,250 measles cases, 166,475 measles-related deaths and save U.S. $408 million. Vaccination recommendations should be tailored to each country, offering a framework where countries can adapt to local epidemiological and economical circumstances in the context of other health priorities. Our results reflect the synergistic effect of two doses of MCV and demonstrate that the most cost-effective approach to measles vaccination in DRC is to incorporate the second dose of MCV in the RI schedule provided that high enough coverage can be achieved. Published by Elsevier Ltd.
Tyukavina, A; Potapov, P V; Turubanova, S A; Hansen, M C; Stehman, S V; Baccini, A; Goetz, S J; Laporte, N T; Houghton, R A
Recent advances in remote sensing enable the mapping and monitoring of carbon stocks without relying on extensive in situ measurements. The Democratic Republic of the Congo (DRC) is among the countries where national forest inventories (NFI) are either non-existent or out of date. Here we demonstrate a method for estimating national-scale gross forest aboveground carbon (AGC) loss and associated uncertainties using remotely sensed-derived forest cover loss and biomass carbon density data. Lidar data were used as a surrogate for NFI plot measurements to estimate carbon stocks and AGC loss based on forest type and activity data derived using time-series multispectral imagery. Specifically, DRC forest type and loss from the FACET (Forêts d’Afrique Centrale Evaluées par Télédétection) product, created using Landsat data, were related to carbon data derived from the Geoscience Laser Altimeter System (GLAS). Validation data for FACET forest area loss were created at a 30-m spatial resolution and compared to the 60-m spatial resolution FACET map. We produced two gross AGC loss estimates for the DRC for the last decade (2000–2010): a map-scale estimate (53.3 ± 9.8 Tg C yr −1 ) accounting for whole-pixel classification errors in the 60-m resolution FACET forest cover change product, and a sub-grid estimate (72.1 ± 12.7 Tg C yr −1 ) that took into account 60-m cells that experienced partial forest loss. Our sub-grid forest cover and AGC loss estimates, which included smaller-scale forest disturbances, exceed published assessments. Results raise the issue of scale in forest cover change mapping and validation, and subsequent impacts on remotely sensed carbon stock change estimation, particularly for smallholder dominated systems such as the DRC. (letter)
Tshibamba Mukendi, John; Hubau, Wannes; Ntahobavuka, Honorine; Boyemba Bosela, Faustin; De Cannière, Charles; Beeckman, Hans
Past disturbances have modified local density, structure and floristic composition of Central African rainforests. As such, these perturbations represent a driving force for forest dynamics and they were presumably at the origin of present-day forest mosaics. One of the most prominent disturbances within the forest is fire, leaving behind charcoal as a witness of past forest dynamics. Quantification and identification of ancient charcoal fragments found in soil layers (= pedoanthracology) allows a detailed reconstruction of forest history, including the possible occurrence of past perturbations. The primary objective of this study is to present palaeoenvironmental evidence for the existence of past disturbances in the forests of the Kisangani region (Democratic Republic of the Congo) using a pedoanthracological approach. We quantified and identified charcoal fragments from pedoanthracological excavations in the Yangambi, Yoko, Masako and Kole forest regions. Charcoal sampling was conducted in pit intervals of 10 cm, whereby pottery fragments were also registered and quantified. Floristic identifications were conducted using former protocols based on wood anatomy, which is largely preserved after charcoalification. 14 excavations were conducted and charcoal was found in most pit intervals. Specifically, 52 out of 56 sampled intervals from the Yangambi forest contained charcoal, along with 47 pit intervals from the Yoko forest reserve, 34 pit intervals from the Masako forest and 16 from the Kole forest. Highest specific anthracomasses were recorded in Yoko (167 mg charcoal per kg soil), followed by Yangambi (133 mg/kg), Masako (71,89 mg/kg) and finally Kole (42,4 mg/kg). Charcoal identifications point at a manifest presence of the family of Fabaceae (Caesalpinioideae). This family is characteristic for the tropical humid rainforest. The presence of charcoal fragments from these taxa, associated with pottery sherds on different depths within the profiles, suggests
Adebowale, Ayo Stephen; Palamuleni, Martin Enoch; Odimegwu, Clifford Obby
Burkina Faso (BF) and Congo Democratic Republic (CDR) are among the top-ten poverty and hunger stricken countries globally. The influence of poverty and hunger on health is enormous. The objectives of the study are to; examine the association between poverty and nutritional status, it also identified socio-demographic and health related mediating factors that contribute to the relationship between poverty and poor nutritional status. The study focused on married or cohabiting women aged 15-49 years and utilized 2010 and 2007 DHS dataset from BF and CDR respectively. Mean age of the women in BF and CDR were 34.4 ± 9.3 and 34.7 ± 9.0 years respectively. About 19.4% and 18.4% of the poor were malnourished as against 7.7% and 9.7% of the rich women in BF and CDR respectively. Obesity and overweight were more prominent among the rich than the poor. Higher prevalence of under-nourish women was found among the older than the younger women in BF. In the countries, the prevalence of malnutrition was significantly higher among women; in the rural areas, with no formal education, anaemic and those who are not working. Multivariate analysis revealed that in the countries, the risk of under-nourishment was significantly higher among poor and middle class than the rich women despite controlling for confounding variables. Undernourished women were more common among the poor and those with no formal education. Programs that target nutrition of women of reproductive age should be strengthened in BF and CDR.
Kalabuanga, Marion; Ravinetto, Raffaella; Maketa, Vivi; Muhindo Mavoko, Hypolite; Fungula, Blaise; Inocêncio da Luz, Raquel; Van Geertruyden, Jean-Pierre; Lutumba, Pascal
In medical research, the ethical principle of respect for persons is operationalized into the process of informed consent. The consent tools should be contextualized and adapted to the different socio-cultural environment, especially when research crosses the traditional boundaries and reaches poor communities. We look at the challenges experienced in the malaria Quinact trial, conducted in the Democratic Republic of Congo, and describe some lessons learned, related to the definition of acceptable representative, the role of independent witness and the impact of socio-economic vulnerability. To ensure children's protection, consent is required by the parents or, in their absence, by a legally mandated representative. In our setting, children's responsibility is often entrusted permanently or temporarily to relatives or friends without a tribunal mandate. Hence, a notion of 'culturally acceptable representative' under supervision of the local Ethics Committee may be more suitable. To ensure protection of illiterate subjects, an independent witness is required to confirm that the consent was freely given. However, in low-literacy contexts, potential witnesses often don't have any previous relationship with patient and there may be power-unbalance in their relationship, rather than genuine dialogue. In poor communities, trial participation may be seen as an opportunity to secure access to healthcare. Poverty may also lead to 'competition' to access the research-related benefits, with a risk of disturbance at societal or household level. Adjusting consent procedures to sociocultural and socioeconomic realities is essential for fulfilling the underlying ethical principles. This requires a collaborative dialogue between researchers, regulators and ethics committees. © 2015 John Wiley & Sons Ltd.
M. Prosper Lutala
Full Text Available Background: Health and social services utilisation is seen to be more closely related to age than to other socio-demographic characteristics. Many health problems are known to increase with age and this demographic trend may lead to an increase in the absolute number of health conditions in this population. However, questions are still emerging as to how the elderly seek care in response to their needs in the context of a war-torn region. Objectives: The aim of this study was to determine the behaviour of the elderly in seeking care during a time of conflict. Method: A descriptive cross-sectional study was carried out in the health district Goma, in the Democratic Republic of the Congo (DRC, using a multistage sampling of 500 senior citizens. Eight trained field-workers were deployed in the field where they administered a structured questionnaire. Results: The public health sector was well known and preferred by 186 participants (37.2%, but only used by 16 (3.2% participants. Financial support received by the elderly came from their own relatives and fellow believers in 33.5% and 20.2% of cases, respectively. Almost 71% of monetary support is the result of begging and unknown sources – there is no government involvement whatsoever. Much of the external support that the elderly receive involves support in the form of food. Disease expenses remain a main concern of the elderly themselves. Conclusion: Government support for the elderly in the DRC is non-existent. There is an overuse of private sector and traditional medicine, despite the preference indicated for the public health sector. As a recommendation, a general increase in income-related activities could contribute to alleviating the health state of the elderly in a war situation. Further studies might explore in future the contribution of those results on the health of elders.
Malukisa, J; Collet, M; Bokata, S; Odio, W
Out of the 3,000 species of snakes described in the world, 163 are currently known from D.R. of Congo. We performed a systematic survey in sugar-cane plantations of the Sugar Company of Kwilu-Ngongo (Bas-Congo), located at 160 km South-West from Kinshasa and exploiting nearly 10,000 ha. The plantation is divided into 3 sectors in the middle of which we deposited barrels filled of formaldehyde. All the employees of the Sugar Company of Kwilu-Ngongo were requested to collect encountered snakes and put them in the nearest barrel. Between August 9th and September 21st, 2004, we collected 36 snakes in two different sites, revealing the presence of 3 families and 12 species. The most abundant species in Causus maculatus (47% in the first site--Point 8--and 29% in the second site--Point 13). The most poisonous and dangerous species were captured only in the first site--point 8, and were Dendroaspis jamesoni and Naja melanoleuca, both young.
Kohli, Anjalee; Tosha, Maphie; Ramazani, Paul; Safari, Octave; Bachunguye, Richard; Zahiga, Isaya; Iragi, Aline; Glass, Nancy
Our purpose in this study is to describe the multiple and inter-related health, economic, and social reasons for rejection and to provide an example of a Congolese-led family mediation program to reintegrate survivors into their families. We conducted this study in Eastern Democratic Republic of Congo (DRC) and included two focus group discussions and twenty-seven interviews. Rejection extends beyond physical dislocation to include economic and social aspects. Family mediation is a process requiring knowledge of traditions and norms. Understanding the context of rejection and supporting promising local reintegration efforts will likely improve health, economic, and social outcomes for the survivor, her family, and her community.
The BaNande, farmers of the hills of the North Kivu (Democratic Republic of the Congo), call themselves proudly abakondi, the young and strong men who cut down the trees, who destroy the forest. Almost their entire culture is based on the principle of the “cut” (eritwa), as well as their social and political organization is due to the historical achievement of their territory wrested from the forest. Even the erotic activity is designed with the typical categories of abakondi. But the traditi...
Bukonda, Ngoyi K Zacharie; Chand, Masud; Disashi, Tumba G
A survey was conducted in Jury 2010 to explore the creation of private health care businesses in Mbuji Mayi, the capital city of the Eastern Kasai Province (EKP), Democratic Republic of the Congo (DRC). The survey yielded 68 responses. The results indicated that the entrepreneurs were predominantly Congolese men with backgrounds in the health services field who had raised their start-up capital mostly from personal savings or from friends and family. Their businesses, which were mostly in the form of sole proprietorships, were likely to be located in areas underserved by government-owned medical facilities.
Full Text Available In recent years the name Banyamulenge has become associated with a warrior group in Eastern Congo because of the role some of its community members played in the war against the Mobutu regime. Researchers have been intrigued by the political motivations which unfortunately do not cover the cultural aspects of this community. This article attempts to document the cultural heritage of the Banyamulenge community. Many of the practices and traditions have become obsolete. The article explains the Banyamulenge cultural way of living, and how the divine was traditionally revealed to them in the form of human deities. Burnt sacrifice was part of community worship. The article documents what has been learnt from elders about the oral tradition, the cultural and religious realities of the community.
Simbi, Kibwe Alphonse; Kazadi, Valentin; Aissi, Louis-Marie; Katsuva, François Mbahewaka; Luboya, Numbi Oscar; Tshilolo, Léon; Zanardo, Vincenzo
Empyema is a serious complication characterized by purulent exudate and bacteria in the pleural space, which may progress to necrosis, cavitations or fistulas in the thoracic cavity. It remains a major challenge throughout low-income countries. Objectives were to emphasize the role of basic medical and radiologic approach and to resolve a severe lung complication when facilities are inadequate. A five-year-old female was referred with distress respiratory to the Emergency Unit of Monkole, a large public-private missionary hospital in Kinshasa, Congo. Chest X-ray showed a massive empyema that was resolved by immediate drainage and antibiotiocs. Results were rapid improvement and discharge after 3 weeks. A classic medical and imaging approach is a winning return in low-income countries. According to the British Thoracic Society guidelines, pleural effusion with compromising respiratory function can be managed by drainage and antibiotics.
Stephen N. M. Nzuve
Full Text Available The International Labour Organization and all organizations of human rights advocate against any form of negative attitude in employment based on gender, its terms, promotion and relations. Shop floor employees play a very important role in the daily advancement and profitability of an organisation. The purpose of this study was to establish the attitude of shop floor employees toward women managers in fuel depots in Lubumbashi, Democratic Republic of the Congo. The study adopted a descriptive survey design with the population consisting of one hundred and ninety three (193 shop floor employees. A semi structured questionnaire was used to collect primary data. In total one hundred and twenty one (121 shop floor employees responded yielding a response rate of sixty three percent (63%. The findings of this study indicate that a negative attitude toward woman managers is prevalent in the Fuel Depots of Lubumbashi, Democratic Republic of the Congo. At the fuel depots, the number of women working was less than a third of the males. In spite of this, women managers are rated higher in management qualities and are considered to be more honest, diligent, compassionate, creative and intelligent when compared to their male counterparts. The study recommends a culture change among employees in fuel depots in Lubumbashi in order to enable them perceive women as equal partners at the work place.
Mittermeier, Russell A.; Wich, Serge; Gouveia, Sidney; Dobrovolski, Ricardo; Nijman, Vincent; Rylands, Anthony B.; Johnson, Steig; Rodrigues de Melo, Fabiano; Schwitzer, Christoph; Roos, Christian; Cheyne, Susan M.; Martins Kierulff, Maria Cecilia; Raharivololona, Brigitte; Ratsimbazafy, Jonah; Supriatna, Jatna; Boonratana, Ramesh; Wedana, Made; Setiawan, Arif
Primates occur in 90 countries, but four—Brazil, Madagascar, Indonesia, and the Democratic Republic of the Congo (DRC)—harbor 65% of the world’s primate species (439) and 60% of these primates are Threatened, Endangered, or Critically Endangered (IUCN Red List of Threatened Species 2017-3). Considering their importance for global primate conservation, we examine the anthropogenic pressures each country is facing that place their primate populations at risk. Habitat loss and fragmentation are main threats to primates in Brazil, Madagascar, and Indonesia. However, in DRC hunting for the commercial bushmeat trade is the primary threat. Encroachment on primate habitats driven by local and global market demands for food and non-food commodities hunting, illegal trade, the proliferation of invasive species, and human and domestic-animal borne infectious diseases cause habitat loss, population declines, and extirpation. Modeling agricultural expansion in the 21st century for the four countries under a worst-case-scenario, showed a primate range contraction of 78% for Brazil, 72% for Indonesia, 62% for Madagascar, and 32% for DRC. These pressures unfold in the context of expanding human populations with low levels of development. Weak governance across these four countries may limit effective primate conservation planning. We examine landscape and local approaches to effective primate conservation policies and assess the distribution of protected areas and primates in each country. Primates in Brazil and Madagascar have 38% of their range inside protected areas, 17% in Indonesia and 14% in DRC, suggesting that the great majority of primate populations remain vulnerable. We list the key challenges faced by the four countries to avert primate extinctions now and in the future. In the short term, effective law enforcement to stop illegal hunting and illegal forest destruction is absolutely key. Long-term success can only be achieved by focusing local and global public
Background Despite the signing of international peace agreements, a deadly war continues in the Democratic Republic of Congo (DRC) and sexual violence is a prominent modus operandi of many military groups operating in the region. Methods Retrospective cohort study of women who presented to Panzi Hospital in 2006 requesting post-sexual violence care. Data was extracted and analyzed to describe the patterns of sexual violence. Results A total of 1,021 medical records were reviewed. A majority of attacks occurred in individual homes (56.5%), with the fields (18.4%) and the forest (14.3%) also being frequent locations of attack. In total, 58.9% of all attacks occurred at night. Of the four primary types of sexual violence, gang rape predominated (59.3%) and rape Not Otherwise Specified (NOS) was also common (21.5%). Sexual slavery was described by 4.9% of the survivors and a combination of gang rape and sexual slavery was described by 11.7%. The mean number of assailants per attack was 2.5 with a range of one to > 15. There were several demographic predictors for sexual slavery. Controlling for age, education level and occupation, a marital status of "single" increased the risk of sexual slavery (OR = 2.97, 95% CI = 1.12-7.85). Similarly, after controlling for other variables, age was a significant predictor of sexual slavery with older women being at a slightly reduced risk (OR = 0.96, 95% CI = 0.92-0.99). Women who experienced sexual slavery were 37 times more likely to have a resultant pregnancy in comparison to those who reported other types of sexual violence (OR = 37.50, 95% CI = 14.57-99.33). Conclusions Among sexual violence survivors presenting to Panzi Hospital in 2006, the majority of attacks occurred in women's own homes, often at night. This represents a pattern of violence that differs from other conflict settings and has important implications regarding protection strategies. Sexual violence in South Kivu was also marked with a predominance of gang rape
Lipton Robert I
Full Text Available Abstract Background Despite the signing of international peace agreements, a deadly war continues in the Democratic Republic of Congo (DRC and sexual violence is a prominent modus operandi of many military groups operating in the region. Methods Retrospective cohort study of women who presented to Panzi Hospital in 2006 requesting post-sexual violence care. Data was extracted and analyzed to describe the patterns of sexual violence. Results A total of 1,021 medical records were reviewed. A majority of attacks occurred in individual homes (56.5%, with the fields (18.4% and the forest (14.3% also being frequent locations of attack. In total, 58.9% of all attacks occurred at night. Of the four primary types of sexual violence, gang rape predominated (59.3% and rape Not Otherwise Specified (NOS was also common (21.5%. Sexual slavery was described by 4.9% of the survivors and a combination of gang rape and sexual slavery was described by 11.7%. The mean number of assailants per attack was 2.5 with a range of one to > 15. There were several demographic predictors for sexual slavery. Controlling for age, education level and occupation, a marital status of "single" increased the risk of sexual slavery (OR = 2.97, 95% CI = 1.12-7.85. Similarly, after controlling for other variables, age was a significant predictor of sexual slavery with older women being at a slightly reduced risk (OR = 0.96, 95% CI = 0.92-0.99. Women who experienced sexual slavery were 37 times more likely to have a resultant pregnancy in comparison to those who reported other types of sexual violence (OR = 37.50, 95% CI = 14.57-99.33. Conclusions Among sexual violence survivors presenting to Panzi Hospital in 2006, the majority of attacks occurred in women's own homes, often at night. This represents a pattern of violence that differs from other conflict settings and has important implications regarding protection strategies. Sexual violence in South Kivu was also marked with a
Tong, Jacqueline; Valverde, Olaf; Mahoudeau, Claude; Yun, Oliver; Chappuis, François
Human African trypanosomiasis (HAT), or sleeping sickness, is a fatal neglected tropical disease if left untreated. HAT primarily affects people living in rural sub-Saharan Africa, often in regions afflicted by violent conflict. Screening and treatment of HAT is complex and resource-intensive, and especially difficult in insecure, resource-constrained settings. The country with the highest endemicity of HAT is the Democratic Republic of Congo (DRC), which has a number of foci of high disease prevalence. We present here the challenges of carrying out HAT control programmes in general and in a conflict-affected region of DRC. We discuss the difficulties of measuring disease burden, medical care complexities, waning international support, and research and development barriers for HAT. In 2007, Médecins Sans Frontières (MSF) began screening for HAT in the Haut-Uélé and Bas-Uélé districts of Orientale Province in northeastern DRC, an area of high prevalence affected by armed conflict. Through early 2009, HAT prevalence rate of 3.4% was found, reaching 10% in some villages. More than 46,000 patients were screened and 1,570 treated for HAT during this time. In March 2009, two treatment centres were forced to close due to insecurity, disrupting patient treatment, follow-up, and transmission-control efforts. One project was reopened in December 2009 when the security situation improved, and another in late 2010 based on concerns that population displacement might reactivate historic foci. In all of 2010, 770 patients were treated at these sites, despite a limited geographical range of action for the mobile teams. In conflict settings where HAT is prevalent, targeted medical interventions are needed to provide care to the patients caught in these areas. Strategies of integrating care into existing health systems may be unfeasible since such infrastructure is often absent in resource-poor contexts. HAT care in conflict areas must balance logistical and medical capacity
Mafuta, Eric M; Dieleman, Marjolein A; Hogema, Lisanne M; Khomba, Paul N; Zioko, François M; Kayembe, Patrick K; de Cock Buning, Tjard; Mambu, Thérèse N M
The Democratic Republic of the Congo is one of the countries in Sub-Saharan Africa with the highest maternal mortality ratio estimated at 846 deaths per 100,000 live births. Innovative strategies such as social accountability are needed to improve both health service delivery and utilization. Indeed, social accountability is a form of citizen engagement defined as the 'extent and capability of citizens to hold politicians, policy makers and providers accountable and make them responsive to their needs.' This study explores existing social accountability mechanisms through which women's concerns are expressed and responded to by health providers in local settings. An exploratory study was conducted in two health zones with purposively sampled respondents including twenty-five women, five men, five health providers, two health zone officers and eleven community stakeholders. Data on women's voice and oversight and health providers' responsiveness were collected using semi-structured interviews and analysed using thematic analysis. In the two health zones, women rarely voiced their concerns and expectations about health services. This reluctance was due to: the absence of procedures to express them, to the lack of knowledge thereof, fear of reprisals, of being misunderstood as well as factors such as age-related power, ethnicity backgrounds, and women's status. The means most often mentioned by women for expressing their concerns were as individuals rather than as a collective. They did not use them instead; instead they looked to intermediaries, mostly, trusted health providers, community health workers and local leaders. Their perceptions of health providers' responsiveness varied. For women, there were no mechanisms for oversight in place. Individual discontent with malpractice was not shown to health providers. In contrast, health providers mentioned community health workers, health committee, and community based organizations as formal oversight mechanisms. All
Full Text Available Abstract Background The province of North Kivu in the Democratic Republic of Congo has been afflicted by conflict for over a decade. After months of relative calm, offences restarted in September 2008. We did an epidemiological study to document the impact of violence on the civilian population and orient pre-existing humanitarian aid. Methods In May 2009, we conducted three cross-sectional surveys among 200 000 resident and displaced people in North Kivu (Kabizo, Masisi, Kitchanga. The recall period covered an eight month period from the beginning of the most recent offensives to the survey date. Heads of households provided information on displacement, death, violence, theft, and access to fields and health care. Results Crude mortality rates (per 10 000 per day were below emergency thresholds: Kabizo 0.2 (95% CI: 0.1-0.4, Masisi 0.5 (0.4-0.6, Kitchanga 0.7 (0.6-0.9. Violence was the reported cause in 39.7% (27/68 and 35.8% (33/92 of deaths in Masisi and Kitchanga, respectively. In Masisi 99.1% (897/905 and Kitchanga 50.4% (509/1020 of households reported at least one member subjected to violence. Displacement was reported by 39.0% of households (419/1075 in Kitchanga and 99.8% (903/905 in Masisi. Theft affected 87.7% (451/514 of households in Masisi and 57.4% (585/1019 in Kitchanga. Access to health care was good: 93.5% (359/384 of the sick in Kabizo, 81.7% (515/630 in Masisi, and 89.8% (651/725 in Kitchanga received care, of whom 83.0% (298/359, 87.5% (451/515, and 88.9% (579/651, respectively, did not pay. Conclusions Our results show the impact of the ongoing war on these civilian populations: one third of deaths were violent in two sites, individuals are frequently subjected to violence, and displacements and theft are common. While humanitarian aid may have had a positive impact on disease mortality and access to care, the population remains exposed to extremely high levels of violence.
Scott, Jennifer; Mullen, Colleen; Rouhani, Shada; Kuwert, Philipp; Greiner, Ashley; Albutt, Katherine; Burkhardt, Gillian; Onyango, Monica; VanRooyen, Michael; Bartels, Susan
Sexual violence is prevalent in eastern Democratic Republic of Congo (DRC) and has potentially devastating psychosocial consequences. Previous studies have reported on sexual violence and its impact on the mental health of survivors, but there are few studies conducted among women with sexual violence-related pregnancies (SVRPs). Women with SVRPs may be at greater risk of complex psychosocial outcomes, including social stigmatization. This study aimed to describe psychosocial outcomes among this subgroup of sexual violence survivors in order to inform future interventions. A mixed methods study was conducted in Bukavu, DRC in 2012 among adult women who self-reported an SVRP and either (1) were currently raising a child from an SVRP (parenting group) or (2) had terminated an SVRP (termination group). This manuscript presents qualitative findings from the mixed methods study. Participants were recruited using respondent-driven sampling and a proportion engaged in semi-structured qualitative interviews conducted by trained female interviewers. Thematic content analysis was conducted and key themes were identified. In total, 55 women were interviewed, of whom 38 were in the parenting group and 17 in the termination group. Women with SVRPs experienced a myriad of emotional responses as they navigated their social environments following the SVRPs. Negative reactions, including social stigmatization and/or social rejection, toward women with SVRPs and toward children born from SVRPs were important influences on psychological well-being. Women expressed both internalized emotionality intertwined with externalized experiences in the social environment. Many women demonstrated resilience, or what could be termed post-traumatic growth, identifying avenues of agency to advance the social conditions for women. The findings from the qualitative study, and in particular, the respondents' needs and suggested strategies, may be useful to inform future research, programs, and
Full Text Available Abstract Background In many developing countries, the majority of births are attended by traditional birth attendants, who lack formal training in neonatal resuscitation and other essential care required by the newly born infant. In these countries, the major causes of neonatal mortality are birth asphyxia, infection, and low-birth-weight/prematurity. Death from these causes is potentially modifiable using low-cost interventions, including neonatal resuscitation training. The purpose of this study was to evaluate the effect on perinatal mortality of training birth attendants in a rural area of the Democratic Republic of Congo (DRC using two established programs. Methods This study, a secondary analysis of DRC-specific data collected during a multi-country study, was conducted in two phases. The effect of training using the WHO Essential Newborn Care (ENC program was evaluated using an active baseline design, followed by a cluster randomized trial of training using an adaptation of a neonatal resuscitation program (NRP. The perinatal mortality rates before ENC, after ENC training, and after randomization to additional NRP training or continued care were compared. In addition, the influence of time following resuscitation training was investigated by examining change in perinatal mortality during sequential three-month increments following ENC training. Results More than two-thirds of deliveries were attended by traditional birth attendants and occurred in homes; these proportions decreased after ENC training. There was no apparent decline in perinatal mortality when the outcome of all deliveries prior to ENC training was compared to those after ENC but before NRP training. However, there was a gradual but significant decline in perinatal mortality during the year following ENC training (RR 0.73; 95% CI: 0.56-0.96, which was independently associated with time following training. The decline was attributable to a decline in early neonatal mortality
Matendo, Richard; Engmann, Cyril; Ditekemena, John; Gado, Justin; Tshefu, Antoinette; Kinoshita, Rinko; McClure, Elizabeth M; Moore, Janet; Wallace, Dennis; Carlo, Waldemar A; Wright, Linda L; Bose, Carl
In many developing countries, the majority of births are attended by traditional birth attendants, who lack formal training in neonatal resuscitation and other essential care required by the newly born infant. In these countries, the major causes of neonatal mortality are birth asphyxia, infection, and low-birth-weight/prematurity. Death from these causes is potentially modifiable using low-cost interventions, including neonatal resuscitation training. The purpose of this study was to evaluate the effect on perinatal mortality of training birth attendants in a rural area of the Democratic Republic of Congo (DRC) using two established programs. This study, a secondary analysis of DRC-specific data collected during a multi-country study, was conducted in two phases. The effect of training using the WHO Essential Newborn Care (ENC) program was evaluated using an active baseline design, followed by a cluster randomized trial of training using an adaptation of a neonatal resuscitation program (NRP). The perinatal mortality rates before ENC, after ENC training, and after randomization to additional NRP training or continued care were compared. In addition, the influence of time following resuscitation training was investigated by examining change in perinatal mortality during sequential three-month increments following ENC training. More than two-thirds of deliveries were attended by traditional birth attendants and occurred in homes; these proportions decreased after ENC training. There was no apparent decline in perinatal mortality when the outcome of all deliveries prior to ENC training was compared to those after ENC but before NRP training. However, there was a gradual but significant decline in perinatal mortality during the year following ENC training (RR 0.73; 95% CI: 0.56-0.96), which was independently associated with time following training. The decline was attributable to a decline in early neonatal mortality. NRP training had no demonstrable effect on early
Lulebo, Aimée M; Kaba, Didine K; Atake, Silvestre E-H; Mapatano, Mala A; Mafuta, Eric M; Mampunza, Julien M; Coppieters, Yves
The Democratic Republic of the Congo (DRC) is characterized by a high prevalence of hypertension (HTN) and a high proportion of uncontrolled HTN, which is indicative of poor HTN management. Effective management of HTN in the African region is challenging due to limited resources, particularly human resources for health. To address the shortage of health workers, the World Health Organization (WHO) recommends task shifting for better disease management and treatment. Although task shifting from doctors to nurses is being implemented in the DRC, there are no studies, to the best of our knowledge, that document the association between task shifting and HTN control. The aim of this study was to investigate the association between task shifting and HTN control in Kinshasa, DRC. We conducted a cross-sectional study in Kinshasa from December 2015 to January 2016 in five general referral hospitals (GRHs) and nine health centers (HCs). A total of 260 hypertensive patients participated in the study. Sociodemographic, clinical, health care costs and perceived health care quality assessment data were collected using a structured questionnaire. To examine the association between task shifting and HTN control, we assessed differences between GRH and HC patients using bivariate and multivariate analyses. Almost half the patients were female (53.1%), patients' mean age was 59.5 ± 11.4 years. Over three-fourths of patients had uncontrolled HTN. There was no significant difference in the proportion of GRH and HC patients with uncontrolled HTN (76.2% vs 77.7%, p = 0.771). Uncontrolled HTN was associated with co-morbidity (OR = 10.3; 95% CI: 3.8-28.3) and the type of antihypertensive drug used (OR = 4.6; 95% CI: 1.3-16.1). The mean healthcare costs in the GRHs were significantly higher than costs in the HCs (US$ 34.2 ± US$3.34 versus US$ 7.7 ± US$ 0.6, respectively). Uncontrolled HTN was not associated with the type of health facility. This finding suggests that the
Full Text Available Abstract Background Prevalence of child stunting in the Democratic Republic of Congo (DRC is among the highest in the world. There is a need to systematically investigate how stunting operates at different levels of determination and identify major factors contributing to the development of stunting. The aim of this study was to look for key determinants of stunting in the DRC. Methods This study used data from the DRC Demographic Health Survey 2013–14 which included anthropometric measurement for 9030 under 5 year children. Height-for-Age Z score was calculated and classified according to the WHO guideline. The association between stunting and bio-demographic characteristics was assessed using logistic regression. Results Prevalence of stunting was much higher in boys than girls. There was a significant rural urban gap in the prevalence of stunting with rural areas having a larger proportion of children living with stunting than urban. Male children, older than 6 months, preceding birth interval less than 24 months, being from lower wealth quintiles had the highest odds of stunting. Several provinces had in particular high odds of stunting. Early initiation of breastfeeding, mother’s age more than 20 years at the time of delivery had lower odds of stunting. The taller the mother the less likely the child was to be stunted. Similarly, mother’s BMI, access to safe water, access to hygienic toilet, mother’s education were found negatively correlated with child stunting in the bivariate logistic regression, but they lost statistical significance in multivariate analysis together with numbers of children in the family and place of residence. Conclusions Child stunting is widespread in the DRC and increasing prevalence is worrisome. This study has identified modifiable factors determining high prevalence of stunting in the DRC. Policy implementation should in particular target provinces with high prevalence of stunting and address
Estrada, Alejandro; Garber, Paul A; Mittermeier, Russell A; Wich, Serge; Gouveia, Sidney; Dobrovolski, Ricardo; Nekaris, K A I; Nijman, Vincent; Rylands, Anthony B; Maisels, Fiona; Williamson, Elizabeth A; Bicca-Marques, Julio; Fuentes, Agustin; Jerusalinsky, Leandro; Johnson, Steig; Rodrigues de Melo, Fabiano; Oliveira, Leonardo; Schwitzer, Christoph; Roos, Christian; Cheyne, Susan M; Martins Kierulff, Maria Cecilia; Raharivololona, Brigitte; Talebi, Mauricio; Ratsimbazafy, Jonah; Supriatna, Jatna; Boonratana, Ramesh; Wedana, Made; Setiawan, Arif
Primates occur in 90 countries, but four-Brazil, Madagascar, Indonesia, and the Democratic Republic of the Congo (DRC)-harbor 65% of the world's primate species (439) and 60% of these primates are Threatened, Endangered, or Critically Endangered (IUCN Red List of Threatened Species 2017-3). Considering their importance for global primate conservation, we examine the anthropogenic pressures each country is facing that place their primate populations at risk. Habitat loss and fragmentation are main threats to primates in Brazil, Madagascar, and Indonesia. However, in DRC hunting for the commercial bushmeat trade is the primary threat. Encroachment on primate habitats driven by local and global market demands for food and non-food commodities hunting, illegal trade, the proliferation of invasive species, and human and domestic-animal borne infectious diseases cause habitat loss, population declines, and extirpation. Modeling agricultural expansion in the 21st century for the four countries under a worst-case-scenario, showed a primate range contraction of 78% for Brazil, 72% for Indonesia, 62% for Madagascar, and 32% for DRC. These pressures unfold in the context of expanding human populations with low levels of development. Weak governance across these four countries may limit effective primate conservation planning. We examine landscape and local approaches to effective primate conservation policies and assess the distribution of protected areas and primates in each country. Primates in Brazil and Madagascar have 38% of their range inside protected areas, 17% in Indonesia and 14% in DRC, suggesting that the great majority of primate populations remain vulnerable. We list the key challenges faced by the four countries to avert primate extinctions now and in the future. In the short term, effective law enforcement to stop illegal hunting and illegal forest destruction is absolutely key. Long-term success can only be achieved by focusing local and global public
Full Text Available Abstract Background Prolonged exposure to war has severely impacted the provision of health services in the Democratic Republic of the Congo (DRC. Health infrastructure has been destroyed, health workers have fled and government support to health care services has been made difficult by ongoing conflict. Poor reproductive health (RH indicators illustrate the effect that the prolonged crisis in DRC has had on the on the reproductive health (RH of Congolese women. In 2007, with support from the RAISE Initiative, the International Rescue Committee (IRC and CARE conducted baseline assessments of public hospitals to evaluate their capacities to meet the RH needs of the local populations and to determine availability, utilization and quality of RH services including emergency obstetric care (EmOC and family planning (FP. Methods Data were collected from facility assessments at nine general referral hospitals in five provinces in the DRC during March, April and November 2007. Interviews, observation and clinical record review were used to assess the general infrastructure, EmOC and FP services provided, and the infection prevention environment in each of the facilities. Results None of the nine hospitals met the criteria for classification as an EmOC facility (either basic or comprehensive. Most facilities lacked any FP services. Shortage of trained staff, essential supplies and medicines and poor infection prevention practices were consistently documented. All facilities had poor systems for routine monitoring of RH services, especially with regard to EmOC. Conclusions Women's lives can be saved and their well-being improved with functioning RH services. As the DRC stabilizes, IRC and CARE in partnership with the local Ministry of Health and other service provision partners are improving RH services by: 1 providing necessary equipment and renovations to health facilities; 2 improving supply management systems; 3 providing comprehensive competency
Mpunga, Dieudonné; Lumbayi, J P; Dikamba, Nelly; Mwembo, Albert; Ali Mapatano, Mala; Wembodinga, Gilbert
To determine the availability and quality of family planning services within health facilities throughout the Democratic Republic of the Congo (DRC). Data were collected for the cross-sectional study from April 2014 to June 2014 by the Ministry of Public Health. A total of 1,568 health facilities that reported data to the National Health Information System were selected by multistage random sampling in the 11 provinces of the DRC existing at that time. Data were collected through interviews, document review, and direct observation. Two dependent variables were measured: availability of family planning services (consisting of a room for services, staff assigned to family planning, and evidence of client use of family planning) and quality of family planning services (assessed as "high" if the facility had at least 1 trained staff member, family planning service delivery guidelines, at least 3 types of methods, and a sphygmomanometer, or "low" if the facility did not meet any of these 4 criteria). Pearson's chi-square test and odds ratios (ORs) were used to test for significant associations, using the alpha significance level of .05. We successfully surveyed 1,555 facilities (99.2%) of those included in the sample. One in every 3 facilities (33%) offered family planning services as assessed by the index of availability, of which 20% met all 4 criteria for providing high-quality services. Availability was greatest at the highest level of the health system (hospitals) and decreased incrementally with each health system level, with disparities between provinces and urban and rural areas. Facilities in urban areas were more likely than in rural areas to meet the standard for high-quality services ( P facilities were less likely than private facilities to have high-quality services ( P =.02). Among all 1,555 facilities surveyed, 14% had at least 3 types of methods available at the time of the survey; the most widely available methods were male condoms, combined oral
Nangana, Luzitu Severin; Monga, Ben; Ngatu, Nlandu Roger; Mbelambela, Etongola Papy; Mbutshu, Lukuke Hendrick; Malonga, Kaj Francoise
Road traffic accident (RTA)-related trauma remains a public health issue. The aim of this study was to determine the frequency, causes and human impact of motor vehicle-related RTA in Lubumbashi, Democratic Republic of Congo. A prospective cross-sectional study was conducted in the first semester of the year 2015 in which 288 drivers (144 RTA-causing drivers and 144 control drivers who have been declared not guilty by road safety agents) involved in 144 motor vehicle-related RTA were interviewed, and only data on all RTA involving two motor vehicles with at least four wheels were recorded and analyzed. Results showed a total of 144 RTA that involved two motor vehicles with four wheels occurring during the study period which affected 104 people, including 93 injury and 11 fatality cases. The mean age of RTA-causing drivers was 33.8 ± 7.4, whereas it was 35 ± 8.8 for control drivers. The majority of RTA-causing drivers (53.4 %) did not attend a driving school. Over speeding (32 %), distracted driving (22 %), overtaking (16 %) and careless driving/risky maneuver (15 %) and driving under the influence of alcohol (9 %) were the main causes of RTA occurrence. In addition, the absence of a valid driving license [aOR = 12.74 (±2.71); 95 % CI 3.877-41.916; p = 0.015], unfastened seat belt for the RTA-causing driver [aOR = 1.85 (±0.62); 95 % CI 1.306-6.661; p = 0.048] and presence of damages on RTA-causing vehicle [aOR = 33.56 (24.01); 95 % CI 1.429-78.352; p = 0.029] were associated with the occurrence of RTA-related fatality. This study showed a relatively high frequency of RTA occurring in Lubumbashi and suggests the necessity to reinforce road traffic regulation.
Full Text Available Data collected during the 2012 Ebola virus disease (EVD epidemic in the Democratic Republic of the Congo were analysed for clinical signs, symptoms and case fatality of EVD caused by Bundibugyo virus (BDBV, establishment of differential diagnoses, description of medical treatment and evaluation of the quality of clinical documentation. In a quantitative observational prospective study, global epidemiological data from 52 patients (34 patients within the community, 18 patients treated in the Ebola Treatment Centre were entered anonymously into a database, subsequently matched and analysed. Relevant findings include an over-representation of females among community EVD cases (85.3% and of community EVD cases in the age group of 15-54 years (82.4%. All ETC patients had fever (55.6% of all 18 ETC patients during their hospital stay or self-reported fever (88.2% upon admission at some point of time during their illness. Major symptoms of ETC patients during hospital stay included asthenia (82.4%, anorexia (82.4%, myalgia (70.6%, sore throat/difficulty swallowing (70.6%, arthralgia (76.5% and nausea (70.6%. Gastrointestinal signs and symptoms (nausea, diarrhoea, vomiting (76.4% as well as general pain (94.1% were frequent in ETC patients. The median duration of EVD was 18 days, while the mean incubation period was 11.3 days. Differential diagnosis of EVD included malaria (28.3%, intestinal parasitosis (10.9%, and infectious syndrome (10.9%. There was also an important variation in clinical evolvement. Quality of documentation was adversely affected by the way patient file contents were transferred from inside to outside the high-risk zone, entailing a mean mismatch value of 27.3% between patient file contents inside vs. outside the high-risk zone. This study adds further description of EVD (frequently non-specific signs and symptoms, non frequent bleeding, a long incubation period, long duration of disease and emphasizes the need for improving
Full Text Available Abstract Background Human African trypanosomiasis (HAT, or sleeping sickness, is a fatal neglected tropical disease if left untreated. HAT primarily affects people living in rural sub-Saharan Africa, often in regions afflicted by violent conflict. Screening and treatment of HAT is complex and resource-intensive, and especially difficult in insecure, resource-constrained settings. The country with the highest endemicity of HAT is the Democratic Republic of Congo (DRC, which has a number of foci of high disease prevalence. We present here the challenges of carrying out HAT control programmes in general and in a conflict-affected region of DRC. We discuss the difficulties of measuring disease burden, medical care complexities, waning international support, and research and development barriers for HAT. Discussion In 2007, Médecins Sans Frontières (MSF began screening for HAT in the Haut-Uélé and Bas-Uélé districts of Orientale Province in northeastern DRC, an area of high prevalence affected by armed conflict. Through early 2009, HAT prevalence rate of 3.4% was found, reaching 10% in some villages. More than 46,000 patients were screened and 1,570 treated for HAT during this time. In March 2009, two treatment centres were forced to close due to insecurity, disrupting patient treatment, follow-up, and transmission-control efforts. One project was reopened in December 2009 when the security situation improved, and another in late 2010 based on concerns that population displacement might reactivate historic foci. In all of 2010, 770 patients were treated at these sites, despite a limited geographical range of action for the mobile teams. Summary In conflict settings where HAT is prevalent, targeted medical interventions are needed to provide care to the patients caught in these areas. Strategies of integrating care into existing health systems may be unfeasible since such infrastructure is often absent in resource-poor contexts. HAT care in
Understanding the local context and its possible influences on shaping, implementing and running social accountability initiatives for maternal health services in rural Democratic Republic of the Congo : a contextual factor analysis
Mafuta, E.M.; Hogema, L.M.; Mambu, T.N.M.; de Cock Buning, J.T.; Dieleman, M.A.
Background Social accountability has to be configured according to the context in which it operates. This paper aimed to identify local contextual factors in two health zones in the Democratic Republic of the Congo and discuss their possible influences on shaping, implementing and running social
Full Text Available Recently, a Salmonella Typhi isolate producing CTX-M-15 extended spectrum β-lactamase (ESBL and with decreased ciprofloxacin susceptibility was isolated in the Democratic Republic of the Congo. We have selected bacteriophages that show strong lytic activity against this isolate and have potential for phage-based treatment of S. Typhi, and Salmonella in general.
Over the last decades, there has been increased attention towards women s and girls protection and participation during conflict, peace processes, and peacebuilding. In the wake of this attention, sexual violence during conflict and in post conflict settings has been put on the international agenda. Both scholars and NGOs share a concern about the possible negative impact sexual violence may have both for the individual survivor as well as for the society as a whole. The Democratic Republic ...
use of violence as being the domain of the modern state, which as a natural consequence, delegitimises non-state providers of security. Legitimacy is, therefore, tied to the formal state. Th e international debate concerning the role of PMSCs has been split primarily into two segments. One argues...... to control confl icts has led to low-intensity confl icts (LIC), which can be witnessed, for instance, in Uganda, the Democratic Republic of Congo, Colombia and Sri Lanka (O’Brien, 1998, p. 80). Since the end of the Cold War it has been common for weak state rulers with formal state legitimacy...... security contractors have led, both historically and at the present day, to fi erce academic and public debate. As Sarah Percy argues, the anti-mercenary discourse has two basic elements. One focuses on the fact that mercenaries use force outside what is considered to be legitimate, authoritative control...
Full Text Available Background: Maternal health care utilization continues to focus on the agenda of health care planners around the world, with high attention being paid to the developing countries. The devastating effect of maternal death at birth on the affected families is untold. This study examines the utilization of obstetric care in the Democratic Republic of Congo. Methods: We have used the nationally representative data from the 2007. Democratic Republic of Congo Demographic and Health Survey. Multilevel regression analysis has been applied to a nationally representative sample of 6,695 women, clustered around 299 communities in the country. Results: The results show that there are variations in the use of antenatal care and delivery care. Individual-level characteristics, such as women′s occupation and household wealth status are shown to be associated with the use of antenatal care. Uptake of facility-based delivery has been seen to be dependent on the household wealth status, women′s education, and partner′s education. The effect of the neighborhoods′ socioeconomic disadvantage on the use of antenatal care and facility-based delivery are the same. Women from highly socioeconomically disadvantaged communities, compared to their counterparts from less socioeconomically disadvantaged neighborhoods, are less likely to utilize both the antenatal services and healthcare facility for child delivery. The result of this study has shown that both individual and contextual socioeconomic status play an important role in obstetric care uptake. Conclusion: Thus, intervention aimed at improving the utilization of obstetrics care should target both the individual economic abilities of the women and that of their environment when considering the demand side.
Schiavetti, Benedetta; Wynendaele, Evelien; De Spiegeleer, Bart; Mbinze, Geremie J; Kalenda, Nicodème; Marini, Roland; Melotte, Vera; Hasker, Epco; Meessen, Bruno; Ravinetto, Raffaella; Van der Elst, Josiane; Mutolo Ngeleka, Daniel
Poor-quality medicines are a threat to public health in many low- and middle-income countries, and prospective surveys are needed to inform corrective actions. Therefore, we conducted a cross-sectional survey on a sample of products used for children and available in the private market in Kinshasa, Democratic Republic Congo: amoxicillin (AX) and artemether/lumefantrine (AL), powders for suspension, and paracetamol (PC) tablets 500 mg. Overall, 417 products were covertly purchased from 61 wholesalers. To obtain a representative sample, the products were weighted on their market shares and a subset of 239 samples was randomly extracted to undergo in-depth visual inspection locally, and they were chemically assessed at two accredited laboratories in Belgium. Samples were defined of "poor-quality" if they failed to comply with at least one specification of the International Pharmacopoeia (for AL) or United States Pharmacopoeia 37 (for AX and PC). Results are reported according to the Medicine Quality Assessment Reporting Guideline. The visual inspection detected nonconformities in the aspects of antimalarial powders for suspension, and poor-quality labels across all medicine types. According to chemical analysis, 27.2% samples were of poor quality and 59.5% of AL samples were underdosed in artemether. Poor quality was more frequent for locally manufactured antimalarials (83.3%, P = 0.021; 86.4%, P = 0.022) and PC (4.8%, P = 0.000). The poor quality of the surveyed products may decrease the treatment's efficacy and favor the development of resistances to antimalarials. It is hoped that these findings may guide the corrective actions of the Democratic Republic of Congo Regulatory Authority, which was the main partner in the research.
Ho, Lara S; Labrecque, Guillaume; Batonon, Isatou; Salsi, Viviana; Ratnayake, Ruwan
More than a decade of conflict has weakened the health system in the Democratic Republic of Congo and decreased its ability to respond to the needs of the population. Community scorecards have been conceived as a way to increase accountability and responsiveness of service providers, but there is limited evidence of their effects, particularly in fragile and conflict-affected contexts. This paper describes the implementation of community scorecards within a community-driven reconstruction project in two provinces of eastern Democratic Republic of Congo. Between June 2012 and November 2013, 45 stories of change in the health system were collected from village development committee, health committee, community members (20 men and 18 women) and healthcare providers (n = 7) in 25 sites using the Most Significant Change technique. Stories were analyzed qualitatively for content related to the types and mechanisms of change observed. The most salient changes were related to increased transparency and community participation in health facility management, and improved quality of care. Quality of care included increased access to services, improved patient-provider relationships, improved performance of service providers, and improved maintenance of physical infrastructure. Changes occurred through many different mechanisms including provider actions in response to information, pressure from community representatives, or supervisors; and joint action and improved collaboration by health facility committees and providers. Although it is often assumed that confrontation is a primary mechanism for citizens to change state-provided services, this study demonstrates that healthcare providers may also be motivated to change through other means. Positive experiences of community scorecards can provide a structured space for interface between community members and the health system, allowing users to voice their opinions and preferences and bridge information gaps for both
Schiavetti, Benedetta; Wynendaele, Evelien; De Spiegeleer, Bart; Mbinze, Geremie J.; Kalenda, Nicodème; Marini, Roland; Melotte, Vera; Hasker, Epco; Meessen, Bruno; Ravinetto, Raffaella; Van der Elst, Josiane; Mutolo Ngeleka, Daniel
Abstract. Poor-quality medicines are a threat to public health in many low- and middle-income countries, and prospective surveys are needed to inform corrective actions. Therefore, we conducted a cross-sectional survey on a sample of products used for children and available in the private market in Kinshasa, Democratic Republic Congo: amoxicillin (AX) and artemether/lumefantrine (AL), powders for suspension, and paracetamol (PC) tablets 500 mg. Overall, 417 products were covertly purchased from 61 wholesalers. To obtain a representative sample, the products were weighted on their market shares and a subset of 239 samples was randomly extracted to undergo in-depth visual inspection locally, and they were chemically assessed at two accredited laboratories in Belgium. Samples were defined of “poor-quality” if they failed to comply with at least one specification of the International Pharmacopoeia (for AL) or United States Pharmacopoeia 37 (for AX and PC). Results are reported according to the Medicine Quality Assessment Reporting Guideline. The visual inspection detected nonconformities in the aspects of antimalarial powders for suspension, and poor-quality labels across all medicine types. According to chemical analysis, 27.2% samples were of poor quality and 59.5% of AL samples were underdosed in artemether. Poor quality was more frequent for locally manufactured antimalarials (83.3%, P = 0.021; 86.4%, P = 0.022) and PC (4.8%, P = 0.000). The poor quality of the surveyed products may decrease the treatment’s efficacy and favor the development of resistances to antimalarials. It is hoped that these findings may guide the corrective actions of the Democratic Republic of Congo Regulatory Authority, which was the main partner in the research. PMID:29313479
Mukeba-Tshialala, D; Nachega, J B; Mutombo-Tshingwali, M; Arendt, V; Gilson, G; Moutschen, M
Little is known about the major cardiovascular risk factors in HIV-infected as compared to the HIV-uninfected patients in the Democratic Republic of Congo (DR Congo). We determined the prevalence of hypertension, obesity (BMI ≥ 30 kg/m 2 ), total cholesterol > 200 mg/dl, HDLcholesterol &≤ 40 mg/dl, and glycemia > 126 mg/dl. We also calculated the average and/or median of total cholesterol, HDL-cholesterol, and glycemia among HIV-infected and HIV-uninfected patients.We conducted a cross-sectional study that enrolled 592 HIV-uninfected and 445 HIV-infected patients of whom 425 (95.5%) were on first-line antiretroviral therapy based on stavudine-lamivudine-nevirapine. Clinical and laboratory data of the patients were collected. The results were analyzed by chi-square, t-student, and Wilcoxon rank sum tests. 11.5% of HIV-infected patients had an average blood pressure suggesting hypertension versus 10.6% of HIV-uninfected (P = 0.751). But in absolute value, HIVinfected patients had a median of diastolic blood pressure of 90 mmHg versus 85 mmHg of HIV-uninfected (P 200 mg/dl and HDL-cholesterol ≤ 40 mg/dl. Proactive screening and prompt management of dyslipidemia and hypertension in this population should be a priority.
Mubedi, Josué Ilunga; Devarajan, Naresh; Le Faucheur, Séverine; Mputu, John Kayembe; Atibu, Emmanuel K; Sivalingam, Periyasamy; Prabakar, Kandasamy; Mpiana, Pius T; Wildi, Walter; Poté, John
Physicochemical and ecotoxicological analyses have been performed to assess the quality of sediments receiving untreated hospital effluents from Indian and Democratic Republic of Congo (DRC) hospitals. The sediments were collected monthly and characterized for grain size, organic matter, total organic carbon, total carbon, nitrogen, phosphorus, toxic metals and ecotoxicity. The results highlight the high concentration of toxic metals from the Indian hospital effluent receiving systems, especially for Cr, Cu, As, Zn and Hg. On the other hand, the metal concentrations in the sediment receiving system from DRC are low (e.g. maximum Hg and Zn concentration were 0.46 and 48.84 mg kg(-1) respectively). Ostracods exposed to sediment samples H2 (September month sample) and H3 (June and September month samples) were found dead after 6d of exposure whereas the higher mortality rate for Congo sediments was 23% but was accompanied with 33 ± 7% of growth inhibition. The results of this study show the variation of sediment composition on toxic metal levels as well as toxicity related to both, the type of hospitals and the sampling period. Additionally, hospital effluent disposal practices at the study sites can lead to the pollution of water resources and may generate risks for aquatic organisms and human health. Copyright © 2013 Elsevier Ltd. All rights reserved.
Mwanamoki, Paola M; Devarajan, Naresh; Thevenon, Florian; Birane, Niane; de Alencastro, Luiz Felippe; Grandjean, Dominique; Mpiana, Pius T; Prabakar, Kandasamy; Mubedi, Josué I; Kabele, Christophe G; Wildi, Walter; Poté, John
This paper discusses the occurrence and spatial distribution of metals and persistent organic pollutants (POPs: including organochlorine pesticides (OCPs), polychlorinated biphenyls (PCBs), Polybrominated diphenyl ethers (PBDEs), and polycyclic aromatic hydrocarbons (PAHs) in sediments from a river-reservoir system. Surface sediments were sampled from thirteen sites of the Congo River Basin and Lake Ma Vallée, both situated in the vicinity of the capital city Kinshasa (Congo Democratic Republic). Sediment qualities were evaluated using toxicity test based on exposing Ostracods to the sediment samples. The highest metal concentrations were observed in sediments subjected to anthropogenic influences, urban runoff and domestic and industrial wastewaters, discharge into the Congo River basin. Ostracods exposed to the sediments resulted in 100% mortality rates after 6d of incubation, indicating the ultimate toxicity of these sediments as well as potential environmental risks. The POPs and PAHs levels in all sediment samples were low, with maximum concentration found in the sediments (area of pool Malebo): OCP value ranged from 0.02 to 2.50 with ∑OCPs: 3.3μgkg(-1); PCB ranged from 0.07 to 0.99 with Total PCBs (∑7×4.3): 15.31μgkg(-1); PAH value ranged from 0.12 to 9.39 with ∑PAHs: 63.89μgkg(-1). Our results indicate that the deterioration of urban river-reservoir water quality result mainly from urban stormwater runoff, untreated industrial effluents which discharge into the river-reservoirs, human activities and uncontrolled urbanization. This study represents useful tools incorporated to evaluate sediment quality in river-reservoir systems which can be applied to similar aquatic environments. Copyright © 2014 Elsevier Ltd. All rights reserved.
Kilunga, Pitchouna I; Kayembe, John M; Laffite, Amandine; Thevenon, Florian; Devarajan, Naresh; Mulaji, Crispin K; Mubedi, Josué I; Yav, Zéphirin G; Otamonga, Jean-Paul; Mpiana, Pius T; Poté, John
Although the United Nations General Assembly recognized in 2010 the right to safe and clean drinking water and sanitation as a human right that is essential to the full enjoyment of life and all other human rights, the contamination of water supplies with faecal pathogens is still a major and unsolved problem in many parts of the world. In this study, faecal indicator bacteria (FIB), including Escherichia coli (E. coli) and Enterococcus (ENT), were quantified over the period of June/July 2014 and June/July 2015 to assess the quality of hospital effluents (n = 3: H1, H2 and H3) and of rivers receiving wastewaters from the city of Kinshasa, Democratic Republic of Congo. The water and sediment samples from the river-receiving systems were collected in, upstream and downstream of the hospital outlet pipe (HOP) discharge. The analysis of E. coli and ENT in water and sediment suspension was performed using the cultural membrane filter method. The FIB characterization was performed for general E. coli, Enterococcus faecalis(E. faecalis) and human-specific Bacteroides by PCR using specific primers. The results revealed very high FIB concentration in the hospital effluent waters, with E. coli reaching the values of 4.2 × 10(5), 16.1 × 10(5) and 5.9 × 10(5) CFU 100 mL(-1), for the hospital effluents from H1, H2, and H3, respectively; and Enterococcus reaching the values of 2.3 × 10(4), 10.9 × 10(4) and 4.1 × 10(4) CFU 100 mL(-1), respectively. Interestingly, the FIB levels in the water and sediment samples from river-receiving systems are spatially and temporally highly variable and present in some samples with higher values than the hospital effluents. The PCR assays for human-specific Bacteroides HF183/HF134 further indicate that more than 98% of bacteria were from human origin. The results of this research therefore confirm the hypothesis of our previous studies, indicating that in developing countries (e.g., Democratic Republic of Congo and South India), the
Full Text Available This experiment was conducted in parallel with work in the Democratic Republic of the Congo with the objective to evaluate the growth performance and production costs of Nile tilapia fed diets formulated using local plant protein sources, and to compare them to those obtained with an optimized commercial fish feed. Ninety monosex male tilapia juveniles (Oreochromis niloticus; mean weight 17.3 ± 0.2 g; mean length 9.6 ± 0.1 cm were reared in 9 acrylic aquaria supplied by closed water recirculation system. Three diets were tested in triplicate: 1 Rcongo, the test diet formulated by using local feed ingredients collected in the DR-Congo; 2 Rcanada, the diet formulated with the same ingredient composition as the first one, but sourced in Canada; and 3 Rcommercial, a fishmeal-based commercial control diet. In vivo feed digestibility and biochemical analysis of samples were carried out. The effects of diet and rearing time were measured on fish performance, including fish biomass, K coefficient, weight gain (WG, feed efficiency (FE, feed conversion rate (FCR, specific growth rate (SGR, protein efficiency ratio (PER, apparent digestibility coefficient (ADC and on nutrient budget and fish biochemical composition. After four weeks, the fish achieved weight gains of 52% for Rcongo diet (17.2 ± 0.4 to 26.2 ± 2.6 g, 59% for Rcanada diet (17.4 ± 0.1 to 27.6 ± 3.2 g and 153% for the commercial diet (17.3 ± 0.2 to 43.8 ± 2.0 g. The cost-benefit analysis has indicated that the Rcongo diet was economically advantageous, reducing fish production cost up to 36% compared to commercial feed.
Ndjinga Julie K
Full Text Available Abstract Background Malaria is the most prominent disease in the Democratic Republic of the Congo (DRC, and long-lasting insecticide-treated nets (LLINs have been distributed free of charge since 2006 to combat the disease. However, the success of this bed net campaign depends on sufficient bed net use in all age groups. This study was designed to examine the factors affecting bed net use in villages outside of Kinshasa. Methods Two villages along the Congo River, totalling 142 households with 640 residents, were surveyed using a standard questionnaire. The interview determined the number, ages, and sexes of family members; the education level of the family head; the number, colour, and type of nets owned; and the number of nets used in the previous night. The size of house was also measured, and numbers of rooms and beds were recorded. These variables were examined to reveal important factors that affect bed net use. Results A total of 469 nets were counted, and nearly all nets were white LLINs. Of these nets, 229 (48.8% nets were used by 284 (44.4% residents. Bed nets were used by over 90% of children 5 to 15 years of age, whereas less than 50% of the residents in other age groups used bed nets. The important variables affecting bed net use were numbers of beds and rooms in the house and the education level of the family head of household. Conclusion Education was the most important factor affecting bed net use in the villages outside Kinshasa. Development of an educational programme, particularly one directed toward parents, is necessary to reduce misconceptions and increase prevalence of bed net use among all age groups.
O'Callaghan, Paul; Branham, Lindsay; Shannon, Ciarán; Betancourt, Theresa S; Dempster, Martin; McMullen, John
Rural communities in the Haut-Uele Province of northern Democratic Republic of Congo live in constant danger of attack and/or abduction by units of the Lord's Resistance Army operating in the region. This pilot study sought to develop and evaluate a community-participative psychosocial intervention involving life skills and relaxation training and Mobile Cinema screenings with this war-affected population living under current threat. 159 war-affected children and young people (aged 7-18) from the villages of Kiliwa and Li-May in north-eastern DR Congo took part in this study. In total, 22% of participants had been abduction previously while 73% had a family member abducted. Symptoms of post-traumatic stress reactions, internalising problems, conduct problems and pro-social behaviour were assessed by blinded interviewers at pre- and post-intervention and at 3-month follow-up. Participants were randomised (with an accompanying caregiver) to 8 sessions of a group-based, community-participative, psychosocial intervention (n=79) carried out by supervised local, lay facilitators or a wait-list control group (n=80). Average seminar attendance rates were high: 88% for participants and 84% for caregivers. Drop-out was low: 97% of participants were assessed at post-intervention and 88% at 3 month follow-up. At post-test, participants reported significantly fewer symptoms of post-traumatic stress reactions compared to controls (Cohen's d=0.40). At 3 month follow up, large improvements in internalising symptoms and moderate improvements in pro-social scores were reported, with caregivers noting a moderate to large decline in conduct problems among the young people. Trial Registration clinicalTrials.gov, Identifier: NCT01542398. Copyright © 2014 Elsevier Ltd. All rights reserved.
Madinga, Joule; Kanobana, Kirezi; Lukanu, Philippe; Abatih, Emmanuel; Baloji, Sylvain; Linsuke, Sylvie; Praet, Nicolas; Kapinga, Serge; Polman, Katja; Lutumba, Pascal; Speybroeck, Niko; Dorny, Pierre; Harrison, Wendy; Gabriel, Sarah
Taenia solium infections are mostly endemic in less developed countries where poor hygiene conditions and free-range pig management favor their transmission. Knowledge on patterns of infections in both human and pig is crucial to design effective control strategies. The aim of this study was to assess the prevalence, risk factors and spatial distribution of taeniasis in a rural area of the Democratic Republic of Congo (DRC), in the prospect of upcoming control activities. A cross-sectional study was conducted in 24 villages of the health zone of Kimpese, Bas Congo Province. Individual and household characteristics, including geographical coordinates were recorded. Stool samples were collected from willing participants and analyzed using the copro-antigen enzyme-linked immunosorbent assay (copro-Ag ELISA) for the detection of taeniasis. Blood samples were collected from pigs and analyzed using the B158/B60 monoclonal antibody-based antigen ELISA (sero-Ag ELISA) to detect porcine cysticercosis. Logistic regression and multilevel analysis were applied to identify risk factors. Global clustering and spatial correlation of taeniasis and porcine cysticercosis were assessed using K functions. Local clusters of both infections were identified using the Kulldorff's scan statistic. A total of 4751 participants above 5 years of age (median: 23 years; IQR: 11-41) were included. The overall proportion of taeniasis positivity was 23.4% (95% CI: 22.2-24.6), ranging from 1 to 60% between villages, with a significant between-household variance of 2.43 (SE=0.29, pTaeniasis was significantly associated with age (ptaeniasis (ptaeniasis in the study area. The role of age in taeniasis patterns and significant spatial clusters of both taeniasis and porcine cysticercosis were evidenced, though no spatial correlation was found between human and pig infections. Urgent control activities are needed for this endemic area. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights
Wachter, Karin; Murray, Sarah M; Hall, Brian J; Annan, Jeannie; Bolton, Paul; Bass, Judy
The aim of this study was to further understanding of the relationship between social support, internalized and perceived stigma, and mental health among women who experienced sexual violence in the eastern Democratic Republic of Congo (DRC). Drawing from baseline survey data collected in eastern DRC, researchers conducted a secondary cross-sectional analysis using data from 744 participants. Regression and moderation analyses were conducted to examine associations between social support variables, felt stigma, and depression, anxiety and posttraumatic stress disorder (PTSD). Emotional support seeking and felt stigma were positively associated with increased symptom severity across all three mental health variables. Stigma modified associations between emotional support seeking and depression (t = -2.49, p = .013), anxiety (t = -3.08, p = .002), and PTSD (t = -2.94, p = .003). Increased frequency of emotional support seeking was associated with higher mental health symptoms of anxiety and PTSD among women experiencing all levels of stigma. Enhancing understanding of social support and stigma may inform research and intervention among Congolese forced migrant populations across circumstances and geographic locations. Implications for practice and research are discussed.
Joković Danilo B.
Full Text Available Background/Aim. Wars of the nineties in former Yugoslavia, Somalia, Rwanda imposed new tasks to the United Nations (UN forces, such as providing humanitarian aid, protection of civilians, peacekeeping, and in many instances providing armed enforcement of peace. The aim of this study was an observational analysis of Serbian participation in the UNs Mission in the Democratic Republic of Congo with the emphasis on stress and coping techniques. Methods. Serbian contribution in this mission dates back to April 2003 till the present days with a military contingent consisting of six members as a part of Air Medical Evacuation Team. The observed stressogenous factors acted before arrival to the mission area and in the mission area. In this paper we analysed ways to overcome them. Results. The productive ways of overwhelming stress used in this mission were: honesty and openness in interpersonal communications, dedication to work, maintaining discipline and order, strict following of appropriate regime of work, diet, rest and recreation; regular communication with family and organizing and participation in various social, cultural and sports manifestations. Conclusion. This analysis indicates that out of all the observed factors, the most important is appropriate selection of personnel.
Bertherat, Eric; Mueller, Melissa J.; Shako, Jean-Christophe; Picardeau, Mathieu
Conditions in the Democratic Republic of the Congo provide an ideal environment for leptospirosis and plague, both of which can cause severe pulmonary manifestations. In December 2004, an outbreak of lethal pneumonia occurred in a local mining camp, affecting 130 persons and killing 57 of them. Clinical signs, fast disease spread, and initial laboratory investigations suggested pneumonic plague. While leptospirosis had not recently been described in the region, it was considered as a differential diagnosis. Anti-Leptospira antibodies were detected by microscopic agglutination test (MAT). A confirmed case of leptospirosis was defined as having consistent clinical signs and any one of the following: seroconversion or four-fold increase in MAT titre for paired serum samples, or a MAT titre ≥ 1:400 for acute-phase serum samples. Twenty-nine of the 54 patients or convalescents tested for leptospirosis were seropositive. Two cases showed a confirmed infection for both plague and leptospirosis. While evidence supports the plague nature of this outbreak, the results suggest that some of the suspected plague cases might be due to leptospirosis. In any case, this diagnosis will have to be evoked in the future if a similar outbreak occurs in this region of Africa. PMID:24514425
Bertherat, Eric; Mueller, Melissa J; Shako, Jean-Christophe; Picardeau, Mathieu
Conditions in the Democratic Republic of the Congo provide an ideal environment for leptospirosis and plague, both of which can cause severe pulmonary manifestations. In December 2004, an outbreak of lethal pneumonia occurred in a local mining camp, affecting 130 persons and killing 57 of them. Clinical signs, fast disease spread, and initial laboratory investigations suggested pneumonic plague. While leptospirosis had not recently been described in the region, it was considered as a differential diagnosis. Anti-Leptospira antibodies were detected by microscopic agglutination test (MAT). A confirmed case of leptospirosis was defined as having consistent clinical signs and any one of the following: seroconversion or four-fold increase in MAT titre for paired serum samples, or a MAT titre ≥ 1:400 for acute-phase serum samples. Twenty-nine of the 54 patients or convalescents tested for leptospirosis were seropositive. Two cases showed a confirmed infection for both plague and leptospirosis. While evidence supports the plague nature of this outbreak, the results suggest that some of the suspected plague cases might be due to leptospirosis. In any case, this diagnosis will have to be evoked in the future if a similar outbreak occurs in this region of Africa.
Papp, John F.
The U.S. Geological Survey (USGS) analyzes mineral and metal supply chains to identify and describe major components of mineral and metal material flows from ore extraction, through intermediate forms, to a final product. Supply chain analyses may be used (1) to identify risks to the United States associated with the supply of critical and strategic minerals and metals and (2) to provide greater supply chain transparency so that policymakers have the fact-based information needed to formulate public policy. This fact sheet focuses on the post-mining/pre-consumer-product part of the tantalum supply chain. The USGS National Minerals Information Center (NMIC) has been asked by governmental and non-governmental organizations to provide information about tantalum, tin, tungsten, and gold (collectively known as “3TG minerals”) processing facilities worldwide in response to U.S. legislation aimed at identifying and removing the supply chain links between the trade in these minerals and civil unrest in the Democratic Republic of the Congo and adjacent countries.
Narat, Victor; Guillot, Jacques; Pennec, Flora; Lafosse, Sophie; Grüner, Anne Charlotte; Simmen, Bruno; Bokika Ngawolo, Jean Christophe; Krief, Sabrina
Phylogenetic and geographic proximities between humans and apes pose a risk of zoonotic transmission of pathogens. Bonobos (Pan paniscus) of the Bolobo Territory, Democratic Republic of the Congo, live in a fragmented forest-savanna mosaic setting, a marginal habitat for this species used to living in dense forests. Human activities in the forest have increased the risk of contacts between humans and bonobos. Over 21 months (September 2010-October 2013), we monitored intestinal parasites in bonobo (n = 273) and in human (n = 79) fecal samples to acquire data on bonobo parasitology and to assess the risk of intestinal helminth transmission between these hosts. Coproscopy, DNA amplification, and sequencing of stored dried feces and larvae were performed to identify helminths. Little difference was observed in intestinal parasites of bonobos in this dryer habitat compared to those living in dense forests. Although Strongylids, Enterobius sp., and Capillaria sp. were found in both humans and bonobos, the species were different between the hosts according to egg size or molecular data. Thus, no evidence of helminth transmission between humans and bonobos was found. However, because humans and this threatened species share the same habitat, it is essential to continue to monitor this risk.
Mwandagalirwa, Melchior Kashamuka; Levitz, Lauren; Thwai, Kyaw L; Parr, Jonathan B; Goel, Varun; Janko, Mark; Tshefu, Antoinette; Emch, Michael; Meshnick, Steven R; Carrel, Margaret
The Democratic Republic of the Congo (DRC) bears a large share of global malaria burden despite efforts to control and eliminate the disease. More detailed understanding of individual and household level characteristics associated with malaria are needed, as is an understanding of how these characteristics vary spatiotemporally and across different community-level malaria endemicities. An ongoing study in Kinshasa Province is designed to address gaps in prior malaria surveillance in the DRC by monitoring malaria across seasons, age groups and in high and low malaria sites. Across seven sites, 242 households and 1591 individuals are participating in the study. Results of the enrollment questionnaire, rapid diagnostic tests and PCR testing of dried blood spots are presented. Overall malaria prevalence in the study cohort is high, 27% by rapid diagnostic test and 31% by polymerase chain reaction, and malaria prevalence is highly varied across very small geographic distances. Malaria prevalence is highest in children aged 6-15. While the majority of households own bed nets, bed net usage is less than 50%. The study cohort will provide an understanding of how malaria persists in populations that have varying environmental exposures, varying community-level malaria, and varying access to malaria control efforts.
Lukuke, Hendrick Mbutshu; Kasamba, Eric; Mahuridi, Abdulu; Nlandu, Roger Ngatu; Narufumi, Suganuma; Mukengeshayi, Abel Ntambue; Malou, Vicky; Makoutode, Michel; Kaj, Françoise Malonga
In Intertropical Africa hospitalized patients are exposed to a risk of nosocomial infections. The dearth of published data on this subject limits the descriptive analysis of the situation. This study aimed to determine the incidence, the germs responsible for these infections and the risk factors of nosocomial infections in the Maternity Ward at the General Referral Hospital in Katuba, Lubumbashi, Democratic Republic of the Congo. We conducted a descriptive, longitudinal study from 1 October 2014 to 1 January 2015. Our study population consisted of 207 women who had been hospitalized in the Maternity Ward at the General Referral Hospital in Katuba. We carried out a comprehensive data collection. Nosocomial infection rate accounted for 15.5%. Parturient women who had been hospitalized for more than three days were three times more likely to develop a nosocomial infection (p=0.003), while those who had had a complicated delivery were four times more likely to be at risk of developing nosocomial infection (p = 0.000). Escherichia coli was the most isolated causative agent (38.1%), followed by Citrobacter freundi (23.8%), Acinobacter baumani (.18, 2%), Staphylococcus aureus (18.2%), Enterococcus aureus (14.3%) and Pseudomonas aeroginosa (9.1%). Ampicillin was the most prescribed antibiotic, to which isolated microbes were resistant. It is necessary to improve hospital hygiene and to conduct further study to examine the similarity between germs strains in the environment and those in biological fluids.
Bass, Judith K; Ryder, Robert W; Lammers, Marie-Christine; Mukaba, Thibaut N; Bolton, Paul A
To determine if a post-partum depression syndrome exists among mothers in Kinshasa, Democratic Republic of Congo, by adapting and validating standard screening instruments. Using qualitative interviewing techniques, we interviewed a convenience sample of 80 women living in a large peri-urban community to better understand local conceptions of mental illness. We used this information to adapt two standard depression screeners, the Edinburgh Post-partum Depression Scale and the Hopkins Symptom Checklist. In a subsequent quantitative study, we identified another 133 women with and without the local depression syndrome and used this information to validate the adapted screening instruments. Based on the qualitative data, we found a local syndrome that closely approximates the Western model of major depressive disorder. The women we interviewed, representative of the local populace, considered this an important syndrome among new mothers because it negatively affects women and their young children. Women (n = 41) identified as suffering from this syndrome had statistically significantly higher depression severity scores on both adapted screeners than women identified as not having this syndrome (n = 20; P depression and validated instruments to screen for this disorder. As the importance of compromised mental health in developing world populations becomes recognized, the methods described in this report will be useful more widely.
The U.S. Geological Survey (USGS) analyzes supply chains to identify and define major components of mineral and material flows from ore extraction, through intermediate forms, to a final product. Two major reasons necessitate these analyses: (1) to identify risks associated with the supply of critical and strategic minerals to the United States and (2) to provide greater supply chain transparency so that policymakers have the information necessary to ensure domestic legislation compliance. This fact sheet focuses on the latter. The USGS National Minerals Information Center has been asked by governmental and non-governmental organizations to provide information on tin, tantalum, tungsten, and gold (collectively known as “3TG minerals”) processing facilities worldwide in response to U.S. legislation aimed at removing the link between the trade in these minerals and civil unrest in the Democratic Republic of the Congo. Post beneficiation processing plants (smelters and refineries) of 3TG mineral ores and concentrates were identified by company and industry association representatives as being the link in the 3TG mineral supply chain through which these minerals can be traced to their source of origin (mine); determining the point of origin is critical to establishing a transparent conflict mineral supply chain. This fact sheet, the first in a series of 3TG mineral fact sheets, focuses on the tungsten supply chain by listing plants that consume tungsten concentrates to produce ammonium paratungstate and ferrotungsten worldwide.
Ntambue, Abel Mukengeshayi; Tshiala, Rachel Ngalula; Malonga, Françoise Kaj; Ilunga, Tabitha Mpoyi; Kamonayi, Josaphat Mulumba; Kazadi, Simon Tshimankinda; Matungulu, Charles Matungu; Musau, Angel Nkola; Mulamba, Diese; Dramaix-Wilmet, Michèle; Donnen, Philippe
This study aimed to determine modern contraceptive prevalence and the barriers to using modern contraceptive methods among the couples in Dibindi health zone, Mbuji-Mayi, in the Democratic Republic of the Congo. We conducted a cross-sectional descriptive study from May to June 2015. Nonpregnant married women aged 15-49 years old at the time of the investigation, living in Dibindi health zone for two years and having freely consented to participate in the study were included. Data were collected by open-ended interview of these women. Modern contraceptive prevalence was referred to women who were currently using, at the time of the investigation, modern contraceptives. The comparison between proportions was performed at the significance threshold of 5%. Bonferroni's test was used to compare, two by two, the proportions of barriers to using modern contraceptive methods. Modern contraceptive prevalence in Dibindi was 18.4% in 2015. It was low with regard to family planning services available in this health zone. Several women refused to use modern contraceptive methods despite available information because of their desire for motherhood, religious prohibition, opposition on the part of their husband and fear of side effects. Sufficient client-centered or couple-centered information and family planning information should be strengthened in order to eliminate the false beliefs and to increase the use of modern contraceptive methods.
Joseph N. Inungu
Full Text Available Background. Insecticide-treated mosquito nets (ITNs are one of the most effective tools for preventing malaria in sub-Saharan Africa. Objective. This study examined knowledge, attitude, and practice on the use of ITNs in the prevention of malaria among pregnant women and guardians of children under five in the Democratic Republic of the Congo. Methods. A total of 5,138 pregnant women and guardians of children under five were interviewed. Results. The majority of participants (>80% knew the signs and symptoms of malaria; 81.6% reported having an ITN in the household, but 78.4% reported using it the night before the interview. Only 71.4% of pregnant women used ITN the night compared to 68.2% of children under five. In the Logistic Regression model, women who believed that it is normal to use ITNs were 1.9 times more likely to use it than those who did not (OR: 1.930; women who were confident in their abilities to use ITNs were 1.9 times more likely than those who were not confident (OR: 1.915; and women who had a good attitude towards ITNs were also more likely to use ITNs compared to those who did not (OR: 1.529. Conclusion. New and innovative evidence-based behavior change interventions are needed to increase the utilization of ITNs among vulnerable groups.
Grolla, A; Jones, S; Kobinger, G; Sprecher, A; Girard, G; Yao, M; Roth, C; Artsob, H; Feldmann, H; Strong, J E
The mobile laboratory provides a safe, rapid and flexible platform to provide effective diagnosis of Ebola virus as well as additional differential diagnostic agents in remote settings of equatorial Africa. During the 2007 Democratic Republic of Congo outbreak of Ebola-Zaire, the mobile laboratory was set up in two different locations by two separate teams within a day of equipment arriving in each location. The first location was in Mweka where our laboratory took over the diagnostic laboratory space of the local hospital, whereas the second location, approximately 50 km south near Kampungu at the epicentre of the outbreak, required local labour to fabricate a tent structure as a suitable pre-existing structure was not available. In both settings, the laboratory was able to quickly set up, providing accurate and efficient molecular diagnostics (within 3 h of receiving samples) for 67 individuals, including four cases of Ebola, seven cases of Shigella and 13 cases of malaria. This rapid turn-around time provides an important role in the support of patient management and epidemiological surveillance. © 2012 Blackwell Verlag GmbH.
Kranz, Olaf; Lang, Stefan; Schoepfer, Elisabeth
Mining natural resources serve fundamental societal needs or commercial interests, but it may well turn into a driver of violence and regional instability. In this study, very high resolution (VHR) optical stereo satellite data are analysed to monitor processes and changes in one of the largest artisanal and small-scale mining sites in the Democratic Republic of the Congo, which is among the world's wealthiest countries in exploitable minerals To identify the subtle structural changes, the applied methodological framework employs object-based change detection (OBCD) based on optical VHR data and generated digital surface models (DSM). Results prove the DSM-based change detection approach enhances the assessment gained from sole 2D analyses by providing valuable information about changes in surface structure or volume. Land cover changes as analysed by OBCD reveal an increase in bare soil area by a rate of 47% between April 2010 and September 2010, followed by a significant decrease of 47.5% until March 2015. Beyond that, DSM differencing enabled the characterisation of small-scale features such as pits and excavations. The presented Earth observation (EO)-based monitoring of mineral exploitation aims at a better understanding of the relations between resource extraction and conflict, and thus providing relevant information for potential mitigation strategies and peace building.
Ribesse, Nathalie; Bossyns, Paul; Marchal, Bruno; Karemere, Hermes; Burman, Christopher J; Macq, Jean
In the field of development cooperation, interest in systems thinking and complex systems theories as a methodological approach is increasingly recognised. And so it is in health systems research, which informs health development aid interventions. However, practical applications remain scarce to date. The objective of this article is to contribute to the body of knowledge by presenting the tools inspired by systems thinking and complexity theories and methodological lessons learned from their application. These tools were used in a case study. Detailed results of this study are in process for publication in additional articles. Applying a complexity 'lens', the subject of the case study is the role of long-term international technical assistance in supporting health administration reform at the provincial level in the Democratic Republic of Congo. The Methods section presents the guiding principles of systems thinking and complex systems, their relevance and implication for the subject under study, and the existing tools associated with those theories which inspired us in the design of the data collection and analysis process. The tools and their application processes are presented in the results section, and followed in the discussion section by the critical analysis of their innovative potential and emergent challenges. The overall methodology provides a coherent whole, each tool bringing a different and complementary perspective on the system.
Pierre Zalagile Akilimali
Full Text Available Anaemia is associated with adverse outcomes including early death in the first year of antiretroviral therapy (ART. This study reports on the factors associated with persistent anaemia among HIV-infected patients initiating ART in the Democratic Republic of Congo (DR Congo.We conducted a retrospective cohort study and analyzed data from patients receiving HIV care between January 2004 and December 2012 at two major hospitals in Goma, DR Congo. Haemoglobin concentrations of all patients on ART regimen were obtained prior to and within one year of ART initiation. A logistic regression model was used to identify the predictors of persistent anaemia after 12 months of ART.Of 756 patients, 69% of patients were anaemic (IC95%: 65.7-72.3 at baseline. After 12 months of follow up, there was a 1.2 g/dl average increase of haemoglobin concentration (P < 0.001 with differences depending on the therapeutic regimen. Patients who received zidovudine (AZT gained less than those who did not receive AZT (0.99 g/dl vs 1.33 g/dl; p< 0.001. Among 445 patient who had anaemia at the beginning, 33% (147/445 had the condition resolved. Among patients with anaemia at ART initiation, those who did not receive cotrimoxazole prophylaxis before starting ART(AOR 3.89; 95% CI 2.09-7.25; P < 0.001 and a AZT initial regimen (AOR 2.19; 95% CI 1.36-3.52; P < 0.001 were significantly at risk of persistent anaemia.More than two thirds of patients had anaemia at baseline. The AZT-containing regimen and absence of cotrimoxazole prophylaxis before starting ART were associated with persistent anaemia 12 months, after initiation of treatment. Considering the large proportion of patients with persistence of anaemia at 12 months, we suggest that it is necessary to conduct a large study to assess anaemia among HIV-infected patients in Goma.
Mawaw, Paul; Yav, Thierry; Lukanka, Olivier; Mukuku, Olivier; Kakisingi, Christian; Kakoma, Jean-Baptiste; Luboya, Oscar Numbi
Obesity is known as one of adjuvant factors for increase in non-communiable diseases (NCDs). The aim of this study was to describe the prevalence of obesity and identify its risk factors among women of the central market of Lusonga in Lubumbashi, Democratic Republic of Congo. In October 2014, we interviewed a total of 430 women selling in the central market of Lusonga in Lubumbashi. Data on sociodemographic characteristics, health-related habits and behaviors, diet, physical activity, chronic diseases, blood pressure and anthropometric measurements were collected. A multivariate logistic regression model was fitted. Prevalence of overweight and obesity was 16.51% and 13.26% respectively. The logistic regression did not show any significant association between age and obesity. Risk of obesity was lower in married women (adjusted odds ratio (aOR) = 0.23 (0.08-0.63)). Women with low educational profile (primary school or less) were more likely to be obese than those with higher education (secondary or high school) (aOR = 2.50 (1.12-5.63)). Risk of obesity increased with living in urban area (aOR = 2.52 (1.00-6.36)), use of oral birth control pills (aOR = 11.07 (3.52-34.83)) and low consumption of fruit (aOR = 5.47 (1.88-15.92)) and vegetable (aOR = 2.42 (1.05-5.56)). Obese women were more likely to be hypertensive than non-obese (aOR = 7.15 (2.46-20.75)) and diabetics (aOR = 3.62 (1.62-8.11)). This study has reported a prevalence of 13.26% of obesity among women selling at Lusonga's market. Marital status, education level, residence, use of oral birth control pills and consumption of fruit and vegetables had a significant association with the prevalence of obesity in this category of women.
Murray, S M; Augustinavicius, J; Kaysen, D; Rao, D; Murray, L K; Wachter, K; Annan, J; Falb, K; Bolton, P; Bass, J K
Sexual violence is associated with a multitude of poor physical, emotional, and social outcomes. Despite reports of stigma by sexual violence survivors, limited evidence exists on effective strategies to reduce stigma, particularly in conflict-affected settings. We sought to assess the effect of group Cognitive Processing Therapy (CPT) on stigma and the extent to which stigma might moderate the effectiveness of CPT in treating mental health problems among survivors of sexual violence in the Democratic Republic of Congo. Data were drawn from 405 adult female survivors of sexual violence reporting mental distress and poor functioning in North and South Kivu. Women were recruited through organizations providing psychosocial support and then cluster randomized to group CPT or individual support. Women were assessed at baseline, the end of treatment, and again six months later. Assessors were masked to women's treatment assignment. Linear mixed-effect regression models were used to estimate (1) the effect of CPT on feelings of perceived and internalized (felt) stigma, and (2) whether felt stigma and discrimination (enacted stigma) moderated the effects of CPT on combined depression and anxiety symptoms, posttraumatic stress, and functional impairment. Participants receiving CPT experienced moderate reductions in felt stigma relative to those in individual support (Cohen's D = 0.44, p = value = 0.02) following the end of treatment, though this difference was no longer significant six-months later (Cohen's D = 0.45, p = value = 0.12). Neither felt nor enacted stigma significantly moderated the effect of CPT on mental health symptoms or functional impairment. Group cognitive-behavioral based therapies may be an effective stigma reduction tool for survivors of sexual violence. Experiences and perceptions of stigma did not hinder therapeutic effects of group psychotherapy on survivors' mental health. ClinicalTrials.gov NCT01385163.
Kilunga, Pitchouna I; Sivalingam, Periyasamy; Laffite, Amandine; Grandjean, Dominique; Mulaji, Crispin K; de Alencastro, Luiz Felippe; Mpiana, Pius T; Poté, John
The increasing contamination of fresh water resource by toxic metals and Persistence Organic Pollutants (POPs) is a major environmental concern globally. In the present investigation, surface sediments collected from three main rivers named, Makelele, Kalamu and Nsanga, draining through the city of Kinshasa, Democratic Republic of the Congo, were characterized for grain size, organic matter, toxic metals, POPs (including organochlorine pesticides (OCPs), polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs)), and polycyclic aromatic hydrocarbons (PAHs). Furthermore, enrichment factor (EF) and geoaccumulation index (Igeo) were performed to determine metal source and pollution status. The results highlighted high concentration of toxic metals in all sediment samples, reaching the values (mg kg -1 ) of 325 (Cu), 549 (Zn), 165 (Pb) and 1.5 (Cd). High values of PCBs and OCPs were detected in sediment samples, e.g. in Makelele river, PCB values ranged from 0.9 to 10.9 with total PCBs (∑7 PCBs × 4.3): 169.3 μg kg -1 ; OCPs from 21.6 to 146.8 with ∑OCPs: 270.6 μg kg -1 . The PBDEs concentrations were higher in investigated rivers comparatively with values detected in many rivers from Sub-Saharan Africa. The ΣPAHs value ranged from 22.6 to 1011.9 μg kg -1 . River contamination may be explained by local intense domestic activities, urban and agricultural runoff, industrial and hospital wastewaters discharge into the rivers without prior treatment. This research provides not only a first baseline information on the extent of contamination in this tropical ecosystem but also represents useful tools incorporated to evaluate sediment quality in the river receiving systems which can be applied to similar aquatic environments. Copyright © 2017 Elsevier Ltd. All rights reserved.
Mwanamoki, Paola M; Devarajan, Naresh; Thevenon, Florian; Atibu, Emmanuel K; Tshibanda, Joseph B; Ngelinkoto, Patience; Mpiana, Pius T; Prabakar, Kandasamy; Mubedi, Josué I; Kabele, Christophe G; Wildi, Walter; Poté, John
This study was conducted to assess potential human health risks presented by pathogenic bacteria in a protected multi-use lake-reservoir (Lake Ma Vallée) located in west of Kinshasa, Democratic Republic of Congo (DRC). Water and surface sediments from several points of the Lake were collected during summer. Microbial analysis was performed for Escherichia coli, Enterococcus (ENT), Pseudomonas species and heterotrophic plate counts. PCR amplification was performed for the confirmation of E. coli, ENT, Pseudomonas spp. and Pseudomonas aeruginosa isolated from samples. The results reveal low concentration of bacteria in water column of the lake, the bacterial quantification results observed in this study for the water column were below the recommended limits, according to WHO and the European Directive 2006/7/CE, for bathing water. However, high concentration of bacteria was observed in the sediment samples; the values of 2.65 × 10(3), 6.35 × 10(3), 3.27 × 10(3) and 3.60 × 10(8) CFU g(-1) of dry sediment for E. coli, ENT, Pseudomonas spp. and heterotrophic plate counts, respectively. The results of this study indicate that sediments of the Lake Ma Vallée can constitute a reservoir of pathogenic microorganisms which can persist in the lake. Possible resuspension of faecal indicator bacteria and pathogens would affect water quality and may increase health risks to the population during recreational activities. Our results indicate that the microbial sediment analysis provides complementary and important information for assessing sanitary quality of surface water under tropical conditions.
Full Text Available It remains to be seen whether the past few months will mark a genuine turning point in the conflict in eastern Democratic Republic of Congo (DRC, as the rebel faction March 23 Movement (M23 announced the end of its 20-month insurgency against the government on 5 November 2013. News of the rebel group’s surrender following its political and military defeat signals an important moment of hope and renewed prospects of peace and stability in a region prone to protracted armed conflict. However, long-term stability in the country and in the region will require a multi-faceted process consisting of comprehensive accountability for human rights violations that have been committed by all parties to the conflict. In this article, I will first lay out the historical context of the fighting and the root causes of conflict present long before M23’s entrance onto the scene as a splintered rebel faction so as to understand M23’s place within the country’s history of protracted violence. Next, I will explain the violations of international humanitarian and human rights law committed by all possible parties, including rebel and government groups, as well as individual criminal responsibility and corporate liability. Lastly, I will chart the pathways of criminal and social accountability at various levels of international and domestic justice systems to see how the DRC may continue to build long-term local stability in the eastern parts of the country by addressing the question of accountability for international crimes. This brief analysis aims to provide a broader understanding of a complex conflict beyond the defeat and disarmament of M23, albeit a key group in a region of contentious cross-border conflict.
Molinario, G.; Hansen, M. C.; Potapov, P. V.
Shifting cultivation has traditionally been practiced in the Democratic Republic of Congo by carving agricultural fields out of primary and secondary forest, resulting in the rural complex: a characteristic land cover mosaic of roads, villages, active and fallow fields and secondary forest. Forest clearing has varying impacts depending on where it occurs relative to this area: whether inside it, along its primary forest interface, or in more isolated primary forest areas. The spatial contextualization of forest cover loss is therefore necessary to understand its impacts and plan its management. We characterized forest clearing using spatial models in a Geographical Information System, applying morphological image processing to the Forets d’Afrique Central Evaluee par Teledetection product. This process allowed us to create forest fragmentation maps for 2000, 2005 and 2010, classifying previously homogenous primary forest into separate patch, edge, perforated, fragmented and core forest subtypes. Subsequently we used spatial rules to map the established rural complex separately from isolated forest perforations, tracking the growth of these areas in time. Results confirm that the expansion of the rural complex and forest perforations has high variance throughout the country, with consequent differences in local impacts on forest ecology and habitat fragmentation. Between 2000 and 2010 the rural complex grew by 10.2% (46 182 ha), increasing from 11.9% to 13.1% of the total land area (1.2% change) while perforated forest grew by 74.4% (23 856 ha), from 0.8% to 1.5%. Core forest decreased by 3.8% (54 852 ha), from 38% to 36.6% of the 2010 land area. Of particular concern is the nearly doubling of perforated forest, a land dynamic that represents greater spatial intrusion of forest clearing within core forest areas and a move away from the established rural complex.
Charchuk, Rhianna; Paul, Makelele Katsuva Jean; Claude, Kasereka Masumbuko; Houston, Stan; Hawkes, Michael T
In the Democratic Republic of the Congo (DRC), violent conflict has caused the displacement of millions of people into camps where they are exposed to poor living conditions and high rates of infectious diseases. Malaria, in particular, is a major cause of mortality in children under five; however, the burden of disease in displacement camps has not previously been described. Two cross-sectional surveys were performed. First, prevalence of Plasmodium falciparum antigenemia was measured in a random sample of 200 children living in a displacement camp and 200 children from a nearby village (control group). Second, the proportion of febrile illness attributable to malaria was measured in a study of 100 children from the displacement camp and 100 children from the control village presenting to the same health clinic with fever. All participants were tested for P. falciparum with a rapid diagnostic test and additional demographic data, clinical characteristics, and malaria risk factors were determined using a parental questionnaire. In the community survey, children living in the displacement camp had a higher prevalence of P. falciparum infection (17 %) than controls (7.5 %) (OR 2.6; 95 % CI 1.3-4.1; P = 0.0095). In the clinic-based survey, the proportion of febrile illness attributable to malaria was higher among children from the displacement camp (78 %) than controls (39 %) (OR 5.5; 95 % CI 3.0-10.3; P displacement camp than control village in both surveys. Statistically significant differences in household wealth, maternal education, and exposure to community violence were also found. Population displacement due to violent conflict appears to be a risk factor for malaria, a major cause of child mortality. Children living in displacement camps are a relatively understudied population, but have a high burden of malaria, despite control programmes focused on bed net distribution.
Kat S Rock
Full Text Available Two goals have been set for Gambian human African trypanosomiasis (HAT, the first is to achieve elimination as a public health problem in 90% of foci by 2020, and the second is to achieve zero transmission globally by 2030. It remains unclear if certain HAT hotspots could achieve elimination as a public health problem by 2020 and, of greater concern, it appears that current interventions to control HAT in these areas may not be sufficient to achieve zero transmission by 2030. A mathematical model of disease dynamics was used to assess the potential impact of changing the intervention strategy in two high-endemicity health zones of Kwilu province, Democratic Republic of Congo. Six key strategies and twelve variations were considered which covered a range of recruitment strategies for screening and vector control. It was found that effectiveness of HAT screening could be improved by increasing effort to recruit high-risk groups for screening. Furthermore, seven proposed strategies which included vector control were predicted to be sufficient to achieve an incidence of less than 1 reported case per 10,000 people by 2020 in the study region. All vector control strategies simulated reduced transmission enough to meet the 2030 goal, even if vector control was only moderately effective (60% tsetse population reduction. At this level of control the full elimination threshold was expected to be met within six years following the start of the change in strategy and over 6000 additional cases would be averted between 2017 and 2030 compared to current screening alone. It is recommended that a two-pronged strategy including both enhanced active screening and tsetse control is implemented in this region and in other persistent HAT foci to ensure the success of the control programme and meet the 2030 elimination goal for HAT.
Kelly, Jocelyn; Albutt, Katherine; Kabanga, Justin; Anderson, Kimberley; VanRooyen, Michael
Female survivors of sexual violence in conflict experience not only physical and psychological sequelae from the event itself, but often many negative social outcomes, such as rejection and ostracisation from their families and community. Male relatives - whether husbands, fathers, brothers - play a key role in determining how the family and community respond to a survivor of sexual violence. Understanding these perspectives could help improve services for survivors of sexual violence, as well as their families and communities. This study draws on qualitative data gathered from focus groups of 68 men in the eastern region of Democratic Republic of Congo. Men were asked about their experiences as relatives of women who had experienced sexual violence. Two dominant themes arose throughout the focus groups: factors driving rejection and pathways to acceptance. Factors driving rejection included: fear of sexually transmitted infections, social stigma directed toward the husbands themselves, and an understanding of marriage and fidelity that is incompatible with rape. Men also touched on their own trauma, including struggling with witnessing a rape that took place in public, or caring for a survivor with a child from rape. They noted that the economic burden of medical treatment for survivors was a salient factor in the decision to reject. Pathways to acceptance included factors such as the love of their spouse or relative, survivors' potential to give continued financial contribution to the family, the need to keep the family together to care for children in the home, and pressure from people of importance in the community. This study provides unique insight into how male relatives respond to close family members who have experienced sexual violence. This is particularly critical since the reaction of a male relative after rape can be the most pivotal factor in promoting or impeding recovery for a survivor. These results emphasise the importance of services that focus
Kaboru, Berthollet Bwira; Ogwang, Brenda A; Namegabe, Edmond Ntabe; Mbasa, Ndemo; Kabunga, Deka Kambale; Karafuli, Kambale
HIV/AIDS and Tuberculosis (TB) are major contributors to the burden of disease in sub-Saharan Africa. The two diseases have been described as a harmful synergy as they are biologically and epidemiologically linked. Control of TB/HIV co-infection is an integral and most challenging part of both national TB and national HIV control programmes, especially in contexts of instability where health systems are suffering from political and social strife. This study aimed at assessing the provision of HIV/TB co-infection services in health facilities in the conflict-ridden region of Goma in Democratic Republic of Congo. A cross-sectional survey of health facilities that provide either HIV or TB services or both was carried out. A semi-structured questionnaire was used to collect the data which was analysed using descriptive statistics. Eighty facilities were identified, of which 64 facilities were publicly owned. TB care was more available than HIV care (in 61% vs. 9% of facilities). Twenty-three facilities (29%) offered services to co-infected patients. TB/HIV co-infection rates among patients were unknown in 82% of the facilities. Only 19 facilities (24%) reported some coordination with and support from concerned diseases' control programmes. HIV and TB services are largely fragmented, indicating imbalances and poor coordination by disease control programmes. HIV and TB control appear not to be the focus of health interventions in this crisis affected region, despite the high risks of TB and HIV infection in the setting. Comprehensive public health response to this setting calls for reforms that promote joint TB/HIV co-infection control, including improved leadership by the HIV programmes that accuse weaknesses in this conflict-ridden region.
Maketa, Vivi; Vuna, Mimy; Baloji, Sylvain; Lubanza, Symphorien; Hendrickx, David; Inocêncio da Luz, Raquel Andrea; Boelaert, Marleen; Lutumba, Pascal
In Democratic Republic of Congo access to health care is limited because of many geographical and financial barriers, while quality of care is often low. Global health donors assist the country with a number of community-oriented interventions such as free distribution of bednets, antihelminthic drugs, vitamin A supplementation and vaccination campaigns, but uptake of these interventions is not always optimal. The aim of this study was to explore the perceptions of poor urban communities of the capital Kinshasa with regard to health issues in general as well as their experiences and expectations concerning facility-based health services and community-oriented health interventions. Applying an approach rooted in the grounded theory framework, focus group discussions were conducted in eight neighborhoods of poor urban areas in the city of Kinshasa in July 2011. Study participants were easily able to evoke the city's major health problems, with the notable exceptions of malnutrition and HIV/AIDS. They perceive the high out-of-pocket cost of health services as the major obstacle when seeking access to quality care. Knowledge of ongoing community-oriented health interventions seems good. Still, while the study participants agree that those interventions are beneficial; their acceptability seems to be problematic. This is chiefly put down to a lack of information and government communication about the programs and their interventions. Furthermore, the study participants referred to rumors and the deterring effect of stories about alleged harmful consequences of those interventions. Along with improving the provision and quality of general health care, the government and international actors must improve their efforts in informing the communities about disease control programs, their rationale and benefit/risk ratio. Directly engaging community members in a dialogue might be beneficial in terms of improving acceptability and overall access to health services and
Kilangalanga, Janvier; Ndjemba, Jean Marie; Uvon, Pitchouna A; Kibangala, Felix M; Mwandulo, Jean-Lebone Safari B; Mavula, Nicaise; Ndombe, Martin; Kazadi, Junior; Limbaka, Henry; Cohn, Daniel; Tougoue, Jean-Jacques; Kabore, Achille; Rotondo, Lisa; Willis, Rebecca; Bio, Amadou Alfa; Kadri, Boubacar; Bakhtiari, Ana; Ngondi, Jeremiah M; Solomon, Anthony W
Trachoma was suspected to be endemic in parts of the Democratic Republic of the Congo (DRC). We aimed to estimate prevalences of trachomatous inflammation-follicular (TF), trichiasis, and water and sanitation (WASH) indicators in suspected-endemic Health Zones. A population-based prevalence survey was undertaken in each of 46 Health Zones across nine provinces of DRC, using Global Trachoma Mapping Project methods. A two-stage cluster random sampling design was used in each Health Zone, whereby 25 villages (clusters) and 30 households per cluster were sampled. Consenting eligible participants (children aged 1-9 years and adults aged ≥15 years) were examined for trachoma by GTMP-certified graders; households were assessed for access to WASH. A total of 32,758 households were surveyed, and 141,853 participants (98.2% of those enumerated) were examined for trachoma. Health Zone-level TF prevalence in 1-9-year-olds ranged from 1.9-41.6%. Among people aged ≥15 years, trichiasis prevalences ranged from 0.02-5.1% (95% CI 3.3-6.8). TF prevalence in 1-9-year-olds was ≥5% in 30 Health Zones, while trichiasis prevalence was ≥0.2% in 37 Health Zones. Trachoma is a public health problem in 39 of 46 Health Zones surveyed. To meet elimination targets, 37 Health Zones require expanded trichiasis surgery services while 30 health zones require antibiotics, facial cleanliness and environmental improvement interventions. Survey data suggest that trachoma is widespread: further surveys are warranted.
Owino, Victor O; Bahwere, Paluku; Bisimwa, Ghislain; Mwangi, Christine M; Collins, Steve
Lipid-based ready-to-use foods are currently used for infant feeding, but their potential effect on breast-milk intake is not well documented. The objective was to assess the breast-milk intake of 9-10-mo-old infants given either a ready-to-use complementary food (RUCF) paste or a standard corn-soy blend (UNIMIX) porridge in South Kivu, Democratic Republic of Congo. Infants were randomly assigned at 6 mo of age to receive either RUCF (n = 700) or UNIMIX (n = 700) for 6 mo. Breast-milk intake was measured at 9-10 mo in a subsample of 58 infants (29 from each group). Mothers received a dose of ≈30 g deuterium oxide. Predose and postdose saliva samples were collected from both mothers and infants over 2 wk. Breast-milk intake (g/d) was measured from saliva samples by using infrared spectroscopy. Mean (±SD) breast-milk intake was not significantly (P = 0.69) different between the 2 groups: RUCF (705 ± 236 g/d) and UNIMIX (678 ± 285 g/d). Mean (±SD) nonmilk oral water intakes were 338.3 ± 251.1 and 336.4 ± 227.2 g/d for RUCF and UNIMIX, respectively (P = 0.98). No differences in breast-milk intake were observed between infants consuming either RUCF or UNIMIX. The deuterium-dose-to-the-mother dilution technique is an affordable technique that we recommend for periodic evaluation of breast-milk intake in resource-poor settings. This trial is registered at controlled-trials.com as ISRCTN20267635.
Boisson, Sophie; Kiyombo, Mbela; Sthreshley, Larry; Tumba, Saturnin; Makambo, Jacques; Clasen, Thomas
Household water treatment can improve the microbiological quality of drinking water and may prevent diarrheal diseases. However, current methods of treating water at home have certain shortcomings, and there is evidence of bias in the reported health impact of the intervention in open trial designs. We undertook a randomised, double-blinded, placebo-controlled trial among 240 households (1,144 persons) in rural Democratic Republic of Congo to assess the field performance, use and effectiveness of a novel filtration device in preventing diarrhea. Households were followed up monthly for 12 months. Filters and placebos were monitored for longevity and for microbiological performance by comparing thermotolerant coliform (TTC) levels in influent and effluent water samples. Mean longitudinal prevalence of diarrhea was estimated among participants of all ages. Compliance was assessed through self-reported use and presence of water in the top vessel of the device at the time of visit. Over the 12-month follow-up period, data were collected for 11,236 person-weeks of observation (81.8% total possible). After adjusting for clustering within the household, the longitudinal prevalence ratio of diarrhoea was 0.85 (95% confidence interval: 0.61-1.20). The filters achieved a 2.98 log reduction in TTC levels while, for reasons that are unclear, the placebos achieved a 1.05 log reduction (pwater the previous day. The filter maintained a constant flow rate over time, though 12.4% of filters were damaged during the course of the study. While the filter was effective in improving water quality, our results provide little evidence that it was protective against diarrhea. The moderate reduction observed nevertheless supports the need for larger studies that measure impact against a neutral placebo. Current Controlled Trials ISRCTN03844341.
Kismul, Hallgeir; Hatløy, Anne; Andersen, Peter; Mapatano, Mala; Van den Broeck, Jan; Moland, Karen Marie
The magnitude of child malnutrition including severe child malnutrition is especially high in the rural areas of the Democratic Republic of Congo (the DRC). The aim of this qualitative study is to describe the social context of malnutrition in a rural part of the DRC and explore how some households succeed in ensuring that their children are well-nourished while others do not. This study is based on participant observation, key informant interviews, group discussions and in-depth interviews with four households with malnourished children and four with well-nourished children. We apply social field theory to link individual child nutritional outcomes to processes at local level and to the wider socio-economic environment. We identified four social fields that have implications for food security and child nutritional outcomes: 1) household size and composition which determined vulnerability to child malnutrition, 2) inter-household cooperation in the form of 'gbisa work party' which buffered scarcity of labour in peak seasons and facilitated capital accumulation, 3) the village associated with usufruct rights to land, and 4) the local NGO providing access to agricultural support, clean drinking water and health care. Households that participated in inter-household cooperation were able to improve food and nutrition security. Children living in households with high pressure on productive members were at danger of food insecurity and malnutrition. Nutrition interventions need to involve local institutions for inter-household cooperation and address the problem of social inequalities in service provision. They should have special focus on households with few resources in the form of land, labour and capital.
Full Text Available In Democratic Republic of Congo access to health care is limited because of many geographical and financial barriers, while quality of care is often low. Global health donors assist the country with a number of community-oriented interventions such as free distribution of bednets, antihelminthic drugs, vitamin A supplementation and vaccination campaigns, but uptake of these interventions is not always optimal. The aim of this study was to explore the perceptions of poor urban communities of the capital Kinshasa with regard to health issues in general as well as their experiences and expectations concerning facility-based health services and community-oriented health interventions. Applying an approach rooted in the grounded theory framework, focus group discussions were conducted in eight neighborhoods of poor urban areas in the city of Kinshasa in July 2011. Study participants were easily able to evoke the city's major health problems, with the notable exceptions of malnutrition and HIV/AIDS. They perceive the high out-of-pocket cost of health services as the major obstacle when seeking access to quality care. Knowledge of ongoing community-oriented health interventions seems good. Still, while the study participants agree that those interventions are beneficial; their acceptability seems to be problematic. This is chiefly put down to a lack of information and government communication about the programs and their interventions. Furthermore, the study participants referred to rumors and the deterring effect of stories about alleged harmful consequences of those interventions. Along with improving the provision and quality of general health care, the government and international actors must improve their efforts in informing the communities about disease control programs, their rationale and benefit/risk ratio. Directly engaging community members in a dialogue might be beneficial in terms of improving acceptability and overall access to health
Full Text Available Abstract Background The problem of training human resources in health is a real concern in public health in Central Africa. What can be changed in order to train more competent health professionals? This is of utmost importance in primary health care. Methods Taking into account the level of training of secondary-level nurses in the Democratic Republic of the Congo (DRC, a systemic approach, based on the PRECEDE PROCEED model of analysis, led to a better understanding of the educational determinants and of the factors favourable to a better match between training in health sciences and the expected competences of the health professionals. This article must be read on two complementary levels: one reading, focused on the methodological process, should allow our findings to be transferred to other problems (adaptation of a health promotion model to the educational sphere. The other reading, revolving around the specific theme and results, should provide a frame of reference and specific avenues for action to improve human resources in the health field (using the results of its application in health science teaching in the DRC. Results The results show that it is important to start this training with a global and integrated approach shared by all the actors. The strategies of action entail the need for an approach taking into account all the aspects, i.e. sociological, educational, medical and public health. Conclusions The analysis of the results shows that one cannot bring any change without integrated strategies of action and a multidisciplinary approach that includes all the complex determinants of health behaviour, and to do it within the organization of local structures and institutions in the ministry of health in the DRC.
Parent, Florence; Kahombo, Gérard; Bapitani, Josué; Garant, Michèle; Coppieters, Yves; Levêque, Alain; Piette, Danielle
BACKGROUND: The problem of training human resources in health is a real concern in public health in Central Africa. What can be changed in order to train more competent health professionals? This is of utmost importance in primary health care. METHODS: Taking into account the level of training of secondary-level nurses in the Democratic Republic of the Congo (DRC), a systemic approach, based on the PRECEDE PROCEED model of analysis, led to a better understanding of the educational determinants and of the factors favourable to a better match between training in health sciences and the expected competences of the health professionals. This article must be read on two complementary levels: one reading, focused on the methodological process, should allow our findings to be transferred to other problems (adaptation of a health promotion model to the educational sphere). The other reading, revolving around the specific theme and results, should provide a frame of reference and specific avenues for action to improve human resources in the health field (using the results of its application in health science teaching in the DRC). RESULTS: The results show that it is important to start this training with a global and integrated approach shared by all the actors. The strategies of action entail the need for an approach taking into account all the aspects, i.e. sociological, educational, medical and public health. CONCLUSIONS: The analysis of the results shows that one cannot bring any change without integrated strategies of action and a multidisciplinary approach that includes all the complex determinants of health behaviour, and to do it within the organization of local structures and institutions in the ministry of health in the DRC.
Emina, Jacques B O; Kandala, Ngianga-Bakwin
To analyse trends in diarrhoea prevalence by maternal education, access to clean water and improved sanitation, household wealth index; to identify the sources of variation and assess contribution of changes in socioeconomic characteristics in the Democratic Republic of Congo (DRC). Consecutive cross-sectional surveys. DRC. The databases contain information on 9748 children from the 2001 Multiple Indicators Cluster Survey and 7987 children from the 2007 Demographic and Health Survey. N/A. Whether the child had diarrhoea 14 days preceding the survey. The overall prevalence of diarrhoea decreased by 26 percent (from 22.1% in 2001 to 16.4% in 2007). Findings from the three complementary statistical methods are consistent and confirm a significant decrease in diarrhoea regardless of socioeconomic characteristics. Changes in behaviour and/or in public health policy seem to be the likely main source of the change. There were no significant changes in diarrhoea prevalence associated with variation of the population structure. It is worth mentioning that the decrease in diarrhoea prevalence is in contrast to the generalised poor living conditions of the population. Therefore, it is difficult to ascertain whether the decline in diarrhoea prevalence was due to real improvement in public-health policy or to data quality issues. The decline of diarrhoea prevalence in our study need to be further investigated by conducting district-based or provincial-based studies to validate findings from household surveys such as Demographic and Health Surveys and Multiple Indicators Cluster Survey taking into account the current context of the country: ongoing conflict, poor socioeconomic and poor health infrastructure. However, improvement in living conditions such as access to clean water and improved sanitation will contribute to accelerate the reduction of diarrhoea prevalence as well as reduction of child mortality.
Full Text Available Little is known about the micronutrient status of women and children in the Democratic Republic of the Congo, which is critical for the design of effective nutrition interventions. We recruited 744 mother-child pairs from South Kivu (SK and Kongo Central (KC. We determined hemoglobin (Hb, serum zinc, vitamin B12, folate, ferritin, soluble transferrin receptor (sTfR, retinol binding protein (RBP, C-reactive protein, and α-1 acid glycoprotein concentrations. Anemia prevalence was determined using Hb adjusted for altitude alone and Hb adjusted for both altitude and ethnicity. Anemia prevalence was lower after Hb adjustment for altitude and ethnicity, compared to only altitude, among women (6% vs. 17% in SK; 10% vs. 32% in KC, children 6–23 months (26% vs. 59% in SK; 25% vs. 42% in KC, and children 24–59 months (14% vs. 35% in SK; 23% vs. 44% in KC, respectively. Iron deficiency was seemingly higher with sTfR as compared to inflammation-adjusted ferritin among women (18% vs. 4% in SK; 21% vs. 5% in KC, children 6–23 months (51% vs. 14% in SK; 74% vs. 10% in KC, and children 24–59 months (23% vs. 4% in SK; 58% vs. 1% in KC. Regardless of indicator, iron deficiency anemia (IDA never exceeded 3% in women. In children, IDA reached almost 20% when sTfR was used but was only 10% with ferritin. Folate, B12, and vitamin A (RBP deficiencies were all very low (<5%; RBP was 10% in children. The prevalence of anemia was unexpectedly low. Inflammation-adjusted zinc deficiency was high among women (52% in SK; 58% in KC, children 6–23 months (23% in SK; 20% in KC, and children 24–59 months (25% in SK; 27% in KC. The rate of biochemical zinc deficiency among Congolese women and children requires attention.
Jerlie Loko Roka
Full Text Available BACKGROUND: Outcomes of sexual violence care programmes may vary according to the profile of survivors, type of violence suffered, and local context. Analysis of existing sexual violence care services could lead to their better adaptation to the local contexts. We therefore set out to compare the Médecins Sans Frontières sexual violence programmes in the Democratic Republic of Congo (DRC in a zone of conflict (Masisi, North Kivu and post-conflict (Niangara, Haut-Uélé. METHODS: A retrospective descriptive cohort study, using routine programmatic data from the MSF sexual violence programmes in Masisi and Niangara, DRC, for 2012. RESULTS: In Masisi, 491 survivors of sexual violence presented for care, compared to 180 in Niangara. Niangara saw predominantly sexual violence perpetrated by civilians who were known to the victim (48% and directed against children and adolescents (median age 15 (IQR 13-17, while sexual violence in Masisi was more directed towards adults (median age 26 (IQR 20-35, and was characterised by marked brutality, with higher levels of gang rape, weapon use, and associated violence; perpetrated by the military (51%. Only 60% of the patients in Masisi and 32% of those in Niangara arrived for a consultation within the critical timeframe of 72 hours, when prophylaxis for HIV and sexually transmitted infections is most effective. Survivors were predominantly referred through community programmes. Treatment at first contact was typically efficient, with high (>95% coverage rates of prophylaxes. However, follow-up was poor, with only 49% of all patients in Masisi and 61% in Niangara returning for follow-up, and consequently low rates of treatment and/or vaccination completion. CONCLUSION: This study has identified a number of weak and strong points in the sexual violence programmes of differing contexts, indicating gaps which need to be addressed, and strengths of both programmes that may contribute to future models of context
Ma, Cary; Claude, Kasereka Masumbuko; Kibendelwa, Zacharie Tsongo; Brooks, Hannah; Zheng, Xiaonan; Hawkes, Michael
In zones of violent conflict in the tropics, social disruption leads to elevated child mortality, of which malaria is the leading cause. Understanding the social determinants of malaria transmission may be helpful to optimize malaria control efforts. We conducted a cross-sectional study of healthy children aged 2 months to 5 years attending well-child and/or immunization visits in the Democratic Republic of Congo (DRC). Six hundred and forty-seven children were tested for malaria antigenemia by rapid diagnostic test and the accompanying parent or legal guardian simultaneously completed a survey questionnaire related to demographics, socioeconomic status, maternal education, as well as bednet use and recent febrile illness. We examined the associations between variables using multivariable logistic regression analysis, chi-squared statistic, Fisher's exact test, and Spearman's rank correlation, as appropriate. One hundred and twenty-three out of the 647 (19%) children in the study tested positive for malaria. Higher levels of maternal education were associated with a lower risk of malaria in their children. The prevalence of malaria in children of mothers with no education, primary school, and beyond primary was 41/138 (30%), 41/241 (17%), and 39/262 (15%), respectively (p = 0.001). In a multivariable logistic regression model adjusting for the effect of a child's age and study site, the following remained significant predictors of malaria antigenemia: maternal education, number of children under five per household, and HIV serostatus. Higher maternal education, through several putative causal pathways, was associated with lower malaria prevalence among children in the DRC. Our findings suggest that maternal education might be an effective 'social vaccine' against malaria in the DRC and globally.
Kandala, Ngianga-Bakwin; Mandungu, Tumwaka P; Mbela, Kisumbula; Nzita, Kikhela P D; Kalambayi, Banza B; Kayembe, Kalambayi P; Emina, Jacques B O
The child mortality rate is a good indicator of development. High levels of infectious diseases and high child mortality make the Democratic Republic of Congo (DRC) one of the most challenging environments for health development in Sub-Saharan Africa (SSA). Recent conflicts in the eastern part of the country and bad governance have compounded the problem. This study aimed to examine province-level geographic variation in under-five mortality (U5M), accounting for individual- and household-level risk factors including environmental factors such as conflict. Our analysis used the nationally representative cross-sectional household sample of 8,992 children under five in the 2007 DRC Demographic and Health Survey. In the survey year, 1,005 deaths among this group were observed. Information on U5M was aggregated to the 11 provinces, and a Bayesian geo-additive discrete-time survival mixed model was used to map the geographic distribution of under-five mortality rates (U5MRs) at the province level, accounting for observable and unobservable risk factors. The overall U5MR was 159 per 1,000 live births. Significant associations with risk of U5M were found for conflict area of the DRC, and the lowest in the conflict area of North Kivu. This study reveals clear geographic patterns in rates of U5M in the DRC and shows the potential role of individual child, household and environmental factors, which are unexplained by the ongoing conflict. The displacement of mothers to safer areas may explain the lower U5MR observed at the epicentre of the conflict in North Kivu, compared with rates in conflict-free areas. Overall, the U5M maps point to a lack of progress towards the Millennium Development Goal of reducing U5M by half by 2015.
Background As teenagers have easy access to both radio programs and cell phones, the current study used these tools so that young people could anonymously identify questions about sex and other related concerns in the urban environment of the Democratic Republic of Congo. The purpose of this healthcare intervention was to identify and address concerns raised by young people, which are related to sexual health, and which promote youth health. Methods This healthcare intervention was conducted over a six month period and consisted of a survey carried out in Kinshasa. This focused on 14 to 24 old young people using phone calls on a radio program raising concerns related to sexuality. The radio program was jointly run by a journalist and a health professional who were required to reply immediately to questions from young people. All sexual health concerns were recorded and analyzed. Results Forty programs were broadcast in six months and 1,250 messages and calls were recorded: 880 (70%) from girls and 370 (30%) from boys, which represents an average of 32 interventions (of which 10 calls and 22 messages) per broadcast. Most questions came from 15-19- and 20-24-year-old girls and boys. Focus of girls’ questions: menstrual cycle calculation and related concerns accounted for the majority (24%); sexual practices (16%), love relationships (15%) and virginity (14%). Boys’ concerns are masturbation (and its consequences) (22%), sexual practices (19%), love relationships (18%) and worries about penis size (10%). Infections (genital and STI) and topics regarding HIV represent 9% and 4% of the questions asked by girls against 7% and 10% by boys. Concerns were mainly related to knowledge, attitudes and competences to be developed. Conclusions Concerns and sexual practices raised by teens about their sexual and emotional life have inspired the design of a practical guide for youth self-training and have steered the second phase of this interactive program towards supporting
Nsakala, Gabriel Vodiena; Coppieters, Yves; Kayembe, Patrick Kalambayi
As teenagers have easy access to both radio programs and cell phones, the current study used these tools so that young people could anonymously identify questions about sex and other related concerns in the urban environment of the Democratic Republic of Congo. The purpose of this healthcare intervention was to identify and address concerns raised by young people, which are related to sexual health, and which promote youth health. This healthcare intervention was conducted over a six month period and consisted of a survey carried out in Kinshasa. This focused on 14 to 24 old young people using phone calls on a radio program raising concerns related to sexuality. The radio program was jointly run by a journalist and a health professional who were required to reply immediately to questions from young people. All sexual health concerns were recorded and analyzed. Forty programs were broadcast in six months and 1,250 messages and calls were recorded: 880 (70%) from girls and 370 (30%) from boys, which represents an average of 32 interventions (of which 10 calls and 22 messages) per broadcast. Most questions came from 15-19- and 20-24-year-old girls and boys. Focus of girls' questions: menstrual cycle calculation and related concerns accounted for the majority (24%); sexual practices (16%), love relationships (15%) and virginity (14%). Boys' concerns are masturbation (and its consequences) (22%), sexual practices (19%), love relationships (18%) and worries about penis size (10%). Infections (genital and STI) and topics regarding HIV represent 9% and 4% of the questions asked by girls against 7% and 10% by boys. Concerns were mainly related to knowledge, attitudes and competences to be developed. Concerns and sexual practices raised by teens about their sexual and emotional life have inspired the design of a practical guide for youth self-training and have steered the second phase of this interactive program towards supporting their responsible sexuality.
Kahindo, M J B; Schirvel, C; Karemere, H; Mitangala, P; Wodon, A; Porignon, D
The aim of this study was to assess the contribution of mid-level management and support practices to the overall performance of a district healthcare system. This case study was carried out in the North Kivu Province of the Democratic Republic of the Congo. It was based on analysis of (i) preventive and curative healthcare services and (ii) management and support practices provided from 2000 to 2008. In response to recurring sociopolitical unrest since 1992, the mid-level health system (provincial level) in North Kivu has strengthened management and support practices. The main goals have been to optimize allocation of interventions by external emergency organizations and integration of specialized program activities, to harmonize intervention techniques implemented by external partners, to standardize supervision of sanitary districts with regard to care provider skills, and to adapt strategic options defined by the Ministry of Health to the provincial level. Using this comprehensive approach, the performance of the North Kivu Province in terms of curative and preventive care has exceeded the national average since 2001. Between 2001 and 2008, use of curative services progressed from 0.36 to 0.50 new cases/capita/year. Positive results have also been recorded for infrastructure coverage, essential medicine stock, health information system, and emergency preparedness. Stronger mid-level management and support practices have improved care activities in the health district while protecting the population from unstructured interventions by emergency organizations or specialized programs. A comprehensive management approach has also improved the resilience of the district and increased its contribution to Millennium Development Goals.
Loko Roka, Jerlie; Van den Bergh, Rafael; Au, Sokhieng; De Plecker, Eva; Zachariah, Rony; Manzi, Marcel; Lambert, Vincent; Abi-Aad, Elias; Nanan-N'Zeth, Kassi; Nzuya, Serge; Omba, Brigitte; Shako, Charly; MuishaBaroki, Derick; Basimuoneye, Jean Paul; Moke, Didier Amudiandroy; Lampaert, Emmanuel; Masangu, Lucien; De Weggheleire, Anja
Outcomes of sexual violence care programmes may vary according to the profile of survivors, type of violence suffered, and local context. Analysis of existing sexual violence care services could lead to their better adaptation to the local contexts. We therefore set out to compare the Médecins Sans Frontières sexual violence programmes in the Democratic Republic of Congo (DRC) in a zone of conflict (Masisi, North Kivu) and post-conflict (Niangara, Haut-Uélé). A retrospective descriptive cohort study, using routine programmatic data from the MSF sexual violence programmes in Masisi and Niangara, DRC, for 2012. In Masisi, 491 survivors of sexual violence presented for care, compared to 180 in Niangara. Niangara saw predominantly sexual violence perpetrated by civilians who were known to the victim (48%) and directed against children and adolescents (median age 15 (IQR 13-17)), while sexual violence in Masisi was more directed towards adults (median age 26 (IQR 20-35)), and was characterised by marked brutality, with higher levels of gang rape, weapon use, and associated violence; perpetrated by the military (51%). Only 60% of the patients in Masisi and 32% of those in Niangara arrived for a consultation within the critical timeframe of 72 hours, when prophylaxis for HIV and sexually transmitted infections is most effective. Survivors were predominantly referred through community programmes. Treatment at first contact was typically efficient, with high (>95%) coverage rates of prophylaxes. However, follow-up was poor, with only 49% of all patients in Masisi and 61% in Niangara returning for follow-up, and consequently low rates of treatment and/or vaccination completion. This study has identified a number of weak and strong points in the sexual violence programmes of differing contexts, indicating gaps which need to be addressed, and strengths of both programmes that may contribute to future models of context-specific sexual violence programmes.
Burnett, Eleanor; Wannemuehler, Kathleen; Ngoie Mwamba, Guillaume; Yolande, Masembe; Guylain, Kaya; Muriel, Nzazi Nsambu; Cathy, Nzuzi; Patrice, Tshekoya; Wilkins, Karen; Yoloyolo, Norbert
Health facility (HF) and household (HH) data can complement each other to provide a better understanding of the factors that contribute to vaccination status. In 12 zones with low vaccination coverage within Kinshasa Province, Democratic Republic of Congo, we conducted 2 surveys: (1) a linked HH and HF survey among 6-11-month-old infants, and (2) a HH survey among 12-23-month-old children. Linked survey objectives were to identify factors associated with vaccination status and to explore methodological considerations for linked survey implementation. To provide linked HH and HF data, we enrolled 6-11-month-old infants in HH clusters in each zone and then surveyed HFs located within the 12 zones and cited by caregivers of the enrolled infants as the most recent HF visited for vaccination or curative care. To provide vaccination coverage estimates for the 12-zone area, we enrolled 12-23-month-old children in every fourth HH. Of the HHs with a child aged 6-23 months, 16% were ineligible because they had resided in the neighborhood for one of the 182 surveyed HFs. For the coverage survey, 710 children aged 12-23 months participated. Home-based vaccination cards were available for 1210 of 1934 children (63%) surveyed. The surveys were successful in assessing HH information for 2 age groups, documenting written vaccination history for a large proportion of 6-23-month-old children, linking the majority of infants with their most recently visited HF, and surveying identified HFs. The implementation of the individually linked survey also highlighted the need for a comprehensive list of HFs and an analysis plan that addresses cross-classified clusters with only 1 child. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.
Tshikeba Kabantu, Martin; Muamba Tshimanga, Raphael; Onema Kileshye, Jean Marie; Gumindoga, Webster; Tshimpampa Beya, Jules
Soil erosion has detrimental impacts on socio economic life, thus increasing poverty. This situation is aggravated by poor planning and lack of infrastructure especially in developing countries. In these countries, efforts to planning are challenged by lack of data. Alternative approaches that use remote sensing and geographical information systems are therefore needed to provide decision makers with the so much needed information for planning purposes. This helps to curb the detrimental impacts of soil erosion, mostly emanating from varied land use conditions. This study was carried out in the city of Kinshasa, the Democratic Republic of Congo with the aim of using alternative sources of data, based on earth observation resources, to determine the spatial distribution of soil loss and erosion hazard in the city of Kinshasa. A combined approach based on remote sensing skills and rational equation of soil erosion estimation was used. Soil erosion factors, including rainfall-runoff erosivity R), soil erodibility (K), slope steepness and length (SL), crop/vegetation and management (C) were calculated for the city of Kinshasa. Results show that soil loss in Kinshasa ranges from 0 to 20 t ha-1 yr-1. Most of the south part of the urban area were prone to erosion. From the total area of Kinshasa (996 500 ha), 25 013 ha (2.3 %) is of very high ( > 15 t ha-1 yr-1) risk of soil erosion. Urban areas consist of 4.3 % of the area with very high ( > 15 t ha-1 yr-1) risk of soil erosion compared to a very high risk of 2.3 % ( > 15 t ha-1 yr-1) in the rural area. The study shows that the soil loss in the study area is mostly driven by slope, elevation, and informal settlements.
Kelly, Jocelyn Td; Branham, Lindsay; Decker, Michele R
Globally, an estimated 300,000 children under the age of 18 participate in combat situations; those in armed groups in particular suffer prolonged exposure to psychological and physical abuse. The Lord's Resistance Army (LRA) is a rebel movement known for its widespread conscription of children; yet little is known about this process once the group moved beyond northern Uganda. In this paper, we describe the processes related to abduction and indoctrination of youth by the LRA in northeastern Democratic Republic of the Congo ( DRC). In-depth interviews were conducted with formerly abducted children, their family members, community leaders, and service providers (total n = 34) in four communities in LRA-affected areas of northeastern DRC. Inductive coding of transcripts was undertaken to identify salient themes. Informants articulated a range of practices by the LRA to exert high levels of control over new recruits, including strict social isolation from recent abductees; control of communication; promoting new identity formation; and compelling children to act out strictly defined gendered roles. Witchcraft and secrecy are used to intimidate recruits and to magnify perception of the group's power. These methods promote de-identification with one's civilian and family life; and eventually the assimilation of a new language and identity. Indoctrination of newly abducted children into the LRA occurs via a complex system of control. This study provides one of the first detailed explorations of social and psychological mechanisms through which this is achieved, and focuses particularly on the gendered differences in the indoctrination process. Results support past findings that the LRA is a strategic and well-organized organization in its approach to enlisting child soldiers. Understanding some of the ways in which the LRA controls its recruits and the psychological impact of indoctrination enables reintegration programs to more effectively address these issues
Rene L Beyers
Full Text Available Human conflict generally has substantial negative impacts on wildlife and conservation. The recent civil war (1995-2006 in the Democratic Republic of Congo (DRC resulted in a significant loss of wildlife, including elephants, due to institutional collapse, lawlessness and unbridled exploitation of natural resources such as minerals, wood, ivory and bushmeat. We used data from distance sampling surveys conducted before and after the war in a protected forest, the Okapi Faunal Reserve, to document changes in elephant abundance and distribution. We employed Generalized Additive Models to relate changes in elephant distribution to human and environmental factors. Populations declined by nearly fifty percent coinciding with a major increase in elephant poaching as indicated by reports of ivory trade during the war. Our results suggest that humans influenced elephant distribution far more than habitat, both before and after the war, but post-war models explained more of the variation. Elephant abundance declined more, closer to the park boundary and to areas of intense human activity. After the war, elephant densities were relatively higher in the centre of the park where they were better protected, suggesting that this area may have acted as a refuge. In other sites in Eastern DRC, where no protection was provided, elephants were even more decimated. Post-war dynamics, such as weakened institutions, human movements and availability of weapons, continue to affect elephants. Survival of remaining populations and recovery will be determined by these persistent factors and by new threats associated with growing human populations and exploitation of natural resources. Prioritizing wildlife protection, curbing illegal trade in ivory and bushmeat, and strengthening national institutions and organizations in charge of conservation will be crucial to counter these threats.
Lusey, Hendrew; San Sebastian, Miguel; Christianson, Monica; Edin, Kerstin E
While women and girls are made vulnerable by inequitable and violent versions of masculinities, there is increasing evidence that gender equality will not be achieved without partnering with men. The aim of this study was to assess gender-equitable norms and their determinants among church-going young men in Kinshasa, the Democratic Republic of Congo. A cross-sectional study was carried out among 289 church-going young men, aged 18-24 years, residing in three disadvantaged communes of Kinshasa. Variables included sociodemographic characteristics, attitudes towards gender equality and responses to issues related to the Gender-Equitable Men (GEM) scale. Logistic regression was applied to identify the associations between sociodemographic characteristics, attitudes and the GEM scale. The findings provide evidence of attitudes and beliefs that act as barriers to gender equality. For instance, the majority of church-going young men (83.74%) agreed that a man is the only decision maker in the home and about half (50.87%) of the respondents supported the statement "There are times a woman deserves to be beaten". Similarly, around half of the participants agreed with the idea of men's uncontrollable sex drive (50.87%) and men's toughness (50.17%). Close to half of the participants (44.29%) agreed that it is women's responsibility to prevent pregnancy. These attitudes co-existed with a few gender-equitable norms as 82.70% agreed on the importance of joint decisions concerning family planning. An association between education, certain places of residence, being single or separated, and supportive attitudes towards gender equality was found with higher scores for the GEM. Our study findings indicate that a high proportion of church-going young men do not endorse gender-equitable norms. Therefore, churches urgently need comprehensive gender equality and masculinity policies and programmes to influence young men's attitudes and behaviours. The promotion of gender equality in
De Merode, Emmanuel; Cowlishaw, Guy
Our understanding of the linkages between the bushmeat trade and the wider informal economy is limited. This lack of knowledge is particularly problematic for conservation under conditions of political instability, when the informal economy can be highly dynamic and impacts on wildlife populations can be severe. To explore these interlinked processes, we conducted a study of the bushmeat trade in Garamba National Park, Democratic Republic of Congo, through a combination of market surveys, semistructured interviews, and direct observation. We focused on the sale of protected and unprotected species in urban and rural markets, and the bushmeat commodity chains that supplied these markets, under conditions of political stability and armed conflict. During peacetime, protected species from the park (predominantly elephant and buffalo) rarely appeared in the rural markets, but they comprised more than half of all bushmeat sales in the urban markets. This pattern reflected differences in the rural and urban commodity chains. Automatic weapons were urban trade. The use of such weapons was discouraged by the traditional chiefs, who administered the village markets. During wartime, the sales of protected species in the urban markets increased fivefold because the military officers fled, leaving behind an open-access system that led to a massive increase in the exploitation of protected species. In contrast, the rural markets remained relatively stable because of the continued authority of the village chiefs. Our results indicate that sociopolitical factors can be an important determinant of species offtake and, therefore, that knowledge of the bushmeat commodity chain can be vital to controlling theprocesses that drive species extraction. In addition, our findings suggest that traditional authorities can be potentially valuable partners for bushmeat management.
Maini, Rishma; Mounier-Jack, Sandra; Borghi, Josephine
Theories of change (ToCs) describe how interventions can bring about long-term outcomes through a logical sequence of intermediate outcomes and have been used to design and measure the impact of public health programmes in several countries. In recognition of their capacity to provide a framework for monitoring and evaluation, they are being increasingly employed in the development sector. The construction of a ToC typically occurs through a consultative process, requiring stakeholders to reflect on how their programmes can bring about change. ToCs help make explicit any underlying assumptions, acknowledge the role of context and provide evidence to justify the chain of causal pathways. However, while much literature exists on how to develop a ToC with respect to interventions in theory, there is comparatively little reflection on applying it in practice to complex interventions in the health sector. This paper describes the initial process of developing a ToC to inform the design of an evaluation of a complex intervention aiming to improve government payments to health workers in the Democratic Republic of Congo. Lessons learnt include: the need for the ToC to understand how the intervention produces effects on the wider system and having broad stakeholder engagement at the outset to maximise chances of the intervention's success and ensure ownership. Power relationships between stakeholders may also affect the ToC discourse but can be minimised by having an independent facilitator. We hope these insights are of use to other global public health practitioners using this approach to evaluate complex interventions.
Berthollet Bwira Kaboru
Full Text Available Background HIV/AIDS and Tuberculosis (TB are major contributors to the burden of disease in sub-Saharan Africa. The two diseases have been described as a harmful synergy as they are biologically and epidemiologically linked. Control of TB/HIV co-infection is an integral and most challenging part of both national TB and national HIV control programmes, especially in contexts of instability where health systems are suffering from political and social strife. This study aimed at assessing the provision of HIV/TB co-infection services in health facilities in the conflict-ridden region of Goma in Democratic Republic of Congo. Methods A cross-sectional survey of health facilities that provide either HIV or TB services or both was carried out. A semi-structured questionnaire was used to collect the data which was analysed using descriptive statistics. Results Eighty facilities were identified, of which 64 facilities were publicly owned. TB care was more available than HIV care (in 61% vs. 9% of facilities. Twenty-three facilities (29% offered services to co-infected patients. TB/HIV co-infection rates among patients were unknown in 82% of the facilities. Only 19 facilities (24% reported some coordination with and support from concerned diseases’ control programmes. HIV and TB services are largely fragmented, indicating imbalances and poor coordination by disease control programmes. Conclusion HIV and TB control appear not to be the focus of health interventions in this crisis affected region, despite the high risks of TB and HIV infection in the setting. Comprehensive public health response to this setting calls for reforms that promote joint TB/HIV co-infection control, including improved leadership by the HIV programmes that accuse weaknesses in this conflict-ridden region.
Understanding How Solidarity Groups-A Community-Based Economic and Psychosocial Support Intervention-Can Affect Mental Health for Survivors of Conflict-Related Sexual Violence in Democratic Republic of the Congo.
Koegler, Erica; Kennedy, Caitlin; Mrindi, Janvier; Bachunguye, Richard; Winch, Peter; Ramazani, Paul; Makambo, Maphie Tosha; Glass, Nancy
Solidarity groups were established in eastern Democratic Republic of Congo to provide female survivors of conflict-related sexual violence an opportunity to generate income, establish networks of support, and cope with atrocities. Qualitative data were collected from 12 members of solidarity groups to explore factors that contributed to members' mental health. All women identified some improvement (physiological, psychological, economic, or social) since joining the solidarity group, but none of the women were free from ailments. Our findings suggest that a multifaceted intervention in women's own communities has the potential to improve multiple aspects of women's lives, including mental health.
Smets, Benoît; Tedesco, Dario; Kervyn, François; Kies, Antoine; Vaselli, Orlando; Yalire, Mathieu Mapendano
The word " mazuku" in Swahili means "evil wind". It corresponds to lowland (depressions) where carbon dioxide is released and, being heavier than air, accumulates at high - often lethal - concentrations (10 vol.% of CO 2 in atmosphere can be considered as the deadly threshold, even for a short time exposure). Mazuku are abundant in Goma and surrounding areas and particularly in the area south of the large volcanic edifices of Nyiragongo and Nyamulagira volcanoes located in the most eastern part of DR Congo, W branch of the East African Rift System (EARS). Our extensive field surveys have indicated that mazuku are concentrated within to and around the densely populated city of Goma close to the N shores of Lake Kivu, mainly near fault or fissure networks. At a more local scale, depressions allowing CO 2-rich gas accumulation are created by lava flow superposition, lava tunnels or cavity collapses, or directly associated with open fractures. People are killed by mazuku every year. Given political and social unrest coupled with the current important demographic and urban growths around Goma, the risks associated to mazuku are increasing accordingly. Mazuku are currently the most important natural risk in terms of human loss for the area and there is an urgent need for further research, more systematic mapping and monitoring of mazuku and for appropriate risk management to be implemented. This paper summarizes the current scientific knowledge on mazuku as well as new advances and a preliminary risk assessment performed recently in the frame of the GORISK project.
Johnson, Kirsten; Scott, Jennifer; Rughita, Bigy; Kisielewski, Michael; Asher, Jana; Ong, Ricardo; Lawry, Lynn
Studies from the Eastern Region of the Democratic Republic of the Congo (DRC) have provided anecdotal reports of sexual violence. This study offers a population-based assessment of the prevalence of sexual violence and human rights abuses in specific territories within Eastern DRC. To assess the prevalence of and correlations with sexual violence and human rights violations on residents of specific territories of Eastern DRC including information on basic needs, health care access, and physical and mental health. A cross-sectional, population-based, cluster survey of 998 adults aged 18 years or older using structured interviews and questionnaires, conducted over a 4-week period in March 2010. Sexual violence prevalence and characteristics, symptoms of major depressive disorder (MDD) and posttraumatic stress disorder (PTSD), human rights abuses, and physical and mental health needs among Congolese adults in specific territories of Eastern DRC. Of the 1005 households surveyed 998 households participated, yielding a response rate of 98.9%. Rates of reported sexual violence were 39.7% (95% confidence interval [CI], 32.2%-47.2%; n = 224/586) among women and 23.6% (95% CI, 17.3%-29.9%; n = 107/399) among men. Women reported to have perpetrated conflict-related sexual violence in 41.1% (95% CI, 25.6%-56.6%; n = 54/148) of female cases and 10.0% (95% CI, 1.5%-18.4%; n = 8/66) of male cases. Sixty-seven percent (95% CI, 59.0%-74.5%; n = 615/998) of households reported incidents of conflict-related human rights abuses. Forty-one percent (95% CI, 35.3%-45.8%; n = 374/991) of the represented adult population met symptom criteria for MDD and 50.1% (95% CI, 43.8%-56.3%; n = 470/989) for PTSD. Self-reported sexual violence and other human rights violations were prevalent in specific territories of Eastern DRC and were associated with physical and mental health outcomes.
Full Text Available The BaNande, farmers of the hills of the North Kivu (Democratic Republic of the Congo, call themselves proudly abakondi, the young and strong men who cut down the trees, who destroy the forest. Almost their entire culture is based on the principle of the “cut” (eritwa, as well as their social and political organization is due to the historical achievement of their territory wrested from the forest. Even the erotic activity is designed with the typical categories of abakondi. But the traditional culture of the BaNande was not geared only to this sense of conquest of the forest. The author of this article tries to show how the forest (omusitu would be made to survive in different ways. First, not all of the forest was destroyed. Indeed islands of forest remain here and there, such as supplies of food, timber, medicines, as memory of what had been destroyed, and as headquarters of the forest spirits. Second, whenever a chief died, he was buried on his hill not underground, but imprisoned by the trees of the forest planted all around his body. These tree tombs, real historical monuments of vegetable nature, are called by the BaNande amahero and are designed as “small forest” (singular akasitu. Finally it was diffused in the nande culture the awareness that the destruction of the forest doesn’t happen with impunity. The pride of abakondi is replaced by the recognition of omusitu (forest as autonomous world, which demands to be at least partially preserved, both physically in the territory, both as an entity with even “consciousness”. Once, the BaNande thought of not being able to break free from this consciousness, and this ecological anxiety emerged especially in the most significant moments of the reproduction of their culture, i.e. when in the olusumba (their rite of initiation in the forest they had to form their new men. But this conscience belongs to the past: on the hills of the Bunande the “spirits of the forest” have
Kraemer, Moritz U G; Faria, Nuno R; Reiner, Robert C; Golding, Nick; Nikolay, Birgit; Stasse, Stephanie; Johansson, Michael A; Salje, Henrik; Faye, Ousmane; Wint, G R William; Niedrig, Matthias; Shearer, Freya M; Hill, Sarah C; Thompson, Robin N; Bisanzio, Donal; Taveira, Nuno; Nax, Heinrich H; Pradelski, Bary S R; Nsoesie, Elaine O; Murphy, Nicholas R; Bogoch, Isaac I; Khan, Kamran; Brownstein, John S; Tatem, Andrew J; de Oliveira, Tulio; Smith, David L; Sall, Amadou A; Pybus, Oliver G; Hay, Simon I; Cauchemez, Simon
Since late 2015, an epidemic of yellow fever has caused more than 7334 suspected cases in Angola and the Democratic Republic of the Congo, including 393 deaths. We sought to understand the spatial spread of this outbreak to optimise the use of the limited available vaccine stock. We jointly analysed datasets describing the epidemic of yellow fever, vector suitability, human demography, and mobility in central Africa to understand and predict the spread of yellow fever virus. We used a standard logistic model to infer the district-specific yellow fever virus infection risk during the course of the epidemic in the region. The early spread of yellow fever virus was characterised by fast exponential growth (doubling time of 5-7 days) and fast spatial expansion (49 districts reported cases after only 3 months) from Luanda, the capital of Angola. Early invasion was positively correlated with high population density (Pearson's r 0·52, 95% CI 0·34-0·66). The further away locations were from Luanda, the later the date of invasion (Pearson's r 0·60, 95% CI 0·52-0·66). In a Cox model, we noted that districts with higher population densities also had higher risks of sustained transmission (the hazard ratio for cases ceasing was 0·74, 95% CI 0·13-0·92 per log-unit increase in the population size of a district). A model that captured human mobility and vector suitability successfully discriminated districts with high risk of invasion from others with a lower risk (area under the curve 0·94, 95% CI 0·92-0·97). If at the start of the epidemic, sufficient vaccines had been available to target 50 out of 313 districts in the area, our model would have correctly identified 27 (84%) of the 32 districts that were eventually affected. Our findings show the contributions of ecological and demographic factors to the ongoing spread of the yellow fever outbreak and provide estimates of the areas that could be prioritised for vaccination, although other constraints such as vaccine
Likofata Esanga, Jean-Robert; Viadro, Claire; McManus, Leah; Wesson, Jennifer; Matoko, Nicaise; Ngumbu, Epiphane; Gilroy, Kate E; Trudeau, Daren
The Democratic Republic of Congo has flagged health workforce management and compensation as issues requiring attention, including the problem of ghost workers (individuals on payroll who do not exist and/or show up at work). Recognising the need for reliable health workforce information, the government has worked to implement iHRIS, an open source human resources information system that facilitates health workforce management. In Kasaï Central and Kasaï Provinces, health workers brought relevant documentation to data collection points, where trained teams interviewed them and entered contact information, identification, photo, current job, and employment and education history into iHRIS on laptops. After uploading the data, the Ministry of Public Health used the database of over 11 500 verified health worker records to analyse health worker characteristics, density, compensation, and payroll. Both provinces had less than one physician per 10 000 population and a higher urban versus rural health worker density. Most iHRIS-registered health workers (57% in Kasaï Central and 73% in Kasaï) reported receiving no regular government pay of any kind (salaries or risk allowances). Payroll analysis showed that 27% of the health workers listed as salary recipients in the electronic payroll system were ghost workers, as were 42% of risk allowance recipients. As a result, the Ministries of Public Health, Public Service, and Finance reallocated funds away from ghost workers to cover salaries (n = 781) and risk allowances (n = 2613) for thousands of health workers who were previously under- or uncompensated due to lack of funds. The reallocation prioritised previously under- or uncompensated mid-level health workers, with 49% of those receiving salaries and 68% of those receiving risk allowances representing cadres such as nurses, laboratory technicians, and midwifery cadres. Assembling accurate health worker records can help governments understand health workforce
Ho, Lara S; Wheeler, Erin
Unmet need for family planning in the conflict-affected area of eastern Democratic Republic of the Congo (DRC) has been reported to be as high as 38%, and women in such conflict settings are often the most at risk for maternal mortality. The International Rescue Committee implements the Family Planning and Post-Abortion Care in Emergencies program in 3 provinces of eastern DRC to provide women and couples access to family planning, including long-acting reversible contraceptives (LARCs). This article presents routine program data from June 2011 through December 2013 from 2 health zones as well as results from a qualitative assessment of family planning clients and of male and female non-users, conducted in 2013. It then describes how these findings were used to make program adjustments to improve access to family planning services and client informed choice and assesses the effects of the program design changes on family planning uptake and method mix using routine program data from January 2014 through December 2016. Between 2011 and 2013, 8,985 clients adopted family planning, with an average 14 clients adopting a method per facility, per month. The method mix remained stable during this period, with implants dominating at 48%. Barriers to uptake identified from the qualitative research were both supply- and demand-related, including misconceptions about certain modern contraceptive methods on the part of providers, users, and other community members. The program implemented several program changes based on the assessment findings, including clinical coaching and supportive supervision to improve provider skills and attitudes, introduction of immediate postpartum insertion of the intrauterine device (IUD) and the levonorgestrel-releasing intrauterine system (LNG-IUS), and behavior change communication campaigns to raise awareness about family planning. After these program changes, the mean number of clients adopting modern family planning per facility, per month
Ross, Jonathan; Edmonds, Andrew; Hoover, Donald R; Shi, Qiuhu; Anastos, Kathryn; Lelo, Patricia; Behets, Frieda; Yotebieng, Marcel
Loss to care is high among asymptomatic HIV-infected women initiated on antiretroviral therapy (ART) during pregnancy or in the postpartum period. However, whether pregnancy itself plays a role in the high loss to care rate is uncertain. We compared loss to care over seven years between pregnant and non-pregnant women at enrollment into HIV care in the Democratic Republic of Congo (DRC). We conducted a retrospective analysis of all ART-naive women aged 15-45 initiating HIV care at two large clinics in Kinshasa, DRC, from 2007-2013. Pregnancy status was recorded at care enrollment. Patients were classified as having no follow-up if they did not return to care after the initial enrollment visit. Among those with at least one follow-up visit after enrollment, we classified patients as lost to care if more than 365 days had passed since their last clinic visit. We used logistic regression to model the association between pregnancy status and no follow-up, and Cox proportional hazards regression to model the association between pregnancy status and time to loss to care. Of 2175 women included in the analysis, 1497 (68.8%) were pregnant at enrollment. Compared to non-pregnant women, pregnant women were less likely to be over 35 years of age (19.1% vs. 31.9%, p<0.0001) and less likely to be in WHO stage III or IV (9.0% vs. 26.3%, p<0.0001). Among pregnant women, 106 (7.1%) were not seen after enrollment, versus 25 (3.7%) non-pregnant women (adjusted odds ratio 2.01, 95% CI 1.24-3.24). Of the 2,044 women with at least one follow-up visit, 46.5% of pregnant women and 46.7% of non-pregnant women were lost to care by 5 years; hazards of loss to care were similar for pregnant and non-pregnant women (adjusted hazard ratio 1.08, 95% CI 0.93-1.26). In this large cohort of HIV-infected women, patients pregnant at care enrollment were more likely to never return for follow-up. Among those who attended at least one follow-up visit, loss to care was not different between pregnant and
Ho, Lara S; Wheeler, Erin
Unmet need for family planning in the conflict-affected area of eastern Democratic Republic of the Congo (DRC) has been reported to be as high as 38%, and women in such conflict settings are often the most at risk for maternal mortality. The International Rescue Committee implements the Family Planning and Post-Abortion Care in Emergencies program in 3 provinces of eastern DRC to provide women and couples access to family planning, including long-acting reversible contraceptives (LARCs). This article presents routine program data from June 2011 through December 2013 from 2 health zones as well as results from a qualitative assessment of family planning clients and of male and female non-users, conducted in 2013. It then describes how these findings were used to make program adjustments to improve access to family planning services and client informed choice and assesses the effects of the program design changes on family planning uptake and method mix using routine program data from January 2014 through December 2016. Between 2011 and 2013, 8,985 clients adopted family planning, with an average 14 clients adopting a method per facility, per month. The method mix remained stable during this period, with implants dominating at 48%. Barriers to uptake identified from the qualitative research were both supply- and demand-related, including misconceptions about certain modern contraceptive methods on the part of providers, users, and other community members. The program implemented several program changes based on the assessment findings, including clinical coaching and supportive supervision to improve provider skills and attitudes, introduction of immediate postpartum insertion of the intrauterine device (IUD) and the levonorgestrel-releasing intrauterine system (LNG-IUS), and behavior change communication campaigns to raise awareness about family planning. After these program changes, the mean number of clients adopting modern family planning per facility, per month
Antonio Isidro Carrión Martín
Full Text Available The area of Walikale in North Kivu, Democratic Republic of Congo, is intensely affected by conflict and population displacement. Médecins-Sans-Frontières (MSF returned to provide primary healthcare in July 2012. To better understand the impact of the ongoing conflict and displacement on the population, a retrospective mortality survey was conducted in April 2013. A two-stage randomized cluster survey using 31 clusters of 21 households was conducted. Heads of households provided information on their household make-up, ownership of non-food items (NFIs, access to healthcare and information on deaths and occurrence of self-reported disease in the household during the recall period. The recall period was of 325 days (July 2012-April 2013. In total, 173 deaths were reported during the recall period. The crude mortality rate (CMR was of 1.4/10,000 persons/day (CI95%: 1.2-1.7 and the under-five- mortality rate (U5MR of 1.9/10,000 persons per day (CI95%: 1.3-2.5. The most frequently reported cause of death was fever/malaria 34.1% (CI95%: 25.4-42.9. Thirteen deaths were due to intentional violence. Over 70% of all households had been displaced at some time during the recall period. Out of households with someone sick in the last two weeks, 63.8% sought health care; the main reason not to seek health care was the lack of money (n = 134, 63.8%, CI95%: 52.2-75.4. Non Food Items (NFI ownership was low: 69.0% (CI95%: 53.1-79.7 at least one 10 liter jerry can, 30.1% (CI95%: 24.3-36.5 of households with visible soap available and 1.6 bednets per household. The results from this survey in Walikale clearly illustrate the impact that ongoing conflict and displacement are having on the population in this part of DRC. The gravity of their health status was highlighted by a CMR that was well above the emergency threshold of 1 person/10,000/day and an U5MR that approaches the 2 children/10,000/day threshold for the recall period.
Carrión Martín, Antonio Isidro; Bil, Karla; Salumu, Papy; Baabo, Dominique; Singh, Jatinder; Kik, Corry; Lenglet, Annick
The area of Walikale in North Kivu, Democratic Republic of Congo, is intensely affected by conflict and population displacement. Médecins-Sans-Frontières (MSF) returned to provide primary healthcare in July 2012. To better understand the impact of the ongoing conflict and displacement on the population, a retrospective mortality survey was conducted in April 2013. A two-stage randomized cluster survey using 31 clusters of 21 households was conducted. Heads of households provided information on their household make-up, ownership of non-food items (NFIs), access to healthcare and information on deaths and occurrence of self-reported disease in the household during the recall period. The recall period was of 325 days (July 2012–April 2013). In total, 173 deaths were reported during the recall period. The crude mortality rate (CMR) was of 1.4/10,000 persons/day (CI95%: 1.2–1.7) and the under-five- mortality rate (U5MR) of 1.9/10,000 persons per day (CI95%: 1.3–2.5). The most frequently reported cause of death was fever/malaria 34.1% (CI95%: 25.4–42.9). Thirteen deaths were due to intentional violence. Over 70% of all households had been displaced at some time during the recall period. Out of households with someone sick in the last two weeks, 63.8% sought health care; the main reason not to seek health care was the lack of money (n = 134, 63.8%, CI95%: 52.2–75.4). Non Food Items (NFI) ownership was low: 69.0% (CI95%: 53.1–79.7) at least one 10 liter jerry can, 30.1% (CI95%: 24.3–36.5) of households with visible soap available and 1.6 bednets per household. The results from this survey in Walikale clearly illustrate the impact that ongoing conflict and displacement are having on the population in this part of DRC. The gravity of their health status was highlighted by a CMR that was well above the emergency threshold of 1 person/10,000/day and an U5MR that approaches the 2 children/10,000/day threshold for the recall period. PMID:25233090
The relationship between Plasmodium infection, anaemia and nutritional status in asymptomatic children aged under five years living in stable transmission zones in Kinshasa, Democratic Republic of Congo.
Maketa, Vivi; Mavoko, Hypolite Muhindo; da Luz, Raquel Inocêncio; Zanga, Josué; Lubiba, Joachim; Kalonji, Albert; Lutumba, Pascal; Van Geertruyden, Jean-Pierre
Malaria is preventable and treatable when recommended interventions are properly implemented. Thus, diagnosis and treatment focus on symptomatic individuals while asymptomatic Plasmodium infection (PI) plays a role in the sustainability of the transmission and may also have an impact on the morbidity of the disease in terms of anaemia, nutritional status and even cognitive development of children. The objective of this study was to assess PI prevalence and its relationship with known morbidity factors in a vulnerable but asymptomatic stratum of the population. A simple random sample, household survey in asymptomatic children under the age of five was conducted from April to September 2012 in two health areas of the health zone of Mont Ngafula 1, Kinshasa, Democratic Republic of Congo. The PI prevalence were 30.9% (95% CI: 26.5-35.9) and 14.3% (95% CI: 10.5-18.1) in Cité Pumbu and Kindele health areas, respectively, (OR: 2.7; p <0.001). All were Plasmodium falciparum infected and 4% were co-infected with Plasmodium malariae. In Cité Pumbu and Kindele, the prevalence of anaemia (haemoglobin <11 g/dL) was 61.6% (95% CI: 56.6-66.5) and 39.3% (95% CI: 34.0-44.6), respectively, (OR: 2.5; p <0.001). The health area of Cité Pumbu had 32% (95% CI: 27.5-37.0) of chronic malnutrition (HAZ score ≤ -2SD) compared to 5.1% (95% CI: 2.8-7.6) in Kindele. PI was predictor factor for anaemia (aOR: 3.5, p =0.01) and within infected children, there was an inverse relationship between parasite density and haemoglobin level (β = -5*10(-5), p <0.001). Age older than 12 months (aOR: 3.8, p = 0.01), presence of anaemia (aOR: 3.4, p =0.001), chronic malnutrition (aOR: 1.8, p = 0.01), having a single parent/guardian (aOR: 1.6, p =0.04), and the non-use of insecticide-treated nets (aOR: 1.7, p = 0.04) were all predictors for PI in the overall population. PI in asymptomatic children was correlated with anaemia and chronic malnutrition and was thus a harmful condition in the study
Initiating NTD programs targeting schistosomiasis and soil-transmitted helminthiasis in two provinces of the Democratic Republic of the Congo: Establishment of baseline prevalence for mass drug administration.
Kabore, Achille; Ibikounle, Moudachirou; Tougoue, Jean Jacques; Mupoyi, Sylvain; Ndombe, Martin; Shannon, Scott; Ottesen, Eric A; Mukunda, Faustin; Awaca, Naomi
Schistosomiasis (SCH) and soil-transmitted helminthiasis (STH) are widely distributed in the Democratic Republic of the Congo (DRC) and constitute a serious public health problem. As recommended by the World Health Organization (WHO), before launching mass chemotherapy to control these diseases, parasitological surveys were conducted in sentinel sites in six health zones (HZs) in Bandundu and Maniema provinces. Baseline prevalence and intensity of infection for SCH and STH were determined to establish the appropriate treatment plan using Praziquantel (PZQ) and Albendazole (ALB). Parasitological surveys were conducted from April to May 2015 in twenty-six selected sampling units (schools) for baseline mapping in six HZs: Fifty school children (25 females and 25 males) aged 9-15 years were randomly selected per sampling unit. A total of 1300 samples (urine and stool) were examined using haematuria dipsticks, parasite-egg filtration and the point-of-care Circulating Cathodic Antigen (POC-CCA) assay for urine samples and the Kato-Katz technique for stool specimens. Three species of schistosomes (S. mansoni, S. haematobium and S. intercalatum) and three groups of STH (hookworm, Ascaris and Trichuris) were detected at variable prevalence and intensity among the schools, the HZs and the provinces. In Bandundu, no SCH was detected by either Kato-Katz or the POC-CCA technique, despite a high prevalence of STH with 68% and 80% at Kiri and Pendjua HZs, respectively. In Maniema, intestinal schistosomiasis was detected by both Kato-Katz and POC-CCA with an average prevalence by Kato-Katz of 32.8% and by POC-CCA of 42.1%. Comparative studies confirmed the greater sensitivity (and operational feasibility) of the POC-CCA test on urine compared to Kato-Katz examination of stool for diagnosing intestinal schistosomiasis even in areas of comparatively light infections. STH was widely distributed and present in all HZs with a mean prevalence (95% CI) of 59.62% (46.00-65.00%). The
Ruh, Emrah; Bateko, Jean Paul; Imir, Turgut; Taylan-Ozkan, Aysegul
Point mutations in Plasmodium falciparum dihydrofolate reductase (Pfdhfr) and dihydropteroate synthase (Pfdhps) genes which confer resistance to sulfadoxine-pyrimethamine (SP) occur at increasing rates. The present study aimed to identify Pfdhfr and Pfdhps mutations in P. falciparum isolates recovered from women who received two doses of SP during pregnancy in Bandundu, the Democratic Republic of Congo (DRC). A total of 48 women with confirmed P. falciparum infection were enrolled in the study. Finger-prick blood samples that were collected on filter paper at the time of delivery were used for DNA isolation. Pfdhfr and Pfdhps genes were amplified by a nested PCR protocol. DNA sequencing was performed on both strands, and the point mutations were analysed. All of the 48 (100.0%) P. falciparum isolates carried at least one polymorphism in both genes. The wild-type haplotypes of Pfdhfr (CNCSI [C50, N51, C59, S108, I164]) and Pfdhps (SAKAA [S436, A437, K540, A581, A613]) were not observed in the study. In Pfdhfr, N51I (85.4%), C59R (60.4%), and S108N (100.0%) polymorphisms were detected. Triple mutation (CIRNI) (mutant amino acids are underlined) was the most prevalent (47.9%) Pfdhfr haplotype. In the study, all P. falciparum isolates (100.0%) harboured the A437G allele in Pfdhps gene. Also, K540E and A581G polymorphisms were observed in one (2.1%) isolate. Single mutant haplotype (SGKAA) was detected in 97.9% of the isolates. Mutant Pfdhfr and Pfdhps allele combinations revealed quintuple (CICNI-SGEGA; 2.1%), quadruple (CIRNI-SGKAA; 47.9%), triple (CICNI-SGKAA; 35.4%, CNRNI-SGKAA; 12.5%), and double (CNCNI-SGKAA; 2.1%) haplotypes. In the study, the rate of SGEGA haplotype was low (2.1%). Although K540E and A581G alleles are more common in Eastern Africa, a distinct lineage of SGEGA is also present in the DRC, which is located in Central Africa. This haplotype is associated with decreased efficacy of SP in pregnant women and infants, therefore, it should be carefully
Full Text Available Abstract Background The Malanga sleeping sickness focus of the Democratic Republic of Congo has shown an epidemic evolution of disease during the last century. However, following case detection and treatment, the prevalence of the disease decreased considerably. No active survey has been undertaken in this focus for a couple of years. To understand the current epidemiological status of sleeping sickness as well as the animal African trypanosomiasis in the Malanga focus, we undertook the identification of tsetse blood meals as well as different trypanosome species in flies trapped in this focus. Methods Pyramidal traps were use to trap tsetse flies. All flies caught were identified and live flies were dissected and their mid-guts collected. Fly mid-gut was used for the molecular identification of the blood meal source, as well as for the presence of different trypanosome species. Results About 949 Glossina palpalis palpalis were trapped; 296 (31.2% of which were dissected, 60 (20.3% blood meals collected and 57 (19.3% trypanosome infections identified. The infection rates were 13.4%, 5.1%, 3.5% and 0.4% for Trypanosoma congolense savannah type, Trypanosoma brucei s.l., Trypanosoma congolense forest type and Trypanosoma vivax, respectively. Three mixed infections including Trypanosoma brucei s.l. and Trypanosoma congolense savannah type, and one mixed infection of Trypanosoma vivax and Trypanosoma congolense savannah type were identified. Eleven Trypanosoma brucei gambiense infections were identified; indicating an active circulation of this trypanosome subspecies. Of all the identified blood meals, about 58.3% were identified as being taken on pigs, while 33.3% and 8.3% were from man and other mammals, respectively. Conclusion The presence of Trypanosoma brucei in tsetse mid-guts associated with human blood meals is indicative of an active transmission of this parasite between tsetse and man. The considerable number of pig blood meals combined
Patient Pyana Pati
Full Text Available Sleeping sickness caused by Trypanosoma brucei (T.b. gambiense constitutes a serious health problem in sub-Sahara Africa. In some foci, alarmingly high relapse rates were observed in patients treated with melarsoprol, which used to be the first line treatment for patients in the neurological disease stage. Particularly problematic was the situation in Mbuji-Mayi, East Kasai Province in the Democratic Republic of the Congo with a 57% relapse rate compared to a 5% relapse rate in Masi-Manimba, Bandundu Province. The present study aimed at investigating the mechanisms underlying the high relapse rate in Mbuji-Mayi using an extended collection of recently isolated T.b. gambiense strains from Mbuji-Mayi and from Masi-Manimba.Forty five T.b. gambiense strains were used. Forty one were isolated from patients that were cured or relapsed after melarsoprol treatment in Mbuji-Mayi. In vivo drug sensitivity tests provide evidence of reduced melarsoprol sensitivity in these strains. This reduced melarsoprol sensitivity was not attributable to mutations in TbAT1. However, in all these strains, irrespective of the patient treatment outcome, the two aquaglyceroporin (AQP 2 and 3 genes are replaced by chimeric AQP2/3 genes that may be associated with resistance to pentamidine and melarsoprol. The 4 T.b. gambiense strains isolated in Masi-Manimba contain both wild-type AQP2 and a different chimeric AQP2/3. These findings suggest that the reduced in vivo melarsoprol sensitivity of the Mbuji-Mayi strains and the high relapse rates in that sleeping sickness focus are caused by mutations in the AQP2/AQP3 locus and not by mutations in TbAT1.We conclude that mutations in the TbAQP2/3 locus of the local T.b. gambiense strains may explain the high melarsoprol relapse rates in the Mbuji-Mayi focus but other factors must also be involved in the treatment outcome of individual patients.
Almost two decades ago, the Democratic Republic of the Congo (DRC) was confronted with a vicious cycle of internationalised armed conflicts in which between six and ten million people are estimated to have been killed. Those conflicts were resolved through peace agreements between the leaders of the warring parties ...
With reference to the Democratic Republic of the Congo (DRC), religious groups wield enormous influence in the public space as providers of social services in a polity that has been characterised by years of misrule, declining state capacity and protracted conflict. The conflict in the DRC has deepened the imperative for ...
Full Text Available Based on previous complaints and reports from farmers to researchers about potato (Solanum tuberosum L. problems in South-Kivu Province, eastern Democratic Republic of Congo (RDCongo, there was a need to understand farmers′ knowledge of existing insect pest problems and current management practice challenges. Such information is important for designing a suitable intervention and successful integrated pest management (IPM strategy for the Province. Hence, using a semi-structured questionnaire, a farm household survey was conducted among 300 potato farmers in six sites belonging to 2 territories (Kabare, Kalehe of South- Kivu Province from June to August 2015. Insect pests, diseases and price fluctuations were among the highest ranked constraints in potato production by farmers. Cutworms (Agrotis spp., aphids (Myzus persicae Sulzer, and potato tuber moth (Phthorimaea operculella Zeller were the most severe insect pests in medium altitude zones (1600-1950m. Ants (Dorylis orantalis Westwood, whiteflies (Bemisia tabaci Gennadius, and leafminer flies (Liriomyza huidobrensis Blanchard were the pests of high importance reported from sites of very high altitude (2000-2600m. Major yield losses were mostly attributed to late blight (Phytophthora infestans Mont. de Bary and or insect pests and reached 65-90% without chemical control in most study sites. On average, farmers had little knowledge about pest characteristics (bio-ecology, behavior,…. Most (71.5% farmers were not able to correctly identify insect pest species names. Sometimes, two or more species had the same local name. There was a great confusion between damages (attacks due to pests, diseases and environmental stresses (rains, soil nutrient deficiency among farmers. Very few (18.5% farmers interviewed knew with precision some insect pests. Most (80% farmers did not know what natural enemies of insect pests and IPM were. Seasonal pest outbreak and emerging new pests were phenomenon related
Background The use of maternal health services, known as an indirect indicator of perinatal death, is still unknown in Lubumbashi. The present study was therefore undertaken in order to determine the factors that influence the use of mother and child healthcare services in Lubumbashi, Democratic Republic of the Congo. Methods This was transversal study of women residing in Lubumbashi who had delivered between January and December 2009. In total, 1762 women were sampled from households using indicator cluster surveys in all health zones. Antenatal consultations (ANC), delivery assisted by qualified healthcare personnel (and delivery in a healthcare facility) as well as postnatal consultations (PNC) were dependent variables of study. The factors determining non-use of maternal healthcare services were researched via logistic regression with a 5% materiality threshold. Results The use of maternal healthcare services was variable; 92.6% of women had attended ANC at least once, 93.8% of women had delivered at a healthcare facility, 97.2% had delivered in the presence of qualified healthcare personnel, while the rate of caesarean section was 4.5%. Only 34.6% postnatal women had attended PNC by 42 days after delivery. During these ANC visits, only 60.6% received at least one dose of vaccine, while 38.1% received Mebendazole, 35.6% iron, 32.7% at least one dose of SulfadoxinePyrimethamine, 29.2% folic acid, 15.5% screening for HIV and 12.8% an insecticide treated net. In comparison to women that had had two or three deliveries before, primiparous and grand multiparous women were twice as likely not to use ANC during their pregnancy. Women who had unplanned pregnancies were also more likely not to use ANC or PNC than those who had planned pregnancies alone or with their partner. The women who had not used ANC were also more likely not to use PNC. The women who had had a trouble-free delivery were more likely not to use PNC than those who had complications when delivering
Abel Ntambue, M L; Françoise Malonga, K; Dramaix-Wilmet, Michèle; Donnen, Philippe
The use of maternal health services, known as an indirect indicator of perinatal death, is still unknown in Lubumbashi. The present study was therefore undertaken in order to determine the factors that influence the use of mother and child healthcare services in Lubumbashi, Democratic Republic of the Congo. This was transversal study of women residing in Lubumbashi who had delivered between January and December 2009. In total, 1762 women were sampled from households using indicator cluster surveys in all health zones. Antenatal consultations (ANC), delivery assisted by qualified healthcare personnel (and delivery in a healthcare facility) as well as postnatal consultations (PNC) were dependent variables of study. The factors determining non-use of maternal healthcare services were researched via logistic regression with a 5% materiality threshold. The use of maternal healthcare services was variable; 92.6% of women had attended ANC at least once, 93.8% of women had delivered at a healthcare facility, 97.2% had delivered in the presence of qualified healthcare personnel, while the rate of caesarean section was 4.5%. Only 34.6% postnatal women had attended PNC by 42 days after delivery. During these ANC visits, only 60.6% received at least one dose of vaccine, while 38.1% received Mebendazole, 35.6% iron, 32.7% at least one dose of SulfadoxinePyrimethamine, 29.2% folic acid, 15.5% screening for HIV and 12.8% an insecticide treated net.In comparison to women that had had two or three deliveries before, primiparous and grand multiparous women were twice as likely not to use ANC during their pregnancy. Women who had unplanned pregnancies were also more likely not to use ANC or PNC than those who had planned pregnancies alone or with their partner. The women who had not used ANC were also more likely not to use PNC. The women who had had a trouble-free delivery were more likely not to use PNC than those who had complications when delivering. In Lubumbashi, a significant
Kayembe, John M; Thevenon, Florian; Laffite, Amandine; Sivalingam, Periyasamy; Ngelinkoto, Patience; Mulaji, Crispin K; Otamonga, Jean-Paul; Mubedi, Josué I; Poté, John
In many urban and peri-urban areas of developing countries, shallow wells and untreated water from urban rivers are used for domestic purposes, including drinking water supply, population bathing and irrigation for urban agriculture. The evaluation and monitoring of water quality are therefore necessary for preventing potential human risk associated with the exposure to contaminated water. In this study, physicochemical and bacteriological parameters were assessed in an urban river (named Kokolo Canal/Jerusalem River) draining the municipality of Lingwala (City of Kinshasa, Democratic Republic of the Congo) and in two shallow wells used as drinking water supplies, during the wet and dry seasons in order to estimate the seasonal variation of contamination. The faecal indicator bacteria (FIB) isolated strains (Escherichia coli (E. coli) and Enterococcus (ENT)) from water and surface sediment, were characterized for human-specific bacteroides by molecular approach. The results revealed very high faecal contamination of water from the shallow wells, and of water and sediments from the river, during both wet and dry seasons. During the wet season, E. coli reached the values of 18.6 × 10 5 and 4.9 × 10 5 CFU 100 mL -1 in Kokolo Canal and shallow wells, respectively; and Enterococcus reached the values of 7.4 × 10 4 and 2.7 × 10 4 CFU 100 mL -1 . Strong mutually positive correlation was observed between E. coli and ENT, with the range of R-value being 0.93 water but also on groundwater contamination. The water samples from the shallow wells and Kokolo Canal were highly polluted with faecal matter in both seasons. However, the pollution level was significantly higher during the wet season compared to the dry season. Physicochemical analysis revealed also very high water electrical conductivity, with values much higher than the recommended limits of the World Health Organization guideline for drinking water. These results highlight the
Full Text Available Abstract Background The use of maternal health services, known as an indirect indicator of perinatal death, is still unknown in Lubumbashi. The present study was therefore undertaken in order to determine the factors that influence the use of mother and child healthcare services in Lubumbashi, Democratic Republic of the Congo. Methods This was transversal study of women residing in Lubumbashi who had delivered between January and December 2009. In total, 1762 women were sampled from households using indicator cluster surveys in all health zones. Antenatal consultations (ANC, delivery assisted by qualified healthcare personnel (and delivery in a healthcare facility as well as postnatal consultations (PNC were dependent variables of study. The factors determining non-use of maternal healthcare services were researched via logistic regression with a 5% materiality threshold. Results The use of maternal healthcare services was variable; 92.6% of women had attended ANC at least once, 93.8% of women had delivered at a healthcare facility, 97.2% had delivered in the presence of qualified healthcare personnel, while the rate of caesarean section was 4.5%. Only 34.6% postnatal women had attended PNC by 42 days after delivery. During these ANC visits, only 60.6% received at least one dose of vaccine, while 38.1% received Mebendazole, 35.6% iron, 32.7% at least one dose of SulfadoxinePyrimethamine, 29.2% folic acid, 15.5% screening for HIV and 12.8% an insecticide treated net. In comparison to women that had had two or three deliveries before, primiparous and grand multiparous women were twice as likely not to use ANC during their pregnancy. Women who had unplanned pregnancies were also more likely not to use ANC or PNC than those who had planned pregnancies alone or with their partner. The women who had not used ANC were also more likely not to use PNC. The women who had had a trouble-free delivery were more likely not to use PNC than those who had
Frecuencia de infecciones de transmisión sexual y factores relacionados en Pweto, República Democrática del Congo, 2004 Frequency of sexually transmitted infections and related factors in Pweto, Democratic Republic of Congo, 2004
Miguel Ángel Luque Fernández
Full Text Available Objetivos: Estimar la prevalencia de ulceración genital y exudado uretral en Pweto, República Democrática del Congo, así como analizar la asociación de las prevalencias estimadas, con la edad, el estado civil, la profesión y el número de parejas sexuales. Métodos: Estudio descriptivo y transversal mediante encuesta, realizada a una muestra representativa de 106 varones de Pweto, de entre 15 y 65 años de edad, en mayo de 2004, con una precisión del 9,5%. Las preguntas sobre la presencia actual o antecedentes de ulceración y exudado fueron autoinformadas y referidas al último año a partir del día de la encuesta. Para el estudio de las asociaciones, se calculó la odds ratio (OR cruda y posteriormente la OR ajustada mediante una regresión logística multivariante. Resultados: La prevalencia fue del 39,6% (intervalo de confianza [IC] del 95%, 30-49 para el exudado uretral y del 33% (IC del 95%, 24-42 para la ulceración genital. Independientemente de la edad, el número de parejas sexuales durante el último año y el estado civil, los militares fueron identificados como un grupo de riesgo. El análisis multivariante nos muestra una OR ajustada de 3,25 (IC del 95%, 1,10-9,95; p Objectives: To estimate the prevalence of genital ulcer and urethral discharge in Pweto, Democratic Republic of Congo, and to analyze the association between the estimated prevalence and age, marital status, profession, and number of sexual partners. Methods: We performed a descriptive cross-sectional study through a survey conducted in May 2004 in a representative sample of 106 men in Pweto aged between 15 and 65 years old, with a precision of 9.5%. Questionnaire items about current or previous ulceration and urethral discharge where self-reported and referred to the previous year as of the date of the survey. To study the associations, crude and adjusted odds ratios (OR were calculated using multivariate logistic regression. Results: The prevalence was 39
Descriptive models, grade-tonnage relations, and databases for the assessment of sediment-hosted copper deposits: with emphasis on deposits in the Central Africa Copperbelt, Democratic Republic of the Congo and Zambia: Chapter J in Global mineral resource assessment
Taylor, Cliff D.; Causey, J. Douglas; Denning, Paul; Hammarstrom, Jane M.; Hayes, Timothy S.; Horton, John D.; Kirschbaum, Michael J.; Parks, Heather L.; Wilson, Anna B.; Wintzer, Niki E.; Zientek, Michael L.
The Central African Copperbelt (CACB) is one of the most important copper-producing regions of the world. The majority of copper produced in Africa comes from this region defined by the Neoproterozoic Katanga sedimentary basin of the southern Democratic Republic of the Congo (DRC) and northern Zambia. Copper in the CACB is mined from sediment-hosted stratabound copper deposits associated with red beds and includes the giant deposits in the Kolwezi and Tenge-Fungurume districts in the DRC and the Konkola-Musoshi and Nchanga-Chingola districts in Zambia. In recent years, sediment-hosted structurally controlled replacement and vein (SCRV) copper deposits, such as the giant Kansanshi deposit in Zambia have become important exploration targets in the CACB region.
Wood, Robin; Richardson, Eugene T
Nowhere are the barriers to a functional health infrastructure more clearly on display than in the Goma region of Democratic Republic of Congo. Kaboru et al. report poorly integrated services for HIV and TB in this war-torn region. Priorities in conflict zones include provision of security, shelter, food, clean water and prevention of sexual violence. In Goma, immediate health priorities include emergency treatment of cholera, malaria, respiratory illnesses, provision of maternal care, millions of measles vaccinations, and management of an ongoing rabies epidemic. It is a daunting task to determine an essential package of medical services in a setting where there are so many competing priorities, where opportunity costs are limited and epidemiologic information is scarce. Non-governmental agencies sometimes add to the challenge via an insidious reduction of state sovereignty and the creation of new levels of income inequality. Kaboru et al. have successfully highlighted many of the complexities of rebuilding and prioritizing healthcare in a conflict zone.
Full Text Available The Democratic Republic of Congo (DRC is the country in the world which reported the highest number of cholera cases to WHO from 2002 to 2007 (128 936 cases out of a worldwide 902 071 cases. We, therefore, implemented research work which intends to understand the epidemiology of cholera in the DRC and to ensure improvements in the strategy to ﬁght against cholera. This broad study enabled us to accurately determine the cholera epidemic’s mechanisms on diﬀerent scales; to identify the source zones of the disease, and the groups of populations acting as vectors of the spread. It was then possible to demonstrate the role of “sanctuary”, played by some suburbs of lakeside cities. A collaborative network, including several scientiﬁc institutions in Europe and in the DRC, local and national government administrations in the ﬁeld of public health and sanitation, international agencies, NGOs and private foundations, was progressively set up. Following the conclusions of our epidemiological studies, a drastic change of strategy was proposed: the limited curative approach on the one hand, the few existing water/sanitation programs on the other hand, have been merged in a global approach involving a larger scale water and sanitation infrastructure improvement, environmental protection, hygiene awareness and medical surveys targeting a few focus areas playing a central role in the epidemics. In conclusion, by better targeting intervention zones, one can gather human and technical resources previously scattered on the vast territory of the DRC. The strategy presented here revives the hope to eliminate cholera in the DRC.La République Démocratique du Congo (RDC est le pays qui a déclaré le plus grand nombre de cas de choléra à l’OMS entre 2002 et 2007 (128 936 cas sur un nombre total de 902 071 de cas dans le monde. Face à cette situation, nous avons mis en œuvre un travail de recherche qui vise à comprendre l’épidémiologie du
Scott, Jennifer; Rouhani, Shada; Greiner, Ashley; Albutt, Katherine; Kuwert, Philipp; Hacker, Michele R; VanRooyen, Michael; Bartels, Susan
Assess mental health outcomes among women raising children from sexual violence-related pregnancies (SVRPs) in eastern Democratic Republic of Congo and stigma toward and acceptance of women and their children. Participants were recruited using respondent-driven sampling. Bukavu, Democratic Republic of Congo in 2012. 757 adult women raising children from SVRPs were interviewed. A woman aged 18 and older was eligible for the study if she self-identified as a sexual violence survivor since the start of the conflict (∼1996), conceived an SVRP, delivered a liveborn child and was currently raising the child. A woman was ineligible for the study if the SVRP ended with a spontaneous abortion or fetal demise or the child was not currently living or in the care of the biological mother. Trained female Congolese interviewers verbally administered a quantitative survey after obtaining verbal informed consent. Symptom criteria for major depressive disorder, post-traumatic stress disorder, anxiety and suicidality were assessed, as well as stigma toward the woman and her child. Acceptance of the woman and child from the spouse, family and community were analysed. 48.6% met symptom criteria for major depressive disorder, 57.9% for post-traumatic stress disorder, 43.3% for anxiety and 34.2% reported suicidality. Women who reported stigma from the community (38.4%) or who reported stigma toward the child from the spouse (42.9%), family (31.8%) or community (38.1%) were significantly more likely to meet symptom criteria for most mental health disorders. Although not statistically significant, participants who reported acceptance and acceptance of their children from the spouse, family and community were less likely to meet symptom criteria. Women raising children from SVRPs experience symptoms of mental health disorders. Programming addressing stigma and acceptance following sexual violence may improve mental health outcomes in this population. Published by the BMJ Publishing Group
Marthe M. Kondemo
Full Text Available Concerned about the relative absence of activities (including the writings by members of the Circle of Concerned African Women Theologians within the Democratic Republic of the Congo Circle, Francophone context in general and her Mongolese context in particular, the author uses the marginalised character of Vashti in the Hebrew Bible to see which light the character might shed within the preceding contexts. Can Vashti�s identity in terms of boldness, courage and independence serve as a model for Congolese women in their efforts to make a positive impact on their contexts which remain glaringly patriarchal even today after many years of political independence? In this article, it is argued that the character of Vashti, especially her sense of independence and courage, can serve as a motivation for Congolese female theologians in their search for new identities.Intradisciplinary and/or interdisciplinary implications: In this article, the disciplines of African studies, political science, gender studies and biblical studies are made to interact with each other in the author�s quest to see how a biblical character such as Vashti can contribute positively to the theory and praxis of theology among emerging Francophone female scholars.Keywords: Circle; Francophone; Vashti; Hebrew Bible; patriarchy
Mueller, Yolanda; Bastard, Mathieu; Ehounou, Geneviève; Itama, Jeff; Quéré, Michel; de la Tour, Roberto; Vala, Louis; Etard, Jean-François; Bottineau, Marie-Claude
To assess the effectiveness of blood transfusions in a hospital of north-eastern Democratic Republic of the Congo. Prospective study of children admitted for severe anaemia. During admission, data were collected on clinical condition and haemoglobin levels, before and after blood transfusion. A linear regression model was built to explore factors associated with haemoglobin level after transfusion. Risk factors for mortality were explored through multivariate logistic regression. Haemoglobin level (Hb) was below 4 g/dl in 35% (230/657), between 4 and 6 g/dl in 58% (348/657) and at least 6 g/dl in another 6% (43/657) of the transfused children. A transfusion of 15 ml/kg of whole blood increased the Hb from 4.4 to 7.8 g/dl. Haemoglobin level after transfusion was associated with baseline Hb, quantity of delivered blood and history of previous transfusions. Overall case-fatality rate was 5.6% (37/657). Risk factors for deaths were co-morbidities such as chest infection, meningitis or malnutrition, Hb ≥ 6 g/dl, impaired consciousness or jugular venous distention on admission, and provenance. Transfusion was a frequent practice, the use of which could clearly have been rationalised. While indications should be restricted, quantities of transfused blood should be adapted to needs. © 2012 Blackwell Publishing Ltd.
Enterocytozoon bieneusi Identification Using Real-Time Polymerase Chain Reaction and Restriction Fragment Length Polymorphism in HIV-Infected Humans from Kinshasa Province of the Democratic Republic of Congo
Wumba, Roger; Jean, Menotti; Benjamin, Longo-Mbenza; Madone, Mandina; Fabien, Kintoki; Josué, Zanga; Jean, Sala; Eric, Kendjo; AC, Guillo-Olczyk; Marc, Thellier
Objective. To determine the prevalence and the genotypes of Enterocytozoon bieneusi in stool specimens from HIV patients. Methods. This cross-sectional study was carried out in Kinshasa hospitals between 2009 and 2012. Detection of microsporidia including E. bieneusi and E. intestinalis was performed in 242 HIV-infected patients. Typing was based on DNA polymorphism of the ribosomal DNA ITS region of E. bieneusi. PCRRFLP generated with two restriction enzymes (Nla III and Fnu 4HI) in PCR-amplified ITS products for classifying strains into different lineages. The diagnosis performance of the indirect immune-fluorescence-monoclonal antibody (IFI-AcM) was defined in comparison with real-time PCR as the gold standard. Results. Out of 242 HIV-infected patients, using the real-time PCR, the prevalence of E. bieneusi was 7.9% (n = 19) among the 19 E. bieneusi, one was coinfected with E. intestinalis. In 19 E. bieneusi persons using PCR-RFLP method, 5 type I strains of E. bieneusi (26.3%) and 5 type IV strains of E. bieneusi (26.3%) were identified. The sensitivity of IFI-AcM was poor as estimated 42.1%. Conclusion. Despite different PCR methods, there is possible association between HIVinfection, geographic location (France, Cameroun, Democratic Republic of Congo), and the concurrence of type I and type IV strains. PMID:22811884
Sistema interactivo como objeto virtual de aprendizaje aplicado a las técnicas de comunicación en comunidades lejanas de la República Democrática del Congo Interactive system as virtual learning object applied to the skils of communication in distant communities of the Democratic Republic of Congo
Gilmar Rolando Anaguano Jiménez
Full Text Available El presente trabajo contiene la descripción del producto final del proyecto 'Sistema interactivo como objeto virtual de aprendizaje aplicado a las técnicas de comunicación en comunidades lejanas de la República Democrática del Congo.', diseñado a la medida y basado en los requerimientos específicos del usuario final (Misioneros de la Consolata radicados en ese país. Este producto consiste en un prototipo de software orientado por los procesos del ciclo de vida del mismo (Planificación, análisis de requerimientos, diseño, desarrollo e implementación, realizado para aplicar las estrategias postuladas por la teoría de aprendizaje mixto (Blended Learning; las cuales se centran en la combinación de sesiones presenciales con actividades virtuales.This article is the result of the research project: 'Interactive System as a Virtual Learning Object Applied Communication Techniques in Distant Communities of the Democratic Republic of the Congo,' customized and based on the final user's specific requirements (Missionaries of the Consolata living in this country. The system is a prototype of software oriented by the processes of the cycle of life (planning, analysis of requirements, design, development and implementation, performed to apply strategies established by the Theory of Blended Learning, which uses face-to-face classrooms, live e-learning, and self-paced learning.
This paper summarizes research and development activities in the field of computerized operator support systems, self-powered detectors, boiling diagnostic and loose part detection systems in the German Democratic Republic
Continuous quality improvement interventions to improve long-term outcomes of antiretroviral therapy in women who initiated therapy during pregnancy or breastfeeding in the Democratic Republic of Congo: design of an open-label, parallel, group randomized trial.
Yotebieng, Marcel; Behets, Frieda; Kawende, Bienvenu; Ravelomanana, Noro Lantoniaina Rosa; Tabala, Martine; Okitolonda, Emile W
Despite the rapid adoption of the World Health Organization's 2013 guidelines, children continue to be infected with HIV perinatally because of sub-optimal adherence to the continuum of HIV care in maternal and child health (MCH) clinics. To achieve the UNAIDS goal of eliminating mother-to-child HIV transmission, multiple, adaptive interventions need to be implemented to improve adherence to the HIV continuum. The aim of this open label, parallel, group randomized trial is to evaluate the effectiveness of Continuous Quality Improvement (CQI) interventions implemented at facility and health district levels to improve retention in care and virological suppression through 24 months postpartum among pregnant and breastfeeding women receiving ART in MCH clinics in Kinshasa, Democratic Republic of Congo. Prior to randomization, the current monitoring and evaluation system will be strengthened to enable collection of high quality individual patient-level data necessary for timely indicators production and program outcomes monitoring to inform CQI interventions. Following randomization, in health districts randomized to CQI, quality improvement (QI) teams will be established at the district level and at MCH clinics level. For 18 months, QI teams will be brought together quarterly to identify key bottlenecks in the care delivery system using data from the monitoring system, develop an action plan to address those bottlenecks, and implement the action plan at the level of their district or clinics. If proven to be effective, CQI as designed here, could be scaled up rapidly in resource-scarce settings to accelerate progress towards the goal of an AIDS free generation. The protocol was retrospectively registered on February 7, 2017. ClinicalTrials.gov Identifier: NCT03048669 .
Assessment of schistosomiasis and soil-transmitted helminths prevalence in school-aged children and opportunities for integration of control in local health services in Kwilu Province, the Democratic Republic of the Congo.
Inocencio da Luz, R; Linsuke, S; Lutumba, P; Hasker, E; Boelaert, M
To determine the prevalence of schistosomiasis (SCH) and soil-transmitted helminths (STH) in the Democratic Republic of Congo, and to assess the capacity of the local health centres for diagnosis and treatment. Cross-sectional school-based survey in two health districts in the Province of Kwilu. We collected a stool and a urine sample for parasitological examination. Urine filtration and duplicate Kato-Katz thick smears were used for the diagnosis of SCH. Health centres were evaluated using a structured questionnaire. In total, 526 children participated in the study and the overall prevalence of Schistosoma mansoni infection was 8.9% (95% CI: 3.5-13.2) in both districts. The prevalence was higher in Mosango (11.7%; 95% CI: 8.9-14.8) than Yasa Bonga district (6.2%; 95% CI: 1.1-11.4). Urine filtration showed that Schistosoma haematobium infection was not present. The combined STH infection prevalence was 58.1% in both districts; hookworm infection was the most common STH found in 52.9% (95% CI: 29.3-62.4) of subjects, followed by Ascaris lumbricoides 9.3% (95% CI: 5.8-15.5) and Trichuris trichiura 2.1% (95% CI: 0.9-4.9). Mixed STH infections were observed as well as SCH-STH coinfection. Further mapping of both SCH and STH burden is needed, and coverage of preventive chemotherapy in school-aged children should be increased. © 2017 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.
Community-based maternal, newborn, and child health surveillance: perceptions and attitudes of local stakeholders towards using mobile phone by village health volunteers in the Kenge Health Zone, Democratic Republic of Congo.
Diese, Mulamba; Kalonji, Albert; Izale, Bibiche; Villeneuve, Susie; Kintaudi, Ngoma Miezi; Clarysse, Guy; Ngongo, Ngashi; Ntambue, Abel Mukengeshayi
In early 2016, we implemented a community-based maternal, newborn, and child health (MNCH) surveillance using mobile phones to collect, analyze, and use data by village health volunteers (VHV) in Kenge Health Zone (KHZ), in the Democratic Republic of Congo (DRC). The objective of this study was to determine the perceptions of households, attitudes of community health volunteers, and opinions of nurses in Health center and administrative authorities towards the use of mobile phones for MNCH surveillance in the rural KHZ in the DRC. We used mixed methods combining phenomenological and descriptive cross-sectional study. Between 3 and 24 March 2016, we collected the data through focus group discussions (FGD) with households, and structured interviews with VHV, local health and administrative authority, and nurses to explore the perceptions on MNCH surveillance using mobile phone. Data from the FGD and interviews were analyzed using thematic analysis techniques and descriptive statistics respectively. Health issues and services for under-five children were well known by community; however, beliefs and cultural norms contributed to the practices of seeking behavior for households. Mobile phones were perceived as devices that render quick services for people who needed help; and the community's attitudes towards the mobile phone use for collection of data, analysis, and use activities were good. Although some of community members did not see a direct linkage between this surveillance approach and health benefits, majority believed that there would be better MNCH services with the use of mobile phone. In addition, VHV will benefit from free healthcare for households and some material benefits and training. The best time to undertake these activities were in the afternoon with mother of the child, being the best respondent at the household. Health issues and services for under-five children are well known and MNCH surveillance using mobile phone by VHV in which the
[Role of GeneXpert MTB/RIF test in the screening for pulmonary tuberculosis at the General Referral Provincial Hospital of Bukavu, in the East of the Democratic Republic of the Congo: balance after 10 months of use].
Lupande, David; Kaishusha, David; Mihigo, Carine; Itongwa, Moise; Yenga, Gustave; Katchunga, Philippe
In sub-Saharan Africa, diagnostic methods for tuberculosis are inadequate and are essentially based on microscopy. They constitute a real obstacle to the control of tuberculosis. This study aimed to evaluate the performance of GeneXpert MTB/RIF test compared to classical Ziehl-Neelsen staining at the the general referral provincial hospital of Bukavu, in the east of the Democratic Republic of the Congo after 10 months of use. The results of Ziehl-Neelsen staining and GeneXpert MTB/RIF molecular biology test performed in 452 patients with suspected tuberculosis were collected. This study compares the validity of these different diagnostic tests in the detection of tuberculosis. In the entire group, the frequency of the pulmonary tuberculosis was 16.3%. The positivity rate was significantly higher in GeneXpert MTB/RIF test than in Ziehl-Neelsen staining in the entire group (15.9% vs 9.3%, p = 0.03) and in HIV seropositive patients (52.0% vs 24.0%; p = 0.007). However, the sensitivity of GeneXpert MTB/RIF test compared to that in Ziehl-Neelsen staining wasn't maximum (95.2%). Finally, GeneXpert MTB/RIF test detected rifampicin resistance in 20.8%. This study confirms the superiority of GeneXpert MTB/RIF test compared to Ziehl-Neelsen staining in the detection of tuberculosis and in the prediction of multi-resistance. Its systematic use coupled with Ziehl-Neelsen staining would better control tuberculosis in sub-Saharan Africa.
Barriers and facilitators to the implementation of antenatal syphilis screening and treatment for the prevention of congenital syphilis in the Democratic Republic of Congo and Zambia: results of qualitative formative research.
Nkamba, Dalau; Mwenechanya, Musaku; Kilonga, Arlette Mavila; Cafferata, Maria Luisa; Berrueta, Amanda Mabel; Mazzoni, Agustina; Althabe, Fernando; Garcia-Elorrio, Ezequiel; Tshefu, Antoniette K; Chomba, Elwyn; Buekens, Pierre M; Belizan, Maria
The impact of untreated syphilis during pregnancy on neonatal health remains a major public health threat worldwide. Given the high prevalence of syphilis during pregnancy in Zambia and Democratic Republic of Congo (DRC), the Preventive Congenital Syphilis Trial (PCS Trial), a cluster randomized trial, was proposed to increase same-day screening and treatment of syphilis during antenatal care visits. To design an accepted and feasible intervention, we conducted a qualitative formative research. Our objective was to identify context-specific barriers and facilitators to the implementation of antenatal screening and treatment during pregnancy. Qualitative research included in-depth semi-structured interviews with clinic administrators, group interviews with health care providers, and focus groups with pregnant women in primary care clinics (PCCs) in Kinshasa (DRC) and Lusaka (Zambia). A total of 112 individuals participated in the interviews and focus groups. Barriers for the implementation of syphilis testing and treatment were identified at the a) system level: fragmentation of the health system, existence of ANC guidelines in conflict with proposed intervention, poor accessibility of clinics (geographical and functional), staff and product shortages at the PCCs; b) healthcare providers' level: lack of knowledge and training about evolving best practices, reservations regarding same-day screening and treatment; c) Pregnant women level: late enrollment in ANC, lack of knowledge about consequences and treatment of syphilis, and stigma. Based on these results, we developed recommendations for the design of the PCS Trial intervention. This research allowed us to identify barriers and facilitators to improve the feasibility and acceptability of a behavioral intervention. Formative research is a critical step in designing appropriate and effective interventions by closing the "know-do gap".
Patou Masika Musumari
Full Text Available BACKGROUND: Food insecurity is increasingly reported as an important barrier of patient adherence to antiretroviral therapy (ART in both resource-poor and rich settings. However, unlike in resource rich-settings, very few quantitative studies to date have investigated the association of food insecurity with patient adherence to ART in Sub-Saharan Africa. The current study examines the association between food insecurity and adherence to ART among HIV-infected adults in the Democratic Republic of Congo (DRC. METHODS AND FINDINGS: This is a cross-sectional quantitative study of patients receiving ART at three private and one public health facilities in Kinshasa, DRC. Participants were consecutively recruited into the study between April and November 2012. Adherence was measured using a combined method coupling pharmacy refill and self-reported adherence. Food insecurity was the primary predictor, and was assessed using the Household Food Insecurity Access Scale (HFIAS. Of the 898 participants recruited into the study, 512 (57% were food insecure, and 188 (20.9% were not adherent to ART. Food insecurity was significantly associated with non-adherence to ART (AOR, 2.06; CI, 1.38-3.09. We also found that perceived harmfulness of ART and psychological distress were associated respectively with increased (AOR, 1.95; CI, 1.15-3.32 and decreased (AOR, 0.31; CI, 0.11-0.83 odds of non-adherence to ART. CONCLUSION: Food insecurity is prevalent and a significant risk factor for non-adherence to ART among HIV-infected individuals in the DRC. Our findings highlight the urgent need for strategies to improve food access among HIV-infected on ART in order to ensure patient adherence to ART and ultimately the long-term success of HIV treatment in Sub-Saharan Africa.
Asymptomatic Plasmodium falciparum infection is associated with anaemia in pregnancy and can be more cost-effectively detected by rapid diagnostic test than by microscopy in Kinshasa, Democratic Republic of the Congo.
Matangila, Junior R; Lufuluabo, Jean; Ibalanky, Axel L; Inocêncio da Luz, Raquel A; Lutumba, Pascal; Van Geertruyden, Jean-Pierre
In areas of high malaria transmission, Plasmodium falciparum infection during pregnancy is characterized by malaria-related anaemia, placental malaria and does not always result in clinical symptoms. This situation is associated with poor pregnancy outcomes. The aim of this study was to determine the extent of asymptomatic P. falciparum infection, its relation with anaemia as well as the most cost-effective technique for its diagnosis in healthy pregnant women living in Kinshasa, Democratic Republic of the Congo. In a cross-sectional study design, information on socio-demographic characteristics and cost data were collected in healthy pregnant women attending antenatal care consultations. Plasmodium falciparum infection was diagnosed using rapid diagnostic test (RDT), microscopy and polymerase chain reaction (PCR). Haemoglobin concentration was also determined. In total, 332 pregnant women were enrolled. RDT and microscopy data were available for all the blood samples and 166 samples were analysed by PCR. The prevalence of asymptomatic P. falciparum infection using microscopy, RDTs and PCR, were respectively 21.6%, 27.4% and 29.5%. Taking PCR as a reference, RDTs had a sensitivity of 81.6% and a specificity of 94.9% to diagnose asymptomatic P. falciparum infection. The corresponding values for microscopy were 67.3% and 97.4%. The prevalence of anaemia was 61.1% and asymptomatic malaria increased five times the odds (p anaemia. RDTs were more cost-effective compared to microscopy. Incremental cost-effectiveness ratio was US$ 63.47 per microscopy adequately diagnosed case. These alarming results emphasize the need to actively diagnose and treat asymptomatic malaria infection during all antenatal care visits. Moreover, in DRC, malaria and anaemia control efforts should be strengthened by promoting the use of insecticide-treated nets, intermittent preventive treatment with sulphadoxine-pyrimethamine and iron and folic acid supplements.
Leyka, Mukandu Basua Babintu; Baum, Prof Mylène; Diadié, Maiga; Kiyombo, Mbela; Mupenda, Bavon
All healthcare providers decide in someone else's place, for someone else. In doing so, they take their place in a long long tradition, that of medical paternalism. Patients are treated as children, incapable of making decisions about themselves. How then are we supposed to deal with patients like the street children of the Democratic Republic of the Congo, who are not part of our health-care system, who refuse care and prescriptions? Their refusal of caregivers forces us to seek strategies to dispel the conflicts, adapt outselves to the situation (self-medication, drug sales outside of dispensaries, etc.), but especially to rethink the relation between caregivers and patients. This does not mean abandoning the authoritarian patriarchal model for total relativism; the use of drugs such as antibiotics is and must remain surrounded by all the precautions necessary to avoid the further development of resistance; it does mean training and informing. The task facing us is that of health education and promotion, a long and continuous process, centered on patients and integrated with their care, aimed at making them capable of managing their disease. This procedure is part of a pragmatic approach: beyond the asymmetry involved in any relationship of power, it is essential to establish informed confidence, to look for adhesion and not constraint. Only this pragmatism can incite young people with sexually transmitted diseases (STDs) to use modern medicine and comply with the dosage instructions. Effective treatment of STDs is, according to WHO, one of the most powerful weapons in the battle against AIDS transmission.
Ageing, exposure to pollution, and interactions between climate change and local seasons as oxidant conditions predicting incident hematologic malignancy at KINSHASA University clinics, Democratic Republic of CONGO (DRC).
Nkanga, Mireille Solange Nganga; Longo-Mbenza, Benjamin; Adeniyi, Oladele Vincent; Ngwidiwo, Jacques Bikaula; Katawandja, Antoine Lufimbo; Kazadi, Paul Roger Beia; Nzonzila, Alain Nganga
The global burden of hematologic malignancy (HM) is rapidly rising with aging, exposure to polluted environments, and global and local climate variability all being well-established conditions of oxidative stress. However, there is currently no information on the extent and predictors of HM at Kinshasa University Clinics (KUC), DR Congo (DRC). This study evaluated the impact of bio-clinical factors, exposure to polluted environments, and interactions between global climate changes (EL Nino and La Nina) and local climate (dry and rainy seasons) on the incidence of HM. This hospital-based prospective cohort study was conducted at Kinshasa University Clinics in DR Congo. A total of 105 black African adult patients with anaemia between 2009 and 2016 were included. HM was confirmed by morphological typing according to the French-American-British (FAB) Classification System. Gender, age, exposure to traffic pollution and garages/stations, global climate variability (El Nino and La Nina), and local climate (dry and rainy seasons) were potential independent variables to predict incident HM using Cox regression analysis and Kaplan Meier curves. Out of the total 105 patients, 63 experienced incident HM, with an incidence rate of 60%. After adjusting for gender, HIV/AIDS, and other bio-clinical factors, the most significant independent predictors of HM were age ≥ 55 years (HR = 2.4; 95% CI 1.4-4.3; P = 0.003), exposure to pollution and garages or stations (HR = 4.9; 95% CI 2-12.1; P pollution, combined local dry season + La Nina and combined local dry season + El Nino were the most significant predictors of incident hematologic malignancy. These findings highlight the importance of aging, pollution, the dry season, El Nino and La Nina as related to global warming as determinants of hematologic malignancies among African patients from Kinshasa, DR Congo. Cancer registries in DRC and other African countries will provide more robust database for future researches on
Rattan, Jesse; Noznesky, Elizabeth; Curry, Dora Ward; Galavotti, Christine; Hwang, Shuyuan; Rodriguez, Mariela
The global health community has recognized that expanding the contraceptive method mix is a programmatic imperative since (1) one-third of unintended pregnancies are due to method failure or discontinuation, and (2) the addition of a new method to the existing mix tends to increase total contraceptive use. Since July 2011, CARE has been implementing the Supporting Access to Family Planning and Post-Abortion Care (SAFPAC) initiative to increase the availability, quality, and use of contraception, with a particular focus on highly effective and long-acting reversible methods-intrauterine devices (IUDs) and implants-in crisis-affected settings in Chad and the Democratic Republic of the Congo (DRC). This initiative supports government health systems at primary and referral levels to provide a wide range of contraceptive services to people affected by conflict and/or displacement. Before the initiative, long-acting reversible methods were either unknown or unavailable in the intervention areas. However, as soon as trained providers were in place, we noted a dramatic and sustained increase in new users of all contraceptive methods, especially implants, with total new clients reaching 82,855, or 32% of the estimated number of women of reproductive age in the respective catchment areas in both countries, at the end of the fourth year. Demand for implants was very strong in the first 6 months after provider training. During this time, implants consistently accounted for more than 50% of the method mix, reaching as high as 89% in Chad and 74% in DRC. To ensure that all clients were getting the contraceptive method of their choice, we conducted a series of discussions and sought feedback from different stakeholders in order to modify program strategies. Key program modifications included more focused communication in mass media, community, and interpersonal channels about the benefits of IUDs while reinforcing the wide range of methods available and refresher training for
Adult and adolescent livestock productive asset transfer programmes to improve mental health, economic stability and family and community relationships in rural South Kivu Province, Democratic Republic of Congo: a protocol of a randomised controlled trial.
Kohli, Anjalee; Perrin, Nancy A; Remy, Mitima Mpanano; Alfred, Mirindi Bacikenge; Arsene, Kajabika Binkurhorhwa; Nadine, Mwinja Bufole; Heri, Banyewesize Jean; Clovis, Mitima Murhula; Glass, Nancy
People living in poverty have limited access to traditional financial institutions. Microfinance programmes are designed to meet this gap and show promise in improving income, economic productivity and health. Our Congolese-US community academic research partnership developed two livestock productive asset transfer programmes, Pigs for Peace (PFP) and Rabbits for Resilience (RFR), to address the interlinked health, social and economic well-being of individuals, their families and communities. The community-based randomised controlled trials examine the effectiveness of PFP and RFR to improve health, economic stability, and family and community relationships among male and female adults and adolescents living in 10 rural, postconflict villages of eastern Democratic Republic of Congo. PFP participants include adult permanent residents of rural villages; adolescent participants in RFR include male and female adolescents 10-15 years old living in the selected rural villages. Participants were randomised to intervention or delayed control group. Participants in PFP completed baseline interview prior to intervention and follow-up interview at 6, 12 and 18 months postintervention. In RFR, participants completed baseline interview prior to intervention and follow-up interview at 6, 12 and 18 months postbaseline. The primary outcome of both trials, the change in baseline mental health distress at 18 months in the intervention group (adults, adolescents) compared to control group, is used to calculate sample size. The Johns Hopkins Medical Institute Internal Review Board approved this protocol. A committee of respected Congolese educators and community members (due to lack of local ethics review board) approved the study. The findings will provide important information on the potential for community-led sustainable development initiatives to build on traditional livelihood (livestock raising, agriculture) to have a sustained health, economic and social impact on the
Evaluating the comparative effectiveness of different demand side interventions to increase maternal health service utilization and practice of birth spacing in South Kivu, Democratic Republic of Congo: an innovative, mixed methods approach.
Dumbaugh, Mari; Bapolisi, Wyvine; van de Weerd, Jennie; Zabiti, Michel; Mommers, Paula; Balaluka, Ghislain Bisimwa; Merten, Sonja
In this protocol we describe a mixed methods study in the province of South Kivu, Democratic Republic of Congo evaluating the effectiveness of different demand side strategies to increase maternal health service utilization and the practice of birth spacing. Conditional service subsidization, conditional cash transfers and non-monetary incentives aim to encourage women to use maternal health services and practice birth spacing in two different health districts. Our methodology will comparatively evaluate the effectiveness of different approaches against each other and no intervention. This study comprises four main research activities: 1) Formative qualitative research to determine feasibility of planned activities and inform development of the quantitative survey; 2) A community-based, longitudinal survey; 3) A retrospective review of health facility records; 4) Qualitative exploration of intervention acceptability and emergent themes through in-depth interviews with program participants, non-participants, their partners and health providers. Female community health workers are engaged as core members of the research team, working in tandem with female survey teams to identify women in the community who meet eligibility criteria. Female community health workers also act as key informants and community entry points during methods design and qualitative exploration. Main study outcomes are completion of antenatal care, institutional delivery, practice of birth spacing, family planning uptake and intervention acceptability in the communities. Qualitative methods also explore decision making around maternal health service use, fertility preference and perceptions of family planning. The innovative mixed methods design allows quantitative data to inform the relationships and phenomena to be explored in qualitative collection. In turn, qualitative findings will be triangulated with quantitative findings. Inspired by the principles of grounded theory, qualitative
probable effects of decentralisation on the two elements of the rule of law to which I referred above: ... Decentralisation will probably increase efficiency and the central power will ...... Most of the ethnically motivated crimes committed in Burundi.
Sistema interactivo de aprendizaje como elemento de apoyo a los procesos de sustentabilidad y educación inclusiva, aplicado en comunidades lejanas de la República Democrática del Congo Interactive learning system as a support in processes of sustainability and inclusive education, applied in distant communities of the Democratic Republic of Congo
Gilmar Rolando Anaguano Jiménez
Full Text Available El presente es un artículo de reflexión, el cual resalta la importancia de los ambientes virtuales de aprendizaje como estrategia de apoyo a los lineamientos actuales de las Naciones Unidas, relacionados con los procesos de sustentabilidad global y educación inclusiva. Contiene la reflexión y descripción, de una investigación realizada por dos integrantes del grupo ARKADIUS del programa en Ingeniería de Sistemas de la Universidad de Medellín, cuyo objetivo general consistió en diseñar un sistema interactivo de aprendizaje para La República Democrática del Congo - África. Metodológicamente fue una investigación de tipo aplicativo-experimental la cual generó un prototipo de software diseñado a la medida para apoyar las estrategias postuladas por la teoría de aprendizaje mixto (B-Learning. El modelo pedagógico sugerido, las herramientas tecnológicas utilizadas y la movilización de un equipo investigativo internacional interdisciplinario constituyen igualmente, un aporte a los procesos de internacionalización y proyección social de la educación.This document is a reflection, which highlights the importance of the virtual learning environments as strategy to support the current tendencies of the United Nations, related to the processes of global sustainability and inclusive education. It contains the reflection and description of a research carried out by two members of the ARKADIUS research group of Computer Science Engineering program of Universidad de Medellín; which general target consisted of designing an interactive learning system for the Democratic Republic of Congo - Africa. Methodologically it was an applicative-experimental research, which generated a prototype of software tailored to support the strategies stated by the theory of Blended Learning. The pedagogic model suggested, technological tools used, and the mobilization of an international and interdisciplinary research team, can be considered as a
Nienie, Alexis B; Sivalingam, Periyasamy; Laffite, Amandine; Ngelinkoto, Patience; Otamonga, Jean-Paul; Matand, Alphonse; Mulaji, Crispin K; Biey, Emmanuel M; Mpiana, Pius T; Poté, John
The availability of safe drinking water in sub-Saharan countries remains a major challenge because poor sanitation has been the cause of various outbreaks of waterborne disease due to the poor microbiological quality of water used for domestic purposes. The faecal indicator bacteria (FIB) used in the present study included Escherichia coli (E. coli) and Enterococcus (ENT). FIB and aerobic mesophilic bacteria (AMB) were quantified during July 2015 (dry season) and November 2015 (rainy season) in order to assess the quality of drinking water from wells (n=3; P1-P3), and two rivers, the River Lukemi (RLK, n=3) and River Luini (RLN, n=2) in the city of Kikwit, which is located in the province of Kwilu in the Democratic Republic of the Congo. Kikwit is well known for its outbreaks of persistent and recurrent waterborne diseases including Entamoeba, Shigella, typhoid fever, cholera, and Ebola Viral Hemorrhagic Fever. Consequently, E. coli, ENT, and AMB were quantified in water samples according to the standard international methods for water quality determination using the membrane filtration method. The FIB characterization was performed for human-specific Bacteroides by PCR using specific primers. The results obtained revealed high FIB concentrations in river samples collected during both seasons. For example, E. coli respectively reached 4.3×10 4 and 9.2×10 4 CFU 100mL -1 in the dry season and the wet season. ENT reached 5.3×10 3 CFU 100mL -1 during the dry season and 9.8×10 3 CFU 100mL -1 in the wet season. The pollution was significantly worse in the wet season compared to the dry season. Surprisingly, no faecal contamination was observed in well water samples collected in the dry season while E. coli and ENT were detected in all wells in the wet season with values of 6, 7, and 11CFUmL -1 for E. coli in wells P1-P3, respectively and 3, 5, 9 CFU mL -1 for ENT in the same wells. Interestingly, the PCR assays for human-specific Bacteroides HF183/HF134 indicated
Sustainable prevention of resource conflicts. Case study and scenarios on copper and cobalt in the Democratic Republic of Congo (Report 3.2); Rohstoffkonflikte nachhaltig vermeiden. Fallstudie und Szenarien zu Kupfer und Kobalt in der Demokratischen Republik Kongo (Teilbericht 3.2)
Taenzler, Dennis; Westerkamp, Meike [Adelphi Research, Berlin (Germany); Supersberger, Nikolaus; Ritthoff, Michael; Bleischwitz, Raimund [Wuppertal Institut (Germany)
The Democratic Republic of Congo has enormous economic potential thanks to its raw material wealth. However, since 1996 (if not before) DR Congo has been seen as a classic example of the linkage between the exploitation of raw materials and the financing of war. The UN Panel of Experts on the Illegal Exploitation of Natural Resources in DR Congo points out that the history of Congo since colonial times has been marked by systematic abuse of natural and human resources (UN Panel 2002). The UN Panel of Experts and the work of NGOs have helped to reveal rebels, senior military figures and private companies as profiteers from the exploitation of raw materials and to identify channels of financing the violent conflict in Congo since 1996 (see reports from the UN Panel, Pole Institute, Global Witness, HRW). Foreign companies mining, trading in or processing raw materials in DR Congo have also been regularly criticised as sharing responsibility for the ongoing violence, principally in the eastern Congo (UN Panel 2002, Cuvelier/Raeymaekers 2002, RAID 2004). Practically every major escalation in conflict in recent years between the various players in Congo has been connected to the management of, or the (legal or illegal) revenues from, natural resources, particularly from mining. This observation was also backed by data from the HIIK's CONIS information system. In 2008, eight of nine conflicts in Congo related at least in part to resources - five being violent and three non-violent (HIIK 2008). Following the coltan boom of 2000/2001, it now primarily profits from the mining and sale of the tin oxide ore cassiterite which continue to serve as the key means of financing violence (see Garrett 2008).1 In DRK it is not only the mining and sale of coltan and cassiterite which represents a nexus of conflict and resources however. Alongside timber, diamonds, oil and gold, it is above all the mining and sale of copper and cobalt from the so-called copper belt in the south
McIntyre, Thomas D.
The use of sports in the German Democratic Republic and the People's Republic of China is both propagandist and ideological. International sports competition can enhance the country's image and domestic sport is a means of political socialization. (DF)
Jansson, Johanna; Jiang, Wenran
An NGO report on Chinese investment in the Democratic Republic of Congo opens a vital debate, but its methodology leaves the reader wanting a fuller version of the facts, write Johanna Jansson and Jiang Wenran.......An NGO report on Chinese investment in the Democratic Republic of Congo opens a vital debate, but its methodology leaves the reader wanting a fuller version of the facts, write Johanna Jansson and Jiang Wenran....
... Cambodia, Cameroon, Canada, Cayman Islands, Central African Republic, Chad, Chile, China, Colombia, Comoros, Congo, Democratic Republic, Congo, Republic, Costa Rica, Côte d'Ivoire, Croatia, Cuba, Curaçao, Cyprus, Czech Republic, Denmark, Djibouti, Dominica, Dominican Republic, Ecuador, Egypt, Arab Rep.
"Was it a mistake to tell others that you are infected with HIV?": factors associated with regret following HIV disclosure among people living with HIV in five countries (Mali, Morocco, Democratic Republic of the Congo, Ecuador and Romania). Results from a community-based research.
Henry, Emilie; Bernier, Adeline; Lazar, Florin; Matamba, Gaspard; Loukid, Mohamed; Bonifaz, Cesar; Diop, Samba; Otis, Joanne; Préau, Marie
This study examined regret following HIV serostatus disclosure and associated factors in under-investigated contexts (Mali, Morocco, Democratic Republic of the Congo, Ecuador and Romania). A community-based cross-sectional study was implemented by a mixed consortium [researchers/community-based organizations (CBO)]. Trained CBO members interviewed 1,500 PLHIV in contact with CBOs using a 125-item questionnaire. A weighted multivariate logistic regression was performed. Among the 1,212 participants included in the analysis, 290 (23.9 %) declared that disclosure was a mistake. Female gender, percentage of PLHIV's network knowing about one's seropositivity from a third party, having suffered rejection after disclosure, having suffered HIV-based discrimination at work, perceived seriousness of infection score, daily loneliness, property index and self-esteem score were independently associated with regret. Discrimination, as well as individual characteristics and skills may affect the disclosure experience. Interventions aiming at improving PLHIV skills and reducing their social isolation may facilitate the disclosure process and avoid negative consequences.
The Potential Financial Costs of Climate Change on Health of Urban and Rural Citizens: A Case Study of Vibrio cholerae Infections at Bukavu Town, South Kivu Province, Eastern of Democratic Republic of Congo.
Munyuli, Mb Théodore; Kavuvu, J-M Mbaka; Mulinganya, Guy; Bwinja, G Mulinganya
Cholera epidemics have a recorded history in eastern Congo dating to 1971. A study was conducted to find out the linkage between climate variability/change and cholera outbreak and to assess the related economic cost in the management of cholera in Congo. This study integrates historical data (20 years) on temperature and rainfall with the burden of disease from cholera in South-Kivu province, eastern Congo. Analyses of precipitation and temperatures characteristics in South-Kivu provinces showed that cholera epidemics are closely associated with climatic factors variability. Peaks in Cholera new cases were in synchrony with peaks in rainfalls. Cholera infection cases declined significantly (Pwater sources by the bacteria (Vibrio cholerae). The consumption of polluted water, promiscuity, population density and lack of hygiene are determinants favoring spread and infection of the bacteria among human beings living in over-crowded environments.
Disclosure of HIV status and its impact on the loss in the follow-up of HIV-infected patients on potent anti-retroviral therapy programs in a (post- conflict setting: A retrospective cohort study from Goma, Democratic Republic of Congo.
Pierre Zalagile Akilimali
Full Text Available The study aimed to identify the impact of non-disclosure of HIV status on the loss to follow-up (LTFU of patients receiving anti-retroviral therapy.A historic cohort of HIV patients from 2 major hospitals in Goma, Democratic Republic of Congo was followed from 2004 to 2012. LTFU was defined as not taking an ART refill for a period of 3 months or longer since the last attendance, and had not yet been classified as 'dead' or 'transferred-out'. Kaplan-Meier plots were used to determine the probability of LTFU as a function of time as inclusive of the cohort. The log-rank test was used to compare survival curves based on determinants. Cox proportional hazard modeling was used to measure predictors of LTFU from the time of treatment induction until December 15th, 2012 (the end-point.The median follow-up time was 3.99 years (IQR = 2.33 to 5.59. Seventy percent of patients had shared their HIV status with others (95% CI: 66.3-73.1. The proportion of LTFU was 12% (95%CI: 9.6-14.4. Patients who did not share their HIV status (Adjusted HR 2.28, 95% CI 1.46-2.29, patients who did not live in the city of Goma (Adjusted HR 1.97, 95% CI 1.02-3.77, and those who attained secondary or higher education level (Adjusted HR 1.60, 95% CI 1.02-2.53 had a higher hazard of being LTFU.This study shows the relationship between the non-disclosure HIV status and LTFU. Healthcare workers in similar settings should pay more attention to clients who have not disclosed their HIV status, and to those living far from health settings where they receive medication.
International Planned Parenthood Federation, London (England).
Data relating to population and family planning in eight foreign countries are presented in these situation reports. Countries included are Afghanistan, Cyprus, Iran, Kenya, Lebanese Republic, Malagasy Republic (Madagascar), Malaysia (West), and People's Democratic Republic of Yemen. Information is provided under two topics, general background and…
Dumas, Wayne; Dumas, Alesia
Investigates civic education curricular reform in the former German Democratic Republic (GDR). Discusses the problems inherent in reforming an entire educational system, from textbooks to teachers, originally designed for Marxist-Leninist purposes. Examines the German state educational structure and the role that the main political parties play in…
Access to improved sanitation is a major concern in the Lao People s Democratic Republic. Only 63 percent of the population of the country had access to improved sanitation facilities in 2010. Sanitation conditions are worse in rural areas. This study aims to generate evidence on the costs and benefits of sanitation improvements Lao PDR.
Protocol between the Democratic Republic of Congo and the International Atomic Energy Agency Additional to the Agreement for the Application of Safeguards in Connection with the Treaty on the Non-proliferation of Nuclear Weapons
The text of the Protocol Additional to the Agreement between the Republic of Zaire and the International Atomic Energy Agency for the Application of Safeguards in Connection with the Treaty on the Non-Proliferation of Nuclear Weapons (NPT)1 is reproduced in the Annex to this document for the information of all Members. The Additional Protocol was approved by the Board of Governors on 28 November 2002. It was signed in Vienna on 9 April 2003
Impact of treatment and re-treatment with artemether-lumefantrine and artesunate-amodiaquine on selection of Plasmodium falciparum multidrug resistance gene-1 polymorphisms in the Democratic Republic of Congo and Uganda.
Full Text Available The emergence of resistance against artemisinin combination treatment is a major concern for malaria control. ACTs are recommended as the rescue treatment, however, there is limited evidence as to whether treatment and re-treatment with ACTs select for drug-resistant P. falciparum parasites. Thus, the purpose of the present study is to investigate the impact of (re-treatment using artesunate-amodiaquine (ASAQ and artemether-lumefantrine (AL on the selection of P. falciparum multidrug resistance-1 (Pfmdr1 alleles in clinical settings.P. falciparum positive samples were collected from children aged 12-59 months in a clinical trial in DR Congo and Uganda. Pfmdr1 single nucleotide polymorphisms (SNPs analysis at codons N86Y, Y184F, and D1246Y were performed at baseline and post-treatment with either AL or ASAQ as a rescue treatment using nested PCR followed by restriction fragment length polymorphism (RFLP assays.The pre-treatment prevalence of Pfmdr1 N86 and D1246Y varied significantly between the sites, (p>0.001 and (p = 0.013, respectively. There was borderline significant directional selection for Pfmdr1 184F in recurrent malaria infections after treatment with AL in Uganda site (p = 0.05. Pfmdr1 NFD haplotype did not significantly change in post-treatment infections after re-treatment with either AL or ASAQ. Comparison between pre-treatment and post-treatment recurrences did not indicate directional selection of Pfmdr1 N86, D1246 alleles in the pre-RCT, RCT and post-RCT phases in both AL and ASAQ treatment arms. Pfmdr1 86Y was significantly associated with reduced risk of AL treatment failure (RR = 0.34, 95% CI:0.11-1.05, p = 0.04 while no evidence for D1246 allele (RR = 1.02; 95% CI: 0.42-2.47, p = 1.0. Survival estimates showed that the Pfmdr1 alleles had comparable mean-time to PCR-corrected recrudescence and new infections in both AL and ASAQ treatment arms.We found limited impact of (re-treatment with AL or ASAQ on selection for Pfmdr1
International relationships in ophthalmology in the former German Democratic Republic (GDR) were directed by the government and predominantly promoted relationships to socialist countries in Eastern Europe. The lack of freedom of travel, restrictions of import for scientific journals and general prevention of contacts by the State security service led to a stagnation in daily practice and in research, mainly from 1961 until 1989.
The radiation monitoring results published in this SAAS report correspond with the introductory paper to the compilation of data measured in the German Democratic Republic in the period May to September 1986, which was submitted to the IAEA in October 1986. The conclusion to be drawn from these results is that it was at no time necessary to restrict food consumption or to change nutritional habits in order to avoid detrimental health effects [fr
van Vliet, Nathalie; Nebesse, Casimir; Gambalemoke, Sylvestre
Given the important contribution of urban consumption in bushmeat trade, information on bushmeat sales in urban markets can provide valuable insights for understanding the dynamics of this trade and its implications for conservation and food security. We monitored bushmeat traded in the market...... bushmeat was one of the cheapest sources of protein available year-round, together with caterpillars, which were only available during the rainy season, and pork. Prices of other domestic meat were significantly higher. This study identified an increase in the market of highly threatened species...
Annual economic growth, buoyed by high global commodity prices , has topped 5% in most recent years. DRC also receives high levels of international...Kenya, Uganda, Rwanda, South Sudan, Sudan, Tanzania, and Zambia . 2 Feingold interview on CNN International, November 5, 2013; transcript via...foreign aid responses to the conflict in the east (e.g., P.L. 109-456); • Restricting certain types of bilateral aid and arms transfers to countries
During 7-10 February 2005, representatives of five francophone African ... Alternatives, Réseau d'action et de communication pour le développement international inc. ... Eleven world-class research teams set to improve livestock vaccine ...
Carruthers, Grant; Yee, Joyce
1989: The German Democratic Republic (GDR) still existed and the Berlin Wall was still standing. Communism was alive in Europe. Hard to believe now, yet only fifteen years ago, a reality. By 1990 the GDR was gone, but it lingers on in the memory of many people now as a dull, repressive, unimaginative place full of cheap plastic, grey concrete, goosestepping soldiers, sports stars with mullets, the dreaded Stasi secret police and of course, the Wall.\\ud \\ud These memories illustrate common Wes...
Jeon, Hyeong-Kyu; Yong, Tai-Soon; Sohn, Woon-Mok; Chai, Jong-Yil; Min, Duk-Young; Yun, Cheong-Ha; Rim, Han-Jong; Pongvongsa, Tiengkham; Banouvong, Virasack; Insisiengmay, Bounnaloth; Phommasack, Bounlay; Eom, Keeseon S
Human taeniasis was investigated in Lao People's Democratic Republic (Lao PDR) between 2000 and 2011 as part of the nation's helminthiasis survey. A total of 55,038 inhabitants, including 29,846 school children, were examined using the Kato-Katz and scotch-tape anal swab method, and morphological observation of adult worms. Molecular identification of Taenia tapeworms was performed by multiplex PCR or DNA sequence analysis of the mitochondrial cox1 gene. Taenia eggs were present at a rate of 1.5% (845/55,038) in the subject population. Adult tapeworms were identified as T. solium or T. saginata by analyzing the collectable stool specimens (n=126). Three specimens identified as T. solium were found in Luang Prabang, while the remaining 123 specimens, which were T. saginata, were found in Bokeo, Bolikhamxay, Champasak, Houaphan, Khammouane, Luang Namta, Luang Prabang, Oudomxay, Phongsaly, Saysomboune, Saravane, Savannakhet, Xayaboury, Xekong, Xieng Khouang Province, and Vientiane Municipality.
Situation Report--Barbados, Finland, German Democratic Republic, Italy, Lesotho, Luxembourg, Malagasy Republic (Madagascar), Malaysia (West), Netherlands, Poland, Portugal, Singapore, Sweden, Syrian Arab Republic, and Yugoslavia.
International Planned Parenthood Federation, London (England).
Data relating to population and family planning in 15 foreign countries are presented in these situation reports. Countries included are Barbados, Finland, German Democratic Republic, Italy, Lesotho, Luxembourg, Malagasy Republic, Malaysia (West), Netherlands, Poland, Portugal, Singapore, Sweden, Syrian Arab Republic, and Yogoslavia. Information…
In October 1994, at Geneva, the United States and the Democratic People's Republic of Korea (DPRK) signed an Agreed Framework as a first step toward resolving international concerns about nuclear activities in the DPRK. This Agreement, when implemented, will ultimately lead to the complete dismantlement of those aspects of the DPRK's nuclear program, including reprocessing-related facilities, that have undermined the viability of the international nuclear non-proliferation regime and the stability of the Asia-Pacific region. The essence of the Agreement is that the DPRK will take near-term action to cease the activities of concern and permit some International Atomic Energy Agency (IAEA) verification inspection. In the future, it will dismantle its production reactors and accept full-scope IAWA safeguards. In return, the United Stated agreed to lead an international effort to supply the DPRK with light-water reactors which are less of proliferation concern than are graphite-moderated production reactors. Until the first LWR is in operation the DPRK will receive shipments of heavy oil to replace the energy lost by shutting down the production reactors
Seebacher, C; Blaschke-Hellmessen, Renate; Kielstein, P
After the Second World War the development of medical mycology in Germany had taken a very different course in the east and west parts depending on the political division. In this respect our contribution deals with the situation in the former German Democratic Republic. Efficient mycological centres were founded step by step almost in all medical universities on the basis of the mycological laboratories in dermatological hospitals competent for diagnostic work, but also for teaching and scientific research. In this context biologists were the main stay of mycology, they finally were integrated to the same degree in the universities like physicians. The effectiveness of the Gesellschaft für Medizinische Mykologie der DDR (GMM), its board of directors and its working groups as well as the topics of human and animal mycology during this period are described. Especially the merger of the GMM with the Deutschsprachige Mykologische Gesellschaft after the reunification of Germany without problems and the kind co-operation of Prof. Dr. Johannes Müller during this procedure are emphasized.
A reliable and low-price electricity supply is an essential part of the economic reconstruction now underway in the five new federal states (lander) of unified Germany, which were created from the former German Democratic Republic (GDR). Acting on the request of the last government of the GDR (which was freely elected), the West German utilities RWE Energie, PreussenElektra and Bayernwerk had already investigated suitable means to ensure the power supply of the five new states after unification. On 22 August 1990, after intensive negotiations with the government of the former GDR and the Treuhand privatisation agency, a set of agreements concerning the takeover and modernisation of the energy industry in eastern Germany was signed. The other German inter-connected utilities are also parties to the agreements. The essential task now for the West German utilities is to develop a reliable, low-priced, electricity supply capacity in the new federal states, which means taking long-term investment decisions. The extremely high environmental impact of the existing facilities must also be reduced considerably. (author)
The attached text of a statement by a spokesman for the Foreign Ministry of the Democratic People's Republic of Korea, dated 1 June 1994, is being circulated to all Member States of the Agency at the request of the Permanent Mission of the Democratic People's Republic of Korea. This text was received by the Secretariat before the withdrawal of the Democratic People's Republic of Korea from the Agency
Nagy, Z. T.; Kusamba, C.; Collet, M.; Gvoždík, Václav
Roč. 6, č. 6 (2013), s. 413-419 ISSN 2071-5773 Institutional support: RVO:68081766 Keywords : Anura * checklist * mangroves * Mayombe * Squamata * Testudines Subject RIV: EG - Zoology http://www.herpetologynotes.seh-herpetology.org/Volume6_PDFs/Nagy_HerpetologyNotes_volume6_pages413-419.pdf
Classification of very high resolution satellite remote sensing data in a pilot phase of the forest cover classification of the Democratic Republic of Congo, Forêts d'Afrique Central Evaluées par Télédetection (FACET) product
Singa Monga Lowengo, C.
The Observatoire Satellital des Forêts d'Afrique Centrale (OSFAC) based in Kinshasa, serves as the focal point of the GOFC-GOLD network for Central Africa. OSFAC's long term objective is building regional capacity to use remotely sensed data to map forest cover and forest cover change across Central Africa. OSFAC archives and disseminates satellite data, offers training in geospatial data applications in coordination with the University of Kinshasa, and provides technical support to CARPE partners. Forêts d'Afrique Centrale Évaluées par Télédétection (FACET) is an OSFAC initiative that implements the UMD/SDSU methodology at the national level and quantitatively evaluates the spatiotemporal dynamics of forest cover in Central Africa. The multi-temporal series of FACET data is a useful contribution to many projects, such as biodiversity monitoring, climate modeling, conservation, natural resource management, land use planning, agriculture and REDD+. I am working as Remote Sensing and GIS Officer in various projects of OSFAC. My activities include forest cover and lands dynamics monitoring in Congo Basin. I am familiar with the use of digital mapping software, GIS and RS (Arc GIS, ENVI and PCI Geomatica etc.), classification and spatial Analysis of satellite images, 3D modeling, etc. I started as an intern at OSFAC, Assistant Trainer (Professional Training) and Consultant than permanent employee since October 2009. To assist in the OSFAC activities regarding the monitoring of forest cover and the CARPE program in the context of natural resources management, I participated in the development of the FACET Atlas (Republic of Congo). I received data from Matt Hansen (map.img), WRI and Brazzaville (shapefiles). With all these data I draw maps of the ROC Atlas and statistics of forest cover and forest loss. We organize field work on land to collect data to validate the FACET product. Therefore, to assess forest cover in the region of Kwamouth and Kahuzi-Maiko Biega
Kalisya, Luc Malemo; Bake, Jacques Fadhili; Bigabwa, Richard; Rothstein, David H; Cairo, Sarah B
Surgery is an essential component of a functional health system, with surgical conditions accounting for nearly 11-15% of world disability. While communicable diseases continue to burden low- and low-middle-income countries, non-communicable diseases, such as cancer, are an important cause of morbidity and mortality worldwide. Preliminary data on malignancies in low- and middle-income countries, specifically in Africa, suggest a higher mortality compared to other regions of the world, a difference partially explained by limited availability of screening and early detection systems as well as poorer access to treatment. To evaluate the diagnosed tumor burden in the Eastern Democratic Republic of Congo (DRC) and review literature on existing and suspected barriers to accessing appropriate oncologic care. This is a retrospective study carried out at Healthcare, Education, community Action, and Leadership development Africa, a 197-bed tertiary referral hospital, in the Province of North Kivu, along the eastern border of the DRC from 2012 to 2015. Patient charts were reviewed for diagnoses of presumed malignancy with biopsy results. A total of 252 cases of suspected cancer were reviewed during the study period; 39.7% were men. The average age of patients was 43 years. Amongst adult patients, the most common presenting condition involved breast lesions with 5.8% diagnosis of fibrocystic breast changes and 2.9% invasive ductal carcinoma of the breast. 37.3% of female patients had lesions involving the cervix or uterus. The most common diagnosis amongst male adults was prostate disease (16.7% of men). For pediatric patients, the most common diagnoses involved bone and/or cartilage (27.3%) followed by skin and soft tissue lesions (20.0%). All patients underwent surgical resection of lesions; some patients were advised to travel out of country for chemotherapy and radiation for which follow-up data are unavailable. Adequate and timely treatment of malignancy in the DRC
Sein, Carolyn; Tiwari, Tejpratap; Macneil, Adam; Wannemuehler, Kathleen; Soulaphy, Chanthavy; Souliphone, Phouthone; Reyburn, Rita; Ramirez Gonzalez, Alejandro; Watkins, Margaret; Goodson, James L
Diphtheria is a vaccine-preventable disease. When vaccination coverage and population immunity are low, outbreaks can occur. We investigated a diphtheria outbreak in Lao People's Democratic Republic that occurred during 2012-2013 and highlighted challenges in immunization services delivery to children in the country. We reviewed diphtheria surveillance data from April 1, 2012-May 31, 2013. A diphtheria case was defined as a respiratory illness consisting of pharyngitis, tonsillitis, or laryngitis, and an adherent tonsillar or nasopharyngeal pseudomembrane. To identify potential risk factors for diphtheria, we conducted a retrospective case-control study with two aged-matched neighborhood controls per case-patient in Houaphan Province, using bivariate analysis to calculate matched odds ratio (mOR) with 95% confidence intervals (CI). Reasons for non-vaccination among unvaccinated persons were assessed. Sixty-two clinical cases of diphtheria and 12 diphtheria-related deaths were reported in seven of 17 provinces. Among case-patients, 43 (69%) were diphtheria case-patients from Houaphan province and 79 matched-controls were enrolled. Five (12%) case-patients and 20 (25%) controls had received DTP3 (mOR=0.4, CI=0.1-1.7). No diphtheria toxoid-containing vaccine was received by 20 (48%) case-patients and 38 (46%) controls. Among case-patients and controls with no DTP dose, 43% of case-patients and 40% of controls lacked access to routine immunization services. Suboptimal DTP3 coverage likely caused the outbreak. To prevent continued outbreaks, access to routine immunization services should be strengthened, outreach visits need to be increased, and missed opportunities need to be minimized. In the short term, to rapidly increase population immunity, three rounds of DTP immunization campaign should be completed, targeting children aged 0-14years in affected provinces. Copyright © 2016 Elsevier Ltd. All rights reserved.
... Determination for the Lao People's Democratic Republic Under Section 2(b)(2) of the Export-Import Bank Act of... 3 The President 1 2010-01-01 2010-01-01 false Presidential Determination for the Lao People's Democratic Republic Under Section 2(b)(2) of the Export-Import Bank Act of 1945, as amended Presidential...
In German Democratic Republic, the research and development program GDR in the field of nuclear energy is directed' only to selected topics. For instances in the Central Institute for Nuclear Research of the Academy of Sciences a number of tasks related to process diagnosis have been solved as a contribution to the safe and economical operation of our nuclear. power plants. As a result of these investigations noise diagnosis systems have been developed for the primary loops of the 440 MW units. Signals of about 120 detectors can be analysed wth this equipment for plant surveillance and for an early detection of malfunctions. Some topics in the research on Fast Breeder Reactors are directed to selected contributions in the field of process diagnosis. Their solution shall support a fast industrial application of this reactor type. In addition to calculations for reactor core design, primarily related to operational safety of large LMFBRs, noise analysis technique has been applied to acoustic signals for leak detection in sodium heated steam generators as well as for boiling detection in the reactor core. It seems to be promising to investigate whether the same signal analysis methods can be applied to leak and boiling detection, respectively. If this would be possible one could take a standard monitor into consideration for the surveillance of both plant components. Our recent investigations have shown that the beginning of the sodium-water reaction as well as the inspection of sodium boiling is characterized by changes in the statistic signal parameters. Deviations from the normal state can be recognized by measuring actual values of such statistic characteristics of acoustic and/or neutron flux signals. Activities were concentrated mainly on surveillance methods for sodium heated steam generators. A system is in preparation using acoustic as well as chemical methods, taking into account the requirement of diversity for a surveillance system. The boiling
Aliyu Mukhtar Katsina
Full Text Available Their nature and functions make political parties central to democratic governance especially in the new democracies of Africa that face the challenge of building strong and enduring democratic institutions. It is accepted that the existing trend in most of these democracies of one big party dominating the political space weakens democracy and undermines its prospects for consolidation. Big parties—usually the ruling ones—exhibit tendencies such as absence of internal democracy that are antithetical to democratic governance. While observations such as these are incontestable, there is little understanding into the nature, character, ideology, and internal structure of big parties generally. In this article, I attempt to address this concern. Specifically, I examine the nature, structure, and ideology of the Peoples Democratic Party (PDP, Nigeria’s ruling party at the federal level with considerable strength at local level between 1999 and 2015. Relying on data obtained from multiple sources, I investigate the process of its formation, the nature of its ideology, internal organization, its electoral strength, and how absence of internal democracy contributed significantly to its defeat in 2015 general elections.
Cartwright, Barbara J.; Wall, John E.; Kaya, J. A. Placide
Among species recovery tools available, re-introduction of animals to the wild is one of the more complex. Since the mid-1990s two successful great ape re-introductions have taken place in the Republic of Congo, leading some conservationists to revisit re-introduction as a strategy. This research explored the role of conservation education and…
, representatives of the Congolese authorities, NGOs and other IOs. EU involvement started with the deployment of Artemis in 2003, and the study ends with the closure of EUSEC in July 2016. All EU missions in the Democratic Republic of Congo (DRC) have been part of EU support for the transition and implementation...
The Minister for Foreign Affairs of the Democratic People's Republic of Korea has informed the Government of the United States of America, as depository of the Agency's Statute, in a diplomatic note dated 13 June 1994, that the Government of the Democratic People's Republic of Korea has decided to withdraw from the IAEA as of 13 June 1994. The Director General of the IAEA was notified of this withdrawal by a letter dated 15 June 1994 from the Resident Representative of the United States of America to the IAEA. The text of this letter and the enclosed diplomatic note from the DPRK are attached hereto. In accordance with Article XVIII, D of the Statute, the Board of Governors was informed on 15 June 1994 (GOV/INF/748). In compliance with the request of the Resident Representative of the United States of America, the Member States of the Agency are informed by this INFCIRC
The present structure of the energy economy in the German Democratic Republic (East Germany) is described and the need of nuclear power stations for the future supply of energy is demonstrated. The selection of the type of nuclear reactor, the existing operating experience with nuclear equipment and the collaboration in this field with the U.S.S.R. is described. The training of personnel in nuclear techniques is noted. (H.E.G.)
Mancini, Silvia; Coldiron, Matthew E; Nicholas, Sarala; Llosa, Augusto E; Mouniaman-Nara, Isabelle; Ngala, Joseph; Grais, Rebecca F; Porten, Klaudia
A large poliomyelitis outbreak occurred in 2010 in the Republic of Congo. This paper describes the demographic and clinical characteristics of poliomyelitis cases and their outcomes following physiotherapy. Demographic and clinical data were collected on 126 individuals between November 23, 2010 and March 23, 2011. The male/female ratio was 2.5 and the median age was 19 years (IQR: 13.5-23). The most severe forms of the disease were more common in older patients, 81 of the 126 patients (64.3%) had multiple evaluations of muscle strength. Among patients with multiple evaluations, 38.1% had improved strength at final evaluation, 48.3% were stable and 13.6% had decreased strength. Most acute poliomyelitis patients receiving physiotherapy had improved or stable muscle strength at their final evaluation. These descriptive results highlight the need for further research into the potential benefits of physiotherapy in polio affected patients.
The texts of an Interview by a Spokesman for the General Department of Atomic Energy of the Democratic People's Republic of Korea, dated 3 June 1994, and Relevant Information, are being circulated to all Member States of the Agency at the request of the Permanent Mission of the Democratic People's Republic of Korea. These texts were received by the Secretariat before the withdrawal of the Democratic People's Republic of Korea from the Agency
The texts of two telex communications, dated 2 and 6 June 1994, which the International Atomic Energy Agency received from the General Department of Atomic Energy of the Democratic People's Republic of Korea are being circulated to all Member States of the Agency at the request of the Permanent Mission of the Democratic People's Republic of Korea. These texts were received by the Secretariat before the withdrawal of the Democratic People's Republic of Korea from the Agency
Communities emerging from violent conflict confront complex challenges that are specifi c from one context to another. The 2002 Peace Accord for the Democratic Republic of Congo (DRC) signed in Pretoria, South Africa, marked a post-confl ict chapter for the country and inaugurated a range of actors and strategies to ...
Introduction: Despite accelerated measles control efforts, a massive measles resurgence occurred in the Democratic Republic of the Congo (DRC) starting in mid-2010, prompting an investigation into likely causes. Methods: We conducted a descriptive epidemiological analysis using measles immunization and surveillance ...
Full Text Available Ebola and Marburg viruses (family Filoviridae, genera Ebolavirus and Marburgvirus cause haemorrhagic fevers in humans, often associated with high mortality rates. The presence of antibodies to Ebola virus (EBOV and Marburg virus (MARV has been reported in some African countries in individuals without a history of haemorrhagic fever. In this study, we present a MARV and EBOV seroprevalence study conducted amongst blood donors in the Republic of Congo and the analysis of risk factors for contact with EBOV.In 2011, we conducted a MARV and EBOV seroprevalence study amongst 809 blood donors recruited in rural (75; 9.3% and urban (734; 90.7% areas of the Republic of Congo. Serum titres of IgG antibodies to MARV and EBOV were assessed by indirect double-immunofluorescence microscopy. MARV seroprevalence was 0.5% (4 in 809 without any identified risk factors. Prevalence of IgG to EBOV was 2.5%, peaking at 4% in rural areas and in Pointe Noire. Independent risk factors identified by multivariate analysis were contact with bats and exposure to birds.This MARV and EBOV serological survey performed in the Republic of Congo identifies a probable role for environmental determinants of exposure to EBOV. It highlights the requirement for extending our understanding of the ecological and epidemiological risk of bats (previously identified as a potential ecological reservoir and birds as vectors of EBOV to humans, and characterising the protection potentially afforded by EBOV-specific antibodies as detected in blood donors.
Ackermann, G.; Endler, A.; Loth, K.H.
In the German Democratic Republic two nuclear power plants equipped with four pressurized-water WWER-440-type reactors were commissioned in the years 1973-1979 and have since been in routine operation. The nuclear power plants (NPPs) in the GDR were constructed on the basis of projects developed and tested in the Soviet Union. Their main equipment was also supplied by the USSR. Under the technical supervision of USSR scientific institutions and design organizations, the construction, commissioning and operation of NPPs had to be prepared and organized by the design organizations, scientific institutions and the prospective user in the German Democratic Republic. To this effect, and to ensure nuclear safety, availability and maximum exploitation of nuclear fuel, it was necessary to develop national scientific capacities. The organizations of the USSR supply basic and supplementary documents prescribing the required extent of investigations to prove that the equipment and systems will meet the projected and operational conditions from loading to commercial operation. Concrete test programmes for commissioning and operational instructions are elaborated by national organizations. Pre-operational and initial startup tests are performed by the personnel of the plant, of enterprises and scientific institutions under the technical supervision of the design organizations of the USSR and the German Democratic Republic. Proceeding from experience gained for more than 15 years in the scientific support of commissioning and operation, the required training and disciplines of personnel are reported. The tasks to be met by the various disciplines are described. Furthermore, information is given on the main stages of commissioning and on a number of results. Finally, selected results of work in connection with operational assistance are reported
Full Text Available Chikungunya is an Aedes -borne disease characterised by febrile arthralgia and responsible for massive outbreaks. We present a prospective clinical cohort study and a retrospective serological study relating to a CHIK outbreak, in the Republic of Congo in 2011.We analysed 317 suspected cases, of which 308 (97.2% lived in the city of Brazzaville (66.6% in the South area. Amongst them, 37 (11.7% were CHIKV+ve patients (i.e., biologically confirmed by a real-time RT-PCR assay, of whom 36 (97.3% had fever, 22 (66.7% myalgia and 32 (86.5% arthralgia. All tested negative for dengue. The distribution of incident cases within Brazzaville districts was compared with CHIKV seroprevalence before the outbreak (34.4% in 517 blood donors, providing evidence for previous circulation of CHIKV. We applied a CHIK clinical score to 126 patients recruited within the two first day of illness (including 28 CHIKV+ves (22.2% with sensitivity (78.6% and specificity (72.4% values comparing with those of the referent study in Reunion Island. The negative predictive value was high (92%, but the positive predictive value (45% indicate poor potential contribution to medical practice to identify CHIKV+ve patients in low prevalence outbreaks. However, the score allowed a slightly more accurate follow-up of the evolution of the outbreak than the criterion "fever+arthralgia". The complete sequencing of a Congolase isolate (Brazza_MRS1 demonstrated belonging to the East/Central/South African lineage and was further used for producing a robust genome-scale CHIKV phylogenetic analysis.We describe the first Chikungunya outbreak declared in the Republic of Congo. The seroprevalence study conducted amongst blood donors before outbreak provided evidence for previous CHIKV circulation. We suggest that a more systematic survey of the entomological situation and of arbovirus circulation is necessary in Central Africa for better understanding the environmental, microbiological and
The paper abstracted informs about the basic principles characterizing the pollution laws and pollution regulations of the German Democratic Republic. The author deals with the constitutional principles, the National Culture Law valid since 1970 and conceived as a general pollution law, the planning of pollution abatement, legal aspects of water pollution abatement, air pollution abatement, waste management, noise pollution abatement and radiation protection. Particular emphasis is on the legal sanctions devised to ensure the observance of environmental laws and restrictions which are both part of the administrative, civil and economic laws and of the disciplinary and criminal laws. (HSCH).
The agreement between Austria and the German Democratic Republic concerning the cooperation in the field of environment protection is in force since 1988 07 01. The mutual pollutant-immission should be reduced by exchange of knowledge and experience, cooperation of experts and development of working plans. The problems of brown-coal combustion should be reduced by extended use of nuclear energy. The article examines the content of the agreement and its coordination with the international agreement about long range transfrontier air-pollution
Muaremoska Abduli, Sevilj; Racaj, Muhamet
The efforts to establish a democratic legal order in the period immediately after the Republic of Macedonia gained its independence in the area of the security sector institutions were carried out with more or less pronounced difficulties. That, more than ever, imposed the need for establishment of parliamentary and other forms of democratic control and monitoring of the work of the security sector institutions, as these institutions are essentially considered as the most conservative and tou...
The text of the Statement by the Spokesman for the Ministry of Foreign Affairs of the Democratic People's Republic of Korea dated 4 April 1994 is being circulated to all Member States of the Agency at the request of the Permanent Mission of the Democratic People's Republic of Korea
The text of an Interview by a Spokesman of the Foreign Ministry of the Democratic People's Republic of Korea concerning the replacement of fuel rods at the 5-Megawatt Experimental Nuclear Power Station, dated 3 May 1994, is being circulated to all Member States of the Agency at the request of the Permanent Mission of the Democratic People's Republic of Korea
The text of a Memorandum of the Foreign Ministry of the Democratic People's Republic of Korea dated 20 April 1994 is being circulated to all Member States of the Agency at the request of the Permanent Mission of the Democratic People's Republic of Korea
Texts of the following communications received from the Permanent Mission of the Democratic People's Republic of Korea, concerning IAEA safeguards inspections, are being circulated to all Member States of the Agency at the Request of the Permanent Mission of the Democratic People's Republic of Korea
The text of an Interview by a Spokesman of the Foreign Ministry of the Democratic People's Republic of Korea, dated 14 May 1994, is being circulated to all Member States of the Agency at the request of the Permanent Mission of the Democratic People's Republic of Korea
The text of the Statement by a Spokesman of the General Department of Atomic Energy of the Democratic People's Republic of Korea dated 24 March 1994 is being circulated to all Member States of the Agency at the request of the Permanent Mission of the Democratic People's Republic of Korea
Keuffel, Eric; Jaskiewicz, Wanda; Paphassarang, Chanthakhath; Tulenko, Kate
Many developing countries are examining whether to institute incentive packages that increase the share of health workers who opt to locate in rural settings; however, uncertainty exists with respect to the expected net cost (or benefit) from these packages. We utilize the findings from the discrete choice experiment surveys applied to students training to be health professionals and costing analyses in Lao People's Democratic Republic to model the anticipated effect of incentive packages on new worker location decisions and direct costs. Incorporating evidence on health worker density and health outcomes, we then estimate the expected 5-year net cost (or benefit) of each incentive packages for 3 health worker cadres--physicians, nurses/midwives, and medical assistants. Under base case assumptions, the optimal incentive package for each cadre produced a 5-year net benefit (maximum net benefit for physicians: US$ 44,000; nurses/midwives: US$ 5.6 million; medical assistants: US$ 485,000). After accounting for health effects, the expected net cost of select incentive packages would be substantially less than the original estimate of direct costs. In the case of Lao People's Democratic Republic, incentive packages that do not invest in capital-intensive components generally should produce larger net benefits. Combining discrete choice experiment surveys, costing surveys and cost-benefit analysis methods may be replicated by other developing countries to calculate whether health worker incentive packages are viable policy options.
Waste management is considered an integral part of measures for the safe utilization of nuclear energy. In the German Democratic Republic, back in 1962 the government established the National Board for Nuclear Safety and Radiation Protection as a special body whose regulatory responsibilities include the setting up of an appropriate waste management policy for the country's nuclear power programme. After studies started in the 1960s a central system for the collection and disposal of low- and intermediate-level radioactive wastes from nuclear power plants and other sources throughout the country was established, this started operation a few years ago. The waste repository is a reconstructed salt mine which is operated by the main waste producer - the nuclear power plant utility. There are no current issues with high-level waste, as the spent fuels are stored for many years and then returned to the supplier country, the Soviet Union. The paper describes the relevant regulatory framework in the German Democratic Republic. The solution established here takes future nuclear power uses into account. (author)
Jeong Ho Park
Full Text Available The floristic inventory of vascular plants in Nam Ha National Biodiversity Conservation Area was conducted to understand the plant diversity in the northern area of Lao People's Democratic Republic. From the joint field surveys between Korean and Laos experts conducted during 2015–2017, it was found that there are 64 families, 145 genera, and 189 species distributed in the Nam Ba National Biodiversity Conservation Area, and a total of 56 families, 117 genera, and 148 species which comprise more than 78% of the total species were identified as endemic plants to the Lao People's Democratic Republic. Considering the usage of the plants, there are 91 species of medicinal plants, 33 species of ornamental plants, eight species of edible plants, and 16 species of economic plants. In addition, it was found out that Dalbergia balansae and Cinnamomum macrocarpum are categorized as vulnerable in the International Union for Conservation of Nature (IUCN Red list, and 13 more species are categorized as the least concern.
This Ordinance sets forth new rules with respect to travel abroad by citizens of the German Democratic Republic. Its major provisions are as follows: 1) the occasions when relatives may travel abroad to other than socialist countries have been increased; 2) travel abroad by pensioners may be undertaken without giving any special reason; 3) travel abroad to socialist countries can be made for any reason; 4) persons may now leave the German Democratic Republic permanently for humanitarian reasons, including the desire of an invalid or old person to receive care or spend his or her days elsewhere and family reunification; 5) requests for permanent departure can be denied on the grounds of national security or defense, because a person has not performed his or her military service, to protect the public order or state interests, and to protect the rights of citizens or socialist morale and social requirements; 6) requests to go abroad temporarily are generally to be handled within 30 days and requests to leave permanently usually within 3 months; 7) adverse decisions may now be appealed both administratively and then through the courts, although in a court the only argument that can be made is that the decision was unlawful; 8) a request that has been denied can be resubmitted if the reason for denial is no longer present; and 9) in the case of a request to leave permanently, 6 months must pass before resubmission.
In 2011, as many as 600,000 people in 58 countries contracted cholera, with thousands succumbing to the disease. In most countries, cholera is rare. In others, like the Democratic Republic of the Congo, cholera is an endemic threat, always lurking in the background waiting for the right set of conditions to spark an outbreak.
Préat, Alain; Delpomdor, Franck; Ackouala Mfere, Anna Perla; Callec, Yannick
The Ediacaran Schisto-Calcaire Group is a ∼1300 m-thick succession belonging to the West Congo Supergroup in Central Africa. In the Comba Basin, it consists of three carbonate-dominated units defined as formations (SCI to SCIII) that are unconformably overlain by clastic deposits (Mpioka Group) interpreted as a molassic formation associated with the Panafrican Orogen. The underlying Upper Tillite and Cap Carbonate (SCIa) units, considered as markers of the Snowball Earth event were studied in three sections. We investigated the carbonates of the Schisto-Calcaire Group by defining new microfacies (MF1-MF7) and we performed C and O isotopic analyses in order to constraint the depositional and diagenetic events directly after the Marinoan interval. Stratigraphic variations of the stable isotopes are important in the series with lighter δ18O values (>1.5‰) than those of the Neoproterozoic ocean in the SCIc unit. According to regional stratigraphy a temperature effect can be dismissed and a freshwater surface layer is the origin of such negative δ18O values in this unit. The negative δ13C anomaly (-3.5‰ on average) of the Cap Carbonate is similarly to the δ18O values (-6.4‰ on average) in the range of the marine domain during postglacial sea level rise. The sample suite as a whole (SCII and SCIII formations) displays heavier δ18O and δ13C than those of the lower part (SCI unit) of the Schisto-Calcaire Group. The comparison with the Lower Congo (Democratic Republic of Congo) and Nyanga (Gabon) basins shows that the meteoric flushing in SCIc unit of the Schisto-Calcaire Group was regional and not local, and could be derived from a climatic evolution. Although an overall overprint is present, our isotopic relationships argue against overall diagenetic resetting of primary compositions and suggest that with careful examination combined with detailed petrographic analysis general depositional and diagenetic controls can be discerned in oxygen and carbon
Mwata, P.K.; SAKI, A.; KAZADI, J.
Illicit trafficking of radioactive minerals, precious metals and nuclear materials is generally expanded practice in some parts of the Democratic Republic of Congo. The phenomenon took place early in 1990 and amplified from 1998. The main causes of this practice are political instability that led to general poverty among population and the lack of legal framework governing the exploitation of minerals. Nuclear Illicit trafficking in Congo concerns radioactive mineral sand precious metals in eastern and southern parts of the country. The unfavorable political environment that took place in Congo in the 1990s resulted in local manpower and mine workers immigrating to neighboring countries. A great fraction of these new jobless started exploiting abandoned mines residues searching for Cu, Co and Au for survival. First cases of illicit exploitation of uranium minerals were reported very soon after rock sliding that occurred in 2004 on Shinkolobwe site in Katanga region. This uncontrolled mineral exploitation got worse when several mining companies were licensed by GECAMINES company to explore, exploit, purchase minerals from individuals and export raw materials and concentrates.
Fara, Mohammed Saeed; Fisher, Nigel
In 1984, the People's Democratic Republic of Yemen undertook a nationwide literacy campaign, which mobilized the entire nation in an effort to reach an estimated 194,000 illiterate people, 77 percent of them women. The campaign plan demanded the full and active participation of formal school teachers and students at secondary level and above as…
The attached text of the Agreed Framework between the United States of America and the Democratic People's Republic of Korea, signed in Geneva on 21 October 1994, is being circulated to all Member States of the Agency at the request of the Resident Representative of the United States of America
Leen P. van Ofwegen
Full Text Available A new genus of soft coral from the Republic of Congo is described, Complexum gen. n. Nine West African octocoral species previously described in the genus Alcyonium by Tixier-Durivault (1955 are referred to this new genus, and a new species is described and figured, C. pusillum sp. n. The new species is characterized by having encrusting growth form and abundant spiny clubs in the surface of the polyparium. It colonizes shallow calcareous rocky banks (5 to 20 m depth existing in coastal water of the region of Pointe-Noire. Based on molecular phylogeny this new genus is well separated from Alcyonium species.
Radioisotope production has been carried out in the German Democratic Republic for 30 years. Based on a 10 MW research reactor, a cyclotron and certain irradiation facilities at units of national nuclear power stations, a widespread assortment of radioisotopes is produced with emphasis to radiopharmaceuticals as the main materials. Domestic production covers the national demand in these products where the production is technologically feasible under our conditions. A complete supply of the users in the country (more than 7000 licences) is accomplished by an intense co-operation with neighbouring countries, including mutual assistance in reactor shut down periods and supply with special radioactive materials and products. International co-operation within the framework of the IAEA takes place, mainly as scientific and technological assistance to many developing countries. (author)
Full Text Available This qualitative research was conducted in three Northern provinces of the Lao People’s Democratic Republic with the aim of investigating the traditional art of khub music and its conservation and inheritance. Data were collected from documents and field research using interviews, observation and focus group discussions as data collection tools. The results show that Morkhub, musicians, teachers, students and audiences all contribute to the success or failure of conservation and inheritance of traditional Laotian music. The majority of problems with conservation stem from a lack of interest and the dilution of local culture with modern Western influences. As a result of this investigation, a four-point plan was proposed to standardize and support future conservation of khub traditions by inclusion in the education system.
van Cakenberghe, V.; de Vree, F.; Leirs, Herwig
The collection of vertebrates made in Kikwit in the aftermath of the 1995 Ebola haemorrhagic fever epidemic included 538 bat specimens, representing 18 species. This collection contains large numbers of a very common species, Chaerephon pumila, but also of Chaerephon ansorgei, which was not yet...
Goede, J de M.
This thesis focuses on liberal peace building in the DRC. The thesis takes a critical approach which emphasises local agencies and their engagements with liberal peace building. However, it seeks to bring this critique back to the institutions with which liberal peace building is preoccupied, by
.... The Transitional Government faces daunting challenges. The eastern part of the country is marred by insecurity and instability due to factional fighting and the presence of the Interhamwe, the group responsible for the 1994 Rwandan genocide...
Full Text Available Despite uncontested evidence for fossils belonging to the early hominin genus Australopithecus in East Africa from at least 4.2 million years ago (Ma, and from Chad by 3.5 Ma, thus far there has been no convincing evidence of Australopithecus, Paranthropus or early Homo from the western (Albertine branch of the Rift Valley. Here we report the discovery of an isolated upper molar (#Ish25 from the Western Rift Valley site of Ishango in Central Africa in a derived context, overlying beds dated to between ca. 2.6 to 2.0 Ma. We used µCT imaging to compare its external and internal macro-morphology to upper molars of australopiths, and fossil and recent Homo. We show that the size and shape of the enamel-dentine junction (EDJ surface discriminate between Plio-Pleistocene and post-Lower Pleistocene hominins, and that the Ishango molar clusters with australopiths and early Homo from East and southern Africa. A reassessment of the archaeological context of the specimen is consistent with the morphological evidence and suggest that early hominins were occupying this region by at least 2 Ma.
absorb rebel units into the national army failed to deconstruct previous personal and ideological allegiances to the former rebel movement and thus...victors our outside interveners, such as India in Sri Lanka, the U.S. in Somalia and Haiti, and UN interventions in Albania and Haiti.30 Nevertheless...Reconstructing Masculinities : The Disarmament, Demobilization, and Reintegration of Former Combatants in Colombia.” Human Rights Quarterly, Vol.31
The funding facilitated the conduct of this study. Lastly, but not least, I thank my family and my parents . Though they were miles away from me...beginning of the end for his regime. To continue stay in power, Mobutu had to do something. He opted for a laissez-faire style of leadership. He allowed...Barahiyan (56.786). 60 Figure 19. Sociogram of Eigenvector Centrality. C. COHESIVE SUBGROUP ANALYSIS 1. Subgroups The Girvan- Newman
Kyamusugulwa, P.M.; Hilhorst, D.; Haar, van der G.
Community-driven reconstruction (CDR) has become a new paradigm in post-conflict development. It combines infrastructure restoration with introducing good governance at the local level. Recent evaluations show that governance objectives are not easily met and significant change cannot be
Schure, J.M.; Ingram, V.; Arts, B.J.M.; Levang, P.; Mvula-Mampasi, E.
A new generation of woodfuel studies focuses on the political dynamics behind access to the woodfuel trade, providing better insights into patterns of inclusion and exclusion and options for resource management. Institutional mechanisms that govern access are difficult to untangle in the context of
Dijkzeul, D; Lynch, C A
The role of cost-sharing in health care is a crucial, yet contentious issue. In conflict situations, cost-sharing becomes even more controversial as health and other institutions are failing. In such situations, NGOs manage health programmes which aim to aid populations in crisis and improve or at least sustain a deteriorating health system. This study looks at the issue of cost-sharing in the wider context of utilization rates and management approaches of three NGOs in the chronic, high-mortality crisis of the eastern DRC. Approaches to increase access to health care were found to exist, yet cost-recovery, even on the basis of maximum utilization rates, would only partially sustain the health system in the eastern DRC. Factors external to the direct management of NGO health programs, such as the wider economic and security situation, local management structures, and international donor policies, need to be taken into account for establishing more integrated management and financing approaches.
to their supposedly exceptional individual qualities nor to a specifically African “Big Man”-syndrome. I propose that while one must be critical of the Weberian notion of “charisma” as a sociological theory of prophecy, one can nonetheless use the notion of “charisma” as a tool to analyse symbolic properties...
Pig farming has been gaining attention in recent years in African countries south of the Sahara as a source of urban farmers’ cash income. This study was undertaken to explain what types of pigs are raised, how and where they are raised, and how pork is distributed in Kinshasa of the DRC . The results indicated that six households had begun pig farming in the past 14 years, two of which had nonetheless lost their pigs to disease. All of the pig farmers surveyed raised their animals in pigpens...
Kolk, A.; Lenfant, F.
Although business-NGO (nongovernmental organizations) partnerships have received much attention in recent years, insights have been obtained only from research in "stable" contexts, not from conflict-ridden countries where such collaboration may be even more crucial in building trust and capacity
A. Kolk (Ans); F. Lenfant (François)
textabstractWhile business-NGO partnerships have received much attention in recent years, insights have been obtained from research in ‘stable’ contexts, not from conflict-ridden countries where such collaboration may be even more crucial in building trust and capacity and in addressing
Koba Bora, Béatrice; Lez, Didier Malamba; Luwa, Daniel Okitundu; Baguma, Marcellin Bugeme; Katumbay, Désiré Tshala; Kalula, Tharcisse Kayembe; Mesu'a Kabwa, Pierre Luabeya
Epilepsy is the most common of serious neurological disorders, yet despite considerable efforts, good access to medication, appropriate social and societal acceptance and acceptable quality of life (QoL) are difficult to achieve especially in developing countries. It is estimated that over 500,000 people suffer from epilepsy in the DRC. There is no report, in our knowledge on the epilepsy in Lubumbashi. A descriptive study was undertaken in individuals with a clinical diagnosis of epilepsy who presented at the CNPJG outpatient clinic in Lubumbashi over a 12 months period. A 64-item questionnaire was used to collect information from the patients. Case records were reviewed and relevant demographic, social, professional, medical history, medical condition data were extracted. Among 3,540 patients who presented to a neuropsychiatric clinic run by the Fracarita charity over a 1-year period, 423 (11.9%) were identified as having epilepsy, and 179 were subsequently included in the survey after they (or their parent/guardian) provided informed consent and completed an EEG investigation. Data were collected using a standardized, 64-item questionnaire. Epilepsy had negative impact on the lives of individuals with the condition; 40.8% had either no education or had completed primary education only, 38.0% were unemployed and the majority (64.6%; n = 113) were unmarried or divorced. Family history of epilepsy (first or second degree) was present in 23.5% of cases. Other reported factors that could potentially precipitate epilepsy included obstetric and perinatal factors (15.1%) and central nervous system infections during infancy (8.4%). Consumption of alcohol or recreational drugs accounted for 10.6%. The treatment gap was above 67% and the delay between first seizure and first consultation was 15 months. When asked to describe their condition, or its cause, 55.3% of participants (or their families) considered epilepsy to be of spiritual/ religious origin, while 25.1% had almost no insight and could not provide any description. This first epidemiological study shows a high prevalence of epilepsy among patients presenting to the clinic in Lubumbashi, DRC, and reveals a significant treatment gap.
Crevecoeur, Isabelle; Skinner, Matthew M.; Bailey, Shara E.; Gunz, Philipp; Bortoluzzi, Silvia; Brooks, Alison S.; Burlet, Christian; Cornelissen, Els; De Clerck, Nora; Maureille, Bruno; Semal, Patrick; Vanbrabant, Yves; Wood, Bernard
Despite uncontested evidence for fossils belonging to the early hominin genus Australopithecus in East Africa from at least 4.2 million years ago (Ma), and from Chad by 3.5 Ma, thus far there has been no convincing evidence of Australopithecus, Paranthropus or early Homo from the western (Albertine) branch of the Rift Valley. Here we report the discovery of an isolated upper molar (#Ish25) from the Western Rift Valley site of Ishango in Central Africa in a derived context, overlying beds dated to between ca. 2.6 to 2.0 Ma. We used µCT imaging to compare its external and internal macro-morphology to upper molars of australopiths, and fossil and recent Homo. We show that the size and shape of the enamel-dentine junction (EDJ) surface discriminate between Plio-Pleistocene and post-Lower Pleistocene hominins, and that the Ishango molar clusters with australopiths and early Homo from East and southern Africa. A reassessment of the archaeological context of the specimen is consistent with the morphological evidence and suggest that early hominins were occupying this region by at least 2 Ma. PMID:24427292
as historians who have an interest in the genealogy of violence. Using an elaborate analytical framework labelled as 'process tracing', Kisangani offers a systematic analysis of several episodes of violence in Congolese history. While the .... virtuous circle that sustains the positive development and positive peacefulness.
The overall aim of the paper is to examine the process of the Inter-Congolese Dialogue (ICD) from the aborted Addis Ababa meeting, through the Sun City I process of February-April 2002, the December 2002 Pretoria agreement up to the Sun City II final talks of April 2003. The specific aim is to look at the politics ...
Callens Steven FJ
Full Text Available Abstract Pulmonary emphysema and bronchiectasis in HIV seropositive patients has been described in the presence of injection drug use, malnutrition, repeated opportunistic infections, such as Pneumocytis jirovici pneumonia and Mycobacterium tuberculosis infection, and has been linked to the presence of HIV virus in lung tissue. Given the high burden of pulmonary infections and malnutrition among people living with HIV in resource poor settings, these individuals may be at increased risk of developing pulmonary emphysema, potentially reducing the long term benefit of antiretroviral therapy (ART if initiated late in the course of HIV infection. In this report, we describe three HIV-infected individuals (one woman and two children presenting with extensive pulmonary cystic disease.
Moula, Nassim; Farnir, Frédéric; Abdellah, Salhi; Do Duc, Luc; Vu Dinh, Ton; Leroy, Pascal; Antoine-Moussiaux, Nicolas
Local chicken breeds contribute significantly to the world production of meat and eggs. Indigenous breeds represent 80% of the world poultry population. However, the majority of these breeds has not been recorded and studied. About 40% of poultry breeds have an unknown risk status. Hence, considerable efforts are necessary to evaluate them. Obviously, managing animal genetic resources requires the identification of the concerned phenotypes, population sizes, their geographical ...
Kashala-Abotnes, Espérance; Sombo, Marie-Thérèse; Okitundu, Daniel L; Kunyu, Marcel; Bumoko Makila-Mabe, Guy; Tylleskär, Thorkild; Sikorskii, Alla; Banea, Jean-Pierre; Mumba Ngoyi, Dieudonné; Tshala-Katumbay, Désiré; Boivin, Michael J
Dietary cyanogen exposure from ingesting bitter (toxic) cassava as a main source of food in sub-Saharan Africa is related to neurological impairments in sub-Saharan Africa. We explored possible association with early child neurodevelopmental outcomes. We undertook a cross-sectional neurodevelopmental assessment of 12-48 month-old children using the Mullen Scale of Early Learning (MSEL) and the Gensini Gavito Scale (GGS). We used the Hopkins Symptoms Checklist-10 (HSCL-10) and Goldberg Depression Anxiety Scale (GDAS) to screen for symptoms of maternal depression-anxiety. We used the cyanogen content in household cassava flour and urinary thiocyanate (SCN) as biomarkers of dietary cyanogen exposure. We employed multivariable generalized linear models (GLM) with Gamma link function to determine predictors of early child neurodevelopmental outcomes. The mean (SD) and median (IQR) of cyanogen content of cassava household flour were above the WHO cut-off points of 10 ppm (52.18 [32·79]) and 50 (30-50) ppm, respectively. Mean (SD) urinary levels of thiocyanate and median (IQR) were respectively 817·81 (474·59) and 688 (344-1032) μmole/l in mothers, and 617·49 (449·48) and 688 (344-688) μmole/l in children reflecting individual high levels as well as a community-wide cyanogenic exposure. The concentration of cyanide in cassava flour was significantly associated with early child neurodevelopment, motor development and cognitive ability as indicated by univariable linear regression (p child neurodevelopment remained the main predictors associated with the concentration of cyanide in cassava flour: coefficients of -0·08 to -.15 (p child linear growth, early child neurodevelopment, cognitive ability and motor development at both univariable and multivariable linear regression analyses coefficients of 1.44 to 7.31 (p early child neurodevelopment, cognitive abilities and motor development, even in the absence of clinically evident paralysis. There is a need for community-wide interventions for better cassava processing practices for detoxification, improved nutrition, and neuro-rehabilitation, all of which are essential for optimal development in exposed children.
Qian, Yi; Yan, Fei; Wang, Wei; Clancy, Shayna; Akkhavong, Kongsap; Vonglokham, Manithong; Outhensackda, Somphou; Østbye, Truls
The Lao People's Democratic Republic is facing a critical shortage and maldistribution of health workers. Strengthening of the health workforce has been adopted as one of the five priorities of the National Health Sector Strategy (2013-2025). This study aims to identify, explore, and better understand the key challenges for strengthening the Laotian health workforce. This study applied exploratory and descriptive qualitative methods and adapted a working life-span framework. Twenty-three key stakeholders with particular insights into the current situation of the health workforce were purposively recruited for in-depth interviews. Important policy documents were also collected from key informants during the interviews. Thematic analysis was employed for the textual data using MAXQDA 10. The overarching problem is that there is a perceived severe shortage of skilled health workers (doctors, nurses, and midwives) and lab technicians, especially in primary health facilities and rural areas. Key informants also identified five problems: insufficient production of health workers both in quantity and quality, a limited national budget to recruit enough health staff and provide sufficient and equitable salaries and incentives, limited management capacity, poor recruitment for work in rural areas, and lack of well-designed continuing education programs for professional development. These problems are interrelated, both in how the issues arise and in the effect they have on one another. To improve the distribution of health workers in rural areas, strategies for increasing production and strengthening retention should be well integrated for better effectiveness. It is also essential to take the Laotian-specific context into consideration during intervention development and implementation. Furthermore, the government should acknowledge the inadequate health management capacity and invest to improve human resource management capacity at all levels. Finally, assessment of
The texts of the communications received from the Permanent Mission of the Democratic People's Republic of Korea are being circulated to all Member States of the Agency at the request of the Permanent Mission of the Democratic People's Republic of Korea: Document presented by the DPRK Delegation to the IAEA Delegation at their Working-Level Consultation on 27 may 1994 (Attachment 1); interview by a Spokesman of the Foreign Ministry of the Democratic People's Republic of Korea of 28 May 1994 (Attachment 2)
The author examines "the impact which various pro-natalist measures adopted since 1976 in the German Democratic Republic have had on women's birth cohorts....A period analysis of subsequent birth and fertility trends would seem to indicate that this policy was remarkably effective. The annual number of births...started to rise rapidly in 1976 and reached a peak of 245,132 births in 1980, an increase of 37%....Furthermore, comparison with the period fertility trend in the Federal Republic of Germany...shows that the gap between the two Germanys has widened since 1977...whereas the trends had been very similar in the two countries before that date....However...other factors should be taken into account: in particular, the number of marriages has fallen steeply during the last few years, and at the same time the number of births outside marriage has soared. These changes, which were in all probability prompted by the adoption of social legislation which favoured single mothers (or fathers)...must be taken into account when assessing the consequences of the new family policy." excerpt
This harmonized set of soil parameter estimates for Central Africa, comprising Burundi, the Democratic Republic of the Congo and Rwanda, was derived from the Soil and Terrain Database for Central Africa (SOTERCAF ver. 1.0) and the ISRIC-WISE soil profile database, using standardized taxonomy-based
Paul, Birthe K.; Muhimuzi, Fabrice L.; Bacigale, Samy B.; Wimba, Benjamin M.M.; Chiuri, Wanjiku L.; Amzati, Gaston S.; Maass, Brigitte L.
Inadequate quantity and quality of livestock feed is a persistent constraint to productivity for mixed crop-livestock farming in eastern Democratic Republic of Congo. To assess on-farm niches of improved forages, demonstration trials and participatory on-farm research were conducted in four
Chesnais, Cédric B; Missamou, François; Pion, Sébastien D; Bopda, Jean; Louya, Frédéric; Majewski, Andrew C; Fischer, Peter U; Weil, Gary J; Boussinesq, Michel
Little is known regarding risk factors for lymphatic filariasis (LF) in Central Africa. We studied the epidemiology of LF in an endemic village in the Republic of Congo. Dependent variables were Wuchereria bancrofti antigenemia (ICT card test) and microfilaremia (night blood smears). The following factors were investigated: sex, age, bed net, latrines, source of water, uptake of anthelmintic drugs, hunting/fishing activities, and occasionally sleeping in the bush. Mixed multivariate logistic regression models were used. 134 of 774 subjects aged ≥ 5 years (17.3%) had W. bancrofti antigenemia and 41 (5.3%) had microfilaremia (mf). Infection rates increased with age up to roughly 20 years and remained stable thereafter. Multivariate analysis of antigenemia demonstrated an increased risk for males (OR = 2.0 [1.3-3.0]) and for people who hunt or fish (OR = 1.5 [1.0-2.4]) and a protective effect of latrines (OR = 0.5 [0.4-0.8]). Among males, those hunting or fishing at night had an increased risk for antigenemia (OR = 1.9 [1.1-3.5]), and use of latrines was protective (OR = 0.5 [0.3-0.9]). For females, bed nets were protective (OR = 0.4 [0.1-0.9]), and there was a strong household effect (intraclass correlation coefficient [ICC]: 0.24). When mf was used as the dependent variable, males had a higher risk for infection (OR = 5.4 [2.1-13.4]), latrines had a protective effect (OR = 0.4 [0.1-0.9]) and there was a marked household effect (ICC = 0.49). Age, sex, and occupation-dependent exposure to mosquitoes were important risk factors for infection with W. bancrofti in this study. It is likely that men often acquire infection in high transmission areas outside of the village, while children and women are infected in areas with lower transmission inside or near the village. Additional studies are needed to determine whether these findings apply to other areas in Central Africa.
Muula Adamson S
Full Text Available Abstract Background Tobacco use is a leading cause of global morbidity and mortality. Much of the epidemiologic research on tobacco focuses on smoking, especially cigarette smoking, but little attention on smokeless tobacco (SLT. Methods Using data from the Republic of Congo Global Youth Tobacco Survey (GYTS of 2006, we estimated the prevalence of SLT use among in-school adolescents. We also assessed the association between SLT use and cigarette smoking as well as the traditional factors which are associated with cigarette smoking among adolescents (e.g. age, sex, parental or peer smoking. Unadjusted odds ratios (OR and adjusted odds ratios (AOR together with their 95% confidence intervals (CI were used to measure magnitudes of associations. Results Of the 3,034 respondents, 18.0% (18.0% males and 18.1% females reported having used smokeless tobacco (chewing tobacco, sniff or dip in the last 30 days. In multivariate analysis, no significant associations were observed between age and sex on one hand and current smokeless tobacco use on the other. Cigarette smokers were more than six times likely to report current use of smokeless tobacco (AOR = 6.65; 95% CI [4.84, 9.14]. Having parents or friends smokers was positively associated with using smokeless tobacco (AOR = 1.98; 95% CI [1.51, 2.59] for parents who smoked cigarettes, AOR = 1.82; 95% CI [1.41, 2.69] for some friends who smoked cigarettes, and AOR = 2.02; 95% CI [1.49, 2.47] for most or all friends who smoked cigarettes. Respondents who reported have seen tobacco advertisement on TV, billboards and in newspapers/magazines were 1.95 times more likely to report current use of smokeless tobacco (AOR = 1.95; 95% CI [1.34, 3.08]. Perception that smoking was harmful to health was negatively associated with current use of smokeless tobacco (AOR = 0.60; 95% CI [0.46, 0.78]. Conclusions Prevention programs aimed to reduce teen [cigarette] smoking must also be designed to reduce other forms of
Rudatsikira, Emmanuel; Muula, Adamson S; Siziya, Seter
Tobacco use is a leading cause of global morbidity and mortality. Much of the epidemiologic research on tobacco focuses on smoking, especially cigarette smoking, but little attention on smokeless tobacco (SLT). Using data from the Republic of Congo Global Youth Tobacco Survey (GYTS) of 2006, we estimated the prevalence of SLT use among in-school adolescents. We also assessed the association between SLT use and cigarette smoking as well as the traditional factors which are associated with cigarette smoking among adolescents (e.g. age, sex, parental or peer smoking). Unadjusted odds ratios (OR) and adjusted odds ratios (AOR) together with their 95% confidence intervals (CI) were used to measure magnitudes of associations. Of the 3,034 respondents, 18.0% (18.0% males and 18.1% females) reported having used smokeless tobacco (chewing tobacco, sniff or dip) in the last 30 days. In multivariate analysis, no significant associations were observed between age and sex on one hand and current smokeless tobacco use on the other. Cigarette smokers were more than six times likely to report current use of smokeless tobacco (AOR = 6.65; 95% CI [4.84, 9.14]). Having parents or friends smokers was positively associated with using smokeless tobacco (AOR = 1.98; 95% CI [1.51, 2.59] for parents who smoked cigarettes, AOR = 1.82; 95% CI [1.41, 2.69] for some friends who smoked cigarettes, and AOR = 2.02; 95% CI [1.49, 2.47] for most or all friends who smoked cigarettes). Respondents who reported have seen tobacco advertisement on TV, billboards and in newspapers/magazines were 1.95 times more likely to report current use of smokeless tobacco (AOR = 1.95; 95% CI [1.34, 3.08]). Perception that smoking was harmful to health was negatively associated with current use of smokeless tobacco (AOR = 0.60; 95% CI [0.46, 0.78]). Prevention programs aimed to reduce teen [cigarette] smoking must also be designed to reduce other forms of tobacco use. The teenagers environment at home, at school and
Suvannaphakdy, Sithanonxay; Tang, Hsiao Chink; DiCaprio, Alisa
Using an unbalanced panel dataset of bilateral exports from 1992 to 2009, this paper assesses the potential trade impacts of the expansion of the Association of Southeast Asian Nations (ASEAN) to ASEAN+3 and ASEAN+6 on the Lao People’s Democratic Republic (Lao PDR). It finds that bilateral exports are positively related to the overall bilateral country size and similarity in country size, but inversely related to the relative factor endowment differences, transportation costs, and import tari...
Lee, Haewon; Ahn, Deborah Y; Choi, Soyoung; Kim, Youngchan; Choi, Hyunju; Park, Sang Min
We investigated the major trends in health aid financing in the Democratic People's Republic of Korea (DPRK) by identifying the primary donor organizations and examining several data sources to track overall health aid trends. We collected gross disbursements from bilateral donor countries and international organizations toward the DPRK according to specific health sectors by using the Organization for Economic Cooperation and Development creditor reporting system database and the United Nations Office for the Coordination of Humanitarian Affairs financial tracking service database. We analyzed sources of health aid to the DPRK from the Republic of Korea (ROK) using the official records from the ROK's Ministry of Unification. We identified the ROK, United Nations Children's Fund (UNICEF), World Health Organization (WHO), United Nations Population Fund (UNFPA), and The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) as the major donor entities not only according to their level of health aid expenditures but also their growing roles within the health sector of the DPRK. We found that health aid from the ROK is comprised of funding from the Inter-Korean Cooperation Fund, private organizations, local governments, and South Korean branches of international organizations such as WHO and UNICEF. We also distinguished medical equipment aid from developmental aid to show that the majority of health aid from the ROK was developmental aid. This study highlights the valuable role of the ROK in the flow of health aid to the DPRK, especially in light of the DPRK's precarious international status. Although global health aid from many international organizations has decreased, organizations such as GFATM and UNFPA continue to maintain their focus on reproductive health and infectious diseases.
Achievements in cultivating sulfur dioxide resistant conifers in the German Democratic Republic are summarized. These conifers will be planted in afforestation programs in smoke damage zones I, i.e. in conifer forests at high elevations with maximum pollution damage. Nurseries with the most promising tree types have been established for harvesting seeds for propagation. Cultivation of cuttings and tree grafting is carried out in experimental nurseries along with laboratory gas treatment tests. Smoke resistant varieties of the common spruce Picae abies (L.) show vigorous growth in smoke damage zone I. Other spruce types suitable for cultivation are Picea pungens Engelm., Picea omorica (Panc.) Purk. with the highest vitality in 15 to 20 year old trial plantings in smoke damage zone I extreme, and Picea glanca, rubens and orientalis. Suitable pines are Pinus contorta Dougl. ex Loud. (Murray pine), Pinus mugo Turra, and others; resistant larches are Larix decidua and Larix leptolepis. Deciduous trees being cultivated for afforestation are aspens (Populus tremula L.) and mountain ash (Sorbus aucuparia L.). 11 references.
Tarvonen, P-L; Sipilä, K; Yang, G S; Kim, J K; Lamidi, M-L; Suominen, A L
The aim was to compare the change in dental caries status in two different intervention groups of the Children's Oral Health Promotion Programme (COHPP). A longitudinal study among 500 children who had participated into the COHPP for 6 years was conducted in Pyongyang, Democratic People's Republic of Korea (DPRK). Children in Group I received intensified school-based intervention and were clinically examined at the age of 7 years in 2007 (n = 250), 10 years in 2010 (n = 250) and 13 years in 2013 (n = 242). Children in Group II (n = 250) joined the programme at the age of 4 years in kindergarten in 2007, were provided with early preschool-based intervention and were clinically examined at the age of 7 years in 2010 and 10 years in 2013. Both the prevalence and the mean number of dt + DT decreased significantly in both groups during the follow-up. This was due to decrease in the number of dt, whereas the number of DT remained relatively constant. Poisson regression showed that the association between the group status and the change in the number of dt + DT was statistically significant when adjusted for gender but disappeared when the school was included in the analysis. The decrease in dental caries may be partly due to the exfoliation of deciduous teeth and dental treatment received. However, the study gave some reference emphasizing the early starting of the prevention. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Keil, G.; Nowak, S.; Fiedrich, G.; Klare, H.; Apelt, E.
This article analyzes general aspects in the development of petrochemistry and carbochemistry on a global scale and for industry in the German Democratic Republic. Diagrams are given for liquid and solid carbon resources and their natural hydrogen content showing the increasing hydrogen demand for chemical fuel conversion processes. The petrochemical and carbochemical industry must take a growing level of hydrogen demand into account, which is at present 25 Mt/a on a global scale and which increases by 7% annually. Various methods for chemical processing of crude oil and crude oil residues are outlined. Advanced coal conversion processes with prospects for future application in the GDR are also explained, including the methanol carbonylation process, which achieves 90% selectivity and which is based on carbon monoxide hydrogenation, further the Transcat process, using ethane for vinyl chloride production. Acetylene and carbide carbochemistry in the GDR is a further major line in research and development. Technological processes for the pyrolysis of vacuum gas oil are also evaluated. (27 refs.)
Grundy, John; Moodie, Rob
The Democratic Peoples Republic of Korea (DPRK), under the leadership of the Ministry of Public Health (MOPH), undertook the development of a Health System Strengthening (HSS) proposal through the support of the Global Alliance for Vaccines and Immunization (GAVI). The aim of this paper is to outline the approach to the development of the HSS strategy in DPRK, and describe opportunities and challenges associated with its development and future implementation. Sources of information for this review have included national programme plans, in country social sector reviews, information generated through HSS proposal developments and the international literature. Updated assessments in DPRK indicate some recent improvements in the health situation for women and children, but there remain ongoing concerns regarding health management, human resource and physical infrastructure barriers to health services access. In response to this situation, the DPRK developed a health system strengthening strategy, the main elements of which are the strengthening of health management and service delivery systems at the implementing agency levels of county (district) and Ri (sub district). Three success factors were associated with the reaching of consensus on HSS strategy in DPRK. These were partnerships formed between system planners and programme planners, the identification of an overall health sector strategic framework, and high-level leadership of the MOPH. Although DPRK is in the very early stages of health system reconstruction, there are significant and new opportunities to alleviate the health conditions of women and children in DPRK, through implementation of health system strengthening strategies that are nationally coordinated and internationally supported.
Hippel, David F. von; Hayes, Peter; Williams, James H.; Greacen, Chris; Sagrillo, Mick; Savage, Timothy
Recent agreements between the Democratic People's Republic of Korea (DPRK) and the other countries involved in the six-party talks on the future of the DPRK's nuclear weapons program have focused attention on the North Korean energy sector, and, specifically, what the international community can or should do to assist the DPRK in energy sector redevelopment. During two visits to North Korea in 1998 and 2000, a team of American and North Korean researchers conducted a unique rural energy use survey in a flood-affected rural village in the DPRK-the farming village of Unhari. The information gathered during the survey has important implications on how to properly approach the ongoing rural energy crisis in the DPRK, and, more broadly, to provide overall energy sector assistance. The results of the Unhari survey are described briefly, followed by suggestions of internal policy and legal reforms, approaches to international cooperation, key and attractive energy sector technologies and processes for energy sector redevelopment in the DPRK
Roehnsch, W.; Gegusch, M.
The system of accountancy for and control of nuclear material in the German Democratic Republic (GDR) with its legal bases and components is embedded in the overall State system of protection in the peaceful uses of nuclear energy. As the competent State authority, the Nuclear Safety and Radiation Protection Board of the GDR is also responsible for meeting the GDR's national and international tasks in the control of nuclear material. At enterprise level, the observance of all safety regulations for nuclear material, including the regulations for the control, is within the responsibility of managers of establishments, which are in any way concerned with the handling of nuclear material. To support managers and to function as internal control authorities, nuclear material officers have been appointed in these establishments. Design information, operating data, physical inventory of nuclear material and the respective enterprise records and reports are subject to State control by the Nuclear Material Inspectorate of the Nuclear Safety and Radiation Protection Board. This Inspectorate keeps the central records on nuclear material, forwards reports and information to, and maintains the necessary contacts with, the IAEA. For the nuclear material in the GDR four material balance areas have been established for control purposes. To rationalize central recording and reporting, electronic data processing is increasingly made use of. In a year-long national and international control of nuclear material, the State control system has stood the test and successfully co-operates with the IAEA. (author)
Cheong, Elaine; Roberts, Tamalee; Rattanavong, Sayaphet; Riley, Thomas V; Newton, Paul N; Dance, David A B
Current knowledge of the epidemiology of Clostridium difficile infection in Asia, and in particular the Greater Mekong Subregion, is very limited. Only a few studies from Thailand and Vietnam have been reported from the region with variable testing methods and results, and no studies from Lao People's Democratic Republic (PDR). Therefore we investigated the presence of C. difficile in a single centre in the Lao PDR and determined the ribotypes present. Seventy unformed stool samples from hospital inpatients at Mahosot Hospital, Vientiane, were tested for the presence of C. difficile using selective differential agar and confirmed by latex agglutination. C. difficile isolates were further characterised by ribotyping and toxin gene detection. C. difficile was isolated from five of the 70 patients, and five different ribotypes were identified (014, 017, 020, QX 107 and QX 574). This is the first isolation of C. difficile from human stool samples in the Lao PDR. These results will add to the limited amount of data on C. difficile in the region. In addition, we hope this information will alert clinicians to the presence of C. difficile in the country and will help inform future investigations into the epidemiology and diagnosis of C. difficile in Lao PDR.
Conlan, James; Khounsy, Syseng; Inthavong, Phouth; Fenwick, Stanley; Blacksell, Stuart; Thompson, R C Andrew
Taeniasis and cysticercosis are important but underreported parasitic zoonoses in the Lao People's Democratic Republic (Lao PDR). Reports of human and pig cysticercosis are rather limited and based largely on anecdotal evidence. To date, no structured surveys of disease prevalence or incidence have been reported. However, one unpublished pilot survey of pig cysticercosis in a slaughterhouse in northern Laos estimated prevalence to be 1.7%, without speciation of parasite cysts. Over the past 20 years, nine surveys of intestinal helminthic infection have been conducted; the prevalence of human taeniasis ranged from 0 to 14.0%. The study designs and sample sizes varied greatly, however a high degree of spatial and age variation in taeniasis prevalence was evident. These results are however inconclusive as the species of tapeworm infecting the people was not determined. To further our knowledge of taeniasis and cysticercosis in Lao PDR, structured community-based surveys in high-risk areas are required in combination with the use of sensitive and specific diagnostic tests capable of identifying the pork tapeworm, Taenia solium. This will enable the development and implementation of control measures that are both appropriate and sustainable if T. solium is shown to be a public health threat.
McMullen, John; O'Callaghan, Paul; Shannon, Ciaran; Black, Alastair; Eakin, John
Background: The Democratic Republic of Congo (DRC) has been home to the world's deadliest conflict since World War II and is reported to have the largest number of child soldiers in the world. Despite evidence of the debilitating impact of war, no group-based mental health or psychosocial intervention has been evaluated in a randomised controlled…
Iloweka, Ernest Manganda
The Lower Congo is one of eleven provinces in the Democratic Republic of Congo, and is located southwest of Kinshasa Town Province. It has an area of approximately 53.947 km2 with a population of 1,504,361 at an estimated 237 persons per km2. The Province comprises five districts, including Lukaya and Cataracts where rural poverty is severe and the population struggle to make a living through agriculture and woodcutting. These activities result in excessive resource exploitation. The high demand for foodstuffs and the high consumption of wood (for energy, construction and export) in Kinshasa, the capital city of the Democratic Republic of Congo and the expanding towns of Matadi and Boma in the Lower Congo Province, are speeding the deforestation rate and unbalancing forest ecosystems. In addition there is the stress resulting from reduced josher (the rest period for agriculture ground), plus climate change and erosion. The phenomena that that we need to address in these two districts include deforestation, reduced josher, excessive agriculture, erosion, burning and climate change which taken together largely explain the current soil degradation. These areas are marked by excessive post deforestation savannah formation and extended areas of sandy soil, distributed throughout grass and shrub savannahs. This desertification, which is rampant in Lukaya and Cataracts, risks imprisoning the rural population in a vicious cycle of poverty if adequate solutions are not found.
Full Text Available The majority of the population in Sub-Saharan Africa is employed in agriculture. Nevertheless, the productivity of the sector is relatively low in comparison with other regions of the world. Based on convergence theory, technology transfer can enhance growth. However, the effective transfer of technology requires a certain absorption capacity from the recipient. Based on the qualitative research on cassava production in Congo Brazzaville, we identified key factors that influence the transfer process. These factors have been divided into four key areas: market, institutions, technology, and social capability. Cassava production value chain in Ignie region served as a case study for the evaluation of technology transfer absorptive capacity in Congo agriculture. We learned that the lack of agro-technical education, shortages in infrastructure, unavailability of business services, and market structure are among the main barriers of the intensification of technology use in agriculture.
Nack, P.; Arndt, D.; Schuettmann, W.
Medical care of radiation casualties in the German Democratic Republic (GDR) is organized on two levels. On the level of users the responsible Medical Officers guarantee both the routine control of persons occupationally exposed to radiation and first aid in the event of accidents. On the second level medical treatment is given either in the Clinical Department of the National Board of Nuclear Safety and Radiation Protection or in specialized national health system clinics having facilities for intensive medical care. A decision on hospitalization is made according to the conditions of the accident and the necessary diagnostic and therapeutic measures as a rule are based on consultations between the responsible Medical Officer and the departments of the Board (Emergency Assistance Service, Clinical Department, Consultative Committee). For serious cases where haematological complications can be expected, a central medical clinic with facilities for bone-marrow transplants is available. The casualties are treated in local clinics which are provided with continuous support and advice by the Board. This support consists in: (i) immediate activity by a consultative committee of the Board's physicians and scientists experienced and trained in radiation protection and the treatment of radiation accidents; (ii) the requirement of compulsory examination methods and take-over of specialized laboratory investigations; and (iii) the use of a mobile emergency measuring system in cases of additional incorporation. It is the main principle of medical care in case of radiation accidents to consult, as early as possible, a medical consultative committee of the Board in the field of radiation protection at each step of medical care. (author)
Jönsson, Kristina; Phoummalaysith, Bounfeng; Wahlström, Rolf; Tomson, Göran
During the last 20 years Lao People's Democratic Republic has successfully developed and adopted some 30 health policies, strategies, decrees and laws in the field of health. Still, the implementation process remains arduous. This article aims at discussing challenges of health policy development and effective implementation by contextualizing the policy evolution over time and by focusing particularly on the National Drug Policy and the Health Care Law. Special attention is given to the role of research in policymaking. The analysis was guided by the conceptual framework of policy context, process, content and actors, combined with an institutional perspective, and showed that effective implementation of a health policy is highly dependent on both structures and agency of those involved in the policy process. The National Drug Policy was formulated and adopted in a short period of time in a resource-scarce setting, but with dedicated policy entrepreneurs and support of concerned international collaborators. Timely introduction of operational health systems research played a crucial role to support the implementation, as well as the subsequent revision of the policy. The development of the Health Care Law took several years and once adopted, the implementation was delayed by institutional legacies and issues concerning the choice of institutional design and financing, despite strong support of the law among the policymakers. Among many factors, timing of the implementation appeared to be of crucial importance, in combination with strong leadership. These two examples show that more research, that problematizes the complex policy environment in combination with improved communication between researchers and policymakers, is necessary to inform about measures for effective implementation. A way forward can be to strengthen the domestic research capacity and the international research collaboration regionally as well as globally. Published by Oxford University Press
Full Text Available Starting from the socio-political context of changes that have affected the education systems of Eastern European countries, the authors summarize the specific nature of the process of democratization of education in Europe at the turn of the century. The paper analyzes the purpose of democratization of education and of introduction of Civic Education and Religious Education classes in the education system of the Republic of Serbia, observing the idea that education may serve as a generator of social changes, and stating that school is an important support pillar in promoting and accepting the values of the community, as well as in personal growth and the development of every individual. The presented theoretical concepts are supported by the summary of results of empirical studies that have been focused on the analysis of the pedagogical aspects of the implementation of teaching these subjects at the secondary level of education from the perspective of teachers, pupils and parents. Based on the insight into the topic, the authors suggest searching for a “common tangent” in Civic Education and Religious Education teaching process via an open and tolerant dialogue of participants of both subjects, which would enable the exchange of experiences, attitudes, and opinions of pupils, as well as coinciding and permeating of spiritual and democratic values as a foundation for further democratization of school in general. [Projekat Ministarstva nauke Republike Srbije, br. 179036: Pedagogical Pluralism as the Basis for Education Policy
Linguissi, Laure Stella Ghoma; Gwom, Luc Christian; Nkenfou, Celine Nguefeu; Bates, Matthew; Petersen, Eskild; Zumla, Alimuddin; Ntoumi, Francine
The Republic of Congo is on the World Health Organization (WHO) list of 'high burden' countries for tuberculosis (TB) and HIV. TB is the leading cause of death among HIV-infected patients in the Republic of Congo. In this viewpoint, the available data on TB and HIV in the Republic of Congo are reviewed, and the gaps and bottlenecks that the National TB Control Program (NTCP) faces are discussed. Furthermore, priority requirements for developing and implementing TB and HIV collaborative service activities are identified. HIV and TB control programs operate as distinct entities with separate case management plans. The implementation of collaborative TB/HIV activities to evaluate and monitor the management of TB/HIV co-infected individuals remains inefficient in most regions, and these activities are sometimes non-existent. This reveals major challenges that require definition in order to improve the delivery of healthcare. The NTCP lacks adequate resources for optimal implementation of control measures of TB and HIV compliance and outcomes. The importance of aligning and integrating TB and HIV treatment services (including follow-up) and adherence support services through coordinated and collaborative efforts between individual TB and HIV programs is discussed. Aligning and integrating TB and HIV treatment services through coordinated and collaborative efforts between individual TB and HIV programs is required. However, the WHO recommendations are generic, and health services in the Republic of Congo need to tailor their TB and HIV programs according to the availability of resources and operational feasibility. This will also open opportunities for synergizing collaborative TB/HIV research and training activities, which should be prioritized by the donors supporting the TB/HIV programs. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Laure Stella Ghoma Linguissi
Full Text Available The Republic of Congo is on the World Health Organization (WHO list of ‘high burden’ countries for tuberculosis (TB and HIV. TB is the leading cause of death among HIV-infected patients in the Republic of Congo. In this viewpoint, the available data on TB and HIV in the Republic of Congo are reviewed, and the gaps and bottlenecks that the National TB Control Program (NTCP faces are discussed. Furthermore, priority requirements for developing and implementing TB and HIV collaborative service activities are identified. HIV and TB control programs operate as distinct entities with separate case management plans. The implementation of collaborative TB/HIV activities to evaluate and monitor the management of TB/HIV co-infected individuals remains inefficient in most regions, and these activities are sometimes non-existent. This reveals major challenges that require definition in order to improve the delivery of healthcare. The NTCP lacks adequate resources for optimal implementation of control measures of TB and HIV compliance and outcomes. The importance of aligning and integrating TB and HIV treatment services (including follow-up and adherence support services through coordinated and collaborative efforts between individual TB and HIV programs is discussed. Aligning and integrating TB and HIV treatment services through coordinated and collaborative efforts between individual TB and HIV programs is required. However, the WHO recommendations are generic, and health services in the Republic of Congo need to tailor their TB and HIV programs according to the availability of resources and operational feasibility. This will also open opportunities for synergizing collaborative TB/HIV research and training activities, which should be prioritized by the donors supporting the TB/HIV programs.
Batala Mpondo, Georges; Bouanga, Marianne; Saya, Yvette Marie Clarisse; Maurice, Pierre; Burigusa, Guillaume
Although road accidents in the Congo are reaching alarming levels (2,720 accidents in 2010 and 3,126 accidents in 2011), especially with the massive arrival of "Jakarta" mopeds, no evaluation has been conducted to identify and understand the factors responsible for this problem. This article reports the results of an exploratory study conducted in Brazzaville and Pointe-Noire based on information collected from existing documents and by semidirective questionnaire of people from various sectors able to elucidate the problem of road safety. Using William Haddon's matrix, the parameters investigated were : road user behaviour ; environmental and technological factors ; characteristics of road accident victims ; quality of care ; intervention times and organization of prevention. This study demonstrated the absence of a road safety policy in Congo. It also showed that the main factors responsible for road accidents are behavioural (failure to wear safety belts, failure to comply with road signs, fatigue, use of a telephone while driving, etc.), followed by environmental and technological factors (insufficient traffic lights, absence of sidewalks, disorganized occupation of roads, general state of vehicles). This study shows that, in order to improve road safety in the Congo, it is essential to promote the development of national road safety policies and an action plan, intervention on the determinants of road accidents, and a change of road user behaviours (compulsory use of safety belts, ban on the use of a telephone and smoking while driving, etc.). Effective organization of the management of road accident victims and allocation of a budget to implement a road safety policy are also necessary.
Southivong, Bouavanh; Ichikawa, Masao; Nakahara, Shinji; Southivong, Chanhpheng
To estimate post-traumatic stress disorder (PTSD) symptoms in those injured and not injured by landmines or unexploded ordnance (UXO) in rural Lao People's Democratic Republic and to determine whether the perception of social support was associated with PTSD symptom severity. A community survey was conducted among 190 people injured by landmines or UXO and 380 age-, sex- and neighbourhood-matched non-injured individuals in the Sepone district of Savannakhet Province, the part of the Lao People's Democratic Republic most heavily bombed during the Viet Nam War. Using the Harvard Trauma Questionnaire and the Medical Outcomes Study Social Support Survey, trained health-care workers conducted face-to-face interviews to assess PTSD symptoms and level of perceived social support. Multiple linear regression was performed to explore the association between social support and other factors and PTSD. The prevalence of PTSD was higher among the injured (10%) than among the non-injured (4%), but the level of perceived social support was not significantly different between the two groups. A higher level of perceived social support was associated with milder symptoms of PTSD. Women, older people and those with a formal education were more often and more severely affected by PTSD. The perception of strong social support might help to alleviate the symptoms of PTSD among people injured by landmines or UXO in rural parts of the Lao People's Democratic Republic. Psychosocial interventions should be incorporated in assistance for the injured because they have more severe and longer-lasting symptoms of PTSD than the non-injured.
Bettin, Hartmut; Nowak, Andreas; Roccia, Maria Gracia; Salloch, Sabine
Discussions on euthanasia ("Sterbehilfe") that took place in the German Democratic Republic (GDR) have remained widely unnoticed by the historical sciences. By referring to various publications dating from the 1950s until today, this paper presents the basic ideas of the debate on euthanasia in the GDR and compares them-partly synchronically, partly diachronically-with the situation in the Federal Republic of Germany (FRG). A special focus is placed on positions and terminology related to medical ethics at the end of life in the former two German states. The methodical approach of the paper allows a transparent analysis of the question of whether the GDR debates on euthanasia are significant and independent, and whether they are relevant to current ethical debates on end-of-life practices in Germany.
Several reports by SAAS (the Nuclear Safety and Radiation Protection Board of the German Democratic Republic) have been discussing the effects of the Chernobyl reactor accident through 1989. Only a summary had been published for 1989 in the environmental radioactivity annual report. Institut fuer Umweltschutz had been in charge of the publication of a more detailed account as part of the 'environmental report' but the project was abandoned since the institute was wound up as of October 1990. The report under review concludes the separate German Demoncratic Republic reporting by publishing the part of the manuscript on environmental contamination caused by artificial radionuclides which gives the 1989 situation on the basis of the previous results on the effects of the Chernobyl reactor accident. The appendix lists the SAAS reports published in the past. (orig./BBR) [de
Oberg, Kevin; Shelton, John M.; Gardiner, Ned; Jackson, P. Ryan
The first direct measurements of discharge of the Lower Congo River below Malebo Pool and upstream from Kinganga, Democratic Republic of Congo (DRC) were made in July 2008 using acoustic Doppler current profilers, differential GPS, and echo sounders. These measurements were made in support of research that is attempting to understand the distribution of fish species in the Lower Congo River and reasons for separation of species within this large river. Analyses of these measurements show that the maximum depth in the Lower Congo River was in excess of 200 m and maximum water velocities were greater than 4 m/s. The discharge measured near Luozi, DRC was 35,800 m3/s, and decreased slightly beginning midway through the study. Local bedrock controls seem to have a large effect on the flow in the river, even in reaches without waterfalls and rapids. Dramatic changes in bed topography are evident in transects across the river.
Kodila Tedika, Oasis
This article analysis a nature of corruption in Democratic Republic of Congo. It shows, with arguments, on the one hand the deserved reputation for a highly corrupt country, that one reads regularly in different collations on corruption and says to the complexity and depth of the corruption. The basis of the systemic side of corruption in this country. Cet article a pour objectif de décortiquer la nature de la corruption en République démocratique du Congo. Il démontre, avec arguments, d’une ...
Casson, Robert J; Kahawita, Shyalle; Kong, Aimee; Muecke, James; Sisaleumsak, Siphetthavong; Visonnavong, Vithoune
Vientiane Province is an urbanizing region in Southeast Asia. We aimed to determine the prevalence of refractive error and visual impairment in primary school-aged children in this region. Prospective, cross-sectional survey. A total of 2899 schoolchildren from Vientiane Province, Lao People's Democratic Republic (Lao PDR). Ten districts from Vientiane were randomly selected and 2 primary schools were randomly selected from each district. All children aged 6 to 11 years at selected schools were eligible to participate. The examination included visual acuity (VA) testing, cycloplegic retinoscopy with subjective refinement if indicated, ocular motility testing, and anterior segment and fundus examinations in visually impaired children. Cycloplegic refraction and VA. There was an estimated total of 3330 children who were eligible to participate, and data were recorded from 2899 (87%) of these children. Complete refractive data were available on 2842 children (85% of eligible population). The mean spherical equivalent (SE) in the right eyes was +0.60 diopter (D) (95% confidence interval [CI], 0.49-0.72), and the mean SE in the left eyes was +0.59 (95% CI, 0.50-0.68). The prevalence of hyperopia was 2.8% (95% CI, 1.9-3.7; 88 subjects), and the prevalence of myopia was 0.8% (95% CI, 0.3-1.4; 24 subjects). The majority of children (98%; 95% CI, 97.0-99.0) had normal unaided binocular VA (at least 20/32 in their better eye). The overall prevalence of any visual impairment (presenting VA <20/32 in the better eye) was 1.9% (95% CI, 1.0-2.9; 55 subjects). In multivariate logistic regression analysis, age (P = 0.001) was a significant predictor, and female gender (P = 0.08) and Yao ethnicity (P = 0.09) were borderline significant predictors of the presence of any visual impairment. Visual impairment is not a public health concern in this primary school-aged population; however, visually impaired children in the community were not studied. From this baseline, future surveys
Duysburgh, Els; Kerstens, Birgit; Diaz, Melissa; Fardhdiani, Vini; Reyes, Katherine Ann V; Phommachanh, Khamphong; Temmerman, Marleen; Rodriques, Basil; Zaka, Nabila
Between 1990 and 2011, global neonatal mortality decline was slower than that of under-five mortality. As a result, the proportion of under-five deaths due to neonatal mortality increased. This increase is primarily a consequence of decreasing post-neonatal and child under-five mortality as a result of the typical focus of child survival programmes of the past two decades on diseases affecting children over four weeks of age. Newborns are lagging behind in improved child health outcomes. The aim of this study was to conduct a comprehensive, equity-focussed newborn care assessment and to explore options to improve newborn survival in Indonesia, Lao People's Democratic Republic (PDR) and the Philippines. We assessed newborn health policies, services and care in the three countries through document review, interviews and health facility visits. Findings were triangulated to describe newborns' health status, the health policy and the health system context for newborn care and the equity situation regarding newborn survival. (1) In the three countries, decline of neonatal mortality is lagging behind compared to that of under-five mortality. (2) Comprehensive newborn policies in line with international standards exist, although implementation remains poor. An important factor hampering implementation is decentralisation of the health sector, which created confusion regarding roles and responsibilities. Management capacity and skills at decentralised level were often found to be limited. (3) Quality of newborn care provided at primary healthcare and referral level is generally substandard. Limited knowledge and skills among providers of newborn care are contributing to poor quality of care. (4) Socio-economic and geographic inequities in newborn care are considerable. Similar important challenges for newborn care have been identified in Indonesia, Lao PDR and the Philippines. There is an urgent need to address weak leadership and governance regarding newborn care, quality
Gouteux, J P; Malonga, J R
A study carried out at villagers level in a focus infected by human trypanosomiasis (Yamba, Bouenza region, Congo, Mikengue ethnic group) revealed that modern medicin is recognized by them as the sole possibility to treat the sleeping sickness. The witch doctor, if he cannot transmit the sickness, is perfectly able to aggravate it. He is considered as the responsible for any fatal issue. Tsetse flies are charged of transmitting the sickness as well as other biting insects (black flies, ceratopogonidae). The elders give an historical role to pigs in spreading the sickness. Villagers seem very determined to assume themselves fighting against the tsetse fly by trapping, but impregnation of traps by an insecticide got some problems (technical know-how, equipment) which have been solved by a new model of trap designed by the ORSTOM Center in Brazzaville.
Gregory, Christopher J; Ndiaye, Serigne; Patel, Minal; Hakizamana, Elisaphan; Wannemuehler, Kathleen; Ndinga, Edouard; Chu, Susan; Talani, Pascal; Kretsinger, Katrina
Multiple cases of paralysis, often resulting in death, occurred among young adults during a wild poliovirus (WPV) type 1 outbreak in Pointe Noire, Republic of Congo, in 2010. We conducted an investigation to identify factors associated with fatal outcomes among persons with poliomyelitis in Pointe Noire. Polio cases were defined as acute flaccid paralysis (AFP) cases reported from 7 October to 7 December 2010 with either a stool specimen positive for WPV or clinically classified as polio-compatible. Data were obtained from medical records, hospital databases, AFP case investigation forms and, when possible, via interviews with persons with polio or surrogates using a standard questionnaire. A total of 369 polio cases occurred in Pointe Noire between 7 October and 7 December 2010. Median age was 22 years for nonsurvivors and 18 years for survivors (P = .01). Small home size, as defined by ≤2 rooms, use of a well for drinking water during a water shortage, and age ≥15 years were risk factors for death in multivariate analysis. Consideration should be given during polio risk assessment planning and outbreak response to water/sanitation status and potential susceptibility to polio in older children and adults. Serosurveys to estimate immunity gaps in older age groups in countries at high risk of polio importation might be useful to guide preparedness and response planning.
Seimon, Tracie A.; Olson, Sarah H.; Lee, Kerry Jo; Rosen, Gail; Ondzie, Alain; Cameron, Kenneth; Reed, Patricia; Anthony, Simon J.; Joly, Damien O.; McAloose, Denise; Lipkin, W. Ian
Infectious diseases have caused die-offs in both free-ranging gorillas and chimpanzees. Understanding pathogen diversity and disease ecology is therefore critical for conserving these endangered animals. To determine viral diversity in free-ranging, non-habituated gorillas and chimpanzees in the Republic of Congo, genetic testing was performed on great-ape fecal samples collected near Odzala-Kokoua National Park. Samples were analyzed to determine ape species, identify individuals in the population, and to test for the presence of herpesviruses, adenoviruses, poxviruses, bocaviruses, flaviviruses, paramyxoviruses, coronaviruses, filoviruses, and simian immunodeficiency virus (SIV). We identified 19 DNA viruses representing two viral families, Herpesviridae and Adenoviridae, of which three herpesviruses had not been previously described. Co-detections of multiple herpesviruses and/or adenoviruses were present in both gorillas and chimpanzees. Cytomegalovirus (CMV) and lymphocryptovirus (LCV) were found primarily in the context of co-association with each other and adenoviruses. Using viral discovery curves for herpesviruses and adenoviruses, the total viral richness in the sample population of gorillas and chimpanzees was estimated to be a minimum of 23 viruses, corresponding to a detection rate of 83%. These findings represent the first description of DNA viral diversity in feces from free-ranging gorillas and chimpanzees in or near the Odzala-Kokoua National Park and form a basis for understanding the types of viruses circulating among great apes in this region. PMID:25781992
Magliocca, F; Querouil, S; Gautier-Hion, A
Population studies are an essential part of conservation actions. Under exceptional observation conditions we studied a western lowland gorilla population visiting the Maya salt-clearing (north of the Parc national d'Odzala, P.N.O., Congo) over an 8 month period; 36 groups and 18 solitary individuals (a total of 420 individuals) have been identified visiting the clearing, which suggests a high gorilla density in the region. Ninety-six percent of the gorillas entered the clearing in groups. One-male groups had a mean size of 11.2. Ninety percent of solitary individuals were silver-back males. Compared with other populations of both lowland gorillas and mountain gorillas, the Maya population had the highest immature rate and the highest number of infants per female. Ecological correlates that could explain the attractiveness of the Maya clearing are discussed. The present status and the renewal rate of the Maya population indicate the need for further studies and confirm the importance of developing eco-tourism in this region as part of the sustainable park management activities developed by the ECOFAC programme (European Union). The results also provide arguments to support the proposal for extending the P.N.O. to include this region, which is rich in salt-clearings and attracts many other key-species of mammal such as forest elephants.
In developing countries, providing all citizens an access to modern forms of energy is among the central energy policy objectives, as the linkages between modern energy services and human development are widely recognized. This paper presents in a scenario analysis of rural energy consumption, how energy services in different sectors of a village economy contribute to the achievement of the UNDP Millennium Development Goals. In a rural village in Lao People's Democratic Republic, household energy demand and energy uses were surveyed immediately prior to the electrification of the village. Based on the situation preceding electrification of the village, the development of village electrification was studied by simulating the village energy system, accounting for all village energy uses but transportation. To study the potential development of electricity demand in the village, three scenarios were constructed using the LEAP model: 'residential demand', 'income generation' and 'public services'. Energy demand in each scenario was analyzed with reference to the Millennium Development Goals.
This paper analyses the role of the ethnic factor in political choices in the Democratic .... 4 Decision no 031/CEI/BUR/06 on the announcing of provisional results of the 30 July .... is complicated when we add the purchasing of consciences.
Sheridan, Sarah; Phimphachanh, Chansy; Chanlivong, Niramonh; Manivong, Sisavath; Khamsyvolsvong, Sod; Lattanavong, Phonesay; Sisouk, Thongchanh; Toledo, Carlos; Scherzer, Martha; Toole, Mike; van Griensven, Frits
Men who have sex with men are at high risk for HIV infection. Here we report the results of the first assessment of HIV prevalence and risk behaviour in this group in Vientiane, Lao People's Democratic Republic. Between August and September 2007, 540 men were enrolled from venues around Vientiane, using venue-day-time sampling. Men of Lao nationality, 15 years and over, reporting oral or anal sex with a man in the previous 6 months were eligible for participation. Demographic and socio-behavioural information was self-collected using hand-held computers. Oral fluid was tested for HIV infection. Logistic regression was used to evaluate risk factors for prevalent HIV infection. The median age of participants was 21 years; the HIV prevalence was 5.6%. Of participants, 39.6% reported exclusive attraction to men and 57.6% reported sex with women. Of those who reported having regular and nonregular sexual partner(s) in the past 3 months, consistent condom use with these partners was 14.4 and 24.2%, respectively. A total of 42.2% self-reported any sexually transmitted infection symptoms and 6.3% had previously been tested for HIV. Suicidal ideation was reported by 17.0%, which was the only variable significantly and independently associated with HIV infection in multivariate analysis. Although the HIV prevalence is low compared with neighbouring countries in the region, men who have sex with men in Lao People's Democratic Republic are at high behavioural risk for HIV infection. To prevent a larger HIV epidemic occurrence and transmission into the broader community, higher coverage of HIV prevention interventions is required.
Situation Reports--Afghanistan, Bahrein, Brazil, Ecuador, Indonesia, Iraq, Morocco, Paraguay, People's Democratic Republic of Yemen, Peru, Qatar, Saudi Arabia, Sri Lanka, St. Christopher/Nevis, Sudan, United Arab Emirates, Yemen Arab Republic.
International Planned Parenthood Federation, London (England).
Data relating to population and family planning in 17 foreign countries are presented in these situation reports. Countries included are Afghanistan, Bahrein, Brazil, Ecuador, Indonesia, Iraq, Morocco, Paraguay, People's Democratic Republic of Yemen, Peru, Qatar, Saudi Arabia, Sri Lanka, St. Christopher/Nevis, Sudan, United Arab Emirates, and…
Full Text Available Nowhere are the barriers to a functional health infrastructure more clearly on display than in the Goma region of Democratic Republic of Congo. Kaboru et al. report poorly integrated services for HIV and TB in this war-torn region. Priorities in conflict zones include provision of security, shelter, food, clean water and prevention of sexual violence. In Goma, immediate health priorities include emergency treatment of cholera, malaria, respiratory illnesses, provision of maternal care, millions of measles vaccinations, and management of an ongoing rabies epidemic. It is a daunting task to determine an essential package of medical services in a setting where there are so many competing priorities, where opportunity costs are limited and epidemiologic information is scarce. Non-governmental agencies sometimes add to the challenge via an insidious reduction of state sovereignty and the creation of new levels of income inequality. Kaboru et al. have successfully highlighted many of the complexities of rebuilding and prioritizing healthcare in a conflict zone.
Full Text Available Decentralization as a way of organizing a state represents the path to its democratization and effectiveness. Furthermore, territorial decentralization establishes the relations between state and local communities, and in order to be efficient some fundamental theoretic conditions should be respected, guidelines followed and two great balances achieved. Generally, an appropriate decentralization can be a catalyst for development and a remedy to overcome internal crises.
The text of the Agreement between the German Democratic Republic and the Agency for the application of safeguards in connection with the Treaty on the Nonproliferation of Nuclear Weapons is reproduced in this document for the information of all Members.
His Excellency Mr Deepak Dhital Ambassador Extraordinary and Plenipotentiary Permanent Representative of the Federal Democratic Republic of Nepal to the United Nations Office and other international organisations in Geneva
Bennett, Sophia Elizabeth
His Excellency Mr Deepak Dhital Ambassador Extraordinary and Plenipotentiary Permanent Representative of the Federal Democratic Republic of Nepal to the United Nations Office and other international organisations in Geneva
Kangoy, Kasangye; Ngoyi, John; Mudimbiyi, Olive
The presence of household waste on public roads affects environmental health leading to unsanitary conditions which may cause disease outbreaks, some of which may occur in epidemic form. Over the past two decades, waste management has become increasingly complex both for developing and underdeveloping countries. This study aims to determine the types of waste and the management of waste generated by the households. This descriptive cross-sectional study conducted in the health district of Bulaska, Kasai Oriental, is a forward-looking approach based upon interview and active observation. The questionnaire was addressed to the head of household or the delegate out of 170 households, representing a convenience sample, from 21 to 25 June 2010. This study revealed that: 94.7% of respondents who answered our questionnaire were female; 47% of respondents had a primary level of study; 41.1% of respondents were housewives; the average household size was 7 people per household; in 83.5% of cases the wastes generated were solid. 50% of households in the health area used public road for trash disposal. Given the results of this study, further development of awareness programs on environmental sanitation is necessary.
Mukaba, Thibaut; Binanga, Arsene; Fohl, Sarah; Bertrand, Jane T
Building on expressed support from the Prime Minister to the Ministries of Health and Planning, the country's new family planning commitment grew out of: (1) recognition of the impact of family planning on maternal mortality and economic development; (2) knowledge sharing of best practices from other African countries; (3) participatory development of a national strategic plan; (4) strong collaboration between stakeholders; (5) effective advocacy by champions including country and international experts; and (6) increased donor support. The question becomes: Will the favorable policy environment translate into effective local programming?
Karemere, H; Kahindo, J B; Ribesse, N; Macq, J
Because hospitals are complex enterprises requiring adaptive systems, it is appropriate to apply the theory and terminology of governance or even better adaptive governance to the interpretation of their management. This study focused on understanding hospital governance in Logo, Bunia, and Katana, three hospitals in two regions of the eastern DRC, which has been characterized by intermittent armed conflict since 1996. In such a context of war and continuous insecurity, how can governance be interpreted for hospitals required to adapt to a constantly changing environment to be able to continue to provide health care? A critical interpretive synthesis of the literature, identified by searching for keywords related to governance. The concepts of governance, adaptive governance, performance, leadership, and complex adaptive system concepts are defined. The interpretation of the concepts helps us to better understand (1) the hospital as a complex adaptive system, (2) the governance of tertiary referral hospitals, (3) analysis of hospital performance, and (4) leadership for good governance of these hospitals. The interpretation of these concepts raises several questions about their application to the eastern DRC. Conclusion. This critical interpretive synthesis opens the door to a new way of exploring tertiary hospitals and their governance in the eastern DRC.
Mulumeoderhwa, Maroyi; Harris, Geoff
This paper reports on fieldwork carried out in 2011 with the aim of investigating the attitudes and reported behaviour of Congolese high school students concerning sexual relationships. A total of 56 boys and girls aged 16-20 from two urban and two rural high schools in South Kivu Province took part in focus groups, and 40 of these were subsequently interviewed individually. The majority of boys felt that they were entitled to sex from their girlfriends and that if persuasion was unsuccessful, the use of force was legitimate; this, in their minds, did not constitute rape. Girls, on the other hand, were clear that such forced sex was rape. However it may be understood, rape was perceived as having increased in recent years and was explained by weak legal systems, pornography and provocative dressing by girls. Boys were angry at the competition from older, often married, men who were able to provide monetary and other incentives to the girls.
Full Text Available Abstract Background There is limited knowledge of Chronic Kidney Disease (CKD among high risk populations, especially in the developing countries. We report our study of testing for CKD in at-risk subjects. Methods In a cross-sectional study, 527 people from primary and secondary health care areas in the city of Kinshasa were studied from a random sample of at-risk out-patients with hypertension, diabetes, obesity, or HIV+. We measured blood pressure (BP, blood glucose level, proteinuria, body mass index, and estimated glomerular filtration rate (eGFR by MDRD equation using calibrated creatinine levels based on one random measurement. The associations between health characteristics, indicators of kidney damage (proteinuria and kidney function (2 were also examined. Results The prevalence of CKD in this study was 36%, but only 12% were aware of their condition. 4% of patients had stage 1 CKD, 6% stage 2, 18% stage 3, 2% stage 4, and 6% had stage 5. 24 hour quantitative proteinuria (>300 mg/day was found in 19%. In those with the at-risk conditions, the % of CKD was: 44% in patients with hypertension, 39% in those with diabetes; 16% in the obese and 12% in those who were HIV+. 82% of those with a history of diabetes had elevated serum glucose levels at screening (≥ 126 mg/dl. Only 6% of individuals with hypertension having CKD had reduced BP to lower than 130/80 mmHg. In multivariate analysis, diabetes, proteinuria and hypertension were the strongest determinants of CKD 3+. Conclusion It appears that one out of three people in this at-risk population has undiagnosed CKD and poorly controlled CKD risk factors. This growing problem poses clear challenges to this developing country. Therefore, CKD should be addressed through the development of multidisciplinary teams and improved communication between traditional health care givers and nephrology services. Attention to CKD risk factors must become a priority.
Full Text Available Abstract Background HIV counseling and testing, HIV prevention and provision of HIV care and support are essential activities to reduce the burden of HIV among patients with TB, and should be integrated into routine TB care. Methods The development of training materials to promote HIV services for TB patients involved the definition of target health care workers (HCWs; identification of required tasks, skills and knowledge; review of international guidelines; and adaptation of existing training materials for voluntary counseling and testing, prevention of mother-to-child transmission of HIV, and management of opportunistic infections (OIs. Training effectiveness was assessed by means of questionnaires administered pre- and post-training, by correlating post-training results of HCWs with the centre's HIV testing acceptance rates, and through participatory observations at the time of on-site supervisory visits and monthly meetings. Results Pre-training assessment identified gaps in basic knowledge of HIV epidemiology, the link between TB and HIV, interpretation of CD4 counts, prevention and management of OIs, and occupational post-exposure prophylaxis (PEP. Opinions on patients' rights and confidentiality varied. Mean test results increased from 72% pre-training to 87% post-training (p Conclusion Many HCWs did not possess the knowledge or skills necessary to integrate HIV activities into routine care for patients with TB. A participatory approach resulted in training materials that fulfilled local needs.
Sakamaki, Tetsuya; Maloueki, Ulrich; Bakaa, Batuafe; Bongoli, Lingomo; Kasalevo, Phila; Terada, Saeko; Furuichi, Takeshi
Findings of regional variations in the behavioral patterns of non-human primates have led to the vigorous study of animal traditions (or culture), which contribute to a biological understanding of diversity in human cultures. Although our knowledge of behavioral variations of the bonobo (Pan paniscus) is limited compared with its sister species, the chimpanzee (P. troglodytes), variations in the prey of this species have been reported across study sites. This study describes evidence of mammals consumed by bonobos in the Iyondji site, which was established in 2010. We found evidence that Iyondji bonobos consumed duikers (Cephalophus dorsalis, C. monticola) and diurnal monkeys (Cercopithecus ascanius), which is notable because only anomalures (Anomalurus spp.) are consumed by bonobos in Wamba, a long-term study site established in 1973, located in an area adjacent to Iyondji. Moreover, bonobos do not transfer between the two populations due to the river between the sites. According to our census of duikers and diurnal monkeys, Iyondji bonobos appeared to encounter diurnal monkeys more frequently than did Wamba bonobos. Although humans have apparently had a more pronounced impact on the habitats in Wamba than on those in Iyondji, it remains unclear how such environmental conditions may have contributed to the differences in the prey consumed by bonobos in different sites. Our findings suggest that additional research at various sites could reveal the nature of the variations in the behavior of bonobos.
André B. Malekani
Full Text Available As part of biodiversity monitoring in the Kisangani Forest Region, a survey of bats was conducted in three protected areas, specifically Lomami, Yangambi and Epulu. In this pilot study, a total of 201 specimens were collected using Japanese nets of different lengths (6, 9 and 12 m long and a height of 2 m with a mesh size of 2 × 2 cm to capture bats. Captured specimens were identified using determination keys appropriate for the study area. The results of inventories in the three sites revealed that 201 specimens of captured bats belong to 2 sub-orders, 4 families, 9 genera and 12 species. The most abundant species were Epomops franqueti, Megaloglossus woermannii and Myotis bocagii. The following species, Epomops franqueti, Megaloglossus woermanii, Casinycteris argynnis, and Hipposideros caffer were found at all three sites. Based on the Shannon Index, it was observed that the Lomami site has a higher specific diversity than the two other areas (Yangambi and Epulu 1.74 against 1.51 and 1.42 respectively.
78 Social, Economic, Ecological , and Political Implications...the international level, a defensive barrier would be necessary to positively affect the social, diplomatic, military, economic, and ecological ...stakeholders will agree to support the decision considering the urgency. It means also that this project is lawful and ethical compared to the mines
Højstrup Christensen, Gitte; Mandrup, Thomas
after the signing of two peace agreements (EUSEC). The EUPOL mission was terminated in 2014 and the EUSEC in 2016. Both missions were successful in some areas and failed in others. Despite their shortcomings, the EUPOL and EUSEC missions can provide valuable lessons for future EU Common Security...
Implications: Research into human capital and links to performance in Africa and emerging markets is valuable as recent research has found that the matching of entrepreneurial human capital with opportunities for growth is the essence of economic development.
Good forest governance is an increasingly important topic for stakeholders in many different settings around the world. Two of the best-known international initiatives to improve forest governance are the regional Forest Law Enforcement and Governance (FLEG) ministerial processes supported by the
Ntamabyaliro, Nsengi Y; Burri, Christian; Nzolo, Didier B; Engo, Aline B; Lula, Yves N; Mampunza, Samuel M; Nsibu, Célestin N; Mesia, Gauthier K; Kayembe, Jean-Marie N; Likwela, Joris L; Kintaudi, Leon M; Tona, Gaston L
Malaria the first causes of death from parasitic infection worldwide. Interventions to reduce the burden of malaria have produced a tremendous drop in malaria morbidity and mortality. However, progress is slower in DRC, which shares with Nigeria 39% of deaths related to malaria globally. Inappropriate use of drugs may be one of the factors of this below-average performance. The aim of this study was to describe the use of drugs in the management of uncomplicated malaria in public health facilities in DRC. A drug use study was carried out in DRC from January to March 2014. In each of the former 11 provinces of DRC, one Rural Health Centre, one Urban Health Centre and one General Hospital were selected. In each of them, 100 patient's files containing prescription of anti-malarials from January to December 2013 were randomly selected. Among them, all of the files with diagnosis of uncomplicated malaria were included in this study. Prescribed anti-malarials, co-prescribed drugs and their indications were collected. Descriptive analyses were performed. A total of 2300 files out of 3300 (69.7%) concerned uncomplicated malaria and were included in analysis. Malaria treatment was initiated after a positive RDT or microscopy in 51.5% of cases, upon suspicion without requesting biological confirmation in 37% and despite negative results in 11%. Twenty-nine (29) different treatment regimens were used. The drugs recommended by the National Malaria Control Programme were used in 54.3% of cases (artesunate-amodiaquine 37.4% or artemether-lumefantrine 16.9%). The second most used anti-malarial was quinine (32.4%). Apart from anti-malarials, an average of 3.1 drugs per patient were prescribed, among which antibiotics (67.9%), analgesics and non-steroidal anti-inflammatory (NSAIDs) (all abbreviations to be explicated on first use) (70.6%), vitamins (29.1%), anaemia drugs, including blood transfusion (9.1%) and corticosteroids (5.7%), In 51.4% of cases there was no indication for the concomitant medication. Management of uncomplicated malaria in DRC is characterized by a low adherence to treatment policy, numerous treatment regimens, and abundant concomitant medication potentially harmful to the patient. This may contribute to the low performance of DRC in malaria control. Determinant of this irrational use of drugs need to be assessed in order to formulate and implement efficient corrective measures.
Muyumba, Emmanuel Kiyana; Nkulu, Dophra Ngoy; Mukeng, Clarence Kaut; Musung, Jacques Mbaz; Kakoma, Placide Kambola; Kakisingi, Christian Ngama; Luboya, Oscar Numbi; Malonga, Françoise Kaj; Kizonde, Justin Kalungwe; Mukuku, Olivier; Yan, Weili
The diagnosis of hypertension in children is complex because based on normative values by sex, age and height, and these values vary depending on the environment. Available BP references used, because of the absence of local data, do not correspond to our pediatric population. Accordingly, our study aimed to provide the BP threshold for children and adolescents in Lubumbashi (DRC) and to compare them with German (KIGGS study), Polish (OLAF study) and Chinese (CHNS study) references. We conducted a cross-sectional study among 7523 school-children aged 3 to 17 years. The standardized BP measurements were obtained using a validated oscillometric device (Datascope Accutor Plus). After excluding overweight and obese subjects according to the IOTF definition (n = 640), gender-specific SBP and DBP percentiles, which simultaneously accounted for age and height by using an extension of the LMS method, namely GAMLSS, were tabulated. The 50th, 90th and 95th percentiles of SBP and DBP for 3373 boys and 3510 girls were tabulated simultaneously by age and height (5th, 25th, 50th, 75th and 95th height percentile). Before 13 years the 50th and 90th percentiles of SBP for boys were higher compared with those of KIGGS and OLAF, and after they became lower: the difference for adolescents aged 17 years was respectively 8 mmHg (KIGGS) and 4 mmHg (OLAF). Concerning girls, the SBP 50th percentile was close to that of OLAF and KIGGS studies with differences that did not exceed 3 mmHg; whereas the 90th percentile of girls at different ages was high. Our oscillometric 50th and 90th percentiles of SBP and DBP were very high compared to referential ausculatory percentiles of the CHNS study respectively for boys from 8 to 14 mmHg and 7 to 13 mmHg; and for girls from 10 to 16 mmHg and 11 to 16 mmHg. The proposed BP thresholds percentiles enable early detection and treatment of children and adolescents with high BP and develop a local program of health promotion in schools and family.
remained at large at the time of writing ( Malinowski 2008). Psychological Effects and Indoctrination Some works defined the psychological effect of...imprisonment. Biyoyo subsequently escaped from prison and remained at large at the time of writing ( Malinowski 2008). From a purely judicial...Armed Conflict on Children. Report of the expert of the Secretary General, New York: United Nations. Malinowski , Tom. 2008. Child Soldiers
Leekitcharoenphon, Pimlapas; Rundsten, Carsten Friis; Zankari, Ea
We showed in a limited number of isolates that S. Typhimurium ST313 is a prevalent sequence-type causing gastrointestinal diseases and septicemia in patients from Nigeria and DRC. We found three distinct phylogenetic clusters based on the origin of isolation suggesting some spatial evolution. Com...
Villun, K.; Gruner, V.; Siebert, Kh.U.; Hoffmann, D.
The authors give a brief description of the destructive and non-destructive methods of measuring the quantity and isotopic composition of fissile materials used in the nuclear materials accounting and control system of the German Democratic Republic. They cite examples of the use of gamma-spectrometry, X-ray fluorescence analysis, neutron activation, radiochemical techniques, mass-spectrometry and alpha-spectrometry. (author)
Kennis, John; Laurent, Crespin; Amundala, Nicaise Drazo
of habitat on rodent life history both in primary rainforest and fallow land. Survival analyses taking into account trap-happiness effects were conducted using the program MARK. Abundance of D. ferrugineus was generally low within all our study grids, but it was lowest in fallow land compared to primary...... rainforest. Numbers of reproductively active females captured were not different between habitats but were larger during the rainy seasons. Daily movements of females, but not of males, were smaller in fallow land. Capture-mark-recapture analyses showed recapture probabilities to vary highly between grids...
Katuala, Pionus G B; Kennis, Jan; Nicolas, Violaine
Praomys (four species), Lophuromys (four) and Deomys (one) are among the most common Muridae in the Kisangani region. To establish whether or not rivers constitute dispersal barriers for these rodents, we investigated the presence of these genera and their species in eight localities that are eit......Praomys (four species), Lophuromys (four) and Deomys (one) are among the most common Muridae in the Kisangani region. To establish whether or not rivers constitute dispersal barriers for these rodents, we investigated the presence of these genera and their species in eight localities...
Rebekah J L Burns
Full Text Available Goat raising is a growing industry in Lao People's Democratic Republic, with minimal disease investigation to date, especially zoonoses. This study determined the proportional seropositivity of two zoonotic diseases: Q fever (causative agent Coxiella burnetii and Brucellosis (Brucella species in goats across five provinces (Vientiane Capital, Xayaboury, Xiengkhuang, Savannakhet and Attapeu. A total of 1458 goat serum samples were tested using commercial indirect ELISA for both pathogens, plus Rose Bengal agglutination test for Brucellosis. Overall individual seropositivity of C. burnetii was 4.1% and Brucella spp. was 1.4%. A multiple logistic regression model identified that province (Vientiane Capital, p = 0.05, breed (introduced Boer mixed breed, p = 0.006 and age (goats ≥3 years old, p = 0.014 were significant risk factors for C. burnetii seropositivity. The results of the survey indicated that province (Vientiane Capital, p<0.001, breed (introduced Boer mixed breed, p<0.001, production system (commercial, p<0.001, age (adult, p = 0.004, and farm size (large, 0.001 were all significant risk factors seropositivity for Brucella spp. It was concluded that Lao goats have been exposed to both C. burnetii and Brucella spp. however the risk of clinical disease has not yet been determined and there is an urgent need to determine human health risks and economic losses caused by Q fever and Brucellosis.
Kyong-Song, Ri; Hammond, James O. S.; Chol-Nam, Ko; Hyok, Kim; Yong-Gun, Yun; Gil-Jong, Pak; Chong-Song, Ri; Oppenheimer, Clive; Liu, Kosima W.; Iacovino, Kayla D.; Kum-Ran, Ryu
Mt. Paektu (also known as Changbaishan) is an enigmatic volcano on the border between the Democratic People’s Republic of Korea (DPRK) and China. Despite being responsible for one of the largest eruptions in history, comparatively little is known about its magmatic evolution, geochronology, or underlying structure. We present receiver function results from an unprecedented seismic deployment in the DPRK. These are the first estimates of the crustal structure on the DPRK side of the volcano and, indeed, for anywhere beneath the DPRK. The crust 60 km from the volcano has a thickness of 35 km and a bulk VP/VS of 1.76, similar to that of the Sino-Korean craton. The VP/VS ratio increases ~20 km from the volcano, rising to >1.87 directly beneath the volcano. This shows that a large region of the crust has been modified by magmatism associated with the volcanism. Such high values of VP/VS suggest that partial melt is present in the crust beneath Mt. Paektu. This region of melt represents a potential source for magmas erupted in the last few thousand years and may be associated with an episode of volcanic unrest observed between 2002 and 2005.
Burns, Rebekah J. L.; Douangngeun, Bounlom; Theppangna, Watthana; Khounsy, Syseng; Mukaka, Mavuto; Selleck, Paul W.; Hansson, Eric; Wegner, Matthew D.; Windsor, Peter A.
Goat raising is a growing industry in Lao People’s Democratic Republic, with minimal disease investigation to date, especially zoonoses. This study determined the proportional seropositivity of two zoonotic diseases: Q fever (causative agent Coxiella burnetii) and Brucellosis (Brucella species) in goats across five provinces (Vientiane Capital, Xayaboury, Xiengkhuang, Savannakhet and Attapeu). A total of 1458 goat serum samples were tested using commercial indirect ELISA for both pathogens, plus Rose Bengal agglutination test for Brucellosis. Overall individual seropositivity of C. burnetii was 4.1% and Brucella spp. was 1.4%. A multiple logistic regression model identified that province (Vientiane Capital, p = 0.05), breed (introduced Boer mixed breed, p = 0.006) and age (goats ≥3 years old, p = 0.014) were significant risk factors for C. burnetii seropositivity. The results of the survey indicated that province (Vientiane Capital, pfarm size (large, 0.001) were all significant risk factors seropositivity for Brucella spp. It was concluded that Lao goats have been exposed to both C. burnetii and Brucella spp. however the risk of clinical disease has not yet been determined and there is an urgent need to determine human health risks and economic losses caused by Q fever and Brucellosis. PMID:29649313
Teitge, M; Kumbier, E
Scientific journals were established in the Soviet occupied zone following WWII in order to distinguish themselves from the other occupying powers. Starting in 1949 a journal with the title "Psychiatry, Neurology and Medical Psychology" was founded as no publishing house existed in the field of psychiatry and neurology and it became necessary to establish a new journal that was competitive. The journal was primarily distributed in the German Democratic Republic (GDR) until 1990 but the interest internationally was very limited. State affairs had a great influence from the very beginning so that the political involvement was reflected in the selection of staff, such as the publishers and the head of the editorial department and by the close interconnection between the Society for Psychiatry and Neurology of the GDR and the editorship of the journal. The publishers who were primarily responsible and the authors were at the interface of politics and science. Nevertheless, in an international comparison many parallels can be found in the orientation with respect to the content.
Lin, Brian M; White, Michelle; Glover, Ana; Wamah, Greta Peterson; Trotti, Davi L; Randall, Kirstie; Alkire, Blake C; Cheney, Mack L; Parker, Gary; Shrime, Mark G
Approximately thirty percent of the global burden of disease is comprised of surgical conditions. However, five billion people lack access to surgery, with complex factors acting as barriers. We examined whether patient demographics predict barriers to care, and the relation between these factors and postoperative complications in a prospective cohort. Participants included people presenting to a global charity in Republic of Congo with a surgical condition between August 2013 and May 2014. The outcomes were self-reported barrier to care and postoperative complications documented by medical record. Logistic regression was used to adjust for covariates. Of 1237 patients in our study, 1190 (96.2 %) experienced a barrier to care and 126 (10.2 %) experienced a postoperative complication. The most frequently reported barrier was cost (73 %), followed by lack of provider (8.2 %). Greater wealth was associated with decreased odds of cost as a barrier (OR 0.72 [0.57, 0.90]). Greater wealth (OR 1.52 [1.03, 2.25]) and rural home location (OR 3.35 [1.16, 9.62]) were associated with increased odds of no surgeon being available. Cost as a barrier (OR 2.82 [1.02, 7.77]), female sex (OR 3.45 [1.62, 7.33]), and lack of surgeon (OR 5.62 [1.68, 18.77]) were associated with increased odds of postoperative complication. Patient wealth was not associated with odds of postoperative complication. Barriers to surgery were common in Republic of Congo. Patient wealth and home location may predict barriers to surgery. Addressing gender disparities, access to providers, and patient perception of barriers in addition to removal of barriers may help maximize patient health benefits.
Full Text Available 2014 was a hopeful year for the Democratic Republic of Congo (DRC. The M23 movement had been defeated in military operations in which one of the last peacekeeping experiments, the UN Force Intervention Brigade, had played a decisive role. A third UN stabilization plan, the ‘islands of stability’ was proposed to continue the stabilization of a country considered in a post-conflict phase. However, the number of internally displaced persons (IDPs has almost tripled in the country since 2007. This article will argue that DRC is still immersed into an old social conflict that existed before the Congo Wars and the roots of which are not being addressed. It will argue that the United Nations Organization Stabilization Mission in the Democratic Republic of the Congo (MONUSCO and the ‘islands of stability’ strategy can address some of the secondary causes of the Congo conflict, such as its internationalization, the presence in DRC of foreign armed groups or the ‘blood minerals’, but cannot address its primary causes: land struggles, an old cycle of violence and the fragmentation of the Congolese society and political elite that is jeopardizing the restoration of the state authority. The huge dimensions of each of these factors make the Congo conflict ‘one of the most complex and intricate environments ever faced by a peacekeeping mission’, for which MONUSCO’s mandate, resources and stabilization strategy do not seem powerful enough. When the UN organized the 2006 elections legitimized a ‘spoiler state’, the bottleneck of all the reforms needed to stabilize the country. The UN fell thus into a trap and became part of the conflict. Lessons learned should be taken for future UN operations.
Tarvonen, P-L; Suominen, A L; Yang, G S; Ri, Y S; Sipilä, K
To evaluate the self-reported oral health habits and their association with the occurrence of dental caries among children in Pyongyang, Democratic People's Republic of Korea (DPRK), after 6 years of activities under the auspices of the Children's Oral Health Promotion Programme (COHPP). The data were collected in September 2013 in two of the most central districts of Pyongyang City, DPRK. The sample consisted of 492 children aged 10 and 13 years who had participated in the COHPP for 6 years. The children filled in a self-completed, structured questionnaire on oral health habits and were examined clinically by a dentist. The differences in mean (SD) number of decayed primary (dt) and permanent teeth (DT) and their sum (dt + DT) subdivided according to genders, age groups, districts and self-reported oral health habits were evaluated using Mann-Whitney U-test. The associations between self-reported oral health habits and the occurrence of dental caries were evaluated with chi-square test and logistic regression analyses. The school-aged children commonly reported healthy oral hygiene habits but sweet snacks were commonly used. The occurrence of dental caries associated statistically significantly with the frequency of sweet snacking (p=0.011) but not with the frequency of tooth brushing (p=0.725) or the use of water for thirst instead of sugary beverages (p=0.189). A more effective promotion of healthy dietary habits with innovative approaches and close collaboration with different social actors will be needed in future. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Tritipsombut, Jaruwan; Sanchaisuriya, Kanokwan; Phollarp, Prachatip; Bouakhasith, Dalouny; Sanchaisuriya, Pattara; Fucharoen, Goonnapa; Fucharoen, Supan; Schelp, Frank P
In order to determine the prevalence of thalassemia and hemoglobinopathies in different regions of northeast (NE) Thailand and Vientiane, Laos People's Democratic Republic (PDR), a total of 1,809 blood samples were collected consecutively from individuals attending antenatal care services at 11 community hospitals in different regions of NE Thailand and three hospitals in Vientiane, Laos PDR, from May 2009 to April 2010. All individuals were investigated for thalassemia and hemoglobinopathies using standard methods. For individuals from NE Thailand, the carrier frequencies were 41.7% for Hb E [β26(B8)Glu→Lys, GAG>AAG], 5.8% for α(0)-thalassemia (α(0)-thal), and 0.9% for β-thal. The THAI deletion type of α(0)-thal was found in one individual from an ethnic minority. From a group of pregnant Laotian women, 30.1% were Hb E carriers. The prevalence of α(0)-thal of 8.6% for the Laotian women was similar to that found in the upper northeastern part of Thailand. The frequency of β-thal was 2.3 %. The proportion of carriers of α(+)-thal and Hb Constant Spring (Hb CS, α142, Term→Gln (TAA>CAA in α2)] ) from Thailand and Laos was significantly different. The frequency of Hb Paksé [α142, Term→Tyr (TAA>TAT in α2)] was relatively low for Thailand as well as for Laos. The results indicate that thalassemia and hemoglobinopathies are a significant health burden in the region and that a prevention and control program for severe thalassemia diseases should be established in Laos.
Iacovino, Kayla; Ju-Song, Kim; Sisson, Thomas W.; Lowenstern, Jacob B.; Ku-Hun, Ri; Jong-Nam, Jang; Kun-Ho, Song; Song-Hwan, Ham; Clive Oppenheimer,; James O.S. Hammond,; Amy Donovan,; Kosima Weber-Liu,; Kum-Ran , Ryu
Paektu volcano (Changbaishan) is a rhyolitic caldera that straddles the border between the Democratic People's Republic of Korea (DPRK) and China. Its most recent large eruption was the Millennium Eruption (ME; 23 km3 DRE) circa 946 CE, which resulted in the release of copious magmatic volatiles (H2O, CO2, sulfur, and halogens). Accurate quantification of volatile yield and composition is critical in assessing volcanogenic climate impacts but is elusive, particularly for pre-historic or unmonitored eruptions. Here we employ a geochemical technique to quantify volatile composition and yield from the ME by examining trends in incompatible trace and volatile element concentrations in crystal-hosted melt inclusions. We estimate a maximum of 45 Tg S was injected into the stratosphere during the ME. If true yields are close to this maximum, this equates to more than 1.5 times the S released during the 1815 eruption of Tambora, which contributed to the "Year Without a Summer". Our maximum gas yield estimates place the ME among the strongest emitters of climate forcing gases in recorded human history in stark contrast to ice core records that indicate minimal atmospheric sulfate loading after the eruption. We conclude that the potential lack of strong climate forcing occurred in spite of the substantial S yield and suggest that other factors predominated in minimizing climatic effects. This paradoxical case in which high S emissions do not result in substantial climate forcing may present a way forward in building more generalized models for predicting which volcanic eruptions will produce large climate impacts.
Agreement of 27 February 1992 between the Government of the People's Democratic Republic of Algeria and the International Atomic Energy Agency for the application of safeguards in connection with the supply of a research reactor from the People's Republic of China
The document reproduces the text of the Agreement of 27 February 1992 between the Government of the People's Democratic Republic of Algeria and the IAEA for the application of safeguards in connection with the supply of a 15 MW (thermal) research reactor from the People's Republic of China. The Agreement was approved by the Agency's Board of Governors on 25 February 1992
Agreement of 27 February 1992 between the government of the People's Democratic Republic of Algeria and the International Atomic Energy Agency for the application of safeguards in connection with the supply of a research reactor from the People's Republic of China
The document informs that the Agreement between the Government of the People's Democratic Republic of Algeria and the International Atomic Energy Agency for the Application of Safeguards in connection with the Supply of a Research Reactor from the People's Republic of China, which has been applied provisionally as from 27 February 1992, entered into force on 2 June 1992
Nsakala, Gabriel Vodiena; Coppieters, Yves
This paper describes a review of the possibilities of improving HIV/AIDS prevention and reproductive health of teenagers and adolescents in the Democratic Republic of Congo (DRC). This approach was based on compilation of institutional, political, legislative and national strategy data. The document review was completed by information collected from 15 key informants and by direct observation of the work of peer educators and community workers, allowing evaluation of the possibilities of deve...
Xeuatvongsa, Anonh; Datta, Siddhartha Sankar; Moturi, Edna; Wannemuehler, Kathleen; Philakong, Phanmanisone; Vongxay, Viengnakhone; Vilayvone, Vansy; Patel, Minal K
Hepatitis B vaccine birth dose (HepB-BD) was introduced in Lao People's Democratic Republic to prevent perinatal hepatitis B virus transmission in 2008; high coverage is challenging since only 38% of births occur in a health facility. Healthcare workers report being unaware of home births and thus unable to conduct timely postnatal care (PNC) home visits. A quasi-experimental pilot study was conducted wherein mobile phones and phone credits were provided to village health volunteers (VHV) and healthcare workers (HCWs) to assess whether this could improve HepB-BD administration, as well as birth notification and increase home visits. From April to September 2014, VHVs and HCWs in four selected intervention districts were trained, supervised, received outreach per diem for conducting home visits, and received mobile phones and phone credits. In three comparison districts, VHVs and HCWs were trained, supervised, and received outreach per diem for conducting home visits. A post-study survey compared HepB-BD coverage among children born during the study and children born one year before. HCWs and VHVs were interviewed about the study. Among intervention districts, 463 study children and 406 pre-study children were enrolled in the survey; in comparison districts, 347 study children and 309 pre-study children were enrolled. In both arms, there was a significant improvement in the proportion of children reportedly receiving a PNC home visit (intervention p<0.0001, comparison p=0.04). The median difference in village level HepB-BD coverage (study cohort minus pre-study cohort), was 57% (interquartile range [IQR] 32-88%, p<0.0001) in intervention districts, compared with 20% (IQR 0-50%, p<0.0001) in comparison districts. The improvement in the intervention districts was greater than in the comparison districts (p=0.0009). Our findings suggest that the provision of phones and phone credits might be one important factor for increasing coverage. However, reasons for improvement
Phoummalaysith, Bounfeng; Yamamoto, Eiko; Xeuatvongsa, Anonh; Louangpradith, Viengsakhone; Keohavong, Bounxou; Saw, Yu Mon; Hamajima, Nobuyuki
Routine vaccination is administered free of charge to all children under one year old in Lao People's Democratic Republic (Lao PDR) and the national goal is to achieve at least 95% coverage with all vaccines included in the national immunization program by 2025. In this study, factors related to the immunization system and characteristics of provinces and districts in Lao PDR were examined to evaluate the association with routine immunization coverage. Coverage rates for Bacillus Calmette-Guerin (BCG), Diphtheria-Tetanus-Pertussis-Hepatitis B (DTP-HepB), DTP-HepB-Hib (Haemophilus influenzae type B), polio (OPV), and measles (MCV1) vaccines from 2002 to 2014 collected through regular reporting system, were used to identify the immunization coverage trends in Lao PDR. Correlation analysis was performed using immunization coverage, characteristics of provinces or districts (population, population density, and proportion of poor villages and high-risk villages), and factors related to immunization service (including the proportions of the following: villages served by health facility levels, vaccine session types, and presence of well-functioning cold chain equipment). To determine factors associated with low coverage, provinces were categorized based on 80% of DTP-HepB-Hib3 coverage (<80% = low group; ≥80% = high group). Coverages of BCG, DTP-HepB3, OPV3 and MCV1 increased gradually from 2007 to 2014 (82.2-88.3% in 2014). However, BCG coverage showed the least improvement from 2002 to 2014. The coverage of each vaccine correlated with the coverage of the other vaccines and DTP-HepB-Hib dropout rate in provinces as well as districts. The provinces with low immunization coverage were correlated with higher proportions of poor villages. Routine immunization coverage has been improving in the last 13 years, but the national goal is not yet reached in Lao PDR. The results of this study suggest that BCG coverage and poor villages should be targeted to improve
Suspense Averti Ifo
Full Text Available Trees species diversity, richness, and similarity were studied in fifteen plots of the tropical rainforests in the northeast of the Republic of Congo, based on trees inventories conducted on fifteen 0.25 ha plots installed along different types of forests developed on terra firma, seasonally flooded, and on flooded terra. In all of the plots installed, all trees with diameter at breast height, DBH ≥ 5 cm, were measured. The Shannon diversity index, species richness, equitability, and species dominance were computed to see the variation in tree community among plots but also between primary forest and secondary forest. A total of 1611 trees representing 114 species and 35 families were recorded from a total area of 3.75 ha. Euphorbiaceae was the dominant family in the forest with 12 species, followed by Fabaceae-Mimosoideae (10 species and Phyllanthaceae (6 species and Guttiferae (6 species. The biodiversity did not vary greatly from plot to plot on the whole of the study area (3.75 ha. The low value of Shannon index was obtained in plot 11 (H′=0.75 whereas the highest value was obtained in plot 12 (H′=4.46. The values of this index vary from 0.23 to 0.95 in plots P11 and P15, respectively. Results obtained revealed high biodiversity of trees of the forest of Impfondo-Dongou. The information on tree species structure and function can provide baseline information for conservation of the biodiversity of the tropical forest in this area.
Drexler, Jan Felix; Grard, Gilda; Lukashev, Alexander N; Kozlovskaya, Liubov I; Böttcher, Sindy; Uslu, Gökhan; Reimerink, Johan; Gmyl, Anatoly P; Taty-Taty, Raphaël; Lekana-Douki, Sonia Etenna; Nkoghe, Dieudonné; Eis-Hübinger, Anna M; Diedrich, Sabine; Koopmans, Marion; Leroy, Eric M; Drosten, Christian
In 2010, a large outbreak of poliomyelitis with unusual 47% lethality occurred in Pointe Noire, Republic of Congo. Vaccine-mediated immunity against the outbreak virus was never investigated. A wild poliovirus 1 (WPV1) isolated from a fatal case (termed PV1-RC2010) showed a previously unknown combination of amino acid exchanges in critical antigenic site 2 (AgS2, VP1 capsid protein positions 221SAAL → 221PADL). These exchanges were also detected in an additional 11 WPV1 strains from fatal cases. PV1-RC2010 escaped neutralization by three different mAbs relevant for AgS2. Virus neutralization was tested in sera from fatal cases, who died before supplementary immunization (n = 24), Gabonese recipients of recent oral polio vaccination (n = 12), routinely vaccinated German medical students (n = 34), and German outpatients tested for antipoliovirus immunity (n = 17) on Vero, human rhabdomyosarcoma, and human epidermoid carcinoma 2 cells. Fatal poliomyelitis cases gave laboratory evidence of previous trivalent vaccination. Neutralizing antibody titers against PV1-RC2010 were significantly lower than those against the vaccine strain Sabin-1, two genetically distinct WPV1s isolated in 1965 and 2010 and two genetically distinct vaccine-derived PV strains. Of German vaccinees tested according to World Health Organization protocols, 15-29% were unprotected according to their neutralization titers (poliomyelitis eradication in populations with predominantly vaccine-derived immunity. Sustained vaccination coverage and clinical and environmental surveillance will be necessary.
The text of the Agreement of 20 July 1977 between the Agency and the Democratic People's Republic of Korea for the application of safeguards in respect of a research reactor facility is reproduced in this document for the information of all Members. The Agreement entered into force, pursuant to Article 23, on 20 July 1977.
The text of the Agreement of 20 July 1977 between the Agency and the Democratic People's Republic of Korea for the application of safeguards in respect of a research reactor facility is reproduced in this document for the information of all Members. The Agreement entered into force, pursuant to Article 23, on 20 July 1977
The attached Note by the Secretariat of the International Atomic Energy Agency (IAEA) in connection with the statement of 11 October 1993 by the Minister of Atomic Energy of the Democratic People's Republic of Korea (INFCIRC/442) is being circulated for the information of Member States
Numerous occurrences of Neo-proterozoic carbonate platforms and glacigenic litho-facies are present around the Congo craton. They are especially well developed on its western and northern borders, i.e. in the fore-lands of the West Congo and Oubanguides belts. Sr isotopic stratigraphy enables us to characterize the deposition age of some carbonate units from these two domains. The 87 Sr/ 86 Sr isotopic ratios of limestones from the late 'Haut Shiloango' (0.7068) and the 'Schisto-calcaire' (0.7075) of the West-Congo domain are of post-Sturtian and post-Marinoan ages, respectively. The Lenda carbonates (0.7066) from the Northeast of the Democratic Republic of Congo and the limestones (0.7076) from the Bangui Basin, both in the Oubanguides fore-land, are of pre-Sturtian and post-Marinoan ages, respectively. These data associated with lithostratigraphic correlations allow us to ascribe the 'Bas Congo' lower mixtite (tillite) and the Akwokwo tillite (Lindian) to the Sturtian ice age. In the same way, the 'Bas Congo' upper mixtite (tillite) and the Bondo tillite (Bakouma Basin) are likely Marinoan in age. A new synthetic stratigraphy for these Neo-proterozoic domains is developed. (author)
Walsh, Linda; Dufey, Florian; Möhner, Matthias; Schnelzer, Maria; Tschense, Annemarie; Kreuzer, Michaela
A previous analysis of the radon-related lung cancer mortality risk, in the German uranium miners cohort, using Poisson modeling techniques, noted internal (spontaneous) rates that were higher on average than the external rates by 16.5% (95% CI: 9%; 24%). The main purpose of the present paper is to investigate the nature of, and possible reasons for, this difference by comparing patterns in spontaneous lung cancer mortality rates in a cohort of male miners involved in uranium extraction at the former Wismut mining company in East Germany with national male rates from the former German Democratic Republic. The analysis is based on miner data for 3,001 lung cancer deaths, 1.76 million person-years for the period 1960-2003, and national rates covering the same calendar-year range. Simple "age-period-cohort" graphical analyses were applied to assess the main qualitative differences between the national and cohort baseline lung cancer rates. Some differences were found to occur mainly at higher attained ages above 70 years. Although many occupational risk factors may have contributed to these observed age differences, only the effects of smoking have been assessed here by applying the Peto-Lopez indirect method for calculating smoking attributability. It is inferred that the observed age differences could be due to the greater prevalence of smoking and more mature smoking epidemic in the Wismut cohort compared to the general population of the former German Democratic Republic. In view of these observed differences between external population-based rates and internal (spontaneous) cohort baseline lung cancer rates, it is strongly recommended to apply only the internal rates in future analyses of uranium miner cohorts. © Springer-Verlag 2010
Full Text Available Bats are suspected to be a reservoir of several bacterial and viral pathogens relevant to animal and human health, but studies on Escherichia coli in these animals are sparse. We investigated the presence of E. coli in tissue samples (liver, lung and intestines collected from 50 fruit bats of five different species (Eidolon helvum, Epomops franqueti, Hypsignathus monstrosus, Myonycteris torquata, Rousettus aegyptiacus of two different areas in the Republic of Congo between 2009 and 2010. To assess E. coli pathotypes and phylogenetic relationships, we determined the presence of 59 virulence associated genes and multilocus sequence types (STs. Isolates were further tested for their susceptibility to several antimicrobial substances by agar disk diffusion test and for the presence of an Extended-Spectrum Beta-Lactamase phenotype. E. coli was detected in 60% of the bats analysed. The diversity of E. coli strains was very high, with 37 different STs within 40 isolates. Occasionally, we detected sequence types (e.g. ST69, ST127, and ST131 and pathotypes (e.g. ExPEC, EPEC and atypical EPEC, which are known pathogens in human and/or animal infections. Although the majority of strains were assigned to phylogenetic group B2 (46.2%, which is linked with the ExPEC pathovar, occurrence of virulence-associated genes in these strains were unexpectedly low. Due to this, and as only few of the E. coli isolates showed intermediate resistance to certain antimicrobial substances, we assume a rather naïve E. coli population, lacking contact to humans or domestic animals. Future studies featuring in depth comparative whole genome sequence analyses will provide insights into the microevolution of this interesting strain collection.
Galford, Gillian L.; Soares-Filho, Britaldo S.; Sonter, Laura J.; Laporte, Nadine
Central Africa’s tropical forests are among the world’s largest carbon reserves. Historically, they have experienced low rates of deforestation. Pressures to clear land are increasing due to development of infrastructure and livelihoods, foreign investment in agriculture, and shifting land use management, particularly in the Democratic Republic of Congo (DRC). The DRC contains the greatest area of intact African forests. These store approximately 22 billion tons of carbon in aboveground live biomass, yet only 10% are protected. Can the status quo of passive protection — forest management that is low or nonexistent — ensure the preservation of this forest and its carbon? We have developed the SimCongo model to simulate changes in land cover and land use based on theorized policy scenarios from 2010 to 2050. Three scenarios were examined: the first (Historical Trends) assumes passive forest protection; the next (Conservation) posits active protection of forests and activation of the national REDD+ action plan, and the last (Agricultural Development) assumes increased agricultural activities in forested land with concomitant increased deforestation. SimCongo is a cellular automata model based on Bayesian statistical methods tailored for the DRC, built with the Dinamica-EGO platform. The model is parameterized and validated with deforestation observations from the past and runs the scenarios from 2010 through 2050 with a yearly time step. We estimate the Historical Trends trajectory will result in average emissions of 139 million t CO2 year-1 by the 2040s, a 15% increase over current emissions. The Conservation scenario would result in 58% less clearing than Historical Trends and would conserve carbon-dense forest and woodland savanna areas. The Agricultural Development scenario leads to emissions of 212 million t CO2 year-1 by the 2040s. These scenarios are heuristic examples of policy’s influence on forest conservation and carbon storage. Our results
leaders. This thesis will help bridge that gap. First, this thesis will review the available literature on theories of democratic civilian control... bastion of stability and provided military assistance to fulfill their own divergent interests, Nepal’s civil-military relations were impacted by such...became suspicious of the Maoists’ motives. The continued presence of a strong NA served the U.S. and Indian interests to keep it as a strong bastion
Letter from the Head of the Czechoslovak Delegation to the Conference, and the Letter from the Prime Minister of the German Democratic Republic to Which it Refers, are Circulated for the Information of Delegates to the Conference
The letter from the Head of the Czechoslovak Delegation to the Conference, and the letter from the Prime Minister of the German Democratic Republic to which it refers, are circulated for the information of delegations to the Conference. The Government of the German Democratic Republic watch with great interest the efforts being made for the peaceful use of atomic energy for the benefit of all States and to set up an International Atomic Energy Agency. In this the Government know that their views are in harmony with the demands of the German people as well as with those of all other peace-loving people in the world for the removal of the threat of an atomic war and for the use of atomic energy to develop their national economy, to raise the well-being and happiness of the population
Letter from the Head of the Czechoslovak Delegation to the Conference, and the Letter from the Prime Minister of the German Democratic Republic to Which it Refers, are Circulated for the Information of Delegates to the Conference
The letter from the Head of the Czechoslovak Delegation to the Conference, and the letter from the Prime Minister of the German Democratic Republic to which it refers, are circulated for the information of delegations to the Conference. The Government of the German Democratic Republic watch with great interest the efforts being made for the peaceful use of atomic energy for the benefit of all States and to set up an International Atomic Energy Agency. In this the Government know that their views are in harmony with the demands of the German people as well as with those of all other peace-loving people in the world for the removal of the threat of an atomic war and for the use of atomic energy to develop their national economy, to raise the well-being and happiness of the population
Mitangala Ndeba, P.; Hennart, P.; D'Alessandro, U.; Donnen, P.; Porignon, Denis; Bisimwa Balaluka, G.; Dramaix Wilmet, M.
In the Kivu region located in east of the Democratic Republic of the Congo, malnutrition and malaria is a major cause of morbidity and mortality. The relationship between malaria and malnutrition is unclear and has never been studied in the Kivu region. This report presents an analysis of data from 5695 children aged 0 to 5 years, admitted to the paediatric ward of Lwiro hospital between November 1992 and February 2004. The weight/age (W/A) index and weight/height (W/H) index expressed with s...
Alexey Alexandrovich Semenov
Full Text Available Rapid economic growth of the PRC has brought new challenges and promoted social transformation in Chinese society. China suffers profound changes involving fundamental principles of public relations. The political regime in China is in a changeable condition, and continues to transform. Some decisions of the Chinese government affect not only the economy and public administration, but also in some ways human rights and political changes. Chinese political regime takes on the pending social problems and begins to gently lift old political bans. There is development of processes which at least by the formal features can be attributed to be democratic or quasi-democratic. However, despite a number of political changes and improving of human rights situation in last decades, China is still an illiberal state. Moreover, the level of repression in China has increased in the last few years. All of these actions raise questions about the political future of China. The scale of the socio-economic changes that have occurred in the PRC is so significant, that the maintaining of the existing governance structure is not possible. Rapid economic growth reduced public discontent at the disregard to fundamental human rights. Yet the “economic miracle” is coming to an end, and the country desperately needs economic and political reforms. Lack of reforms or its incorrect implementation can put the existing system out of balance, which will lead to adverse effects not only in China but also in the world. Depending on the reforms we can assume several scenarios for further development of the PRC.
Kitamura, Tomomi; Bouakhasith, Viraneth; Phounphenghack, Kongxay; Pathammavong, Chansay; Xeuatvongsa, Anonh; Norizuki, Masataro; Okabayashi, Hironori; Mori, Yoshio; Machida, Munehito; Hachiya, Masahiko
All childhood vaccines, except the oral polio vaccine, should be kept at 2-8 °C, since the vaccine potency can be damaged by heat or freezing temperature. A temperature monitoring study conducted in 2008-2009 reported challenges in cold chain management from the provincial level downwards. The present cross-sectional pilot study aimed to assess the current status of the cold chain in two provinces (Saravan and Xayabouly) of Lao People's Democratic Republic between March-April 2016. Two types of temperature data loggers recorded the temperatures and the proportions of time exposed to 8 °C were calculated. The temperature remained within the appropriate range in the central and provincial storages. However, the vaccines were frequently exposed to > 8 °C in Saravan and 8 °C during the transportation in Saravan and to both > 8 and cold chain in the district storage and during transportation remain, despite improvements at the provincial storage. A detailed up-to-date nationwide analysis of the current situation of the cold chain is warranted to identify the most appropriate intervention to tackle the remaining challenges.
Full Text Available The ecosystem across the Democratic People’s Republic of Korea (DPRK is threatened by deforestation. However, there is very little attention being given to government efforts for afforestation and rehabilitation plan. The most significant barriers to addressing this problem are technique limitations, availability of information, and lack of a stepwise forest management plan. This study identifies spatially suitable tree species, and establishes a stepwise restoration plan to support decision making for restoring degraded forest in the DPRK throughout a suitable restoration map. First off, target species were chosen from reference data, and spatial distribution maps for each tree species were prepared based on social needs as well as natural conditions in the DPRK. The suitable restoration map was calculated by two priorities in a weighting method; suitable priority, and distributional clustering level. Finally, the 23 afforestation species were selected for the suitable restoration map, including 11 coniferous and 12 deciduous tree species. We introduced a stepwise afforestation/restoration plan of degraded forest in the DPRK; general (long-term, detailed (medium-term, implementation (short-term plans. Maps with different spatial resolutions were prepared for each of the plans. A restoration map with 12.5 km spatial resolution can be used for the general plan at the national level, and maps with 5 km and 1 km spatial resolutions can be used for detailed plan at the local level and implementation plan at the site level, respectively.
Tarvonen, Pirkko-Liisa; Sipilä, Kirsi; Ri, Yon Sil; Jang, Jong Hyon; Kim, Jong Hyok; Suominen, Anna L
The study aimed to examine awareness of and compliance with healthy oral habits reported by children and their parents in Pyongyang, Democratic People's Republic of Korea (DPRK), after a preventive programme. The data were collected in 2013 with self-completed, partly structured questionnaires from 1994 children aged 10 and 13 years and from 200 parents. Association between awareness of and compliance with healthy oral habits reported by the children and their parents was evaluated using Chi square tests and multivariate logistic regression analyses, children's oral health habits according to themselves and their parents were analysed using McNemar's test. Both children and their parents seemed to be familiar with healthy oral habits, although the awareness was not directly related to the reports of the children's oral practices. Most of the children reported brushing their teeth at least twice a day, using fluoride toothpaste and drinking water for thirst but frequent sweet snacking was common. Children's and their parents' reports were consistent with regard to sweet snacking frequency (p = 0.736) and the main thirst quencher (p = 0.349). Awareness of healthy oral habits appeared to be good among children and their parents. Unhealthy oral habits seemed to coincide with one another.
The legislative basis, structure, functions, records and experience of the State System of Accounting for and Control of Nuclear Materials (SSAC) in the German Democratic Republic (GDR) are reviewed. The GDR's nuclear activities are characterized by research establishments and power reactors and by the absence of industrial bulk handling facilities such as fuel fabrication, reprocessing and enrichment plants. As a consequence both the national and the international safeguards approach can be based on the principles of item accountability which does not require the establishment of an elaborate measurement system. Right from the beginning the safeguards implemented were of the NPT type as the GDR was among the early parties to the Non-Proliferation Treaty. The national rules and procedures of safeguards were thus established in harmony with the international requirements and have closely followed their development. The SSAC in the GDR is part of the comprehensive set-up of protective measures against the potential hazards in the use of nuclear energy under the National Board for Atomic Safety and Radiation Protection which has established a number of inspectorates, among them the inspection group for nuclear material control -the Nuclear Material Inspectorate. 5 figs., 2 tabs