Establishing a postgraduate programme in nutritional epidemiology to strengthen resource capacity, academic leadership and research in the democratic republic of Congo.

BACKGROUND: Low- and Middle-income countries (LMIC) face considerable health and nutrition challenges, many of which can be addressed through strong academic leadership and robust research translated into evidence-based practice. A North-South-South partnership between three universities was established to implement a master's programme in nutritional epidemiology at the Kinshasa School of Public Health (KSPH), Democratic Republic of Congo (DRC). The partnership aimed to develop academic leadership and research capacity in the field of nutrition in the DRC. In this article we describe the educational approach and processes used, and discuss successes, challenges, and lessons learned. METHODS: Self-administered questionnaires, which included both open and closed questions, were sent to all graduates and students on the master's programme to explore students' experiences and perceptions of all aspects of the educational programme. Quantitative data was analysed using frequencies, and a thematic approach was used to analyse responses to open-ended questions. RESULTS: A two-year master's programme in Nutritional Epidemiology was established in 2014, and 40 students had graduated by 2020. Key elements included using principles of authentic learning, deployment of students for an internship at a rural residential research site, and support of selected students with bursaries. Academic staff from all partner universities participated in teaching and research supervision. The curriculum and teaching approach were well received by most students, although a number of challenges were identified. Most students reported benefits from the rural internship experience but were challenged by the isolation of the rural site, and felt unsupported by their supervisors, undermining students' experiences and potentially the quality of the research. Financial barriers were also reported as challenges by students, even among those who received bursaries. CONCLUSION: The partnership was successful in establishing a Master Programme in Nutritional Epidemiology increasing the number of nutrition researchers in the DRC. This approach could be used in other LMIC settings to address health and nutrition challenges.

[Adolescents and teachers´ knowledge, attitude and practice towards contraception: results from a qualitative study conducted in the Democratic Republic of the Congo]. / Connaissances, attitudes et pratiques des adolescents et des enseignants en matière de contraception: résultats d'une étude qualitative réalisée en République Démocratique du Congo.

INTRODUCTION: the purpose of this study was to assess adolescents and teachers´ knowledge, attitude and practices towards family planning (FP). METHODS: in 2018, a qualitative study was conducted among seven teachers and 62 teenagers aged 15-19 years based on the Theory of Reasoned Action published by Fishbein and Ajzen in 2011. Data were collected from six focus group (FG) with adolescents and seven semi-structured interviews of teachers. They were analyzed using Atlas Ti software on the basis of a deductive approach. RESULTS: periodic abstinence, male condoms and pills were the only contraceptive methods reported. Adolescents and teachers were apprehensive about using artificial contraceptive methods other than irregularly used male condom. Girls prefer natural methods fearing side effects. The majority of adolescents wanted to be informed about FP in school; however, they felt that the content of the Life Education Course (EVIE) was insufficient and that teachers lacked of openness. Peers, brothers, sisters and internet were the main sources of information. Mothers were an important source of information especially for girls, unlike fathers who were generally less appreciated. CONCLUSION: knowledge about FP is weak. Misconceptions about contraception lead to the use of ineffective practices to prevent unintended pregnancies. Training programs to improve teachers´ knowledge should be developed and the content of the EVIE course should be formalized and regulated.

Availability and Quality of Family Planning Services in the Democratic Republic of the Congo: High Potential for Improvement.

OBJECTIVE: To determine the availability and quality of family planning services within health facilities throughout the Democratic Republic of the Congo (DRC). METHODS: 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. RESULTS: 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<.001). Public 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 contraceptive pills, and progestin-only injectable contraceptives. CONCLUSION: Availability and quality of family planning services in health facilities in the DRC remain low, with inequitable distribution of services throughout the country. To improve access to and use of family planning, efforts should focus on improving availability and quality at lower health system levels and in rural areas where the majority of the population lives.

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.

BACKGROUND: 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. METHODOLOGY: 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). RESULTS: 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. CONCLUSION: 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.

[Asymptomatic Parasitemia in under five, school age children and households self-medication, Lubumbashi, Democratic Republic of Congo]. / Parasitémie asymptomatique chez les enfants de moins de 5 ans, enfants en âge scolaire et prise en charge des épisodes fébriles dans les ménages de Lubumbashi, République Démocratique du Congo.

INTRODUCTION: Long neglected, asymptomatic malaria is currently recognized as a potential threat and obstacle to malaria control. In DR Congo, the prevalence of this parasite is poorly documented. This study aims to determine the prevalence of asymptomatic parasitaemia in children less than 5 years of age as well as in those aged over five years for what concerns ongoing mass control interventions (LLINs). METHODS: This is a cross-sectional study conducted among school age children, children less than 5 years of age living in the household of Lubumbashi. Schools, students and children less than 5 years of age were selected randomly. Thick and thin blood smears and rapid tests were performed and read. RESULTS: Out of 350 examined students, 43 (12, 3%), IC 95% (9, 14-16, 04) had positive thick smear. Only plasmodium falciparum was identified in all the 43 cases. 314 households (90.5%) declared that they had administered anti-malarial drugs to their children to treat fever at home. More than one-third of households (39.9%) declared that they had administered antipyretics to their children to relieve fever, 19.7% administered quinine and only less than 2% artemether-lumefantrine. Considering the use of the TDR technique, the prevalence of asymptomatic parasitaemia was 3%, IC 95% (from 2.075 to 4.44), but if we consider microscopy as the gold standard, the prevalence was 1.9%, IC 95% (from 1.13 to 3.01). CONCLUSION: Asymptomatic malaria is not without health consequences, so it is important to conduct such investigations to detect new malaria device programmes.