A mixed-methods assessment of sexual and gender-based violence in eastern Democratic Republic of Congo to inform national and international strategy implementation.

CONTEXT: National and international strategies were implemented in eastern Democratic Republic of Congo (DRC) to address sexual and gender-based violence (SGBV). OBJECTIVES: The objective was to assess community attitudes of SGBV and health facility capacity to address SGBV in eastern DRC. DESIGN AND SETTING: The design and setting are as follows: a cross-sectional, population-based cluster survey of 998 adults in eastern DRC territories, a convenience sample of 27 adults using semi-structured directed interviews, qualitative data from 37 focus groups conducted in three health zones, assessment of 64 health facilities and a comparative analysis of SGBV strategies. MAIN OUTCOME MEASURES: The main outcome measures opinions regarding SGBV prevention and justice and health facility capacity to address SGBV. RESULTS: The majority of respondents favored the legal system over community mediation to obtain justice for SGBV. However, 61.1% (95% CI, 51.8-70.5%) of SGBV survivors reported being forced to accept community mediation. Among SGBV survivors, 81.2% (95% CI, 74.5-87.8%) reported no available mental health care. Less than half of all respondents reported access to a hospital, clinic or pharmacy. The analyses and facility assessment reinforce the need to improve SGBV care. CONCLUSIONS: Mixed methodologies point to the complexities of addressing SGBV, assess key elements of SGBV prevention, justice and response, and may ultimately inform national and international strategies.

Pre-deployment vaccinations and perception of risk among US military personnel.

BACKGROUND: Vaccination programs have significantly reduced the incidence of numerous infectious diseases; however, public attitudes toward immunization oftentimes remain contentious. Concerns over vaccine safety and effectiveness, compounded with reduced perceived risk of disease, influence decision making and frequently override public health recommendations. Although vaccinations are compulsory for US military personnel, their concerns mirror the general population, resulting in sub-optimal coverage. RESULTS: Demographics of the 1,757 respondents: 83.3% male, 71.1% Army, 87.5% enlisted, mean age of 29.2 years (standard deviation: 8.3). The majority (89.3%) reported receiving all pre-deployment vaccines; 17.1% stated they would decline if given the opportunity. Factors associated with an increased likelihood of declining vaccines included a perception that the vaccines were not safe (odds ratio [OR]: 3.7; p < 0.001) and rarely/never believing information from the military command (OR: 2.2; p < 0.001). Those with a perceived risk for the diseases targeted by the vaccines were less likely to decline (OR: 0.6; p < 0.001). DISCUSSION: In US military personnel, negative perceptions of pre-deployment vaccines exist. These attitudes appear to be associated with negative perceptions of vaccine safety and low perceived disease risk. Targeted interventions, focusing on the drivers of negative perceptions toward vaccines, and accounting for the source of the educational material, may influence attitudes and improve vaccination perceptions. METHODS: A self-administered questionnaire was completed by a convenience sample of US military personnel deployed to Iraq, Afghanistan and surrounding regions. Questions solicited demographic information and assessed agreement with statements in an attempt to identify factors associated with declining pre-deployment vaccines.