Magnitude and factors associated with sexual re-victimization among adolescent girls and young women in Kinshasa, Democratic Republic of the Congo: a retrospective multicenter study.

BACKGROUND: Adolescent girls and young women are more exposed to sexual violence. A significant proportion of victims of sexual abuse are victims of sexual re-victimization. However, information on the burden of sexual re-victimization among AGYW in contexts other than conflict-affected areas in the Democratic Republic of the Congo (DRC) is limited. The aim of this study was to assess the magnitude of sexual re-victimization among AGYW and to identify associated risk factors in the capital, Kinshasa. METHODS: We conducted a retrospective multicenter cohort study in which sexual violence records between 2015 and 2020 were used to extract and analyze victims' sociodemographic and behavioral characteristics and profiles of sexual violence perpetrated. Multivariate logistic regression models were employed to identify factors associated with sexual re-victimization using the adjusted odds ratio (AOR) with its 95% confidence interval (95% CI) and p value < 0.05. RESULTS: We found that 74 (31%) of the 241 AGYW included in this study had experienced sexual re-victimization. Sexual re-victimization was associated with being older (> 19 years), sexually active, and living in a single-parent family, and with perpetrator types, particularly intimate partners and family members. CONCLUSIONS: Our findings provide tools for developing and implementing targeted prevention and intervention programs to reduce sexual violence in general and sexual re-victimization in particular.

Impact of patron saint festivities on cholera in three communes in Haiti.

BACKGROUND: Religious pilgrimages are among the anthropogenic factors known to be associated with the transmission of diarrheal diseases, such as cholera. This ecological study aimed to describe the evolution of cholera and assess the relationship between the implementation of the 'coup de poing' strategy during the patron saint festivities and the incidence of cholera in the three communes of Cabaret, Carrefour, and Croix-des-Bouquets in Haiti in 2017. METHODS: An epidemiological curve was produced to illustrate the evolution of cholera at the communal level. Generalized linear models assuming a Poisson distribution were used to weight the annual cholera incidence of communal sections against variables such as the number of patronal festivities, population density and annual precipitation rates. The number of cases in the week of the festivity as well as one and 2 weeks later was weighted against patronal festivities and weekly precipitation rates. RESULTS: In total, 3633 suspected cholera cases were continuously reported in three communes in Haiti (Cabaret, Carrefour, Croix-des-bouquets) during the 52-epidemiological week period in 2017. After controlling for rainfall and population density, the implementation of the 'coup de poing' strategy during the patron saint festivities was associated with a significant reduction in cholera incidence of 57.23% [PR = 0.4277 (97.5% CI: 0.2798-0.6193), p = 0.0000244]. The implementation of the strategy was associated with a reduction in cholera incidence of 25.41% 1 week following patronal festivities. CONCLUSION: This study showed a continuous presence of cholera in three communes in Haiti in 2017 and an association between the implementation of the 'coup de poing' strategy during patronal festivities and a reduction in cholera incidence. The findings imply that the multi-partner 'coup de poing' strategy may have contributed to the reduced cholera incidence following patron saint festivities and in Ouest department in Haiti in 2017.

Drivers of the dynamics of the spread of cholera in the Democratic Republic of the Congo, 2000-2018: An eco-epidemiological study.

BACKGROUND: The dynamics of the spread of cholera epidemics in the Democratic Republic of the Congo (DRC), from east to west and within western DRC, have been extensively studied. However, the drivers of these spread processes remain unclear. We therefore sought to better understand the factors associated with these spread dynamics and their potential underlying mechanisms. METHODS: In this eco-epidemiological study, we focused on the spread processes of cholera epidemics originating from the shores of Lake Kivu, involving the areas bordering Lake Kivu, the areas surrounding the lake areas, and the areas out of endemic eastern DRC (eastern and western non-endemic provinces). Over the period 2000-2018, we collected data on suspected cholera cases, and a set of several variables including types of conflicts, the number of internally displaced persons (IDPs), population density, transportation network density, and accessibility indicators. Using multivariate ordinal logistic regression models, we identified factors associated with the spread of cholera outside the endemic eastern DRC. We performed multivariate Vector Auto Regressive models to analyze potential underlying mechanisms involving the factors associated with these spread dynamics. Finally, we classified the affected health zones using hierarchical ascendant classification based on principal component analysis (PCA). FINDINGS: The increase in the number of suspected cholera cases, the exacerbation of conflict events, and the number of IDPs in eastern endemic areas were associated with an increased risk of cholera spreading outside the endemic eastern provinces. We found that the increase in suspected cholera cases was influenced by the increase in battles at lag of 4 weeks, which were influenced by the violence against civilians with a 1-week lag. The violent conflict events influenced the increase in the number of IDPs 4 to 6 weeks later. Other influences and uni- or bidirectional causal links were observed between violent and non-violent conflicts, and between conflicts and IDPs. Hierarchical clustering on PCA identified three categories of affected health zones: densely populated urban areas with few but large and longer epidemics; moderately and accessible areas with more but small epidemics; less populated and less accessible areas with more and larger epidemics. CONCLUSION: Our findings argue for monitoring conflict dynamics to predict the risk of geographic expansion of cholera in the DRC. They also suggest areas where interventions should be appropriately focused to build their resilience to the disease.