Association of comprehensiveness of antiretroviral care and detectable HIV viral load suppression among pregnant and postpartum women in the Democratic Republic of the Congo: a cross-sectional study.

Introduction: Worldwide, over two-thirds of people living with HIV are on antiretroviral therapy (ART). Despite increased ART access, high virological suppression prevalence remains out of reach. Few studies consider the quality of ART services and their impact on recipients' viral suppression. We assessed the association between ART service readiness and HIV viral load suppression among pregnant and breastfeeding women living with HIV (WLH) receiving ART in maternal and child health (MCH) clinics in Kinshasa, Democratic Republic of Congo. Methods: We performed a cross-sectional analysis leveraging data from a continuous quality improvement intervention on WLH's long-term ART outcomes. From November 2016 to May 2020, we enrolled WLH from the three largest clinics in each of Kinshasa'Ls 35 health zones. We measured clinic's readiness using three WHO-identified ART care quality indicators: relevant guidelines in ART service area, stocks of essential ART medicines, and relevant staff training in ≥24 months, scoring clinics 0-3 based on observed indicators. We defined viral load suppression as ≤1,000 cp/ml. Multilevel mixed-effect logistic models were used to estimate prevalence odds ratios (ORs) measuring the strength of the association between ART service readiness and viral suppression. Results: Of 2,295 WLH, only 1.9% received care from a clinic with a score of 3, 24.1% received care from a 0-scoring clinic, and overall, 66.5% achieved virologically suppression. Suppression increased from 65% among WLH receiving care in 0-scoring clinics to 66.9% in 1-scoring clinics, 65.8% in 2-scoring clinics, and 76.1% in 3-scoring clinics. We did not observe a statistically significant association between ART service readiness score and increased viral suppression prevalence, however we did find associations between other factors, such as the location of the health center and pharmacist availability with suppressed viral load. Discussion: A lack of comprehensive ART care underscores the need for enhanced structural and organizational support to improve virological suppression and overall health outcomes for women living with HIV..

Breastfeeding practices and social norms in Kinshasa, Democratic Republic of the Congo: A qualitative study.

INTRODUCTION: Breastfeeding has many benefits for both mothers and children. The World Health Organization recommends exclusive breastfeeding for the first six months of life. However, in the Democratic Republic of the Congo, slightly under half of children under six months are exclusively breastfed. This study aimed to describe breastfeeding practices and to explore perceived social norms regarding breastfeeding among mothers in Kinshasa. MATERIALS AND METHODS: A qualitative descriptive study was conducted in Kinshasa from June to July 2013. This study purposively sampled 54 mothers of infants aged 6 to 12 months, who participated in six focus group discussions. Based on the Theory of Planned Behaviour, the discussion guide explored infant feeding in the first six months, knowledge of breastfeeding, perception of the feasibility of exclusive breastfeeding, and perception of the social norms with regard to exclusive breastfeeding. The content analysis approach was used to analyse data. RESULTS: Mothers had good breastfeeding knowledge; however, few of them had practised exclusive breastfeeding as recommended during the first six months. Exclusive breastfeeding was considered unfeasible in their context. Barriers to exclusive breastfeeding were reported as baby's cries, social pressure, warm climate, and poor maternal diet. Social norms were supportive of breastfeeding but unfavourable to exclusive breastfeeding. CONCLUSION: In Kinshasa, mothers have a good knowledge of breastfeeding. However, few practise exclusive breastfeeding. Social pressure plays an important role in the cessation of exclusive breastfeeding before six months. In order to improve the practice of exclusive breastfeeding in this context, social and behaviour change programmes should target the entire population rather than mothers only.

Using intervention mapping to develop an implementation strategy to improve timely uptake of streamlined birth-dose vaccines in the Democratic Republic of the Congo.

Despite the policy recommendation and effectiveness of administering the hepatitis B birth-dose vaccine (HepB-BD) to newborns to prevent mother-to-child hepatitis B transmission, timely uptake remains an issue. Countries adopting the HepB-BD to their national immunization schedule report programmatic challenges to administering the vaccine within the recommended 24-hour window after delivery. Further, while the World Health Organization recommends streamlining three birth-dose vaccines (HepB-BD, BCG, and OPV0), scarce Sub-Saharan(SSA)-based literature reports on a streamlined and timely approach to birth-dose vaccines. As more SSA countries adopt the new birth-dose vaccine to their immunization schedules, a systematically developed implementation strategy-Vaccination of Newborns-Innovative Strategies to Hasten Birth-Dose vaccines' delivery (VANISH-BD)-will facilitate the adoption and implementation of timely birth-dose vaccine uptake. In this paper, we describe the development of the implementation strategy using intervention mapping, an evidence-based and theory-driven approach. We report on the development of our intervention, beginning with the needs assessment based in Kinshasa Province, Democratic Republic of the Congo (DRC), informing step 1 of intervention mapping. The intervention is contextually relevant, locally produced, sustainable, and designed to improve timely birth-dose vaccine uptake in the DRC. We intend to inform future implementers about improving timely and streamlined birth-dose vaccine uptake and for VANISH-BD to be adapted for similar contexts.

Childhood immunization uptake determinants in Kinshasa, Democratic Republic of the Congo: ordered regressions to assess timely infant vaccines administered at birth and 6-weeks.

BACKGROUND: Despite global efforts to reduce preventable childhood illness by distributing infant vaccines, immunization coverage in sub-Saharan African settings remains low. Further, timely administration of vaccines at birth-tuberculosis (Bacille Calmette-Guérin [BCG]) and polio (OPV0)-remains inconsistent. As countries such as Democratic Republic of the Congo (DRC) prepare to add yet another birth-dose vaccine to their immunization schedule, this study aims to improve current and future birth-dose immunization coverage by understanding the determinants of infants receiving vaccinations within the national timeframe. METHODS: The study used two ordered regression models to assess barriers to timely BCG and first round of the hepatitis B (HepB3) immunization series across multiple time points using the Andersen Behavioral Model to conceptualize determinants at various levels. The assessment leveraged survey data collected during a continuous quality improvement study (NCT03048669) conducted in 105 maternity centers throughout Kinshasa Province, DRC. The final sample included 2398 (BCG analysis) and 2268 (HepB3 analysis) women-infant dyads living with HIV. RESULTS: Between 2016 and 2020, 1981 infants (82.6%) received the BCG vaccine, and 1551 (68.4%) received the first dose of HepB3 vaccine. Of those who received the BCG vaccine, 26.3%, 43.5%, and 12.8% received BCG within 24 h, between one and seven days, and between one and 14 weeks, respectively. Of infants who received the HepB3 vaccine, 22.4% received it within six weeks, and 46% between six and 14 weeks of life. Many factors were positively associated with BCG uptake, including higher maternal education, household wealth, higher facility general readiness score, and religious-affiliated facility ownership. The factors influencing HepB3 uptake included older maternal age, higher education level, household wealth, transport by taxi to a facility, higher facility general and immunization readiness scores, and religious-affiliated facility ownership. CONCLUSIONS: This study demonstrated that the study participants' uptake of vaccines was consistent with the country average, but not in a timely manner. Various factors were associated with timely uptake of BCG and HepB3 vaccines. These findings suggest that investment to strengthen the vaccine delivery system might improve timely vaccine uptake and equity in vaccine coverage.

Common breastfeeding problems experienced by lactating mothers during the first six months in Kinshasa.

INTRODUCTION: Breastfeeding has numerous advantages for infant, mother and society. However, many mothers discontinue breastfeeding due to problems they encounter. This study aimed to identify problems commonly experienced by breastfeeding mothers during the first six months in Kinshasa. METHODS: A prospective cohort study was carried out in Kinshasa from October 2012 to July 2013. A total of 422 mother-infant couples were recruited shortly after being discharged from twelve maternity facilities in Kinshasa and followed-up for six months. Interviews were conducted at the mother's house during the first week after birth, and thereafter at monthly intervals for six months. Data included mother's sociodemographic characteristics, the breastfeeding problems she experienced and information on child's feeding. Incidences of breastfeeding problems encountered during different periods were calculated as well as their confidence intervals. RESULTS: Cracked or sore nipples, insufficient production of milk and breast engorgement were the most commonly experienced problems by lactating mothers. The problems occurred mainly during the first week (17.1%; CI95% 13.7-21.1) and the rest of the first month (16.2%; CI95% 12.8-20.3). CONCLUSIONS: The first month after birth presents the most risk for the occurrence of breastfeeding problems. Mothers should be supported as soon as possible after delivery, to improve their breastfeeding performance and to be informed on how to maintain breast milk supply.

HIV disclosure and depressive symptoms among pregnant women living with HIV: a cross-sectional study in the Democratic Republic of Congo.

INTRODUCTION: Disclosure of one's HIV status may decrease depression and improve the quality of life among people living with HIV. However, there is mixed evidence on the impact of disclosure to partners for pregnant women living with HIV (WLHIV) in areas of intersecting social concerns over disclosure and high prevalence of intimate partner violence (IPV). We assessed the association between HIV disclosure and depressive symptoms among pregnant WLHIV in the Democratic Republic of Congo (DRC) and examined whether the knowledge of partner's status or recent IPV modified this association. METHODS: We utilized data from participants enrolled in a trial to evaluate the effect of continuous quality interventions on long-term therapy outcomes among HIV-positive pregnant and breastfeeding women in DRC (NCT03048669). Only pregnant women (n = 1392) were included in this cross-sectional analysis. Between November 2016 and June 2019, enrolled participants completed a survey that included the Patient Health Questionnaire-9 (PHQ-9) to screen recent depressive symptoms, questions about disclosure, knowledge of partner's status and IPV. We used linear models to calculate crude and adjusted mean differences (MDs) between disclosure and depressive symptoms. All analyses were stratified by timing of HIV diagnosis. RESULTS: Disclosure was higher among participants diagnosed prior to current pregnancy (41% to their partners and 24% to family, friends or others) relative to those diagnosed during current pregnancy (21% to partners and 12% to family). About one-quarter of women reported any type of IPV in the past 12 months. Disclosure to a partner was associated with lower depressive symptoms among women diagnosed prior to current pregnancy (MD -0.55; 95% CI: -1.06, -0.04) but the opposite was observed among those diagnosed during current pregnancy (MD 0.5; 95% CI: -0.4, 1.4). Adjustment for IPV, knowledge of partner's status, age, number of living children and primigravidae did not change MDs substantially. CONCLUSIONS: Women in our sample mostly disclosed to partners despite high IPV burden. The observed association between disclosure to partners and lower depressive symptoms among women diagnosed prior to current pregnancy is consistent with cross-national evidence. A prospective study among pregnant WLHIV is needed to examine longitudinal effects of HIV status disclosure.

Assessing routine health information system performance during the tenth outbreak of Ebola virus disease (2018-2020) in the Democratic Republic of the Congo: A qualitative study in North Kivu.

The Democratic Republic of Congo has implemented reforms to its national routine health information system (RHIS) to improve timeliness, completeness, and use of quality data. However, outbreaks can undermine efforts to strengthen it. We assessed the functioning of the RHIS during the 2018-2020 outbreak of Ebola Virus Disease (EVD) to identify opportunities for future development. We conducted a qualitative study in North Kivu, from March to May 2020. Semi-structured interviews were conducted with 34 key informants purposively selected from among the personnel involved in the production of RHIS data. The topics discussed included RHIS functioning, tools, compilation, validation, quality, sharing, and the use of data. Audio recordings were transcribed verbatim and thematic analysis was used to study the interviewees' lived experience. The RHIS retained its structure, tools, and flow during the outbreak. The need for other types of data to inform the EVD response created other parallel systems to the RHIS. This included data from Ebola treatment centers, vaccination against Ebola, points of entry surveillance, and safe and dignified burial. The informants indicated that the availability of weekly surveillance data had improved, while timeliness and quality of monthly RHIS reporting declined. The compilation of data was late and validation meetings were irregular. The upsurge of patients following the implementation of the free care policy, the departure of healthcare workers for better-paid jobs, and the high prioritization of the outbreak response over routine activities led to RHIS disruptions. Delays in decision-making were one of the consequences of the decline in data timeliness. Adequate allocation of human resources, equitable salary policy, coordination, and integration of the response with local structures are necessary to ensure optimal functioning of the RHIS during an outbreak. Future research should assess the scale of data quality changes during outbreaks.

Assessing Readiness to Provide Comprehensive Abortion Care in the Democratic Republic of the Congo After Passage of the Maputo Protocol.

CONTEXT: The Democratic Republic of the Congo (DRC) decriminalized abortion under certain circumstances in 2018 through the Maputo Protocol. However, little is known about the readiness of the country's health facilities to provide comprehensive abortion care. METHODS: Data on 1,380 health facilities from the 2017-2018 DRC Service Provision Assessment (SPA) inventory survey were used to assess readiness to provide abortion care in four domains: termination of pregnancy, basic treatment of postabortion complications, comprehensive treatment of postabortion complications and postabortion contraceptive care. Analyses used a modified application of the emergency obstetric care signal function approach; criteria for readiness were based on World Health Organization guidelines. RESULTS: Thirty-one percent of DRC facilities met the criteria for readiness to provide abortions. The proportion of facilities classified as ready was higher among urban facilities than rural ones (50% vs. 26%), and among hospitals than health centers or reference health centers (72% vs. 25% and 45%, respectively). Few facilities were ready to provide either basic or comprehensive treatment of postabortion complications (4% and 1%); readiness to provide these services was greatest among hospitals (14% and 11%). Only a third of facilities displayed readiness to provide postabortion contraceptive care. Inadequate supplies of medication (e.g., misoprostol, antibiotics, contraceptives) and equipment were the greatest barrier to readiness. CONCLUSIONS: Most DRC facilities were not ready to provide comprehensive abortion care. Improving supplies of vital health commodities will improve readiness, and has the potential to reduce the prevalence of unplanned pregnancies and future demand for abortions.

RESUMEN Contexto: En 2018, la República Democrática del Congo (RDC) despenalizó el aborto bajo ciertas circunstancias a través del Protocolo de Maputo. Sin embargo, poco se sabe sobre la disposición de las instituciones de salud del país para proveer servicios integrales de aborto. Métodos: Se utilizaron datos de 1,380 instituciones de salud a partir de la Encuesta Inventario sobre la Evaluación de la Prestación de Servicios (EPS) con el fin de evaluar la disposición para proveer servicios de aborto en cuatro dominios: terminación del embarazo, tratamiento básico de complicaciones postaborto, tratamiento integral de complicaciones postaborto y servicios anticonceptivos postaborto. Los análisis utilizaron una aplicación modificada del enfoque de función de señales de atención obstétrica de emergencia; los criterios para disposición se basaron en las pautas de la Organización Mundial de la Salud. Resultados: Treinta y un porciento de las instituciones de salud de la RDC cumplieron con los criterios de disposición para la provisión de servicios de aborto. La proporción de instituciones clasificadas como preparadas fue mayor en los centros urbanos que en los rurales (50% vs. 26%) y en hospitales respecto de centros de salud o centros de salud de referencia (72% vs. 25% y 45%, respectivamente). Pocas instituciones de salud estuvieron preparadas para proveer ya fueran servicios básicos o tratamiento integral para complicaciones postaborto (4% y 1%); la mayor preparación para proveer esos servicios se presentó en los hospitales (14% y 11%). Solamente un tercio de las instituciones de salud mostró estar preparado para proveer servicios anticonceptivos postaborto. La inadecuada disponibilidad de medicamentos (ej., misoprostol, antibióticos, anticonceptivos) y de equipo fueron las más grandes barreras para la preparación. Conclusiones: La mayoría de las instituciones de salud de la RDC no estuvieron preparadas para proveer servicios integrales de aborto. Mejorar la disponibilidad de productos vitales para la salud aumentará la preparación y tiene el potencial de reducir la prevalencia de embarazos no planeados y la demanda futura de servicios de aborto.

RÉSUMÉ Contexte: La République démocratique du Congo (RDC) a décriminalisé l'avortement dans certaines circonstances en 2018, du fait du Protocole de Maputo. La préparation des formations sanitaires du pays à assumer des soins d'avortement complets n'est cependant guère documentée. Méthodes: Les données relatives à 1 380 formations sanitaires comprises dans l'enquête d'évaluation de la prestation des services de soins de santé (EPSS) ont servi à évaluer l'état de préparation à offrir et assurer des soins d'avortement sur quatre plans: l'interruption de grossesse, le traitement de base des complications après avortement, le traitement complet des complications après avortement et les soins de contraception après avortement. Les analyses reposent sur une application modifiée de l'approche des fonctions fondamentales des soins obstétricaux d'urgence; les critères de préparation, sur les directives de l'Organisation mondiale de la Santé. Résultats: Trente-et-un pour cent des formations sanitaires de RDC répondaient aux critères de préparation à la prestation de l'avortement. La proportion qualifiée de prête était plus grande parmi les formations urbaines que rurales (50% contre 26%) et parmi les hôpitaux que dans les centres de santé ou de référence (72% contre 25% et 45%, respectivement). Peu de formations étaient prêtes à traiter, selon une approche de base ou complète, les complications après avortement (4% et 1%). Cette préparation était supérieure dans les hôpitaux (14% et 11%). Un tiers seulement des formations sanitaires étaient prêtes à offrir des soins contraceptifs après avortement. La disponibilité inadéquate de médicaments (par ex., misoprostol, antibiotiques, contraceptifs) et d'équipements était le plus grand obstacle à la préparation. Conclusions: La plupart des formations sanitaires en RDC n'étaient pas prêtes à assumer les soins complets de l'avortement. L'amélioration de l'approvisionnement en produits de santé vitaux renforcera l'état de préparation tout en offrant le potentiel de réduire la prévalence des grossesses non planifiées et la demande future d'avortements.

Evaluation of the influenza sentinel surveillance system in the Democratic Republic of Congo, 2012-2015.

BACKGROUND: The World Health Organization recommends periodic evaluations of influenza surveillance systems to identify areas for improvement and provide evidence of data reliability for policymaking. However, data about the performance of established influenza surveillance systems are limited in Africa, including in the Democratic Republic of Congo (DRC). METHODS: We used the Centers for Disease Control and Prevention guidelines to evaluate the performance of the influenza sentinel surveillance system (ISSS) in DRC during 2012-2015. The performance of the system was evaluated using eight surveillance attributes: (i) data quality and completeness for key variables, (ii) timeliness, (iii) representativeness, (iv) flexibility, (v) simplicity, (vi) acceptability, (vii) stability and (viii) utility. For each attribute, specific indicators were developed and described using quantitative and qualitative methods. Scores for each indicator were as follows: < 60% weak performance; 60-79% moderate performance; ≥80% good performance. RESULTS: During 2012-2015, we enrolled and tested 4339 patients with influenza-like illness (ILI) and 2869 patients with severe acute respiratory illness (SARI) from 11 sentinel sites situated in 5 of 11 provinces. Influenza viruses were detected in 446 (10.3%) samples from patients with ILI and in 151 (5.5%) samples from patients with SARI with higher detection during December-May. Data quality and completeness was > 90% for all evaluated indicators. Other strengths of the system were timeliness, simplicity, stability and utility that scored > 70% each. Representativeness, flexibility and acceptability had moderate performance. It was reported that the ISSS contributed to: (i) a better understanding of the epidemiology, circulating patterns and proportional contribution of influenza virus among patients with ILI or SARI; (ii) acquisition of new key competences related to influenza surveillance and diagnosis; and (iii) continuous education of surveillance staff and clinicians at sentinel sites about influenza. However, due to limited resources no actions were undertaken to mitigate the impact of seasonal influenza epidemics. CONCLUSIONS: The system performed overall satisfactorily and provided reliable and timely data about influenza circulation in DRC. The simplicity of the system contributed to its stability. A better use of the available data could be made to inform and promote prevention interventions especially among the most vulnerable groups.

Epidemiology of circulating human influenza viruses from the Democratic Republic of Congo, 2015.

INTRODUCTION: The establishment of the influenza sentinel surveillance system in Kinshasa, Bas Congo, Maniema, Katanga, and Kasai Provinces allowed generation of important data on the molecular epidemiology of human influenza viruses circulating in the Democratic Republic of Congo (DRC). However, some challenges still exist, including the need for extending the influenza surveillance to more provinces. This study describes the pattern of influenza virus circulating in DRC during 2015. METHODOLOGY: Nasopharyngeal swabs were collected from January to December 2015 from outpatients with influenza-like illness (ILI) and in all hospitalized patients with Severe Acute Respiratory Infection (SARI). Molecular analysis was done to determine influenza type and subtype at the National Reference Laboratory (NRL) in Kinshasa using real time reverse transcription-polymerase chain reaction (rRT-PCR). Analysis of antiviral resistance by enzyme inhibition assay and nucleotide sequencing was performed by the Collaborating center in the USA (CDC, Atlanta). RESULTS: Out of 2,376 nasopharyngeal swabs collected from patients, 218 (9.1%) were positive for influenza virus. Among the positive samples, 149 were characterized as influenza virus type A (Flu A), 67 as type B (Flu B) and 2 mixed infections (Flu A and B). Flu A subtypes detected were H3N2 and H1N1. The Yamagata strain of Flu B was detected among patients in the country. Individuals aged between 5 and 14 years accounted for the largest age group affected by influenza virus. All influenza viruses detected were found to be sensitive to antiviral drugs such as oseltamivar, zanamivir, peramivir and laninamivar. CONCLUSION: The present study documented the possible involvement of both circulation of Flu A and B viruses in human respiratory infection in certain DRC provinces during 2015. This study emphasises the need to extend the influenza surveillance to other provinces for a better understanding of the epidemiology of influenza in DRC. It is envisioned that such a system would lead to improved disease control and patient management.

The national and provincial burden of medically attended influenza-associated influenza-like illness and severe acute respiratory illness in the Democratic Republic of Congo, 2013-2015.

BACKGROUND: Estimates of influenza-associated outpatient consultations and hospitalizations are severely limited in low- and middle-income countries, especially in Africa. METHODS: We conducted active prospective surveillance for influenza-like illness (ILI) and severe acute respiratory illness (SARI) at 5 healthcare facilities situated in Kinshasa Province during 2013-2015. We tested upper respiratory tract samples for influenza viruses using a reverse transcription-polymerase chain reaction assay. We estimated age-specific numbers and rates of influenza-associated ILI outpatient consultations and SARI hospitalizations for Kinshasa Province using a combination of administrative and influenza surveillance data. These estimates were extrapolated to each of the remaining 10 provinces accounting for provincial differences in prevalence of risk factors for pneumonia and healthcare-seeking behavior. Rates were reported per 100 000 population. RESULTS: During 2013-2015, the mean annual national number of influenza-associated ILI outpatient consultations was 1 003 212 (95% Confidence Incidence [CI]: 719 335-1 338 050 - Rate: 1205.3; 95% CI: 864.2-1607.5); 199 839 (95% CI: 153 563-254 759 - Rate: 1464.0; 95% CI: 1125.0-1866.3) among children aged <5 years and 803 374 (95% CI: 567 772-1 083 291 - Rate: 1154.5; 95% CI: 813.1-1556.8) among individuals aged ≥5 years. The mean annual national number of influenza-associated SARI hospitalizations was 40 361 (95% CI: 24 014-60 514 - Rate: 48.5; 95% CI: 28.9-72.7); 25 452 (95% CI: 19 146-32 944 - Rate: 186.5; 95% CI: 140.3-241.3) among children aged <5 years and 14 909 (95% CI: 4868-27 570 - Rate: 21.4; 95% CI: 28.9-72.7) among individuals aged ≥5 years. CONCLUSIONS: The burden of influenza-associated ILI outpatient consultations and SARI hospitalizations was substantial and was highest among hospitalized children aged <5 years.

Effects of unconditional cash transfers on the outcome of treatment for severe acute malnutrition (SAM): a cluster-randomised trial in the Democratic Republic of the Congo.

BACKGROUND: Cash transfer programs (CTPs) aim to strengthen financial security for vulnerable households. This potentially enables improvements in diet, hygiene, health service access and investment in food production or income generation. The effect of CTPs on the outcome of children already severely malnourished is not well delineated. The objective of this study was to test whether CTPs will improve the outcome of children treated for severe acute malnutrition (SAM) in the Democratic Republic of the Congo over 6 months. METHODS: We conducted a cluster-randomised controlled trial in children with uncomplicated SAM who received treatment according to the national protocol and counselling with or without a cash supplement of US$40 monthly for 6 months. Analyses were by intention to treat. RESULTS: The hazard ratio of reaching full recovery from SAM was 35% higher in the intervention group than the control group (adjusted hazard ratio, 1.35, 95% confidence interval (CI) = 1.10 to 1.69, P = 0.007). The adjusted hazard ratios in the intervention group for relapse to moderate acute malnutrition (MAM) and SAM were 0.21 (95% CI = 0.11 to 0.41, P = 0.001) and 0.30 (95% CI = 0.16 to 0.58, P = 0.001) respectively. Non-response and defaulting were lower when the households received cash. All the nutritional outcomes in the intervention group were significantly better than those in the control group. After 6 months, 80% of cash-intervened children had re-gained their mid-upper arm circumference measurements and weight-for-height/length Z-scores and showed evidence of catch-up. Less than 40% of the control group had a fully successful outcome, with many deteriorating after discharge. There was a significant increase in diet diversity and food consumption scores for both groups from baseline; the increase was significantly greater in the intervention group than the control group. CONCLUSIONS: CTPs can increase recovery from SAM and decrease default, non-response and relapse rates during and following treatment. Household developmental support is critical in food insecure areas to maximise the efficiency of SAM treatment programs. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02460848 . Registered on 27 May 2015.

Molecular Analysis of Influenza A(H3N2) and A(H1N1)pdm09 Viruses circulating in the Democratic Republic of Congo, 2014.

BACKGROUND: Very little is known about influenza viruses circulating in the Democratic Republic of Congo (DRC). We aim to characterize genetically and antigenically Influenza A(H3N2) and A(H1N1)pdm09 viruses circulating in the country. METHODS: From August to December 2014, specimens were collected from patients with influenza like-illness (ILI) or severe acute respiratory infection (SARI) in various surveillance sites. Specimens were tested using real time reverse transcription polymerase chain reaction (RT-PCR) method for the detection of influenza viruses. Positive influenza samples with a cycle threshold (Ct) <30 were genetically and antigenically characterized. RESULTS: 32 samples tested were found positive to influenza A with Ct <30. At CDC Atlanta, 28 out of 32 samples (88%) were tested positive for influenza A virus, including 26 seasonal influenza A viruses subtype H3N2 and 2 pandemic influenza A viruses subtype H1N1pdm 2009. The majority of influenza A(H3N2) viruses were antigenically related to the A/Switzerland/9715293/2013 vaccine virus, while two influenza A(H1N1)pdm09 isolates were antigenically characterized as A/California/07/2009-like. All A(H3N2) and A(H1N1)pdm09 virus isolates characterized were sensitive to oseltamivir and zanamivir. CONCLUSION: Two genetically distinct influenza subtypes were co-circulating in the DRCongo. Effective measures against influenza have been suggested.

Predictors of discontinuing exclusive breastfeeding before six months among mothers in Kinshasa: a prospective study.

BACKGROUND: Although breastfeeding is common in Democratic Republic of the Congo, the proportion of women who exclusively breastfeed their babies up to 6 months remains low. This study aimed at identifying predictors of discontinuing exclusive breastfeeding before six months among mothers in Kinshasa. METHODS: A prospective study was carried out from October 2012 to July 2013 among 422 mother-child pairs recruited shortly after discharge from twelve maternities in Kinshasa and followed up to six months. Interviews were conducted at each woman's house during the first week after birth, and at one, two, three, four, five and six months. Collected data included history of child's feeding and mother's socio-demographic and psychosocial characteristics. The Cox Proportional Model was used to identify predictors of discontinuing exclusive breastfeeding before six months. RESULTS: The median duration of exclusive breastfeeding was 10.9 weeks (Inter Quartile Range 4.3 to 14.9). At six months, 2.8 % of infants were exclusively breastfed. The factors independently associated with the discontinuation of exclusive breastfeeding before six months were: not confident in the ability to breastfeed [Adjusted hazard ratio (AHR) = 3.90; 95 % CI 1.66, 9.16)], no plan on the duration of EBF (AHR = 2.86; 95 % CI 1.91, 4.28), breastfeeding problems during the first week (AHR = 1.54; 95 % CI 1.13, 2.11), low level of breastfeeding knowledge (AHR = 1.52; 95 % CI 1.08, 2.15), and experienced less than five Baby-friendly practices during the maternity stay (AHR = 1.47; 95 % CI 1.05, 2.06). CONCLUSIONS: Confidence in the ability to breastfeed and intention to exclusively breastfeed were the most important predictors of discontinuing exclusive breastfeeding before six months. To have a greater impact on the duration of exclusive breastfeeding, interventions should focus on these factors.