Provincial Intra-Action Review of the COVID-19 Vaccination Programme: Opportunities to Improve Vaccine Response in North Kivu, Democratic Republic of Congo.

Background: Low levels of COVID-19 vaccination coverage in many countries prompted the use of rapid assessments to characterize barriers to vaccination and identify corrective measures. The World Health Organization recommended the use of intra-action reviews (IARs) to identify best practices, gaps, and lessons learned to make real-time improvements to the COVID-19 vaccination response. Objective: The Democratic Republic of the Congo (DRC) implemented a national IAR in July 2021 that was poorly attended by the provincial health level, where vaccination activities are planned and implemented. To bridge this gap, we proposed sub-national IARs focused on COVID-19 vaccine program implementation at the provincial level. Methods: Using the WHO methodology, we organized a four-day provincial IAR workshop and invited national, provincial and health zone Ministry of Health (MoH) representatives and private and non-governmental organizations involved in the provincial COVID-19 vaccination response. Participants were divided into six groups based on their expertise, affiliation, and role within the health system to assess and identify lessons learned, challenges and the solutions within each of the six technical areas: (1) coordination, planning and monitoring; (2) service delivery; (3) risk communication and community engagement; (4) adverse effects following immunization (AEFI); (5) logistics; (6) and data management, monitoring and evaluation. Results: The first provincial COVID-19 IAR was conducted in Goma, North Kivu, from January 19-22, 2022. A total of 56 participants came from provincial and health zone offices, and non-governmental organizations. Through work group discussions, they identified best practices, challenges, and lessons learned, and made recommendations to improve implementation of vaccination activities and reach coverage targets. Activities were proposed to operationalize recommendations and address challenges to improve the provincial response. Conclusion: This provincial IAR was a useful tool for reviewing progress and areas of improvement, while evaluating aspects of the COVID-19 vaccine rollout. It provided a means to share information with vaccination partners on areas of intervention, tailored to the local context.

Nutritional Status Link with Polioseronegativity Among Children from Poliomyelitis Transmission High-Risk Area of the Democratic Republic of the Congo (DRC).

Background: Malnutrition is identified as a risk-factor for insufficient polioseroconversion in the context of a vaccine-derived polio virus (VDPV) outbreak prone region. To assess the prevalence of malnutrition and its link to poliovirus insufficient immunity, a cross-sectional household survey was conducted in the regions of Haut- Lomami and Tanganyika, DRC. Methods: In March 2018, we included 968 healthy children aged 6 to 59 months from eight out of 27 districts. Selection of study locations within these districts was done using a stratified random sampling method, where villages were chosen based on habitat characteristics identified from satellite images. Consent was obtained verbally in the preferred language of the participant (French or Swahili) by interviewers who received specific training for this task. Furthermore, participants contributed a dried blood spot sample, collected via finger prick. To assess malnutrition, we measured height and weight, applying WHO criteria to determine rates of underweight, wasting, and stunting. The assessment of immunity to poliovirus types 1, 2, and 3 through the detection of neutralizing antibodies was carried out at the CDC in Atlanta, USA. Results: Of the study population, we found 24.7% underweight, 54.8% stunted, and 15.4% wasted. With IC95%, underweight (OR=1.50; [1.11-2.03]), and the non-administration of vitamin A (OR=1.96; [1.52-2.54]) were significantly associated with seronegativity to polioserotype 1. Underweight (OR=1.64; [1.20-2.24]) and the non-administration of vitamin A (OR=1.55; [1.20-2.01]) were significantly associated with seronegativity to polioserotype 2. Underweight (OR=1.50; [1.11-2.03]), and the non-administration of vitamin A (OR=1.80. [1.38-2.35]) were significantly associated with seronegativity to polioserotype 3. Underweight (OR=1.68; IC95% [1.10-2.57]) and the non-administration of vitamin A (OR=1.82; IC95% [1.30-2.55]) were significantly associated with seronegativity to all polioserotypes. Conclusion: This study reveals a significant association between underweight and polioseronegativity in children. In order to reduce vaccine failures in high-risk areas, an integrated approach by vaccination and nutrition programs should be adopted.

Poliovirus-Neutralizing Antibody Seroprevalence and Vaccine Habits in a Vaccine-Derived Poliovirus Outbreak Region in the Democratic Republic of Congo in 2018: The Impact on the Global Eradication Initiative.

Despite the successes in wild-type polio eradication, poor vaccine coverage in the DRC has led to the occurrence of circulating vaccine-derived poliovirus outbreaks. This cross-sectional population-based survey provides an update to previous poliovirus-neutralizing antibody seroprevalence studies in the DRC and quantifies risk factors for under-immunization and parental knowledge that guide vaccine decision making. Among the 964 children between 6 and 35 months in our survey, 43.8% (95% CI: 40.6-47.0%), 41.1% (38.0-44.2%), and 38.0% (34.9-41.0%) had protective neutralizing titers to polio types 1, 2, and 3, respectively. We found that 60.7% of parents reported knowing about polio, yet 25.6% reported knowing how it spreads. Our data supported the conclusion that polio outreach efforts were successfully connecting with communities-79.4% of participants had someone come to their home with information about polio, and 88.5% had heard of a polio vaccination campaign. Additionally, the odds of seroreactivity to only serotype 2 were far greater in health zones that had a history of supplementary immunization activities (SIAs) compared to health zones that did not. While SIAs may be reaching under-vaccinated communities as a whole, these results are a continuation of the downward trend of seroprevalence rates in this region.

Factors associated with COVID-19 vaccine uptake and hesitancy among healthcare workers in the Democratic Republic of the Congo.

Vaccination is a critical intervention to reduce morbidity and mortality and limit strain on health systems caused by COVID-19. The slow pace of COVID-19 vaccination uptake observed in some settings raises concerns about COVID-19 vaccine hesitancy. The Democratic Republic of the Congo experienced logistical challenges and low uptake at the start of vaccine distribution, leading to one of the lowest overall COVID-19 vaccine coverage rates in the world in 2021. This study assessed the magnitude and associated factors of COVID-19 vaccine uptake among healthcare workers (HCWs) in seven provinces in DRC. We implemented a cross-sectional Knowledge, Attitudes, and Practices (KAP) questionnaire targeting HCWs, administered by trained data collectors in Haut-Katanga, Kasaï Orientale, Kinshasa, Kongo Centrale, Lualaba, North Kivu, and South Kivu provinces. Data were summarized and statistical tests were performed to assess factors associated with vaccine uptake. HCWs across the seven provinces completed the questionnaire (N = 5,102), of whom 46.3% had received at least one dose of COVID-19 vaccine. Older age, being married, being a medical doctor, being a rural resident, and having access to or having previously worked in a COVID-19 vaccination site were all strongly associated with vaccination uptake. Vaccinated individuals most frequently cited protection of themselves, their families, and their communities as motivations for being vaccinated, whereas unvaccinated individuals were most concerned about safety, effectiveness, and risk of severe side effects. The findings suggest an opinion divide between vaccine-willing and vaccine-hesitant HCWs. A multidimensional approach may be needed to increase the acceptability of the COVID-19 vaccine for HCWs. Future vaccine campaign messaging could center around the positive impact of vaccination on protecting friends, family, and the community, and also emphasize the safety and very low risk of adverse effects. These types of messages may further be useful when planning future immunization campaigns with new vaccines.

Challenges to COVID-19 vaccine introduction in the Democratic Republic of the Congo - a commentary.

COVID-19 vaccination in the Democratic Republic of the Congo (DRC) began in April 2021. A month later, most COVID-19 vaccine doses were reallocated to other African countries, due to low vaccine uptake and the realization that the doses would expire before use. Based on data available on 13 August 2022, 2.76% of the DRC population had been fully vaccinated with last dose of primary series of COVID-19 vaccine, placing the country second to last in Africa and in the last five in global COVID-19 vaccination coverage. The DRC's reliance on vaccine donations requires continuous adaptation of the vaccine deployment plan to match incoming COVID-19 vaccines shipments. Challenges in planning vaccine deployments, vaccinating priority populations, coordinating, and implementing the communications plan, disbursing funds, and conducting supervision of vaccination activities have contributed to low COVID-19 vaccine coverage. In addition, the spread of rumors through social media and by various community and religious leaders resulted in high levels of vaccine hesitancy. A strong risk communication and community engagement plan, coupled with innovative efforts to target the highest-risk populations are critical to increase vaccine uptake during the next phase of COVID-19 vaccine introduction.

Hesitancy to receive the novel coronavirus vaccine and potential influences on vaccination among a cohort of healthcare workers in the Democratic Republic of the Congo.

Hesitancy to receive the COVID-19 vaccine among healthcare workers (HCWs) in low-resource settings, such as the Democratic Republic of the Congo (DRC), is a major global health challenge. This study identifies changes in willingness to receive vaccination among 588 HCWs in the DRC and reported influences on COVID-19 vaccination intentions. Up to 25 repeated measures were collected from participants between August 2020 to August 2021. Among the overall cohort, between August 2020 and mid-March 2021, the proportion of HCWs in each period of data collection reporting COVID-19 vaccine hesitancy ranged from 8.6% (95% CI: 5.97, 11.24) to 24.3% (95% CI: 20.12, 28.55). By early April 2021, the proportion reporting hesitancy more than doubled (52.0%; 95% CI: 46.22, 57.83). While hesitancy in the cohort began to decline by late-June 2021, 22.6% (95% CI: 18.05, 27.18) respondents indicated hesitancy in late-August 2021 which remains greater than the proportion of hesitancy at any time prior to early-March 2021. Patterns in reported influences on COVID-19 vaccination were varied with the proportion reporting some influences (e.g., no serious side effects, country of vaccine production) remaining stable throughout the year and other factors (e.g., recommendation of Ministry of Health, ease of vaccination) falling in popularity among respondents. Agreement that the national vaccination schedule should be followed apart from the COVID-19 vaccine remained high among respondents throughout the study period. This study shows that, among a cohort of HCWs in the DRC who have likely been influenced by regional, national, and global factors, COVID-19 vaccine hesitancy has fluctuated during the pandemic and should not be treated as a static factor. Additional research to determine which factors most influence HCWs' willingness to receive the COVID-19 vaccine offers opportunities to reduce vaccine hesitancy among this important population through tailored public health messaging.

Acceptability of Vaccination Against COVID-19 Among Healthcare Workers in the Democratic Republic of the Congo.

PURPOSE: This study aims to estimate the acceptability of a future vaccine against COVID-19 and associated factors if offered in Congolese health-care workers (HCWs), since they have the highest direct exposure to the disease. PATIENTS AND METHODS: We conducted an analytical cross-sectional study among 23 Congolese referral hospitals, including three university hospitals, located in three towns from March through 30 April 2020. The main outcome variable was healthcare workers' acceptance of a future vaccine against COVID-19. The associated factors of vaccination willingness were identified through a logistic regression analysis. RESULTS: A sample of 613 HCWs participated in the study and completed the study questionnaire, including 312 (50.9%) men and 301 (49.1%) women. Only 27.7% of HCWs said that they would accept a COVID-19 vaccine if it was available. From the logistic regression analysis, male healthcare workers (ORa=1.17, 95% CI: 1.15-2.60), primarily doctors (ORa=1.59; 95% CI:1.03-2.44) and having a positive attitude towards a COVID-19 vaccine (ORa=11.49; 95% CI: 5.88-22.46) were significantly associated with reporting willingness to be vaccinated. CONCLUSION: For acceptability of vaccination against COVID-19 among others education among HCWs is crucial because health professionals' attitudes about vaccines are an important determinant of their own vaccine uptake and their likelihood of recommending the vaccine to their patients.

Predictors of Non-Adherence to Public Health Instructions During the COVID-19 Pandemic in the Democratic Republic of the Congo.

BACKGROUND: Adherence to public health instructions for the COVID-19 is important for controlling the transmission and the pandemic's health and economic impacts. The aim of this study was to determine the associated factors of non-adherence to public health and social measures instructions. METHODS: This was a cross-sectional study conducted with 1913 participants in two provinces of DRC, Mbuji-Mayi, and Kamina. Predictors of non-adherence to COVID-19 preventive measures were identified using binary logistic regression analysis. P-value<0.05 was considered as a significant predictor. RESULTS: Among 1913 participants (1057 [55.3%] male, age 34.1 [14.9] years), 36.6% were defined as non-adherents. Non-adherence was associated with never studied and primary education level [adjusted odds ratio (aOR)=1.63, CI=1.31-2.03], unemployed status [aOR=1.29, CI=1.01-1.67], living in Kamina (Haut-Lomami province) [aOR=1.63, CI=1.31-2.03], female gender of head of household [aOR=1.53, CI=1.16-2.03], no attending lectures/discussions about COVID-19 [aOR=1.61, CI=1.08-2.40], not being satisfied with the measures taken by the Ministry of Health [aOR=2.26, CI=1.78-2.81], not been regularly informed about the pandemic [aOR=2.25, CI=1.80-2.03], and bad knowledge about COVID-19 [aOR=2.36, CI=1.90-2.93]. CONCLUSION: The rate of non-observance of preventive measures for the COVID-19 pandemic is high, and different factors contributed. The government has to counsel the permanent updating of messages taking into account the context and the progress of the pandemic by using several communication channels.

[Frequency and Maternals risk factors of fœtal intra uterin death at Kamina, Democratic Republic of Congo]. / Fréquence et facteurs de risque maternels de la mort fœtale in utero à Kamina, République Démocratique du Congo.

INTRODUCTION: Fetal intrauterine death constitutes a frequent problem in obstetric practice. The objectives of this study were to determine the frequency and to identify risk factors of fetal death at Reference General Hospital of Kamina. METHODS: The study was done in two times. First, a cross-sectional descriptive study of 379 deliveries which allowed to determine the frequency of fetal death. Then, the determination of risk factors was made using a case-control study in which the characteristics of 53 fetal deaths were compared to 106 controls constituted of live births. RESULTS: The fetal intrauterine death's frequency at Reference General Hospital of Kamina was at 13,98%. After adjustment, maternal age over 35 years (OR = 6,23; IC= (1,30-29,80)), antecedent of fetal intrauterine death (OR = 3,13; IC= (1,06-9,27)) and diseases during pregnancy (OR = 31,6, IC= [7,66-130,71]) have been identified as factors significantly associated with increased occurrence fetal death. The high maternal education (OR = 0,11; IC= (0,03-0,42)) and Kamina's residency (OR = 0,23; IC= (0,08-0,62)) decreased this risk. CONCLUSION: The frequency of fetal death was 13,9%. The advanced maternal age, the history of fetal death and disease during pregnancy was associated with fetal intra uterin death but the high maternal instruction and the Kamina residence reduced the risk. The monitoring of at-risk pregnant, screening and the treatment of diseases during pregnancy are necessary in view of reducing prevalence of fetal death in our midst.

[Ovarian pregnancy: a case report]. / A propos d'un cas de grossesse ovarienne.

We here report a case of left ovarian pregnancy passively detected in the General Reference Hospital outpatient clinic in Dilolo, Democratic Republic of Congo. The diagnosis was confirmed by ultrasound; the patient underwent surgery with uneventful postoperative course. Pregnant women and healthcare personnel should be aware of the importance of proper clinical and echographic monitoring in pregnancy for early diagnosis of abnormal implantations.

Influence de l'age et de la parite de la mere sur le poids de naissance (Cas du Centre de Sante Shungu en RDC)

OBJECTIF:Cette etude avait pour objectif d'etablir la relation entre l'age; la parite de la mere d'une part et le poids a la naissance d'autre part MeTHODOLOGIE: Une etude transversale et descriptive; a ete menee sur un echantillon de 314 couples meres - enfants au Centre de Sante Shungu en RDC durant la periode allant du 1er Janvier 2010 au 31 Decembre 2011. Notre population d'etude concerne tous les cas des accouchements a terme durant la periode de l'etude. Les donnees ont ete recueillies a l'aide d'une grille a partir des registres de la maternite. Puis elles ont ete encodees; saisies; traitees et analysees a l'aide du logiciel SPSS (version 19). ReSULTATS L'analyse a revele que le poids moyen de naissance est significativement plus bas chez les primipares que chez les multipares et chez les meres de moins de 18 ans que chez celles de plus de 18 ans. Le risque d'accoucher d'un enfant de faible poids de naissance a ete 9 fois plus eleve chez les primipares que chez les multipares et 23 fois superieures chez les meres de moins de 18 ans que chez celles de plus de 18 ans. CONCLUSION : Le faible poids de la naissance est un probleme majeur de sante publique aussi bien dans les pays en voie de developpement que dans les pays developpes. La maitrise des facteurs maternels qui ont le plus d'influence sur le poids et sur lequel on peut agir tel que l'age; la parite; et l'etat nutritionnel est d'une necessite dans la lutte contre le faible poids de naissance

[A study of the prevalence of infectious markers in blood donors in rural areas. The case of Kamina hospital]. / Prévalence des marqueurs infectieux chez les donneurs de sang en milieu rural. Cas de l'hôpital général de référence de Kamina.

INTRODUCTION: The transmission of infectious agents such as the human immunodeficiency virus (HIV), hepatitis B (HBV), hepatitis C (HCV) and syphilis is the greatest threat to transfusion recipient safety. The purpose of this study was to determine the seroprevalence of infectious markers with a view to contributing to transfusion safety by selecting donors. METHODS: A retrospective analysis of the medical records ofblood donors covering the period 1 January to 31 December 2008 was conducted. The global seroprevalence of HIV HBV HCV and syphilis was, respectively, 2.9%, 1.6%, 0.2% and 0.2%. A high seroprevalence was found in the 16-25 and 46-55-year age groups, while there was a high prevalence of syphilis in the 16-25-year age group. RESULTS: The results confirm the presence of infection by hepatitis B in Kamina and provide an initial insight into the circulation of the hepatitis C virus, the HIV virus and syphilis in the blood donor population. DISCUSSION: Rigorous selection and screening procedures among blood donors are needed to ensure transfusion recipient safety.