A Successful National and Multipartner Approach to Increase Immunization Coverage: The Democratic Republic of Congo Mashako Plan 2018-2020.

BACKGROUND: The immunization system in the Democratic Republic of the Congo faces many challenges, including persistent large-scale outbreaks of polio, measles, and yellow fever; a large number of unvaccinated children for all antigens; minimal and delayed funding; and poor use of immunization data at all levels. In response, the Expanded Programme on Immunization within the Ministry of Health (MOH) collaborated with global partners to develop a revitalization strategy for the routine immunization (RI) system called the Mashako Plan. MASHAKO PLAN DESIGN AND DEVELOPMENT: The Mashako Plan aimed to increase full immunization coverage in children aged 12-23 months by 15 percentage points overall in 9 of 26 provinces within 18 months of implementation. In 2018, we conducted a diagnostic review and identified gaps in coordination, service delivery, vaccine availability, real-time monitoring, and evaluation as key areas for intervention to improve the RI system. Five interventions were then implemented in the 9 identified provinces. DISCUSSION: According to the 2020 vaccine coverage survey, full immunization coverage increased to 56.4%, and Penta3/DTP3 increased to 71.1% across the Mashako Plan provinces; the initial objective of the plan was reached and additional improvements in key service delivery indicators had been achieved. Increases in immunization sessions held per month, national stock of pentavalent vaccine, and supervision visits conducted demonstrate that simple, measurable changes at all levels can quickly improve immunization systems. Despite short-term improvements in all indicators tracked, challenges remain in vaccine availability, regular funding of immunization activities, systematic provision of immunization services, and ensuring long-term sustainability. CONCLUSIONS: Strong commitment of MOH staff combined with partner involvement enabled the improvement of the entire system. A simple set of interventions and indicators focused the energy of managers on discrete actions to improve outcomes. Further exploration of the results is necessary to determine the long-term impact and generate all-level engagement for sustainable success in all provinces.

The burden of diarrhoeal diseases in the Democratic Republic of Congo: a time-series analysis of the global burden of disease study estimates (1990-2019).

BACKGROUND: Diarrhoeal diseases are important causes of disability and mortality being one of the main causes of mortality in the Democratic Republic of Congo (DRC). One of the largest and wealthiest African countries, DRC has been for long subjected to continuous political and economic instability, conflicts and disease outbreaks. This study aimed to address the knowledge gap in understanding how prevalence, mortality and burden of diseases in DRC changed over time and examine the influence of specific factors in these disease-related outcomes. METHODS: A time-series analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 estimates was performed to describe prevalence, years lived with disabilities (YLDs) and mortality due to diarrhoeal diseases, by age-group and sex, between 1990-2019 in DRC. The contribution of water, sanitation and hygiene (WASH) and child malnutrition risk factors to these outcomes was also analysed. Piecewise regression analysis was used to assess trends over time. RESULTS: The overall age-standardised prevalence of diarrhoeal diseases for both sexes in DRC was 1350.84 (UI:1240.16-1461.62) cases per 100,000 people in 1990. The prevalence increased until 2019, also fuelled by the movement of Rwandan refugees to DRC and First/Second Congo wars between 1996-2003. Age-standardised prevalence and mortality were consistently higher in males, compared to females, decreasing by 42% and 54%, respectively, between 1990 and 2019. Overall prevalence was also usually higher in over 70 years old, except between 1998-2003 when mortality in under five years old was the highest. Unsafe water sources and child wasting among under five years old were the main contributors to YLDs and deaths associated to diarrhoeal diseases in DRC. CONCLUSION: Diarrhoeal diseases are important and preventable causes of disability and mortality in DRC. National measures of surveillance and cost-effective interventions targeting the identified risk groups could be effective in reducing its prevalence and associated burden.