Dosithée Ngo-Bebe’s research while affiliated with University of Kinshasa and other places

Cholera remains a major healthcare issue in the Democratic Republic of the Congo with recurrent cholera outbreaks in its eastern provinces since 1994. Cholera cases and deaths increased from 18 403 and 302 in 2022 to 52 570 and 470 in 2023. From October 1st to December 31st, 2022, we conducted a mixed descriptive study to analyze the management process underpinning the cholera vaccination campaign in the Katana health district, South Kivu province, DRC. The survey targeted households (n = 404) with 1 adult person per household responding on behalf of all the members of the household and key informants (KI) who were health workers (n = 6) in 5 health areas of the Katana health district. The overall cholera prevalence in the surveyed households was 4.7% (95% CI 2.9-7.3), and the overall vaccination rate was 25.0% (95% CI 20.9-29.5). Most interviewed household respondents (54.5%) were eager for their household members to get vaccinated, and 61% had to walk for more than 1 hour to reach the vaccination center. Cholera vaccine for children under 2 years was available in all the 5 health areas investigated, only 2 out of 5 health areas had enough vaccine stockpiles. Only 33.3% of KI administering vaccines were trained at least once during the past 3 years. All the KI (100%) complained about delays or absence of payment for their services which negatively impacted their implication. Our findings highlight weaknesses in the planning of the last cholera vaccination campaign in the health district of Katana.

Background The National Expanded Program on Immunization in the Democratic Republic of the Congo implemented a program in 9 Provinces to generate georeferenced immunization microplans to strengthen the planning and implementation of vaccination services. The intervention aimed to improve identification and immunization of zero-dose children and overall immunization coverage. Methods This study applies a mixed-methods design including survey tools, in-depth interviews and direct observation to document the uptake, use, and acceptance of the immunization microplans developed with geospatial data in two intervention provinces and one control province from February to June 2023. A total of 113 health facilities in 98 Health Areas in 15 Health Zones in the three provinces were included in the study sample. Select providers received training on gender-intentional approaches for the collection and use of geospatial data which was evaluated through a targeted qualitative study. A secondary analysis of immunization coverage survey data (2020–2022) was conducted to assess the associated effects on immunization coverage, especially changes in rates of zero dose children, defined as those aged 12–23 months who have not received a single dose of Pentavalent vaccine. Results This research study shows that georeferenced microplans are well received, utilized, and led to changes in routine immunization service planning and delivery. In addition, the gender intervention is perceived to have led to changes in the approaches taken to overcome sociocultural gender norms and engage communities to reach as many children as possible, leveraging the ability of women to engage more effectively to support vaccination services. The quantitative analyses showed that georeferenced microplans may have contributed to a dramatic and sustained trend of high immunization coverage in the intervention site of Haut-Lomami, which saw dramatic improvement in coverage for 3 antigens and little change in Pentavalent drop-out rate over three years of implementation. Conclusion The overall study identified positive contributions of the georeferenced data in the planning and delivery of routine immunization services. It is recommended to conduct further analyses in Kasai in 2024 and 2025 to evaluate the longer-term effects of the gender intervention on immunization coverage and equity outcomes. Trial registration The study was registered and given BMC Central International Standard. Randomised Controlled Trial Number ISRCTN65876428 on March 11, 2021.

Background An Ebola Virus Disease (EVD) outbreak occurred in North Kivu between 2018 and 2020. This eastern province of the Democratic Republic of Congo was also grappling with insecurity caused by several armed groups. This study aimed to explore the barriers and facilitators to utilizing Healthcare Facilities (HCFs) by non-Ebola patients during the crisis. Methods A qualitative case study was conducted in Beni and Butembo with 24 relatives of 15 deceased non-EVD patients, 47 key informants from healthcare workers (HCWs), as well as community leaders. Semi-structured interviews were conducted to explore three key areas: (i) the participants’ illness history, care pathway, care, and social support; (ii) their perceptions of how EVD affected the care outcome; and (iii) their opinions on the preparedness, supply, use, and quality of healthcare before and during the outbreak. All interviews were recorded, transcribed verbatim, and thematically analysed using Atlas-ti 8.0. Results Nine of the 15 deaths were female and their ages ranged from 7 to 79 years. The causes of death were non-communicable (13) or infectious (2) diseases. Conspiracy theories, failure to establish security, and the concept of the ''Ebola business'' were associated with misinformation and lower levels of trust in government and HCFs. The negative perceptions, fear of being identified as an Ebola case, apprehension about the triage unit, and inadequacy of personal protective equipment resulted in a preference for private or informal HCFs. For half of the deceased’s relatives, the Ebola outbreak hastened their death. Conversely, community involvement, employing familiar, neutral, and credible HCWs, and implementing a free care policy increased the number of visits. These results were observable despite a lack of funds, overstretched HCWs, and long waiting time. Conclusions Our findings can inform policies before and during future outbreaks to enhance the resilience of routine HCFs by maintaining dialogue between HCWs and patients, and rebuilding confidence in HCFs. Quantitative studies including context analysis are essential to identify the determinants of care-seeking during such a crisis.

Background The National Expanded Program on Immunization in the Democratic Republic of the Congo started using geospatial data at scale in 8 Provinces to strengthen the planning and implementation of vaccination services with a focus on the identification and immunization of zero-dose children, children who have not received the first dose of diphtheria-tetanus-pertussis containing vaccine (DTP1). Methods The study used a mixed-methods research design including survey tools, in-depth interviews and direct observation to document the uptake, use, and perceived impact of georeferenced immunization microplans in the intervention provinces of Haut-Lomami and Kasai and in the control province of Kasai Central. A total of 113 health facilities in 98 Health Areas in 15 Health Zones in the three provinces were included in the study sample. A gender intervention in select Health Zones and Health Areas in Kasai Province was also evaluated through a targeted qualitative study. A secondary analysis of immunization coverage survey data was conducted to assess the associated effects on immunization coverage, especially for rates of zero-dose children. Results This research study shows that georeferenced microplans are well received, utilized, and led to changes in routine immunization service planning and delivery with perceived improvements in identification and reaching zero-dose children. In addition, the gender intervention is perceived to have led to a significant change in the approaches taken to overcome sociocultural gender norms and engage communities to reach as many children as possible, leveraging the ability of women to engage more effectively to support vaccination services. The quantitative analyses showed that georeferenced microplans may have contributed to a dramatic and sustained trend towards high immunization coverage in the intervention site of Haut Lomami, which rose dramatically from 8.9% in 2020 to 76.8% in 2021 and to 92% in 2022 for Pentavalent 3 antigen, while the DPT1-DPT3 drop-out rate changed little from 1% in 2020 to 1.7% in 2021 and 1.6% in 2022 after three years of implementation. Conclusion The overall study identified positive contributions of the georeferenced data in the planning and delivery of routine immunization services. It is recommended to conduct further analyses in Kasai in 2024 and 2025 to evaluate the effects of the gender intervention on immunization coverage and equity outcomes.