Théophane Kekemb Bukele’s research while affiliated with University of Kinshasa and other places

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 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.

Background With the epidemiological transition, non-communicable diseases are now a major problem, including in the Democratic Republic of the Congo, where the population’s eating habits are constantly changing, with obesity and hyperglycemia in increase. This study aimed to examine the association between dietary habits, factors associated with type 2 diabetes mellitus and weight status in people over 18 years of age in Kinshasa, Democratic Republic of the Congo. Methods In a descriptive cross-sectional study among 182 adults, selected using multistage probability sampling (Health Zone, Health Area, Household, Individual), a structured questionnaire was used to collect behavioural data. The World Health Organization (WHO) Anthro plus was used to calculate body mass index. Descriptive statistics were completed with the Chi2 test, whereas a multivariate analysis used correlation with 95% confidence interval (CI) with eating habits, glycemic status and weight status as major variables. Results There were 68.8% respondents with high weight trouble (44.4% overweight and 24.0% obese). Up to 14.8% respondents were both overweight and hyperglycemic. Only 14.8% respondents reading labels of paid products was associated with glycemic status ( P <0.05). Up to 61.5% respondents reported preparing own food, 54.4% eating alone, 96.7% consuming oils, sugar and sweet products, 92.9% consuming milk and its derivatives, 85.2% meat and fish, and 82.4% consumed fruits. However, none of these parameters was significantly associated with glycemic status Conclusions Stakeholders, including MoH, community, and civil society need to partner in raising awareness for changing behavior and eating habits such as mindful eating, balanced diet and regular eating.

Background Since the 1980s, the liberalisation of the healthcare sector, driven by structural adjustment policies promoted by the Bretton Woods Institutions, has resulted in a significant increase in private healthcare entrepreneurs. One of the primary goals of this shift was to enhance geographical access to healthcare. However, there have been no comprehensive studies analysing the determinants of local healthcare entrepreneurship development in the Democratic Republic of Congo (DRC). This study aims to evaluate the relationship between the health zone profile and the development of private healthcare service provision in the DRC. Methods This research employs a cross-sectional and analytical approach, using a quantitative methodology based on the Partial Least Squares Path Modeling (PLS-PM) technique. The focus was on measuring the relationship between variables associated with the health zone profile and the growth of private healthcare services. An econometric analysis was used to test and validate this relationship. Results The findings reveal a positive relationship between the profile of the health zone and the development of private health services in Kinshasa (coefficient of 0.720). The health zone profile is primarily influenced by the mortality rate (coefficient of 0.793), while the development of private healthcare entrepreneurship is most strongly reflected by the number of paramedical practices (coefficient of 0.293). Conclusions The study suggests that continuous training initiatives and efforts to reduce mortality are crucial for improving health zone management. Moreover, managing healthcare infrastructure effectively in response to growing urbanization, rather than merely increasing the number of health areas, is recommended for better health zone management in the DRC.

Contexte et objectif. Avec une grande majorité d’habitants sans couverture-maladie, l’inaccessibilité aux soins pour manque d’argent est un problème réel parmi les habitants de Kinshasa en raison des paiements directs. La présente étude a évalué le coût direct de la maladie du point de vue des ménages et identifié les facteurs déterminants dudit coût. Méthodes. Une enquête a été menée dans la commune de Limete auprès de 150 ménages choisis de manière aléatoire dans huit quartiers. Les données collectées ont été soumises d’abord à un traitement comptable, puis à l'analyse statistique et à l’analyse économétrique. Résultats. Le coût total direct moyen était de 145.258,88 CDF (environ 88 US $) par épisode-patient en ambulatoires. Dominés largement par les médicaments, les frais médicaux représentent 86,57$) contre 13,43 % de frais non médicaux (12 US $). Excepté la consultation, les autres frais médicaux influent positivement sur le total des frais médicaux. De même, tous les frais non médicaux, sauf les frais d’appel téléphonique, influent sur le total des frais non médicaux. Conclusion. Le coût médical en ambulatoire par patient-épisode est dominé à 65$) per outpatient episode. Largely dominated by drug cost, medical costs represented 86.57 % of the total (US $76) against 13.43$12). Apart from the consultation, the other medical costs had a positive influence on the total medical costs. Similarly, all non-medical expenses, except for phone calls, affected the total non-medical expenses. Conclusion. The outpatient medical cost per patient-episode is dominated by drug costs, but its impact on the medical cost of the disease remains lower. Keywords: out-of-pocket payments; healthcare; ABC; regression; DR Congo