Browsing by Subject "Democratic Republic of Congo"

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    Adapting a community first aid responder programme to increase out-of-hospital capacity in Kinshasa, Democratic Republic of Congo
    (2025) Diango, Ken Ngoy; Hodkinson, Peter; Cunningham, Charmaine; Mafuta, Eric; Wallis, Lee
    In 2023, the seventy-sixth World Health Assembly passed a significant resolution – WHA76.2 – calling for global efforts to strengthen the provision of quality Emergency, Critical, and Operative care (ECO) to address the growing burden of acute and critical illnesses, particularly in low- and middle-income countries (LMICs). In areas where formalised prehospital care systems are being established to improve outcomes, the incorporation of a layperson first responder programme could facilitate greater access to care for individuals in need and serve as an effective initial intervention to bolster out-of-hospital emergency care (OHEC) capacity. WHO developed the Community First Aid Response (CFAR) training program to support this approach. For the course to be appropriately and sustainably implemented, contextual adaptations are necessary. The prerequisites for this country-specific adaptation include, among other factors, a systematic evaluation of the country's emergency care landscape, a needs assessment and understanding the acceptability of the proposed intervention. Aim and Objectives: The aim of the thesis was to adapt a country-specific CFAR program for the Democratic Republic of Congo (DRC) as an initial intervention to increase OHEC capacity. Four studies were planned to fulfil the main objectives. The first was to outline the key functions and related components of the country's emergency care system, identify the gaps, and define priority areas for strengthening. The second was to evaluate community needs for, and the availability of, emergency care services in Kinshasa, DRC, to determine the nature and magnitude of unmet needs, especially in OHEC. The third study was to assess the usefulness and acceptability of an adapted CFAR programme designed to strengthen OHEC capacity in Kinshasa. The fourth and final study was to describe and assess a pilot CFAR course, including the process, resources, curriculum, and teaching methods, while also capturing knowledge and confidence gains from the perspectives of both organisers and participants. Methods: A series of four studies was carried out in Kinshasa, DRC. The first study used a consensus method to describe essential components of the country's emergency care system utilizing the WHO Emergency Care System Assessment (ECSA) tool. The second study involved a household survey that contrasted the needs and availability of emergency care services within Kinshasa's communities. The third utilized focus groups to evaluate the usefulness and acceptability of an adapted CFAR programme. The final study consisted of a feasibility assessment using mixed methods analysis to describe and assess core elements of the implementation of a pilot CFAR training and provide key outcomes. Results: The evaluation of the DRC ECSA revealed several gaps, including an inadequate OHEC capacity. The household survey indicated significant unmet needs in the provision of emergency care, particularly regarding out-of-hospital services. An adapted CFAR program was recognised as a suitable and acceptable strategy to increased OHEC capacity in Kinshasa. Finally, a CFAR pilot was successfully conducted and found to be contextually relevant, representing a potential initial step to address the existing OHEC capacity shortfalls in Kinshasa. Conclusion: This dissertation offers significant conceptual, analytical, and empirical insights into the context-specific adaptation of a CFAR program as an initial intervention to increase OHEC capacity in a nascent emergency care system of a resource-constrained setting. Our results suggest that a comprehensively implemented tailored system could potentially enhance OHEC capacity in low-resource settings and likely impact outcomes.
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    “It’s a secret between us”: a qualitative study on children and care-giver experiences of HIV disclosure in Kinshasa, Democratic Republic of Congo
    (2021-02-06) Sumbi, Elysée M; Venables, Emilie; Harrison, Rebecca; Garcia, Mariana; Iakovidi, Kleio; van Cutsem, Gilles; Chalachala, Jean L
    Background It is estimated that 64,000 children under 15 years of age are living with HIV in the Democratic Republic of Congo (DRC). Non-disclosure – in which the child is not informed about their HIV status - is likely to be associated with poor outcomes during adolescence including increased risk of poor adherence and retention, and treatment failure. Disclosing a child’s HIV status to them can be a difficult process for care-givers and children, and in this qualitative study we explored child and care-giver experiences of the process of disclosing, including reasons for delay. Methods A total of 22 in-depth interviews with care-givers and 11 in-depth interviews with HIV positive children whom they were caring for were conducted in one health-care facility in the capital city of Kinshasa. Care-givers were purposively sampled to include those who had disclosed to their children and those who had not. Care-givers included biological parents, grandmothers, siblings and community members and 86% of them were female. Interviews were conducted in French and Lingala. All interviews were translated and/or transcribed into French before being manually coded. Thematic analysis was conducted. Verbal informed consent/assent was taken from all interviewees. Results At the time of interview, the mean age of children and care-givers was 17 (15–19) and 47 (21–70) years old, respectively. Many care-givers had lost family members due to HIV and several were HIV positive themselves. Reasons for non-disclosure included fear of stigmatisation; wanting to protect the child and not having enough knowledge about HIV or the status of the child to disclose. Several children had multiple care-givers, which also delayed disclosure, as responsibility for the child was shared. In addition, some care-givers were struggling to accept their own HIV status and did not want their child to blame them for their own positive status by disclosing to them. Conclusions Child disclosure is a complex process for care-givers, health-care workers and the children themselves. Care-givers may require additional psycho-social support to manage disclosure. Involving multiple care-givers in the care of HIV positive children could offer additional support for disclosure.
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    Self-medication and Anti-malarial Drug Resistance in the Democratic Republic of the Congo (DRC): A silent threat
    (BioMed Central, 2022-10-04) Akilimali, Aymar; Bisimwa, Charles; Aborode, Abdullahi T.; Biamba, Chrispin; Sironge, Leonard; Balume, Alain; Sayadi, Rahma; Ajibade, Samuel B.; Akintayo, Akintola A.; Oluwadairo, Tolulope O.; Fajemisin, Emmanuel A.
    Background Malaria is a global infectious (vector-borne: Anopheles mosquitoes) disease which is a leading cause of morbidity and mortality in Sub-Saharan Africa (SSA). Among all its parasitic (protozoan: Plasmodium sp.) variants, Plasmodium falciparum (PF) is the most virulent and responsible for above 90% of global malaria deaths hence making it a global public health threat. Main context Despite current front-line antimalarial treatments options especially allopathic medications and malaria prevention (and control) strategies especially governmental policies and community malaria intervention programs in SSA, PF infections remains prevalent due to increased antimicrobial/antimalarial drug resistance caused by several factors especially genetic mutations and auto(self)-medication practices in SSA. In this article, we focused on the Democratic Republic of Congo (DRC) as the largest SSA country by bringing perspective into the impact of self-medication and antimalarial drug resistance, and provided recommendation for long-term improvement and future analysis in malaria prevention and control in SSA. Conclusions Self-medication and anti-malarial drug resistance is a major challenge to malaria control in DRC and sub-Saharan Africa, and to achieve sustainable control, individual, community and governmental efforts must be aligned to stop self-medication, and strengthen the health systems against malaria.