BackgroundHypertension remains a public health challenge worldwide. In the Democratic Republic of Congo, its prevalence has increased in the past three decades. Higher prevalence of poor blood pressure control and an increasing number of reported cases of complications due to hypertension have also been observed. It is well established that non-adherence to antihypertensive medication contributes to poor control of blood pressure. The aim of this study is to measure non-adherence to antihypertensive medication and to identify its predictors.MethodsA cross-sectional study was conducted at Kinshasa Primary Health-care network facilities from October to November 2013. A total of 395 hypertensive patients were included in the study. A structured interview was used to collect data. Adherence to medication was assessed using the Morisky Medication Scale. Covariates were defined according to the framework of the World Health Organization. Logistic regression was used to identify predictors of non-adherence.ResultsA total of 395 patients participated in this study. The prevalence of non-adherence to antihypertensive medication and blood pressure control was 54.2 % (95 % CI 47.3–61.8) and 15.6 % (95 % CI 12.1–20.0), respectively. Poor knowledge of complications of hypertension (OR = 2.4; 95 % CI 1.4–4.4), unavailability of antihypertensive drugs in the healthcare facilities (OR = 2.8; 95 % CI 1.4–5.5), lack of hypertensive patients education in the healthcare facilities (OR = 1.7; 95 % CI 1.1–2.7), prior experience of medication side effects (OR = 2.2; 95 % CI 1.4–3.3), uncontrolled blood pressure (OR = 2.0; 95 % CI 1.1–3.9), and taking non-prescribed medications (OR = 2.2; 95 % CI 1.2–3.8) were associated with non-adherence to antihypertensive medication.ConclusionThis study identified predictors of non-adherence to antihypertensive medication. All predictors identified were modifiable. Interventional studies targeting these predictors for improving adherence are needed.

BackgroundThe Democratic Republic of the Congo (DRC) is characterized by a high prevalence of hypertension (HTN) and a high proportion of uncontrolled HTN, which is indicative of poor HTN management. Effective management of HTN in the African region is challenging due to limited resources, particularly human resources for health. To address the shortage of health workers, the World Health Organization (WHO) recommends task shifting for better disease management and treatment. Although task shifting from doctors to nurses is being implemented in the DRC, there are no studies, to the best of our knowledge, that document the association between task shifting and HTN control. The aim of this study was to investigate the association between task shifting and HTN control in Kinshasa, DRC.MethodsWe conducted a cross-sectional study in Kinshasa from December 2015 to January 2016 in five general referral hospitals (GRHs) and nine health centers (HCs). A total of 260 hypertensive patients participated in the study. Sociodemographic, clinical, health care costs and perceived health care quality assessment data were collected using a structured questionnaire. To examine the association between task shifting and HTN control, we assessed differences between GRH and HC patients using bivariate and multivariate analyses.ResultsAlmost half the patients were female (53.1%), patients’ mean age was 59.5 ± 11.4 years. Over three-fourths of patients had uncontrolled HTN. There was no significant difference in the proportion of GRH and HC patients with uncontrolled HTN (76.2% vs 77.7%, p = 0.771). Uncontrolled HTN was associated with co-morbidity (OR = 10.3; 95% CI: 3.8–28.3) and the type of antihypertensive drug used (OR = 4.6; 95% CI: 1.3–16.1). The mean healthcare costs in the GRHs were significantly higher than costs in the HCs (US$ 34.2 ± US$3.34 versus US$ 7.7 ± US$ 0.6, respectively).ConclusionUncontrolled HTN was not associated with the type of health facility. This finding suggests that the management of HTN at primary healthcare level might be just as effective as at secondary level. However, the high proportion of patients with uncontrolled HTN underscores the need for HTN management guidelines at all healthcare levels.

Context and objectivesNon-communicable diseases and injuries (NCDIs) comprise a large share of mortality and morbidity in low-income countries (LICs), many of which occur earlier in life and with greater severity than in higher income settings. Our objective was to assess availability of essential equipment and medications required for a broad range of acute and chronic NCDI conditions.DesignSecondary analysis of existing cross-sectional survey data.SettingWe used data from Service Provision Assessment surveys in Bangladesh, the Democratic Republic of the Congo, Ethiopia, Haiti, Malawi, Nepal, Senegal and Tanzania, focusing on public first-referral level hospitals in each country.Outcome measuresWe defined sets of equipment and medications required for diagnosis and management of four acute and nine chronic NCDI conditions and determined availability of these items at the health facilities.ResultsOverall, 797 hospitals were included. Medication and equipment availability was highest for acute epilepsy (country estimates ranging from 40% to 95%) and stage 1–2 hypertension (28%–83%). Availability was low for type 1 diabetes (1%–70%), type 2 diabetes (3%–57%), asthma (0%–7%) and acute presentations of diabetes (0%–26%) and asthma (0%–4%). Few hospitals had equipment or medications for heart failure (0%–32%), rheumatic heart disease (0%–23%), hypertensive emergencies (0%–64%) or acute minor surgical conditions (0%–5%). Data for chronic pain were limited to only two countries. Availability of essential medications and equipment was lower than previous facility-reported service availability.ConclusionsOur findings demonstrate low availability of essential equipment and medications for diverse NCDIs at first-referral level hospitals in eight LICs. There is a need for decentralisation and integration of NCDI services in existing care platforms and improved assessment and monitoring to fully achieve universal health coverage.

BackgroundDemocratic Republic of the Congo (DRC) is experiencing an increase in the morbi-mortality related to Non Communicable Diseases (NCD). The reform of DRC health system, based on Health District model, is needed in order to tackle this public issue. This article used 2006 International Diabetes Federation (IDF)’s guidelines to assess the capacities of health facilities belonging to Kinshasa Primary Health Care Network (KPHCN) in terms of equipments, as well as the knowledge, and the practice of their health providers related to type 2 diabetes care.MethodsA multicentric cross-sectional study was carried in 18 Health Facilities (HF) of KPHCN in charge of the follow-up of diabetic patients. The presence of IDF recommended materials and equipment was checked and 28 health providers were interviewed about their theoretical knowledge about patients’ management and therapeutic objectives during recommended visits. Chi square test or Fisher exact test was used to compare proportions and the Student t-test to compare means.ResultsThe integration of NCD healthcare in the KPHC network is feasible. The majority of HF possessed IDF recommended materials except for the clinical practice guidelines, urinary test strips, and monofilament, available in only one, two and four HF, respectively. KPHCN referral facilities had required materials for biochemical analyses, the ECG and for the fundus oculi test. Patients’ management is characterized by a lack of attention on the impairment of renal function during the first visits and a poor respect of recommended practices during quarterly and annual visits. A poor knowledge of the reduction of cardiovascular risk factors-related therapeutic objectives has been also reported.ConclusionThe capacities, knowledge, and practice of T2D care were poor among HF of KPHCN. The lack of equipment and training of healthcare professionals should be supplied even to those who are not medical doctors. Special attention must to be put on the clinical practice guidelines formulation and sensitization and on supervision.

(1) Background: The Democratic Republic of the Congo (DRC) is one of the countries with the highest number of never vaccinated or “zero-dose” (ZD) children in the world. This study was conducted to examine the proportion of ZD children and associated factors in the DRC. (2) Methods: Child and household data from a provincial-level vaccination coverage survey conducted between November 2021–February 2021 and 2022 were used. ZD was defined as a child aged 12 to 23 months who had not received any dose of pentavalent (diphtheria-tetanus-pertussis-Haemophilus influenzae type b (Hib)-Hepatitis B) vaccine (by card or recall). The proportion of ZD children was calculated and associated factors were explored using logistic regression, taking into account the complex sampling approach. (3) Results: The study included 51,054 children. The proportion of ZD children was 19.1% (95%CI: 19.0–19.2%); ZD ranged from 62.4% in Tshopo to 2.4% in Haut Lomami. After adjustment, being ZD was associated with low level of maternal education and having a young mother/guardian (aged ≤ 19 years); religious affiliation (willful failure to disclose religious affiliation as the highest associated factor compared to being Catholic, followed by Muslims, revival/independent church, Kimbanguist, Protestant); proxies for wealth such as not having a telephone or a radio; having to pay for a vaccination card or for another immunization-related service; not being able to name any vaccine-preventable disease. A child’s lack of civil registration was also associated with being ZD. (4) Conclusions: In 2021, one in five children aged 12–23 months in DRC had never been vaccinated. The factors associated with being a ZD child suggest inequalities in vaccination that must be further explored to better target appropriate interventions.