Child mortality in the Democratic Republic of Congo: cross-sectional evidence of the effect of geographic location and prolonged conflict from a national household survey

Abstract

BackgroundThe child mortality rate is a good indicator of development. High levels of infectious diseases and high child mortality make the Democratic Republic of Congo (DRC) one of the most challenging environments for health development in Sub-Saharan Africa (SSA). Recent conflicts in the eastern part of the country and bad governance have compounded the problem. This study aimed to examine province-level geographic variation in under-five mortality (U5M), accounting for individual- and household-level risk factors including environmental factors such as conflict.MethodsOur analysis used the nationally representative cross-sectional household sample of 8,992 children under five in the 2007 DRC Demographic and Health Survey. In the survey year, 1,005 deaths among this group were observed. Information on U5M was aggregated to the 11 provinces, and a Bayesian geo-additive discrete-time survival mixed model was used to map the geographic distribution of under-five mortality rates (U5MRs) at the province level, accounting for observable and unobservable risk factors.ResultsThe overall U5MR was 159 per 1,000 live births. Significant associations with risk of U5M were found for < 24 month birth interval [posterior odds ratio and 95% credible region: 1.14 (1.04, 1.26)], home birth [1.13 (1.01, 1.27)] and living with a single mother [1.16 (1.03, 1.33)]. Striking variation was also noted in the risk of U5M by province of residence, with the highest risk in Kasaï-Oriental, a non-conflict area of the DRC, and the lowest in the conflict area of North Kivu.ConclusionThis study reveals clear geographic patterns in rates of U5M in the DRC and shows the potential role of individual child, household and environmental factors, which are unexplained by the ongoing conflict. The displacement of mothers to safer areas may explain the lower U5MR observed at the epicentre of the conflict in North Kivu, compared with rates in conflict-free areas. Overall, the U5M maps point to a lack of progress towards the Millennium Development Goal of reducing U5M by half by 2015.

A geostatistical analysis of the association between armed conflicts and Plasmodium falciparum malaria in Africa, 1997–2010

“…These factors can also affect the spatially (hidden trends) and especially non-spatially correlated variance (known as the nugget variance in geostatistics, or measurement error), which account for 11 % of the sill (the total amount of variance given by the sum of non-spatially correlated variance and spatially correlated variance in the residuals) [ 54 ]. On the other hand, the large amount of spatially correlated variance (the remaining 89 %) confirms the importance of spatiotemporal autocorrelation in malaria surveys [ 55 ] and conflict events [ 56 ] and in general for malaria transmission statistical analyses [ 11 , 31 , 42 , 45 , 57 ]. In this study, the optimization of the variogram based on the distances between conflicts and variance in the malaria surveys (Eq.…”

“…Autoregressive components are often used in spatiotemporal analyses of malaria prevalence [ 43 , 44 ], and enable relative (to its initial value) measures of the Pf PR variation to be produced. Spatial and spatiotemporal autocorrelation has been found to be significant in other conflicts [ 11 , 42 , 45 ] and malaria studies [ 31 , 44 , 46 ].…”

Using geographical analysis to identify child health inequality in sub-Saharan Africa

“…Moreover, an increase in under-5 mortality was observed in several African countries during the 1990s; data from five of those countries indicate that mortality increases were concentrated in specific population subgroups, whose education level and urban/rural residence varied by country [41]. A study of Demographic Health Survey (DHS) data from the DRC in 2007 found unexpected geographic patterns in under-5 mortality, and highlights subnational areas where a potential confluence of individual, household and environmental elements affecting child mortality may be spatially clustered [42]. Studies in rural Tanzania and Burkina Faso found that physical access to health facilities was associated with child mortality [43,44].…”

Antimicrobial resistance of bacteria isolated from patients with bloodstream infections at a tertiary care hospital in the Democratic Republic of the Congo

“…[3][4][5][6][7] Infectious diseases are the leading cause of death in the Democratic Republic of the Congo (DRC). [8] In fact, the DRC has a crude mortality rate well above the average for sub-Saharan countries [9] and the highest under-5 mortality rate in Africa, [10] with malaria, pneumonia and diarrhoea the leading causes of death. [11,12] In South Kivu Province, most healthcare facilities lack the capacity to identify causative agents of infectious diseases reliably, including invasive bacterial infections such as BSIs.…”