Under-five mortality in the Democratic Republic of the Congo: secondary analyses of survey and conflict data by province

Schedwin, Mattias; Furaha, Aurélie Bisumba; Kapend, Richard; Akilimali, Pierre; Malembaka, Espoir Bwenge; Hildenwall, Helena; Alfvén, Tobias; Tylleskär, Thorkild; Mapatano, Mala Ali; King, Carina

doi:10.2471/blt.22.287915

Cited by 3 publications

(7 citation statements)

References 25 publications

(28 reference statements)

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“…53 However, there were mixed results for conflict-affected areas within provinces, with some displaying higher healthcare coverage than stable areas. 34,37,52 A study of RMNCH service coverage found increases in coverage over the course of the study in North and South Kivu. 34 Health facility data showed a small negative correlation between insecurity and preventive service coverage within provinces overall.…”

Section: Conflictmentioning

confidence: 99%

“…ASSESSMENT OF STUDY QUALITY Of the 26 studies, none were assessed as "weak," 13 as "moderate" 15,23,[30][31][32][33][34][35][36][37][38][39][40] and 13 as "strong". 36,[41][42][43][44][45][46][47][48][49][50][51][52] STUDY LOCATION All documents included the DRC. Six had a multi-country scope.…”

Section: Data Extraction and Synthesismentioning

confidence: 99%

“…Seven articles included the effect of conflict on the availability of MNCH services. 23,34,37,44,48,52,53 Conflict decreased the availability of HRH in North and South Kivu, limiting access to the population, causing fear and anxiety, creating difficult working conditions, and disrupting training and supervision. 23,44 Conflict zones were characterized by deficits of equipment and supplies due to pillaging, targeted attacks, and transportation difficulties.…”

Section: Conflictmentioning

confidence: 99%

“…34 Health facility data showed a small negative correlation between insecurity and preventive service coverage within provinces overall. 23 Furthermore, Schedwin et al (2022) found that conflict alone was a poor predictor for child health -the odds of coverage for indicators of preventive care (e.g., skilled birth attendance, exclusive breastfeeding for the first six months, kangaroo mother care) were higher in conflict-affected provinces for 13 indicators, compared to one indicator that had higher odds of coverage in non-conflict provinces. 52 A childhood measles vaccination study reported that residing in a province experiencing displacement due to conflict was predictive of increased vaccination.…”

Section: Conflictmentioning

confidence: 99%

“…23 Furthermore, Schedwin et al (2022) found that conflict alone was a poor predictor for child health -the odds of coverage for indicators of preventive care (e.g., skilled birth attendance, exclusive breastfeeding for the first six months, kangaroo mother care) were higher in conflict-affected provinces for 13 indicators, compared to one indicator that had higher odds of coverage in non-conflict provinces. 52 A childhood measles vaccination study reported that residing in a province experiencing displacement due to conflict was predictive of increased vaccination. 37 Authors attributed the correlation to the increased number of aid workers providing essential services, noting the finding was consistent with other published studies showing that reactive campaigns in high-risk areas tended to improve vaccination levels.…”

Section: Conflictmentioning

confidence: 99%

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Facilitators and barriers to supply-side maternal, newborn, and child health service availability in DRC: a systematic review and narrative synthesis

Duff,

Patel,

Dumouza

et al. 2024

Journal of Global Health Economics and Policy

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Background This study is a systematic review of barriers and facilitators of supply-side maternal, newborn, and child health (MNCH) service availability in the Democratic Republic of the Congo (DRC). Given gaps in understanding of the factors affecting supply-side service availability, authors reviewed the literature to describe the DRC’s landscape and inform future research and programming. # Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, authors searched two databases and grey literature, using the Quality Assessment with Diverse Studies tool to assess quality. Authors identified key themes and used a narrative approach to analyze extracted data. # Results The search identified 2160 articles, with 26 meeting the inclusion criteria. Authors grouped them according to the following key themes: facility readiness, human resources for health (HRH), geography and transportation, conflict, financing, and governance. MNCH service availability was hindered by lack of supplies, logistical challenges, weak infrastructure, unmet staffing needs, HRH turnover, poor HRH distribution, career and payment obstacles, long distances to facilities and poor transportation, system strain and disruption due to conflict, low government expenditure, high out of pocket costs, fragmented stakeholders, and low government prioritization. Authors found facilitating factors in each key theme, including parallel supply chains and buffer stocks, proactive staffing policies, motivated HRH, novel transportation methods, health posts, concentrations of stakeholders in conflict zones, universal health coverage policies, provider payment reforms, stakeholder coordination, and horizontal integration efforts. # Conclusions The DRC faces substantial supply-side barriers to MNCH service availability. Progress towards the Sustainable Development Goals and better MNCH outcomes requires additional work to build on existing facilitators and investments in service availability. Additional research on demand-side factors and quality of care could inform these efforts.

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Section: Conflictmentioning

confidence: 99%

Section: Data Extraction and Synthesismentioning

confidence: 99%

Section: Conflictmentioning

confidence: 99%

Section: Conflictmentioning

confidence: 99%

Section: Conflictmentioning

confidence: 99%

See 3 more Smart Citations

Facilitators and barriers to supply-side maternal, newborn, and child health service availability in DRC: a systematic review and narrative synthesis

Duff,

Patel,

Dumouza

et al. 2024

Journal of Global Health Economics and Policy

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Exploring different health care providers´ perceptions on the management of diarrhoea in cholera hotspots in the Democratic Republic of Congo: A qualitative content analysis

Schedwin,

Furaha,

Hildenwall

et al. 2024

PLOS Glob Public Health

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Global cholera guidelines support wider healthcare system strengthening interventions, alongside vertical outbreak responses, to end cholera. Well-trained healthcare providers are essential for a resilient health system and can create synergies with childhood diarrhoea, which has higher mortality. We explored how the main provider groups for diarrhoea in cholera hotspots interact, decide on treatment, and reflect on possible limiting factors and opportunities to improve prevention and treatment. We conducted focus group discussions in September 2022 with different healthcare provider types in two urban and two rural cholera hotspots in the North Kivu and Tanganyika provinces in the Eastern Democratic Republic of Congo. Content analysis was used with the same coding applied to all providers. In total 15 focus group discussions with medical doctors (n = 3), nurses (n = 4), drug shop vendors (n = 4), and traditional health practitioners (n = 4) were performed. Four categories were derived from the analysis. (i) Provider dynamics: scepticism between all cadres was prominent, whilst also acknowledging the important role all provider groups have in current case management. (ii) Choice of treatment: affordability and strong caregiver demands shaped by cultural beliefs strongly affected choice. (iii) Financial consideration on access: empathy was strong, with providers finding innovative ways to create access to treatment. Concurrently, financial incentives were important, and providers asked for this to be considered when subsiding treatment. (iv) How to improve: the current cholera outbreak response approach was appreciated however there was a strong wish for broader long-term interventions targeting root causes, particularly community access to potable water. Drug shops and traditional health practitioners should be considered for inclusion in health policies for cholera and other diarrhoeal diseases. Financial incentives for the provider to improve access to low-cost treatment and investment in access to potable water should furthermore be considered.

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Interactions between Health and the Sustainable Development Goals: The Case of the Democratic Republic of Congo

et al. 2023

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A systematic and contextualized assessment of the interactions between the Sustainable Development Goals and health in the Democratic Republic of Congo is currently lacking. This study aimed to characterize and classify the linkages between the Sustainable Development Goals in the DRC with a focus on health and well-being. In this semi-qualitative participatory study, 35 experts assessed 240 interactions between 16 of the 17 SDGs during a two-day workshop in Kinshasa, Democratic Republic of the Congo, using a scale from +3 (strongly promoting) to −3 (strongly restricting). SDG 16 (Peace, justice, and strong institutions) had the strongest promoting influence on other goals and was identified as a key priority for the DRC to attain the SDGs. Progress on SDG 3 (good health and well-being) was perceived as promoting progress on most SDGs, and through second-order interactions, a positive feedback loop was identified. Furthermore, progress on the other SDGs was deemed to promote progress on SDG 3, with SDG 16 having the greatest positive potential when second-order interactions were taken into account. Our results show the importance of recognizing synergies and trade-offs concerning the interactions between health and other SDGs and that it is imperative to set up structures bringing together different sectors to accelerate work towards achieving the 2030 Agenda.

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Under-five mortality in the Democratic Republic of the Congo: secondary analyses of survey and conflict data by province

Cited by 3 publications

References 25 publications

Facilitators and barriers to supply-side maternal, newborn, and child health service availability in DRC: a systematic review and narrative synthesis

Facilitators and barriers to supply-side maternal, newborn, and child health service availability in DRC: a systematic review and narrative synthesis

Exploring different health care providers´ perceptions on the management of diarrhoea in cholera hotspots in the Democratic Republic of Congo: A qualitative content analysis

Interactions between Health and the Sustainable Development Goals: The Case of the Democratic Republic of Congo

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