To Örebro University

Background: The impact of sexual violence in any community is extremely devastating and women in the Eastern part of the Congo are no exception. Sexual violence not only affects the health of women, but it impacts their social life within the community too.

Objective: The study aims to investigate the experiences of female victims of sexual violence in accessing medical care in North Kivu.

Design: An interpretive, phenomenological approach was used for this inductive and qualitative study. In-depth informant interviews were the main data collection tool. Open-ended questions were used during the interviews in order to garner more information from the interviewees. Heidegger’s approach was utilized in analyzing the collected data.

Results: The analyzed and interpreted results of the data indicated that survivors of sexual violence are engaged in an ongoing struggle. The victims demonstrated immense resilience despite the lack of comprehensive medical care and have continued to reassemble their broken lives. In order to present the outcomes of the research in a succinct and coherent manner, the outcomes are categorized into five sub-themes: managing worries and shame; regaining happiness; healing and restoration; the need for professional assistance and struggles in daily life.

Conclusion: The study provides an understanding of the recovery processes of survivors of sexual violence in North Kivu, with important insights into dimensions that rehabilitation programs should take into consideration.

Background: Throughout the long war that the Democratic Republic of Congo (DRC) has endured,women and children have been depicted as the primary victims of widespread sexual violence. Insome settings women have been raped in entire villages, with devastating physical and psychologicalconsequences, which include sexually transmitted infections such as HIV, trauma and fistulas,as well as social isolation and involuntary pregnancies. The aim of this study was to assess theprevalent perceptions of health professionals on the magnitude of urine and/or fecal incontinenceamong assaulted women, caused by sexual violence, as well as the opinions regarding the type ofcare provided to affected women.

Methods: The study was part of a larger pilot study that had across-sectional design and a descriptive approach, which explored health professionals’ views regarding their own levels of competence at responding to the health needs of victims of sexual violence, in the form of a semi-structured questionnaire.

Results: 104 health workers responded to the questionnaire. Nurses reported seeing raped women more frequently on a day-to-day basis (69.2%), in comparison to medical doctors and social workers (11.5%). Urinary incontinence was common according to 79% of health workers, who estimated that up to 15% of the women affected experienced huge amounts of urine leakage. Only 30% of the care seekers underwent in depth investigations, but the majority of the victims were not offered any further examination or appropriate treatments.

Conclusion: Urinary and fecal incontinence due to urogenital or colorectalfistulas among women exposed to sexual violence is a common in the specified setting, but lack of systematic investigation and appropriate treatment means that the quality of life of the victims may be negatively affected. An improvement in the ability of health workers to manage these complex diagnoses is urgently needed, as well as adequately equipping health services in the affected settings.

The aim of this study was to assess the status of Family Planning (FP) service uptake through its integration in HIV program for identification of determinants of its low use in Solwezi district of Zambia. Comparative quantitative FP/HIV data was gathered during quality improvement process from database at Zambia Prevention Care and TreatmentPartnership (ZPCT) Consortium for 2012 and 2013. Qualitative data was collected using semi-structured interviews with 29professionals, at the main urban clinic in the district, from January to June 2013. Two key indicators were assessed: HIV/FPreferrals at facility level and male partners’ involvement in seeking HIV/FP services. Referrals between HIV and FP servicesduring the first semester of 2013 increased by 1.0% compared to 2012, whilst male involvement in integrated FP/HIV services remained stagnant at 11%. Low male involvement in FP/HIV service was linked to busy spouses’ work schedules(74%), and lack of knowledge (16%). FP/HIV couple counseling was offered on selected clinic days in 74%, whilst lackof policy implementation encouraging male involvement was noted in 58% of responses. Fear of FP side effects (89%), longdistances to the clinic (74%), lack of adequate health information on FP (17%) and unavailability of the preferred FP method(11%) were essential obstacles to service accessibility. Internal systems improvement indicated slight progress incross-referrals reported. Interventions on the demand side are required, such as in strengthening male involvement in FP/HIVservice. FP services in the district would also benefit from increased variety of accessible FP methods.

The aim of this study was to assess health professionals’ opinions of their competence levels in responding to health needs of victims of sexual violence. This study used a cross-sectional design with a descriptive approach. A total of 104 physicians, nurses and social workers participated in the study. The data was collected using a questionnaire consisting of open and close-ended questions.  Overall, 75% of the respondents were university graduates, but only a quarter of them felt they have adequate competence to care for these women; 36% had difficulties with general health assessment of assaulted women. The results indicated that nurses are critical professionals in caring for victims of sexual violence, that they see these women more than any other professional category. However, they are more likely than other categories to report being incompetent. Access to continued education was difficult, and more so for clinically-oriented health professionals than for others social professionals. Human resources capacity strengthening and particularly that of nurses will be the key investment in addressing assaulted women’s health needs in this region. Clinical researchers are called to identify rapid methods to reinforce nurses’ capacity and role in such a context with deprived health systems.

Introduction: The Democratic Republic of Congo (DRC) is one of the high-burden TB countries in the world. The most affected provinces were North and South Kivu where displacements of the population favor transmission of infections. Delays in diagnosis are often causes for excessive mortality among TB patients. Aim of the Study: The study aimed to test an intervention designed to increase detection of TB cases in internally displaced persons and their host communities in South Kivu province. Methods: The project used a quasi-experimental method, with prospective data collection every six months. Two peri-urban districts were selected and designated as intervention and control districts respectively. Twenty peer educators were selected among prospective TB suspects who sought care in health facilities. The peer educators were trained and encouraged to actively influence, identify and refer potential TB suspects to health centers. The data on new TB suspects seen and cases diagnosed in both districts were collected and compared over two and a half years period. Results: This pilot study has demonstrated that the intervention has had some positive effects on both the number of persons suspected with TB who were diagnosed using either microscopy or clinical assessment. Even in terms of case detection, the study demonstrated that the number of cases detected in the intervention district was at least twice the number of cases detected in the control district. Conclusion:  Nonprofessional educators can influence TB case detection even in unstable settings, but their effectiveness is dependent on the security situation. National TB control programs need to adapt community mobilization strategies to local developments even in unsafe settings.

Sexual violence has become endemic in the Democratic Republic of Congo (DRC), but the perspectives of rural communities of the scourge remain poorly researched. This study aims to describe the attitudes and knowledge of rural communities in regard to sexual violence, its occurrence and associated problems in rural communities in the Itebero/Walikale district in the DRC. A descriptive cross-sectional design was adopted, and a structured questionnaire used. Four hundred respondents participated, representing a group of ten villages populated by a total of 10,000 inhabitants. The respondents stated that perpetrators were often men from their own village. The fields were cited as being the place where most of the assaults occurred. A substantial proportion of the respondents lacked sufficient knowledge of the health outcomes of sexual violence. HIV infection and unwanted pregnancies were the most feared consequences. The victims of violence either experienced compassion or suffered rejection, depending on the community groups. Victims were mostly supported by women from their community, followed by husbands, relatives and authorities. Health facilities were the primary sources of support for victims. Rural health facilities need to revolutionise their health education strategies to improve the current situation.

Background

In TB control, poor treatment adherence is a major cause of relapse and drug resistance. Nurses have a critical role in supporting patients in TB treatment process. Yet, very little research has been done to inform policymakers and practitioners on nurses’ experiences of treatment adherence among patients with TB.

Aim.

To describe nurses’ experiences of supporting treatment adherence among patients with tuberculosis in Burundi.

Method

The study adopted qualitative approach with a descriptive design. A purposive sampling was performed. Eight nurses were selected from two TB treatment centers in Burundi. Content analysis was used to analyze the data.

Result

According to the nurses,most patients complete their treatment. Educating patients, providing the medication, observing and following up treatment, and communicating with the patients were the key tasks by nurses to support adherence. Causes for interruption were medication-related difficulties, poverty, and patients’ indiscipline. Treatment adherence could also be affected by patients’ and nurses’ feelings. Providing transportation and meals could enhance treatment compliance.

Conclusion

Nurses are critical resources to TB treatment success. In a poverty stricken setting, nurses’ work could be facilitated and adherence further could be enhanced if socioeconomic problems (transportation and nutritional support) were alleviated.

BACKGROUND AND OBJECTIVE: The involvement of traditional healthcare providers (THPs) has been suggested among strategies to increase tuberculosis case detection. Burkina Faso has embarked on such an attempt. This study is a preliminary assessment of that model.

METHODS: Qualitative data were collected using unstructured key informant interviews with policy makers, group interviews with THPs and health workers, and field visits to THPs. Quantitative data were collected from program reports and the national tuberculosis (TB) control database.

RESULTS AND ANALYSIS: The distribution of tasks among THPs, intermediary organizations and clinicians is appealing, especially the focus on active referral. THPs are offered incentives based on numbers of suspected cases confirmed by health workers at the clinic, based on microscopy results or clinical assessment. The positivity rate was 23% and 9% for 2006 and 2007, respectively. The contribution of the program to national case detection was estimated at 2% for 2006. Because it relied totally on donor funding, the program suffered from irregular disbursements, resulting in periodic decreases in activities and outcomes.

CONCLUSIONS: The study shows that single interventions require a broader positive policy environment to be sustainable. Even if the active referral approach seems effective in enhancing TB case detection, more complex policy work and direction, domestic financial contribution and additional evidence for cost-effectiveness are needed before the approach can be established as a national policy.

Background: The Democratic Republic of Congo (DRC) is one of the high burden TB countries. The country has been affected by a political conflict for more than 15 years now. HIV prevalence has been increasing in the country too. Detection and care of TB/HIV co-infected cases is a major problem in the country. Aim: This study aimed at describing patterns of health seeking behaviors among patients with TB/HIV regarding their choice of health facilities for integrated TB/HIV care in the Goma and surrounding health districts.

Methods: The methods used included a cross-sectional descriptive survey with TB/HIV co-infected patients and qualitative interviews of health workers.

Results: The study found that geographical residence did not play a major role in choice of facility for care by patients infected with TB and HIV. Many patients shun facilities which are close and seek care relatively far away. Instead of geographical proximity, availability of drugs and welcoming attitudes determined the choice of integrated care facilities. Also, fear for discrimination and stigmatization in the community result into patients in this area concealing their infection; rather, they claim being victim of empoisoning.

Conclusion: Sustained decentralization of integrated TB/HIV services through better programs’ coordination and community involvement to address misconceptions about TB and HIV and stigmatization are essential to promote uptake of TB/HIV services and retain patients in treatment.

Studies suggest that poor adherence to hypertension treatment is responsible for about two-thirds of uncontrolled hypertension, leading to complications such as stroke. Yet, patients-associated factors explaining poor adherence to antihypertensive treatment in Africa remains under-researched. This study aimed at assessing the level of compliance in hypertensive patients and identifying patients-related predictors of poor compliance. The study was a prospective cross-sectional. The data was collected during a six-month period. Participants were recruited from outpatients’ departments in three urban hospitals in Congo-Brazzaville. Bivariate and multivariate analyses (using T-test and chi-2) were performed to identify predictors of poor compliance. In total, 212 hypertensive patients were included. Their mean age was 58.3 ± 10.6 years (range 34 – 81). Compliance was poor in 69 (32.5%) and good or fair in 143 cases (67.5%). Bivariate analysis indicated several patient-related factors that could predict poor adherence. However, after adjustment by logistic regression, only knowledge of the treatment and perception of the severity of complications of hypertension showed statistically significant associations with poor compliance (p =0.0170 and p=0.0373 respectively). Efforts to enhance patients’ awareness about hypertension’s treatment and severity of the complications associated with the disease are called for in this particular context.