Iron deficiency (ID), the leading cause of anemia and the most common nutritional deficiency globally, is not well reported among children in malaria-endemic settings, and little is known about its contribution to anemia in these settings. We aimed to assess the prevalence of anemia, the role of ID using multiple parameters, and the factors associated with anemia in a malaria-endemic rural area. We conducted a community-based cross-sectional study of 432 children aged 1–5 years from the Popokabaka Health Zone, Democratic Republic of Congo. Sociodemographic characteristics, medical history, anthropometric parameters, and biochemical parameters were considered. Hemoglobin and malaria prevalence were assessed using rapid finger-prick capillary blood testing in the field. Venous blood samples were analyzed for serum ferritin, serum iron, total iron-binding capacity, and C-reactive protein (CRP) in a laboratory. Anemia was found in 294 out of 432 (68%) patients. Malaria was found in 375 out of 432 (87%), and ID in 1.8% according to diagnosis by adjusted ferritin only and in 12.9% according to transferrin saturation. ID indicators were not significantly correlated with low hemoglobin levels. Malaria, fever, and CRP > 5 mg/L were major factors associated with anemia in Popokabaka. Anemia control should focus on treating inflammatory conditions and infectious diseases among children in such settings.

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.

Despite efforts to increase childhood vaccination coverage in the Democratic Republic of the Congo (DRC), approximately 20% of infants have not started their routine immunization schedule (zero-dose). The present study aims to evaluate the relative influence of geospatial access to health facilities and caregiver perceptions of vaccines on the vaccination status of children in rural DRC. Pooled data from two consecutive nationwide immunization surveys conducted in 2022 and 2023 were used. Geographic accessibility was assessed based on travel time from households to their nearest health facility using the AccessMod 5 model. Caregiver attitudes to vaccination were assessed using the survey question “How good do you think vaccines are for your child?” We used logistic regression to assess the relationship between geographic accessibility, caregiver attitudes toward vaccination, and their child’s vaccination status. Geographic accessibility to health facilities was high in rural DRC, with 88% of the population living within an hour’s walk to a health facility. Responding that vaccines are “Bad, Very Bad, or Don’t Know” relative to “Very Good” for children was associated with a many-fold increased odds of a zero-dose status (ORs 69.3 [95%CI: 63.4–75.8]) compared to the odds for those living 60+ min from a health facility, relative to <5 min (1.3 [95%CI: 1.1–1.4]). Similar proportions of the population fell into these two at-risk categories. We did not find evidence of an interaction between caregiver attitude toward vaccination and travel time to care. While geographic access to health facilities is crucial, caregiver demand appears to be a more important driver in improving vaccination rates in rural DRC.

Information about essential trace elements among children in many African countries, including the Democratic Republic of Congo (DRC), is limited. We aimed to measure the distribution and determinants of serum zinc (Zn), copper (Cu), and selenium (Se) concentrations in a representative sample of children under five years old. We conducted a community-based cross-sectional study in Popokabaka, DRC. Blood samples were drawn from 412 children. The serum concentrations of minerals were measured using inductively coupled plasma–mass spectrometry. The median concentrations (P25–P75) of Zn, Cu, and Se were 61.9 µg/dL (52.8–70.2), 145.5 (120.0–167.0) µg/dL and 5.3 (4.3–6.3) µg/dL. The CRP-adjusted prevalence of serum Se deficiency was 84.1% (95% confidence interval [CI] 81.4–87.0) and of Zn deficiency was 64.6% (95% CI 59.8–69.1%). Only a few children were Cu deficient [1.5% (0.6–3.2)]. Evidence of inflammation (C-reactive protein, >5 mg/L) was associated with a lower Se concentration and higher Cu concentration. Furthermore, serum Se concentration was positively associated with linear growth. The average Cu/Zn molar ratio (2:1) was twice that recommended. Children in western Popokabaka had higher Zn and Se levels than their eastern neighbors. Zinc and selenium deficiencies are common among children in Popokabaka and require attention and prioritization.

Exposure to heavy metals can affect cell differentiation, neurocognitive development, and growth during early life, even in low doses. Little is known about heavy metal exposure and its relationship with nutrition outcomes in non-mining rural environments. We carried out a community-based cross-sectional study to describe the distribution of four heavy metal concentrations [arsenic (As), cadmium (Cd), lead (Pb), and mercury (Hg)] in the serum of a representative population of children aged 12 to 59 months old from the rural region of Popokabaka, Democratic Republic of Congo. The four metals were measured in 412 samples using inductively coupled plasma–mass spectrometry (ICP–MS). Limits of detection (LoD) and quantification (LoQ) were set. Percentiles were reported. Statistical and geospatial bivariate analyses were performed to identify relationships with other nutrition outcomes. Arsenic was quantified in 59.7%, while Cd, Hg, and Pb were quantified in less than 10%, all without toxicities. The arsenic level was negatively associated with the zinc level, while the Hg level was positively associated with the selenium level. This common detection of As in children of Popokabaka requires attention, and urgent drinking water exploration and intervention for the profit of the Popokabaka community should be considered.