Background: Environmentally related morbidity and mortality still remain high worldwide, although they have decreased significantly in recent decades. This study aims to forecast malaria epidemics taking into account climatic and spatio-temporal variations and therefore identify geo-climatic factors predictive of malaria prevalence from 2001 to 2019 in the Democratic Republic of Congo. Methods: This is a retrospective longitudinal ecological study. The database of the Directorate of Epidemiological Surveillance including all malaria cases registered in the surveillance system based on positive blood test results, either by microscopy or by a rapid diagnostic test for malaria was used to estimate malaria morbidity and mortality by province of the DRC from 2001 to 2019. The impact of climatic factors on malaria morbidity was modeled using the Generalized Poisson Regression, a predictive model with the dependent variable Y the count of the number of occurrences of malaria cases during a period of time adjusting for risk factors. Results: Our results show that the average prevalence rate of malaria in the last 19 years is 13,246 (1,178,383–1,417,483) cases per 100,000 people at risk. This prevalence increases significantly during the whole study period (p < 0.0001). The year 2002 was the most morbid with 2,913,799 (120,9451–3,830,456) cases per 100,000 persons at risk. Adjusting for other factors, a one-day in rainfall resulted in a 7% statistically significant increase in malaria cases (p < 0.0001). Malaria morbidity was also significantly associated with geographic location (western, central and northeastern region of the country), total evaporation under shelter, maximum daily temperature at a two-meter altitude and malaria morbidity (p < 0.0001). Conclusions: In this study, we have established the association between malaria morbidity and geo-climatic predictors such as geographical location, total evaporation under shelter and maximum daily temperature at a two-meter altitude. We show that the average number of malaria cases increased positively as a function of the average number of rainy days, the total quantity of rainfall and the average daily temperature. These findings are important building blocks to help the government of DRC to set up a warning system integrating the monitoring of rainfall and temperature trends and the early detection of anomalies in weather patterns in order to forecast potential large malaria morbidity events.

Background: The 2018–2020 Ebola outbreak in the Democratic Republic of the Congo marked the first major cohort of Ebola survivors treated with advanced therapeutics, including monoclonal antibodies (REGN-EB3, ansuvimab, ZMapp) and remdesivir. This study explored factors influencing long-term sequelae in survivors who received these specific therapies. Methods: A prospective multicenter study enrolled 750 Ebola survivors from the 10th outbreak in the Democratic Republic of the Congo between April and October 2020. Participants were followed for 12 months to assess the recurrence of clinical sequelae according to Weibull and shared frailty models. Results: Of 750 of Ebola survivors, 650 (86.7%) experienced post-Ebola sequalae. The median age of survivors was 32 years and 56.7% were female. Among them, 463 (61.7%) experienced neurologic sequelae, 373 (49.7%) musculoskeletal sequelae, and 288 (38.4%) general sequelae. Globally, these persisted for at least 38 months postdischarge, with slight decreases over time. At enrollment (median time to baseline visit, 330 days after discharge), neurologic sequelae were more frequent in the REGN-EB3 group (hazard ratio, 2.14; 95% CI, 1.28–3.57) as compared with the remdesivir group. Musculoskeletal sequelae were associated with age (1.02; 1.00–1.03), ZMapp treatment (3.17; 1.81–5.56), and acute-phase hemorrhagic symptoms (1.64; 1.14–2.36). Ocular sequelae were associated with age (1.04; 1.02–1.06). Female sex, older age, metabolic comorbidities, and REGN-EB3 therapy were associated with recurrent neurologic and musculoskeletal sequelae. Recurrent ocular sequelae were more frequent in adults (1.02; 1.01–1.03). Conclusions: Despite improved survival with monoclonal antibody therapy, our findings highlight a high incidence of neurologic sequelae in the REGN-EB3 group and musculoskeletal sequelae in the ZMapp group as compared with the remdesivir group, as well as among older survivors, women, and those with comorbidities. These results underscore the need for targeting long-term care to effectively manage post-Ebola sequelae.

Seroprevalence surveys constitute a critical tool for estimating population exposure to infectious agents, particularly during public health emergencies. In the context of the coronavirus disease 2019 (COVID-19) pandemic, such surveys revealed that the circulation of Severe Acute Respiratory Syndrome Coronavirus 2 in Africa had been largely underestimated. The validity of these surveys, however, depends not only on the reliability of diagnostic tests but also on operational conditions, which are frequently challenged by fear, misinformation, and logistical constraints. In the Democratic Republic of the Congo, the National Institute of Biomedical Research conducted two seroprevalence surveys in Kinshasa in 2020 on behalf the project “Appui à la Riposte Africaine à l’Epidémie de COVID-19” (ARIACOV). This study described the challenges encountered and the adaptive strategies employed during these surveys, in order to improve future investigations. The study population comprised 41 eligible field workers who participated in the 2020 ARIACOV seroprevalence surveys in Kinshasa, including 28 interviewers and 13 specimen collectors. Of these, 24 individuals (16 interviewers and 8 specimen collectors) initially confirmed their participation. Ultimately, 15 participants took part in the focus group discussions, comprising 11 interviewers (39.3% of the 28 eligible interviewers) and 4 specimen collectors (30.8% of the 13 eligible specimen collectors). We collected data through two focus groups held in a single session, using a pre-tested semi-structured guide. Discussions were audio-recorded and complemented by observational notes until empirical saturation was achieved. We applied deductive thematic analysis, following Braun and Clarke’s framework, to three predefined domains: transportation, survey procedures, and sample management. The application of systematic manual coding, combined with researcher triangulation, reinforced the rigor and enhanced the credibility of the findings. The findings highlighted community mistrust, driven by rumors, apprehension regarding blood collection, financial suspicions, and inadequate communication. In addition, logistical and transportation challenges significantly constrained survey feasibility. Nonetheless, a range of adaptive strategies were implemented, enabling the successful conduct of the surveys despite the pandemic context and limited resources. The participants’ narratives suggest that strengthening field workers’ training, improving transparency, and working alongside community health workers could contribute to enhance the effectiveness of serological surveys during health crises in resource-constrained environments.