Introduction Health service use among the public can decline during outbreaks and had been predicted among low and middle-income countries during the COVID-19 pandemic. In March 2020, the government of the Democratic Republic of the Congo (DRC) started implementing public health measures across Kinshasa, including strict lockdown measures in the Gombe health zone. Methods Using monthly time series data from the DRC Health Management Information System (January 2018 to December 2020) and interrupted time series with mixed effects segmented Poisson regression models, we evaluated the impact of the pandemic on the use of essential health services (outpatient visits, maternal health, vaccinations, visits for common infectious diseases and non-communicable diseases) during the first wave of the pandemic in Kinshasa. Analyses were stratified by age, sex, health facility and lockdown policy (ie, Gombe vs other health zones). Results Health service use dropped rapidly following the start of the pandemic and ranged from 16% for visits for hypertension to 39% for visits for diabetes. However, reductions were highly concentrated in Gombe (81% decline in outpatient visits) relative to other health zones. When the lockdown was lifted, total visits and visits for infectious diseases and non-communicable diseases increased approximately twofold. Hospitals were more affected than health centres. Overall, the use of maternal health services and vaccinations was not significantly affected. Conclusion The COVID-19 pandemic resulted in important reductions in health service utilisation in Kinshasa, particularly Gombe. Lifting of lockdown led to a rebound in the level of health service use but it remained lower than prepandemic levels.

(1) Introduction: The Democratic Republic of the Congo (DRC) has one of the largest cohorts of un- and under-vaccinated children worldwide. This study aimed to identify and compare the main reasons for there being zero-dose (ZD) or under-vaccinated children in the DRC. (2) Methods: This is a secondary analysis derived from a province-level vaccination coverage survey conducted between November 2021 and February 2022; this survey included questions about the reasons for not receiving one or more vaccines. A zero-dose child (ZD) was a person aged 12–23 months not having received any pentavalent vaccine (diphtheria–tetanus–pertussis–Hemophilus influenzae type b (Hib)–Hepatitis B) as per card or caregiver recall and an under-vaccinated child was one who had not received the third dose of the pentavalent vaccine. The proportions of the reasons for non-vaccination were first presented using the WHO-endorsed behavioral and social drivers for vaccination (BeSD) conceptual framework and then compared across the groups of ZD and under-vaccinated children using the Rao–Scott chi-square test; analyses were conducted at province and national level, and accounting for the sample approach. (3) Results: Of the 51,054 children aged 12–23 m in the survey sample, 19,676 ZD and under-vaccinated children were included in the study. For the ZD children, reasons related to people’s thinking and feelings were cited as 64.03% and those related to social reasons as 31.13%; both proportions were higher than for under-vaccinated children (44.7% and 26.2%, respectively, p < 0.001). Regarding intentions to vaccinate their children, 82.15% of the parents/guardians of the ZD children said they wanted their children to receive “none” of the recommended vaccines, which was significantly higher than for the under-vaccinated children. In contrast, “practical issues” were cited for 35.60% of the ZD children, compared to 55.60% for the under-vaccinated children (p < 0.001). The distribution of reasons varied between provinces, e.g., 12 of the 26 provinces had a proportion of reasons for the ZD children relating to practical issues that was higher than the national level. (4) Conclusions: reasons provided for non-vaccination among the ZD children in the DRC were largely related to lack of parental/guardian motivation to have their children vaccinated, while reasons among under-vaccinated children were mostly related to practical issues. These results can help inform decision-makers to direct vaccination interventions.

(1) Background: The Democratic Republic of the Congo (DRC) is one of the countries with the highest number of never vaccinated or “zero-dose” (ZD) children in the world. This study was conducted to examine the proportion of ZD children and associated factors in the DRC. (2) Methods: Child and household data from a provincial-level vaccination coverage survey conducted between November 2021–February 2021 and 2022 were used. ZD was defined as a child aged 12 to 23 months who had not received any dose of pentavalent (diphtheria-tetanus-pertussis-Haemophilus influenzae type b (Hib)-Hepatitis B) vaccine (by card or recall). The proportion of ZD children was calculated and associated factors were explored using logistic regression, taking into account the complex sampling approach. (3) Results: The study included 51,054 children. The proportion of ZD children was 19.1% (95%CI: 19.0–19.2%); ZD ranged from 62.4% in Tshopo to 2.4% in Haut Lomami. After adjustment, being ZD was associated with low level of maternal education and having a young mother/guardian (aged ≤ 19 years); religious affiliation (willful failure to disclose religious affiliation as the highest associated factor compared to being Catholic, followed by Muslims, revival/independent church, Kimbanguist, Protestant); proxies for wealth such as not having a telephone or a radio; having to pay for a vaccination card or for another immunization-related service; not being able to name any vaccine-preventable disease. A child’s lack of civil registration was also associated with being ZD. (4) Conclusions: In 2021, one in five children aged 12–23 months in DRC had never been vaccinated. The factors associated with being a ZD child suggest inequalities in vaccination that must be further explored to better target appropriate interventions.

Whilst men and boys account for more COVID-19 cases and deaths, the secondary impacts of the outbreak on women and girls in the Democratic Republic of the Congo are cross-cutting and far-reaching. School closures put girls at increased risk of adolescent pregnancy, sexual violence and early marriage; more women working in the informal sector have lost jobs and been affected by closures of markets and borders; and frequent restrictions on sexual and reproductive healthcare have impacted access to services for women. Lessons learnt from previous health crises can help to highlight the extent of these issues. However, a lack of sex disaggregated data around COVID-19 morbidity and mortality in the DRC means that it is impossible to fully measure and understand the impact of the outbreak on women and girls or develop and implement appropriate interventions. This article presents a metasynthesis of existing and ongoing analyses to highlight the broader impacts of COVID-19 on women and girls in the country.

While global interest in mpox may be waning, outbreaks, illness, and death continue across Africa and the world. Ending transmission requires a sustained global response that moves beyond reactive measures.

This study examines the community integration and One Health strategies employed to combat Ebola virus disease in the Democratic Republic of Congo from 2007 to 2022. We synthesized 12 outbreak reports, conducted qualitative interviews with 36 managers, organized three focus groups, and adapted an analytical framework (MATCH) to evaluate three essential dimensions: the integration of the One Health approach, community involvement, and bottom-up approaches. This study evidences progressive improvement in all domains. The first outbreaks (2007–2009) were marked by moderate community engagement and a One Health approach that was largely limited to the human health sector, deemed suboptimal. The 10th outbreak represented an era of transformation, when the Incident Management System (IMS) was adopted to better manage the response to the virus. The latest outbreaks (13th to 15th) demonstrate an “optimal” implementation of the “One Health” approach through effective collaboration between those in charge of ensuring human, animal, and environmental health and that of the community. This study demonstrates that success is largely dependent on bottom-up initiatives in which local populations, their leaders (both traditional and religious), community liaisons, and specific groups (women and youth) are involved in the design and implementation of such measures. The inclusion of anthropologists and psychologists in addressing the psychosocial dimensions—fear, stigma, and distress—has been critical in ensuring the success of these initiatives and the degree to which the public trusts and accepts them. However, many issues still need to be addressed, including poor coordination among sectoral ministries and the partial implementation of IMS at the grassroots level. In summary, the authors of this study propose that these integrated and participatory models are sustainable and imperative to building the resilience of the Congolese health system to future outbreaks.