(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.

Background: Access to quality healthcare is a global fundamental human right. However, in the Democratic Republic of the Congo, several parameters affect the choices of health service users in fragile, rural contexts (zones). The overarching aim of this study was to identify the first recourse of healthcare-seeking and the determinants of utilization of health centers (primary health care structures) in the rural health zones of Katana and Walungu. Methods: A cross-sectional survey was conducted from June to September 2017. Consenting respondents comprised 1751 adults. Continuous data were summarized using means (standard deviation) and medians (interquartile range). We used Pearson’s chi-square test and Fisher exact test to compare proportions. Logistic regression was run to assess socio-determinants of health center utilization. Results: The morbidity rate of the sample population for the previous month was 86.4% (n = 1501) of which 60% used health centers for their last morbid episode and 20% did not. 5.3% of the respondents patronized prayer rooms and 7.9% resorted to self-medication principally because the cost was low, or the services were fast. Being female (OR: 1.51; p = 0.005) and a higher level of education (OR: 1.79; p = 0.032) were determinants of the use of health centers in Walungu. Only the level of education was associated with the use of health centers in Katana (OR: 2.78; p = 0.045). Conclusion: Our findings suggest that health centers are the first recourse for the majority of the population during an illness. However, a significant percentage of patients are still using traditional healers or prayer rooms because the cost is low. Our results suggest that future interventions to encourage integrated health service use should target those with lower levels of education.

The African Journal of Primary Health & Family Medicine welcomes submissions that encourage scholarly exchange between family medicine and primary health care researchers and practitioners across Africa and the developing world, whilst providing a contextual and holistic view of family medicine as practiced across the continent.

Background: The prevalence of hepatitis B virus infection remains high in the Democratic Republic of Congo (DRC), constituting a public health problem in view of the fatal complications it causes, notably cirrhosis and hepatocellular carcinoma. The aim of this study was to provide an overview of the situation of viral hepatitis B in the DRC and in particular its implications for public health. Methods: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) group guidelines. Google Scholar, PubMed, and ResearchGate were used as databases. The review essentially analyzed the viral hepatitis B (HBV) vaccination status of study subjects, diagnostic means, HBV genotypes in DR Congo, seroprevalence of HBV infection, subjects’ level of knowledge and perceptions of HBV, co-infection/comorbidity with HBV infection, factors associated with HBV infection and public health issues raised by HBV infection. Results: The vast majority of studies (69%) were carried out to determine the seroprevalence of HBV infection. The Determine rapid test was the most widely used test (10 studies), sometimes combined with ELISA (3 studies) and polymerase chain reaction (PCR) (1 study, for genotyping). Some of the public health issues raised by hepatitis B virus infection were identified in the course of the included studies, in relation to co-infection, comorbidity, associated factors, and individuals’ level of knowledge and perceptions of HBV. Certain factors were identified as being closely associated with HBV, notably healthcare professions (e.g., doctor, laboratory technician) and having several sexual partners. In terms of perception of HBV, the hepatitis B virus is recognized as dangerous, and the majority of people questioned in the various studies were aware that vaccination remains the most effective means of prevention. Conclusions: Hepatitis B is a highly contagious infectious disease present in the DRC, with a higher prevalence among healthcare professionals, sex workers, patients with certain diseases including HIV, and people with a history of blood transfusion. The surveillance system within the national blood transfusion program needs to be strengthened. Raising public awareness of the seriousness of viral hepatitis B, offering vaccination to at-risk populations, and systematically screening pregnant women and blood donors for HBV infection could help reduce the prevalence of viral hepatitis B.

Background: Poliomyelitis is a vaccine-preventable disease, with oral poliomyelitis vaccines (OPVs) and injectable poliomyelitis vaccines. In the Democratic Republic of the Congo (DRC), circulating vaccine-derived polioviruses (VDPVs) persist due to intrinsic and extrinsic factors, including the quality of the cold chain, which may make the vaccines less effective. This study’s objective was to evaluate the cold chain’s quality of OPVs and its effect on the vaccine’s viability and potency at different levels in health systems in Kinshasa. Methods: A cross-sectional study was conducted in Kinshasa, collecting OPVs at different levels of the health pyramid. Vaccine viability was assessed by cell culture using a modified World Health Organization (WHO) protocol, and the viral titer was determined using the Karber formula. The vaccine titer was classified as “very good”, “good”, or “poor” according to the WHO standard’s viral titer. Results: A total of 53 vaccines were collected and analyzed, compressing 38 bivalent oral poliomyelitis (bOPV) vaccines and 15 novel oral poliomyelitis vaccines, type 2 (nOPV2). The viral titer ranged from log10^5.8 to log 10^7.3 and from log10^5.4 to log10^8.9 for the nOPV2 and the bOPV, respectively. Of these 53 vaccine samples, 10% of the bOPVs showed viral titers below the recommended WHO threshold (>10⁶ CCID₅₀/dose), 100% of the nOPV2 had viral titers within the WHO standards (>10⁵ CCID₅₀/dose), and a significant decline in the viral titer was observed for both types of vaccines (nOPV2 and bOPV) as the distribution progressed along the level of the health pyramid. Conclusions: This study demonstrated that the viral titer of OPV declined from central to peripheral areas in routine and campaign strategies in Kinshasa.