Search Results (31)

Background: The 2026 outbreak of Bundibugyo Ebola virus disease (BDBV) in eastern Democratic Republic of the Congo (DRC), centered in Ituri Province, represents the largest documented outbreak caused by Bundibugyo ebolavirus since its discovery in Uganda in 2007. The outbreak evolved within a complex humanitarian setting characterized by armed conflict, population displacement, mining-related migration, weak health systems, extensive population mobility, and an infodemic environment marked by misinformation and reduced public trust. We conducted a field investigation to assess epidemiological, operational, laboratory, infection prevention and control (IPC), community engagement, risk communication, and infodemic management challenges and identify priority interventions to strengthen outbreak control. Methods: A rapid field assessment was conducted between 12–15 June 2026 in Bunia, Rwampara Health Zone, and the Ituri Provincial Public Health Laboratory. Data were collected through direct observation, review of surveillance and laboratory reports, health facility assessments, stakeholder interviews, and analysis of outbreak response indicators. Epidemiological trends, surveillance performance, laboratory capacity, clinical care, IPC activities, logistics, risk communication, community engagement, and infodemic management approaches were evaluated. Results: As of 12 July 2026, the outbreak had resulted in 1926 laboratory-confirmed cases and 702 deaths, corresponding to an overall case fatality rate (CFR) of 36.4% across affected provinces. Ituri Province remained the epicenter, accounting for 90.8% of confirmed cases (1705/1877) and 85.5% of reported deaths (577/675). During the preceding 24 h, 53 new confirmed cases and 30 deaths were reported, including 20 community deaths (66.7%), highlighting persistent delays in detection, referral, and access to care. Surveillance systems identified 766 alerts, of which 678 (88.5%) were investigated, resulting in 235 suspected cases. Contact tracing remained a major challenge, with only 64.4% (4171/6475) of registered contacts successfully followed, below the recommended ≥95% target. Laboratory activities included testing of 137 specimens, with 29 positive results and an overall positivity rate of 21.2%. Decentralized molecular diagnostic platforms improved access to testing; however, data inconsistencies, delayed investigations, and gaps in outcome classification affected response monitoring. Major operational challenges included limited treatment capacity, high occupancy of Ebola treatment centres, shortages of trained personnel and IPC supplies, insecurity affecting response teams, and insufficient preparedness in newly affected areas. Community resistance, attacks on burial teams, detention of frontline responders, misinformation, and rumors contributed to delayed care-seeking, reduced acceptance of public health measures, and incomplete cooperation with contact tracing. Risk communication and community engagement efforts were constrained by limited outreach capacity, language barriers, low trust, and inadequate systems for rumor detection and infodemic response. Conclusions: The ongoing BDBV outbreak in eastern DRC demonstrates the difficulty of controlling Ebola transmission in conflict-affected and socially complex settings. Sustained transmission, community deaths, geographic expansion, and operational constraints highlight the urgent need to strengthen surveillance, contact tracing, laboratory systems, IPC capacity, clinical care, and integrated risk communication and infodemic management strategies. Building trust through community-centered approaches, proactive misinformation management, and engagement of trusted local actors will be essential to accelerate outbreak containment and strengthen preparedness across the Great Lakes region. Full article

Climate-related disturbances are increasingly identified as major determinants of food insecurity in fragile environments, yet empirical evidence remains scarce in conflict-affected areas such as the eastern Democratic Republic of Congo (DRC). Using high-frequency FAO DIEM-Monitoring surveys (2022–2026), this paper estimates the causal effect of climate shocks on household food security in the provinces of Ituri, North Kivu, South Kivu, and Tanganyika. Food security is measured with five validated indicators (FCS, HDDS, HHS, FIES, and rCSI); capturing multiple dimensions of access, consumption, and coping. To address endogeneity in self-reported shock exposure, the authors apply an instrumental-variable Conditional Mixed Process (IV-CMP) model and triangulate results with a pseudo-panel fixed-effects ordered probit model based on FIES severity. Objective climate proxies (rainfall and NDVI) are used to reinforce robustness. The results indicate that climate shocks lead to a significant deterioration in food consumption and raise the likelihood of households experiencing both moderate and severe food insecurity, thereby undermining sustainable food security. Effects are heterogeneous across provinces, reflecting the interaction between climate variability, conflict intensity, and market access constraints. Female-headed households are disproportionately affected in some areas, highlighting gendered vulnerabilities, while income, education, livestock ownership, and land access mitigate vulnerability. These findings highlight the need for integrated and sustainability-oriented policy responses combining climate-smart agriculture, adaptive social protection, early warning systems, and conflict-sensitive programming. Overall, this research advances existing knowledge by delivering rigorous causal insights based on multiple food security indicators and advanced econometric techniques in a highly fragile setting. Full article

Mpox remains endemic in the Democratic Republic of the Congo (DRC), where co-endemic infections and non-communicable comorbidities may influence disease severity and clinical outcomes. However, data on associated factors of adverse outcomes among hospitalised adults with mpox in African settings remain limited. This study aimed to describe the clinical profile of adults hospitalised with mpox in South Kivu Province, eastern DRC, and to explore associations between selected comorbid conditions, including HIV infection, malaria, and hyperglycaemia, and mpox disease severity, mortality, and hospitalisation duration. We conducted a multicentre retrospective observational study among adults admitted to five mpox treatment centres in South Kivu Province, DRC, between January 2024 and December 2025. Demographic, clinical, and laboratory data were extracted from routine hospital registers. Mpox disease severity (available only for a subset of participants) was classified according to WHO criteria. Participants included adults with suspected, probable or laboratory-confirmed mpox according to WHO case definitions in use during the study period. In addition to mpox disease severity, outcomes of interest included in-hospital mortality and duration of hospitalisation. Multivariable regression models were used to explore associations between selected comorbidities and clinical outcomes after adjustment for age and sex. Among 652 hospitalised adults included in the analysis, the median age was 26 years (IQR 21.0–35.0), and 383/652 (58.7%) were female. Among patients with recorded severity data (n = 104), moderate or severe mpox was documented in 88/104 (84.6%) patients. Overall mortality was 14/645 (2.2%). HIV infection was identified in 5 of the 71 participants tested (7.0%). Among participants with available test results, HIV infection appeared to be associated with higher mpox severity and mortality. Increasing age, but not HIV infection, malaria, or glycaemic status, was associated with longer hospitalisation. Because laboratory investigations were performed in only a subset of participants and missing data were substantial, these findings should be interpreted cautiously and considered exploratory. Prospective studies incorporating systematic laboratory testing and standardised clinical data collection are needed to better define factors associated with severe mpox in endemic African settings. Full article

In August 2024, the Africa Centres for Disease Control and Prevention (Africa CDC) declared mpox a Public Health Emergency of Continental Security (PHECS), and the World Health Organization (WHO) followed with a second Public Health Emergency of International Concern (PHEIC), in response to the rapid expansion of clade Ib monkeypox virus (MPXV) across eastern Democratic Republic of the Congo (DRC) and neighboring countries. Both declarations have since been lifted (September 2025 and January 2026), yet clade Ib transmission and severe outcomes in pregnant women and children persist. We argue that closing these emergency mechanisms marks not the end of the epidemic but the start of a harder phase: sustaining surveillance, care, and research amid shrinking donor support, including the dissolution of the United States Agency for International Development (USAID). We contend that integrating mpox into existing HIV, sexually transmitted infection (STI), and reproductive health platforms is the most realistic route to durable routine care, while pregnancy, paediatric disease, severe cases, and zoonotic spillover still need dedicated pathways. Sustainable management ultimately depends on domesticated financing, stronger institutions, genuine community engagement, and action on the ecological drivers of spillover. Full article

Maize is vital for food systems and rural livelihoods in the Democratic Republic of Congo (DRC). Continuous cultivation depletes soil nutrients, reducing maize production. Inorganic (or mineral) fertilizers provide nutrients rapidly, but their cost and sustainability concerns have prompted interest in alternatives. Biological amendments improve nutrient uptake and soil structure and boost crop resistance, potentially cutting mineral fertilizer use. The present study aims to investigate the direct and residual effects of biological amendments (BAs) on maize productivity in the Eastern DRC, both when applied alone or combined with inorganic fertilizer, with trials conducted in the Kabare, Kalehe, and Ruzizi Plain regions from October 2022 to June 2024. Two trials across four seasons gathered data using a randomized complete block design (RCBD) with nine treatments and three replicates: Control, without fertilizer application; farmer practice; inorganic fertilizer (NPK 17-17-17 and urea); BA_1: Lactobacillus; BA_2: fish serum; BA_3: black soldier fly (BSF) compost; BA_1 + inorganic fertilizer; BA_2 + inorganic fertilizer; and BA_3 + inorganic fertilizer. The results identified three categories: integrated organic and inorganic fertilizers, single applications, and inconsistent uses. The best outcomes emerged from treatments combining Lactobacillus, fish serum, and BSF compost with inorganic fertilizer, positively impacting maize yield parameters. The study confirms that combining biological amendments and mineral fertilizers significantly (p < 0.001) enhances maize productivity in the Eastern DRC. Performance differences across locations emphasize the influence of local soil characteristics and targeted nutrient strategies. Full article

Cabbage (Brassica oleracea Linnaeus) is an important vegetable crop for food security and income generation for farmers in the Democratic Republic of Congo (DRC). However, production is severely undermined by a complex of insect pests. This study investigates farmers’ knowledge, perception, and pest management practices in key cabbage-growing areas surrounding Goma city in Eastern DRC. A total of 430 farmers were interviewed using a structured survey administered via the KoboToolbox platform. The diamondback moth (Plutella xylostella Linnaeus, 1758) and the cabbage aphid (Brevicoryne brassicae Linnaeus, 1758) were identified as the main pests, with peak incidences reported during the dry mid-season. Pest damages are most frequently observed at the post-transplanting and heading stages of cabbage. Although chemical control was the dominant strategy (69.4%), concerns arise due to the widespread use of moderately to highly hazardous insecticides, including pyrethroid, organophosphorus, and avermectin-based formulations. The insufficient use of personal protective equipment (PPE) and limited training on safe pesticide handling remain further challenges. While indigenous practices, such as crop rotation, handpicking of insects, and the use of botanical extracts, are employed to a lesser extent, awareness and implementation of biological control are almost nonexistent. The findings underscore the need to promote integrated pest management (IPM) approaches based on agroecological principles, including the safe use of (bio-)pesticides, training programs, and stakeholder engagement to enhance sustainable cabbage production. Full article

The ongoing mpox clade Ib outbreak was first detected in the eastern Democratic Republic of Congo (DRC) and was associated with sexual transmission. It emerged in Kamituga, a mining city and spread rapidly in surrounding health zones and reached cities like Bukavu and Goma. Here, we describe the clinical, epidemiological, and virological characteristics of the first case of clade Ib in Kinshasa, the capital city in the western DRC. The case involved a young adult woman from Kinshasa who reported unprotected sexual contact with an occasional partner, a former friend, and subsequently developed genital lesions, including vesicles and pustules. These lesions evolved and spread to the entire body, including the limbs, eyes, and soles. The diagnosis was confirmed by PCR and sequencing allowed us to assign clade Ib. We show that infection with mpox clade Ib through sexual transmission can lead to limbal nodular keratoconjunctivitis and focal conjunctivitis as complications. Importantly, these results suggest that clade Ib may have been circulating silently in Kinshasa prior to the official declaration by the Ministry of Health. This also raises concerns about the potential risk of global spread, as is currently being observed. Further studies are needed to investigate whether subsequent outbreaks of clade Ib in Kinshasa may have emerged independently of introductions from Kivu, pointing to a more complex pattern of co-circulation that could define the mpox epidemic in the capital. Full article

The city of Uvira, located in the eastern Democratic Republic of Congo (DRC), is increasingly experiencing flood events with devastating impacts on human life, infrastructure, and livelihoods. This study evaluates flood susceptibility in Uvira using Geographic Information Systems (GISs), and an Analytical Hierarchy Process (AHP)-based Multi-Criteria Decision Making approach. It integrates eight factors contributing to flood occurrence: distance from water bodies, elevation, slope, rainfall intensity, drainage density, soil type, topographic wetness index, and land use/land cover. The results indicate that proximity to water bodies, drainage density and slope are the most influential factors driving flood susceptibility in Uvira. Approximately 87.3% of the city’s land area is classified as having high to very high flood susceptibility, with the most affected zones concentrated along major rivers and the shoreline of Lake Tanganyika. The reliability of the AHP-derived weights is validated by a consistency ratio of 0.008, which falls below the acceptable threshold of 0.1. This research provides valuable insights to support urban planning and inform flood management strategies. Full article

The Sustainable Development Goals commit states to Universal Health Coverage (UHC) for all; yet displaced populations—including asylum seekers, refugees, internally displaced persons (IDPs), and undocumented migrants—remain systematically excluded from national health systems across southern and eastern Africa. This paper applies a whole-of-route, rights-based framework to examine how legal status, policy implementation, and structural governance shape healthcare access for displaced populations across South Africa, Kenya, Somalia, and the Democratic Republic of Congo (DRC). Drawing on 70 key informant interviews and policy analysis conducted between 2020 and 2025, the study finds that despite formal commitments to health equity, access remains constrained by restrictive legal regimes, administrative discretion, and fragmented service delivery models. Critical gaps persist in migration-sensitive planning, gender-responsive care, and mental health integration. The findings highlight the limitations of rights-based rhetoric in the absence of legal coherence, intersectoral coordination, and political will. To realise UHC in displacement contexts, health systems must move beyond citizen-centric models and embed migration-aware, inclusive, and sustainable approaches across all stages of displacement. Without such structural reforms, displaced populations will remain at the margins of national health agendas—and the promise of health for all will remain unmet. Full article

Healthcare-acquired infections are a major problem in healthcare facility settings around the world. The Democratic Republic of the Congo (DRC) has over 2 million diarrhea patients hospitalized each year. These healthcare settings become high-risk environments for spreading diarrheal illnesses such as cholera. The objective of the Preventative Intervention for Cholera for 7 Days (PICHA7) program is to develop evidence-based water, sanitation, and hygiene (WASH) interventions to reduce cholera and other severe diarrheal diseases in the DRC. The study objective was to evaluate the effectiveness of PICHA7 program delivery in increasing handwashing with a cleansing agent at stool/vomit- and food-related events in a healthcare facility setting among diarrhea patients and patient attendants. A pilot of the PICHA7 program was conducted among 284 participants in 27 healthcare facilities from March 2020 to November 2021 in urban Bukavu in the South Kivu Province of the DRC. The standard arm received the standard message provided in the DRC to diarrhea patients on the use of oral rehydration solution and a basic WASH message at healthcare facility discharge. The PICHA7 arm received the PICHA7 WASH pictorial module delivered by a health promoter focused on handwashing with a cleansing agent at the bedside of the diarrhea patient in the healthcare facility and provision of a soapy water bottle (water and detergent powder). Within 24 h of intervention delivery, a three-hour structured observation of handwashing practices at stool/vomit- and food-related events (key events) was conducted in healthcare facilities of diarrhea patients and their attendants. Compared to the standard arm, there was significantly more handwashing with a cleansing agent at key events in the PICHA7 arm (40% vs. 15%) (odds ratio: 5.04; (95% confidence interval (CI): 2.01, 12.7)). These findings demonstrate that delivery of the PICHA7 WASH pictorial module and provision of a soapy water bottle to diarrhea patients and their attendants presents a promising approach to increase handwashing with a cleansing agent among this high-risk population in healthcare facilities in the eastern DRC. Full article

Two novel vaccines against malaria are proposed as a complementary control tool to prevent and reduce Plasmodium falciparum related disease and death in under-five children from moderate to high malaria transmission regions. The Democratic Republic of Congo (DRC) has committed to eradicate malaria by 2030, and significant efforts have been deployed to strengthen control and elimination measures. We aimed to understand factors influencing the malaria vaccine acceptability among the general population in eastern DRC. We conducted a survey among adult Congolese in Bukavu in March 2022. The questionnaire was adapted from the Behavioral and Social Drivers of vaccine uptake (BeSD) framework and was administered online and physically. Multivariate logistic regressions were built, and estimates were represented as adjusted odds ratios (aOR) and corresponding 95% confidence intervals (95%CI). Out of 1612 adults (median age: 39 years, 46.15% female) surveyed, only 7.26% were aware of the malaria vaccine. However, 46.53% expressed willingness to vaccinate themselves, and 52.60% were open to vaccinating their under-five children. Adjusting for confounding factors, non-student/non-healthcare worker professions (aOR = 0.58, 95%CI [0.42–0.78]) and middle-income status (aOR = 1.87, 95%CI [1.25–2.80]) were significantly associated with self-vaccination acceptance. Age played a role in under-five child vaccination acceptability, with 25 to over 64 years showing increased acceptability compared to the 18–24 age group. Additionally, non-student/non-healthcare worker professions (aOR = 1.88, 95%CI [1.37–2.59]), medium education levels (aOR = 2.64, 95%CI [1.29–5.79]), and residing in semi-rural areas (aOR = 1.63, 95%CI [1.27–2.10]) were predictors of under-five child vaccination acceptance. The acceptability of the malaria vaccine for self and for under-five children was suboptimal for effective malaria control in this community in the DRC. Our study constitutes a call for the Expanded Program on Immunization to closely work with various stakeholders to strengthen risk communication for community engagement prior to and during the introduction of this novel and lifesaving tool, malaria vaccination. Full article

In Africa, rice has always been a staple food in some countries and the fastest growing food source there. In the Democratic Republic of Congo (DRC), in terms of cereal production, rice is ranked second after maize and is an important source of income for the rice farmer. The objective of this study was to analyze and understand consumers’ preferences and behaviors towards local and imported rice in the South Kivu and Tanganyika provinces, DRC. Data collected on 1565 rice-consuming households in eastern DRC showed that there is a great opportunity for the rice value chain and food policy development, and the promotion of local rice consumption. Consumers focus on local rice because it is cheaper, but it does not always meet their desired needs. Indeed, only urban consumers were more willing to pay for higher-quality rice. The development of the demand for local rice calls for strong investment in improving production, post-harvest practices, and market aspects. It was found that over 90% of rice consumers know about local rice production and over 84% have consumed it. In rural areas, there is typically lower consumption of imported rice. However, as households require more rice, they tend to rely more on imported varieties due to their availability in the market. The most preferred rice attributes were flavor, aroma, purity, swelling capacity, breakage rate, and whiteness. Therefore, rice producers should consider the habits and needs of consumers to improve market demand. In addition, good packaging, labeling, and marketing can also enhance local rice preference and competitiveness in South Kivu and Tanganyika provinces in eastern DRC. The findings of this study indicated that research aimed at improving local rice varieties with regard to yield, disease resistance, and organoleptic qualities could enable the population to consume more locally produced rice, which is often more affordable than imported rice. This could in turn significantly reduce the need for rice imports. These results suggest that research carried out to improve the yield and organoleptic qualities of local rice in this area can allow it to be more competitive on the market and can reduce the importation of rice. Full article

A lack of awareness regarding obstetric danger signs (ODS) is one of the factors that delay a pregnant woman’s decision to seek emergency obstetric care. In developing countries, this delay can lead to high morbidity and mortality among pregnant women. In eastern Democratic Republic of Congo (DRC), very few studies have been conducted to assess the level of knowledge of pregnant women about ODS. Therefore, this study aimed to assess the knowledge of pregnant women about ODS in health facilities in eastern DRC. This quantitative cross-sectional, descriptive, and analytical study was conducted in 19 health facilities in the Kasongo health zone in the south Maniema Province of eastern DRC. A total of 624 pregnant women aged 12–49 years were interviewed in this study. Of these, 60.6% were secondary school graduates, >99% were married, 85.5% were cultivators, and 67.9% were Muslims. The knowledge of ODS among pregnant women was low (21.9%). The most cited danger signs during pregnancy, labor/delivery, and postpartum included severe abdominal pain and severe vaginal bleeding. Additionally, pregnant women aged 30–39 years (p = 0.015) and those who had given birth once (p = 0.049), twice (p = 0.003), 3–5 times (p = 0.004), and >5 times (p = 0.009) were more likely to be aware of ODS than others. Our findings indicated that pregnant women have little knowledge of ODS, which makes it difficult for them to take prompt decisions to seek emergency obstetric care. Thus, strategies to increase the knowledge of pregnant women about obstetrical danger signs by healthcare providers during prenatal consultations (antenatal care) must be developed to improve their rapid decision-making skills during pregnancy, labor, and postpartum. Full article

Multidrug-resistant (MDR) and extended spectrum β-lactamase (ESBL)-producing extra-intestinal K. pneumoniae are associated with increased morbidity and mortality. This study aimed to characterize the resistance and virulence profiles of extra-intestinal MDR ESBL-producing K. pneumoniae associated with infections at a tertiary hospital in South-Kivu province, DRC. Whole-genome sequencing (WGS) was carried out on 37 K. pneumoniae isolates displaying MDR and ESBL-producing phenotype. The assembled genomes were analysed for phylogeny, virulence factors and antimicrobial resistance genes (ARG) determinants. These isolates were compared to sub-Saharan counterparts. K. pneumoniae isolates displayed a high genetic variability with up to 16 sequence types (ST). AMR was widespread against β-lactamases (including third and fourth-generation cephalosporins, but not carbapenems), aminoglycosides, ciprofloxacin, tetracycline, erythromycin, nitrofurantoin, and cotrimoxazole. The bla_CTX-M-15 gene was the most common β-lactamase gene among K. pneumoniae isolates. No carbapenemase gene was found. ARG for aminoglycosides, quinolones, phenicols, tetracyclines, sulfonamides, nitrofurantoin were widely distributed among the isolates. Nine isolates had the colistin-resistant R256G substitution in the pmrB efflux pump gene without displaying reduced susceptibility to colistin. Despite carrying virulence genes, none had hypervirulence genes. Our results highlight the genetic diversity of MDR ESBL-producing K. pneumoniae isolates and underscore the importance of monitoring simultaneously the evolution of phenotypic and genotypic AMR in Bukavu and DRC, while calling for caution in administering colistin and carbapenem to patients. Full article

In the Democratic Republic of Congo (DRC), entrepreneurship in the agriculture sector remains for youth a key pillar for income creation. However, few are attracted by agribusiness despite stakeholders’ efforts toward engaging youth in agriculture. Therefore, this study examines the relationship between entrepreneurial potential characteristics and youth desirability to start an enterprise in agriculture among 514 young people in Eastern DRC. This study revealed that youth in South Kivu have different entrepreneurship potential features and agribusiness desirability levels according to their gender and living area. Hence, the youth’s agribusiness desirability is motivated by an awareness of emerging agripreneurial activities, land ownership, parent involvement in farming activities as a role model, perceived agribusiness as an employment source, management-organizing and opportunistic competencies, market analysis, negotiating, and planning skills. Therefore, efforts to attract youth into agribusiness should focus on the use of media, the creation of awareness of available agribusiness initiatives in their area, and the setup of land policy. This is in addition to putting in place capacity-building programs on entrepreneurial and business skills through incubators, and the formalization of youth agribusiness groups that foster capitalizing experiences between new and accelerated agripreneurial enterprises, with the support of parents and financial institutions, focusing on gender sensitivity, in both rural and urban areas. Full article