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This study aims to estimate the acceptability of a future vaccine against COVID-19 and associated factors if offered in Congolese health-care workers (HCWs), since they have the highest direct exposure to the disease. We conducted an analytical cross-sectional study among 23 Congolese referral hospitals, including three university hospitals, located in three towns from March through 30 April 2020. The main outcome variable was healthcare workers' acceptance of a future vaccine against COVID-19. The associated factors of vaccination willingness were identified through a logistic regression analysis. A sample of 613 HCWs participated in the study and completed the study questionnaire, including 312 (50.9%) men and 301 (49.1%) women. Only 27.7% of HCWs said that they would accept a COVID-19 vaccine if it was available. From the logistic regression analysis, male healthcare workers (ORa=1.17, 95% CI: 1.15-2.60), primarily doctors (ORa=1.59; 95% CI:1.03-2.44) and having a positive attitude towards a COVID-19 vaccine (ORa=11.49; 95% CI: 5.88-22.46) were significantly associated with reporting willingness to be vaccinated. For acceptability of vaccination against COVID-19 among others education among HCWs is crucial because health professionals' attitudes about vaccines are an important determinant of their own vaccine uptake and their likelihood of recommending the vaccine to their patients.

Tuberculosis (TB) remains one of the leading causes of death in Mbuji-Mayi, as in many other cities worldwide. Despite the availability of free treatment, TB continues to spread in the city due to weaknesses in health system performance, socioeconomic conditions, and limited financial resources. This study aimed to contribute to reducing TB-related mortality in Mbuji-Mayi by identifying risk factors affecting the survival of patients undergoing anti-tuberculosis treatment. A retrospective cohort study was conducted among tuberculosis patients registered and followed up in the TB treatment centers (CDTs) of Mbuji-Mayi between January 1 and December 31, 2024. Data were collected from patient records and treatment registers. A total of 1,633 cases were included in the analysis. Survival probabilities were estimated using the Kaplan-Meier method, and factors associated with survival were identified using the Cox proportional hazards model. Multivariate analysis showed that comorbid conditions such as HIV and diabetes were significantly associated with mortality among TB patients (adjusted Hazard Ratio [aHR] = 4.65; = 0.003). Drug resistance was strongly associated with reduced survival time (aHR = 12.12; < 0.001). Male sex was more exposed to mortality compared to females (aHR = 9.94; = 0.026), and tobacco or alcohol use was also a significant risk factor associated with decreased survival (aHR = 3.31; = 0.046). The overall survival probability remained high, ranging from 99.7% in the first month to 98.8% in the fifth month of treatment. Most deaths occurred early during therapy. Mortality among TB patients in Mbuji-Mayi is mainly influenced by comorbidity, drug resistance, male sex, and tobacco or alcohol consumption. Strengthening early detection, adherence support, and management of comorbid conditions could improve patient survival.

Malnourished children in low- and middle-income countries (LMICs) often exhibit reduced vaccine efficacy, particularly for oral vaccines like polio and rotavirus, due to impaired immune responses. Nutritional deficiencies, such as in vitamin A and zinc, along with environmental factors like poor sanitation, exacerbate this issue. Existing research has explored the individual impacts of malnutrition on vaccine outcomes, but a comprehensive framework that integrates nutritional, immune, and environmental factors has been lacking. This article proposes a new conceptual framework that integrates nutritional status, immune function, and environmental context to explain the reduced vaccine efficacy in malnourished populations. The study highlights practical interventions to improve vaccine outcomes in these vulnerable populations. A comprehensive literature review was conducted, focusing on vaccine efficacy in malnourished children, with data drawn from cross-sectional surveys, program evaluations, and peer-reviewed studies. Key interventions, including vitamin A supplementation, flexible immunization schedules, and environmental health programs, were analyzed for their impact on improving seroconversion rates. The review confirms that malnourished children exhibit significantly lower seroconversion rates for vaccines like oral polio and rotavirus, with a 30-40% reduction in efficacy for OPV and up to a 50% reduction for rotavirus. Nutritional interventions, particularly vitamin A supplementation, increased seroconversion rates by up to 30%, while flexible vaccination schedules and environmental improvements further enhanced vaccine responses in severely malnourished populations. This framework addresses a critical gap in the literature by offering a holistic approach that integrates nutrition, immunization, and environmental health. Global health organizations, such as WHO and UNICEF, must prioritize the integration of nutrition and immunization programs, alongside environmental health initiatives, to reduce the burden of vaccine-preventable diseases in malnourished populations. Future research should focus on longitudinal studies to assess the long-term impact of these integrated interventions.

Adherence to public health instructions for the COVID-19 is important for controlling the transmission and the pandemic's health and economic impacts. The aim of this study was to determine the associated factors of non-adherence to public health and social measures instructions. This was a cross-sectional study conducted with 1913 participants in two provinces of DRC, Mbuji-Mayi, and Kamina. Predictors of non-adherence to COVID-19 preventive measures were identified using binary logistic regression analysis. -value<0.05 was considered as a significant predictor. Among 1913 participants (1057 [55.3%] male, age 34.1 [14.9] years), 36.6% were defined as non-adherents. Non-adherence was associated with never studied and primary education level [adjusted odds ratio (aOR)=1.63, CI=1.31-2.03], unemployed status [aOR=1.29, CI=1.01-1.67], living in Kamina (Haut-Lomami province) [aOR=1.63, CI=1.31-2.03], female gender of head of household [aOR=1.53, CI=1.16-2.03], no attending lectures/discussions about COVID-19 [aOR=1.61, CI=1.08-2.40], not being satisfied with the measures taken by the Ministry of Health [aOR=2.26, CI=1.78-2.81], not been regularly informed about the pandemic [aOR=2.25, CI=1.80-2.03], and bad knowledge about COVID-19 [aOR=2.36, CI=1.90-2.93]. The rate of non-observance of preventive measures for the COVID-19 pandemic is high, and different factors contributed. The government has to counsel the permanent updating of messages taking into account the context and the progress of the pandemic by using several communication channels.

Introduction In low-income countries such as the Democratic Republic of the Congo (DRC), the strategies implemented to combat tuberculosis (TB) are threatened by the emergence of non-communicable diseases (NCDs), such as diabetes mellitus (DM). Very little data on the implementation of services to manage TB-DM are generally available in these low-income countries. The aim of this study was therefore to assess the level of implementation of DM screening and treatment activities in TB unit clinics (TUCs) in Lubumbashi, DRC. Methods A cross-sectional study was conducted using the Service Availability and Readiness Assessment (SARA) questionnaire from June to July 2023. Fourteen tracer items, divided into 4 domains—i) guidelines and staff, ii) basic equipment, iii) diagnostic capacity, and iv) drugs and products—were assessed. The readiness indices were compared according to the managerial instance and the activity package organized in each of the selected TUCs. A Chi 2 test with a significance level set at p  =  0.05 was used for this comparison, and Cronbach's α coefficient was calculated to estimate the reliability or consistency of the questionnaire. Results Of the 35 TUCs visited, 19 (54.3%) were public health facilities, and 20 (57.1%) had a supplementary package of activities (SPA). The readiness of TUCs for providing DM diagnostic and treatment services was around 50%. A statistically significant difference was observed based on the managerial instance overseeing the TUC ( p  =  0.00 ) and the package of activities offered within these institutions ( p  =  0.00 ). Conclusion The current study has underscored the limited capability of TUCs in Lubumbashi to provide services for managing TB-DM comorbidity in DRC. It is imperative to implement strategies aimed at enhancing this capacity and taking into account the local context and influencing factors.

Background Malnutrition impairs immune function and vaccine responses, particularly in low-income settings. This can lead to reduced seroconversion rates and compromised herd immunity in children. Nutritional interventions have been proposed to enhance vaccine immunogenicity, yet evidence remains scattered and context specific. Objective This systematic review assesses the impact of nutritional interventions—especially vitamin A, zinc supplementation, and protein-energy rehabilitation—on serological responses to routine childhood vaccines among malnourished children in low- and middle-income countries. Methods Following PRISMA guidelines, we searched PubMed, Embase, Cochrane Library, and WHO Global Health Library for studies published between 2000 and 2024. Eligible studies included randomized trials, cohort studies, and systematic reviews reporting on nutritional supplementation and vaccine seroconversion outcomes in malnourished children. Results From 3,245 records, 42 studies met the inclusion criteria. Vitamin A supplementation improved measles vaccine seroconversion by 35%, especially among deficient children. Zinc enhanced responses to oral vaccines by 20%. Protein-energy rehabilitation significantly increased seroconversion rates for BCG and measles vaccines, particularly in children recovering from severe acute malnutrition. Conclusion Nutritional interventions improve vaccine immunogenicity among malnourished children. Integrated strategies combining immunization and nutrition services should be prioritized to address immunity gaps in vulnerable populations.

(1) Background: “Zero-dose” (ZD) refers to a child who has not received any doses of the pentavalent (diphtheria–tetanus–pertussis–Haemophilus influenzae type b (Hib)–hepatitis B) vaccine. ZD children are vulnerable to vaccine-preventable diseases (VPDs). Luambo health district (HD) is one of 26 HDs in Kasai Central Province in Democratic Republic of the Congo and had the largest number of ZD children in 2021. This study was conducted to identify factors associated with ZD status among children in Luambo HD. (2) Methods: We conducted a mixed-methods study of children aged 12–23 months in Luambo HD. (3) Results: A total of 445 children aged 12–23 months were included in the study, including 89 cases and 356 controls. Children who were born in Angola (AOR = 3.2; 95% CI = 1.1 to 9.8; p = 0.046), born at home (AOR = 5.2; 95% CI = 2.1 to 12.5; p < 0.001), whose mothers did not receive antenatal care (AOR = 4.4; 95% CI = 1.2 to 16.3; p = 0.023), or did not know any vaccine preventable disease (AOR = 13.3; 95% CI = 4.6 to 38.4; p < 0.001) were more likely to be ZD than their counterparts. In addition, perceptions of children’s parents influenced child immunization. (4) Conclusions: Factors associated with being a ZD child suggest inequalities in vaccination that need to be addressed through appropriate interventions. Maternal and child health services need to be strengthened while also targeting children’s fathers. This will make it possible to considerably reduce the proportion of ZD and undervaccinated children and effectively fight against VPDs.

•COVID-19 vaccine hesitancy was not static among a HCW cohort in the DRC over time.•Vaccine hesitancy among the HCWs dramatically increased in mid-March 2021.•Nearly a quarter of respondents reported vaccine hesitancy in late-August 2021.•Patterns between reported influences on willingness to get vaccinated varied over time.•Support for vaccine schedule adherence, apart from COVID-19, was consistently high. Hesitancy to receive the COVID-19 vaccine among healthcare workers (HCWs) in low-resource settings, such as the Democratic Republic of the Congo (DRC), is a major global health challenge. This study identifies changes in willingness to receive vaccination among 588 HCWs in the DRC and reported influences on COVID-19 vaccination intentions. Up to 25 repeated measures were collected from participants between August 2020 to August 2021. Among the overall cohort, between August 2020 and mid-March 2021, the proportion of HCWs in each period of data collection reporting COVID-19 vaccine hesitancy ranged from 8.6% (95% CI: 5.97, 11.24) to 24.3% (95% CI: 20.12, 28.55). By early April 2021, the proportion reporting hesitancy more than doubled (52.0%; 95% CI: 46.22, 57.83). While hesitancy in the cohort began to decline by late-June 2021, 22.6% (95% CI: 18.05, 27.18) respondents indicated hesitancy in late-August 2021 which remains greater than the proportion of hesitancy at any time prior to early-March 2021. Patterns in reported influences on COVID-19 vaccination were varied with the proportion reporting some influences (e.g., no serious side effects, country of vaccine production) remaining stable throughout the year and other factors (e.g., recommendation of Ministry of Health, ease of vaccination) falling in popularity among respondents. Agreement that the national vaccination schedule should be followed apart from the COVID-19 vaccine remained high among respondents throughout the study period. This study shows that, among a cohort of HCWs in the DRC who have likely been influenced by regional, national, and global factors, COVID-19 vaccine hesitancy has fluctuated during the pandemic and should not be treated as a static factor. Additional research to determine which factors most influence HCWs’ willingness to receive the COVID-19 vaccine offers opportunities to reduce vaccine hesitancy among this important population through tailored public health messaging.

Despite the successes in wild-type polio eradication, poor vaccine coverage in the DRC has led to the occurrence of circulating vaccine-derived poliovirus outbreaks. This cross-sectional population-based survey provides an update to previous poliovirus-neutralizing antibody seroprevalence studies in the DRC and quantifies risk factors for under-immunization and parental knowledge that guide vaccine decision making. Among the 964 children between 6 and 35 months in our survey, 43.8% (95% CI: 40.6–47.0%), 41.1% (38.0–44.2%), and 38.0% (34.9–41.0%) had protective neutralizing titers to polio types 1, 2, and 3, respectively. We found that 60.7% of parents reported knowing about polio, yet 25.6% reported knowing how it spreads. Our data supported the conclusion that polio outreach efforts were successfully connecting with communities—79.4% of participants had someone come to their home with information about polio, and 88.5% had heard of a polio vaccination campaign. Additionally, the odds of seroreactivity to only serotype 2 were far greater in health zones that had a history of supplementary immunization activities (SIAs) compared to health zones that did not. While SIAs may be reaching under-vaccinated communities as a whole, these results are a continuation of the downward trend of seroprevalence rates in this region.

Millions of healthcare workers experience percutaneous exposure to bloodborne communicable infectious disease pathogens annually, with the risk of contracting occupationally acquired infections. In this study, we aimed to assess the status of occupational safety and outbreak preparedness in Congolese nurses and laboratory technicians in Kongo central and the Katanga area, amidst multiple ongoing public health emergencies in the Democratic Republic of the Congo (DRC). This was a multicenter analytical cross-sectional study conducted in five referral hospitals located in Kongo central province and the Katanga area between 2019 and 2020 amidst Ebola, Yellow fever, Cholera and Chikungunya outbreaks. Participants were adult A0 grade nurses, A1 nurses, A2 nurses and medical laboratory technicians (N = 493). They answered a structured, self-administered questionnaire related to hospital hygiene and standard precautions for occupational infection prevention. The majority of the respondents were females (53.6%), and 30.1% of them have never participated in a training session on hospital infection prevention during their career. The proportions of those who have been immunized against hepatitis B virus (HBV) was markedly low, at 16.5%. Of the respondents, 75.3% have been using safety-engineered medical devices (SEDs), whereas 93.5% consistently disinfected medical devices after use. Moreover, 78% of the respondents used gloves during medical procedures and 92.2% wore masks consistently. A large majority of the respondents, 82.9%, have been recapping the needles after use. Regarding participation in outbreak response, 24.5% and 12.2% of the respondents were Chikungunya and Cholera epidemic responders, respectively; 1.8% have served in Ebola outbreak sites. The proportion of the respondents who sustained at least one percutaneous injury by needlestick or sharp device, blood/body fluid splash or both in the previous 12-month period was high, 89.3% (41.8% for injury, 59.2% for BBF event), and most of them (73%) reported over 11 events. Compared to laboratory technicians, nurses had higher odds for sustaining percutaneous injury and BBF events [OR = 1.38 (0.16); p < 0.01], whereas respondents with longer working experience were less likely to sustain those events [OR = 0.47 (0.11); p < 0.001]. Findings from this study suggest that Congolese nurses and laboratory technicians experience a high frequency of injury and BBF events at work, and remain at high risk for occupationally acquired infection. There is a need for periodic capacity-building training for the healthcare workforce to improve infection prevention in health settings, the provision of sufficient and appropriate PPE and SEDs, post-exposure follow-up and keeping records of occupational injuries in hospitals in Congolese healthcare settings.