Health in the Democratic Republic of the Congo
Health problems have been a long-standing issue limiting development in the Democratic Republic of the Congo (DR Congo).
Medical facilities are severely limited, and medical materials are in short supply. An adequate supply of prescription or over-the-counter drugs in local stores or pharmacies is also generally not available. Payment for any medical services is expected in cash in the DR Congo, in advance of treatment.
In 2018, the CIA estimated the average life expectancy in the DR Congo to be 59,8 years. 58,6 for the male population and 61,1 for females (est. 2017.)
HIV/Aids is the most serious health problem in the DR Congo due to the incurable nature of the disease. By the end of 2003, UNAIDS estimated that 1.1 million people were living with HIV/AIDS, for an overall adult HIV prevalence of 4.2%. Life expectancy in the DR Congo dropped 9% in the 1990s as a result of HIV/AIDS.
According to UNAIDS, several factors fuel the spread of HIV in the DR Congo, including the movement of large numbers of refugees and soldiers, scarcity and high cost of safe blood transfusions in rural areas, a lack of counseling, few HIV testing sites, high levels of untreated sexually transmitted infections among sex workers and their clients, and low availability of condoms outside Kinshasa and one or two provincial capitals.
With an eventual end of hostilities and a government in transition, population movements associated with increased stability and economic revitalization will exacerbate the spread of HIV, which is now localized in areas most directly affected by the presence of troops and war-displaced populations. Consecutive wars have made it nearly impossible to conduct effective and sustainable HIV/AIDS prevention activities.
Cholera is an acute diarrheal illness that caused by the gram-negative bacteria Vibrio cholerae. Cholera is most commonly contracted through the ingestion of water or food that is contaminated with the bacteria. Cholera results in severe watery diarrhea. Severe cholera can cause significant fluid and electrolyte loss, and ultimately, it can result in losing more than 20% of your body’s blood or fluid supply or death.
Risk factors for contracting cholera include living in high risk regions, such as the Democratic Republic of Congo, living in refugee camps or unplanned settlements with inadequate sanitation systems, and drinking unboiled or untreated water. In general, any individuals with limited access to water or living with poor or non-existent sanitation systems are at a high risk for contracting cholera. Although coastal areas and bodies of water are most commonly seen as potential sources of V. cholerae, recent data indicates that inland bodies of water should be further examined as important source of cholera.
Although incidence and mortality from cholera can be difficult to estimate, several studies demonstrate that the Democratic Republic of Congo experiences a significant burden of disease. This is likely due to the fact that the DRC has the lowest rates of access to clean drinking water in Sub-Saharan Africa. Only 46 percent of the population had access to an improved drinking water source in 2012. A United Nations Environment Programme report from 2011 described that drinking water problems within the DRC stem from water infrastructure breakdown in both urban and rural environments. Access to clean water in urban areas of the DRC has suffered as the country has experienced rapid urban population growth. The water supply infrastructure has not been able to keep up with the population growth, so much so that one third of the available treatment plants are not operational. Rural areas in the DRC have even worse access to clean water as 60% of water systems in rural areas are not functional and most water access is informal or improvised and thus lacks adequate monitoring and maintenance. Importantly, water in rural areas of the DRC has high incidence of bacteriologic contamination, thus contributing to the burden of diseases such as cholera. These water infrastructure problems and the burden of cholera in the DRC are important indicators of the need for significant investment and prioritization of access to clean water in the country.
Global Burden of Disease:
Cholera is endemic in some regions of the DRC, which means that there have been reported cholera cases in at least three of the five past years. Specifically, where cholera is endemic, there is an estimated 3 million cases of diarrheal illness and approximately 100,000 deaths worldwide caused by cholerae annually. Cholera is endemic in 51 countries mostly found in Africa and Asia. In areas of high endemicity, the incidence of V. cholerae infection follows a seasonal distribution, with peaks before and after rainy seasons. Additionally, the incidence rate of cholera increases dramatically during floods and other natural disasters Experience from such outbreaks demonstrates that fatality rates in epidemic cholera which are consistently higher than 1 percent, particularly in the early stages of an epidemic and in rural areas  The mortality of cholera may reach 50 to 70 percent in untreated patients.
Exposure Assessment of Cholera in the DRC:
The cholera burden of disease is often difficult to estimate because of lack of resources and inadequate surveillance systems. Additionally, few cases are laboratory-confirmed, so the incidence of cholera can be under-estimated. In 2015, 19,705 cases of cholera were reported in the DRC.
The highest annual attack rates occurred in 2011 in the Eastern provinces of the Democratic Republic of Congo that border the Great Lakes. These provinces are Orientale, North and South Kivu, Katanga and Kasai Oriental. North and South Kivu as well as Katanga had the highest attack rate with over 10 cases per 100,000 people, every year between 2000 and 2011. The high annual attack rates occurred in the Eastern provinces because there is an environmental reservoir for V. cholerae in the lakes of the rift valley. Additionally, there are seasonal peaks that usually occur during the first quarter of the year which also increases the attack rate. Furthermore, fishermen travel from the eastern lakes in the Democratic Republic of Congo to larger cities at the end of the dry season which gives way to seasonal variations in incidence of Cholera. Cross-border cholera remains difficult to track due to the lack of collaboration and communication between the Sub-Saharan countries.
Future Prevention of Disease:
Addressing cholera in the Democratic Republic of Congo involves improving the access to safe water and sanitation, including creating water treatment systems and sewage management systems. Approximately 760 million people around the world lack the critical access to clean water that would prevent them from contracting cholera. Due to political instabilities, it may be difficult for a country such as the Democratic Republic of Congo to develop water treatment systems on a large scale. Therefore, individuals can take the necessary steps to have clean water. For example, filtering water through a coarse cloth or boiling water can reduce the incidence of cholera in endemic areas.
Another preventative measure is the Oral Cholera Vaccine (OCV). The OCV is an effective method for reducing the risk of cholera by 65-70% for 3 to 5 years after the vaccine has been given. However, in children under the age of 5 there is a decrease of efficacy by 10% to 31%. The OCV is effective in vulnerable populations that do not have access to safe drinking water. Its use is widely accepted if the cost of the vaccine is free. However, the limited supply of OCV can be expensive (approximately $3.70 USD), limiting its widespread use.
A final preventive measure to assist in prevention, controlling and treating cholera would be the use of a national database such as IDSR//International Health Regulation. The database would allow the countries to communicate and collaborate on outbreaks, treatment, and preventive measures. This would assist in eliminating or reducing cross-border transmission outbreaks.
People are at risk of onchocerciasis (River blindness) in parts of the DR Congo.
Maternal and child healthcare
The 2010 maternal mortality rate per 100,000 births for Democratic Republic of the Congo is 670. This is compared with 533.6 in 2008 and 550 in 1990. The under 5 mortality rate, per 1,000 births is 199 and the neonatal mortality as a percentage of under 5's mortality is 26. In Democratic Republic of the Congo the number of midwives per 1,000 live births is 2 and the lifetime risk of death for pregnant women 1 in 24.
The DRC nutritional situation is still alarming despite global health progress. More than half (69%) of its population suffers from undernutrition The prevalence of stunting is 43% amomg children under 5 years old, with 14% of women in childbearing age; 8% for wasting with 3% of Severe Acute Malnutrition in children under 5 years old and finally 23% for underweight in children of the same age group. Stunting prevalence still higher and remains the most common of undernutrition in the country according to the Demographic and Health Survey 2013-2014 of DRC. Undernutrition has significant long term impact on the cognitive development of children, particularly those under 5 years old and of women in childbearing age previously malnourished. Consequently affect human capital and the country's economic productivity. Undernutrition common indicators recommended by WHO include anthropometric measurements, biochemichal indicators and clinical signs of undernutrition. Micronutrient deficiencies in DRC are caused mostly by food deprivation and poverty, with a particularly high incidence of vitamin A deficiency 61%; iron deficiency with 47% among children under 5 years old, 38% among women in reproductive age and 23% men. The improvement of the nutritional status of the population, particularly those of children under 5 and women of childbearing age, would reduce the mortality rate in this age group and make progress on Health Outcome Indicators specially the achievement of objective 3 of sustainable development, which aims to ensure a healthy life and promote the well-being of all at all ages. Hence on human capital, economic productivity and development.
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