Université de Kisangani

The Ministry of Health of the Democratic Republic of Congo set out to revitalise health districts by strengthening the leadership and management capacities of the District Health Management Teams (DHMTs). This capacity strengthening, called technical support, was provided by staff from the reformed Provincial Health Administration (PHA) through supervision and coaching. We aimed to understand how, for whom, and under what conditions such technical support works (or not) in the Tshopo Province. Our study adopted a realist approach and a case study design. We collected data from document reviews, interviews, questionnaires, and routine data from the health information management system. Data analysis followed a two-step process: first, we identified key features of interventions, context, actors, mechanisms, and outcomes through thematic content analysis. Second, we formulated intervention–context–actor–mechanism–outcome (ICAMO) configurations using a retroductive approach. We found that challenging conditions, such as limited resources, hierarchical culture, poor leadership and narrow decision spaces, hinder the capacity building and motivation of PHA staff, resulting in mixed competencies. This adversely affected the quality of their technical support to DHMT members, failing to fully meet the criteria of being personalised and need-driven, problem-solving-centred, reflection-stimulating, comprehensive, and regular. This sub-optimal support undermined the perceived support’s relevance and the perceived credibility of PHA staff among DHMT members, hindering their active participation and learning and resulting in inconsistent management capacities. Consequently, DHMT members experienced low levels of motivation, self-efficacy and perceived autonomy to improve the performance of their health district. Our findings highlight the need for strong political will and leadership to address contextual challenges, a structured training programme to enhance the competencies of PHA staff, and participatory approaches to tailor technical support to the specific needs of DHMTs.

Background: Several governments and their development partners are making significant investments to build and equip basic health centres. Does this support improve attendance at FOSAs and the quality of services offered? Purpose: This study was conducted to explore the perception of the quality of health services by users and providers in subsidised health facilities in the Bunia health zone. Methods: This exploratory study was conducted in the Bunia health zone using ethnographic methods. The sample, consisting of 59 participants, was made up of providers, CODESA members, users, community leaders, and neighbourhood chiefs. Convenience and purposive sampling were used to select the sample. Focus group discussions (FGDs) and semi-structured interviews were used to collect data. NVIvo was used for data analysis. Results: Users experience multiple difficulties in subsidised facilities, including poor reception, high costs, inadequate human resources, drug shortages, and discrimination. They believe that providers should prioritise human life and that FOSA should organise training for their staff. Registered nurses (IT) and providers observe a gap between the public and private sectors and agree that only users can provide an accurate assessment. They confirm the possibility of deferred payment in subsidised FOSAs, unlike private ones, and deplore the lack of materials and equipment, in addition to the reduced number of qualified staff in subsidised health facilities. Conclusion: Improving service delivery in healthcare facilities and promoting humanised care could help improve user perception.

ABSTRACT This study examines the linear and the non‐linear effects of international trade taxes on access to clean cooking technologies in Sub‐Saharan Africa between 2000 and 2023. The study adopts several robust estimation strategies, including the Driscoll–Kraay cross‐sectional dependence estimation, the two‐step system GMM approach, and the Dynamic Panel Thresholds strategy. The findings reveal a dual effect: while international trade taxes exert a positive linear impact at moderate levels, they produce a negative non‐linear effect once the tax rate surpasses a dynamic threshold of 5.039. The estimated dynamic threshold of 5.039% marks the turning point beyond which trade taxes negatively affect clean cooking access. The results are consistent across rural and urban populations, low and middle‐income economies, as well as between countries with low versus high energy import dependence, with the non‐linear effect most severe among high importers. Complementary factors such as internet penetration, trade openness, governance quality, and domestic credit significantly enhance access to clean cooking fuels and technologies. These results underscore the need for “smart” taxation policies that balance fiscal space generation with household affordability. Policy recommendations emphasise differentiated tariff regimes, strengthened credit markets, improved governance, and regional trade cooperation to accelerate universal clean cooking access in SSA.

Purpose: To assess the anatomical, radiological, and functional outcomes of fluoroscopy-free percutaneous intrafocal pinning for distal radius fractures in adults in resource-constrained settings of South Kivu, Democratic Republic of Congo.Methods: In a prospective, multicenter, interventional study, 101 adults with distal radius fractures were treated from January 2018 to December 2023 across four hospitals. Fractures were reduced using external maneuvers and stabilized with three-pin percutaneous intrafocal pinning without fluoroscopy. Outcomes were evaluated using the Grumillier Criteria and modified Castaing classification, with a minimum six-month follow-up. Data analysis with R software (R Foundation for Statistical Computing, Vienna, Austria) included descriptive statistics, principal component analysis, and factorial analysis.Results: Patients had a mean age of 36.41 ± 12.61 years (range: 18-70). Castaing type I fractures comprised 92.08% of cases, with types 2 and 4 each at 2.97%. Consolidation occurred at a mean of 46.82 ± 4.67 days. Complications included superficial infections (three cases), callus formation (three cases), pin migration (two cases), algodystrophy (one case), twisted pin (one case), radial sensory branch injury (one case), and thumb extensor tendon injury (one case). At a mean follow-up of 27.27 ± 11.85 months, subjective outcomes were very good in 84.16% and good in 9.90%; objective outcomes were very good in 77.23% and good in 16.83%; and radiological outcomes were very good in 75.25% and good in 19.80%. Longer rehabilitation correlated with poorer scores, while extended hospitalization was associated with worse objective outcomes. Socio-professional reintegration was reduced with poor objective scores. Age and gender had no impact on outcomes.Conclusion: Fluoroscopy-free percutaneous intrafocal pinning is a safe and effective technique for managing distal radius fractures in low-resource settings. It delivers excellent anatomical, radiological, and functional results.

ABSTRACT This study examines the linear and non‐linear effects of natural resource rents on health performance in 48 Sub‐Saharan African countries between 2000 and 2023. By employing the Driscoll–Kraay strategy to correct for cross‐sectional dependence and the IV‐GMM approach to address potential endogeneity, the analysis reveals a nuanced and robust inverted U‐shaped relationship between natural resource rents and health outcomes. Specifically, the results show that natural resources exert a positive linear effect at moderate levels, suggesting that resource revenues, when effectively mobilized, enhance health performance. However, the negative non‐linear effects highlight that over‐reliance on resource rents undermines sustainability, as volatility and misallocation erode the capacity of resource wealth to translate into long‐term improvements in population health. The robustness checks reinforce these findings across resource‐rich and resource‐poor countries, as well as among middle‐income economies, while differences emerge for low‐income economies where modest levels of resource rents remain insufficient to overcome the severe deficit in health infrastructure and institutional capacity. The disaggregation of resource types further reveals that oil, gas, coal, and forest rents are associated with health performance gains at moderate levels, though the non‐linear results confirm that higher dependence on any resource rent type eventually worsens health performance. Overall, the study highlights that policy design must establish frameworks that ensure natural resource wealth is converted into sustainable health improvements for populations across Sub‐Saharan Africa.

Wood density is a key plant property, indispensable for estimating forest biomass. Yet, despite tropical regions' substantial contributions to global tree diversity and carbon cycling, they remain underrepresented in wood density datasets such as the CIRAD and Global Wood Density Database (GWDD). To address this gap, we present the 'Tervuren xylarium Wood Density Database' (TWDD), containing 13,332 samples from 2,994 species, 1,022 genera, and 156 plant families across six continents (72% from Africa). TWDD offers direct measurements of oven-dry (oven-dry mass/oven-dry volume, all samples), air-dry (air-dry mass/air-dry volume, 6,408 samples), green (green mass/green volume, 1,657 samples), and basic wood density (oven-dry mass/green volume, 1,686 samples). Basic density was estimated for the remaining 11,646 samples via conversion from oven-dry density. TWDD closes a substantial wood density data gap, especially in Africa, adding 1,164 new species, 160 new genera, and 8 new plant families not included in GWDD or CIRAD datasets. The TWDD provides a critical resource for advancing research on forest community dynamics, ecosystem functioning, carbon cycling, and trait-based ecology worldwide.

Abstract Due to its mitigation potential, the Congo Basin attracts attention from regional and international stakeholders. Its sustainable management and conservation is essential for climate regulation, biodiversity preservation, and the livelihoods of billions. Yet, the Congo Basin has not attracted much attention from the scientific community and remains relatively understudied. With respect to public investments, the Basin receives less international financial flows that promote ecological, social, and economic sustainability. This chapter assesses the role of data generated knowledge and reliable information in guiding policy. It surmises that research and sustainable development projects are not adequately financed in the region to produce knowledge that inform policymaking. Over the previous decades, some efforts have been made at the different scales under the Congo Basin Forest Partnership, the World Bank’s Congo Basin Carbon Partnership Facility and the Central African Forest Initiative, the Congo Basin Blue Fund, and the Congo Critical Forest Biome Integrated Program, among others. Nonetheless, the Congo Basin remains enormously underfunded comparatively. There is need for an expanded Congo Basin Climate Science Initiative, which comprises of both infrastructure and human capacity building programs. Such an initiative should seek to transform the understanding of the Basin and provide crucial inputs for policymaking. A properly conceived blended finance model shall be required to attract public and private investments needed to strengthen knowledge systems for data generation and information to guide attainment of global sustainable development objectives.

<title>Abstract</title> Introduction: Bacterial vaginosis (BV) and antisperm antibodies (ASA) are recognised contributors to infertility, yet their combined involvement in unexplained infertility remains insufficiently documented. Their combined influence on unexplained infertility (UI) remains inadequately documented. This study aimed to examine the relationship between BV, its associated pathogens, and ASA in women with UI in Kisangani, Democratic Republic of Congo. Methods A cross-sectional analytical study was conducted from August to November 2023 among 523 infertile couples who had completed the standard investigations. One hundred and forty-four women met the criteria for UI. ASA were detected using a rapid diagnostic test, followed by an indirect mixed antiglobulin reaction test when positive. BV was diagnosed using Nugent scoring. Vaginal pathogens were identified with the VITEK 2 Compact system. Associations were evaluated using the chi-square test, Phi coefficient, and logistic regression models. Results In the full infertile cohort, bacterial vaginosis was significantly linked to ASA positivity (p &lt; 0.001, Phi = 0.383). This association was stronger among women with UI (p &lt; 0.001, Phi = 0.879). In multivariable analysis, ASA were independently associated with <italic>Atopobium vaginae</italic> (aOR 15.08 [3.30-68.89]), <italic>Gardnerella vaginalis</italic> (aOR 6.31 [2.09–19.08]), <italic>Mobiluncus species</italic> (aOR 3.24 [1.07–9.82]), <italic>Mycoplasma hominis</italic> (aOR 3.60 [1.11–11.68]), and <italic>Prevotella timonensis</italic> (aOR 3.88 [1.28–11.74]). Conclusion BV and several of its core pathogens show strong associations with ASA in women with UI. These findings support an infection-immune pathway that may contribute to infertility and emphasise the importance of combining microbiological and immunological tests in infertility assessments, highlighting the need for longitudinal studies to clarify temporal relationships.

Abstract. The Lake Nokoué and Porto-Novo Lagoon complex represents the most important Lagoon system in Benin and is influenced by saltwater intrusion during Low water period via Cotonou channel. The main objective was to determine the composition and structure of benthic macroinvertebrates based on their preferred habitat. Samples were collected from 15 stations between November 2022 and October 2023, following the fluctuations of the hydrological regime notably High water (October and November), Low water (January and March) and Slight rise water (June and August). The results reveal a total of 79 species across the entire studied Lagoon complex. For Lake Nokoué, the following abundances were obtained for: strictly freshwater taxa (4.27 %), strictly brackish taxa (44.58 %), and strictly saltwater taxa (11.86 %). In the Porto-Novo Lagoon, the following abundances were recorded for: strictly freshwater taxa (7.78 %), strictly brackish taxa (6.96 %), and strictly saltwater taxa (16.83 %). Regarding the hydrological regime, a predominance of strictly freshwater taxa was noted during the High water period in Lake Nokoué. Furthermore, this predominance was recorded during both High and Low water periods within the Porto-Novo Lagoon. Thus, the variation of these taxa was found to be more pronounced in Lake Nokoué (p&lt;0.01) than in the Porto-Novo Lagoon (p&gt;0.05).