Health as a Democratic republic of Congo

This article tackles the health questions in Democratic republic of Congo.

The retrospective investigations into mortality revealed that approximately 126 children out of 1000 die before the one year age and 213 out of 1000 die before the age of 5 ans13. Maternal death is also high with 1.289 deaths out of 100.000 live births (MICS 2,2001). 97% of the p Congolese opulation are exposed to endemic paludism. The prevalence of the fever in the children of less than 5 years is of 42,0%, which corresponds to a going number of episodes from 6 to 10 per child and per annum. One estimates between 150.000 and 250.000, the number of children of less than 5 years which die each year of paludism. Other share, the DRC is one of the 22 countries most affected by tuberculosis in the world, with an annual incidence of the TPM+ of 160 cases for 100.000 inhabitants. Approximately 23,6 people million is exposed to the onchocercose in DRC among which more half (14 million) are infected. The geographic coverage is of 67,34% while the therapeutic cover is of 50,12%. On the 300.000 to 500.000 cases of trypanosomiasis which account Africa, half is in DRC (150 000 to 250.000 cases).

The proportion of newborns with a weak weight is approximately 10,0%. Malnutrition and mortality in the children of less than five years are higher among the poor. Acute malnutrition has increased in the children by less than 5 years passing from 12 to 16%. It touches 20% children in the poorest quintile against 8,0% in the richest quintile. The prevalence of malnutrition chronicle did not evolve/move much during this period. The rate of breast feeding generally amounts to 95,0% according to investigation MICS 2. However the proportion of children exclusively nourished with the center during the first six months of life is weak: 29,0% children of less than two years were exclusively nursed until the age of 4 months and 24,0% until the old one six months. According to these same estimates, 4,2 million children of less than 5 years suffers from malnutrition in DRC.

In comparison with the evolution of the know-evoked medical indicators, the country is exposed to a resurgence of several formerly controlled or éradiquées epidemics. It is in particular about: the Measles, the Whooping-cough, the Plague, the Poliomyelitis, the bacillar Dysentery, the Cholera and the Variola of the monkey (“ monkey-pox ”). With this nonexhaustive list diseases of more recent appearance such as the VIH/AIDS and the hemorrhagic fever are added to the Ebola virus.

Use of the Departments of health

According to the Report/ratio of the State Health and Poverty (RESP) in DRC, the average rate of use of the departments of health is approximately 0,15 consultations per capita and an14. With regard to the use of the hospital services, the number of hospital recordings which was of 35 per thousand inhabitants during decade 80 fell to 15 per thousand in 2001. In 2001, the proportion of children from 12 to 23 months which had received all their vaccines was only of 29% (MICS 2). On a purely illustrative basis, 41,0% children who received the first amount of the DTC did not receive the third. Being maternal and reproductive health, the use of the departments of health knew the same tendency these last years. The contraceptive prevalence was of 4,4% in 2001 (MICS 2). Only 46,1% of the expectant mothers profited from the care prénatals carried out by the medical personnel. During the same year, the proportion of the expectant mothers whose childbirth was assisted by the medical personnel was of 23,7%. On the other hand, that of the expectant mothers who are made assist by unqualified personnel (relative, friend) or without assistance during the childbirth approaches the 40%. The percentage of excluded for financial reasons varies from 7 to 30% according to the cases.

Organization of the Services

The health system in DRC is organized in the form of unepyramide on three levels, namely: the Zone of health (ZS), the General hospital of Reference (HGR) and the Health center (CS). In the Eighties, the DRC was one of the first countries to be engaged of the reforms centered on the primary education health care integrated in the ZS. Since 2003, the number of the ZS passed from 306 to 515. This new cartography of the ZS poses a certain number of problems in particular:
(I) the increase in the requirements in human resources and infrastructures (General hospitals of Reference and Central Offices of ZS, Health centres, etc);
(II) a fall of the functionality of the Zones resulting from the new cutting;
(III) the inadequacy enters the request of the departments of health of quality and the multiplication of the nonviable ZS, etc

Although fragmentary, the current data relating to human resources in the field of health give a report on:
(I) a fall of professional quality;
(II) a proliferation of the schools and academics offering a medical teaching to the reduction;
(III) a lack of the work conditions decent and justifying;
(iv) an inequitable distribution of little the qualified personnel which is unstable in addition.

The share of the budget of the State devoted to health appreciably dropped, until reaching proportions lower than 1%. One observes also a disengagement of the Partners to the Development in the sector. This situation involved a deterioration of the health system and led the households to practically assume all the financial expenses of the departments of health in the absence of a well organized system of health insurance. Since 2002, one witnesses an increase in the financing of the sector of health due on the one hand to the financings of certain projects of the sector such as the AIDS, paludism, Tuberculosis. However, of the efforts still remain to provide in the capacity for absorption of the resources mobilized in the sector.

Specific studies carried out in particular in North-Kivu (year to be specified) showed that costs of the departments of health have an impoverishing effect of the populations. Indeed, 24,0% of patients sold their goods and 18,0% were involved in debt to face the costs of the health care. In Maniema, a study undertaken by an ONG (year to specify) determined that 30,0% of patients sold their goods and 15% were involved in debt to face the costs of the health care.

14 This rate was measured on a sample which accounts for approximately 54,0% of the total population of the country. This average rate (0,15 consultations/habitant/an) corresponds to less than one consultation by anybody all the 6 ans.

VIH/SIDA

The epidemic of the HIV /SIDA in DRC is in clear progression with a rate of prevalence estimated at 4,5% (PNLS, 2004). Indeed, the number of people infected in 2004 was of 2,6 million compared with approximately 700.000 in 1995, of which approximately 780.000 would be at the advanced stage of the disease. This number would represent a multiplication by 3 in 10 years of the number of HIV positives estimated of 1995, which in absolute term, predicted an aggravation of the situation. The number of deaths (children and adults) borders 110.000, that is to say on average 305 deaths per day. It results from this that the orphans due to the AIDS are estimated with the surroundings from 700.000 currently in the country.

The prevalence in the age bracket 14-19 years is worrying: it is of 3,6%, that is to say of 2% higher than the standard of WHO (1,6%). According to this agency, this can lead to an exponential propagation of the epidemic in this age bracket and even in the population as a whole. According to the PNLS (2002), the estimate of the percentage of the men of the age bracket 20-29 years (most affected) infected by the virus is of 8% and that of the women of the same age bracket of 14%. The epidemic is feminized and juvénilise. The investigations carried out respectively in the nonaffected zones by the armed conflicts (2003) and in the part Is country affected by the conflicts (2004) gives a séroprévalence of 4,1% and 4,7%. The disease would more touch at any age the women the men. In the mode of transmission of the disease that of the mother to the child becomes extensive with 8% of case.

The patients of the AIDS are often confronted with health expenditure and funeral related to the reduction in the income trained either by the loss of work (stigmatization), or the incapacity to work, or the cost of treatment (360 $ per annum). To counter these difficulties, the affected households are obliged to sell their physical credits (agricultural cattle and equipment, movable and means of transport), for lack of a policy of assumption of responsibility adequate.

The investigations show that the population mainly is rather informed on STI and the VIH/SIDA (more than 95%). However, knowledge on the various modes of prevention and of transmission on the VIH/SIDA remains always weak on the level of the population. Indeed, if the majority intended some to speak and knows its consequences mortals, the real knowledge of its prevention and transmission systems is unequal. It is larger among most educated women (15,0%) that at those which do not have any educational level (7,0%). According to the medium of origin, the women of urban environment (13,0%) are more informed through the campaigns of information and prevention that the women of rural environment (9,0%). This weakness of the educational level explains the persistence of the unfavourable cultural practices and taboos which influence the transmission of the VIH/SIDA such as the lévirat, the sororat, polygamy, the deprivation of heritage, etc

Paludism

The ministry for health recorded more than 4 million case of Paludisme on the whole of the territory, having resulted in the death of 13.000 people, which makes this disease the first cause of mortality.

But, according to the National program of fight against paludism (PNLP), 80% of the people reached by this disease do not consult in the hospitals and are thus not entered in the statistics.

Traditional medicine

Tradipraticien

References

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