Comparative Analysis of the Health Status of the Population in Six Health Zones in South Kivu: a Cross-sectional Population Study Using the WHODAS

Abstract

Background: The eastern Democratic Republic of Congo (DRC) has experienced decades-long armed conflicts which might have had a negative impact on population’s health. Most studies have used reductionist health measures such as morbidity and mortality rather than person-centered approaches for measuring the health status of the population. The aim of this study was to assess the health status of the population and its predictors in conflict settings of South Kivu province, using the World Health Organization Disability Assessment Schedule (WHODAS). Methods: Between May and June 2019, we conducted a community-based cross-sectional survey among 1,440 adults in six health zones (HZ), classified according to their level of armed conflict intensity and chronicity in four types (accessible and stable, remote and stable, intermediate and unstable). The data were collected by a questionnaire including socio-demographic data and the WHODAS 2.0 tool with 12 items. The main variable of the study was the WHODAS summary score measuring individual’s health status and synthesize in six domains of disability (household, cognitive, mobility, self-care, social and society). Univariate analysis, correlation and comparison tests as well as hierarchical multiple linear regression were performed.Results: The median WHODAS score in the accessible and stable (AS), remote and stable (RS), intermediate (I) and unstable (U) HZ was 6.3 (0-28.6); 25 (6.3-41.7); 22.9 (12.5-33.3) and 39.6 (22.9-54.2), respectively. Four of the six WHODAS domain scores (household, cognitive, mobility and society) were the most altered in the UHZs. The RSHZ and IHZ had statistically comparable global WHODAS scores. The stable HZs (accessible and remote) had statistically lower scores than the UHZ on all items. In regression analysis, the factors significantly associated with an overall poor health status (or higher whodas score) were advanced age, being woman, being membership of an association; being divorced, separated or widower and living in an unstable HZ.Conclusions: Armed conflicts have a significantly negative impact on people’s perceived health, particularly in crisis health zones. In this area, we must accentuate actions aiming to strengthen people’s psychosocial well-being.

Adaptive Mechanisms of Health Zones to Chronic Traumatics Events in Eastern DRC: A Mul-tiple Case Study

“…In order to provide a good opportunity to comprehend the adaptation mechanisms put in place, the selection criteria were based on the idea that the HZs should be diversified according to the degree of damage caused by armed conflict. To achieve this, 4 of the 34 HZs in the South Kivu province were selected based on the typology developed in a prior study 27 ( Figure 1 ). In order to exclude the periods of the two Kivu major wars (1996-2003) and those during which there were major rebellions in South-Kivu, we have chosen the period from 2013 (integration of the most influential armed group (Yakutumba) into the Congolese army) 6 to 2018 (election of a new political regime to the head of the county).…”

“…This HZ was chosen on purpose from the 3 urban HZs (which have the same stability and geographic accessibility characteristics) in South Kivu province in accordance with our previous study. 27 The second case was the HZ of Idjwi, a rural island located 50 km from the shore of the city of Bukavu and accessible only by sea. Since the armed conflict in South Kivu began, this HZ has been spared because its difficult accessibility, which makes it landlocked compared to the rest of the HZs.…”

“…Armed conflicts, mainly concentrated in the Eastern part of DRC, has a negative impact on population well-being, 27 causes a high number of deaths 28 and other adverse effects such as sexual violences. 29 , 30 Although this is a major issue in eastern DRC, few studies have assessed the impact that armed conflict can have on the health system.…”