A Cross-Sectional Retrospective Study of Mortality, Nutritional Status, Violence, and Measles Vaccination Coverage in Bulengo, Elohim, Rusayo, and Shabindu, in the Goma, Karisimbi, and Nyiragongo Health Zones, DRC
Study design
Cross-sectional survey, including a geospatial sampling
Context
In 2022, the rapidly changing dynamics of the conflict in North Kivu, particularly between the Armed Forces of the Democratic Republic of the Congo (FARDC) and the M23, led to numerous waves of population displacement and an increase in medical and humanitarian needs. In Goma, displaced persons are primarily settled in several sites, notably to the west and north of the city. There is a lack of recent mortality data since the surveys conducted in early and mid-2023, and the figures currently available do not reflect the health situation of displaced populations in North Kivu, particularly given the recent increase in new arrivals. Consequently, we conducted a survey to describe the health status of displaced populations in camps in western Goma.
Our role
Coordination
Methodology
A cross-sectional survey, including a geospatial sampling of households in the Bulengo, Elohim, Rusayo 1 and 2, and Shabindu camps, was conducted in April 2024. This survey focused on retrospective mortality, the frequency and type of violent incidents experienced, as well as measles vaccination coverage and the nutritional status of children aged 6 to 59 months (based on upper arm circumference and the presence or absence of nutritional edema). The recall period extended from November 19, 2023 (start of the presidential campaign) to the day of the survey.
Results
Retrospective Mortality
Among households in Bulengo, Elohim, Rusayo 1 & 2, and Shabindu, 34, 26, 22, and 12 deaths were reported, respectively, with crude mortality rates (CMR) of 0.55 (95% CI: 0.35–0.75), 0.93 (95% CI: 0.55–1.30), 0.43 (95% CI: 0.24–0.63), and 0.31 (95% CI: 0.10–0.52). Among children under five, the mortality rate was 0.91 (95% CI: 0.41–1.42), 1.50 (95% CI: 0.55–2.45), 1.00 (95% CI: 0.36–1.65), and 0.99 (95% CI: 0.08–1.90) in Bulengo, Elohim, Rusayo 1 & 2, and Shabindu, respectively. Violence was the leading reported cause of death among households in Rusayo 1 & 2 (n=8; 36.4%) and Bulengo (n=14; 14.2%), and one of the leading causes in Shabindu (n=3; 25.0%) and Elohim (n=6; 23.1%). Most violent deaths occurred either in the village of origin or during displacement, except in Rusayo 1 & 2, where two violent deaths were reported on-site or nearby, and in Shabindu, where one person died from an explosive device inside the camp. Diarrhea is the leading cause of death at the sites and is particularly high in Bulengo (n=9; 45.0% of deaths reported in or near the camp) and Elohim (n=7; 38.9% of deaths in or near the camp). Diarrhea, fever, and neonatal deaths are the most common causes of death among children under 5 years of age.
Prevalence and Main Causes of Violence
The overall prevalence of violence among households in Bulengo, Elohim, Rusayo 1 & 2, and Shabindu during the recall period was 5.3%, 5.6%, 5.3%, and 4.8%, respectively. The main form of violence is sexual violence, with physical and psychological violence also frequently reported. Among young adult women aged 20 to 44, more than one in ten reported having been raped during the recall period, including more than 17% in Rusayo 1 & 2, with high rates also observed among adolescent girls and older women.
Prevalence of Acute Malnutrition
Among children aged 6 to 59 months, the prevalence of global acute malnutrition (GAM) based on upper arm circumference and/or edema ranged from 1.5% (95% CI 0.7 – 2.9) in Rusayo 1 & 2 to 5.1% (95% CI 3 | 21 3.1 – 8.3) in Elohim, and from 0 cases in Bulengo to 1.8% (95% CI 0.8 – 4.3) in Elohim for severe acute malnutrition (SAM). The 6–23-month age group is the most affected by acute malnutrition at all sites, and malnutrition is particularly high in Elohim (9.7%; 95% CI 5.2–17.3).
Measles Vaccination
Among children aged 6 to 59 months for whom information on measles vaccination was available, vaccination coverage was similar and approximately 80% (ranging from 78.9% to 81.1%) across the four sites.
Conclusions
The mortality rate was generally lower than that observed in similar surveys conducted in 2023. In Elohim, the mortality rate was significantly higher than in the other three camps. This appears to be largely due to diarrhea-related deaths and is consistent with persistent problems related to water, sanitation, and hygiene in several sites. Episodes of violence, including high levels of sexual, physical, and psychological violence, were common among households at all sites; the persistence of multifaceted violence against civilians highlights significant gaps in the effective protection of the civilian population. The prevalence of severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) among children aged 6 to 59 months was generally low; the situation in Elohim should be monitored more closely. Finally, measles vaccination coverage is below the 95% coverage recommended by the WHO to prevent outbreaks.
