Prevalence and risk of self -medication with antibiotic and determinants factors in patients admitted to the emergency department in a resource-limited setting: a cross-sectional study Freddy Zihindula, Aymar Akilimali, Amidu Alhassan, Elsayed S. Moubarak, Fabien Imani Shangalume, Zehra Sadia, Ankini Mukherjee, Fabien Balagizi, Rodrigue Fikiri Bavurhe, Calvin R. Wei, Jones Onesime, Samson Hangi, Amos Kipkorir Langat, Saralees Nadarajah Discover Public Health, 2026 The overuse of antibiotics without medical prescription is a major public health concern, leading to bacterial resistance that causes severe infections and increases global mortality. This study aimed to determine the prevalence and identify the main risk factors of antibiotic self-medication among patients admitted to the emergency department. This cross-sectional, descriptive, and analytical study was conducted over a five-month period (July to November 2024) among patients aged 18 years and older admitted to the emergency department. We collected sociodemographic data, data on self-medication practices, and data on access to care. Multivariable logistic regression was applied to identify independent factors associated with antibiotic self-medication. The prevalence of antibiotic self-medication among participants was 77.7%, with amoxicillin (38.3%) and metronidazole (27.6%) being the most commonly used antibiotics, followed by penicillin V (19.0%) and chloramphenicol (17.1%). Bivariate analyses showed that age was strongly associated with antibiotic self-medication (χ² = 25.4, p < 0.001), with the highest prevalence among individuals aged 35–44 years (32.9%), while marital status (χ² = 18.5, p < 0.001), occupation (χ² = 17.1, p = 0.002), monthly income (χ² = 29.0, p < 0.001), and distance to the health facility (χ² = 9.2, p = 0.027) were also significantly associated; in contrast, sex, education level, and health insurance status were not significant. In the multivariable logistic regression analysis, age emerged as the only independent predictor of antibiotic self-medication, with participants aged 55–64 years having significantly higher odds compared with those aged 18–24 years (OR = 6.98, 95% CI 1.77–27.58; p = 0.006), and those aged 65 years and older showing markedly increased odds (OR = 43.36, 95% CI 4.06-462.91; p = 0.002). Although self-employed participants demonstrated higher odds of self-medication compared with employed participants, this association was not statistically significant after adjustment (OR = 1.38, 95% CI 0.86–2.22; p = 0.184), and none of the monthly income categories remained independently associated in the adjusted model. The study highlights the influence of demographic and socioeconomic factors on antibiotic self-medication, emphasizing the need for awareness programs and stricter control of over-the-counter antibiotic sales.
Addressing sexual violence as a weapon of war: A critical call for action in eastern Democratic Republic of Congo Aymar Akilimali, Fabien Balagizi, Priyadarshini Bhattacharjee, Nathan Mugenyi, Amos Kipkorir Langat, Adolphe Karegeya, Innocent Mufungizi, Gaurang Narayan, Dieudonné Kakusu, Freddy Zihindula, Isaac Isiko, Styves Banga, Lucien Baraka, Denis Mukwege, Olivier Nyakio International Journal of Gynecology and Obstetrics, 2026 The eastern Democratic Republic of Congo (DR Congo) is an ongoing conflict zone that experiences organized sexual violence tactics that both serve to intimidate local populations and defend occupied territories.1 DR Congo experienced ramped-up military confrontation between several government forces and the M23 rebel unit and over 120 rebel groups that caused the displacement of 1.7 million civilians and intensified humanitarian disasters in 2023.2 Since its evacuation in 2023, the United Nations Stabilization Mission in the DR Congo (MONUSCO) has fallen short of sustaining mobile crime courts alongside evidence collection tasks, thus creating space for legal considerations.3 Conflicts in this context have transformed into a symbol of sexual violence, including rape as well as sexual slavery and forced pregnancy. This experience remains an obstacle for survivors trying to access justice and care.4 This paper investigates the core causes behind violence while assessing current intervention methods and offering practical solutions for healthcare practitioners and policy developers to control this human rights emergency. Sexual violence continues to be a problem in the eastern DR Congo because of colonial exploitation that led to the development of both exploitative economic systems and racial conflicts. Following independence dictatorships together with genocide spillover effects contributed toward an increase in armed groups that extracted natural resources, including coltan and gold for survival. Analysis conducted by Solidarité des Femmes pour le Développement Intégral (SOFEPADI) shows that reported sexual violence cases involving women and girls stand at 78%, but cases involving males have increased to 22% since 2020, amounting to a double-figure surge. Militarized masculinity and targeting practices directed at lesbian, gay, bisexual, transgender, and queer or questioning individuals and ethnic minorities among other groups have increased in both scale and scope according to researchers.4, 5 Years of official statistics show that when sexual violence cases reach law enforcement, there is just 12% investigation success followed by only 2% conviction rates.5 Cultural standards enhance the process through which survivors become marginalized by society. The patriarchal system chooses to punish victims by labelling them as family dishonorers, which causes both isolation and forced marriages to their attackers.5 According to HEAL Africa research in Masisi Territory rural areas in 2023, interviews established that 34% of survivors were rejected by family members when they reported sexual assaults.1, 3 Through two major legislative changes, the Congolese Government passed both the Sexual Violence Act of 2006 and established the Tribunaux Militaires de Garnison (Military Garrison Courts) in 2018. The departure of MONUSCO soldiers has led to more instability throughout the affected area. MONUSCO supported military mobile courts that convicted 148 offenders of sexual violence crimes from 2017 to 2022.6 The troop withdrawal created an obstacle for 63 ongoing cases and forensic training delays that made it harder for survivors to receive justice. Various legal reforms face obstacles because of inadequate funding alongside corruption within the system. During the 2022 audit, inspection officials discovered that 45% of mobile court funding had disappeared through corruption, thus delaying trials and with accompanying delays to protection schemes.2, 3 Non-governmental organizations successfully occupy the essential roles that public institutions have failed to fulfill. Dr. Denis Mukwege established Panzi Hospital as a facility that combines medical services with legal assistance and social rehabilitation programs for patients. Panzi Hospital assisted 8200 survivors during 2020–2023 and managed to obtain 72% of convictions through their mobile court partnerships.4, 7 Through its HEAL Africa community advocacy networks, the organization has established 15 advocacy networks in North Kivu, which resulted in a 30% increase in reporting activity across those communities.5, 8 There is an immediate need for stable funding sources to replace terminated foreign assistance projects, such as those of the European Union and Canada. Donor funding needs to be shifted to establish mobile healthcare services and legal support systems. In 2019, the Kavumu model was demonstrated to be successful as clinicians, police and lawyers teamed up to bring 11 militia members to justice through their integrated services.9 Duplicating this method requires money for safe evidence management with protection for witnesses and outreach services for communities. The International Criminal Court needs to intensify its investigation of sexual violence cases as part of crimes against humanity in the DR Congo, while third-party states should implement universal jurisdiction laws to prosecute perpetrators who live outside the country. The government of DR Congo must establish independent oversight. The eastern DR Congo requires urgent joint intervention measures that target impunity systems while placing victim needs first. The healthcare community together with funding supporters and global health organizations need to celebrate local achievements demonstrated at Panzi Hospital and encourage continued financial backing as well as legislative change. Continued attention on this region will help end the pattern of violence and establish healing alongside justice in this highly traumatized area. Conceptualization: Aymar Akilimali, Priyadarshini Bhattacharjee and Fabien BALAGIZI, Investigation: Amos Kipkorir Langat and Styves Banga, Project administration: Olivier Nyakio and Aymar Akilimali, Resources: Nathan Mugenyi, Supervision: Olivier Nyakio, Priyadarshini Bhattacharjee, and Denis Mukwege, Validation: Adolphe Karegeya, Dieudonné Kakusu and Priyadarshini Bhattacharjee, Visualization: Lucien BARAKA, Aymar Akilimali, Isaac Isiko and Freddy Zihindula, Writing—original draft: All Authors, Writing—review & editing: All Authors, Final approval of manuscript: All Authors. The authors would like to thank the direction of the Medical Research Circle (MedReC) of the Democratic Republic of the Congo for the realization of this present paper. The authors did not receive any financial support for this work. No funding has been received for the conduct of this study. All authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Data sharing is not applicable to this article as no new data were created or analyzed in this study.
Challenges and Prospects in Managing Hypertensive Disorders of Pregnancy in Sub-Saharan Africa: A Narrative Review Constance Nguru Musese, Raha Maroyi, Balagizi Ganywamulume, Alain Maha, Olivier Ngeleza, Denis Mukwege International Journal of Women S Health, 2026 Background: Hypertensive disorders of pregnancy (HDP) are the leading cause of maternal mortality in sub-Saharan Africa (SSA), accounting for 70% of the global maternal death burden. Despite international guidelines, the management of these conditions, particularly preeclampsia, is hindered by significant structural, clinical, and sociocultural challenges in low-income countries. This narrative review critically analyzes the challenges in the prevention, diagnosis, and management of HDP in resource-constrained settings in SSA, and identifies contextually appropriate solutions to improve maternal outcomes. Methods: A literature search of studies published between 2014 and 2024 was conducted using the PubMed, Scopus, Google Scholar, and African Journal Online databases. This review synthesizes evidence from qualitative, quantitative, and mixed-method studies and systematic reviews focusing on the epidemiological, organizational, and community dimensions of care for hypertensive disorders across SSA countries. Studies were selected on the basis of their relevance to HDP care challenges and innovations in SSA. The Scale for the Assessment of Narrative Review Articles (SANRA) guided the rigor and reporting of this review, with six core criteria systematically applied: justification of article selection, comprehensive literature search, quality assessment, evidence synthesis, transparent reporting, and methodological transparency. Results: Key challenges identified included fragmented health systems, poor adherence to clinical protocols, shortages of essential medicines and equipment, inadequate healthcare worker training, delayed care-seeking due to low health literacy and cultural beliefs, and insufficient epidemiological data. Promising strategies include strengthening antenatal care and screening, maternal education, task-sharing with community health workers, providing targeted training for healthcare workers, implementing simplified protocols, utilizing task sharing with community health workers, and enhancing interdisciplinary coordination. Conclusion: Reducing maternal mortality due to HDP in SSA requires an integrated approach that combines strengthening health systems, community engagement, targeted training, and context-adapted guidelines. Sustained investment in local research, data sharing, and policy reform is essential for achieving sustainable improvements in maternal health care.
Determinants of urogenital tract infection symptoms among adolescent girls and young women in secondary schools and universities in Bukavu, Democratic Republic of Congo: a cross-sectional study Raha Maroyi, Chirimwami Matabaro Espoir, Ushindi Muzikwa Chrispin, Mupenda Ngolombe Gloire, Mamy Matumwabiri Rolande, Balagizi Ganywamulume, Lampard Omari Mukanga, Musafiri Cirholo, Denis Mukwege BMC Women S Health, 2025 BACKGROUND: Globally, 40% of adolescent girls and young women suffer from urogenital tract infections (UGTIs) that affect their quality of life (QOL). Despite their significant health burdens, these conditions remain underreported and understudied, particularly in Low and Middle-income Countries (LMICs)This study aimed to examine the determinants of urogenital infection-related symptoms in adolescent girls and young adult women students. METHODS: This cross-sectional study was conducted among adolescent girls and young women in ten secondary and university institutions from December 2022 to April 2023 in Bukavu, Eastern DRC. Using purposive sampling, 1,500 questionnaires were distributed with 1,048 completed responses from 1,200 returns. The variables included age, education level, origin, knowledge of infections, hygiene behaviors (self-medication, contraception, water intake, and sanitation), and urogenital infection symptoms. A logistic regression model was used to examine predictors of urogenital infections using Stata SE14.0. RESULTS: A total of 1048 adolescent girls and young women, aged between 12 and 30 years with a mean age of 20 years, were enrolled in the study. The prevalence of related urogenital infection symptoms was 12% among school-going adolescent girls and young women in secondary schools and universities in Bukavu town, eastern Democratic Republic of Congo. Several factors were significantly associated, notably information about UGTIs and their symptoms (AOR: 4.52; 95% CI: 2.45-8.22; p < 0.001). The use of rain, ground, river or lake water while bathing increased the risk of UGTI symptoms (AOR: 4.08; 95% CI: 2.10-7.95; p < 0.001). Adding disinfectants to water reduced this risk but did not cancel it (AOR: 1.37; 95% CI: 1.10-2.05, p = 0.034). Communal bathing vessels (AOR: 1.85; 95% CI: 1.17-2.94, p = 0.008), the habit of wearing clothing that permanently tightens the perineum(AOR: 2.12; 95% CI: 1.14-3.90, p = 0.016), and antibiotic self-medication (AOR: 2.03; 95% CI: 1.36-3.02, p < 0.001) were associated with UGTI symptoms. CONCLUSION: Urogenital tract infections (UGTIs) are common among adolescent girls and young women in educational settings in Bukavu, DRC. Symptoms were determined by a lack of information on UGTIs, women's hygiene practices, self-medication, and lifestyle habits. Comprehensive health education overhaul is needed to effectively address public health concerns.
Adolescent anorectal malformations: Case series about 3 cases Alumeti Munyali, Cikwanine Buhendwa, Balagizi Ganywamulume, Byabene Gloire, Luhiriri Ndanda, Ahuka Ona Longombe International Journal of Surgery Case Reports, 2025 INTRODUCTION: Anorectal malformations (ARM) are an anatomically complex in which anorectum is either agenesic or communicates with neighboring organs. They are rarely found in adolescents. The aim of this study was to describe and discuss according to literature the three cases of ARM in adolescents. CASE PRESENTATION: There were three young girls who were 12, 17 and 18 years old, transferred to the department of surgery for investigation and management. One of them consulted for chronic constipation and the two others for recto-vestibular fistula. One patient was admitted with a left colostomy. For the two others, no previous surgery had been performed. The diagnosis was made after a review of the perineum. The treatment consisted of a lowering according to Peña. The postoperative course was uneventful. For the three cases, evaluation of their fecal continence by Hassink criteria was good after surgery. At up to 18 months later; those patients had presented no symptoms. CLINICAL DISCUSSION: Each patient consulted with a specific complaint, including elimination of feces through the vagina and chronic constipation; clinical signs of associated malformations were absent in our patients. Clinical examination of the perineum allowed diagnosis and typing of ARM in these three patients. CONCLUSION: Anorectal malformations should be diagnosed during the first examination of a newborn. The presence of a large fistula represents a trap that often laid to late diagnosis in children and teenager suffering from chronic constipation evolving since birth.
A call for action to stop sexual violence against women in the Democratic Republic of Congo: A brief report Olivier Nyakio, Denis Mukwege, Fabien Balagizi, Malik Olatunde Oduoye, Styves Banga, Jones Onesime, Priyadarshini Bhattacharjee, Hardy Elembwe, Hugues Cakwira, Elie Kihanduka, Afissa Amiri, Excellent Rugendabanga, Samson Hangi, Chloe Makungu, Aymar Akilimali International Journal of Gynecology and Obstetrics, 2025 SynopsisSexual violence in the Democratic Republic of Congo is also described as a weapon of war.
Bone tumors in children: Round cell sarcoma of the thigh: A case report Bugashane Bwa Mihigo Elie, Chasinga Baharanyi Tshass, Balagizi Ganywamulume, Patrick Musimwa, Nfundiko Kaguku, Alumeti Munyali Désiré International Journal of Surgery Case Reports, 2024 INTRODUCTION AND IMPORTANCE: Bone tumor in children is a very large pathology and represents about 5% of pediatric cancers located mainly in the limbs. This is a case of a rare form of bone tumor of the round cell sarcoma type of the right femur in an 18-month-old female infant whose diagnosis and therapeutic decision are specific. CASE PRESENTATION: We present an 18-month-old girl, admitted to the panzi general reference hospital and presenting a painful swelling of the right thigh evolving for more than a month and which gradually increased in size in a febrile context with ipso-lateral inguinal adenopathy; Bone biopsy revealed round cell sarcoma and immunohistochemistry was not available. While waiting for chemotherapy, the proposed surgery was a hip disarticulation in an 18-month-old girl. CLINICAL DISCUSSION: Early discovery of the tumor at infant age is rare, it can occur in any part of the limb. The lower end of the femur and the upper end of the tibia or fibula account for 60% of cases. Its diagnosis is not easy, the management and improvement of the prognosis are linked to the use of chemotherapy and local treatment and conservative surgical resection, avoiding amputation or disarticulation. It is not easy to accept, neither for the child's parents nor for the healthcare team. CONCLUSION: Thigh sarcoma in an infant is rare and atypically discovered when faced with complications, infection or remote signs with difficulty in diagnosis and management; multidisciplinarity is very necessary, also involving psychologists despite the poor prognosis.
Gastric cancer for young adults: Case series of three cases Amisi Mangaza, Bwemere Mungwete Josué, Byabene Gloire, Balagizi Ganywamulume, Mongwa Justin, Alumeti Munyali Désiré International Journal of Surgery Case Reports, 2023 INTRODUCTION AND IMPORTANCE: Gastric cancer is the fifth most common malignant tumor in the world. It is considered to be the second most common cause of cancer-related death. It is still described as the preserve of people aged over 50. However, it is rarely described in young people. In this study, we report three cases of gastric cancer for subjects under 35 years of age. METHODS: The study was a retrospective single-center non-consecutive case series. RESULTS: We report three cases of gastric cancer for young people under 35 years old. The consultation reason was chronic pain with a mean evolution of 2.1 years associated with post prandial vomiting. Clinical, biological and prognostic aspects were evaluated. Biopsies in all these patients were consistent with a moderately differentiated adenocarcinoma. The mean age was 28.3 years, with males predominating. CONCLUSION: Gastric cancer is generally considered to be a pathology of the elderly, but it can also occur in younger patients. Late consultation for treatment leads to late-stage diagnosis and a poorer prognosis.
Malnutrition among under-five children in Democratic Republic of the Congo: A plague of the health system Aymar Akilimali, Styves Banga, Malik Olatunde Oduoye, Chrispin Biamba, Ami Munyangi, Elysée Byiringiro, Balagizi Fabien, MUBAGWA Guy Laroche, Wanny Masirika Annals of Medicine and Surgery, 2022 Malnutrition in children has been recognized as a major public health problem in the world and in particular in the Democratic Republic of Congo, which directly contributes to the increase in mortality and morbidity in this already fragile population. The Democratic Republic of Congo is a country plagued by repeated conflicts between different local armed groups and instability in the management of political affairs. There is a high prevalence of malnutrition in the eastern provinces of the country. Although it is a major public health problem, the inadequacy of the system in question plays an important role in the inequality of access to health care and therefore in the lack of growth monitoring of very young children under 5 years old. The rate of malnourished children has been observed in the country. Malnutrition in these children causes several alterations such as delayed physical and motor growth, a decrease in immune defenses which considerably increases the mortality rate and a decrease in cognitive and learning abilities. Malnutrition remains a serious public health problem in low-income countries and is reflected in various statistics from the World Health Organization. Children are more at risk of being at nutritional risk or suffering from malnutrition. This narrative review summarizes current data on the prevalence and determinants of malnutrition in children, including the difficulty of providing children with a consistent food intake due to mass displacement from conflict areas, the inability of nutritional centers to care of patients admitted for malnutrition due to lack of equipment and the many epidemics the country has had to deal with which have severely handicapped the already unstable health system.
