title: A mixed-methods assessment of sexual and gender-based violence in eastern Democratic Republic of Congo to inform national and international strategy implementation.
abstract: BACKGROUND
  National and international strategies were implemented in eastern Democratic Republic of Congo (DRC) to address sexual and gender-based violence (SGBV).
  
  
  OBJECTIVE
  The objective was to assess community attitudes of SGBV and health facility capacity to address SGBV in eastern DRC.
  
  
  METHODS
  The design and setting are as follows: a cross-sectional, population-based cluster survey of 998 adults in eastern DRC territories, a convenience sample of 27 adults using semi-structured directed interviews, qualitative data from 37 focus groups conducted in three health zones, assessment of 64 health facilities and a comparative analysis of SGBV strategies.
  
  
  METHODS
  The main outcome measures opinions regarding SGBV prevention and justice and health facility capacity to address SGBV.
  
  
  RESULTS
  The majority of respondents favored the legal system over community mediation to obtain justice for SGBV. However, 61.1% (95% CI, 51.8-70.5%) of SGBV survivors reported being forced to accept community mediation. Among SGBV survivors, 81.2% (95% CI, 74.5-87.8%) reported no available mental health care. Less than half of all respondents reported access to a hospital, clinic or pharmacy. The analyses and facility assessment reinforce the need to improve SGBV care.
  
  
  CONCLUSIONS
  Mixed methodologies point to the complexities of addressing SGBV, assess key elements of SGBV prevention, justice and response, and may ultimately inform national and international strategies.
authors.affiliation: Division of Women's Health, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Scott
authors.forename: Suzanne
authors.initials: S
authors.lastname: Polak
authors.forename: Michael
authors.initials: M
authors.lastname: Kisielewski
authors.forename: Mary
authors.initials: M
authors.lastname: McGraw-Gross
authors.forename: Kirsten
authors.initials: K
authors.lastname: Johnson
authors.forename: Miel
authors.initials: M
authors.lastname: Hendrickson
authors.forename: Lynn
authors.initials: L
authors.lastname: Lawry
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D016000:Cluster Analysis; D003150:Community Health Workers; D003430:Cross-Sectional Studies; D015023:Democratic Republic of the Congo; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D038622:Internationality; D008297:Male; D036301:Qualitative Research; D012737:Sex Factors; D012742:Sex Offenses / Q000517:prevention & control*; D012935:Social Justice; D014754:Violence / Q000517:prevention & control*; D055815:Young Adult
keywords: Democratic Republic of Congo; community mediation; conflict; justice; sexual gender-based violence