title: Patterns of Congenital Malformations and Barriers to Care in Eastern Democratic Republic of Congo.
abstract: BACKGROUND
  An increase of congenital anomalies in the eastern Democratic Republic of the Congo (DRC) has been reported. Congenital malformations (CMs) are not uncommon among newborns and, if left untreated, can contribute to increased neonate morbidity and mortality.
  
  
  METHODS
  Medical records of all individuals admitted with a diagnosed CM to HEAL Africa Teaching Hospital (Goma, DRC) from 2002 to 2014 (n=1301) were reviewed. Data were analysed using descriptive statistics to summarize chart records, and inferential statistics to investigate significant barriers to earlier treatment.
  
  
  RESULTS
  Since 2012, the number of patients treated each year for CMs has increased by over 200% compared to the average annual number of cases treated from 2002-2011. Though delayed presentation of patients to HEAL Hospital was very obvious, with an average age of 8.2 years. We find that patient age has been significantly decreasing (p=0.037) over time. The average distance separating patients from HEAL Hospital was 178 km, with approximately one third living 350 km or further from the treatment center. Distance is the most significant (p=3.33x10(-6)) barrier to earlier treatment. When controlling for an interaction between gender and the use of mercy funds, we also find that female patients are at a significant (p=1.04x10(-3)) disadvantage to undergo earlier corrective surgery. This disadvantage is further illustrated by our finding that 89% of women and girls, and over 81% of all patients, required mercy funds to cover the cost of surgery in 2014. Lastly, the mortality rate for surgery was low and averaged less than 1.0%.
  
  
  CONCLUSIONS
  Despite a formal end to the war in 2009, and an overall increase in individuals undergoing corrective surgery, distance, poverty, and gender are still massive barriers to CM care at HEAL Hospital, Goma, DRC. We find that patients have been successfully treated earlier by HEAL, although the average age of CM correction in 2014 (4.9 years) is still above average for Sub-Saharan Africa. Thus, we advocate for further funding from the National Government and international health agencies to enable continued treatment of CMs in rural residents of the eastern DRC. Distance, the most significant barrier to care can be mitigated by the implementation of additional mobile clinics and the construction of regional surgery centers along with the associated hiring of surgeons trained in CM repair.
authors.affiliation: HEAL Africa, 111 Avenue des Ronds Points, Box 319, Goma, Nord Kivu, Democratic Republic of Congo.
authors.forename: Luc
authors.initials: L
authors.lastname: Malemo Kalisya
authors.affiliation: HEAL Africa, 111 Avenue des Ronds Points, Box 319, Goma, Nord Kivu, Democratic Republic of Congo.
authors.forename: Kavira
authors.initials: K
authors.lastname: Nyavandu
authors.affiliation: HEAL Africa, 111 Avenue des Ronds Points, Box 319, Goma, Nord Kivu, Democratic Republic of Congo.
authors.forename: Bahati
authors.initials: B
authors.lastname: Machumu
authors.affiliation: HEAL Africa, 111 Avenue des Ronds Points, Box 319, Goma, Nord Kivu, Democratic Republic of Congo.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Kwiratuwe
authors.affiliation: Department of Anthropology, University of Florida, Turlington Hall, Room 1112, PO 117305, Gainesville, FL, 32611-7305, United States of America; University of Florida Genetics Institute, University of Florida, PO Box 103610, Gainesville, FL, 32610-3610, United States of America.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Rej
mesh_terms: D000013:Congenital Abnormalities / Q000453:epidemiology* / Q000601:surgery*; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies