Strengthening Health Systems in Humanitarian Settings: Multi-Stakeholder Insights on Contraception and Postabortion Care Programs in the Democratic Republic of Congo and Somalia

Access to mifepristone, misoprostol, and contraceptive medicines in eight countries in the Eastern Mediterranean Region: descriptive analyses of country-level assessments

BACKGROUND

Despite their importance in reducing maternal mortality, information on access to Mifepristone, Misoprostol, and contraceptive medicines in the Eastern Mediterranean Region is limited.

METHODS

A standardized assessment tool measuring access to Mifepristone, Misoprostol, and contraceptive medicines included in the WHO essential medicines list (EML) was implemented in eight countries in the Eastern Mediterranean Region (Afghanistan, Iraq, Lebanon, Libya, Morocco, Palestine, Pakistan, and Somalia) between 2020-2021. The assessment focused on five access measures: 1) the inclusion of medicines in national family planning guidelines; 2) inclusion of medicines in comprehensive abortion care guidelines; 3) inclusion of medicines on national essential medicines lists; 4) medicines registration; and 5) procurement and forecasting of Mifepristone, Misoprostol, and contraceptive medicines. A descriptive analysis of findings from these eight national assessments was conducted.

RESULTS

Only Lebanon and Pakistan included all 12 contraceptives that are enlisted in the WHO-EML within their national family planning guidelines. Only Afghanistan and Lebanon included mifepristone and mifepristone-misoprostol combination in post-abortion care guidelines, but these medicines were not included in their national EMLs. Libya and Somalia lacked a national regulatory authority for medicines registration. Most contraceptives included on the national EMLs for Lebanon, Morocco and Pakistan were registered. Misoprostol was included on the EMLs-and registered-in six countries (Afghanistan, Iraq, Lebanon, Morocco, Palestine, and Pakistan). However, only three countries procured misoprostol (Iraq, Morocco, and Somalia).

CONCLUSION

These findings can guide efforts aimed at improving the availability of Mifepristone, Misoprostol, and contraceptive medicines in the Eastern Mediterranean Region. Opportunities include expanding national EMLs to include more options for Mifepristone, Misoprostol, and contraceptive medicines and strengthening the registration and procurement systems to ensure these medicines' availability were permitted under national law and where culturally acceptable.

Psychopathological states among Congolese health workers during the first wave of COVID-19 pandemic: links with emotion regulation and social support

Background: The COVID-19 pandemic is an unprecedented stressor for frontline healthcare workers, notably increasing acute stress disorder and depression rates. Emotion regulation and social support could be major protective factors against such psychopathological states, but their role has not been explored outside Western contexts. Objective: To assess the association between emotion regulation, social support, acute stress disorder, and depression among healthcare workers directly confronted with the first wave of COVID-19 pandemic in the eastern Democratic Republic of the Congo. Method: A cross-sectional study assessed acute stress disorder, depression, adaptive (i.e. acceptance, positive refocusing, …) and maladaptive (i.e. self-blame, rumination, catastrophizing, …) emotion regulation strategies, social support (instrumental, emotional, and informational levels), as well as self-reported situations and feelings related to COVID-19, in a population of 252 frontline healthcare workers (121 women; 131 men; mean age: 39 ± 11 years old) at the Referral General Hospital of Bukavu. We also explored the relations between these variables through bivariate and multivariate logistic regression. Results: Forty percent of participants presented symptoms of depression, and 16% presented acute stress disorder. In bivariate logistic regression, these psychiatric outcomes were associated with the availability of a COVID-19 protection kit [OR = 0.24 (0.12-0.98)], hostility toward health workers [OR = 3.21 (1.23-4.21)], putting into perspective [OR = 0.91 (0.43-0.98)], self-blame [OR = 1.44 (1.11-2.39)], catastrophizing [OR = 1.85 (1.01-4.28)], blaming others [OR = 1.77 (1.04-3.32)], emotional support [OR = 0.83 (0.49-0.98)], instrumental support [OR = 0.74 (0.28-0.94)], and informational support [OR = 0.73 (0.43-0.98)]. In multivariate logistic regression, hostility [OR = 2.21 (1.54-3.78)], self-blame [OR = 1.57 (1.02-2.11)], rumination [OR = 1.49 (1.11-3.13)] and emotional support [OR = 0.94 (0.65-0.98)] remained significantly associated with psychiatric outcomes. Conclusion: Depression and acute stress disorder were highly prevalent among Congolese healthcare workers during the first wave of the COVID-19 health pandemic. Hostility, self-blame, rumination, and social support were associated with depression and/or acute stress disorder and should be targeted by interventions aiming to support health workers' wellbeing.

HIGHLIGHTS

Frontline health workers presented high prevalence of acute stress disorder (16%) and depression (40%) during the first wave of COVID-19 pandemic in the Eastern Democratic Republic of the Congo, as they were working in hostile environment without enough protection kits.Acute stress disorder and depression were negatively associated with adaptive emotion regulation and social support; and positively with maladaptive emotion regulation.Intervention aiming to support health workers in pandemics should target emotion regulation and social support.