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Abstract

Background: This study analysed the coverage and determinant factors for COVID-19 vaccination in Ituri, North Kivu, and South Kivu provinces in the Democratic Republic of the Congo (D.R.C). These are war-affected provinces that have experienced prolonged armed conflict, potentially limiting vaccine access.

Methods: A cross-sectional analysis of 9,795 people aged at least 15 years old and older fromyears from the 2023–2024 D.R.C Demographic and Health III Survey was conducted. Weighted descriptive statistics, design-adjusted chi-square tests, and multivariable logistic regression identified determinants of vaccination uptake.

Results: Overall vaccination coverage was 14.1% (95% CI: 11.3% - 17.4%)16.6% (95% CI= 14.2–19.3), with marked regional variation: Ituri (24.8%), South Kivu (15.913.2%), and North Kivu (6.0%). Lower odds of vaccination were observed in North Kivu (AOR=0.17, 95% CI=  0.10–0.29) and South Kivu (AOR=0.49, 95% CI=  0.30–0.79) compared to Ituri. Marital status (AOR = 1.71, 95% CI= 1.31–2.23), older age  55+ years (AOR = 1.62, 95% CI=1.13–2.23), 35–44 years old (AOR = 1.75, 95% CI=1.30–2.34 ), higher education (AOR=3.2, 95% CI=1.96–5.42) and radio ownership (A.O.RAOR = 0.66, 95% CI= 0.4906 -– 0.870.21) were significantly associated with covid 19 vaccination in then study population.

Conclusions: COVID-19 vaccination coverage is low with substantial geographic disparities in eastern DRC. Conflict-related barriers might limit healthcare access, highlighting the need for targeted, context-specific interventions.

Keywords: COVID-19 vaccination, armed conflict, Democratic Republic of Congo, Demographic Health Survey.

References

References

1.        Msemburi W, Karlinsky A, Knutson V, Aleshin-guendel S, Chatterji S, Wakefield J. The WHO estimates of excess mortality associated with the COVID-19 pandemic. 2023;613(January).

2.        Watson OJ, Barnsley G, Toor J, Hogan AB, Winskill P, Ghani AC. Articles Global impact of the first year of COVID-19 vaccination : a mathematical modelling study. Lancet Infect Dis [Internet]. 2021;22(9):1293–302. Available from: http://dx.doi.org/10.1016/S1473-3099(22)00320-6

3.        Zola T, Doshi RH, Muya A, Cikomola A, Milabyo A, Nasaka P. Challenges to COVID-19 vaccine introduction in the Democratic Republic of the Congo – a commentary ABSTRACT. Hum Vaccin Immunother [Internet]. 2022;18(6). Available from: https://doi.org/10.1080/21645515.2022.2127272

4.        Dutta PK, Lewis D, Levinson R, McClure J, Rolley S. A tinderbox conflict in Congo is ready to explode [Internet]. 2025. Available from: https://www.reuters.com/graphics/CONGO-SECURITY/MAPS/movaykzaava/

5.        Ditekemena JD, Nkamba DM, Mutwadi A, Mavoko HM, Nelson J, Fodjo S, et al. COVID-19 Vaccine Acceptance in the Democratic Republic of Congo : A Cross-Sectional Survey. 2021;1–11.

6.        International Committee Of the Red Cross. Democratic Republic of the Congo: Health care increasingly difficult to access in North and South Kivu. 2025;

7.        Bendavid E, Boerma T, Akseer N, Langer A, Malembaka EB, Okiro EA, et al. Women ’ s and Children ’ s Health in Conflict Settings 2 The effects of armed conflict on the health of women and children. 2021;397.

8.        Garry S, Checchi F. Armed conflict and public health : into the 21st century. 2019;42(3):287–97.

9.        Ali M. Mapping the human toll of the conflict in DR Congo. Aljazeera [Internet]. 2025; Available from: https://www.aljazeera.com/news/2025/3/24/mapping-the-human-toll-of-the-conflict-in-dr-congo

10.      Eiden AL. Drivers of and barriers to routine adult vaccination : A systematic literature review. Hum Vaccin Immunother [Internet]. 2022;18(6). Available from: https://doi.org/10.1080/21645515.2022.2127290

11.      Karp SR, Jean YB, Ashiru OA, Rangrej SB. COVID-19 Vaccine Willingness and Education Level : A Multinational Cross-Sectional Analysis. cereus [Internet]. 2025;17(6). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC12237217/

12.      Dadras O, El C. Vaccination Coverage and Determinants Among Children Aged 12 – 35 Months Following Internal Conflict in Yemen : Insights from a Nationwide Population-Based Survey. Matern Child Heal Journa [Internet]. 2025;1696–706. Available from: https://link.springer.com/article/10.1007/s10995-025-04156-w#:~:text=The overall vaccination coverage was,Significance

13.      Shiferie F, Gebremedhin S, Andargie G, Tsegaye DA, Alemayehu WA, Mekuria LA, et al. cross-sectional evaluation survey. Frontiers (Boulder) [Internet]. 2023;(October):1–11. Available from: file:///C:/Users/tonym/Downloads/Vaccination_dropout_and_wealth_related_inequality_.pdf

14.      Rodrigues F, Ziade N, Jatuworapruk K, Caballero-uribe C V, Khursheed T, Gupta L. The Impact of Social Media on Vaccination : A Narrative Review. 2023;38(40):1–13. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10578995/pdf/jkms-38-e326.pdf

15.      Hedström J. Women ’ s sexual and reproductive health in war and conflict : are we seeing the full picture ? Glob Health Action [Internet]. 2023;16(1):16–9. Available from: https://doi.org/10.1080/16549716.2023.2188689

16.      Lankiewicz E, Kabele J, Mpemba N, Samson P, Dikassa L, Mayala V, et al. Trends in vaccination coverage and equity in the Democratic Republic of the Congo from 2017 to 2023. Vaccine [Internet]. 2025;62(August):127609. Available from: https://doi.org/10.1016/j.vaccine.2025.127609

Bahasa Abstract

   Latar Belakang: Studi ini menganalisis cakupan dan faktor penentu vaksinasi COVID-19 di provinsi Ituri, Kivu Utara, dan Kivu Selatan di Republik Demokratik Kongo (DRC). Ini adalah provinsi yang terkena dampak perang yang telah mengalami konflik bersenjata yang berkepanjangan, yang berpotensi membatasi akses vaksin.   

Metode: Analisis cross-sectional terhadap 9.795 orang berusia minimal 15 years old and older fromtahun dari Survei  Demografi dan Kesehatan DRC III 2023–2024  dilakukan. Statistik deskriptif tertimbang, tes chi-square yang disesuaikan dengan desain, dan regresi logistik multivariabel mengidentifikasi penentu penyerapan vaksinasi.

Hasil: Cakupan vaksinasi keseluruhan adalah 14,1% (95% CI: 11,3% - 17,4%) 16.6% (95% CI= 14.2–19.3), dengan variasi regional yang nyata: Ituri (24,8%), Kivu Selatan (15,913.2%), dan Kivu Utara (6,0%). Peluang vaksinasi yang lebih rendah diamati di Kivu Utara (AOR = 0,17, 95% CI =  0,10–0,29) dan Kivu Selatan (AOR = 0,49, 95% CI = 0,30–0,79 ) dibandingkan dengan Ituri. Status perkawinan (AOR = 1,71, 95% CI= 1,31–2,23), usia yang lebih tua 55+ tahun (AOR = 1,62, 95% CI=1,13–2,23), 35–44 tahun (AOR = 1,75, 95% CI=1,30–2,34),  pendidikan tinggi (AOR=3,2, 95% CI=1,96–5,42) dan kepemilikan radio (A.O.RAOR = 0,66, 95% CI= 0.4906 -– 0,870.21) secara signifikan terkait dengan vaksinasi COVID 19 pada populasi penelitian saat itu.

Kesimpulan: Cakupan vaksinasi COVID-19 rendah dengan kesenjangan geografis yang substansial di DRC timur. Hambatan terkait konflik mungkin membatasi akses perawatan kesehatan, menyoroti perlunya intervensi khusus konteks yang ditargetkan.

Kata kunci: vaksinasi COVID-19, konflik bersenjata, Republik Demokratik Kongo, Survei Kesehatan Demografis.

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