Individual and contextual determinants of early access to post-rape care: A retrospective cohort study of 4048 women in the Democratic Republic of Congo from 2014 to 2019.

Background: Armed conflict in the eastern Democratic Republic of Congo (DRC) has significantly increased the incidence of sexual violence against women. Victims who manage to access health care within 72 h of experiencing rape can receive critical preventive care to mitigate the consequences of such violence. Despite this, a disproportionately small number of victims are able to obtain medical care within this crucial time frame. This study aimed to identify both individual and contextual factors that influence the likelihood of accessing post-rape care within 72 h in the eastern DRC.

Methods: This retrospective cohort study utilized patient records from Panzi Hospital along with contextual data provided by the South Kivu Provincial Ministry of Health. It encompassed rape victims residing in South Kivu province who sought post-rape care between 2014 and 2019. To identify individual and contextual factors influencing timely access to care (within 72 h), multilevel logistic regression analysis was employed.

Results: The study included a total of 4,048 women, with 30 % being under 18 years old and 40 % married. Around 13 % accessed care within 72 h of rape. Multivariate analysis revealed that timely access to care (within 72 h) was negatively influenced by factors such as the isolation of the victim's health zone of residence (aOR = 0.29 [0.14-0.63], p = 0.002), the distance between the home health zone and the hospital (aOR = 0.75 [0.54-0.99], p = 0.041), instances of rape occurring in 2015 or earlier (aOR = 0.44 [0.34-0.57], p < 0.001), and referrals to the hospital from other health facilities or organizations (aOR = 0.78 [0.61-1.00], p = 0.049). Conversely, being single was positively associated with access to care within this critical period (aOR = 1.29 [1.03-1.61], p = 0.024). Furthermore, statistical trends indicate that the presence of Panzi partner NGOs in the victim's health zone might facilitate access to care (aOR = 1.33 [0.99-1.80], p = 0.057), highlighting an area of interest, while being internally displaced at the time of rape was associated with a trend towards reduced access to care (aOR = 0.78 [0.59-1.02], p = 0.068), underscoring the need for further research and targeted interventions.

Conclusion: To enhance access to post-rape care, our study highlights the need for strengthened collaboration with all partnering organizations and focused efforts on raising awareness, particularly among married women and their husbands. Enhancing security measures, constructing or upgrading roads to better connect major cities with currently inaccessible or isolated areas, bolstering the efforts of both local and international NGOs, and offering comprehensive reproductive health services to internally displaced women and those residing in the victims' health zones, are crucial steps toward ensuring access to post-rape care within the critical 72-hour window.