A Congolese-US participatory action research partnership to rebuild the lives of rape survivors and their families in eastern Democratic Republic of Congo.

Nancy Glass, Paul Ramazani, Mafille Tosha, Mitima Mpanano & Matthias Cinyabuguma
Journal: Global Public Health: An International Journal for Research, Policy and Practice

Posted in 2012

The Democratic Republic of Congo (DRC) remains an all-too-potent reminder of how war, human rights violations and their related health and economic impacts can devastate a society. The last decade has seen the use of rape as a weapon of war in the DRC, where rebels and soldiers subject women and girls to brutalising attacks, rape, torture and mutilation.

Survivors of sexual and gender-based violence (SGBV) are often further traumatised by infections, disease, poverty, stigma and social isolation. Substantial evidence exists showing an association between social determinants (e.g., poverty, stress and trauma, stigma, lack of access to health care) and health; however, limited research has been conducted to elucidate these relationships or to develop and test interventions to change social determinants of health, especially in conflict and post-conflict settings such as the DRC.

The purpose of this article is to present a Congolese–US community-academic research partnership to obtain evidence to develop and implement a sustainable intervention to begin to address the social determinants of health, including poverty and traumatic stress for survivors of SGBV and their families in the South Kivu province of eastern DRC.


Social interaction in the aftermath of conflict-related trauma experiences among women in Walungu Territory, Democratic Republic of Congo

NAnjalee Kohli, Nancy Perrin, Remy Mitima Mpanano, James Case, Clovis Mitima Murhula, Arsène Kajabika Binkurhorhwa, Alfred Bacikenge Mirindi, Jean Heri Banywesize, Nadine Mwinja Bufole, Eric Mpanano Ntwali & Nancy Glass
Journal: Global Public Health: An International Journal for Research, Policy and Practice

Posted in2014


The aim of this study was to understand the relative contribution of posttraumatic stress disorder (PTSD)- and non-PTSD-associated reductions in social interaction among a group of adult Congolese women (N = 701) who have experienced multiple and different traumatic events and are participating in a village livestock microfinance programme.

The two main outcomes were frequency of (1) family/community members visiting women’s homes and (2) women visiting family/community members in their home. Bivariate and multivariable linear regression was used to understand relationships between multiple and grouped trauma experiences, PTSD, depression and social interaction. The majority of women (51.6%) reported rarely or never visiting family/community members or having family/community members visit the woman’s home (54.9%). In the multivariable model, material deprivation was significantly associated with fewer visits in the woman’s home.

Exposure to certain conflict-related traumas, but not material deprivation, was significantly associated with fewer visits to the homes of family/community members. Increased symptoms of PTSD were significantly associated with fewer visitors in woman’s home and fewer visits to the homes of family/community members. A better understanding of the social effects of conflict on individuals and local communities is necessary to support rebuilding of local communities.


Livestock/Animal Assets Buffer the Impact of Conflict-Related Traumatic Events on Mental Health Symptoms for Rural Women

Nancy Glass, Nancy A. Perrin, Anjalee Kohli, Mitima Mpanano Remy
Journal: PLoS One

Posted in 2014

Background: In the context of multiple adversities, women are demonstrating resilience in rebuilding their futures, through participation in microfinance programs. In addition to the economic benefits of microfinance, there is evidence to suggest that it is an effective vehicle for improving health.

Methods: The parent study is a community-based trial to evaluate the effectiveness of a livestock microfinance intervention, Pigs for Peace (PFP), on health and economic outcomes with households in 10 villages in eastern Democratic Republic of Congo. The analysis for this manuscript includes only baseline data from female participants enrolled in the ongoing parent study. Multiple regression analysis was used to examine if livestock/animal asset value moderates the relationship between conflict-related traumatic events and current mental health symptoms.

Findings: The majority of women are 25 years or older, married, have on average 4 children in the home and have never attended school. Nearly 50% of women report having at least one livestock/animal asset at baseline. Over the past 10 years, women report on average more than 4 (M=4.31, SD 3.64) traumatic events (range 0–18). Women reported symptoms consistent with PTSD with a mean score of 2.30 (SD: 0.66, range 0–4) and depression with a mean score of 1.86 (SD 0.49, range 0–3.47). The livestock/animal asset value by conflict-related traumatic events interaction was significant for both the PTSD (p=0.21) and depression (p=0.002) symptom models.

Interpretation: The study provides evidence of the moderating affect of livestock/animal assets on mental health symptoms for women who have experienced conflict. The findings supports evidence about the importance of livestock/animal assets to economics in rural households but expands on previous research by demonstrating the psychosocial effects of these assets on women’s health.


Risk for Family Rejection and Associated Mental Health Outcomes Among Conflict- Affected Adult Women Living in Rural Eastern Democratic Republic of the Congo

Anjalee Kohli, Nancy A. Perrin, Remy Mitima Mpanano, Luke C. Mullany, Clovis Mitima Murhula, Arsène Kajabika Binkurhorhwa, Alfred Bacikengi Mirindi, Jean Heri Banywesize, Nadine Mwinja Bufole, Eric Mpanano Ntwali & Nancy Glass
Journal: Health Care for Women International

Posted in 2014

Risk for Family Rejection and Associated Mental Health Outcomes Among Conflict-Affected Adult Women Living in Rural Eastern Democratic Republic of the Congo

Stigma due to sexual violence includes family rejection, a complex outcome including economic, behavioral, and physical components. We explored the relationship among conflict-related trauma, family rejection, and mental health in adult women living in rural eastern Democratic Republic of the Congo, who participate in a livestock-based microfinance program, Pigs for Peace.

Exposure to multiple and different types of conflict-related trauma, including sexual assault, was associated with increased likelihood of family rejection, which in turn was associated with poorer mental health outcomes. Design of appropriate and effective interventions will require understanding family relationships and exposure to different types of trauma in postconflict environments.


Family and community driven response to intimate partner violence in post-conflict settings

Anjalee Kohli, Nancy Perrin, Remy Mitima Mpanano, Luhazi Banywesize, Alfred Bacikenge Mirindi, Jean Heri Banywesize, Clovis Murhula Mitima, Arsène Kajabika Binkurhorhwa, Nadine Mwinja Bufole, Nancy Glass
Journal: Social Science & Medicine

Posted in 2012

This study explores risk factors, individual and family consequences and community-driven responses to intimate partner violence (IPV) in post-conflict eastern Democratic Republic of Congo (DRC).

This qualitative study was conducted in 3 rural villages in South Kivu Province of DRC, an area that has experienced prolonged conflict. Participants included 13 female survivors and 5 male perpetrators of IPV as reported during baseline data collection for the parent study, an impact evaluation of the Congolese-led livestock microfinance program, Pigs for Peace. Participants described social and behavioral circumstances that increase risk for IPV; social, health and economic consequences on women and their families; and resources to protect women and their families. Social and behavioral factors reported by survivors and perpetrators indicate that IPV was linked to husband's alcohol consumption, household economic instability, male desire to maintain his position as head of family and perceived disrespect of husband by wife.

In addition to well-known health consequences of IPV, women reported negative social consequences, such as stigma, resulting in barriers for the well-being of the family. Survivors and perpetrators described the impact of IPV on their children, specifically the lack of proper parental guidance and lack of safety and stability that could result in the child(ren) misbehaving and using violence in their relationships resulting in further stigma towards the child and family. Strategies employed by survivors to protect themselves and family, include placating male behaviors (e.g., not responding to insults, trying to meet household demands). Perpetrators that tried to reduce the impact of IPV reported a preference for social and financial control of their partner rather than physical violence, believing this to be less severe. Participants described community and family based social support systems including couple's mediation, responsible partner and fatherhood programs and economic activities that can influence behavior, maintain confidentiality, address social stigma and other multi-level outcomes.


Coping among trauma-affected youth: a qualitative study

Megan Cherewick, Anjalee Kohli, Mitima Mpanano Remy, Clovis Mitima Murhula, Arsene Kajabika Bin Kurhorhwa, Alfred Bacikenge Mirindi, Nadine Mwinja Bufole, Jean Heri Banywesize, Gisele Mushengezi Ntakwinja, Gracia Mitima Kindja & Nancy Glass
Journal: Conflict and Health

Posted in2015



Eastern Democratic Republic of Congo has endured decades of conflict resulting in widespread experiences of conflict related trauma and destruction to health and social infrastructure. The aim of this qualitative study was to provide a context specific understanding of youth exposure to violence (ages 10–15 years) and use of cognitive and behavioral coping strategies.


A purposive sampling strategy based on age, gender and exposure to traumatic events was used to identify eligible youth in an ongoing parent study from four villages in the Walungu Territory, Eastern Democratic Republic of Congo. These four villages were selected from a total of 10 participating in the parent study because of the reported high exposure to conflict-related trauma. The interview guide consisted of broad open-ended questions related to the following topics, 1) identification of traumatic experiences, 2) methods for coping and changes in coping behavior 3) gender and age differences in coping, 4) sources of psychosocial support. A grounded theory approach was used to identify emergent themes.


Of the 48 eligible participants identified, 30 youth completed the interview, 53 % were female (n = 16) and 47 % were male (n = 14). Youth ranged in age from 10–15 (mean age = 13.07). Exposures to different forms of violence and stress were reported among youth participants. Exposures to traumatic stressors occur at the individual, family and community level. In response to traumatic stress, youth reported both cognitive and behavioral coping strategies. Cognitive coping strategies included trying to forget and praying. Behavioral coping strategies included social support seeking and risk-taking behavior. These strategies may be used in mutually reinforcing ways, with youth employing more than one coping strategy.


This qualitative research provides important, culturally grounded information on coping strategies used by youth in rural post-conflict settings where limited psychosocial support services are available. Understanding use of cognitive and behaviors coping strategies may inform local community and international development programs to support youth mental health along adaptive trajectories resulting in promotion of well-being and reduced risk taking behaviors