1Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK; 2Bukavu Medical University College/Institut Supérieur des Techniques Médicales de Bukavu (ISTM-Bukavu), Bukavu, Eastern Democratic Republic of Congo; 3Centre de Recherche sur la Démocratie et le Développement en Afrique (CREDDA), Université Libre des Pays des Grands Lacs, Goma, Democratic Republic of Congo; 4School of Environmental Sciences, Njala University, Freetown, Sierra Leone; 5Hygiene, State Administration, Kikwit, Democratic Republic of Congo Correspondence: Susannah H Mayhew Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1E 9SH, UK