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Angèle MN, Abel NM, Jacques OM, Henri MT, Françoise MK. Social and economic consequences of the cost of obstetric and neonatal care in Lubumbashi, Democratic Republic of Congo: a mixed methods study. BMC Pregnancy Childbirth 2021; 21:315. [PMID: 33882894 PMCID: PMC8059173 DOI: 10.1186/s12884-021-03765-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 03/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to explore and measure the social and economic consequences of the costs of obstetric and neonatal care in Lubumbashi, the Democratic Republic of Congo. Methods We conducted a mixed qualitative and quantitative study in the maternity departments of health facilities in Lubumbashi. The qualitative results were based on a case study conducted in 2018 that included 14 respondents (8 mothers of newborns, 2 accompanying family members and 4 health care providers). A quantitative cross-sectional analytical study was carried out in 2019 with 411 women who gave birth at 10 referral hospitals. Data were collected for one month at each hospital, and selected mothers of newborns were included in the study only if they paid out-of-pocket and at the point of care for costs related to obstetric and neonatal care. Results Costs for obstetric and neonatal care averaged US $77, US $207 and US $338 for simple, complicated vaginal and caesarean deliveries, respectively. These health expenditures were greater than or equal to 40% of the ability to pay for 58.4% of households. At the time of delivery, 14.1% of women giving birth did not have enough money to pay for care. Of those who did, 76.5% spent their savings. When households did not pay for care, mothers and their babies were held for a long time at the place of care. This resulted in the prolonged absence of the mother from the household, reduced household income, family conflicts, and the abandonment of the home by the spouse. At the health facility level, the increase in length of stay did not generate any additional financial benefits. Mothers no longer had confidence in nurses; they were sometimes separated from their babies, and they could not access certain prescribed medications or treatments. Conclusion The government of the DRC should implement a mechanism for subsidizing care and associate it with a cost-sharing system. This would place the country on the path to achieving universal health coverage in improving the physical, mental and social health of mothers, their babies and their households. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03765-x.
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Affiliation(s)
- Musau Nkola Angèle
- School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo.
| | | | | | - Mundongo Tshamba Henri
- School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Malonga Kaj Françoise
- School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
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Tshinzobe JCK, Ngaya DK. [Case-control study of factors associated with low birth weight at the Kingasani Hospital Center, Kinshasa (Democratic Republic of Congo)]. Pan Afr Med J 2021; 38:94. [PMID: 33889260 PMCID: PMC8035683 DOI: 10.11604/pamj.2021.38.94.16099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 05/08/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction l´insuffisance pondérale à la naissance est considérée comme l´un des plus importants indicateurs de chances de survie d´un nouveau-né et un risque majeur de morbidité, de mortalité périnatale et infantile. L´objectif de cet article est d´étudier les facteurs associés à l´insuffisance pondérale à la naissance au Centre Hospitalier de Kingasani, à Kinshasa. Méthodes une étude rétrospective de type cas-témoins a été réalisée. Les informations sur les parturientes et leurs enfants nés du 1er janvier au 31 décembre 2016 ont été collectées dans le registre de la maternité du Centre Hospitalier Kingasani. Quatre cent cinquante-huit (458) cas (moins de 2500 grammes) ont été comparés aux 458 témoins (2500-4000 grammes). L´analyse multivariée a été faite à l´aide de la régression logistique binaire pour identifier les facteurs associés au faible poids de naissance. Résultats en 2016, 3451 naissances vivantes ont été enregistrées et la prévalence de l´insuffisance pondérale a été estimée à 13,27%. Il a été trouvé, dans l´analyse bivariée, que la parité, le terme de grossesse, le type de grossesse et le sexe du nouveau-né sont des variables significativement associées à l´insuffisance pondérale à la naissance. Après ajustement sur les variables intégrées dans l´analyse multivariée, la parité, le terme de grossesse et le type de grossesse sont demeurés significativement associées à l´insuffisance pondérale à la naissance. Conclusion de ces résultats, nous suggérons la promotion des études intégrant tous les paramètres impliqués dans la survenue de l´insuffisance pondérale à la naissance pour suivre l´évolution régulière de ce problème et des facteurs associés.
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Affiliation(s)
- Jean Claude Kaka Tshinzobe
- Institut Supérieur des Techniques Médicales de Kinshasa, Section Santé Communautaire, Kinshasa, République Démocratique du Congo
| | - Denise Kwango Ngaya
- Centre Hospitalier Kingasani, Service de Maternité, Kinshasa, République Démocratique du Congo
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Musau NA, Ntambue MA, Ilunga KS, Matungulu MC, Ilunga MT, Mundongo TH, Malonga KF. [The cost of obstetric and neonatal care: Case study of the Jason Sendwe hospital maternity in Lubumbashi, Democratic Republic of Congo in 2015]. Rev Epidemiol Sante Publique 2018; 66:117-124. [PMID: 29371034 DOI: 10.1016/j.respe.2017.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 10/26/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the user cost for obtaining obstetric and neonatal care during childbirth in the Jason Sendwe hospital in the city of Lubumbashi, Democratic Republic of Congo. METHODS We conducted a cross-sectional study at the maternity of the Jason Sendwe hospital in Lubumbashi, reviewing charts and using a questionnaire given to 145 women who gave birth from 1st August to 30th September 2015. We calculated the cost based on the amounts paid by users for obtaining care, expressed in US dollars ($) at an exchange rate of 900 Congolese Francs (CDF) for $1. RESULTS The average age of parturients was 27±6 years (m±SD). Nearly 9 out of 10 women were married (84.8%), 24.1% had a primary school educational level. The majority (62.1%) had no occupational activity and the average monthly income of those employed was $28. Many of their spouses were self-employed (36.6%) with an average monthly income of $113. Hemorrhage was the most common complication (12.4%); perinatal mortality was 12.4%, and was only registered in cases of dystocia. Cost of care for eutocic delivery was 5 times greater than for complicated vaginal delivery that in turn had a 2-fold lower cost than caesarean section. It follows from this study that the cost of care for eutocic delivery, complicated vaginal delivery and cesarean section was, respectively: 1.4%, 7.5%, and 13.4% of annual household income. In general, in case of childbirth, 51%, 40.7%, and 34.4% of households devoted more than 5%, 10% and 20% respectively of their annual income to obtain obstetric and neonatal care. CONCLUSION The cost of obstetric and neonatal care is catastrophically high for households in Lubumashi. Undoubtedly, those who seek hospital care for childbirth must cope with financial problems related to the incurred debt. The State should review its healthcare financial policy to ensure access to quality care for all.
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Affiliation(s)
- N A Musau
- École de santé publique, université de Lubumbashi, avenue Njamena, commune Lubumbashi, Lubumbashi, République démocratique du Congo.
| | - M A Ntambue
- École de santé publique, université de Lubumbashi, avenue Njamena, commune Lubumbashi, Lubumbashi, République démocratique du Congo
| | - K S Ilunga
- École de santé publique, université de Lubumbashi, avenue Njamena, commune Lubumbashi, Lubumbashi, République démocratique du Congo
| | - M C Matungulu
- École de santé publique, université de Lubumbashi, avenue Njamena, commune Lubumbashi, Lubumbashi, République démocratique du Congo
| | - M T Ilunga
- École de santé publique, université de Lubumbashi, avenue Njamena, commune Lubumbashi, Lubumbashi, République démocratique du Congo
| | - T H Mundongo
- École de santé publique, université de Lubumbashi, avenue Njamena, commune Lubumbashi, Lubumbashi, République démocratique du Congo
| | - K F Malonga
- École de santé publique, université de Lubumbashi, avenue Njamena, commune Lubumbashi, Lubumbashi, République démocratique du Congo.
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Getiye Y, Fantahun M. Factors associated with perinatal mortality among public health deliveries in Addis Ababa, Ethiopia, an unmatched case control study. BMC Pregnancy Childbirth 2017; 17:245. [PMID: 28747161 PMCID: PMC5530490 DOI: 10.1186/s12884-017-1420-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 07/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND perinatal mortality is the sum of still birth (fetal death) and early neonatal death (ENND) i.e. death of live newborn before the age of 7 completed days. Perinatal mortality accounts three fourth of the deaths of the neonatal period and is one of the major challenges for under-five mortality. Therefore this study was conducted to better understand the common and avoidable factors that affect perinatal mortality in Addis Ababa, Ethiopia. METHODS An unmatched case control study design using secondary data as a source of information was conducted. Cases were still births or early neonatal deaths and controls were live births and neonates who were discharged alive from the hospital and did not die before the age of 7 days. The study period was from 1st January up to 30th February 2015. Epi-Info version 7.0 and SPSS Version 21 were used for data entry and analysis. Descriptive statistics, frequencies, proportions and diagrams were used to check the distribution of outcome variable and describe the study population. Logistic regression model was used to identify the important factors that are associated with perinatal mortality. RESULTS A total of 1113(376 cases and 737 controls) maternal charts were reviewed. The mean age of the mothers for cases and controls were 26.47 ± 4.87 and 26.95 ± 4.68 respectively. Five hundred ninety seven (53.6%) mothers delivered for the first time. Factors that are significantly associated with increased risk of perinatal mortality were birth interval less than 2 years, preterm delivery, anemia, congenital anomaly, previous history of early neonatal death and low birth weight. Use of partograph was also associated with decreased risk of perinatal mortality. CONCLUSION From factors that are associated with perinatal mortality, some of them can be prevented with early investigation of pregnant mothers on their antenatal care follow. Appropriate labor follow-up and monitoring with regular use of partograph, immediate newborn care and interventions to delay birth interval also minimize perinatal mortality.
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Kaboré R, Meda IB, Koulidiati JLE, Millogo T, Kouanda S. Factors associated with very early neonatal mortality in Burkina Faso: A matched case-control study. Int J Gynaecol Obstet 2016; 135 Suppl 1:S93-S97. [DOI: 10.1016/j.ijgo.2016.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ntambue AM, Malonga FK, Dramaix-Wilmet M, Ngatu RN, Donnen P. Better than nothing? maternal, newborn, and child health services and perinatal mortality, Lubumbashi, democratic republic of the Congo: a cohort study. BMC Pregnancy Childbirth 2016; 16:89. [PMID: 27118184 PMCID: PMC4847211 DOI: 10.1186/s12884-016-0879-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 04/19/2016] [Indexed: 11/21/2022] Open
Abstract
Background The Democratic Republic of Congo (DRC) has a high rate of perinatal mortality (PMR), and health measures that could reduce this high rate of mortality are not accessible to all women. Where they are in place, their quality is not optimal. This study was initiated to assess the relationship between these suboptimal maternal, newborn and child health (MNCH) services and perinatal mortality (PM) in Lubumbashi, DRC’s second-largest city. Methods We conducted a prospective cohort study, comparing women who had no, low, moderate, or high numbers of antenatal care (ANC) visits; three different levels of delivery care; and who did or did not attend postnatal care (PNC). Women were followed for 50 days after delivery, with PM as the primary endpoint. Results Uptake of recommended prenatal interventions was between 11-43 % among ANC attenders, regardless of the frequency of their visits. PM was 26 per 1000. ANC attendance was associated with PM. Newborns of mothers who had the lowest attendance had a mortality two times higher than newborns of women who had not attended ANC (low visits: adjusted odds ratio (aOR) = 2.2; 95 % confidence interval (CI) = 1.4-3.8). However, moderate (aOR = 1.4; 95 % CI =0.7–2.2) and high (aOR = 1.3; 95 % CI 0.7–2.2) attendance were not statistically significantly associated with PM. PNC attendance was not significantly associated with lower PM (relative risk 0.4, 95 % CI 0.1–2.6). Emergency obstetric and newborn care (EmONC) was significantly associated with a reduction in mortality (aOR = 0.2; 95 % CI = 0.2–0.8), with an 84.4 % reduction among newborns at risk, and an overall reduction in mortality of 10 % for all births. Conclusion Perinatal mortality was high among the infants of women in the cohort under study (26 per 1000 live births). Availability of MNCH, specifically EmONC, was associated with lower perinatal mortality, and if this association is causal, might avert 84.4 % of perinatal deaths among newborns at high-risk.
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Affiliation(s)
- Abel Mukengeshayi Ntambue
- Université de Lubumbashi: École de Santé Publique, Unité d'Epidémiologie et de Santé de la Mère, du Nouveau-né et de l'enfant, Lubumbashi (DRC), Democratic Republic of the Congo.
| | - Françoise Kaj Malonga
- Université de Lubumbashi: École de Santé Publique, Unité d'Epidémiologie et de Santé de la Mère, du Nouveau-né et de l'enfant, Lubumbashi (DRC), Democratic Republic of the Congo
| | - Michele Dramaix-Wilmet
- Université Libre de Bruxelles: École de Santé Publique: Centre de recherche en Epidémiologie, Biostatistiques et recherche clinique, Brussels, Belgium
| | - Roger Nlandu Ngatu
- Graduate School of Health and Nursing Sciences & Disaster Nursing Global Leader doctoral program (DNGL), University of Kochi, Kochi, Japan
| | - Philippe Donnen
- Université Libre de Bruxelles: École de Santé Publique: Centre de recherche en Epidémiologie, Biostatistiques et recherche clinique, Brussels, Belgium.,Université Libre de Bruxelles: École de Santé Publique: Centre de Recherche en Politiques et systèmes de santé-Santé internationale, Brussels, Belgium
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Luhete PK, Mukuku O, Kayamba PKM. [Study of low birth weight associated with maternal age and parity in a population of mother and children in Lubumbashi]. Pan Afr Med J 2015; 20:246. [PMID: 26161169 PMCID: PMC4484401 DOI: 10.11604/pamj.2015.20.246.5169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 03/02/2015] [Indexed: 02/05/2023] Open
Abstract
Introduction Evaluer l'influence de l’âge maternel et de la parité sur la naissance d'un faible poids de naissance (FPN) à Lubumbashi. Méthodes Il s'agit d'une étude basée sur une analyse documentaire des dossiers médicaux des accouchées enregistrées dans les maternités des 10 hôpitaux généraux de référence (HGR) de la ville de Lubumbashi en République Démocratique du Congo entre le 1er décembre 2013 et le 31 mars 2014. Ces accouchées ont été réparties en deux groupes, en fonction du poids de naissance de leurs enfants: groupe I (femmes ayant accouché de nouveau-nés vivants dont le poids était inférieur à 2500 grammes) et groupe II (femmes ayant accouché de nouveau-nés vivants dont le poids était supérieur ou égal à 2500 grammes). Il s'agissait dans tous les cas de grossesses monofoetales âgées de 28 semaines ou plus. L’âge maternel et la parité ont été étudiés et comparés dans les deux groupes. Les données ont été analysées à l'aide des logiciels Épi info version 7.0 et SPSS version 19. Les différences étaient jugées significatives pour un seuil p < 0,05. Résultats La prévalence du FPN chez les nouveau-nés issus de ces accouchées était ainsi de 6,4% (71/1112). En analyse univariée, les femmes d’âge < 20 ans présentent un risque multiplié par 2,47 fois d'avoir un nouveau-né de FPN comparativement à celles de ≥20 ans (OR = 2,47; IC95%: 1,26-4,78) et celui pour les primipares d'avoir un enfant de FPN est 2,3 fois supérieur à celui de multipares (OR = 2,32; IC95%: 1,34-3,99). En faisant la régression logistique, nous avons observé que seule la parité est significativement corrélée au poids de naissance (OR ajusté = 2,61; IC95%: 1,43-4,74). Conclusion L’étude que nous avons menée montre que le taux de FPN diminue considérablement avec l’âge de la mère à partir de 20 ans et la multiparité.
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Affiliation(s)
- Prosper Kakudji Luhete
- Département de Gynécologie-Obstétrique, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | - Olivier Mukuku
- Département de Gynécologie-Obstétrique, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
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Nkwo PO, Lawani LO, Ezugwu EC, Iyoke CA, Ubesie AC, Onoh RC. Correlates of poor perinatal outcomes in non-hospital births in the context of weak health system: the Nigerian experience. BMC Pregnancy Childbirth 2014; 14:341. [PMID: 25271134 PMCID: PMC4262084 DOI: 10.1186/1471-2393-14-341] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 09/24/2014] [Indexed: 11/15/2022] Open
Abstract
Background Nigeria’s high perinatal mortality rate (PNMR) could be most effectively reduced by targeting factors that are associated with increased newborn deaths. Low access to skilled birth attendants (SBAs) and weak health system are recognized factors associated with high PNMR but other socio-demographic and reproductive factors could have significant influences as well. Identification of the major factors associated with high PNMR would be required in designing interventions to improve perinatal outcomes. Methods For this cross-sectional study, data from the Nigeria Demographic and Health Survey 2008 were used to estimate the PNMR of non-hospital births in identified socio-demographic and reproductive situations that are known to influence PNMR. The estimated PNMR were compared using logistic regression analysis. Results The PNMR was 36 per 1000 live births. North central region had the lowest PNMR while the south east region had the highest rate (odds ratio 1.59; 95% CI: 1.03, 2.45). Other correlates of high PNMR were belonging to the poorest wealth quintile (odds ratio 1.87; 95% CI: 1.30, 2.70), maternal age group 15–19 years (odds ratio 1.59; 95% CI: 1.05, 2.22), multiple birth (odds ratio 3.12; 95% CI: 2.11, 4.59), history of previous perinatal death (odds ratio 3.31; 95% CI: 2.73, 4.02), birth interval shorter than 18 months (odds ratio 1.65; 95% CI: 1.26, 2.17) and having a small birth size (odds ratio 2.56; 95% CI 1.79, 3.69). Birth attendant, place of birth, parity, maternal education and rural/urban residence had no association with PNMR. Conclusions Reproductive factors that require midwifery skills were found to contribute most to PNMR. We recommend general strengthening of the health system, recruitment of SBAs and retraining of available birth attendants with emphasis on identification and referral of complicated cases. Family planning should be a core MCH activity to address the issues of teenage pregnancy and short pregnancy intervals.
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Affiliation(s)
- Peter Onubiwe Nkwo
- Department of Obstetrics & Gynecology, University of Nigeria Teaching Hospital Ituku-Ozalla Enugu Nigeria, Ozalla, Nigeria.
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Ossou-Nguiet PM, Okoko AR, Ekouya Bowassa G, Oko AP, Mabiala-Babela JR, Ndjobo Mamadoud IC, Moyen G. [Determinants of cerebral malaria in Congolese children]. Rev Neurol (Paris) 2013; 169:510-4. [PMID: 23394850 DOI: 10.1016/j.neurol.2012.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 11/01/2012] [Accepted: 11/07/2012] [Indexed: 10/27/2022]
Abstract
Malaria still constitutes a worrying problem of public health. It remains an important cause of infant mortality. To determine the determinants of severe malaria a case control study was carried out from July to December 2011 in the pediatric intensive care department of the university hospital of Brazzaville. The group included 230 children hospitalised for severe malaria, and the control group consisted of children followed up for non-severe malaria. Cases and controls were compared using statistical tests for matched group. The young age of the mother (OR=4.13), her poor education level (OR=2.36), the low socioeconomic level of parents (OR=5.90), the malnutrition (OR=2.67), the delay of consultation (OR=13.69) and parasitemia were associated with significantly higher risk of severe malaria. The importance of identified determinants imposes the implementation of primary prevention measures, which pass through the amelioration of socioeconomic and cultural conditions of populations, the reinforcement of sanitary education, and also a secondary prevention consisting of an early and accurate management of ordinary malaria.
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Affiliation(s)
- P M Ossou-Nguiet
- Service de neurologie, université de Brazzaville, CHU de Brazzaville, 13, boulevard Maréchal-Lyautey, BP 32, Brazzaville, Congo.
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