[Assessment of vaccination status and booster vaccinations in adolescents attending school in Libreville, Gabon]

Introduction

La vaccination chez l'adolescent est particulière et le statut vaccinal de ce dernier est peu connu. L'objectif de cette étude était d'apprécier ce statut vaccinal et d'identifier les facteurs associés à la compliance vaccinale chez les adolescents scolarisés à Libreville.

Méthodes

Une enquête observationnelle transversale descriptive a été réalisée chez les élèves des classes de 6^edu Lycée national Léon MBA de Libreville.

Résultats

Au total, 304 élèves ont été inclus dans l'étude. L'âge moyen des élèves était de 11,60±1,20 ans et le sexe ratio était de 0,6. Deux cent soixante-six enfants (87,5%) vivaient avec leur géniteur direct (père et/ou mère). Le nombre moyen d'enfants par famille était de 4. Le taux de couverture vaccinale était de 78,3%. Le nombre d'enfants par famille n'était pas associée à la couverture vaccinale des vaccins du PEV (p=0,088), par contre les enfants vivant avec au moins l'un des parents avaient une meilleure couverture vaccinale respectivement par les vaccins du PEV (p=0,025) et les vaccins hors PEV (p=0,035). Les facteurs évoqués par les parents pour expliquer la non-vaccination étaient le manque d'information (30,59%), l'oubli (24,67%) et le manque de moyens financiers (12,82%).

Conclusion

La couverture vaccinale des adolescents scolarisés à Libreville semble relativement proche des objectifs du PEV, mais elle reste associée à la situation familiale. D'autres campagnes de sensibilisation seraient utiles pour améliorer cette couverture vaccinale au Gabon.

Incidence of catastrophic expenditures linked to obstetric and neonatal care at 92 facilities in Lubumbashi, Democratic Republic of the Congo, 2015

Background

In the Democratic Republic of the Congo (DRC), more than 93% of users must pay out of pocket for care. Despite the risk of catastrophic expenditures (CE), 94% of births in Lubumbashi are attended by skilled personnel. We aimed to identify risk factors for CE associated with obstetric and neonatal care in this setting, to document coping mechanisms employed by households to pay the price of care, and to identify consequences of CE on households.

Methods

We used mixed methods and conducted both a cross-sectional study and a phenomenological study of women who delivered at 92 health care facilities in all 11 health zones of Lubumbashi. In April and May 2015 we followed 1,627 women and collected data on their health care and household expenses to determine whether they experienced CE, defined as payments that reached or exceeded 40% of a household’s capacity to pay. Two months after discharge, we conducted semi-structured interviews with 58 women at their homes to assess the consequences of CE.

Results

In all, 261 of 1,627 (16.0%) women experienced CE. Whether a woman or her infant experienced complications was an important contributor to her risk of CE; poverty, younger age, being unmarried, and delivering in a parastatal facility or with more highly trained personnel also increased risk. Among a subset of women with CE interviewed 2 months after discharge, those who were in debt or who had lost their trading income or goods were unable to pay their rent, their children’s school fees, or were obliged to reduce food consumption in the household; some had become victims of mistreatment such as verbal abuse, disputes with in-laws, denial of paternity, abandonment by partners, financial deprivation, even divorce.

Conclusions

We found a higher proportion of CE than previously reported in the DRC or in other urban settings in Africa. We suggest that the government and funders in DRC support initiatives to put in place mutual-aid health risk pools and health insurance and introduce and institutionalize free maternal and infant care. We further suggest that the government ensure decent and regular payment of providers and improve the financing and functioning of health care facilities to improve the quality of care and alleviate the burden on users.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7260-9) contains supplementary material, which is available to authorized users.

Commercialization of obstetric and neonatal care in the Democratic Republic of the Congo: A study of the variability in user fees in Lubumbashi, 2014

OBJECTIVE

In the Democratic Republic of the Congo, insufficient state financing of the health system produced weak progress toward targets of Millennium Development Goals 4 and 5. In Lubumbashi, almost all women pay out-of-pocket for obstetric and neonatal care. As no standard pricing system has been implemented, there is great variation in payments related to childbirth between health facilities and even within the same facility. This work investigates the determinants of this variation.

METHODS

We conducted a cross-sectional study including women from admission through discharge at 92 maternity wards in Lubumbashi in March 2014. The women's payments were collected and validated by triangulating interviews of new mothers and nurses with document review. We studied payments related to delivery from the perspective of women delivering. The total was the sum of the payments linked to seeking and accessing care and transport of the woman and companion. The determinants were assessed by multilevel regression.

RESULTS

Median payments for delivery varied by type: for an uncomplicated vaginal delivery, US$45 (range, US$17-260); for a complicated vaginal delivery US$60 (US$16-304); and for a Cesarean section, US$338 (US$163-782). Vaginal delivery was more expensive at health centers than in general referral hospitals or polyclinics. Cesarean sections done in corporate polyclinics and hospitals were more expensive than those done in the general referral hospitals. Referral of delivering women, use of more highly trained personnel, and a longer stay in the maternity unit contributed to higher expenses. A vaginal delivery in the private sector was more cost-effective than in the public sector.

CONCLUSION

To guarantee universal coverage of high-quality care, we suggest that the government and funders in DRC support health insurance and risk pool initiatives, and introduce and institutionalize free mother and infant care.

[External anthropometric measurement and pelvimetry among nulliparous women in Lubumbashi: risk factors and predictive score of mechanical dystocia]

Introduction

Maternal and perinatal morbi-mortality is higher in most of sub-Saharan Africa compared to the rest of the world. All women at risk for mechanical dystocia should be screened before labor and referred to a better equipped Hospital for childbirth. This would reduce morbi-mortality. This study aims to develop a predictive score of mechanical dystocia during childbirth among nulliparous Congolese women.

Methods

We conducted a cross-sectional study of nulliparous women with single pregnancy in 7 Maternity Units in the city of Lubumbashi (DRC). Women' size, weight, and external pelvimetry results were collected and analyzed. Univariate and multivariate analyses were performed. Discrimination score was assessed using the ROC curve.

Results

We included in the study 535 nulliparous women, of whom 126 (23.55%) had given birth by cesarean section due to mechanical dystocia. After logistic modelling, three criteria emerged as predictive factors for mechanical dystocia: maternal height <150 cm (adjusted OR=2.96 [1,49-5,87]), bi-ischiatic diameter <8 cm (adjusted OR =15.96 [3,46-73,56]), and Trillat's pre-pubic diameter <11 cm (adjusted OR =2.34 [1,36-4,01]). The area under the ROC curve of the score was 0.6549 with a sensitivity of 23.81%, a specificity of 97.80% and a positive predictive value of 76.92%.

Conclusion

It has been observed that 10th percentile of the three maternal anthropometric measures was predictive of mechanical dystocia. When they were used together, these three values allowed for the development of lowest-cost screening score for use in low income settings.

[Risk factors for maternal and perinatal mortality among women undergoing cesarean section in Lubumbashi, Democratic Republic of Congo II]

Introduction

L’objectif était d’analyser les facteurs de risque de mortalité maternelle et périnatale de la césarienne à Lubumbashi, République Démocratique du Congo (RDC).

Méthodes

Étude multicentrique de 3643 césariennes réalisées entre le 1er janvier 2009 et le 31 décembre 2013 sur un total de 34199 accouchements dans cinq formations hospitalières de référence à Lubumbashi (RDC). Les données sociodémographiques, les indications, l’environnement obstétrical et la morbi-mortalité maternelles et périnatales ont été analysés au logiciel Epi Info 2011. Les fréquences calculées sont exprimées en pourcentage et les moyennes avec leurs écart-types. Le test de Chi-carré et le test exact de Fisher lorsque recommandés ont été utilisés pour la comparaison des fréquences. L’odds ratio a été calculé avec l’intervalle de confiance de 95% de Cornfield grâce à un modèle de régression logistique pour déterminer la puissance de facteurs de risque. Le seuil de signification a été fixé à p < 0,05.

Résultats

La fréquence de la césarienne était de 10,65%. L'âge moyen des césarisées était de 28,83±6,8 ans (extrêmes: 14 et 49 ans). La parité variait de 1 à 16 avec une moyenne de 2,6. De ces opérées, une sur neuf (10,9%) était porteuse d’un utérus cicatriciel de césarienne antérieure et 22,3% étaient des évacuées obstétricales. Les taux de létalité maternelle et périnatale étaient respectivement de 1,4% et 7,07% lors de la césarienne. L’analyse des facteurs de risque montre que la grande multiparité (≥5), l’absence de surveillance de la grossesse, le caractère urgent de l’indication opératoire influent significativement sur la mortalité maternelle. A ces facteurs s’ajoutent pour la mortalité périnatale l’âge maternel avancé (> 35 ans), l’évacuation comme mode d’admission et l’immaturité fœtale.

Conclusion

Cette étude montre que la césarienne dans nos conditions de travail est couplée à une forte mortalité maternelle et périnatale. Les facteurs de risque identifiés sont en grande partie évitables, surtout à tort ou à raison imputés à l’opération masquant ipso facto les circonstances souvent irrationnelles de sa pratique.

Introduction

The objective was to analyze risk factors for maternal and perinatal mortality among women undergoing cesarean section in Lubumbashi, Democratic Republic of Congo (DRC).

Methods

We conducted a multicenter study of 3643 women undergoing cesarean sections between 1 January 2009 and 31 December 2013 out of 34199 women delivering in five general referral hospitals in Lubumbashi (DRC). Sociodemographic data, indications, obstetrical environment as well as maternal and perinatal morbi-mortality were analyzed using Epi Info 2011 software. Computed frequencies were expressed in percentage and mean values were expressed in terms of standard deviations. Chi-square test and Fisher’s exact test, when recommended, were used to compare frequencies. The odds ratio was calculated using Cornfield 95% confidence interval based on a logistic regression model in order to determine the strength of risk factors. Threshold significance level was set at p < 0.05.

Results

The frequency of cesarean sections was 10.65%. The average age of women undergoing cesarean section was 28.83 ± 6.8 years (with a range from 14 to 49 years). Parity ranged from 1 to 16 with an average of 2.6. 1 out of 9 (10.9%) women undergoing cesarean section were patients with previous caesarean section uterine scar on the anterior wall of the uterus and 22.3% of women were patients with previous obstetric evaquation. Maternal and perinatal mortality rate was 1.4% and 7.07% during cesarean section respectively. The analysis of risk factors shows that the great multiparity (≥5), the absence of monitoring during pregnancy, the urgent nature of emergency surgery significantly affect maternal mortality. Other factors for perinatal mortality included advanced maternal age (>35 years), patients referral from one facility to another as a mode of admission and fetal immaturity.

Conclusion

This study shows that cesarean section in our working condition is associated to a significant maternal and perinatal mortality. Identified risk factors are largely preventable, because they are rightly or wrongly ascribed to cesarean section glossing over, ipso facto, the often irrational circumstances of its practice.

Health-seeking behaviour in the city of Lubumbashi, Democratic Republic of the Congo: results from a cross-sectional household survey

Background

Concerns about the occurrence of disease among household members generally initiate treatment-seeking actions. This study aims to identify the various treatment-seeking options of patients in Lubumbashi, analyze their health-seeking behaviour, identify determinants for the use of formal care, and analyze direct health care expenditure.

Methods

A cross-sectional survey of households in Lubumbashi was conducted in July 2010. Information was collected from a randomly selected sample of 251 households with at least one member who had been ill in the 2 weeks preceding the survey.

Results

Frequently used initial treatment-seeking options consist of self-medication based on modern medicines (54.6%), the use of first-line health services (23.1%) and hospitals (11.9%), with a perceived effectiveness of 51%, 83% and 91% respectively. If people go for a second option, then formal health care services are most often preferred. The majority (60%) of patients’ spontaneous itineraries reflect the expected functioning of a local health care system, with a patient flow characterised by the use of a first line health facility prior to the use of hospital-based services. Chronicity of the disease is the main determinant of seeking formal care. Analysis of care expenditure reveals that drugs are the only line of expenditure in the informal system and the main source of expenditure in the formal system; costs do not discriminate between first-line health services and hospitals, and the payment system is regressive since the poorest patients pay the same amounts as the richest.

Conclusions

This study points to the importance of self-medication as the first therapeutic option for the majority of patients in Lubumbashi, whatever the nature of the health problem. There is a lot of room to rationalise this practice. Although formal care is not common initial therapeutic option, it is the source of care most patients turn to, especially when they believe having a chronic disease. Patients’ itineraries in this urban environment are complex; health managers should try and deal with this reality. Finally, our study indicates that poor patients face the same level of out-of-pocket payments as the more wealthy ones, hence the need for more equitable health care financing arrangements.

Determinants of maternal health services utilization in urban settings of the Democratic Republic of Congo--a case study of Lubumbashi City

Background

The use of maternal health services, known as an indirect indicator of perinatal death, is still unknown in Lubumbashi. The present study was therefore undertaken in order to determine the factors that influence the use of mother and child healthcare services in Lubumbashi, Democratic Republic of the Congo.

Methods

This was transversal study of women residing in Lubumbashi who had delivered between January and December 2009. In total, 1762 women were sampled from households using indicator cluster surveys in all health zones. Antenatal consultations (ANC), delivery assisted by qualified healthcare personnel (and delivery in a healthcare facility) as well as postnatal consultations (PNC) were dependent variables of study. The factors determining non-use of maternal healthcare services were researched via logistic regression with a 5% materiality threshold.

Results

The use of maternal healthcare services was variable; 92.6% of women had attended ANC at least once, 93.8% of women had delivered at a healthcare facility, 97.2% had delivered in the presence of qualified healthcare personnel, while the rate of caesarean section was 4.5%. Only 34.6% postnatal women had attended PNC by 42 days after delivery. During these ANC visits, only 60.6% received at least one dose of vaccine, while 38.1% received Mebendazole, 35.6% iron, 32.7% at least one dose of SulfadoxinePyrimethamine, 29.2% folic acid, 15.5% screening for HIV and 12.8% an insecticide treated net.

In comparison to women that had had two or three deliveries before, primiparous and grand multiparous women were twice as likely not to use ANC during their pregnancy. Women who had unplanned pregnancies were also more likely not to use ANC or PNC than those who had planned pregnancies alone or with their partner. The women who had not used ANC were also more likely not to use PNC. The women who had had a trouble-free delivery were more likely not to use PNC than those who had complications when delivering.

Conclusion

In Lubumbashi, a significant proportion of women continue not to make use of healthcare services during pregnancy, as well as during and after childbirth. Women giving birth for the first time, those who have already given birth many times, and women with an unwanted pregnancy, made less use of ANC. Moreover, women who had not gone for ANC rarely came back for postnatal consultations, even if they had given birth at a healthcare facility. Similarly, those who gave birth without complications, less frequently made use of postnatal consultations. As with ANCs, women with unwanted pregnancies rarely went for postnatal visits.

In addition to measures aimed at reinforcing women’s autonomy, efforts are also needed to reinforce and improve the information given to women of childbearing age, as well as communication between the healthcare system and the community, and participation from the community, since this will contribute to raising awareness of safe motherhood and the use of such services, including family planning.