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Mwene-Batu P, Ndokabilya E, Lembebu JC, Ngaboyeka G, Mary M, Tappis H, Dramaix M, Chimanuka C, Chiribagula C, Bigirinama R, Hermans MP, Bisimwa G. Maternal mortality in Eastern Democratic Republic of Congo: a 10-year multi-zonal institutional death review. BMC Public Health 2024; 24:2280. [PMID: 39174933 PMCID: PMC11340148 DOI: 10.1186/s12889-024-19804-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 08/14/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Maternal mortality (MM) remains a real scourge that hits hardest in the poorest regions of the world, particularly those affected by conflict. However, despite this worrying reality, few studies have been conducted about MM ratio in the Democratic Republic of Congo (DRC). The study aimed to describe the trends as well as the epidemiological profile and causes of reported institutional maternal deaths between 2013 and 2022 in Eastern DRC. METHODS A retrospective descriptive study was conducted between March 2023 and August 2023 in eight Health Zones (HZ), five in South Kivu Province (Mwana, Minova, Miti-Murhesa, Kamituga and Idjwi) and three in North Kivu Province (Kirotshe, Karisimbi and Kayna) in the eastern region of the DRC. Our study covers 242 health facilities: 168 health centers (HC), 16 referral health centers (RHCs),50 referral hospitals (RH) and 8 general referral hospitals (GRHs). Data from registers and medical records of maternal deaths recorded in these zones from 2013-2022 were extracted along with information on the number of deliveries and live births. Sociodemographic, clinical parameters, blood and ultrasound tests and suspected causes of death between provinces were assessed. RESULTS In total, we obtained 177 files on deceased women. Of these, 143 (80.8%) were retained for the present study, including 75 in the 3 HZs of North Kivu and 68 in the 5 HZs of South Kivu. From 2013 to 2022, study sites experienced two significant drops in maternal mortality ratio (MMR) (in 2015 and 2018), and a spike in 2016-2017. Nonetheless, the combined MMR (across study sites) started and ended the 10-year study period at approximately the same level (53 and 57 deaths per 100,000 live births in 2013 and 2022 respectively). Overall, 62,6% of the deaths were reported from secondary hospital. Most deaths were of married women in their thirties (93.5%). Almost half (47.8%) had not completed four antenatal consultations. The main direct causes of death were, in decreasing order of frequency: post-partum haemorrhage (55.2%), uterine rupture (14.0), hypertensive disorders (8.4%), abortion (7.7%) puerperal infections (2.8%) and placental abruption (0.7%). When comparing among provinces, reported abortion-related maternal mortality (14.1% vs 0%) was more frequent in North Kivu than in South Kivu. CONCLUSION This study imperatively highlights the need for targeted interventions to reduce maternal mortality. By emphasizing the crucial importance of antenatal consultations, intrapartum/immediate post-partum care and quality of care, significant progress can be made in guaranteeing maternal health and reducing many avoidable deaths.
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Affiliation(s)
- Pacifique Mwene-Batu
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu (ERSP-UCB), Bukavu, Democratic Republic of the Congo.
- Faculté de Médecine, Université de Kaziba, Kaziba, Democratic Republic of the Congo.
- Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, Democratic Republic of the Congo.
| | - Eustache Ndokabilya
- Direction du Développement Et de La Coopération Suisse (DDC), Bukavu, Democratic Republic of the Congo
| | - Jean Corneille Lembebu
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu (ERSP-UCB), Bukavu, Democratic Republic of the Congo
| | - Gaylord Ngaboyeka
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu (ERSP-UCB), Bukavu, Democratic Republic of the Congo
| | - Meighan Mary
- Johns Hopkins Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Hannah Tappis
- Johns Hopkins Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Michelle Dramaix
- Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Christine Chimanuka
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu (ERSP-UCB), Bukavu, Democratic Republic of the Congo
| | - Christian Chiribagula
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu (ERSP-UCB), Bukavu, Democratic Republic of the Congo
| | - Rosine Bigirinama
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu (ERSP-UCB), Bukavu, Democratic Republic of the Congo
| | - Michel P Hermans
- Division of Endocrinology & Nutrition, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Ghislain Bisimwa
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu (ERSP-UCB), Bukavu, Democratic Republic of the Congo
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Bigirinama RN, Mothupi MC, Mwene-Batu PL, Kozuki N, Chiribagula CZ, Chimanuka CM, Ngaboyeka GA, Bisimwa GB. Prioritization of maternal and newborn health policies and their implementation in the eastern conflict affected areas of the Democratic Republic of Congo: a political economy analysis. Health Res Policy Syst 2024; 22:55. [PMID: 38689347 PMCID: PMC11061947 DOI: 10.1186/s12961-024-01138-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/30/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Maternal and neonatal mortality remains a major concern in the Democratic Republic of Congo (DRC), and the country's protracted crisis context exacerbates the problem. This political economy analysis examines the maternal and newborn health (MNH) prioritization in the DRC, focussing specifically on the conflict-affected regions of North and South Kivu. The aim is to understand the factors that facilitate or hinder the prioritization of MNH policy development and implementation by the Congolese government and other key actors at national level and in the provinces of North and South Kivu. METHODS Using a health policy triangle framework, data collection consisted of in-depth interviews with key actors at different levels of the health system, combined with a desk review. Qualitative data were analysed using inductive and then deductive approaches, exploring the content, process, actor dynamics, contextual factors and gender-related factors influencing MNH policy development and implementation. RESULTS The study highlighted the challenges of prioritizing policies in the face of competing health and security emergencies, limited resources and governance issues. The universal health coverage policy seems to offer hope for improving access to MNH services. Results also revealed the importance of international partnerships and global financial mechanisms in the development of MNH strategies. They reveal huge gender disparities in the MNH sector at all levels, and the need to consider cultural factors that can positively or negatively impact the success of MNH policies in crisis zones. CONCLUSIONS MNH is a high priority in DRC, yet implementation faces hurdles due to financial constraints, political influences, conflicts and gender disparities. Addressing these challenges requires tailored community-based strategies, political engagement, support for health personnel and empowerment of women in crisis areas for better MNH outcomes.
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Affiliation(s)
- Rosine Nshobole Bigirinama
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Avenue Michombero No. 02, Bukavu, Democratic Republic of Congo.
- School of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo.
- Ecole de Santé Publique, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo.
| | | | - Pacifique Lyabayungu Mwene-Batu
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Avenue Michombero No. 02, Bukavu, Democratic Republic of Congo
- School of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- School of Medicine, Université de Kaziba, Bukavu, Democratic Republic of Congo
| | - Naoko Kozuki
- Airbel Impact Lab, International Rescue Committee, Washington, DC, United States of America
| | - Christian Zalinga Chiribagula
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Avenue Michombero No. 02, Bukavu, Democratic Republic of Congo
| | - Christine Murhim'alika Chimanuka
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Avenue Michombero No. 02, Bukavu, Democratic Republic of Congo
- Centre de Recherche en Sciences Naturelles, Lwiro, Democratic Republic of Congo
- Centre de Recherche Politiques, Systèmes de Santé, Santé Internationale (CR3), Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Gaylord Amani Ngaboyeka
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Avenue Michombero No. 02, Bukavu, Democratic Republic of Congo
- Centre de Recherche Politiques, Systèmes de Santé, Santé Internationale (CR3), Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Ghislain Balaluka Bisimwa
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Avenue Michombero No. 02, Bukavu, Democratic Republic of Congo
- School of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- Centre de Recherche en Sciences Naturelles, Lwiro, Democratic Republic of Congo
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Cañedo MC, Lopes TIB, Rossato L, Nunes IB, Faccin ID, Salomé TM, Simionatto S. Impact of COVID-19 pandemic in the Brazilian maternal mortality ratio: A comparative analysis of Neural Networks Autoregression, Holt-Winters exponential smoothing, and Autoregressive Integrated Moving Average models. PLoS One 2024; 19:e0296064. [PMID: 38295029 PMCID: PMC10830046 DOI: 10.1371/journal.pone.0296064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 12/05/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The acute respiratory infection caused by severe acute respiratory syndrome coronavirus disease (COVID-19) has resulted in increased mortality among pregnant, puerperal, and neonates. Brazil has the highest number of maternal deaths and a distressing fatality rate of 7.2%, more than double the country's current mortality rate of 2.8%. This study investigates the impact of the COVID-19 pandemic on the Brazilian Maternal Mortality Ratio (BMMR) and forecasts the BMMR up to 2025. METHODS To assess the impact of the COVID-19 pandemic on the BMMR, we employed Holt-Winters, Autoregressive Integrated Moving Average (ARIMA), and Neural Networks Autoregression (NNA). We utilized a retrospective time series spanning twenty-five years (1996-2021) to forecast the BMMR under both a COVID-19 pandemic scenario and a controlled COVID-19 scenario. RESULTS Brazil consistently exhibited high maternal mortality values (mean BMMR [1996-2019] = 57.99 ±6.34/100,000 live births) according to World Health Organization criteria. The country experienced its highest mortality peak in the historical BMMR series in the second quarter of 2021 (197.75/100,000 live births), representing a more than 200% increase compared to the previous period. Holt-Winter and ARIMA models demonstrated better agreement with prediction results beyond the sample data, although NNA provided a better fit to previous data. CONCLUSIONS Our study revealed an increase in BMMR and its temporal correlation with COVID-19 incidence. Additionally, it showed that Holt-Winter and ARIMA models can be employed for BMMR forecasting with lower errors. This information can assist governments and public health agencies in making timely and informed decisions.
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Affiliation(s)
- Mayara Carolina Cañedo
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados, Dourados, MS, Brazil
| | - Thiago Inácio Barros Lopes
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados, Dourados, MS, Brazil
| | - Luana Rossato
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados, Dourados, MS, Brazil
| | - Isadora Batista Nunes
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados, Dourados, MS, Brazil
| | - Izadora Dillis Faccin
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados, Dourados, MS, Brazil
| | - Túlio Máximo Salomé
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados, Dourados, MS, Brazil
| | - Simone Simionatto
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados, Dourados, MS, Brazil
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Imani Ramazani BE, Mabakutuvangilanga Ntala SD, Katuashi Ishoso D, Rothan-Tondeur M. Knowledge of Obstetric Danger Signs among Pregnant Women in the Eastern Democratic Republic of the Congo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085593. [PMID: 37107875 PMCID: PMC10139184 DOI: 10.3390/ijerph20085593] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 05/10/2023]
Abstract
A lack of awareness regarding obstetric danger signs (ODS) is one of the factors that delay a pregnant woman's decision to seek emergency obstetric care. In developing countries, this delay can lead to high morbidity and mortality among pregnant women. In eastern Democratic Republic of Congo (DRC), very few studies have been conducted to assess the level of knowledge of pregnant women about ODS. Therefore, this study aimed to assess the knowledge of pregnant women about ODS in health facilities in eastern DRC. This quantitative cross-sectional, descriptive, and analytical study was conducted in 19 health facilities in the Kasongo health zone in the south Maniema Province of eastern DRC. A total of 624 pregnant women aged 12-49 years were interviewed in this study. Of these, 60.6% were secondary school graduates, >99% were married, 85.5% were cultivators, and 67.9% were Muslims. The knowledge of ODS among pregnant women was low (21.9%). The most cited danger signs during pregnancy, labor/delivery, and postpartum included severe abdominal pain and severe vaginal bleeding. Additionally, pregnant women aged 30-39 years (p = 0.015) and those who had given birth once (p = 0.049), twice (p = 0.003), 3-5 times (p = 0.004), and >5 times (p = 0.009) were more likely to be aware of ODS than others. Our findings indicated that pregnant women have little knowledge of ODS, which makes it difficult for them to take prompt decisions to seek emergency obstetric care. Thus, strategies to increase the knowledge of pregnant women about obstetrical danger signs by healthcare providers during prenatal consultations (antenatal care) must be developed to improve their rapid decision-making skills during pregnancy, labor, and postpartum.
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Affiliation(s)
- Bin-Eradi Imani Ramazani
- Nursing Sciences Research Chair, Laboratory Educations and Health Practices (LEPS), (EA 3412), UFR SMBH, University Paris, Sorbonne Paris Cite, F-93017 Bobigny, France; (S.-D.M.N.); (M.R.-T.)
- Nursing Sciences Section, Institut Supérieur des Techniques Médicales de Kindu (ISTM-KINDU), PB.304, Kindu P.O. Box 9912, Democratic Republic of the Congo
- Center for Research in Nursing Sciences and Health Innovation (CReSIIS), K-012, Kinshasa P.O. Box 11850, Democratic Republic of the Congo;
- Correspondence: ; Tel.:+243-81-14-89-176
| | - Simon-Decap Mabakutuvangilanga Ntala
- Nursing Sciences Research Chair, Laboratory Educations and Health Practices (LEPS), (EA 3412), UFR SMBH, University Paris, Sorbonne Paris Cite, F-93017 Bobigny, France; (S.-D.M.N.); (M.R.-T.)
- Center for Research in Nursing Sciences and Health Innovation (CReSIIS), K-012, Kinshasa P.O. Box 11850, Democratic Republic of the Congo;
- Section of Nursing Sciences, Institut Supérieur des Techniques Médicales de Kinshasa, BP 774 Lemba, Kinshasa P.O. Box 11850, Democratic Republic of the Congo
| | - Daniel Katuashi Ishoso
- Center for Research in Nursing Sciences and Health Innovation (CReSIIS), K-012, Kinshasa P.O. Box 11850, Democratic Republic of the Congo;
- Department of Community Health, Kinshasa School of Public Health, University of Kinshasa, Kinshasa P.O. Box 11850, Democratic Republic of the Congo
| | - Monique Rothan-Tondeur
- Nursing Sciences Research Chair, Laboratory Educations and Health Practices (LEPS), (EA 3412), UFR SMBH, University Paris, Sorbonne Paris Cite, F-93017 Bobigny, France; (S.-D.M.N.); (M.R.-T.)
- Center for Research in Nursing Sciences and Health Innovation (CReSIIS), K-012, Kinshasa P.O. Box 11850, Democratic Republic of the Congo;
- Assistance Publique-Hôpitaux de Paris (AP-HP), Nursing Sciences Research Chair, F-75005 Paris, France
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Damayanti NA, Wulandari RD, Ridlo IA. Maternal Health Care Utilization Behavior, Local Wisdom, and Associated Factors Among Women in Urban and Rural Areas, Indonesia. Int J Womens Health 2023; 15:665-677. [PMID: 37163191 PMCID: PMC10164391 DOI: 10.2147/ijwh.s379749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/24/2023] [Indexed: 05/11/2023] Open
Abstract
Purpose Maternal mortality is one problem that still affects countries like Indonesia and others globally. The World Health Organization (WHO) notes that Southeast Asian countries have a high MMR. Indonesia's maternal mortality ranks third highest in Southeast Asia, with a 177 maternal mortality rate per 100,000 live births in 2017. In 2018, the maternal mortality rate reached 91.45 per 100,000 live births. Pregnant women's deaths can be caused inadequate medical care due to how frequently they seek treatment. This study intends to identify and analyze how knowledge, education, and myths affect pregnant women's attitudes toward seeking health services. Materials and Methods The study involved 175 pregnant and postpartum women who visited 10 health public centers in two cities in East Java by accidental sampling. Data regarding intrapersonal, interpersonal, and local wisdom were collected through surveys with structured instruments and in-depth interviews. Data statistics used pathway analysis with a p-value of >0.05. Results Intrapersonal, interpersonal, and local wisdom variables have a significant direct or indirect effect on utilizing health services. Knowledge was the variable with the greatest influence (t-value, 27.96). Conclusion Myth and culture as local wisdom and intrapersonal factors significantly affect the pattern of utilizing health services.
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Affiliation(s)
- Nyoman Anita Damayanti
- Department of Health Policy and Administration, Faculty of Public Health, Unversitas Airlangga, Surabaya, Indonesia
- Correspondence: Nyoman Anita Damayanti, Department of Health Policy and Administration, Faculty of Public Health, Unversitas Airlangga, St. Ir. Soekarno, Kampus C, Surabaya, East Java, 60115, Indonesia, Tel +62818518232, Fax +62315920948, Email
| | - Ratna Dwi Wulandari
- Department of Health Policy and Administration, Faculty of Public Health, Unversitas Airlangga, Surabaya, Indonesia
| | - Ilham Akhsanu Ridlo
- Department of Health Policy and Administration, Faculty of Public Health, Unversitas Airlangga, Surabaya, Indonesia
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