Family planning (FP) is an effective strategy to prevent unintended pregnancies of adolescents. We aimed at identifying the socio-demographic factors underlying the low use of contraceptive methods by teenage girls in the Democratic Republic of the Congo (DRC). A secondary analysis targeting teenage girls aged 15–19 was carried out on the Performance, Monitoring and Accountability project 2020 (PMA 2020) round 7 data, collected in Kinshasa and Kongo Central provinces. The dependent variable was the “use of contraceptive methods by sexually active teenage girls”, calculated as the proportion of teenagers using modern, traditional or any contraceptive methods. Independent variables were: level of education, age, province, religion, marital status, number of children, knowledge of contraceptive methods and household income. Pearson's chi-square and logistic regression tests helped to measure the relationship between variables at the alpha significance cut point of 0.05. A total of 943 teenagers were interviewed; of which 22.6, 18.1 and 19.9

Background Delays in identification of women with preeclampsia is a contributing factor to maternal deaths in developing countries. We conducted this study to assess the prevalence of screening for preeclampsia in the Democratic Republic of Congo (DRC), and to identify factors associated with the screening. Methods We used data from the 2017-2018 DRC Service Provision Assessment survey, a nationwide survey that samples services, including antenatal care (ANC), in representative health facilities. A pregnant woman was deemed screened for preeclampsia if she had received the two following services: blood pressure measurement and assessment for warning signs of preeclampsia. We used multiple logistic regression, with generalized estimating equations, to identify factors associated with screening for preeclampsia. Results Of the 3763 pregnant women, 719 (19.1%; 95% CI, 15.8% – 22.9%) were screened for preeclampsia, 815 (21.7%; 95% CI, 18.2% - 25.6%) were assessed for preeclampsia-related warning signs and symptoms, and 2941 (78.2%; 95% CI 73.6 – 82.1%) had their blood pressure checked.In multivariable analyses, the percentage of women receiving screening for preeclampsia was significantly higher among women with a secondary level of schooling or above (adjusted odds ratio [AOR] = 1.21; 95% CI, 1.04-1.42; P=0.016) and among women having a subsequent ANC visit (AOR = 1.39; 95% CI, 1.20-1.62; P<0.001). It was also higher among women receiving care in facilities with a low number of women attended per day (AOR = 1.28; 95% CI, 1.09-1.51; P=0.003) and in urban settings (AOR = 1.36; 95% CI, 1.02-1.82; P=0.036). There was a regional variation in the screening for preeclampsia, with the lowest prevalence observed in the Central (10.7%) and the highest in the Eastern provinces (22.5%). Conclusion Our study shows that screening for preeclampsia during ANC visits in DRC is not systematic, with disparities between provinces. We found that a low schooling level, a low number of ANC visits, rural areas, province of residence, and a high volume of ANC visits at the facility were associated with a low screening for preeclampsia. These factors should be considered for setting up strategies in order to increase the screening for preeclampsia during ANC visits in provinces of DRC with too low screening.

Background Poor awareness of obstetric danger signs is a major contributing factor to delays in seeking obstetric care and hence to high maternal mortality and morbidity worldwide. We conducted the current study to assess the level of agreement on receipt of counseling on obstetric danger signs between direct observations of antenatal care (ANC) consultation and women’s recall in the exit interview. We also identified factors associated with pregnant women’s awareness of obstetric danger signs during pregnancy in the Democratic Republic of Congo (DRC) Methods We used data from the 2017–2018 DRC Service Provision Assessment survey. Agreement between the observation and woman’s recall was measured using Cohen’s kappa statistic and percent agreement. Multivariable Zero-Inflated Poisson (ZIP) regression was used to identify factors associated with the number of danger signs during pregnancy the woman knew. Results On average, women were aware of 1.5 ± 1.34 danger signs in pregnancy (range: 0 to 8). Agreement between observation and woman’s recall was 70.7%, with a positive agreement of 16.9% at the country level but ranging from 2.1% in Bandundu to 39.7% in Sud Kivu. Using multivariable ZIP analysis, the number of obstetric danger signs the women mentioned was significantly higher in multigravida women (Adj.IRR = 1.38; 95% CI: 1.23–1.55), in women attending a private facility (Adj.IRR = 1.15; 95% CI: 1.01–1.31), in women attending a subsequent ANC visit (Adj.IRR = 1.11; 95% CI: 1.01–1.21), and in women counseled on danger signs during the ANC visit (Adj.IRR = 1.19; 95% CI: 1.05–1.35). There was a regional variation in the awareness of danger signs, with the least mentioned signs in the middle and the most in the eastern provinces. Conclusions Our findings indicated poor agreement between directly observed counseling and women’s reports that counseling on obstetric danger signs occurred during the current ANC visit. We found that province of residence , provision of counseling on obstetric danger signs, facility ownership, gravidity and the number of ANC visits were predictors of the awareness of obstetric danger signs among pregnant women. These factors should be considered when developing strategies aim at improving women’s awareness about obstetric danger signs in the DRC

Background Hypertensive disorders in pregnancy are the second most common cause of maternal mortality in the Democratic Republic of Congo (DRC), accounting for 23% of maternal deaths. This study aimed to assess facility readiness, and providers’ knowledge to prevent, diagnose, and treat pre-eclampsia. Methods A facility-based cross-sectional study was conducted in 30 primary health centres (PHCs) and 28 referral facilities (hospitals) randomly selected in Kinshasa, DRC. In each facility, all midwives and physicians involved in maternal care provision ( n = 197) were included. Data on facility infrastructure and providers’ knowledge about pre-eclampsia were collected using facility checklists and a knowledge questionnaire. Facility readiness score was defined as the sum of 13 health commodities needed to manage pre-eclampsia. A knowledge score was defined as the sum of 24 items about the diagnosis, management, and prevention of pre-eclampsia. The score ranges from 0 to 24, with higher values reflecting a better knowledge. The Mann-Witney U test was used to compare median readiness scores by facility type and ownership; and median knowledge scores between midwives in hospitals and in PHCs, and between physicians in hospitals and in PHCs. Results Overall, health facilities had 7 of the 13 commodities, yielding a median readiness score of 53.8%(IQR: 46.2 to 69.2%). Although all provider groups had significant knowledge gaps about pre-eclampsia, providers in hospitals demonstrated slightly more knowledge than those in PHCs. Midwives in public facilities scored higher than those in private facilities (median(IQR): 8(5 to 12) vs 7(4 to 8), p = 0.03). Of the 197 providers, 91.4% correctly diagnosed severe pre-eclampsia. However, 43.9 and 82.2% would administer magnesium sulfate and anti-hypertensive drugs to manage severe pre-eclampsia, respectively. Merely 14.2 and 7.1% of providers were aware of prophylactic use of aspirin and calcium to prevent pre-eclampsia, respectively. Conclusion Our study showed poor availability of supplies to diagnose, prevent and treat pre-eclampsia in Kinshasa. While providers demonstrated good knowledge regarding the diagnosis of pre-eclampsia, they have poor knowledge regarding its prevention and management. The study highlights the need for strengthening knowledge of providers toward the prevention and management of pre-eclampsia, and enhancing the availability of supplies needed to address this disease.

Results of a cross-sectional Study from two settings in the Democratic Republic of the Congo Dieudonné Mpunga Mukendi*1, Faustin Chenge Mukalenge2, Mapatano Mala Ali1, Gilbert Wembodinga Utshudienyema1 1. Kinshasa School of Public Health, University of Kinshasa, RDC 2. School of Public Health, University of Lubumbashi, RDC Corresponding author: Dieudonné Mpunga Mukendi, Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, P.O. Box: 11850 Kinshasa I, Kinshasa, Democratic Republic of the Congo, Email: mpungadieudonn@yahoo.fr

BackgroundThe Demographic and Health Survey 2013-14 indicated that the Democratic Republic of the Congo (DRC) is still challenged by high maternal and neonatal mortality. The aim of this study was to assess the availability, quality and equity of emergency obstetric care (EmOC) in the DRC.MethodsA cross-sectional survey of 1,568 health facilities selected by multistage random sampling in 11 provinces of the DRC was conducted in 2014. Data were collected through interviews, document reviews, and direct observation of service delivery. Collected data included availability, quality, and equity of EmOC depending on the location (urban vs. rural), administrative identity, type of facility, and province. Associations between variables were tested by Pearson's chi-squared test using an alpha significance level of 0.05.ResultsA total of 1,555 health facilities (99.2%) were surveyed. Of these, 9.1% provided basic EmOC and 2.9% provided comprehensive EmOC. The care was unequally distributed across the provinces and urban vs. rural areas; it was more available in urban areas, with the provinces of Kinshasa and Nord-Kivu being favored compared to other provinces. Caesarean section and blood transfusions were provided by health centers (6.5 and 9.0%, respectively) and health posts (2.3 and 2.3%, respectively), despite current guidelines disallowing the practice. None of the facilities provided quality EmOC, mainly due to the lack of proper standards and guidelines.ConclusionsThe distribution and quality of EmOC are problematic. The lack of regulation and monitoring appears to be a key contributing factor. We recommend the Ministry of Health go beyond merely granting funds, and also ensure the establishment and monitoring of appropriate standard operating procedures for providers.

Screening for hypertensive disorders in pregnancy (HDP) is clinically important for identifying women at high risk, and planning early preventative interventions to improve pregnancy outcomes. Several studies in developing countries show that pregnant women are seldom screened for HDP. We conducted a study in Kinshasa, DR Congo, in order to assess the proportion of pregnant women screened for HDP, and to identify factors associated with the screening. We conducted a facility-based cross-sectional study in a random sample of 580 pregnant women attending the first antenatal visit. Data collection consisted of a review of antenatal records, observations at the antenatal care services, and interviews. A pregnant woman was considered as screened for HDP if she had received the tree following services: blood pressure measurement, urine testing for proteinuria, and HDP risk assessment. Multivariable logistic regression, with generalized estimating equations, was used to identify factors associated with the screening for HDP. Of the 580 pregnant women, 155 (26.7%) were screened for HDP, 555 (95.7%) had their blood pressure checked, 347(59.8%) were assessed for risk factors of HDP, and 156 (26.9%) were tested for proteinuria. After multivariable analysis, screening for HDP was significantly higher in parous women (AOR = 2.09; 95% CI, 1.11–3.99; P = 0.023), in women with a gestational age of at least 20 weeks (AOR = 5.50; 95% CI, 2.86–10.89; P = 0.002), in women attending in a private clinic (AOR = 3.49; 95% CI, 1.07–11.34; P = 0.038), or in a hospital (AOR = 3.24; 95% CI, 1.24–8.47; P = 0.017), and when no additional payment was required for proteinuria testing at the clinic (AOR = 2.39; 95% CI, 1.14–5.02; P = 0.021). Our results show that screening for HDP during the first antenatal visit in Kinshasa is not universal. The factors associated with screening included maternal as well as clinics’ characteristics. More effort should be made both at maternal and clinic levels to improve the screening for HDP in Kinshasa.

OBJECTIVE:To determine the availability and quality of family planning services within health facilities throughout the Democratic Republic of the Congo (DRC).METHODS:Data were collected for the cross-sectional study from April 2014 to June 2014 by the Ministry of Public Health. A total of 1,568 health facilities that reported data to the National Health Information System were selected by multistage random sampling in the 11 provinces of the DRC existing at that time. Data were collected through interviews, document review, and direct observation. Two dependent variables were measured: availability of family planning services (consisting of a room for services, staff assigned to family planning, and evidence of client use of family planning) and quality of family planning services (assessed as "high" if the facility had at least 1 trained staff member, family planning service delivery guidelines, at least 3 types of methods, and a sphygmomanometer, or "low" if the facility did not meet any of these 4 criteria). Pearson's chi-square test and odds ratios (ORs) were used to test for significant associations, using the alpha significance level of .05.RESULTS:We successfully surveyed 1,555 facilities (99.2%) of those included in the sample. One in every 3 facilities (33%) offered family planning services as assessed by the index of availability, of which 20% met all 4 criteria for providing high-quality services. Availability was greatest at the highest level of the health system (hospitals) and decreased incrementally with each health system level, with disparities between provinces and urban and rural areas. Facilities in urban areas were more likely than in rural areas to meet the standard for high-quality services (P<.001). Public facilities were less likely than private facilities to have high-quality services (P=.02). Among all 1,555 facilities surveyed, 14% had at least 3 types of methods available at the time of the survey; the most widely available methods were male condoms, combined oral contraceptive pills, and progestin-only injectable contraceptives.CONCLUSION:Availability and quality of family planning services in health facilities in the DRC remain low, with inequitable distribution of services throughout the country. To improve access to and use of family planning, efforts should focus on improving availability and quality at lower health system levels and in rural areas where the majority of the population lives.

Objective: To determine the feasibility of introducing a simple indicator of quality of obstetric and neonatal care and to determine the proportion of potentially avoidable perinatal deaths in hospitals in low-income countries. Methods: Between September 1, 2011, and February 29, 2012, data were collected from consecutive women who were admitted to the labor ward of 1 of 6 hospitals in 4 low-income countries. Fetal heart tones on admission were monitored, and demographic and birth data were recorded. Results: Data were obtained for 3555 women and 3593 neonates (including twins). The doptone was used on 97% of women admitted. The overall perinatal mortality rate was 34 deaths per 1000 deliveries. Of the perinatal deaths, 40%-45% occurred in the hospital and were potentially preventable by better hospital care. Conclusion: The results demonstrated that it is possible to accurately determine fetal viability on admission via a doptone. Implementation of doptone use, coupled with a concise data record, might form the basis of a low-cost and sustainable program to monitor and evaluate efforts to improve quality of care and ultimately might help to reduce the in-hospital component of perinatal mortality in low-income countries. (C) 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.