Better than nothing? maternal, newborn, and child health services and perinatal mortality, Lubumbashi, democratic republic of the Congo: a cohort study.
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.


CONCLUSIONS
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.
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. abelntambue@yahoo.fr.
Abel Mukengeshayi
AM
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
FK
Malonga
Université Libre de Bruxelles: École de Santé Publique: Centre de recherche en Epidémiologie, Biostatistiques et recherche clinique, Brussels, Belgium.
Michele
M
Dramaix-Wilmet
Graduate School of Health and Nursing Sciences & Disaster Nursing Global Leader doctoral program (DNGL), University of Kochi, Kochi, Japan.
Roger Nlandu
RN
Ngatu
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.
Philippe
P
Donnen
D000328:Adult; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D000068101:Maternal-Child Health Services / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D054238:Perinatal Mortality; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors
Democratic Republic of the Congo; Emergency obstetric and neonatal care; Maternal health services; Perinatal care; Perinatal mortality; Postnatal care