title: Emergency obstetric and neonatal care availability, use, and quality: a cross-sectional study in the city of Lubumbashi, Democratic Republic of the Congo, 2011.
abstract: BACKGROUND
  While emergency obstetric and neonatal care (EmONC) is a proxy indicator for monitoring maternal and perinatal mortalities, in Democratic Republic of the Congo (DRC), data on this care is rarely available. In the city of Lubumbashi, the second largest in DRC with an estimated population of 1.5 million, the availability, use and quality of EmONC are not known. This study aimed to assess these elements in Lubumbashi.
  
  
  METHODS
  This cross-sectional survey was conducted in April and May 2011. Fifty-three of the 180 health facilities that provide maternity care in Lubumbashi were included in this study. Only health facilities with at least six deliveries per month over the course of 2010 were included. The availability, use and quality of EmONC at each level of the health care system were assessed according to the WHO standards.
  
  
  RESULTS
  The availability of EmONC in Lubumbashi falls short of WHO standards. In this study, we found one facility providing Comprehensive EmONC (CEmONC) for a catchment area of 918,819 inhabitants. Apart from the tertiary hospital (Sendwe), no other facility provided all the basic emergency obstetric and neonatal care (BEmONC) signal functions. However, all had carried out at least one of the nine signal functions during the 3 months preceding our survey: 73.6% of 53 facilities had administered parenteral antibiotics, 79.2% had systematically offered oxytocics, 39.6% had administered magnesium sulfate, 73.6% had manually evacuated placentas, 81.1% had removed retained placenta products, 54.7% had revived newborns, 35.8% had performed caesarean sections, and 47.2% had performed blood transfusions. Function 6, vaginal delivery assisted by ventouse or forceps, was performed in only two (3.8%) facilities. If this signal function was not taken into account in our assessment of EmONC availability, there would be five facilities providing CEmONC for 918,819 inhabitants, rather than one. In 2010, all the women in the surveyed facilities with obstetric complications delivered in facilities that had carried out at least one signal function in the 3 months before our survey; 7.0% of these women delivered in the facility which provided CEmONC. Mortality due to direct obstetric causes was 3.9% in the health facility that provided CEmONC. The intrapartum mortality was also high in this facility (5.1%). None of the maternity ward managers in any of the facilities surveyed had received training on the EmONC package. Essential supplies and equipment for performing certain EmONC functions were not available in all the surveyed facilities.
  
  
  CONCLUSIONS
  Audits of maternal and neonatal deaths and near-misses should be established and used as a basis for monitoring the quality of care in Lubumbashi. To reduce maternal and perinatal mortality, it is essential that staff skills regarding EmONC be strengthened, the availability of supplies and equipment be increased, and that care processes be standardized in all health facilities in Lubumbashi.
authors.affiliation: Université de Lubumbashi. École de Santé Publique : Unité d'Epidémiologie et de Santé de la mère, du nouveau-né et de l'enfant, Lubumbashi, Democratic Republic of the Congo. abelntambue@yahoo.fr.
authors.forename: Abel Mukengeshayi
authors.initials: AM
authors.lastname: Ntambue
authors.affiliation: Université de Lubumbashi. École de Santé Publique : Unité d'Epidémiologie et de Santé de la mère, du nouveau-né et de l'enfant, Lubumbashi, Democratic Republic of the Congo.
authors.forename: Françoise Kaj
authors.initials: FK
authors.lastname: Malonga
authors.affiliation: University of Washington Tacoma, Tacoma, WA, USA.
authors.forename: Karen D
authors.initials: KD
authors.lastname: Cowgill
authors.affiliation: Université Libre de Bruxelles: École de Santé Publique: Centre de recherche en Epidémiologie, Biostatistiques et recherche clinique, Brussels, Belgium.
authors.forename: Michèle
authors.initials: M
authors.lastname: Dramaix-Wilmet
authors.affiliation: 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.
authors.forename: Philippe
authors.initials: P
authors.lastname: Donnen
mesh_terms: D002391:Catchment Area, Health / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D015023:Democratic Republic of the Congo; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D008428:Maternal Mortality; D000068101:Maternal-Child Health Services / Q000706:statistics & numerical data*; D009774:Obstetrics / Q000379:methods / Q000706:statistics & numerical data*; D054238:Perinatal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*
keywords: Democratic Republic of the Congo; Maternal mortality; Maternal-Child Health Services; Obstetric labor complications; Perinatal care; Perinatal death