Introduction
Method
Design
Setting
Operational level health facility staff in the DRC
Population and sampling
Delay as a risk factor for maternal death | These factors affect the interval between the onset of an obstetric complication in a pregnant woman and her outcome. These factors delay the parturient’s decision to seek healthcare in time (first delay), delay her arrival at a health facility in time (second delay), and delay the timely provision of adequate healthcare (third delay) [19] |
Delay I (R1) | This delay pertains to the decision by the woman, family, or community to go to the hospital for obstetric care when she begins to feel the signs of danger before delivery [20]. It is associated with the sociocultural context, socioeconomic status of the parturient, knowledge of the signs of danger in pregnancy and/or perception of the severity of the disease during pregnancy, previous cost of care, and previous experience with the health system [21] |
Delay II (R2) | This delay pertains to the arrival of the parturient at the health facility for obstetric care. It refers to the problems of accessibility—the distance between the woman’s home and the health facility, poor road infrastructure, cost of transportation, and distribution of health facilities in the health zone where she resides—that prevent her from timely arriving at the hospital [22] |
Delay III (R3), | This delay pertains to obstetric care of the woman by the healthcare personnel in a health facility. This factor is linked to the service offered by the health facility to the parturient and refers to the incompetence of the healthcare personnel and the insufficiency or absence of materials, medical equipment, supplies (medicines), and qualified personnel who could provide a suitable environment and other essential factors [23] |
Variables | Définitions | Types | Modalities | Rationale | |
---|---|---|---|---|---|
Sociodemographic, clinical and therapeutic characteristics of respondents | |||||
Age | This is the age range of respondents between: ≤ 19 and ≥ 35 years Continuous and categorical | ≤ 19 20–24 25–29 30–34 ≥ 35 | May explain maternal mortality | ||
Educational level, | These are the trainings that the respondent had taken: either primary, secondary or higher or nothing at all | categorical | Unschooled Primary Secondary Superior | May explain maternal mortality | |
Profession | These are activities that the respondent performs in life | categorical | Unemployed Farmer Pupil Trader Official | May explain maternal mortality | |
Religion | This is the church in which the respondent prays | categorical | Muslim Catholic Protestant Kimbanguist Church of awakening Other (s) to be specified | May explain maternal mortality | |
Marital status | This is the marital status of the respondent who lives in union or alone | categorical | Married Single Divorcee Widow | May explain maternal mortality | |
Parity | These are the number of deliveries that the respondent has already experienced in her life | categorical | Primiparité(1accouch) Paucipares (2 accouch) Multipares (3–5 accouch) Grande multipares (6 accouch et plus) | May explain maternal mortality | |
Gesture | These are the numbers of pregnancies that the respondent has already had | categorical | Too early (before 19 years old) Too much reproached (before 2 years) Too many (more than 5 deliveries) Too late (over 35) | May explain maternal mortality | |
Prenatal care (ANC) | These are the numbers of times the respondent attended antenatal care sessions according to the immunization schedule | categorical | ANC 0 ANC 1 ANC 2 ANC 3 ANC 4 | May explain maternal mortality | |
Use of partograph | This concerns the use of the partograph by nursing staff for monitoring the labor and delivery of respondent | dichotomo us | Yes No Not available | May explain maternal mortality | |
Liability (3 delays) | This is the responsibility for the occurrence of the death of a parturient | categorical | R1 (Delay in decision-making by the parturient or the family, R2. (Late arrival at the structure) R3. (Delay in taking charge) | May explain maternal mortality | |
Variables relating to the timing of maternal deaths | |||||
Times of death | This is the period during which the death of the respondent woman occurred | categorical | Prepartum Perpartum Postpartum | Important variable | |
Variables relating to the causes of death in kindergartens | |||||
Direct causes of maternal mortality | These are the direct medical causes which caused the death of the respondent | categorical | Bleeding, Infections Eclampsia Abortions Obstructed labor Uterine rupture | Important variable | |
Indirect causes of maternal mortality | These are the indirect medical causes which caused the death of the respondent | categorical | Anemia Malaria Tuberculosis HIV / AIDS Gastrointestinal bleeding Diabetes Pulmonary embolism Cardiovascular patients Kidney failure | Important variable |
Data collection
Data quality control
Statistical processing and analysis of data
Ethical considerations
Results
Description of the study population
Maternal mortality rate
Variables | Maternal deaths related to the types of obstetric complications | Number of maternal deaths | Percentage |
---|---|---|---|
Direct obstetric causes | |||
Presence of hemorrhage | 326 | 598 | 54.5 |
Uterine rupture | 92 | 600 | 15.3 |
Dystocia | 87 | 600 | 14.5 |
Infection | 68 | 599 | 11.3 |
Abortion complications | 55 | 601 | 9.2 |
Pre-eclampsia/eclampsia | 18 | 598 | 3.0 |
Indirect obstetric causes | |||
Anemia | 113 | 600 | 18.8 |
Malaria | 20 | 600 | 3.3 |
Digestive hemorrhage | 10 | 600 | 1.7 |
HIV/AIDS | 5 | 600 | 0.8 |
Cardiovascular disease | 5 | 599 | 0.8 |
Tuberculosis | 2 | 600 | 0.3 |
Factors associated with the risk of maternal death
Variables | n | % | Med (P25-P75) | Min–Max |
---|---|---|---|---|
Age of pregnant women | 600 | 29 (20–36) | 15–45 | |
≤ 19 years | 120 | 20,0 | ||
20 years and over | 480 | 80,0 | ||
Educational attainment of pregnant women | 600 | |||
No schooling | 115 | 19,2 | ||
Primary | 287 | 47,8 | ||
Secondary | 191 | 31,8 | ||
Superior | 7 | 1,2 | ||
Occupation of pregnant women | 600 | |||
Trader | 17 | 2,8 | ||
Farmer | 465 | 77,5 | ||
Pupil | 41 | 6,8 | ||
Official | 16 | 2,7 | ||
Unemployed | 61 | 10,2 | ||
Religion of pregnant women | 601 | |||
Catholic | 114 | 19,0 | ||
Revival Church | 120 | 20,0 | ||
Kimbanguist | 23 | 3,8 | ||
Muslim | 271 | 45,2 | ||
Protestant | 73 | 12,2 | ||
Marital status of pregnant women | 599 | |||
Single / divorced | 28 | 4,7 | ||
Married | 571 | 95,3 |
Variables | n | % | Med (P25-P75) | Min–Max |
---|---|---|---|---|
Parity | 600 | 4 (1–6) | 0–12 | |
Primigest | 63 | 10,5 | ||
Primiparous | 98 | 16,3 | ||
Pauciparous | 61 | 10,2 | ||
Multiparous | 216 | 36,0 | ||
Large multipare | 162 | 27,0 | ||
Carrying out pre-natal consultations (ANC1) | 600 | |||
Yes | 332 | 55,3 | ||
No | 268 | 44,7 | ||
Completion of all 4 CPNs (ANC4 completeness) | 600 | |||
Yes | 117 | 19,5 | ||
No | 483 | 80,5 | ||
Using the partograph | 599 | |||
Yes | 305 | 50,9 | ||
No | 294 | 49,1 |
Variables | Maternal deaths related to delays | Total number of maternal deaths delay | Percentage |
---|---|---|---|
Delay I (delay in decision making by the woman/family to go to the place of delivery) | 275 | 599 | 45,9 |
Delay II (delay in arriving at a health center/hospital) | 254 | 598 | 45,5 |
Delay III (delay in getting to the hospital) | 225 | 601 | 37,4 |
Description of the population in 2020
Clinical and therapeutic sociodemographic characteristics of parturients
Variables | N | % | Moy (± DS) | Min–Max |
---|---|---|---|---|
Age (years) | 5 085 | 27 (± 6,8) | 14–49 | |
≤ 19 year | 792 | 15,6 | ||
20–29 year | 2 774 | 54,6 | ||
30–39 year | 1 194 | 23,5 | ||
40–49 year | 325 | 6,4 | ||
Educational level | 5 086 | |||
No schooling | 355 | 7,0 | ||
Primary | 1 804 | 35,5 | ||
Secondary | 2 805 | 55,2 | ||
Superior | 122 | 2,4 | ||
Marital status | 5 085 | |||
Single | 67 | 1,3 | ||
Divorcee | 72 | 1,4 | ||
Married / common-law | 4 928 | 96,9 | ||
Widow | 18 | 0,4 | ||
Woman's profession | 5 086 | |||
Unemployed | 732 | 14,4 | ||
Pupil | 494 | 9,7 | ||
Farmer / Trader | 3 605 | 70,9 | ||
Official | 255 | 5,0 | ||
Woman's religion | 5 085 | |||
Muslim | 2 481 | 48,8 | ||
Catholic | 1 090 | 21,4 | ||
Protestant | 863 | 17,0 | ||
Revival Church | 558 | 11,0 | ||
Kimbanguist | 93 | 1,8 |
Variables | N | % | |
---|---|---|---|
Parity | 5 084 | ||
Primigest | 928 | 18,3 | |
Primiparous | 826 | 16,3 | |
Pauciparous | 867 | 17,1 | |
Multiparous | 1 857 | 36,5 | |
Large multipare | 606 | 11,9 | |
Carrying out near-natal consultations (ANC 1) | 5 086 | ||
Oui | 4 333 | 85,2 | |
Non | 753 | 14,8 | |
Completion of all 4 ANC (completion of ANC 4) | 5 077 | ||
Yes | 946 | 18,6 | |
No | 4 131 | 81,4 | |
Using the partograph | 5 081 | ||
Yes | 4 907 | 96,6 | |
No | 174 | 3,4 |
Maternal mortality rate in 2020
Determinants of mortality
Variables | Adjusted OR (IC95%) | p |
---|---|---|
Age groups (years) | < 0,001 | |
≤ 19 years | 1 | |
20–29 years | 0,3 (0,2 à 0,5) | |
30–39 years | 0,2 (0,1 à 0,4) | |
40–49 years | 0,9 (0,4 à 1,9) |
Variables | Adjusted OR (IC95%) | p |
---|---|---|
Parity | 0,001 | |
Nulliparous | 1 | |
Primiparous | 0,5 (0,3 à 1,1) | |
Pauci pare | 0,2 (0,1 à 0,5) | |
Multiparous | 0,3 (0,2 à 0,7) | |
Large multipare | 0,9 (0,5 à 1,9) |
Variables | n | % death | Adjusted OR ( IC95%) | p |
---|---|---|---|---|
Haemorrhages | 5 084 | < 0,001 | ||
Yes | 528 | 8,3 | 17,2 (10,4 à 28,5) | |
No | 4556 | 0,5 | 1 | |
Dystocies (DFP…) | 5 082 | 0,583 | ||
Yes | 917 | 1,5 | 1,2 (0,7 à 2,1) | |
No | 4165 | 1,3 | 1 | |
Infections | 5 082 | 0,091f | ||
Yes | 80 | 3,8 | 2,9 (0,9 à 9,6) | |
No | 5002 | 1,3 | 1 | |
Rupture utérine | 5 080 | 0,038f | ||
Yes | 56 | 5,4 | 4,3 (1,3 à 14,2) | |
No | 5024 | 1,3 | 1 | |
Complications abortives | 5 081 | < 0,001f | ||
Yes | 12 | 33,3 | 39,1 (11,5 à 133,2) | |
No | 5 069 | 1,3 | 1 |