Abstract
Background: Current facility conditions, obstetric and neonatal care practices, and availability of emergency obstetric and neonatal care (EmONC) were assessed in the Kwango and Kwilu provinces of the Democratic Republic of the Congo (DRC). Methods: This is an analysis of the baseline survey data from an ongoing clinical mentoring program among 72 rural health facilities in the DRC. Data collectors visited each of the facilities and collected data through a pre-programmed smartphone. Frequencies of selected indicators were calculated by province and facility type-general referral hospital (GRH) and primary health centers (HC). Results: Facility conditions varied across province and facility type. Maternity wards and delivery rooms were available in the highest frequency of rooms assessed (>95% of all facilities). Drinking water was available in 25.0% of all facilities; electricity was available in 49.2% of labor rooms and 67.6% of delivery rooms in all facilities. Antenatal, delivery, and postnatal care services were available but varied across facilities. While the proportion of blood pressure measured during antenatal care was high (94.9%), the antenatal screening rate for proteinuria was low (14.7%). The use of uterotonics immediately after birth was observed in high numbers across both provinces (94.4% in Kwango and 75.6% in Kwilu) and facility type (91.3% in GRH and 81.4% in HC). The provision of immediate postnatal care to mothers every 15 minutes was provided in less than 50% of all facilities. GRH facilities generally had higher frequencies of available equipment and more services available than HC. GRH facilities provided an average of 6 EmONC signal functions (range: 2-9). Conclusions: Despite poor facility conditions and a lack of supplies, GRH and HC facilities were able to provide EmONC care in rural DRC. These findings could guide the provision of essential needs to the health facilities for better delivery of maternal and neonatal care.
Highlights
Maternal and neonatal deaths are a global issue but disproportionately affect low- or middle-income countries
The objective of this paper is to describe the current facility conditions, obstetric and neonatal care practices, and availability and use of emergency obstetric and neonatal care (EmONC) among a sample of 72 rural health facilities in the Kwango and Kwilu provinces, Democratic Republic of the Congo (DRC)
Despite these poor facility conditions, we observed that GRH and health centers (HC) facilities in rural DRC have higher than expected proportions of the key 7–9 EmONC signal functions
Summary
Maternal and neonatal deaths are a global issue but disproportionately affect low- or middle-income countries. An estimated 99% of maternal deaths occur in low- or middle-income countries, and nearly two-thirds occur in the sub-Saharan African regions[1]. Many maternal and newborn deaths are a result of preventable complications during pregnancy and childbirth and immediately after birth. Strategies aimed to reduce maternal and neonatal deaths are centered around improving quality and access to antepartum or antenatal care, delivery assisted by a skilled birth attendant, increasing rates of institutional deliveries for better access to intrapartum and postpartum care, and ensuring availability of life saving drugs as well as the good quality of health facility conditions[1]. The use of uterotonics immediately after birth was observed in high numbers across both provinces (94.4% in Kwango and 75.6% in Kwilu) and facility
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