Abstract
BackgroundPregnancy-related mortality remains persistently higher in post-conflict areas. Part of the blame lies with continued disruption to vital care provision, especially emergency obstetric and newborn care (EmONC). In such settings, assessment of EmONC is essential for data-driven interventions needed to reduce preventable maternal and neonatal mortality. In the North Kivu Province (NKP), the epicentre of armed conflict in eastern Democratic Republic of the Congo (DRC) between 2006 and 2013, the post-conflict status of EmONC is unknown. We assessed the availability, use, and quality of EmONC in 3 health zones (HZs) of the NKP to contribute to informed policy and programming in improving maternal and newborn health (MNH) in the region.MethodA cross-sectional survey of all 42 public facilities designated to provide EmONC in 3 purposively selected HZs in the NKP (Goma, Karisimbi, and Rutshuru) was conducted in 2017. Interviews, reviews of maternity ward records, and observations were used to assess the accessibility, use, and quality of EmONC against WHO standards.ResultsOnly three referral facilities (two faith-based facilities in Goma and the MSF-supported referral hospital of Rutshuru) met the criteria for comprehensive EmONC. None of the health centres qualified as basic EmONC, nor could they offer EmONC services 24 h, 7 days a week (24/7). The number of functioning EmONC per 500,000 population was 1.5. Assisted vaginal delivery was the least performed signal function, followed by parenteral administration of anticonvulsants, mainly due to policy restrictions and lack of demand. The 3 HZs fell short of WHO standards for the use and quality of EmONC. The met need for EmONC was very low and the direct obstetric case fatality rate exceeded the maximum acceptable level. However, the proportion the proportion of births by caesarean section in EmONC facilities was within acceptable range in the HZs of Goma and Rutshuru. Overall, the intrapartum and very early neonatal death rate was 1.5%.ConclusionThis study provides grounds for the development of coordinated and evidence-based programming, involving local and external stakeholders, as part of the post-conflict effort to address maternal and neonatal morbidity and mortality in the NKP. Particular attention to basic EmONC is required, focusing on strengthening human resources, equipment, supply chains, and referral capacity, on the one hand, and on tackling residual insecurity that might hinder 24/7 staff availability, on the other.
Highlights
Pregnancy-related mortality remains persistently higher in post-conflict areas
Profile of surveyed health facilities and volume of deliveries Of the 42 public health facilities surveyed in the 3 health zones (HZ), 24 were health centres, all owned and managed by the state, and 18 were referral institutions, of which 5 were referral hospital (RH) and 13 were referral health centre (RHC) (Table 2)
In the HZ of Karisimbi, half of the referral facilities (3 RHCs) were faith-based organisations managed by Protestant churches
Summary
Pregnancy-related mortality remains persistently higher in post-conflict areas. Part of the blame lies with continued disruption to vital care provision, especially emergency obstetric and newborn care (EmONC). Emergency obstetric and newborn care (EmONC) is globally recognized as an essential health package for reducing preventable maternal and neonatal mortality, in countries with persistently higher mortality rates [1,2,3,4,5] Most of these countries are located in sub-Saharan Africa (SSA) [6, 7], a region that has witnessed the majority of armed conflicts over the past 3 decades [8]. The EmONC life-saving services, or signal functions, define 2 types of complementary health facilities based on their capacity to provide, within a 3-month period, the 7 basic signal functions or all 9 signal functions when pregnancy- and childbirth-related complications occur (see Table 1) These complications, including haemorrhage, hypertensive disorders, sepsis, obstructed labour, complications of abortion, and intrapartum related asphyxia, cause most maternal deaths, stillbirths, and early neonatal deaths [18,19,20]. The disruptive and lingering effects of conflict on health services provision—deficient health personnel, damaged health infrastructure, inadequate healthcare coordination, and weak supply chains—contribute to increased vulnerability to adverse outcomes related to these complications [15, 23]
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