Ecole Régionale de Santé Publique, Université Catholique de Bukavu (ERSP-UCB), Bukavu, Democratic Republic of the Congo.
Faculté de Médecine, Université de Kaziba, Kaziba, Democratic Republic of the Congo.
BMC Public Health. 2024 Aug 22;24(1):2280. doi: 10.1186/s12889-024-19804-z.
Maternal mortality (MM) remains a real scourge that hits hardest in the poorest regions of the world, particularly those affected by conflict. However, despite this worrying reality, few studies have been conducted about MM ratio in the Democratic Republic of Congo (DRC). The study aimed to describe the trends as well as the epidemiological profile and causes of reported institutional maternal deaths between 2013 and 2022 in Eastern DRC.
A retrospective descriptive study was conducted between March 2023 and August 2023 in eight Health Zones (HZ), five in South Kivu Province (Mwana, Minova, Miti-Murhesa, Kamituga and Idjwi) and three in North Kivu Province (Kirotshe, Karisimbi and Kayna) in the eastern region of the DRC. Our study covers 242 health facilities: 168 health centers (HC), 16 referral health centers (RHCs),50 referral hospitals (RH) and 8 general referral hospitals (GRHs). Data from registers and medical records of maternal deaths recorded in these zones from 2013-2022 were extracted along with information on the number of deliveries and live births. Sociodemographic, clinical parameters, blood and ultrasound tests and suspected causes of death between provinces were assessed.
In total, we obtained 177 files on deceased women. Of these, 143 (80.8%) were retained for the present study, including 75 in the 3 HZs of North Kivu and 68 in the 5 HZs of South Kivu. From 2013 to 2022, study sites experienced two significant drops in maternal mortality ratio (MMR) (in 2015 and 2018), and a spike in 2016-2017. Nonetheless, the combined MMR (across study sites) started and ended the 10-year study period at approximately the same level (53 and 57 deaths per 100,000 live births in 2013 and 2022 respectively). Overall, 62,6% of the deaths were reported from secondary hospital. Most deaths were of married women in their thirties (93.5%). Almost half (47.8%) had not completed four antenatal consultations. The main direct causes of death were, in decreasing order of frequency: post-partum haemorrhage (55.2%), uterine rupture (14.0), hypertensive disorders (8.4%), abortion (7.7%) puerperal infections (2.8%) and placental abruption (0.7%). When comparing among provinces, reported abortion-related maternal mortality (14.1% vs 0%) was more frequent in North Kivu than in South Kivu.
This study imperatively highlights the need for targeted interventions to reduce maternal mortality. By emphasizing the crucial importance of antenatal consultations, intrapartum/immediate post-partum care and quality of care, significant progress can be made in guaranteeing maternal health and reducing many avoidable deaths.
孕产妇死亡率（MM）仍然是一个严重的问题，在世界上最贫穷的地区尤为严重，特别是在受冲突影响的地区。然而，尽管存在这种令人担忧的现实，但关于刚果民主共和国（DRC）孕产妇死亡率比率的研究很少。本研究旨在描述 2013 年至 2022 年期间在刚果民主共和国东部地区南基伍省（姆瓦纳、米诺瓦、米提-穆雷萨、卡米图加和伊朱瓦）的五个卫生区和北基伍省（基罗齐、卡里辛比和卡尼亚）的三个卫生区报告的机构产妇死亡的趋势以及流行病学特征和原因。
这是一项 2023 年 3 月至 2023 年 8 月在刚果民主共和国东部地区八个卫生区（HZ）进行的回顾性描述性研究。五个位于南基伍省（姆瓦纳、米诺瓦、米提-穆雷萨、卡米图加和伊朱瓦），三个位于北基伍省（基罗齐、卡里辛比和卡尼亚）。我们的研究涵盖了 242 个卫生设施：168 个卫生中心（HC）、16 个转诊卫生中心（RHC）、50 个转诊医院（RH）和 8 个普通转诊医院（GRH）。从这些地区 2013-2022 年记录的产妇死亡登记册和病历中提取数据，同时获取分娩和活产数量的信息。评估了各省之间的社会人口统计学、临床参数、血液和超声检查以及疑似死因。
我们总共获得了 177 份关于死亡妇女的档案。其中，143 份（80.8%）被保留用于本研究，包括北基伍省 3 个卫生区的 75 份和南基伍省 5 个卫生区的 68 份。2013 年至 2022 年期间，研究地点的孕产妇死亡率（MMR）经历了两次显著下降（2015 年和 2018 年）和 2016-2017 年的一次上升。尽管如此，10 年研究期间的综合 MMR（在研究地点之间）开始和结束时基本相同（2013 年和 2022 年分别为每 10 万活产 53 和 57 例死亡）。总的来说，62.6%的死亡发生在二级医院。大多数死亡是三十多岁的已婚妇女（93.5%）。几乎一半（47.8%）没有完成四次产前检查。主要直接死因按频率降序排列为：产后出血（55.2%）、子宫破裂（14.0%）、高血压疾病（8.4%）、流产（7.7%）、产褥期感染（2.8%）和胎盘早剥（0.7%）。在比较各省时，北基伍省报告的与流产相关的孕产妇死亡率（14.1% vs 0%）比南基伍省更为频繁。
本研究迫切需要强调采取有针对性的干预措施，以减少孕产妇死亡率。通过强调产前检查、分娩/立即产后护理和护理质量的重要性，可以在保障产妇健康和减少许多可避免的死亡方面取得重大进展。
