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Background: The use of maternal health services, known as an indirect indicator of perinatal death, is still unknown in Lubumbashi. The present study was therefore undertaken in order to determine the factors that influence the use of mother and child healthcare services in Lubumbashi, Democratic Republic of the Congo.Methods: This was transversal study of women residing in Lubumbashi who had delivered between January and December 2009. In total, 1762 women were sampled from households using indicator cluster surveys in all health zones. Antenatal consultations (ANC), delivery assisted by qualified healthcare personnel (and delivery in a healthcare facility) as well as postnatal consultations (PNC) were dependent variables of study. The factors determining non-use of maternal healthcare services were researched via logistic regression with a 5% materiality threshold.Results: The use of maternal healthcare services was variable; 92.6% of women had attended ANC at least once, 93.8% of women had delivered at a healthcare facility, 97.2% had delivered in the presence of qualified healthcare personnel, while the rate of caesarean section was 4.5%. Only 34.6% postnatal women had attended PNC by 42 days after delivery. During these ANC visits, only 60.6% received at least one dose of vaccine, while 38.1% received Mebendazole, 35.6% iron, 32.7% at least one dose of SulfadoxinePyrimethamine, 29.2% folic acid, 15.5% screening for HIV and 12.8% an insecticide treated net.In comparison to women that had had two or three deliveries before, primiparous and grand multiparous women were twice as likely not to use ANC during their pregnancy. Women who had unplanned pregnancies were also more likely not to use ANC or PNC than those who had planned pregnancies alone or with their partner. The women who had not used ANC were also more likely not to use PNC. The women who had had a trouble-free delivery were more likely not to use PNC than those who had complications when delivering.Conclusion: In Lubumbashi, a significant proportion of women continue not to make use of healthcare services during pregnancy, as well as during and after childbirth. Women giving birth for the first time, those who have already given birth many times, and women with an unwanted pregnancy, made less use of ANC. Moreover, women who had not gone for ANC rarely came back for postnatal consultations, even if they had given birth at a healthcare facility. Similarly, those who gave birth without complications, less frequently made use of postnatal consultations. As with ANCs, women with unwanted pregnancies rarely went for postnatal visits.In addition to measures aimed at reinforcing women’s autonomy, efforts are also needed to reinforce and improve the information given to women of childbearing age, as well as communication between the healthcare system and the community, and participation from the community, since this will contribute to raising awareness of safe motherhood and the use of such services, including family planning. © 2012 Ntambue et al.; licensee BioMed Central Ltd.
The study was carried out in the city of Lubumbashi, the Democratic Republic of Congo. Lubumbashi is the administrative centre of Katanga province and the second most populated city in DRC after Kinshasa. It is located in the South East of the DRC, 135 km from the northern boarder of Zambia. Although no census has taken place here since 1984, fore casts within the vaccination programme of 2009 estimated this population to be 1,415,835[7], and the rate of natural growth is as for the whole country at 4% [8]. The city consists of seven administrative districts and eleven healthcare zones; some of which are urban–rural. In order of magnitude, the population is spread as follows in the healthcare zones: Kampemba (276,112), Katuba (200,829), Ruashi (194,355), Lubumbashi (127,071), Kenya (116,766), Kisanga (116,297), Tshiamilemba (111,074), Mumbunda (108,365), Vangu (91,986), Kamalondo (49,393), Kowe (23,587) [7]. Data were collected in specific areas in each of these healthcare zones. This was a transversal study carried out in order to determine the use of maternal healthcare services in Lubumbashi. Data were collected between January and February 2010 with help of a questionnaire written in French (interpreted in accordance with the understanding of the interviewee) consisting of closed and semi-open questions administered by surveyors. A pre-survey was carried out in order to test the questionnaire. The study was carried out on women residing in Lubumbashi who had delivered during the 12 months prior to the survey (January to December 2009). Women who delivered in Lubumbashi during the same period but had not lived there during their pregnancy were excluded from our sample [9]. Women’s informed consent was obtained prior to commencing the interview. This study was conducted in collaboration with the provincial office of the national program of the reproductive health (PNSR), and it was approved and authorized by the medical ethics committee of the University of Lubumbashi. Sample size was calculated according to antenatal consultation coverage of 78% in the province of Katanga [5]. With an accuracy of 3% and a confidence level of 95%, a proportion of non-respondents of 10% and a design effect of two, at least 1460 women were recruited for our study [9]. Women were selected by cluster sampling. The clusters were made up of the different healthcare areas. There were 30 clusters for the whole city (Table (Table1)1) and clusters were selected by systematic random sampling according to the cumulative frequency of the population that used these services during 2009 [9]. Number of clusters and subjects surveyed according to healthcare zones In the same cluster, data collection was carried out systematically according to households using a set inclusion criteria until the limit number required for the healthcare area was reached [9]. Women’s and household data were collected including socio-demographic, attendance at ANC (reasons for attendance and non-attendance, the health interventions received, perceptions of the quality of care received), the place of delivery and the presence of qualified healthcare personnel at the time of delivery, as well as the use of PNC. Women were interviewed within the households. In order to verify the exactness of the information provided by the women, each one was asked to give the name of the facility where she went for antenatal consultations (ANC). At the facility, the data of the interviewed women were looked up in the registers and records of ANC, and compared with the women’s statements. This procedure was followed as women in Lubumbashi do not have ANC cards on which the frequency and care administered during ANC can be indicated. All such information is usually written in the register and record, which is often kept at the ANC facility. In rare cases where women take the ANC sheet with them, they either tend to forget it at home at the time of childbirth, or they leave it at the maternity home after the birth. Information regarding the delivery itself was obtained by going to the maternity home. Besides the information provided by each woman, the healthcare facility in which she gave birth was visited to confirm the status of the healthcare staff who attended the birth. At the same time, information regarding complications and the outcome of the delivery was obtained. For women who gave birth at home, the name of the healthcare practitioner who attended the birth was searched in order to confirm their training and aptitude to attend during childbirth. This information was obtained by interviewing the person in question. The status of personnel qualified to attend childbirth was recognised if, in addition to their basic training as healthcare practitioner, they had attended at least one birth in the month preceding the delivery in relation to which the information is sought. If the person could not be found, the healthcare area or the official nurse of the healthcare centre was contacted to confirm the status of the person who attended the birth. In total, 2177 of the households visited had at least one woman who had carried a pregnancy in 2009. Among these, 0.9% (20 women) had miscarried, 0.2% (four) had died during pregnancy, 17.5% (381) were still pregnant at the time of the survey and 81.3% (1772) had already delivered. Among the women who had delivered, 0.2% (three) had died during delivery, 0.2% (four) had died within the 42 days after delivery and 0.2% (three) of the survivors refused to take part in the survey. All together, 1762 women who had delivered during 2009 took part in the survey. Included in maternal healthcare services were antenatal consultations, delivery assisted by qualified healthcare personnel and postnatal consultations. The use of healthcare services was defined as being the use and access to healthcare linked to these services at a health facility. ANC was defined as healthcare linked to pregnancy received by a woman at a health facility before labour [4]. Assisted delivery was defined as delivery taking place under supervision of qualified healthcare personnel. Qualified healthcare personnel was considered as all healthcare professionals who have accredited training in healthcare and have the competencies required to enable them to oversee pregnancy, delivery and immediate normal postpartum period, as well as knowing how to identify, treat, and when necessary, take the decision to transfer women or newborn presenting with complications. This category was comprised of doctors and nurses, while traditional midwives were not included [10]. With regard to postnatal consultations, these are planned according to the rule of six: six hours, six days and six weeks after delivery [4]. At least one visit at the facility is expected within a maximum period of 42 days following delivery and at least two visits are expected after this period. Within the framework of this research, we evaluated recourse to the PNC for respective periods of seven days, 28 days (corresponding to the end of the neonatal period) and 42 days [4,11]. Use of healthcare services was defined as use of and access to healthcare linked to these services at a health facility, whereas non-use was defined as the absence of use and the lack of access to healthcare linked to these services. Non-use of ANC, PNC and home delivery were studied as dependent variables. Thus, the women who had not attended ANC were considered as not having used this service; they were compared to those who had attended them at least once during pregnancy. In addition, the women who had delivered at home were compared to those who had delivered at a health facility. All of the women who had not used PNC within seven days, 28 days and 42 days (limit days inclusive) after delivery were compared with those who had used them respectively during the course of these periods. The different data collected were processed and analysed using Stata 11.0 software. The use of each of the healthcare services was calculated as the proportion of women having used the service in comparison with the total women surveyed. The different quantitative variables (age, gestational age at first visit, frequency of visits, age of the child at the first postnatal visit) were synthesized for their position and dispersion parameters. The comparison of quantitative variables was performed using Student’s t-test or the Mann–Whitney test accordingly [12]. The qualitative variables were compared using the chi-square test. The materiality threshold was 5%. Odds ratios (OR) and their 95% confidence intervals (95%CI) were calculated in order to estimate the strength of association between dependent variables and independent variables. Logistic regression models were established by progressive selection and only statistically significant variables were conserved. In the tables, the OR (95%CI) derived from final logistic models were presented as well as the p-value of the Wald test. The suitability of the models was verified using the Hosmer and Lemeshow test [12,13]. The materiality threshold was set at 5% for all analyses, which were performed using Stata 11.0 software.
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