The Impact of Insecurity on the Care of Pregnant Women in the Democratic Republic of the Congo: A Cross-Sectional Study

Author(s): Michel DIKETE EKANGA, Philippe SIMON, Yves COPPIETERS, Anne DELBAERE, Clotilde LAMY, WEI-HONG ZHANG, KASUNZU HAKIZIMANA, JOLIE KINJA, ALINE KATEREKWA, MARIE-IMMACULEE KASELA KAPUNGWE, Michel Kyembwa, Richard KABUYANGA KABUSEBA

Introduction:

The highest levels of maternal mortality and obstetric complications are found in conflict and post-conflict areas, where the number of maternal deaths per 100,000 live births is generally above 800. According to a recent analysis of demographic data and healthcare surveys, local exposure to incidents of armed conflict increases the risk of mortality during pregnancy and delivery by 10% for each additional incident recorded. The purpose of our study is to analyse the care and outcomes of deliveries at Rutshuru General Hospital, which is located in the east of the Democratic Republic of the Congo, in a region faced with insecurity.

Materials and methods:

The reference population was recruited at the Rutshuru General Hospital (North Kivu) between September 2021 and January 2022. It is an observational, prospective, descriptive and analytical study examining all deliveries that occurred during the study period. The normality test of continuous variables was applied using graphs (histograms, box plots). The median and interquartile range were calculated to describe asymmetrical distributions. The mean and standard deviation were calculated to describe normally distributed variables. Associations between delivery via caesarean section and the various explanatory variables were analysed using logistic regression.

Results:

1,243 patients delivered at the Rutshuru General Hospital during the period studied. The average age of our population was 25 years. The majority of the women were married (93.5%), had no level of education (74.3%) and no profession (93.7%). 45% of patients had a prior history of caesarean sections. The percentage of caesarean sections in this study was 52.1%. The incision was most commonly transverse (84.5%) and the type of anaesthesia used was most commonly locoregional (spinal anaesthesia) (99.4%). 11% of deliveries included intra-operative complications and 89% of new-borns did not require intensive neonatal care and were with their mothers. Maternal mortality was estimated at 0.5%, with an average length of stay of seven days.

Conclusions:

Insecurity resulting from armed conflicts had a negative impact on the education, employment and socio-economic status of the population and, as a result of this, poor care for pregnant woman. This story shows that new-borns delivered via caesarean section have a lower risk of perinatal complications that new-borns delivered via vaginal delivery in areas faced with insecurity as a result of armed conflicts. We observed, however, a higher number of maternal complications following delivery via caesarean section than via vaginal delivery.