背景:孕产妇死亡率(MM)仍然是世界上最贫穷地区最严重的灾难,特别是受冲突影响的人。然而,尽管现实令人担忧,在刚果民主共和国(DRC),很少有关于MM比率的研究。该研究旨在描述2013年至2022年在刚果民主共和国东部报告的机构孕产妇死亡的趋势以及流行病学概况和原因。
方法:在2023年3月至2023年8月之间在八个健康区(HZ)进行了回顾性描述性研究,南基伍省(Mwana,米诺娃,Miti-Murhesa,Kamituga和Idjwi)和北基伍省的三个(Kirotshe,卡里辛比和凯纳)在刚果民主共和国东部地区。我们的研究涵盖242个医疗机构:168个健康中心(HC),16个转诊健康中心(RHC),50家转诊医院(RH)和8家普通转诊医院(GRH)。从这些地区记录的2013-2022年孕产妇死亡的登记和医疗记录中提取了数据,以及有关分娩和活产数量的信息。社会人口统计学,临床参数,评估了各省之间的血液和超声检查以及可疑的死亡原因。
结果:总计,我们获得了177份死者的档案.其中,143(80.8%)保留用于本研究,包括北基伍3个HZ的75个和南基伍5个HZ的68个。从2013年到2022年,研究中心的孕产妇死亡率(MMR)(2015年和2018年)下降了两次。以及2016-2017年的峰值。尽管如此,10年研究期间的合并MMR(跨研究中心)开始和结束时的水平大致相同(2013年和2022年分别为53例和57例死亡/10万活产).总的来说,62,6%的死亡报告来自二级医院。大多数死亡是30多岁的已婚妇女(93.5%)。几乎一半(47.8%)没有完成四次产前咨询。死亡的主要直接原因是,按频率递减顺序: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%)。在各省之间进行比较时,报告的堕胎相关孕产妇死亡率(14.1%vs0%)在北基伍比南基伍更常见。
结论:本研究强调需要有针对性的干预措施来降低孕产妇死亡率。通过强调产前咨询的至关重要性,产时/立即产后护理和护理质量,在保障孕产妇健康和减少许多可避免的死亡方面可以取得重大进展。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.