Maternal Mortality Study in the Eastern Democratic Republic of the Congo

Abstract Background: Affordable, quality health care for pregnant women can improve their health. Thus, performance-based financing (PBF) remains one of the outcomes for improving the health system and increasing the accessibility of the poorest pregnant women to health care and reducing the maternal mortality rate. However, there is no up-to-date data on maternal mortality in the health structures using PBF in the Democratic Republic of the Congo (DRC). This study measures the mortality rate among pregnant women in health facilities by applying the PBF approach and identifies the associated risk factors.Methods: This analytical epidemiological study was based on rétrospective data materna deaths recorded in 59 health facilities, using the PBF approach in three health zones in the southern part of Maniema province in east DRC. The study was conducted from July 1, 2015 to June 30, 2020. Descriptive, bi and multivariate analyses were used.Results: The maternal mortality rate was estimated at 620 deaths per 100,000 live births, of which 46% of maternal deaths were related to a parturients’ delayed decision in seeking healthcare in time (first delay). Maternal deaths were significantly associated with extreme ages (≤19 years and ≥40 years: p = <0.001), patient parity (in primigravidas and in large multiparas: p = 0.001), complications such as hemorrhagic, (p = <0.001), uterine ruptures:(p = <0.001), infections, (p = <0.001), and dystocia (p = <0.001).Conclusion: Despite the establishment of the PBF approach in this part of eastern DRC, women continue to lose their lives when they decide to give birth. The results imply that it is imperative to strengthen both women and health professionals’ knowledge about pregnancy and maternal health and their power to reduce instances of first delay by supporting women in formulating their birth plans