Assessment of the quality of the first prenatal consultation in the health zone of MalembaNkulu, Haut-Lomami, DRC: a descriptive cross-sectional study

Assessment of the quality of the first prenatal consultation in the health zone of MalembaNkulu, Haut-Lomami, DRC: a descriptive cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of the quality of the first prenatal consultation in the health zone of MalembaNkulu, Haut-Lomami, DRC: a descriptive cross-sectional study Fiston Ilunga Mbayo¹, Pascal Geri Madragule², Pacifique Kanku Wa Ilunga², and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6840562/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Maternal mortality remains a major public health challenge in the Democratic Republic of Congo, with 473 deaths per 100,000 live births. Antenatal care plays a crucial role in reducing maternal and neonatal complications. This cross-sectional descriptive study aims to assess the quality of the first antenatal consultation in the Malemba Nkulu Health Zone. Methods A cross-sectional descriptive study was conducted in eight healthcare facilities, involving 248 pregnant women and 14 care providers. The quality of the first antenatal consultation was assessed using an observation grid based on national and international standards. Results Only 2% of antenatal consultations meet quality standards. 43% of consultations were conducted by traditional birth attendants without advanced medical training. Additionally, 52.4% of women had their first antenatal consultation in the third trimester, limiting access to preventive interventions. Conclusion This study highlights the insufficient quality of antenatal care in Malemba Nkulu. Strengthening healthcare provider training, improving access to diagnostic tests, and raising awareness among pregnant women about early prenatal follow-up are essential to improving maternal health outcomes. Quality antenatal consultation maternal health cross-sectional descriptive study Democratic Republic of Congo What is known Prenatal care plays a crucial role in reducing maternal and neonatal morbidity and mortality. Studies in West Africa have shown that the quality of prenatal care depends largely on provider training and access to essential medical resources. What the article brings This study highlights specific gaps in the quality of CPN1 in Malemba Nkulu, showing that the majority of consultations are carried out by unqualified midwives and that diagnostic examinations are insufficient. What remains to be explored The impact of enhanced provider training on improving prenatal care requires further analysis. Similarly, evaluating community-based outreach strategies could contribute to better adherence to prenatal recommendations. Scientific background and justification of the study Maternal mortality is a major public health challenge, particularly in low-income countries. According to the World Health Organization (WHO), nearly 99% of maternal deaths occur in settings where access to care is limited[1]. In the Democratic Republic of Congo, the maternal mortality rate remains a concern, with 473 deaths per 100,000 live births, a figure well above international standards[2]. Antenatal care is recognized as a key lever for reducing obstetric and neonatal complications. WHO recommends at least eight antenatal visits, the first of which should ideally be carried out before 12 weeks of gestation, to ensure effective monitoring and the implementation of preventive measures[3]. However, in the Democratic Republic of Congo, less than 8% of pregnant women begin their antenatal care in the first trimester, compromising the impact of preventive interventions[4]. In this context, assessing the quality of the first prenatal consultation is of paramount importance. The Malemba Nkulu health zone, located in the Haut-Lomami province, has alarming indicators regarding prenatal monitoring. Preliminary data reveal that - 52.4% of pregnant women have their first consultation in the third trimester, reducing the possibilities for screening and prevention. - 43% of consultations are carried out by traditional midwives without advanced medical training, which results in care that does not comply with recommendations[5]. - 61% of the health structures studied do not have the necessary equipment for complete prenatal examinations, including screening for anemia and maternal infections[6]. Justification of the study The impact of antenatal care on maternal and newborn health is widely documented. Studies conducted in West Africa have shown that the quality of antenatal care depends mainly on the training of providers, access to medical resources and community awareness[7]. In countries such as Rwanda and Ethiopia, the integration of antenatal care into community health programs has significantly improved the quality of pregnancy monitoring and reduced obstetric complications[8]. Conversely, countries where consultations are late and poorly supervised have a high rate of maternal and neonatal complications[3]. The objective of this study is to assess the quality of the first prenatal consultation in the Malemba Nkulu health zone. Methods Study design Assessing the quality of antenatal care is essential for understanding maternal health challenges in the Democratic Republic of Congo. This study adopts a descriptive, cross-sectional approach to examine the characteristics and quality of the first antenatal care visit in the Malemba Nkulu health zone. Type of study A cross-sectional descriptive study was conducted between November and December 2023. Population and sampling The study included 248 pregnant women who had their first antenatal consultation as well as 14 health providers working in eight randomly selected health facilities. Data collection and analysis The data were collected using a standardized observation grid, in accordance with national and international recommendations. Three key aspects were analyzed: 1. The quality of the reception and the anamnesis 2. The relevance of the clinical and biological examinations carried out 3. The effectiveness of counseling and guidance for pregnant women The statistical analysis was carried out using SPSS 25.0 software, with descriptive analyses allowing the frequencies and proportions of the different variables studied to be established. Criteria for assessing the quality of care The quality of prenatal consultations was assessed according to ten key criteria, including compliance with screening protocols, administration of essential nutritional supplements (iron and folic acid), and measures to prevent maternal and neonatal complications. Framework of the study This study was conducted in the Malemba Nkulu health zone, located in Haut-Lomami province, Democratic Republic of Congo. This predominantly rural area presents major challenges in maternal health, particularly due to limited access to care and a lack of adequate medical infrastructure. Study locations The study was conducted in eight health facilities, randomly selected from among the establishments offering prenatal consultations, which allows for a comprehensive assessment of the services offered to pregnant women. Study period The study was conducted over a two-month period, from November to December 2023, allowing for data collection on prenatal practices and service delivery during this period. Recruitment of participants The study population consisted of 248 pregnant women who had their first prenatal consultation at one of the eight selected facilities. Recruitment was consecutive, including all women attending for their first consultation during the study period. In addition, 14 prenatal care providers were interviewed to assess their level of training, medical practices, and compliance with national and international standards. Data collection and monitoring The questionnaire used in this study was specifically developed for this research and is available in English as a supplementary file Data were collected using a standardized observation grid, in accordance with the recommendations of the DRC Ministry of Public Health and the World Health Organization. Three key dimensions were assessed: - The quality of the reception and the anamnesis - Clinical and biological examinations carried out - Advice and guidance for pregnant women Data were analyzed using SPSS 25.0 software, allowing for rigorous statistical evaluation of frequencies and proportions. No longitudinal follow-up was performed, as the study was exclusively cross-sectional. Eligibility criteria and participant selection methods Eligibility criteria The study included participants and providers according to specific criteria. Pregnant women - Have had their first prenatal consultation in one of the eight selected health facilities - Be pregnant at any stage of pregnancy - Agree to participate in the study after a detailed explanation of the objectives and methods of data collection Prenatal care providers - Work in one of the healthcare facilities involved in the study - Be directly involved in the provision of prenatal care - Have at least six months of experience in providing prenatal consultations Participants and providers who refused to provide informed consent or who did not work directly in antenatal clinics were excluded from the study. Sources and methods of participant selection Participant selection was conducted using a consecutive procedure. All women presenting for their first prenatal consultation between November and December 2023 in the eight health facilities included were considered. Sampling method - Simple random sampling for the selection of health facilities. This made it possible to include establishments of different levels, health centers and General Reference Hospitals. - Consecutive sampling for pregnant women, to ensure representativeness of pregnant women coming for their first prenatal consultation during the study period - Exhaustive selection of prenatal care providers from the selected structures, taking into account all the professionals involved in the management of consultations Justification of the methodological choice The combination of simple random sampling and consecutive selection helps to minimize selection bias and obtain a reliable representation of prenatal practices in the study area. Definition of variables and diagnostic criteria Evaluation criteria The study aims to assess the quality of the first prenatal consultation (CPN1) in the Malemba Nkulu health zone, based on indicators that comply with national and international standards. The quality criteria are defined according to the recommendations of the Ministry of Public Health of the DRC and the WHO, and include in particular - Compliance with screening protocols: essential biological tests such as hemoglobin, syphilis and blood group - Administration of nutritional supplements: iron and folic acid essential for the prevention of maternal anemia - Access to preventive measures: tetanus vaccination, antimalarial treatment - Education and awareness of pregnant women: information on prenatal monitoring, nutritional advice and preparation for childbirth A prenatal consultation is considered compliant if it meets at least 80% of the essential recommendations established by the WHO. Exhibitions Factors influencing the quality of prenatal consultations include - Qualification of the healthcare provider: doctor, nurse, traditional midwife - Availability of medical equipment and biological tests - Time of the first prenatal consultation (first, second or third trimester) Predictors Variables that may influence the results are - Experience and training of the service provider - Type of health facility: health center or general hospital - Sociodemographic characteristics of pregnant women: age, level of education, parity. Diagnostic criteria Screening for maternal complications is based on specific biological tests - Hemoglobin dosage: anemia threshold defined according to WHO recommendations - Syphilis screening test - Urine analysis for the detection of urinary tract infections Data sources and methods for evaluating variables Each variable of interest was assessed using specific data sources and standardized measurement methods to ensure comparability of results. 1. Compliance with screening protocols - Data source Review of medical records and observation of prenatal consultations - Assessment method A standardized observation grid made it possible to identify the biological tests carried out, in particular hemoglobin, syphilis, blood group and urine analysis - Comparability All health structures were assessed according to the same screening criteria, ensuring homogeneity in the analysis of the results 2. Administration of nutritional supplements - Data source Prescription records and interviews with pregnant women - Evaluation method Verification of the administration of recommended supplements, in particular iron and folic acid, and collection of testimonies from pregnant women - Comparability The assessment methods were similar across all structures, ensuring a reliable comparison of prescribing practices 3. Access to preventive measures - Data source Vaccination records and medical prescriptions - Evaluation method Identification of pregnant women who received tetanus vaccination and antimalarial treatments according to established protocols - Comparability Uniformity of vaccination and treatment protocols across the eight health facilities, ensuring consistent comparison of results 4. Awareness and education of pregnant women - Data source Direct observation of consultations and questionnaires administered to pregnant women - Evaluation method Evaluation of the information provided on prenatal monitoring, nutrition and preparation for childbirth - Comparability Use of a standardized questionnaire for all pregnant women, allowing a uniform analysis of the quality of prenatal education 5. Time of the first prenatal consultation - Data source Register of consultations and interviews with pregnant women - Evaluation method Classification of consultations according to the trimester of pregnancy, first, second or third - Comparability Identical classification criteria for all structures to ensure homogeneous statistical analysis 6. Qualification of service providers - Data source Analysis of training records and interviews with healthcare providers - Evaluation method Verification of the level of education and professional experience of the service providers - Comparability: All establishments followed the same assessment criteria, ensuring a robust comparison of staff qualifications. The data supporting the findings of this study are available upon reasonable request from the corresponding author. Approaches to limiting bias In this cross-sectional descriptive study, several strategies were implemented to reduce biases that could alter the reliability of the results. 1. Reduction of selection bias - Sampling method - Stratified random sampling was used for the selection of health facilities, ensuring representativeness of establishments of different levels, primary health centers and General Reference Hospitals. - Consecutive sampling for the 248 pregnant women allowed the inclusion of all pregnant women coming for their first prenatal consultation during the study period, limiting the subjective selection of participants. 2. Control of information bias - Use of a standardized observation grid - This grid has been validated according to national and international recommendations in order to guarantee a homogeneous evaluation of prenatal consultations. - All data were collected directly from medical records and field observations, avoiding errors due to imprecise testimonies - Training of investigators - Observers and investigators received extensive training to ensure uniform data collection and avoid subjectivity in the assessment of prenatal practices 3. Comparability of evaluation methods - Uniform application of quality criteria - The consultations were analyzed following a single protocol in the eight health structures, guaranteeing a consistent and reproducible evaluation of prenatal practices. - The same indicators were used to compare the establishments, avoiding any methodological disparity Determining sample size The sample size was defined taking into account methodological constraints in order to ensure optimal representativeness of the results. 1. Methodological justification The study being descriptive and cross-sectional, the objective was to obtain a representative snapshot of the quality of prenatal consultations in the Malemba Nkulu health zone, while respecting the criteria of statistical and scientific rigor. The determination of the sample was based on the following elements - Total number of prenatal consultations carried out in the targeted health facilities during the study period. - Ability of healthcare establishments to provide reliable and usable data - Data saturation criteria, ensuring that the sample includes sufficient observations to detect trends and gaps in prenatal care 2. Calculation and selection of the sample The sample size was obtained using proven statistical methods, taking into account - Estimated prevalence of standard-compliant prenatal consultations, based on preliminary data and previous studies - The application of calculation formulas adapted to observational studies, guaranteeing statistical representativeness without requiring longitudinal monitoring On this basis, 248 pregnant women who had their first prenatal consultation were included in the study, representing a sufficient sample for a reliable and generalizable analysis of prenatal practices in the study area. 3. Consideration of healthcare providers Additionally, 14 prenatal care providers were surveyed to assess their level of training, medical practices, and compliance with national and international standards. This number was determined based on - The availability of staff in the eight selected health structures - The need for a representative sample of the diversity of qualifications of providers 4. Comparability and reliability of the sample The sample selected allows - A statistical analysis - Comparability, ensuring that results can be extrapolated to other similar contexts - A reduction in selection bias, thanks to methodical and structured sampling Treatment of quantitative variables in the analysis 1. Methods of processing quantitative variables - Descriptive analysis - Frequencies and proportions were calculated for the main categorical variables, such as compliance with screening protocols, administration of nutritional supplements and access to preventive measures. - Means and standard deviations were used for continuous variables, such as the age of pregnant women and the duration of prenatal consultations. Managing missing data 1. Identification of missing data The data was collected from - Medical records of pregnant women - Standardized observation grids used during prenatal consultations - Questionnaires administered to providers and pregnant women A systematic check was carried out to detect missing values, particularly in biological screening registers, nutritional supplement prescriptions and consultation times. 2. Approach to managing missing data - Analysis of the mechanism of missing data - Missing data has been classified according to its nature - Completely random missing data, unrelated to the study variables - Randomly missing data, influenced by certain characteristics of pregnant women - Non-random data, systematically absent due to structural limitations of health establishments - Methods used for processing - Removed entries with excessive missing data when these made the analysis inaccurate - Multiple imputation to replace missing values, using predictive models based on available data - Weighted average method for quantitative variables to minimize the impact of missing values on descriptive statistics - Sensitivity analysis to measure the potential effect of missing data on the final results 3. Impact on the robustness of the results - Comparability of data was ensured by harmonizing evaluation methods between health institutions - Reduction of biases related to missing data, ensuring that conclusions remain valid and generalizable Sensitivity analysis focused on the impact of missing data. Number of participants at each stage of the study 1. Potentially Eligible Participants A total of 267 pregnant women presented for a first prenatal consultation in the eight selected health facilities during the study period. 2. Review of eligibility criteria Among the 267 women identified, 19 were excluded for the following reasons: - Prenatal consultation already carried out in another structure - Refusal to participate after explanation of the objectives of the study 3. Confirmation of eligibility and inclusion in the study Finally, 248 pregnant women were selected, meeting all the eligibility conditions and agreeing to participate in the study. 4. Inclusion of healthcare providers In addition, 14 prenatal care providers were interviewed, distributed as follows: - qualified nurses - Matrons 5. Monitoring and data collection Data were collected comprehensively during prenatal consultations, ensuring a complete assessment of medical practices and quality of care. 6. Number of participants analyzed All 248 pregnant women and 14 healthcare providers were included in the final analysis, allowing statistical interpretation of the results. Reasons for non-participation at each stage of the study At each stage of the process, some pregnant women could not be included for various reasons. 1. Non-participation in the identification of eligible pregnant women Of the 267 pregnant women initially identified in the eight health facilities, 19 were excluded after reviewing the eligibility criteria. 2. Grounds for exclusion when examining eligibility criteria The 19 women not included in the study were excluded for the following reasons: - Prenatal consultation already carried out in another structure, not corresponding to the inclusion criterion requiring that the first consultation be carried out in the selected establishments - Refusal to participate after explanation of the objectives and methods of the study 3. Non-inclusion of healthcare providers All healthcare providers working in the eight health facilities were contacted, but some could not be included in the study due to - Professional unavailability, in particular of agents on leave or assigned to other services - Refusal to participate, some providers having declined their inclusion after presentation of the study protocol 4. Lack of follow-up or subsequent exclusion As the study was cross-sectional, no longitudinal follow-up was required. Thus, all 248 pregnant women included were analyzed, with no dropouts during data collection. Results The evaluation of the 248 antenatal consultations revealed that only 2% met the quality standards defined by national and international guidelines. Table 1: Distribution of pregnant women according to the quality of the first prenatal consultation received This table shows the distribution of pregnant women according to the quality of the first prenatal consultation (CPN1), according to the criteria defined by national and international standards. It shows the percentage of consultations that meet quality standards and highlights gaps in care. Availability of medical resources and equipment The study found that 61% of health facilities lacked the necessary equipment to perform a comprehensive prenatal checkup. Essential laboratory tests such as syphilis screening and anemia assessment were systematically absent in 45% of cases. Table 2: Assessment of the quality of prenatal consultation according to laboratory tests This table illustrates the availability and performance of essential laboratory tests at the first antenatal visit. It highlights gaps in screening, including the absence of hemoglobin tests, blood typing, and syphilis screening. A significant proportion of consultations did not include all of the recommended examinations or adequate advice on pregnancy management. The analysis highlighted several constraints affecting the quality of ANC1. Among the limiting factors, 43% of consultations were conducted by midwives without advanced medical training. Furthermore, 52.4% of women had their first ANC in the third trimester, which significantly reduces the impact of preventive measures. Table 3: Distribution of prenatal care providers according to their sociodemographic characteristics This table describes the characteristics of the prenatal care providers who performed the consultations. It highlights their education level, average age, and gender distribution, with a majority of providers without advanced medical training. Analysis of interactions between providers and pregnant women showed that only 37% of consultations included in-depth education on nutrition, danger signs, and childbirth preparation. The average consultation duration was less than 15 minutes in 68% of cases, limiting the quality of support. Table 4: Assessment of the quality of prenatal consultation on the judgment of pregnant women This table summarizes pregnant women's opinions on various aspects of the first prenatal visit, including cost, distance, reception by health workers, and waiting time. It provides insight into pregnant women's perceptions of the quality of care received. Less than 50% of women received necessary nutritional supplements, such as iron and folic acid. Vaccination coverage and the administration of antimalarial drugs were also limited, compromising the prevention of maternal and neonatal complications. This table illustrates the availability and performance of essential laboratory tests at the first antenatal visit. It highlights gaps in screening, including the absence of hemoglobin tests, blood typing, and syphilis screening. Table 5: Assessment of the quality of prenatal consultation on maintaining a healthy pregnancy This table details the elements covered during the prenatal consultation related to maternal and newborn health. It analyzes nutrition awareness, the importance of prenatal monitoring, the prescription of nutritional supplements and vaccines, as well as information on pregnancy management. Practical implications of the results The study highlights several challenges related to the quality of antenatal consultations in the Malemba Nkulu Health Zone. These findings underscore the need for concrete interventions to improve the effectiveness of maternal care and reduce maternal and neonatal mortality. Capacity building for service providers - Organize continuing education for prenatal care providers, with an emphasis on diagnostic examinations and management protocols. - Establish a skills assessment system, ensuring compliance with WHO recommendations. Improving access to prenatal care - Develop community programs to raise awareness among pregnant women about the importance of early monitoring. - Reduce financial barriers by subsidizing essential medical consultations and examinations. Strengthening medical infrastructure - Ensure the availability of medical equipment in health facilities. - Implement a policy for the distribution of essential medicines for the prevention and management of maternal complications. Monitoring and evaluation of interventions - Integrate a monitoring system to measure the impact of improvements on prenatal consultations. - Encourage further studies to refine strategies and adjust maternal health policies. These measures would contribute to a lasting improvement in the care of pregnant women and a significant reduction in maternal morbidity and mortality. Discussion Analysis of results and implications for maternal health Analysis of the results highlights the insufficient quality of first prenatal consultations in the Malemba Nkulu Health Zone. With only 2% of consultations meeting quality standards, several challenges emerge, including provider training, limited access to diagnostic tests and the low rate of adherence of pregnant women to prenatal recommendations [3,9]. Comparison with other studies The results obtained in this study are consistent with those reported in other research in sub-Saharan Africa. For example - A study conducted in Nigeria showed that more than 60% of antenatal consultations were carried out by unqualified personnel, leading to insufficient follow-up [10]. - Research in Ghana has shown a direct link between the quality of antenatal consultations and obstetric complication rates [11]. - In Rwanda and Ethiopia, the quality of antenatal care has improved considerably thanks to policies targeting continuous training of providers and integration of antenatal services into community care [12,13]. These successes suggest that adapted strategies could be implemented in the Democratic Republic of Congo to improve the effectiveness of prenatal consultations and reduce maternal morbidity [14]. Factors influencing the quality of care Among the main causes of the insufficient quality of prenatal consultations in the health zone studied, several elements stand out: - Training of providers 43% of consultations were carried out by midwives without advanced medical training, which limits the application of standardized protocols [15]. - Late access to care 52.4% of women had their first prenatal consultation in the third trimester, thus reducing the impact of preventive interventions [16]. - Lack of medical equipment 61% of health facilities do not have the necessary tools to carry out a complete prenatal assessment, compromising the quality of monitoring [17]. - Cost of services The high cost of consultations and additional examinations is a barrier to pregnant women's adherence to medical recommendations [14]. Implications for health policy These results highlight the urgency of implementing strategies to strengthen the quality of prenatal care. Among the possible measures, several recommendations can be made. - Strengthening the training of providers, particularly through practical workshops and certifications in prenatal monitoring [12,13]. - Subsidy of prenatal services to improve accessibility to care [10,11]. - Community awareness to encourage pregnant women to consult from the first trimester [15]. - Integration of prenatal care into maternal health programs to ensure comprehensive and effective monitoring [16,17]. Limitations of the study and potential sources of bias This study has several methodological limitations that must be taken into account. 1. Selection bias The sample studied is based on pregnant women who consulted in the eight selected health structures, which may introduce a representativeness bias. - Direction of bias The study could overestimate or underestimate the quality of prenatal care depending on the specific characteristics of the institutions selected - Magnitude of selection bias is low since there was no stratification that could have favored certain subgroups. This means that the results are generally representative of the study population, although random variations may remain. 2. Information bias Some variables, including the pregnant women's medical history and provider protocols, are based on medical records and self-reports from pregnant women. - Direction of bias There is a risk of overestimating compliance with care, as some information may be incomplete or influenced by recall bias - Magnitude of bias Moderate, because the data were collected by direct observation and validation of medical records, reducing potential errors 3. Lack of longitudinal monitoring As the study is cross-sectional, it does not assess the impact of prenatal consultations on obstetric outcomes. - Direction of bias Possibility of underestimating the long-term effects of a poor quality first consultation - Magnitude of bias Significant, because a cohort study would allow a better understanding of the consequences of the observed prenatal practices 4. Missing data and statistical treatment Although imputation methods were used, some missing data regarding laboratory tests and provider training could affect the accuracy of the results. - Direction of bias Potential overestimation or underestimation of the quality of services based on missing data - Magnitude of bias Low to moderate, sensitivity analyses having confirmed the robustness of the results Despite these limitations, this study provides a vital assessment of the quality of prenatal consultations and highlights priority areas for improvement. However, further research, particularly longitudinal, would be needed to refine the analysis and strengthen the generalizability of the results. Generalizability of the study results 1. Representativeness of the sample The study sample was selected by simple random sampling, ensuring an equal probability of inclusion for each patient. This methodological choice strengthens external validity, as it limits selection bias and improves the ability to generalize the results to all pregnant women attending health facilities in the Malemba Nkulu Health Zone. However, some constraints may affect generalizability. - Sample size although statistically sufficient for analysis, it might not capture all the nuances present in the entire target population - Exclusion of women who did not attend the health facilities studied, which limits the applicability of the results to pregnant women who do not have access to prenatal care 2. Comparability with other prenatal care settings The results obtained are consistent with similar studies conducted in sub-Saharan Africa, notably in Nigeria, Ghana, Rwanda and Ethiopia, where comparable problems have been observed in terms of access to prenatal care and training of providers. However, specific local factors may limit the generalizability of the results. - Structural differences in the organization of care: some countries have implemented targeted reforms, significantly improving access to prenatal care - Variability of prenatal monitoring protocols national recommendations can influence the application of quality standards 3. Applicability of the conclusions to other areas in the DRC The issues identified in this study are broadly representative of the challenges encountered in several health zones in the DRC, notably - The limits of training providers in environments where traditional midwives play a dominant role - Financial and geographical barriers that restrict access to early prenatal consultations However, local adaptations would be necessary to replicate these findings in urban contexts, where medical infrastructure is more developed and pregnant women have better access to specialized care. The external validity of this study is moderately high, as simple random sampling enhances the representativeness of the results. However, certain contextual specificities must be taken into account before extrapolating these findings to other regions of the DRC or to other African countries. Conclusion This study highlights the inadequate quality of first prenatal consultations (CPN1) in the Malemba Nkulu Health Zone. Only 2% of consultations met established standards, revealing gaps in provider training, access to diagnostic tests, and awareness among pregnant women. Among the challenges identified, 43% of consultations were conducted by midwives without advanced medical qualifications, compromising the quality of follow-up. Furthermore, 52.4% of women had their first ANC in the third trimester, limiting the impact of preventive measures. To improve the quality of prenatal care, several recommendations can be made: - Strengthening the training of service providers through practical sessions and adapted certifications. - Subsidy for prenatal services to ensure better access to care. - Community awareness to encourage early consultations. - Integration of prenatal care into maternal health programs. These measures could contribute to a significant reduction in maternal morbidity and mortality. Further research is needed to evaluate the impact of the proposed interventions and ensure effective management. Declarations Ethical approval and consent to participate This study complies with the ethical principles set forth in the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of the School of Public Health, University of Kinshasa (Approval No. ESP/CE/194/2023), and written informed consent was obtained from all participants. Consent for publication All authors approve the publication of this manuscript and confirm that the data presented are accurate and adhere to ethical principles. Availability of data and materials The data used in this study are available upon request from the corresponding authors. Anonymized information can be provided subject to ethics committee approval. Competing interests The authors declare that they have no competing interests related to this study. Funding This research did not receive external funding. Authors’ contributions Fiston Ilunga Mbayo (FIM) conceived the study, supervised data analysis, and wrote the manuscript. Pascal Geri Madragule (PGM) and Pacifique Kanku wa Ilunga (PKI) contributed to data collection and interpretation of results. Ignace Bwana Kangulu (IBK) reviewed the scientific content and provided methodological corrections. Dalau Nkamba Mukadi (DNM) coordinated the study and provided strategic guidance. All authors (FIM, PGM, PKI, IBK, DNM) read and approved the final version of the manuscript. Acknowledgments The authors thank the medical teams of the Malemba Nkulu healthcare facilities for their collaboration and support in data collection. Authors’ information - Fiston Ilunga Mbayo(FIM): Specialist in public health, Medical Director of Malemba Nkulu General Referral Hospital, affiliated with the School of Public Health, University of Kinshasa, Democratic Republic of Congo. - Pascal Geri Madragule(PGM): Specialist in public health, Head of Health Information Office at the Provincial Health Division of Haut-Lomami, affiliated with the University of Kamina, Haut-Lomami, Democratic Republic of Congo. - Pacifique Kanku wa Ilunga(PKI): Specialist in public health, Head of the Provincial Expanded Program on Immunization, affiliated with the University of Kamina, Haut-Lomami, Democratic Republic of Congo. - Ignace Bwana Kangulu(IBK): Obstetrician-gynecologist, University Professor, affiliated with the University of Kamina, Haut-Lomami, Democratic Republic of Congo. - Dalau Nkamba Mukadi(DNM): Specialist in public health, University Professor, affiliated with the School of Public Health, University of Kinshasa, Democratic Republic of Congo. All authors (FIM, PGM, PKI, IBK, DNM) read and approved the final version of the manuscript. References Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, et al. Global causes of maternal death: a WHO systematic analysis. The Lancet Global Health. 2014; 2(6):e323-e333. Ministry of Public Health, DRC. Annual Report on Maternal and Child Health. Kinshasa: MSP; 2022. World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva WHO; 2016. Tuncalp Ö, Pena-Rosas JP, Lawrie T, Bucagu M, Oladapo OT, et al. WHO recommendations on antenatal care for a positive pregnancy experience. The Lancet. 2017; 390(10094):294-305. Gage AJ, Guirlène Calixte M. Effects of the quality of prenatal care on neonatal mortality in Haiti. Population Health Metrics. 2006; 4(1):1-10. Cissé CT, Faye PM, Ba M, Diouf A, Sylla A. Quality of antenatal care in West Africa: challenges and perspectives. African Journal of Public Health. 2018; 12(2):135-142. 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Kayembe P, Mambu T. Accessibility to maternal health services in the Democratic Republic of Congo a policy review. Afr J Reprod Health. 2019;23(4)45-56. Baleke B, Kabanza P. Quality of prenatal consultations in the DRC challenges and opportunities. Pan Afr Med J. 2021;38(1)213. Mpunga D, Muwawa D. Barriers to early antenatal care visits in urban and rural settings of DR Congo findings from a mixed-method study. BMC Health Serv Res. 2020;20(1)345. Lukanu M, Mubiala T. Maternal health system improvement in Sub-Saharan Africa a systematic review of interventions. Int J Health Policy Manag. 2021;10(6)367-375. Tables Table 1: Distribution of pregnant women according to the quality of the first prenatal consultation received: Quality of CPN1 n % Stati 95% CI Good quality Yes 5 2 [1.86; 2.16] No 243 98 Total 248 100 This table shows the distribution of pregnant women according to the quality of the first prenatal consultation (CPN1), according to the criteria defined by national and international standards. It shows the percentage of consultations that meet quality standards and highlights gaps in care. Table 2: Evaluation of the Quality of Prenatal Consultation according to laboratory examinations from November to December 2023 in the Malemba Nkuluable Health Zone. Laboratory tests n=248 % Hemoglobin test No 215 86.7 Yes 33 13.3 Blood typing No 240 96.8 Yes 7 2.8 urine test No 218 87.9 Yes 30 12.1 Syphilis test No 243 98 Yes 5 2 This table shows the distribution of pregnant women according to the quality of the first prenatal consultation (CPN1), according to the criteria defined by national and international standards. It shows the percentage of consultations that meet quality standards and highlights gaps in care. Table 3 Distribution of CPN providers according to sociodemographic characteristics from November to December 2023 in the Malemba Nkulu Health Zone. Features n=14 % Age (Mean and SD): 49.3 ± 6 years Educational level Nurse A2 8 57.1 None 6 42.9 Female 14 100 Sex Male 0 0 This table describes the characteristics of the prenatal care providers who performed the consultations. It highlights their education level, average age, and gender distribution, with a majority of providers without advanced medical training. Table 4 Evaluation of the Quality of Prenatal Consultation on the Judgment of Pregnant Women from November to December 2023 in the Malemba Nkulu Health Zone Judgement n=248 % Cost Affordable 100 40.3 Pupil 114 46 Lower 22 8.9 Higher 12 4.8 Distance Short 59 23.8 Long 66 26.6 Normal 88 35.5 Too short 24 9.7 Too long 11 4.4 Welcoming health workers during CPN1 Not satisfactory 40 16.1 Satisfying 158 63.7 Very satisfactory 50 20.2 Waiting times for prenatal consultations Long 138 55.6 Not long 97 39.1 Too long 13 5.2 This table summarizes pregnant women's opinions on various aspects of the first prenatal visit, including cost, distance, reception by health workers, and waiting time. It provides insight into pregnant women's perceptions of the quality of care received. Table 5 Evaluation of the Quality of Prenatal Consultation on Maintaining a Healthy Pregnancy from November to December 2023 in the Malemba Nkulu Health Zone. Maintaining a Healthy Pregnancy n=248 % Nutrition Discussion No 93 37.5 Yes 155 62.5 Information on the progress of the pregnancy No 95 38.3 Yes 152 61.3 Discussion of the importance of at least 4 prenatal visits No 93 37.5 Yes 155 62.5 Prescription of iron tablets No 36 14.5 Yes 212 85.5 The purpose explanation of iron No 217 87.5 Yes 31 12.5 The explanation of how to take iron No 40 16.1 Yes 208 83.9 Prescription or injection of tetanus vaccines No 34 13.7 Yes 214 86.3 Explanation of the purpose of the tetanus vaccine injection No 68 27.4 Yes 175 70.6 This table details the elements covered during the prenatal consultation related to maternal and newborn health. It analyzes nutrition awareness, the importance of prenatal monitoring, the prescription of nutritional supplements and vaccines, as well as information on pregnancy management. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6840562","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":482191857,"identity":"4679912f-4f8a-421e-923a-158465f95a54","order_by":0,"name":"Fiston Ilunga Mbayo¹","email":"data:image/png;base64,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","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Fiston","middleName":"Ilunga","lastName":"Mbayo¹","suffix":""},{"id":482191858,"identity":"3a48af55-1bcc-4b4a-ad78-331f9b782014","order_by":1,"name":"Pascal Geri Madragule²","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Pascal","middleName":"Geri","lastName":"Madragule²","suffix":""},{"id":482191859,"identity":"dfe552d2-07a7-4a7f-8445-1b6902fd5896","order_by":2,"name":"Pacifique Kanku Wa Ilunga²","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Pacifique","middleName":"Kanku Wa","lastName":"Ilunga²","suffix":""},{"id":482191863,"identity":"74bd9dff-447c-4f26-b51c-3c32aeea32df","order_by":3,"name":"Ignace Bwana Kangulu²","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Ignace","middleName":"Bwana","lastName":"Kangulu²","suffix":""},{"id":482191864,"identity":"8644f62f-b13c-45bb-a26f-6569650a19a8","order_by":4,"name":"Dalau Nkamba Mukadi","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Dalau","middleName":"Nkamba","lastName":"Mukadi","suffix":""}],"badges":[],"createdAt":"2025-06-07 04:53:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6840562/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6840562/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91767780,"identity":"1ea324f9-5508-44d7-97c2-95116d0f7f43","added_by":"auto","created_at":"2025-09-20 13:31:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1170682,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6840562/v1/d866eb5a-5c27-44ed-af89-803ff30ac7c4.pdf"},{"id":86308258,"identity":"9c96cb3d-d263-4744-871e-7f24c42d573a","added_by":"auto","created_at":"2025-07-09 07:39:19","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":24613,"visible":true,"origin":"","legend":"","description":"","filename":"QUESTIONNAIREDECOLLECTEDEDONNEES.docx","url":"https://assets-eu.researchsquare.com/files/rs-6840562/v1/bd9fbfccc9dfd7c7a30af977.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment of the quality of the first prenatal consultation in the health zone of MalembaNkulu, Haut-Lomami, DRC: a descriptive cross-sectional study","fulltext":[{"header":"What is known","content":"\u003cp\u003ePrenatal care plays a crucial role in reducing maternal and neonatal morbidity and mortality. Studies in West Africa have shown that the quality of prenatal care depends largely on provider training and access to essential medical resources.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWhat the article brings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study highlights specific gaps in the quality of CPN1 in Malemba Nkulu, showing that the majority of consultations are carried out by unqualified midwives and that diagnostic examinations are insufficient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWhat remains to be explored\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe impact of enhanced provider training on improving prenatal care requires further analysis. Similarly, evaluating community-based outreach strategies could contribute to better adherence to prenatal recommendations.\u003c/p\u003e"},{"header":"Scientific background and justification of the study","content":"\u003cp\u003eMaternal mortality is a major public health challenge, particularly in low-income countries. According to the World Health Organization (WHO), nearly 99% of maternal deaths occur in settings where access to care is limited[1]. In the Democratic Republic of Congo, the maternal mortality rate remains a concern, with 473 deaths per 100,000 live births, a figure well above international standards[2].\u003c/p\u003e\n\u003cp\u003eAntenatal care is recognized as a key lever for reducing obstetric and neonatal complications. WHO recommends at least eight antenatal visits, the first of which should ideally be carried out before 12 weeks of gestation, to ensure effective monitoring and the implementation of preventive measures[3]. However, in the Democratic Republic of Congo, less than 8% of pregnant women begin their antenatal care in the first trimester, compromising the impact of preventive interventions[4].\u003c/p\u003e\n\u003cp\u003eIn this context, assessing the quality of the first prenatal consultation is of paramount importance. The Malemba Nkulu health zone, located in the Haut-Lomami province, has alarming indicators regarding prenatal monitoring. Preliminary data reveal that\u003c/p\u003e\n\u003cp\u003e- 52.4% of pregnant women have their first consultation in the third trimester, reducing the possibilities for screening and prevention.\u003c/p\u003e\n\u003cp\u003e- 43% of consultations are carried out by traditional midwives without advanced medical training, which results in care that does not comply with recommendations[5].\u003c/p\u003e\n\u003cp\u003e- 61% of the health structures studied do not have the necessary equipment for complete prenatal examinations, including screening for anemia and maternal infections[6].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJustification of the study\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe impact of antenatal care on maternal and newborn health is widely documented. Studies conducted in West Africa have shown that the quality of antenatal care depends mainly on the training of providers, access to medical resources and community awareness[7].\u003c/p\u003e\n\u003cp\u003eIn countries such as Rwanda and Ethiopia, the integration of antenatal care into community health programs has significantly improved the quality of pregnancy monitoring and reduced obstetric complications[8]. Conversely, countries where consultations are late and poorly supervised have a high rate of maternal and neonatal complications[3].\u003c/p\u003e\n\u003cp\u003eThe objective of this study is to assess the quality of the first prenatal consultation in the Malemba Nkulu health zone.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAssessing the quality of antenatal care is essential for understanding maternal health challenges in the Democratic Republic of Congo. This study adopts a descriptive, cross-sectional approach to examine the characteristics and quality of the first antenatal care visit in the Malemba Nkulu health zone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eType of study\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA cross-sectional descriptive study was conducted between November and December 2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePopulation and sampling\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study included 248 pregnant women who had their first antenatal consultation as well as 14 health providers working in eight randomly selected health facilities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection and analysis\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe data were collected using a standardized observation grid, in accordance with national and international recommendations.\u003c/p\u003e\n\u003cp\u003eThree key aspects were analyzed:\u003c/p\u003e\n\u003cp\u003e1. The quality of the reception and the anamnesis\u003c/p\u003e\n\u003cp\u003e2. The relevance of the clinical and biological examinations carried out\u003c/p\u003e\n\u003cp\u003e3. The effectiveness of counseling and guidance for pregnant women\u003c/p\u003e\n\u003cp\u003eThe statistical analysis was carried out using SPSS 25.0 software, with descriptive analyses allowing the frequencies and proportions of the different variables studied to be established.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCriteria for assessing the quality of care\u003c/strong\u003e\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe quality of prenatal consultations was assessed according to ten key criteria, including compliance with screening protocols, administration of essential nutritional supplements (iron and folic acid), and measures to prevent maternal and neonatal complications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFramework of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in the Malemba Nkulu health zone, located in Haut-Lomami province, Democratic Republic of Congo. This predominantly rural area presents major challenges in maternal health, particularly due to limited access to care and a lack of adequate medical infrastructure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy locations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in eight health facilities, randomly selected from among the establishments offering prenatal consultations, which allows for a comprehensive assessment of the services offered to pregnant women.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy period\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted over a two-month period, from November to December 2023, allowing for data collection on prenatal practices and service delivery during this period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecruitment of participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study population consisted of 248 pregnant women who had their first prenatal consultation at one of the eight selected facilities. Recruitment was consecutive, including all women attending for their first consultation during the study period. In addition, 14 prenatal care providers were interviewed to assess their level of training, medical practices, and compliance with national and international standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection and monitoring\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe questionnaire used in this study was specifically developed for this research and is available in English as a supplementary file\u003c/p\u003e\n\u003cp\u003eData were collected using a standardized observation grid, in accordance with the recommendations of the DRC Ministry of Public Health and the World Health Organization. Three key dimensions were assessed:\u003c/p\u003e\n\u003cp\u003e- The quality of the reception and the anamnesis\u003c/p\u003e\n\u003cp\u003e- Clinical and biological examinations carried out\u003c/p\u003e\n\u003cp\u003e- Advice and guidance for pregnant women\u003c/p\u003e\n\u003cp\u003eData were analyzed using SPSS 25.0 software, allowing for rigorous statistical evaluation of frequencies and proportions. No longitudinal follow-up was performed, as the study was exclusively cross-sectional.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEligibility criteria and participant selection methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEligibility criteria\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study included participants and providers according to specific criteria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePregnant women\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Have had their first prenatal consultation in one of the eight selected health facilities\u003c/p\u003e\n\u003cp\u003e- Be pregnant at any stage of pregnancy\u003c/p\u003e\n\u003cp\u003e- Agree to participate in the study after a detailed explanation of the objectives and methods of data collection\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrenatal care providers\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Work in one of the healthcare facilities involved in the study\u003c/p\u003e\n\u003cp\u003e- Be directly involved in the provision of prenatal care\u003c/p\u003e\n\u003cp\u003e- Have at least six months of experience in providing prenatal consultations\u003c/p\u003e\n\u003cp\u003eParticipants and providers who refused to provide informed consent or who did not work directly in antenatal clinics were excluded from the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSources and methods of participant selection\u003c/strong\u003e\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipant selection was conducted using a consecutive procedure. All women presenting for their first prenatal consultation between November and December 2023 in the eight health facilities included were considered.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling method\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Simple random sampling for the selection of health facilities. This made it possible to include establishments of different levels, health centers and General Reference Hospitals.\u003c/p\u003e\n\u003cp\u003e- Consecutive sampling for pregnant women, to ensure representativeness of pregnant women coming for their first prenatal consultation during the study period\u003c/p\u003e\n\u003cp\u003e- Exhaustive selection of prenatal care providers from the selected structures, taking into account all the professionals involved in the management of consultations\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJustification of the methodological choice\u003c/strong\u003e\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe combination of simple random sampling and consecutive selection helps to minimize selection bias and obtain a reliable representation of prenatal practices in the study area.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eDefinition of variables and diagnostic criteria\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEvaluation criteria\u003c/strong\u003e\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study aims to assess the quality of the first prenatal consultation (CPN1) in the Malemba Nkulu health zone, based on indicators that comply with national and international standards. The quality criteria are defined according to the recommendations of the Ministry of Public Health of the DRC and the WHO, and include in particular\u003c/p\u003e\n\u003cp\u003e- Compliance with screening protocols: essential biological tests such as hemoglobin, syphilis and blood group\u003c/p\u003e\n\u003cp\u003e- Administration of nutritional supplements: iron and folic acid essential for the prevention of maternal anemia\u003c/p\u003e\n\u003cp\u003e- Access to preventive measures: tetanus vaccination, antimalarial treatment\u003c/p\u003e\n\u003cp\u003e- Education and awareness of pregnant women: information on prenatal monitoring, nutritional advice and preparation for childbirth\u003c/p\u003e\n\u003cp\u003eA prenatal consultation is considered compliant if it meets at least 80% of the essential recommendations established by the WHO.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExhibitions\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFactors influencing the quality of prenatal consultations include\u003c/p\u003e\n\u003cp\u003e- Qualification of the healthcare provider: doctor, nurse, traditional midwife\u003c/p\u003e\n\u003cp\u003e- Availability of medical equipment and biological tests\u003c/p\u003e\n\u003cp\u003e- Time of the first prenatal consultation (first, second or third trimester)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePredictors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVariables that may influence the results are\u003c/p\u003e\n\u003cp\u003e- Experience and training of the service provider\u003c/p\u003e\n\u003cp\u003e- Type of health facility: health center or general hospital\u003c/p\u003e\n\u003cp\u003e- Sociodemographic characteristics of pregnant women: age, level of education, parity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnostic criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eScreening for maternal complications is based on specific biological tests\u003c/p\u003e\n\u003cp\u003e- Hemoglobin dosage: anemia threshold defined according to WHO recommendations\u003c/p\u003e\n\u003cp\u003e- Syphilis screening test\u003c/p\u003e\n\u003cp\u003e- Urine analysis for the detection of urinary tract infections\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData sources and methods for evaluating variables\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEach variable of interest was assessed using specific data sources and standardized measurement methods to ensure comparability of results.\u003c/p\u003e\n\u003cp\u003e1. Compliance with screening protocols\u003c/p\u003e\n\u003cp\u003e- Data source Review of medical records and observation of prenatal consultations\u003c/p\u003e\n\u003cp\u003e- Assessment method A standardized observation grid made it possible to identify the biological tests carried out, in particular hemoglobin, syphilis, blood group and urine analysis\u003c/p\u003e\n\u003cp\u003e- Comparability All health structures were assessed according to the same screening criteria, ensuring homogeneity in the analysis of the results\u003c/p\u003e\n\u003cp\u003e2. Administration of nutritional supplements\u003c/p\u003e\n\u003cp\u003e- Data source Prescription records and interviews with pregnant women\u003c/p\u003e\n\u003cp\u003e- Evaluation method Verification of the administration of recommended supplements, in particular iron and folic acid, and collection of testimonies from pregnant women\u003c/p\u003e\n\u003cp\u003e- Comparability The assessment methods were similar across all structures, ensuring a reliable comparison of prescribing practices\u003c/p\u003e\n\u003cp\u003e3. Access to preventive measures\u003c/p\u003e\n\u003cp\u003e- Data source Vaccination records and medical prescriptions\u003c/p\u003e\n\u003cp\u003e- Evaluation method Identification of pregnant women who received tetanus vaccination and antimalarial treatments according to established protocols\u003c/p\u003e\n\u003cp\u003e- Comparability Uniformity of vaccination and treatment protocols across the eight health facilities, ensuring consistent comparison of results\u003c/p\u003e\n\u003cp\u003e4. Awareness and education of pregnant women\u003c/p\u003e\n\u003cp\u003e- Data source Direct observation of consultations and questionnaires administered to pregnant women\u003c/p\u003e\n\u003cp\u003e- Evaluation method Evaluation of the information provided on prenatal monitoring, nutrition and preparation for childbirth\u003c/p\u003e\n\u003cp\u003e- Comparability Use of a standardized questionnaire for all pregnant women, allowing a uniform analysis of the quality of prenatal education\u003c/p\u003e\n\u003cp\u003e5. Time of the first prenatal consultation\u003c/p\u003e\n\u003cp\u003e- Data source Register of consultations and interviews with pregnant women\u003c/p\u003e\n\u003cp\u003e- Evaluation method Classification of consultations according to the trimester of pregnancy, first, second or third\u003c/p\u003e\n\u003cp\u003e- Comparability Identical classification criteria for all structures to ensure homogeneous statistical analysis\u003c/p\u003e\n\u003cp\u003e6. Qualification of service providers\u003c/p\u003e\n\u003cp\u003e- Data source Analysis of training records and interviews with healthcare providers\u003c/p\u003e\n\u003cp\u003e- Evaluation method Verification of the level of education and professional experience of the service providers\u003c/p\u003e\n\u003cp\u003e- Comparability:\u003c/p\u003e\n\u003cp\u003eAll establishments followed the same assessment criteria, ensuring a robust comparison of staff qualifications.\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study are available upon reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eApproaches to limiting bias\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this cross-sectional descriptive study, several strategies were implemented to reduce biases that could alter the reliability of the results.\u003c/p\u003e\n\u003cp\u003e1. \u003cstrong\u003eReduction of selection bias\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Sampling method\u003c/p\u003e\n\u003cp\u003e- Stratified random sampling was used for the selection of health facilities, ensuring representativeness of establishments of different levels, primary health centers and General Reference Hospitals.\u003c/p\u003e\n\u003cp\u003e- Consecutive sampling for the 248 pregnant women allowed the inclusion of all pregnant women coming for their first prenatal consultation during the study period, limiting the subjective selection of participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Control of information bias\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-\u0026nbsp;\u003c/strong\u003eUse of a standardized observation grid\u003c/p\u003e\n\u003cp\u003e- This grid has been validated according to national and international recommendations in order to guarantee a homogeneous evaluation of prenatal consultations.\u003c/p\u003e\n\u003cp\u003e- All data were collected directly from medical records and field observations, avoiding errors due to imprecise testimonies\u003c/p\u003e\n\u003cp\u003e- Training of investigators\u003c/p\u003e\n\u003cp\u003e- Observers and investigators received extensive training to ensure uniform data collection and avoid subjectivity in the assessment of prenatal practices\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Comparability of evaluation methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e- Uniform application of quality criteria\u003c/p\u003e\n\u003cp\u003e- The consultations were analyzed following a single protocol in the eight health structures, guaranteeing a consistent and reproducible evaluation of prenatal practices.\u003c/p\u003e\n\u003cp\u003e- The same indicators were used to compare the establishments, avoiding any methodological disparity\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDetermining sample size\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe sample size was defined taking into account methodological constraints in order to ensure optimal representativeness of the results.\u003c/p\u003e\n\u003cp\u003e1. Methodological justification\u003c/p\u003e\n\u003cp\u003eThe study being descriptive and cross-sectional, the objective was to obtain a representative snapshot of the quality of prenatal consultations in the Malemba Nkulu health zone, while respecting the criteria of statistical and scientific rigor. The determination of the sample was based on the following elements\u003c/p\u003e\n\u003cp\u003e- Total number of prenatal consultations carried out in the targeted health facilities during the study period.\u003c/p\u003e\n\u003cp\u003e- Ability of healthcare establishments to provide reliable and usable data\u003c/p\u003e\n\u003cp\u003e- Data saturation criteria, ensuring that the sample includes sufficient observations to detect trends and gaps in prenatal care\u003c/p\u003e\n\u003cp\u003e2. Calculation and selection of the sample\u003c/p\u003e\n\u003cp\u003eThe sample size was obtained using proven statistical methods, taking into account\u003c/p\u003e\n\u003cp\u003e- Estimated prevalence of standard-compliant prenatal consultations, based on preliminary data and previous studies\u003c/p\u003e\n\u003cp\u003e- The application of calculation formulas adapted to observational studies, guaranteeing statistical representativeness without requiring longitudinal monitoring\u003c/p\u003e\n\u003cp\u003eOn this basis, 248 pregnant women who had their first prenatal consultation were included in the study, representing a sufficient sample for a reliable and generalizable analysis of prenatal practices in the study area.\u003c/p\u003e\n\u003cp\u003e3. Consideration of healthcare providers\u003c/p\u003e\n\u003cp\u003eAdditionally, 14 prenatal care providers were surveyed to assess their level of training, medical practices, and compliance with national and international standards. This number was determined based on\u003c/p\u003e\n\u003cp\u003e- The availability of staff in the eight selected health structures\u003c/p\u003e\n\u003cp\u003e- The need for a representative sample of the diversity of qualifications of providers\u003c/p\u003e\n\u003cp\u003e4. Comparability and reliability of the sample\u003c/p\u003e\n\u003cp\u003eThe sample selected allows\u003c/p\u003e\n\u003cp\u003e- A statistical analysis\u003c/p\u003e\n\u003cp\u003e- Comparability, ensuring that results can be extrapolated to other similar contexts\u003c/p\u003e\n\u003cp\u003e- A reduction in selection bias, thanks to methodical and structured sampling\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment of quantitative variables in the analysis\u003c/strong\u003e\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1. Methods of processing quantitative variables\u003c/p\u003e\n\u003cp\u003e- Descriptive analysis\u003c/p\u003e\n\u003cp\u003e- Frequencies and proportions were calculated for the main categorical variables, such as compliance with screening protocols, administration of nutritional supplements and access to preventive measures.\u003c/p\u003e\n\u003cp\u003e- Means and standard deviations were used for continuous variables, such as the age of pregnant women and the duration of prenatal consultations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eManaging missing data\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1. Identification of missing data\u003c/p\u003e\n\u003cp\u003eThe data was collected from\u003c/p\u003e\n\u003cp\u003e- Medical records of pregnant women\u003c/p\u003e\n\u003cp\u003e- Standardized observation grids used during prenatal consultations\u003c/p\u003e\n\u003cp\u003e- Questionnaires administered to providers and pregnant women\u003c/p\u003e\n\u003cp\u003eA systematic check was carried out to detect missing values, particularly in biological screening registers, nutritional supplement prescriptions and consultation times.\u003c/p\u003e\n\u003cp\u003e2. Approach to managing missing data\u003c/p\u003e\n\u003cp\u003e- Analysis of the mechanism of missing data\u003c/p\u003e\n\u003cp\u003e- Missing data has been classified according to its nature\u003c/p\u003e\n\u003cp\u003e- Completely random missing data, unrelated to the study variables\u003c/p\u003e\n\u003cp\u003e- Randomly missing data, influenced by certain characteristics of pregnant women\u003c/p\u003e\n\u003cp\u003e- Non-random data, systematically absent due to structural limitations of health establishments\u003c/p\u003e\n\u003cp\u003e- Methods used for processing\u003c/p\u003e\n\u003cp\u003e- Removed entries with excessive missing data when these made the analysis inaccurate\u003c/p\u003e\n\u003cp\u003e- Multiple imputation to replace missing values, using predictive models based on available data\u003c/p\u003e\n\u003cp\u003e- Weighted average method for quantitative variables to minimize the impact of missing values on descriptive statistics\u003c/p\u003e\n\u003cp\u003e- Sensitivity analysis to measure the potential effect of missing data on the final results\u003c/p\u003e\n\u003cp\u003e3. Impact on the robustness of the results\u003c/p\u003e\n\u003cp\u003e- Comparability of data was ensured by harmonizing evaluation methods between health institutions\u003c/p\u003e\n\u003cp\u003e- Reduction of biases related to missing data, ensuring that conclusions remain valid and generalizable\u003c/p\u003e\n\u003cp\u003eSensitivity analysis focused on the impact of missing data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNumber of participants at each stage of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. Potentially Eligible Participants\u003c/p\u003e\n\u003cp\u003eA total of 267 pregnant women presented for a first prenatal consultation in the eight selected health facilities during the study period.\u003c/p\u003e\n\u003cp\u003e2. Review of eligibility criteria\u003c/p\u003e\n\u003cp\u003eAmong the 267 women identified, 19 were excluded for the following reasons:\u003c/p\u003e\n\u003cp\u003e- Prenatal consultation already carried out in another structure\u003c/p\u003e\n\u003cp\u003e- Refusal to participate after explanation of the objectives of the study\u003c/p\u003e\n\u003cp\u003e3. Confirmation of eligibility and inclusion in the study\u003c/p\u003e\n\u003cp\u003eFinally, 248 pregnant women were selected, meeting all the eligibility conditions and agreeing to participate in the study.\u003c/p\u003e\n\u003cp\u003e4. Inclusion of healthcare providers\u003c/p\u003e\n\u003cp\u003eIn addition, 14 prenatal care providers were interviewed, distributed as follows:\u003c/p\u003e\n\u003cp\u003e- qualified nurses\u003c/p\u003e\n\u003cp\u003e- Matrons\u003c/p\u003e\n\u003cp\u003e5. Monitoring and data collection\u003c/p\u003e\n\u003cp\u003eData were collected comprehensively during prenatal consultations, ensuring a complete assessment of medical practices and quality of care.\u003c/p\u003e\n\u003cp\u003e6. Number of participants analyzed\u003c/p\u003e\n\u003cp\u003eAll 248 pregnant women and 14 healthcare providers were included in the final analysis, allowing statistical interpretation of the results.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eReasons for non-participation at each stage of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt each stage of the process, some pregnant women could not be included for various reasons.\u003c/p\u003e\n\u003cp\u003e1. Non-participation in the identification of eligible pregnant women\u003c/p\u003e\n\u003cp\u003eOf the 267 pregnant women initially identified in the eight health facilities, 19 were excluded after reviewing the eligibility criteria.\u003c/p\u003e\n\u003cp\u003e2. Grounds for exclusion when examining eligibility criteria\u003c/p\u003e\n\u003cp\u003eThe 19 women not included in the study were excluded for the following reasons:\u003c/p\u003e\n\u003cp\u003e- Prenatal consultation already carried out in another structure, not corresponding to the inclusion criterion requiring that the first consultation be carried out in the selected establishments\u003c/p\u003e\n\u003cp\u003e- Refusal to participate after explanation of the objectives and methods of the study\u003c/p\u003e\n\u003cp\u003e3. Non-inclusion of healthcare providers\u003c/p\u003e\n\u003cp\u003eAll healthcare providers working in the eight health facilities were contacted, but some could not be included in the study due to\u003c/p\u003e\n\u003cp\u003e- Professional unavailability, in particular of agents on leave or assigned to other services\u003c/p\u003e\n\u003cp\u003e- Refusal to participate, some providers having declined their inclusion after presentation of the study protocol\u003c/p\u003e\n\u003cp\u003e4. Lack of follow-up or subsequent exclusion\u003c/p\u003e\n\u003cp\u003eAs the study was cross-sectional, no longitudinal follow-up was required. Thus, all 248 pregnant women included were analyzed, with no dropouts during data collection.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe evaluation of the 248 antenatal consultations revealed that only 2% met the quality standards defined by national and international guidelines.\u003c/p\u003e\n\u003cp\u003eTable 1: Distribution of pregnant women according to the quality of the first prenatal consultation received\u003c/p\u003e\n\u003cp\u003eThis table shows the distribution of pregnant women according to the quality of the first prenatal consultation (CPN1), according to the criteria defined by national and international standards. It shows the percentage of consultations that meet quality standards and highlights gaps in care.\u003c/p\u003e\n\u003cp\u003eAvailability of medical resources and equipment\u003c/p\u003e\n\u003cp\u003eThe study found that 61% of health facilities lacked the necessary equipment to perform a comprehensive prenatal checkup. Essential laboratory tests such as syphilis screening and anemia assessment were systematically absent in 45% of cases.\u003c/p\u003e\n\u003cp\u003eTable 2: Assessment of the quality of prenatal consultation according to laboratory tests\u003c/p\u003e\n\u003cp\u003eThis table illustrates the availability and performance of essential laboratory tests at the first antenatal visit. It highlights gaps in screening, including the absence of hemoglobin tests, blood typing, and syphilis screening.\u003c/p\u003e\n\u003cp\u003eA significant proportion of consultations did not include all of the recommended examinations or adequate advice on pregnancy management.\u003c/p\u003e\n\u003cp\u003eThe analysis highlighted several constraints affecting the quality of ANC1. Among the limiting factors, 43% of consultations were conducted by midwives without advanced medical training. Furthermore, 52.4% of women had their first ANC in the third trimester, which significantly reduces the impact of preventive measures.\u003c/p\u003e\n\u003cp\u003eTable 3: Distribution of prenatal care providers according to their sociodemographic characteristics\u003c/p\u003e\n\u003cp\u003eThis table describes the characteristics of the prenatal care providers who performed the consultations. It highlights their education level, average age, and gender distribution, with a majority of providers without advanced medical training.\u003c/p\u003e\n\u003cp\u003eAnalysis of interactions between providers and pregnant women showed that only 37% of consultations included in-depth education on nutrition, danger signs, and childbirth preparation. The average consultation duration was less than 15 minutes in 68% of cases, limiting the quality of support.\u003c/p\u003e\n\u003cp\u003eTable 4: Assessment of the quality of prenatal consultation on the judgment of pregnant women\u003c/p\u003e\n\u003cp\u003eThis table summarizes pregnant women\u0026apos;s opinions on various aspects of the first prenatal visit, including cost, distance, reception by health workers, and waiting time. It provides insight into pregnant women\u0026apos;s perceptions of the quality of care received.\u003c/p\u003e\n\u003cp\u003eLess than 50% of women received necessary nutritional supplements, such as iron and folic acid. Vaccination coverage and the administration of antimalarial drugs\u003c/p\u003e\n\u003cp\u003ewere also limited, compromising the prevention of maternal and neonatal complications.\u003c/p\u003e\n\u003cp\u003eThis table illustrates the availability and performance of essential laboratory tests at the first antenatal visit. It highlights gaps in screening, including the absence of hemoglobin tests, blood typing, and syphilis screening.\u003c/p\u003e\n\u003cp\u003eTable 5: Assessment of the quality of prenatal consultation on maintaining a healthy pregnancy\u003c/p\u003e\n\u003cp\u003eThis table details the elements covered during the prenatal consultation related to maternal and newborn health. It analyzes nutrition awareness, the importance of prenatal monitoring, the prescription of nutritional supplements and vaccines, as well as information on pregnancy management.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePractical implications of the results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study highlights several challenges related to the quality of antenatal consultations in the Malemba Nkulu Health Zone. These findings underscore the need for concrete interventions to improve the effectiveness of maternal care and reduce maternal and neonatal mortality.\u003c/p\u003e\n\u003cp\u003eCapacity building for service providers\u003c/p\u003e\n\u003cp\u003e- Organize continuing education for prenatal care providers, with an emphasis on diagnostic examinations and management protocols.\u003c/p\u003e\n\u003cp\u003e- Establish a skills assessment system, ensuring compliance with WHO recommendations.\u003c/p\u003e\n\u003cp\u003eImproving access to prenatal care\u003c/p\u003e\n\u003cp\u003e- Develop community programs to raise awareness among pregnant women about the importance of early monitoring.\u003c/p\u003e\n\u003cp\u003e- Reduce financial barriers by subsidizing essential medical consultations and examinations.\u003c/p\u003e\n\u003cp\u003eStrengthening medical infrastructure\u003c/p\u003e\n\u003cp\u003e- Ensure the availability of medical equipment in health facilities.\u003c/p\u003e\n\u003cp\u003e- Implement a policy for the distribution of essential medicines for the prevention and management of maternal complications.\u003c/p\u003e\n\u003cp\u003eMonitoring and evaluation of interventions\u003c/p\u003e\n\u003cp\u003e- Integrate a monitoring system to measure the impact of improvements on prenatal consultations.\u003c/p\u003e\n\u003cp\u003e- Encourage further studies to refine strategies and adjust maternal health policies.\u003c/p\u003e\n\u003cp\u003eThese measures would contribute to a lasting improvement in the care of pregnant women and a significant reduction in maternal morbidity and mortality.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAnalysis of results and implications for maternal health\u003c/p\u003e\n\u003cp\u003eAnalysis of the results highlights the insufficient quality of first prenatal consultations in the Malemba Nkulu Health Zone. With only 2% of consultations meeting quality standards, several challenges emerge, including provider training, limited access to diagnostic tests and the low rate of adherence of pregnant women to prenatal recommendations [3,9].\u003c/p\u003e\n\u003cp\u003eComparison with other studies\u003c/p\u003e\n\u003cp\u003eThe results obtained in this study are consistent with those reported in other research in sub-Saharan Africa. For example\u003c/p\u003e\n\u003cp\u003e- A study conducted in Nigeria showed that more than 60% of antenatal consultations were carried out by unqualified personnel, leading to insufficient follow-up [10].\u003c/p\u003e\n\u003cp\u003e- Research in Ghana has shown a direct link between the quality of antenatal consultations and obstetric complication rates [11].\u003c/p\u003e\n\u003cp\u003e- In Rwanda and Ethiopia, the quality of antenatal care has improved considerably thanks to policies targeting continuous training of providers and integration of antenatal services into community care [12,13].\u003c/p\u003e\n\u003cp\u003eThese successes suggest that adapted strategies could be implemented in the Democratic Republic of Congo to improve the effectiveness of prenatal consultations and reduce maternal morbidity [14].\u003c/p\u003e\n\u003cp\u003eFactors influencing the quality of care\u003c/p\u003e\n\u003cp\u003eAmong the main causes of the insufficient quality of prenatal consultations in the health zone studied, several elements stand out:\u003c/p\u003e\n\u003cp\u003e- Training of providers 43% of consultations were carried out by midwives without advanced medical training, which limits the application of standardized protocols [15].\u003c/p\u003e\n\u003cp\u003e- Late access to care 52.4% of women had their first prenatal consultation in the third trimester, thus reducing the impact of preventive interventions [16].\u003c/p\u003e\n\u003cp\u003e- Lack of medical equipment 61% of health facilities do not have the necessary tools to carry out a complete prenatal assessment, compromising the quality of monitoring [17].\u003c/p\u003e\n\u003cp\u003e- Cost of services The high cost of consultations and additional examinations is a barrier to pregnant women\u0026apos;s adherence to medical recommendations [14].\u003c/p\u003e\n\u003cp\u003eImplications for health policy\u003c/p\u003e\n\u003cp\u003eThese results highlight the urgency of implementing strategies to strengthen the quality of prenatal care. Among the possible measures, several recommendations can be made.\u003c/p\u003e\n\u003cp\u003e- Strengthening the training of providers, particularly through practical workshops and certifications in prenatal monitoring [12,13].\u003c/p\u003e\n\u003cp\u003e- Subsidy of prenatal services to improve accessibility to care [10,11].\u003c/p\u003e\n\u003cp\u003e- Community awareness to encourage pregnant women to consult from the first trimester [15].\u003c/p\u003e\n\u003cp\u003e- Integration of prenatal care into maternal health programs to ensure comprehensive and effective monitoring [16,17].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations of the study and potential sources of bias\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study has several methodological limitations that must be taken into account.\u003c/p\u003e\n\u003cp\u003e1. Selection bias\u003c/p\u003e\n\u003cp\u003eThe sample studied is based on pregnant women who consulted in the eight selected health structures, which may introduce a representativeness bias.\u003c/p\u003e\n\u003cp\u003e- Direction of bias The study could overestimate or underestimate the quality of prenatal care depending on the specific characteristics of the institutions selected\u003c/p\u003e\n\u003cp\u003e- Magnitude of selection bias is low since there was no stratification that could have favored certain subgroups. This means that the results are generally representative of the study population, although random variations may remain.\u003c/p\u003e\n\u003cp\u003e2. Information bias\u003c/p\u003e\n\u003cp\u003eSome variables, including the pregnant women\u0026apos;s medical history and provider protocols, are based on medical records and self-reports from pregnant women.\u003c/p\u003e\n\u003cp\u003e- Direction of bias There is a risk of overestimating compliance with care, as some information may be incomplete or influenced by recall bias\u003c/p\u003e\n\u003cp\u003e- Magnitude of bias Moderate, because the data were collected by direct observation and validation of medical records, reducing potential errors\u003c/p\u003e\n\u003cp\u003e3. Lack of longitudinal monitoring\u003c/p\u003e\n\u003cp\u003eAs the study is cross-sectional, it does not assess the impact of prenatal consultations on obstetric outcomes.\u003c/p\u003e\n\u003cp\u003e- Direction of bias Possibility of underestimating the long-term effects of a poor quality first consultation\u003c/p\u003e\n\u003cp\u003e- Magnitude of bias Significant, because a cohort study would allow a better understanding of the consequences of the observed prenatal practices\u003c/p\u003e\n\u003cp\u003e4. Missing data and statistical treatment\u003c/p\u003e\n\u003cp\u003eAlthough imputation methods were used, some missing data regarding laboratory tests and provider training could affect the accuracy of the results.\u003c/p\u003e\n\u003cp\u003e- Direction of bias Potential overestimation or underestimation of the quality of services based on missing data\u003c/p\u003e\n\u003cp\u003e- Magnitude of bias Low to moderate, sensitivity analyses having confirmed the robustness of the results\u003c/p\u003e\n\u003cp\u003eDespite these limitations, this study provides a vital assessment of the quality of prenatal consultations and highlights priority areas for improvement. However, further research, particularly longitudinal, would be needed to refine the analysis and strengthen the generalizability of the results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeneralizability of the study results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. Representativeness of the sample\u003c/p\u003e\n\u003cp\u003eThe study sample was selected by simple random sampling, ensuring an equal probability of inclusion for each patient. This methodological choice strengthens external validity, as it limits selection bias and improves the ability to generalize the results to all pregnant women attending health facilities in the Malemba Nkulu Health Zone.\u003c/p\u003e\n\u003cp\u003eHowever, some constraints may affect generalizability.\u003c/p\u003e\n\u003cp\u003e- Sample size although statistically sufficient for analysis, it might not capture all the nuances present in the entire target population\u003c/p\u003e\n\u003cp\u003e- Exclusion of women who did not attend the health facilities studied, which limits the applicability of the results to pregnant women who do not have access to prenatal care\u003c/p\u003e\n\u003cp\u003e2. Comparability with other prenatal care settings\u003c/p\u003e\n\u003cp\u003eThe results obtained are consistent with similar studies conducted in sub-Saharan Africa, notably in Nigeria, Ghana, Rwanda and Ethiopia, where comparable problems have been observed in terms of access to prenatal care and training of providers.\u003c/p\u003e\n\u003cp\u003eHowever, specific local factors may limit the generalizability of the results.\u003c/p\u003e\n\u003cp\u003e- Structural differences in the organization of care: some countries have implemented targeted reforms, significantly improving access to prenatal care\u003c/p\u003e\n\u003cp\u003e- Variability of prenatal monitoring protocols national recommendations can influence the application of quality standards\u003c/p\u003e\n\u003cp\u003e3. Applicability of the conclusions to other areas in the DRC\u003c/p\u003e\n\u003cp\u003eThe issues identified in this study are broadly representative of the challenges encountered in several health zones in the DRC, notably\u003c/p\u003e\n\u003cp\u003e- The limits of training providers in environments where traditional midwives play a dominant role\u003c/p\u003e\n\u003cp\u003e- Financial and geographical barriers that restrict access to early prenatal consultations\u003c/p\u003e\n\u003cp\u003eHowever, local adaptations would be necessary to replicate these findings in urban contexts, where medical infrastructure is more developed and pregnant women have better access to specialized care.\u003c/p\u003e\n\u003cp\u003eThe external validity of this study is moderately high, as simple random sampling enhances the representativeness of the results. However, certain contextual specificities must be taken into account before extrapolating these findings to other regions of the DRC or to other African countries.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights the inadequate quality of first prenatal consultations (CPN1) in the Malemba Nkulu Health Zone. Only 2% of consultations met established standards, revealing gaps in provider training, access to diagnostic tests, and awareness among pregnant women.\u003c/p\u003e\n\u003cp\u003eAmong the challenges identified, 43% of consultations were conducted by midwives without advanced medical qualifications, compromising the quality of follow-up. Furthermore, 52.4% of women had their first ANC in the third trimester, limiting the impact of preventive measures.\u003c/p\u003e\n\u003cp\u003eTo improve the quality of prenatal care, several recommendations can be made:\u003c/p\u003e\n\u003cp\u003e- Strengthening the training of service providers through practical sessions and adapted certifications.\u003c/p\u003e\n\u003cp\u003e- Subsidy for prenatal services to ensure better access to care.\u003c/p\u003e\n\u003cp\u003e- Community awareness to encourage early consultations.\u003c/p\u003e\n\u003cp\u003e- Integration of prenatal care into maternal health programs.\u003c/p\u003e\n\u003cp\u003eThese measures could contribute to a significant reduction in maternal morbidity and mortality. Further research is needed to evaluate the impact of the proposed interventions and ensure effective management.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study complies with the ethical principles set forth in the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of the School of Public Health, University of Kinshasa (Approval No. ESP/CE/194/2023), and written informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors approve the publication of this manuscript and confirm that the data presented are accurate and adhere to ethical principles. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used in this study are available upon request from the corresponding authors. Anonymized information can be provided subject to ethics committee approval. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests related to this study. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive external funding. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFiston Ilunga Mbayo (FIM) conceived the study, supervised data analysis, and wrote the manuscript. Pascal Geri Madragule (PGM) and Pacifique Kanku wa Ilunga (PKI) contributed to data collection and interpretation of results. Ignace Bwana Kangulu (IBK) reviewed the scientific content and provided methodological corrections. Dalau Nkamba Mukadi (DNM) coordinated the study and provided strategic guidance. All authors (FIM, PGM, PKI, IBK, DNM) read and approved the final version of the manuscript. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the medical teams of the Malemba Nkulu healthcare facilities for their collaboration and support in data collection. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e- Fiston Ilunga Mbayo(FIM): Specialist in public health, Medical Director of Malemba Nkulu General Referral Hospital, affiliated with the School of Public Health, University of Kinshasa, Democratic Republic of Congo. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Pascal Geri Madragule(PGM): Specialist in public health, Head of Health Information Office at the Provincial Health Division of Haut-Lomami, affiliated with the University of Kamina, Haut-Lomami, Democratic Republic of Congo. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Pacifique Kanku wa Ilunga(PKI): Specialist in public health, Head of the Provincial Expanded Program on Immunization, affiliated with the University of Kamina, Haut-Lomami, Democratic Republic of Congo. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Ignace Bwana Kangulu(IBK): Obstetrician-gynecologist, University Professor, affiliated with the University of Kamina, Haut-Lomami, Democratic Republic of Congo. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Dalau Nkamba Mukadi(DNM): Specialist in public health, University Professor, affiliated with the School of Public Health, University of Kinshasa, Democratic Republic of Congo. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors (FIM, PGM, PKI, IBK, DNM) read and approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSay L, Chou D, Gemmill A, Tun\u0026ccedil;alp \u0026Ouml;, Moller AB, et al. Global causes of maternal death: a WHO systematic analysis. The Lancet Global Health. 2014; 2(6):e323-e333.\u003c/li\u003e\n\u003cli\u003eMinistry of Public Health, DRC. Annual Report on Maternal and Child Health. Kinshasa: MSP; 2022.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva WHO; 2016.\u003c/li\u003e\n\u003cli\u003eTuncalp \u0026Ouml;, Pena-Rosas JP, Lawrie T, Bucagu M, Oladapo OT, et al. WHO recommendations on antenatal care for a positive pregnancy experience. The Lancet. 2017; 390(10094):294-305.\u003c/li\u003e\n\u003cli\u003eGage AJ, Guirl\u0026egrave;ne Calixte M. Effects of the quality of prenatal care on neonatal mortality in Haiti. Population Health Metrics. 2006; 4(1):1-10.\u003c/li\u003e\n\u003cli\u003eCiss\u0026eacute; CT, Faye PM, Ba M, Diouf A, Sylla A. Quality of antenatal care in West Africa: challenges and perspectives. African Journal of Public Health. 2018; 12(2):135-142.\u003c/li\u003e\n\u003cli\u003eBhutta ZA, Das JK, Bahl R, Lawn JE, Salam RA, et al. Can interventions be available to end preventable deaths in mothers, newborn babies, and stillbirths? The Lancet. 2014; 384(9940):347-370.\u003c/li\u003e\n\u003cli\u003eMcDonagh M. Is antenatal care effective in reducing maternal morbidity and mortality? Health Policy and Planning. 1996; 11(1): \u003cstrong\u003e1-15.\u003c/strong\u003e\u003c/li\u003e\n\u003cli\u003eMinistry of Public Health, DRC. National Guide to Prenatal Care. Kinshasa MSP; 2019.\u003c/li\u003e\n\u003cli\u003eAdepoju OE, Oluwaseun A. Assessment of antenatal care services in Nigeria a cross-sectional study. BMC Pregnancy Childbirth. 2021;21(1)442.\u003c/li\u003e\n\u003cli\u003eNyarko SH. Prevalence and correlates of inadequate antenatal care in Ghana. BMC Public Health. 2020;20(1)446.\u003c/li\u003e\n\u003cli\u003eNsereko E, Tuyisenge G. Strengthening community-based antenatal care in Rwanda lessons from implementation research. Global Health Action. 2019;12(1)1675938.\u003c/li\u003e\n\u003cli\u003eTefera B, Alemayehu M. Impact of health system strengthening initiatives on antenatal care uptake in Ethiopia a population-based study. PLoS One. 2022;17(3)e0265281.\u003c/li\u003e\n\u003cli\u003eKayembe P, Mambu T. Accessibility to maternal health services in the Democratic Republic of Congo a policy review. Afr J Reprod Health. 2019;23(4)45-56.\u003c/li\u003e\n\u003cli\u003eBaleke B, Kabanza P. Quality of prenatal consultations in the DRC challenges and opportunities. Pan Afr Med J. 2021;38(1)213.\u003c/li\u003e\n\u003cli\u003eMpunga D, Muwawa D. Barriers to early antenatal care visits in urban and rural settings of DR Congo findings from a mixed-method study. BMC Health Serv Res. 2020;20(1)345.\u003c/li\u003e\n\u003cli\u003eLukanu M, Mubiala T. Maternal health system improvement in Sub-Saharan Africa a systematic review of interventions. Int J Health Policy Manag. 2021;10(6)367-375.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1: Distribution of pregnant women according to the quality of the first prenatal consultation received:\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"546\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 273px;\"\u003e\n \u003cp\u003eQuality of CPN1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e% Stati 95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 136px;\"\u003e\n \u003cp\u003eGood quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e2 [1.86; 2.16]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThis table shows the distribution of pregnant women according to the quality of the first prenatal consultation (CPN1), according to the criteria defined by national and international standards. It shows the percentage of consultations that meet quality standards and highlights gaps in care.\u003c/p\u003e\n\u003cp\u003eTable 2: Evaluation of the Quality of Prenatal Consultation according to laboratory examinations from November to December 2023 in the Malemba Nkuluable Health Zone.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"615\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 354px;\"\u003e\n \u003cp\u003eLaboratory tests\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003en=248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 226px;\"\u003e\n \u003cp\u003eHemoglobin test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e86.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 226px;\"\u003e\n \u003cp\u003eBlood typing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e96.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 226px;\"\u003e\n \u003cp\u003eurine test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e87.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e12.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 226px;\"\u003e\n \u003cp\u003eSyphilis test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThis table shows the distribution of pregnant women according to the quality of the first prenatal consultation (CPN1), according to the criteria defined by national and international standards. It shows the percentage of consultations that meet quality standards and highlights gaps in care.\u003c/p\u003e\n\u003cp\u003eTable 3 Distribution of CPN providers according to sociodemographic characteristics from November to December 2023 in the Malemba Nkulu Health Zone.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"586\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 359px;\"\u003e\n \u003cp\u003eFeatures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003en=14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eAge (Mean and SD):\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003e49.3\u0026nbsp;\u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e6 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 189px;\"\u003e\n \u003cp\u003eEducational level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eNurse A2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e57.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e42.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThis table describes the characteristics of the prenatal care providers who performed the consultations. It highlights their education level, average age, and gender distribution, with a majority of providers without advanced medical training.\u003c/p\u003e\n\u003cp\u003eTable 4 Evaluation of the Quality of Prenatal Consultation on the Judgment of Pregnant Women from November to December 2023 in the Malemba Nkulu Health Zone\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"607\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 438px;\"\u003e\n \u003cp\u003eJudgement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003en=248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 288px;\"\u003e\n \u003cp\u003eCost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eAffordable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e40.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003ePupil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e8.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eHigher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 288px;\"\u003e\n \u003cp\u003eDistance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eShort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e23.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eLong\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e26.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e35.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eToo short\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e9.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eToo long\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 288px;\"\u003e\n \u003cp\u003eWelcoming health workers during CPN1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eNot satisfactory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e16.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eSatisfying\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e63.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eVery satisfactory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e20.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 288px;\"\u003e\n \u003cp\u003eWaiting times for prenatal consultations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eLong\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e55.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eNot long\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e39.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eToo long\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThis table summarizes pregnant women\u0026apos;s opinions on various aspects of the first prenatal visit, including cost, distance, reception by health workers, and waiting time. It provides insight into pregnant women\u0026apos;s perceptions of the quality of care received.\u003c/p\u003e\n\u003cp\u003eTable 5 Evaluation of the Quality of Prenatal Consultation on Maintaining a Healthy Pregnancy from November to December 2023 in the Malemba Nkulu Health Zone.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"597\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 383px;\"\u003e\n \u003cp\u003eMaintaining a Healthy Pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003en=248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 276px;\"\u003e\n \u003cp\u003eNutrition Discussion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e37.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e62.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 276px;\"\u003e\n \u003cp\u003eInformation on the progress of the pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e38.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e61.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 276px;\"\u003e\n \u003cp\u003eDiscussion of the importance of at least 4 prenatal visits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e37.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e62.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 276px;\"\u003e\n \u003cp\u003ePrescription of iron tablets\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e14.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e212\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e85.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 276px;\"\u003e\n \u003cp\u003eThe purpose explanation of iron\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e87.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 276px;\"\u003e\n \u003cp\u003eThe explanation of how to take iron\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e16.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e83.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 276px;\"\u003e\n \u003cp\u003ePrescription or injection of tetanus vaccines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e86.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 276px;\"\u003e\n \u003cp\u003eExplanation of the purpose of the tetanus vaccine injection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e27.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e70.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThis table details the elements covered during the prenatal consultation related to maternal and newborn health. It analyzes nutrition awareness, the importance of prenatal monitoring, the prescription of nutritional supplements and vaccines, as well as information on pregnancy management.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Quality, antenatal consultation, maternal health, cross-sectional descriptive study, Democratic Republic of Congo","lastPublishedDoi":"10.21203/rs.3.rs-6840562/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6840562/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMaternal mortality remains a major public health challenge in the Democratic Republic of Congo, with 473 deaths per 100,000 live births. Antenatal care plays a crucial role in reducing maternal and neonatal complications. This cross-sectional descriptive study aims to assess the quality of the first antenatal consultation in the Malemba Nkulu Health Zone.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA cross-sectional descriptive study was conducted in eight healthcare facilities, involving 248 pregnant women and 14 care providers. The quality of the first antenatal consultation was assessed using an observation grid based on national and international standards.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOnly 2% of antenatal consultations meet quality standards. 43% of consultations were conducted by traditional birth attendants without advanced medical training. Additionally, 52.4% of women had their first antenatal consultation in the third trimester, limiting access to preventive interventions.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study highlights the insufficient quality of antenatal care in Malemba Nkulu. Strengthening healthcare provider training, improving access to diagnostic tests, and raising awareness among pregnant women about early prenatal follow-up are essential to improving maternal health outcomes.\u003c/p\u003e","manuscriptTitle":"Assessment of the quality of the first prenatal consultation in the health zone of MalembaNkulu, Haut-Lomami, DRC: a descriptive cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-09 07:39:14","doi":"10.21203/rs.3.rs-6840562/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2b894462-5880-410c-935f-94b44bae5263","owner":[],"postedDate":"July 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-20T13:23:30+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-09 07:39:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6840562","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6840562","identity":"rs-6840562","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}