Introduction: The nursing approach (NA) is the essence of the nursing profession. However, its implementation is almost absent in the hospitals of the Democratic Republic of Congo (DRC). Objectives: The aim of this study was to determine nurses' knowledge, attitudes and practices in relation to the nursing approach and to identify barriers to the implementation of this approach. Methods: To achieve these objectives, we carried out a cross-sectional descriptive study among the nurses of the 11 public hospitals of Lubumbashi, from June to September 2015. Thanks to a validated questionnaire, we collected the data by interview, supported by participatory observation. Results: The results showed that 67.6% of respondents were trained on NA; However, 99.3% did not know the exact number of NA steps and 62.6% did not cite any steps; The majority (93.5%) of trainees on NA find that this process provides quality patient care; 100% of the sample wish to put it into practice; 100% of the sample need continuous training on NA including 67.6% to improve knowledge and 32.4% to learn; 89.1% of those trained reported not practicing NA, but participating direct observation gave 100% of non-practice. The barriers to implementation of the NA were inadequate nursing staff (75.6%), inadequate equipment (71.5%), lack of time (62.6%), lack of theoretical and practical knowledge (47.2%), lack of nursing records (26%) and lack of institution for nursing care within the hospital (17%). Conclusion: Therefore, capacity building of nurses through continuing education, as well as initial training on NA, would increase their knowledge, reinforce positive attitude and promote its implementation, all supported by improved working condi-

Background The aim of this study was to explore and measure the social and economic consequences of the costs of obstetric and neonatal care in Lubumbashi, the Democratic Republic of Congo. Methods We conducted a mixed qualitative and quantitative study in the maternity departments of health facilities in Lubumbashi. The qualitative results were based on a case study conducted in 2018 that included 14 respondents (8 mothers of newborns, 2 accompanying family members and 4 health care providers). A quantitative cross-sectional analytical study was carried out in 2019 with 411 women who gave birth at 10 referral hospitals. Data were collected for one month at each hospital, and selected mothers of newborns were included in the study only if they paid out-of-pocket and at the point of care for costs related to obstetric and neonatal care. Results Costs for obstetric and neonatal care averaged US $77, US $207 and US $338 for simple, complicated vaginal and caesarean deliveries, respectively. These health expenditures were greater than or equal to 40% of the ability to pay for 58.4% of households. At the time of delivery, 14.1% of women giving birth did not have enough money to pay for care. Of those who did, 76.5% spent their savings. When households did not pay for care, mothers and their babies were held for a long time at the place of care. This resulted in the prolonged absence of the mother from the household, reduced household income, family conflicts, and the abandonment of the home by the spouse. At the health facility level, the increase in length of stay did not generate any additional financial benefits. Mothers no longer had confidence in nurses; they were sometimes separated from their babies, and they could not access certain prescribed medications or treatments. Conclusion The government of the DRC should implement a mechanism for subsidizing care and associate it with a cost-sharing system. This would place the country on the path to achieving universal health coverage in improving the physical, mental and social health of mothers, their babies and their households.

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Introduction:The continuum of maternal care along antenatal (ANC), intrapartum, and postnatal care (PNC) is fundamental for protecting women’s and newborns’ health. The COVID-19 pandemic and accompanying mitigation measures interrupted the provision and use of these essential services globally. This study examines maternal healthcare utilisation along the continuum during the COVID-19 pandemic in the Democratic Republic of the Congo, and explores factors associated with use of the full continuum.Methods:This is a cross-sectional study using data collected on a survey of 599 households in Lubumbashi using stratified random sampling. We included 604 women (15-49 years) who were pregnant between March 2020-May 2021. A structured interview involved questions on sociodemographic characteristics, attitudes regarding COVID-19, and maternal service use and cost. Complete continuum of care was defined as receiving ANC 4+ consultations, skilled birth attendance, and at least one PNC check for both mother and newborn. Data were analysed in SPSS using descriptive statistics and multivariable logistic regression.Results:Of the women who gave birth during the COVID-19 pandemic, 61% had ANC 4+ consultations, most had a skilled birth attendant (97%), and more than half (55%) had a PNC check for themselves and the newborn. One-third (36%) of women completed the continuum of maternal healthcare. Factors significantly associated with completing the continuum included higher education (aOR=2.6; p-value<0.001) and positive attitude towards the COVID-19 vaccination (aOR=1.9; p-value=0.04). Reasons for not seeking maternal care included lack of money and avoiding COVID-19 vaccination.Conclusion:During the COVID-19 pandemic, maternal healthcare seeking behaviours were shaped by vaccine hesitancy and care unaffordability in Lubumbashi. By disproportionately affecting women and vulnerable populations, the pandemic could exacerbate pre-existing structural barriers to maternal healthcare utilisation. Addressing the high cost of maternal healthcare and vaccine hesitancy appear essential to avoid deepening pre-existing socio-economic inequalities.

Introduction: The nursing process is an organized method that focuses on the individual reactions of a person (or group) in order to produce a clinical judgment about the person's state of health in order to make decisions about to the care to be given [1]. Method: The qualitative study has been carried out in this work. This involves exploring the factors related to their experience and the feelings of each caregiver in order to identify possible pathways for the implementation of the nursing process in public hospitals in Lubumbashi. Results: The results showed that the factors that can favor the implementation of the nursing process according to the expression of the nurses surveyed are: updating knowledge on the nursing procedure, setting up the nursing file, availability nursing staff (sufficient staff and permanence in the workplace), motivation of nurses (salary, promotion, bonus, etc.), availability of work equipment. Conclusion: Ultimately, the main challenges remain the training, the equipment of the hospitals and the financial motivation of the nurses.