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 long-term availability of contraceptive methods and the provision of quality planning services are bedrock for increasing contraceptive prevalence. The objectives of this study are to determine the coverage and availability of family planning (FP) services, as well as to evaluate the quality of these services in the city of Lubumbashi. Methods: From May to June 2017, we carried out a descriptive transversal study in several health facilities (HF) in the city of Lubumbashi. We have comprehensively included all the health facilities we have identified. The data were collected by interviews, documentary analyses and observation, guided by a questionnaire. We calculated the proportions for the different variables and the quality was evaluated using the score we built for this purpose. Results: Our study involved 570 health facilities. The coverage for family planning services was 0.7/10,000 inhabitants. Their availability was 29.6% among the visited structures; 10.1% of HF had no contraceptives in stock, 10.1% had one to two contraceptives and 79.9% had three or more. The quality of FP services was good in the majority (82%) of HF, average in 12% and poor in 6% of the cases. Conclusion: The coverage of FP services and their availability in the city of Lubumbashi were low. The quality of family planning services was good in most health facilities offering FP services. Improving coverage and availability of family planning services in Lubumbashi, as well as the innovation of the most appropriate supply strategies, is essential to increase contraceptive prevalence.

Contexte : La maternité précoce est la survenue d’une grossesse chez une femme dont l’âge est inférieur à 19 ans pour les uns et inférieur à 21 ans pour les autres au moment de la naissance de son bébé. Elle présente de nombreuses complications fœto-maternelles et demeure une préoccupation sociale et sanitaire majeure. Cependant, la survenue d'une maternité pendant cette période et surtout à l'adolescence est considérée par nombre de gynécologues obstétriciens comme non recommandable et devant être prévenue. Méthodologie : Nous avons mené une étude transversale à visée analytique. Notre milieu d’étude a été fait de 5 zones de santé de la Province du Lualaba (2 urbaines et 3 rurales). Les registres de maternité ont été consultés dans ces structures. 25815 accouchements ont été enregistrés dont 3550 étaient de survenue précoce. Résultats : La prévalence des maternités précoces était de 13,8% (IC 95% : 13,4 ; 14,2. Les prévalences élevées ont été enregistrées dans les structures rurales que celles urbaines (65,2% Vs 34,8%). L’âge moyen aux maternités précoces était de 17,1 ans avec une déviation standard de 0,82. Les extrêmes étaient de 13 ans et de 18 ans. Les mères des villages ont présenté un risque OR=5,65 de ne pas suivre la CPN face à celles de la ville et Bidonville. Comparée à la tranche d’âge de 15-18 ans, la tranche de 13 à 15 ans a présenté un risque élevé des conséquences d’accouchement dont : 3,41 [2,42 ; 4,79] pour les déchirures des parties molles et de 6,57 [4,38 ; 9,82] pour les hémorragies du post partum. Sur les 1,4 % de nouveaux nés de faible poids de naissance, le risque était élevé chez les mères de 13-15 ans OR= 3,96 [1,68 ; 9,0]. Celles du milieu rural comprises dans la tranche d’âge de 13-15 ans ont présenté le risque de faible poids de naissance estimé à OR= 5,39[1,21 ; 20,58], contre celles de la ville et Bidon ville OR= 3,983 de s’accoucher des enfants de faible poids à la naissance. Le décès avant 8 jours a été vécu dans 12,2% chez les victimes de maternités précoces. Le risque était élevé chez celles de 13 à 15ans. OR=1,61 [1,10; 2,56] pour le décès des enfants avant le 8ème jour de vie. Les faibles poids de naissance ont couru un risque 33,45 fois plus élevé de décéder avant le 8ème jour de vie OR=33,45 [15,41 ; 74,91]. Conclusion : Les maternités précoces dans la province du Lualaba sont présentes avec des conséquences semblables à celles du reste du monde. Ces conséquences entraînent les risques pathologiques liés à l’immaturité des organes génitaux de la jeune mère (déchirure périnéale), césarienne, séjours prolongés dans les hôpitaux. L’étude permet d’appuyer les stratégies internationales décourageant les maternités précoces à cause des effets néfastes en matière de santé reproductive aboutissant aux graves complications et décès maternels. Summary Context: Early motherhood is the occurrence of a pregnancy in a woman whose age is less than 19 years for some and less than 21 years for others at the time of birth of her baby. It presents numerous feto-maternal complications and remains a major social and health concern. However, the occurrence of maternity during this period and especially in adolescence is considered by many gynecologists obstetricians as not recommendable and to be prevented. Kasongo Kayembe Aimé et al Prévalence et risque fœto-maternel de la maternité précoce dans la province du Lualaba en.. 314 | Int. J. of Multidisciplinary and Current research, Vol.7 (May/June 2019) Methodology: We did an analytical cross-sectional study. Our study area was made of 5 health zones of Province of Lualaba (2 urban and 3 rural). Maternity records were consulted in these structures. 25815 births were recorded, of which 3550 were early births. Results: The prevalence of early motherhood was 13.8% 95% CI [13.4; 14.2]. High prevalence have been recorded in rural structures as urban ones (65.2% vs 34.8%). The average age for early motherhood was 17.1 years with a standard deviation of 0.82. The extremes were 13 and 18. Mothers in villages have ran a risk estimated to OR = 5.65 of not following the NHC during this pregnancy in the face of the city and slums. Compared to the age group of 16-18, the age group 13 to 15 years has a high risk of childbirth. Consequences whose risks were estimated as follows: The tears of the soft parts OR = 3.43 [2.50; 4, 71]; the postpartum hemorrhage OR = 2.64 [1.68; 4.17]. Of the 1.4% of low birth weights experienced, the risk was high for mothers aged 13-15 years OR = 4.15 [1.99; 8.65]. Those in rural areas included in the age group 13-15 years ran, the risk of low birth weight estimated at OR = 7.15 [2.32; 22,04]. Against those of the city and in the slums OR = 3.78 [1.25; 9.78] to give birth to children of low birth weight. The death before 8 days was experienced in 12.2% among the victims of early maternity. The risk was high for those aged 13 to 15 years OR = 1.72 [1.16; 2.53] for death of children before 8th day of life. In 12.2% among the victims of early maternity. The risk was high among those aged 13 to 15 years OR = 1.72 [1.16; 2.53]. For the death of children before the 8th day of life, the birth with low weights ran a risk estimated OR = 32.50 [16.15; 65, 39] to die before the 8th day of life. ORaMH = 1.64. There were 817 maternal deaths per 100,000 live births. Conclusion: Early maternity in the province of Lualaba is present with consequences similar to those of the rest of the world. These consequences result to pathological risks associated with the immaturity of the young mother's genitalia (perinea tear), cesarean section, and extended stays in hospitals. The study supports international strategies that discourage early motherhood due to adverse reproductive health effects leading to severe complications and maternal deaths.

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