Evaluation of needs and supply of emergency care in Kinshasa, Democratic Republic of Congo: a cross-sectional household survey

Abstract

ObjectiveEmergency care can address over half of deaths occurring each year in low-income countries. A baseline evaluation of the specific needs and gaps in the supply of emergency care at community level could help tailor suitable interventions in such settings. This study evaluates access to, utilisation of, and barriers to emergency care in the city of Kinshasa, Democratic Republic of Congo.DesignA cross-sectional, community-based household survey.Setting12 health zones in Kinshasa, Democratic Republic of Congo.ParticipantsThree-stage randomised cluster sampling was used to identify approximately 100 households in each of the 12 clusters, for a total of 1217 households. The head of each household or an adult representative responded on behalf of the household. Additional 303 respondents randomly selected in the households were interviewed regarding their personal reasons for not accessing emergency care.Primary outcomeAvailability and utilisation of emergency care services.ResultsIn August 2021, 1217 households encompassing 6560 individuals were surveyed (response rate of 96.2%). Most households were economically disadvantaged (70.0% lived with <US$100 per person per month) and had no health insurance (98.4%) in a country using a fee-for-service healthcare payment system. An emergency visit in the last 12 months was reported in 52.6% of households. Ambulance utilisation was almost non-existent (0.2%) and access to health facilities for emergencies was mostly by walking (60.6% and 56.7% by day and night, respectively). Death in the last 12 months was reported in 12.8% of households, of which 20.6% occurred out-of-hospital with no care received within 24 hours prior to death. Self-medication (71.3%) and the expected high cost of care (19.5%) were the main reasons for unmet emergency care needs.ConclusionThere is a substantial gap in the supply of emergency care in Kinshasa, with several unmet needs and reasons for poor access identified.

Seeking and reaching emergency care: A cross sectional household survey across two Liberian counties

“…Our findings suggest limitations in access to facility-based emergency care, as well as provision of both informal and formal out-of-hospital emergency care. We observed very similar proportions of household emergency health visits as those described in the Democratic Republic of the Congo, with just over half of households having made one or more emergency visits to a health facility (clinic, health center, or hospital) in the last year [20]. Of note, our data revealed a high proportions of clinics as the destination for these emergency health visits in Liberia, which may not have sufficient capacities to deliver the necessary emergency care.…”

“…Though approximately 10% of these individuals cited this to be a preference, the two most frequent factors influencing the lack of use were high cost and lack of transportation, suggesting significant unmet emergency care needs across the spectrum of access. In both Cameroon and the DRC, economic concerns and self-medication were also found to be among the most frequent reasons for not seeking healthcare [20,21].…”

“…We designed a 91-item questionnaire, divided into five sections related to individual and household socio-demographics, emergency care access, and care seeking behavior. Sociodemographic and emergency care questions were largely based on previously validated questions from the Democratic Republic of Congo, South Africa, and Cameroon [20][21][22]. Eleven additional questions, not explored in this study, specific to climate related health effects, were also based on previously validated studies in other low-income countries [23].…”

Implementation and evaluation of a pilot WHO community first aid responder training in Kinshasa, DR Congo: A mixed method study

“…As is commonly observed in LMICs, the Democratic Republic of Congo (DRC) suffers from a significant burden of ill health across all age groups and disease categories, and health indicators point towards an urgent need for health system strengthening [ 12 , 13 ]. The country's recent ECS strategic planning identified key system deficiencies [14] and a household survey showed substantial unmet needs in the supply of emergency care to communities in Kinshasa, the capital city [15] . One solution to help address this need lies within prehospital care systems, and the CFAR programme is ideally suited to support system development in the DRC.…”