Trends, epidemiology and causes of maternal deaths over a decade (2013-2022) in a context of crisis among 8 health zones in Eastern Democratic Republic of Congo

Abstract

Background Maternal mortality (MM) remains a real scourge that hits hardest in the poorest regions of the world, particularly those affected by conflict. However, despite this worrying reality, few studies have been conducted about MM in the Democratic Republic of Congo (DRC). The study aimed to describe the trends as well as the epidemiological profile and causes of maternal deaths between 2013 and 2022 in Eastern DRC. Methods A cross-sectional study was conducted between March 2023 and August 2023 in eight Health Zones (HZ), five in South Kivu Province (Mwana, Minova, Miti-Murhesa, Kamituga and Idjwi) and three in North Kivu Province (Kirotshe, Karisimbi and Kayna) in the eastern region of the DRC. Data from registers and medical records of maternal deaths recorded in these zones over the last 10 years (2013–2022) were extracted along with information on the number of deliveries and live births. Differences in sociodemographic, clinical parameters, Blood and ultrasound tests and suspected causes of death between provinces were assessed using chi-square and non-parametric Wilcoxon-Mann-Whitney tests, with a 5% significance level. RESULTS From 2013 to 2022, the study sites experienced two significant drops in MMR (in 2015 and 2018), and a spike in 2016–2017. Nonetheless, the combined MMR (across study sites) started and ended the 10-year study period at approximately the same level (53 in 2013 and 57 in 2022). Overall, 62,6% of the deaths were reported from secondary hospital. Most deaths were of married women in their thirties (93.5%). Almost 47.8% had not completed four antenatal consultations (ANC). The main direct causes of death were, in decreasing order of frequency: post-partum haemorrhage (55.2%), uterine rupture (14.0), hypertensive disorders (8.4%), abortions (7.7%) puerperal infections (2.8%) and placental abruption (0.7%).When comparing among provinces, reported abortion-related maternal mortality (14.1% vs 0%, p = 0,001) was significantly more frequent in North Kivu than in South Kivu. CONCLUSION This study imperatively highlights the need for targeted interventions to reduce maternal mortality. By emphasizing the crucial importance of antenatal consultations, intrapartum/immediate post-partum care and quality of care, significant progress can be made in guaranteeing maternal health and reducing many avoidable deaths.