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Strategies to prevent maternal, perinatal and infant mortalities in Democratic Republic of Congo: impact of the organizational model of healthcare

par Ntambue, A.M.;Malonga, F.K.;Dramaix Wilmet, Michèle ;Donnen, Philippe
Référence Maternal mortality, Schwartz DA, New York, Ed. 1, page (373-424)
Publication Publié, 2015

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Résumé :

The Democratic Republic of Congo (DRC) is one of the ten African countries with highest number of maternal deaths (MD) and deaths of children under 5 years (U5D) - the risk of maternal mortality (MM) and children under 5 years mortality (U5M) is respectively 534 per 100,000 and 158 in 1000 live births. According to the United Nations Millennium Development Goals (MDG) 4&5, in 2015 DRC should reach mortality rates of 68 U5D per 1,000 and 138 MD per 100,000 live births, respectively for the fourth and fifth MDGs. Current data indicate that DRC will not achieve these targets by this deadline. This chapter aims to determine the impact of a maternal, neonatal and child health (MNCH) care strategy based on the health system, and on the reduction of the MM and U5M in DRC Using data from national surveys of 2010 (MICS4), we modeled the reduction of MM, perinatal mortality (PM) and U5M, depending on the change in the utilization of MNCH care. This model, which covered the period 2010-2015, was conducted with the Live saved tool software (LiST 4.2.1). We tested the reduction of mortality by strengthening strategies based on MNCH care delivery. Under these rules, MNCH care can be: family-community care (FCC), Outreach, and facility-based clinical care (FBC). To evaluate the effect of the use of MNCH care on reducing of MM, PM and U5M, we gradually varied the level of MNCH care utilization between 60%, 80% and 90% rates. For MNCH care whose the level of use was already above the thresholds above (ANC and skilled attendance at birth), it was not changed. Taking into account the mortality rate in DRC, it is estimated that in 2010, there were 16,390 MD, 71,644 FD and 454,613 U5D. It was clear from our results that the magnitude of reinforcement of MNCH care delivery strategies depends on the result to be achieved; the reduction is greater with universal coverage (=90%) of care rather than with less than 90% coverage. Strategies based on strengthening of FBC are certainly the most effective in the fight against MM, stillbirths and neonatal mortality. Strengthening of FCC and FBC is the strategy most likely to significantly reduce the U5M. MNCH interventions can reduce by more than half the mother-child mortality in DRC. In order to significantly reduce the mortality in countries with high mortality rates, universal healthcare coverage must be a goal. This can only be achieved within the overall strengthening of the health system.