Child mortality in the Democratic Republic of Congo: cross-sectional evidence of the effect of geographic location and prolonged conflict from a national household survey

Background The child mortality rate is a good indicator of development. High levels of infectious diseases and high child mortality make the Democratic Republic of Congo (DRC) one of the most challenging environments for health development in Sub-Saharan Africa (SSA). Recent conflicts in the eastern part of the country and bad governance have compounded the problem. This study aimed to examine province-level geographic variation in under-five mortality (U5M), accounting for individual- and household-level risk factors including environmental factors such as conflict. Methods Our analysis used the nationally representative cross-sectional household sample of 8,992 children under five in the 2007 DRC Demographic and Health Survey. In the survey year, 1,005 deaths among this group were observed. Information on U5M was aggregated to the 11 provinces, and a Bayesian geo-additive discrete-time survival mixed model was used to map the geographic distribution of under-five mortality rates (U5MRs) at the province level, accounting for observable and unobservable risk factors. Results The overall U5MR was 159 per 1,000 live births. Significant associations with risk of U5M were found for < 24 month birth interval [posterior odds ratio and 95% credible region: 1.14 (1.04, 1.26)], home birth [1.13 (1.01, 1.27)] and living with a single mother [1.16 (1.03, 1.33)]. Striking variation was also noted in the risk of U5M by province of residence, with the highest risk in Kasaï-Oriental, a non-conflict area of the DRC, and the lowest in the conflict area of North Kivu. Conclusion This study reveals clear geographic patterns in rates of U5M in the DRC and shows the potential role of individual child, household and environmental factors, which are unexplained by the ongoing conflict. The displacement of mothers to safer areas may explain the lower U5MR observed at the epicentre of the conflict in North Kivu, compared with rates in conflict-free areas. Overall, the U5M maps point to a lack of progress towards the Millennium Development Goal of reducing U5M by half by 2015

Les retards de recours et de soins à Kinshasa en cas de maladie sévère chez la femme en âge de procréer

Background. - Mortality of adult females is very high in Democratic Republic of Congo and often caused by diseases that could have been controlled if treated in time. This is a qualitative study on delays and their causes in the care-seeking process offal women who died prematurely in Kinshasa from non-immediately fatal causes. Method. - This study concerned 60 women identified in two Kinshasa mortuaries in March and April 2004 who had died at the age of IS to 49 years. Deaths considered to be unavoidable were excluded. The history of their disease and death was collected from family members and community leaders, and from the available medical records. The analysis focused on delays occurring at the different stages of the women's care seeking process, from the first signs of danger until death. Results. - The analysis identified different delays: the delay in danger awareness, the delay in taking the care-seeking decision and the delay due to alternative care linked to cultural perceptions of the disease, the delay in reaching a medical facility related to lack of money or vehicles, the delay in patient care related to an absent or incompetent health staff or by inappropriate choice of structure, and finally the delay in administration of the prescribed treatment. In Kinshasa, emergency care may be delayed by slow awareness of danger, but most of all by the poor quality and poor organisation of the health services. On the other hand, the use of non-medical alternatives and a poor perception of the medical services do rarely interfere in the decision to seek medical care. Conclusion. - In Kinshasa, to guarantee the patients rights to quality health care, one must first strengthen and control medical services. One should also teach people to identify services appropriate to medical emergencies. Transportation and pre-financing of emergency care should be organised by local authorities. (C) 2010 Elsevier Masson SAS. All rights reserved