Complications of childbirth and maternal deaths in Kinshasa hospitals: testimonies from women and their families

<p>Abstract</p> <p>Background</p> <p>Maternal mortality in Kinshasa is high despite near universal availability of antenatal care and hospital delivery. Possible explanations are poor-quality care and by delays in the uptake of care. There is, however, little information on the circumstances surrounding maternal deaths. This study describes and compares the circumstances of survivors and non survivors of severe obstetric complications.</p> <p>Method</p> <p>Semi structured interviews with 208 women who survived their obstetric complication and with the families of 110 women who died were conducted at home by three experienced nurses under the supervision of EK. All the cases were identified from twelve referral hospitals in Kinshasa after admission for a serious acute obstetric complication. Transcriptions of interviews were analysed with N-Vivo 2.0 and some categories were exported to SPSS 14.0 for further quantitative analysis.</p> <p>Results</p> <p>Testimonies showed that despite attendance at antenatal care, some women were not aware of or minimized danger signs and did not seek appropriate care. Cost was a problem; 5 deceased and 4 surviving women tried to avoid an expensive caesarean section by delivering in a health centre, although they knew the risk. The majority of surviving mothers (for whom the length of stay was known) had the caesarean section on the day of admission while only about a third of those who died did so. Ten women died before the required caesarean section or blood transfusion could take place because they did not bring the money in time. Negligence and lack of staff competence contributed to the poor quality of care. Interviews revealed that patients and their families were aware of the problem, but often powerless to do anything about it.</p> <p>Conclusion</p> <p>Our findings suggest that women with serious obstetric complications have a greater chance of survival in Kinshasa if they have cash, go directly to a functioning referral hospital and have some leverage when dealing with health care staff</p

Installation et renouvellement de l'agriculture familiale: un constat de la diversite des facteurs et tendances d'evolution

National audienceLe theme de l'installation est traite ici a partir de deux aspects. En premier lieu les auteurs, partant des travaux consacres aux determinants macroeconomiques de l'evolution de l'emploi agricole, en tirent des enseignements pour ce qui concerne les flux d'installation dans l'agriculture. En second lieu, ils font le point sur les conditions actuelles du renouvellement des exploitations agricoles et de leurs chefs et sur l'evolution des comportements socioeconomiques dans les familles agricoles. Sont ainsi caracterisees differentes modalites de reproduction de l'agriculture familiale. Les unes sont marquees par la capacite des nouvelles generations a minimiser les couts d'installation dans le cadre d'une logique interne de renouvellement; d'autres sont plutot caracterisees par le fait de mobiliser des ressouces en dehors de l'activite agricole et de la famille paysanne pour assurer le renouvellement de l'exploitation