BackgroundDespite efforts to achieve the Millennium Development Goals, the maternal mortality ratio in the Democratic Republic of Congo was 693 per 100,000 in 2015—the 6th highest in the world and higher than the average (547 per 100,000) in sub-Saharan Africa. Antenatal care (ANC) service is a cost-effective intervention for reducing the maternal mortality ratio in low-income countries. This study aimed to identify the intervention effect of the maternal and child health care (MCH) project on the use of four or more (4+) ANC services.MethodsThe MCH project was implemented using the three delays model in Kenge city by the Ministry of Public Health (MoPH) of the DRC with technical assistance from Korea International Cooperation Agency (KOICA) and the Yonsei Global Health Center from 2014 to 2017. Furthermore, Boko city was selected as the control group. A baseline and an endline survey were conducted in order to evaluate the effectiveness of this project. We interviewed 602 and 719 participants in Kenge, and 150 and 614 participants in Boko in the baseline and endline surveys, respectively. We interviewed married reproductive-aged women (19–45 years old) in both cities annually. The study instruments were developed based on the UNICEF Multiple Indicator Cluster Surveys. This study used the homogeneity test and the binary logistic regression difference-in-differences method of analysis.ResultsThe odds of reproductive-aged women’s 4+ ANC service utilization at the intervention site increased 2.280 times from the baseline (OR: 2.280, 95% CI: 1.332–3.902, p = .003) as compared to the control site.ConclusionsThis study showed that the KOICA MCH project effectively increased the 4+ ANC utilization by reproductive-aged women in Kenge. As the 4+ ANC services are expected to reduce maternal deaths, this project might have contributed to reducing maternal mortality in Kenge. In the future, we expect these findings to inform MCH policies of the MoPH in the DRC.

A project on maternal and child health (MCH) was conducted by the Korea International Cooperation Agency to reduce maternal and child mortality rates in Kwango, Democratic Republic of Congo (DRC). The objective of this study was to evaluate the costs and benefits of the MCH project, which was under Official Development Assistance for a period of 3 years from 2014 to 2016. The study conducted a cost-benefit analysis (CBA) using a benefit-cost ratio (BCR). The costs were the total costs incurred in implementing the MCH project. The benefits of the MCH project were estimated as the monetary values of the reduction in maternal mortality rates and the mortality rates of infants and children aged under 5 years. The adjusted costs that converted the time value for 2016 were estimated as USD 1,969,532 as part of the CBA. The benefits of reduced maternal mortality and the mortality of infants and children aged under 5 years were estimated as USD 681,416, USD 4,332,376, and USD 1,710,184, respectively, in monetary terms. The total benefits were estimated as USD 6,723,976 and the BCR was calculated at 3.41. In addition, the benefits were estimated by the different economic assumptions through a sensitivity analysis. The MCH project was economically satisfied under the most conservative assumptions.

Background:In 2015, the United Nations set the sustainable development goals (SDGs) with a focus on the maternal mortality ratio (MMR), to decrease the mortality rate of newborns to 70 per 100,000 by 2030. Despite efforts to achieve the SDGs, the MMR in the Democratic Republic of Congo (DRC) was 693 per 100,000 in 2015—the sixth highest in the world and higher than the average (547 per 100,000) of sub-Saharan Africa.Objectives:The primary aim was to identify effect factors of 4+ antenatal care (ANC) of the maternal and child health care (MCH) project focused on reproductive women in the DRC.Methods:This study used a before and after study design and focused on ANC utilization of reproductive age women in Kenge, DRC. This study provided the MCH intervention based on three phases of the Three Delays Model from 2014 to 2017. We interviewed 2,663 participants from 2014 to 2017. This study used the decision tree node for prediction of 4+ ANC utilization.Findings:The decision tree showed that hand-washing (1.000) was the most important factor for receiving 4+ ANC services in the midline I survey, followed by writing skills (0.891), satisfaction with health facilities (0.869), age (0.782), and awareness of interventions (0.621). The results of the midline II decision tree demonstrated that MCH promotion by signboard (1.000) was the most important factor for 4+ ANC services, followed by income (0.970), and abortion (0.894). In the third year, distance (1.000) was the most important factor, followed by abortion (0.940) and knowledge of exclusive breastfeeding (0.806).Conclusions:The most important factors were related to awareness. We recommend conducting interventions focused on improving awareness increase 4+ ANC utilization. Sustainability intervention for improving the 4+ ANC utilization requires that focus on the infrastructure, such as accessibility and knowledge, of reproductive women.

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