Utilisation of services along the continuum of maternal healthcare during the COVID-19 pandemic in Lubumbashi, DRC: findings from a cross-sectional household survey of women

Abstract

ObjectivesThe continuum of maternal care along antenatal (ANC), intrapartum and postnatal care (PNC) is fundamental for protecting women’s and newborns’ health. The COVID-19 pandemic interrupted the provision and use of these essential services globally. This study examines maternal healthcare utilisation along the continuum during the COVID-19 pandemic in the Democratic Republic of the Congo (DRC).DesignThis is a cross-sectional study using data collected on a survey of 599 households in Lubumbashi, DRC, using stratified random sampling.ParticipantsWe included 604 women (15–49 years) who were pregnant between March 2020 and May 2021.Outcome measuresA structured interview involved questions on sociodemographic characteristics, attitudes regarding COVID-19 and maternal service use and cost. Complete continuum of care was defined as receiving ANC 4+ consultations, skilled birth attendance and at least one PNC check for both mother and newborn. Data were analysed in SPSS using descriptive statistics and multivariable logistic regression.ResultsOne-third (36%) of women who gave birth during the COVID-19 pandemic completed the continuum of maternal healthcare. Factors significantly associated with completing the continuum included higher education (aOR=2.6; p<0.001) and positive attitude towards the COVID-19 vaccination (aOR=1.9; p=0.04). Reasons for not seeking maternal care included lack of money and avoiding COVID-19 vaccination.ConclusionDuring the COVID-19 pandemic, maternal healthcare seeking behaviours were shaped by vaccine hesitancy and care unaffordability in Lubumbashi. Addressing the high cost of maternal healthcare and vaccine hesitancy appear essential to improve access to maternal healthcare.

Impact of Ebola and COVID-19 on maternal, neonatal, and child health care among populations affected by conflicts: a scoping review exploring demand and supply-side barriers and solutions

“…This was often a result of refugees’ fear of contracting COVID-19 together with poverty, which meant that they could not afford masks or the cost of private maternity services Altare et al [ 46 ] COVID-19 epidemiology and changes in health service utilization in Azraq and Zaatari refugee camps in Jordan: A retrospective cohort study Observational Secondary data analysis To describe the epidemiology of COVID-19 in Azraq and Zaatari refugee camps in Jordan and evaluate changes in routine health services during the COVID-19 pandemic Azraq and Zaatari refugee camps, Jordan Syrian war 2011 9 Refugees COVID-19 Mothers and Children ANC, FP, PNC The pandemic has both exacerbated existing inequalities and demonstrated that until all populations are included in national response plans, the world remains vulnerable to the current and the next pandemic Hossain et al [ 66 ] Exploring healthcare-seeking behavior of most vulnerable groups amid the COVID-19 pandemic in the humanitarian context in Cox’s Bazar, Bangladesh: Findings from an exploratory qualitative study Mixed-method research In-depth interviews To understand the factors influencing healthcare-seeking behavior of the most vulnerable groups during COVID-19 pandemic Ukhiya sub-district of Cox’s Bazar, Bangladesh Persecution in Myanmar 2017 3 Refugees COVID-19 Pregnant and lactating women as well as other population ANC and IPC The healthcare-seeking behavior of MVGs amid the COVID-19 pandemic in the context of Rohingya and the host communities of Cox’s Bazar was influenced by several factors ranging from socioeconomic, demographic, individual, health belief-related, and institutional factors. However, these factors are not linear rather they are intertwined, and their intersectionality represents diverse nuances of the lived realities of these most vulnerable groups during the COVID-19 pandemic Galle et al [ 49 ] Utilization of services along the continuum of maternal healthcare during the COVID-19 pandemic in Lubumbashi, DRC: findings from a cross-sectional household survey of women Cross-sectional Survey …”

“…‘Care during pregnancy and childbirth’ i.e., ANC and IPC were the domains in which most of the studies reported greater barriers [ 42 , 43 , 47 , 49 ]. The most frequently described challenges faced by women were associated with health workforce constraints for both Ebola [ 50 , 51 ], and COVID-19 [ 42 , 43 , 47 , 49 ].…”

“…‘Care during pregnancy and childbirth’ i.e., ANC and IPC were the domains in which most of the studies reported greater barriers [ 42 , 43 , 47 , 49 ]. The most frequently described challenges faced by women were associated with health workforce constraints for both Ebola [ 50 , 51 ], and COVID-19 [ 42 , 43 , 47 , 49 ]. These constraints were mostly related to limited staffing, overburdened health services, or insensitive behavior of staff, which at times led women to prefer unskilled birth attendants [ 42 , 47 , 50 , 52 , 53 ].…”

“…Community-centered initiatives, such as community engagement and refugee-centered approaches, have been emphasized as leading ways to improve access across the continuum of care [ 45 , 53 , 57 , 63 ]. Furthermore, ‘strengthening communication’ with women through community messaging and community support systems has been described as a key solution to achieving the optimal utilization of services [ 46 , 49 , 56 ]. and continuity of care.…”

“…Among MNCH service domains, supply-side factors have been reported in more studies compared to demand-side factors [ 42 , 44 , 45 , 49 , 52 , 53 , 64 , 65 ]. Care during pregnancy and childbirth, specifically IPC, had the highest number of reported challenges [ 42 , 44 , 45 , 48 , 52 , 55 , 66 , 68 , 70 ], while nutrition had the lowest [ 42 ].…”