Insight into Audit Reports on the Causes of Maternal Deaths in Poor Health Settings: The Case of North Kivu Province in Democratic Republic of Congo

Background: Maternal mortality is a major public health problem in the world and particularly in developing countries. Understanding the causes and responsibilities remain capital when action is needed by policymakers and practitioners or by caregivers. The objective was to analyze audit data reported on maternal deaths and highlight the major causes of mortality as well as responsibilities. Methods: We analyzed 48 cases of maternal deaths that were reported to the health information bureau of the province of North Kivu in DR Congo in the first semester of 2017. The audit was conducted in various health facilities located in both rural and urban areas including General Reference Hospital and Reference Health Centers as Category-2, private polyclinics and small medical centers as Category-1. The audit consisted of verbal autopsy, verbal determination of non-clinical causes of death and verbal communication of basic characteristics using a standardized national Audit Form. The causes of mother death were defined as direct or indirect and related to heath facilities or to mother next of kin. Results: The analysis shows the mothers were aged 15-43 years, of which 54.9% were in good health at the admission to health centers. The causes were considered as direct in 75.1% and indirect in 24.9% of all cases. More than half of women died of hemorrhage (52%) followed by thromboembolism and cardiovascular diseases (14.6%). Lack of quality infrastructure in health facilities and incompetence of care practitioners were responsible for 68% of deaths against 32% cases related to mothers and next of kin persons. The majority of deaths occurred in multiparinous (45.8%) than primiparous (20.8%) mothers, during postpartum (64.5%) than intrapartum (6.2%) period, in rural (62.5%) than in urban (37.5%) areas. Conclusions: Maternal mortality is subjected to many causes implicating particularly poor quality of infrastructures and inexperience of practitioners. That is, upgrading the infrastructure of obstetrical medical facilities and the professionalism of nurses and other health practitioners, while educating pregnant women about childbirth good practice, may significantly reduce maternal mortality in this Province and in the Country.