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