Prevention of hypertensive disorders in pregnancy in the Democratic Republic of Congo : challenges and perspectives

Hypertensive disorders in pregnancy (HDP) are the second most common cause of maternal mortality worldwide. Most deaths occur in low- and middle-income countries (LMICs) and are however preventable. Effective interventions to address HDP exist, however, their implementation in LMICs still challenging. The overall objective of this thesis is to contribute to improving the prevention of HDP in the Democratic Republic of Congo (DRC) through a better understanding of prevention related challenges. Specifically, we aimed at 1) determining the prevalence as well as factors associated with the screening for HDP; 2) assessing health facility readiness and provider knowledge to diagnose, prevent and manage HDP; and 3) identifying factor associated with pregnant women knowledge about obstetric danger signs. We conducted a facility-based cross-sectional survey in Kinshasa and we analysed data from the 2017-2018 DRC Service Provision Assessment survey (DRC-SPA), a nationwide survey that samples services including antenatal care (ANC), in representative health facilities. We found a low provision of screening for HDP in DRC (19.1 %; 95% IC, 15.8% – 22.9%). The screening is highly driven by emergency and obstetric care policies, providers and clinics related factors. Health commodities and guidelines needed for the prevention and management of HDP were scarcely available in health facilities, mainly in primary health centres. While healthcare providers demonstrated good knowledge regarding the diagnosis of HDP, they have poor knowledge regarding its prevention and management. In average, women were aware of 1.5±1.34 danger signs in pregnancy (range: 0 to 8). We found that province of residence, provision of counseling on obstetric danger signs, facility ownership, gravidity and the number of ANC visits were predictors of the awareness of obstetric danger signs among pregnant women. To improve the prevention of HDP in DRC, our research urges the need for a comprehensive strategy including updating national guidelines, enhancing the availability of health commodities, strengthening knowledge of providers toward the prevention and management of HDP, and improving women’s ANC seeking behaviors and awareness about obstetric danger signs.(SP - Sciences de la santé publique) -- UCL, 202