Background: The reduction of maternal mortality in developing countries such as the Democratic Republic of Congo (DRC) still raises many questions. Indeed, this large country in the heart of Africa ranks 4th among the eight countries that alone account for more than 50% of maternal deaths in the world, behind India, Nigeria and Pakistan. However, there is no up-to-date data on maternal mortality in eastern DRC. This study measures the mortality rate rate in health facilities in eastern DRC and identifies the associated risk factors. Methods: This analytical epidemiological study was based on retrospective data materna deaths recorded in 59 health facilities, in three health zones in the southern part of Maniema province in east DRC. The study was conducted from July 1, 2015 to June 30, 2020. Descriptive, bi and multivariate analyses were used. Results: The maternal mortality rate was estimated at 620 deaths per 100,000 live births, of which 46% of maternal deaths were related to a parturients’ delayed decision in seeking healthcare in time (first delay). Maternal deaths were significantly associated with extreme ages (≤ 19 years and ≥ 40 years: p = < 0.001), patient parity (in primigravidas and in large multiparas: p = 0.001), complications such as hemorrhagic, (p = < 0.001), uterine ruptures:(p = < 0.001), infections, (p = < 0.001), and dystocia (p = < 0.001). Conclusion: Despite the efforts made by the DRC and its partners in the fight against maternal mortality, women continue to lose their lives when they decide to give birth. The results imply that it is imperative to strengthen both women and health professionals’ knowledge about pregnancy and maternal health and their power to reduce instances of first delay by supporting women in formulating their birth plans.

A lack of awareness regarding obstetric danger signs (ODS) is one of the factors that delay a pregnant woman’s decision to seek emergency obstetric care. In developing countries, this delay can lead to high morbidity and mortality among pregnant women. In eastern Democratic Republic of Congo (DRC), very few studies have been conducted to assess the level of knowledge of pregnant women about ODS. Therefore, this study aimed to assess the knowledge of pregnant women about ODS in health facilities in eastern DRC. This quantitative cross-sectional, descriptive, and analytical study was conducted in 19 health facilities in the Kasongo health zone in the south Maniema Province of eastern DRC. A total of 624 pregnant women aged 12–49 years were interviewed in this study. Of these, 60.6% were secondary school graduates, >99% were married, 85.5% were cultivators, and 67.9% were Muslims. The knowledge of ODS among pregnant women was low (21.9%). The most cited danger signs during pregnancy, labor/delivery, and postpartum included severe abdominal pain and severe vaginal bleeding. Additionally, pregnant women aged 30–39 years (p = 0.015) and those who had given birth once (p = 0.049), twice (p = 0.003), 3–5 times (p = 0.004), and >5 times (p = 0.009) were more likely to be aware of ODS than others. Our findings indicated that pregnant women have little knowledge of ODS, which makes it difficult for them to take prompt decisions to seek emergency obstetric care. Thus, strategies to increase the knowledge of pregnant women about obstetrical danger signs by healthcare providers during prenatal consultations (antenatal care) must be developed to improve their rapid decision-making skills during pregnancy, labor, and postpartum.

Background: The Democratic Republic of the Congo accounts for approximately 12–13% of the global malaria burden. While international guidelines oppose the use of Artemisia annua infusions due to risks of sub-therapeutic dosing and resistance selection, the plant remains widely used in resource-limited regions. This study evaluates the clinical acceptability and perceptions of healthcare providers regarding the integration of Artemisia annua tea into formal malaria control in the Maniema province. Methods: A cross-sectional survey was conducted among 337 healthcare professionals in the Kalima health district using the KoboCollect digital platform. Multivariate logistic regression was employed to identify the primary socio-professional determinants of clinical acceptability. Results: The overall clinical acceptability of Artemisia annua integration was 81.0%, with 82.8% of providers perceiving the preparation as effective. Rural residency was the strongest predictor of adherence (AOR = 6.847; p = 0.003), reflecting a pragmatic response to frequent ACT stockouts and high treatment costs. Despite high acceptability, 49.0% of providers identified the lack of clinical evidence as a major barrier, and 91.4% demanded formal training on standardized dosage and biological mechanisms. Conclusions: A significant “policy–practice gap” exists between international guidelines and field realities in the DRC. Healthcare providers demonstrate high readiness for integration but emphasize the absolute necessity of galenic standardization to mitigate resistance risks. To address these concerns, a complementary genomic investigation is currently underway in the same study area, comparing PfKelch13 mutation prevalence among Artemisia tea users versus ACT-treated patients. This molecular surveillance will provide essential evidence to define safety parameters for future phytopharmaceutical integration.

Background: Affordable, quality health care for pregnant women can improve their health. Thus, performance-based financing (PBF) remains one of the outcomes for improving the health system and increasing the accessibility of the poorest pregnant women to health care and reducing the maternal mortality rate. However, there is no up-to-date data on maternal mortality in the health structures using PBF in the Democratic Republic of the Congo (DRC). This study measures the mortality rate among pregnant women in health facilities by applying the PBF approach and identifies the associated risk factors.Methods: This analytical epidemiological study was based on rétrospective data materna deaths recorded in 59 health facilities, using the PBF approach in three health zones in the southern part of Maniema province in east DRC. The study was conducted from July 1, 2015 to June 30, 2020. Descriptive, bi and multivariate analyses were used.Results: The maternal mortality rate was estimated at 620 deaths per 100,000 live births, of which 46% of maternal deaths were related to a parturients’ delayed decision in seeking healthcare in time (first delay). Maternal deaths were significantly associated with extreme ages (≤19 years and ≥40 years: p = <0.001), patient parity (in primigravidas and in large multiparas: p = 0.001), complications such as hemorrhagic, (p = <0.001), uterine ruptures:(p = <0.001), infections, (p = <0.001), and dystocia (p = <0.001).Conclusion: Despite the establishment of the PBF approach in this part of eastern DRC, women continue to lose their lives when they decide to give birth. The results imply that it is imperative to strengthen both women and health professionals’ knowledge about pregnancy and maternal health and their power to reduce instances of first delay by supporting women in formulating their birth plans

Background: Malaria is a significant public health challenge in the Democratic Republic of the Congo. In conflict-affected areas, access to quality-assured ACTs is restricted by chronic stockouts and circulation of substandard and falsified antimalarials. This study investigates perceptions and social acceptability of Artemisia annua herbal tea in the Kalima Health Zone. Methods: Distinct from the prior provider-arm cross-sectional survey of the same program in the Kalima Health Zone which sampled only biomedical healthcare workers (n = 337), this exploratory qualitative study adopted a socio-anthropological design across three stakeholder strata (community users, biomedical providers, opinion leaders). Maximum-variation purposive sampling recruited 30 informants across five health areas (11 end-users, 11 providers, 8 opinion leaders). Sample-size adequacy was assessed against Malterud’s information power framework; data collection continued until operational thematic saturation. Hybrid inductive–deductive thematic content analysis followed COREQ reporting. Results: End-users demonstrated high willingness, driven by accessibility, perceived three-day recovery, and avoidance of unreliable ACTs. Biomedical providers voiced intense posological anxieties over uncalibrated raw biomass and sub-therapeutic dosing. Behavioral patterns were shaped by socio-religious norms and digitally mediated religious discourse. A unanimous demand for industrial galenic transformation of raw biomass into calibrated tablets emerged across all groups. Conclusions: This study does not validate the clinical efficacy, safety, posological adequacy, or resistance-attenuation potential of Artemisia annua herbal tea. It documents a transversal household-level consensus, across the three strata and five health areas, that Artemisia annua herbal tea adoption responds to documented double ACT supply chain failure. A unanimous demand for industrial galenic transformation emerged across all stakeholder groups.