Pregnancy and neonatal outcomes in Eastern Democratic Republic of the Congo: a systematic review

Abstract

Background: Conflict is known to impact maternal and neonatal health in Eastern Democratic Republic of the Congo (DRC), an area of longstanding insecurity. We conducted a systematic review on pregnancy and neonatal outcomes in this region to provide a comprehensive overview of maternal and neonatal outcomes over a 20-year period.

Methods: We systematically searched databases, such as Medline, EMBASE, Global Health, ClinicalTrials.gov and the Cochrane Library, along with grey literature, for articles published between 2001 and 2021. These articles provided quantitative data on selected pregnancy and neonatal outcomes in the provinces of Ituri, Maniema and North and South Kivu, Eastern DRC. We conducted a descriptive analysis, combining results from different data sources and comparing incidence of outcomes in North Kivu with those in other provinces in Eastern DRC.

Results: A total of 1,065 abstracts from peer-reviewed publications and 196 articles from the grey literature were screened, resulting in the inclusion of 14 scientific articles in the review. The most frequently reported pregnancy complications were caesarean sections (11.6%-48.3% of deliveries) and miscarriage (1.2%-30.0% of deliveries). The most common neonatal outcomes were low birth weight (3.8%-21.9% of live births), preterm birth (0.9%-74.0%) and neonatal death (0.2%-43.3%).

Conclusion: Our review provides data on pregnancy and neonatal outcomes in Eastern DRC, which will be valuable for future studies. Despite the area's ongoing armed conflict, the percentages of complications we noted in Eastern DRC are comparable with those observed in other countries in the region.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=262553, PROSPERO (CRD42021262553).

Keywords: DRC; conflict; eastern; neonatal; outcomes; pregnancy.

Figure 1

PRISMA flow diagram of article selection. * Referred to as ‘articles’. ^† For ClinicalTrials.gov, this refers to the study details published online. ** Previously screened references were excluded. ^‡ For ClinicalTrials.gov, this refers to the number of trials. We used PRISMA flow diagram template available from https://www.prisma-statement.org/prisma-2020-flow-diagram.

Figure 2

Geographic distribution of the study sites in the included scientific articles. The areas shaded blue in (A) are the provinces included in the review. The coloured dots in (B) represent the GPS coordinates of the scientific articles. The map was created using R software. Coordinates for the research sites of the different publications came from Google. The shapefile (base layer) for making the map came from Humanitarian Data Exchange. https://data.humdata.org/dataset/cod-ab-cod.

Figure 3

Percentage of pregnancy outcomes reported by each scientific article. The position of squares represents the percentage of subjects with each outcome and bars the 95% confidence interval (95%CI). The size of the squares is weighted accorded to the size of the denominator (provided in supplementary material 6). Red squares represent scientific articles conducted in North Kivu and blue squares conducted outside North Kivu. The asterisk (*) indicates scientific articles for which the denominator is non-standard. Placenta praevia in the study by Michel (2019) is given as the post-operative diagnosis only.

Figure 4

The position of squares represents the percentage of subjects with each outcome and bars the 95% confidence interval (95%CI). The size of the squares is weighted according to the size of the denominator (provided in supplementary material 6). Red squares represent scientific articles conducted in North Kivu and blue squares, conducted outside North Kivu. The indications in the scientific article by Michel (2019) are those provided as the post-operative diagnoses only.

Figure 5

Proportion of neonatal outcomes for each scientific article. The position of squares represents the percentage of subjects with each outcome and the bars, the 95% confidence intervals (95%CI). The size of the squares is weighted accorded to the size of the denominator (provided in supplementary material 6). Red squares represent scientific articles conducted in North Kivu and blue squares, conducted outside North Kivu. The asterisk (*) indicates the scientific articles for which the denominator is non-standard. The abnormal Apgar score in Kambale (2016) is defined as “moderate asphyxia or state of apparent death” and in Michel (2019) as <7 at 10 min.