ArticleBMC pregnancy and childbirth2025
Assessing the impact of complex health systems strengthening programs on maternal health care utilization in fragile and conflict-affected states: evidence from the Democratic Republic of the Congo.
Article in BMC pregnancy and childbirth, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- Availability of essential medicines in conflict-affected african regions: a systematic review and meta-analysis.Conflict and health · 2026Review
- Midwives workload in the context of free maternal healthcare: a cross-sectional study based on the Workload Indicators of Staffing Needs (WISN) method in primary healthcare facilities in Kananga, Democratic Republic of the Congo.BMC health services research · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe maternal mortality ratio in the Democratic Republic of the Congo (DRC) remains among the highest globally. Despite ongoing investments in maternal health, there is only limited evidence on the effectiveness of health systems strengthening interventions in improving maternal health service quality and utilization in fragile settings. The study assesses the impact of a large, complex health systems strengthening program on maternal health care utilization in the DRC.
methodsA difference-in-differences approach was applied using population-based household survey data at baseline (2014) and endline (2017) from treatment and matched comparison areas in three provinces. The dependent variables were antenatal care (ANC) utilization and facility-based delivery. Additionally, qualitative data were analyzed to assess perceptions of maternal health care offered and identify barriers and strategies to improve care delivery.
resultsThe health systems strengthening program significantly increased the probability of facility-based delivery, but had no significant impact on receiving at least four ANC visits. Qualitative findings suggest that uptake of ANC was constrained by travel distance, time burdens, limited community outreach, and cultural norms discouraging early ANC initiation.
conclusionsFindings highlight the reliance on health centers and posts offering basic maternal services and limited accessibility of hospitals offering lifesaving comprehensive emergency obstetric care. This underscores the importance of formative research to inform interventions that align with social norms, address local barriers, and enhance the effectiveness of maternal health programs in fragile settings.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.