Effect of home-based follow-up strategies for pregnant women lost to antenatal care (ANC) on the reduction of emergency cesarean sections in Mbandaka, Democratic Republic of the Congo.

Abstract

In the DRC, emergency cesarean sections account for nearly 50% of all interventions, often performed late, with high morbidity and mortality rates. This situation is explained by a lack of prenatal care, the low rate of prophylactic cesarean sections, and delays in treatment, leading to serious complications such as hemorrhages and infections. In Mbandaka, the emergency cesarean section rate reaches 62.7%, well above the recommended 10–15%. The abandonment of prenatal care (pregnant women lost to follow-up) exacerbates this risk. This study evaluates the impact of a community-based catch-up strategy, using home visits, to locate these women in order to convert emergencies into planned interventions or normal deliveries, and improve maternal safety. A quasi-experimental analytical mixed-methods study (January–December 2025) was conducted in three health zones, involving 384 women (340 in quantitative analysis, 54 in qualitative analysis). The primary outcome was emergency cesarean section. The results showed a rate of 8.2% among women who received catch-up cesarean sections versus 41.2% among those who did not (OR=0.128; p<0.001), representing an 87% risk reduction. After adjustment, community-based catch-up cesarean sections remained highly protective (OR=0.002; p<0.001), corresponding to a 99.8% risk reduction. An insufficient number of prenatal visits increased this risk twelvefold (OR=12.364; p<0.001), while at least one ultrasound was a protective factor (OR=0.089; p<0.001). In conclusion, community catch-up significantly reduces emergency cesarean sections and improves maternal safety.