Determinants of maternal mortality in the Province of Maniema, Democratic Republic of the Congo.

Maternal mortality remains a major public health problem in the Democratic Republic of the Congo. This case-control study, conducted in four health zones of the province of Maniema, aimed to identify the independent determinants of maternal death. A total of 197 maternal death cases were matched with 394 controls (surviving women). Multivariate analysis showed that lack of attendance at antenatal care visits, non-use of the partograph, receiving antenatal consultations in community health centers, as well as delivery in these facilities, were significant risk factors for maternal mortality. In contrast, the age group of 18 to 34 years, absence of delay in decision-making, and good knowledge of obstetric danger signs were protective factors. The main direct causes of death were hemorrhage, complicated abortions, and anemia. These results highlight the need to strengthen the quality of antenatal and obstetric care, as well as community-based interventions.