BACKGROUND Despite efforts to achieve the Millennium Development Goals, the maternal mortality ratio in the Democratic Republic of Congo was 693 per 100,000 in 2015-the 6th highest in the world and higher than the average (547 per 100,000) in sub-Saharan Africa. Antenatal care (ANC) service is a cost-effective intervention for reducing the maternal mortality ratio in low-income countries. This study aimed to identify the intervention effect of the maternal and child health care (MCH) project on the use of four or more (4+) ANC services. METHODS The MCH project was implemented using the three delays model in Kenge city by the Ministry of Public Health (MoPH) of the DRC with technical assistance from Korea International Cooperation Agency (KOICA) and the Yonsei Global Health Center from 2014 to 2017. Furthermore, Boko city was selected as the control group. A baseline and an endline survey were conducted in order to evaluate the effectiveness of this project. We interviewed 602 and 719 participants in Kenge, and 150 and 614 participants in Boko in the baseline and endline surveys, respectively. We interviewed married reproductive-aged women (19-45 years old) in both cities annually. The study instruments were developed based on the UNICEF Multiple Indicator Cluster Surveys. This study used the homogeneity test and the binary logistic regression difference-in-differences method of analysis. RESULTS The odds of reproductive-aged women's 4+ ANC service utilization at the intervention site increased 2.280 times from the baseline (OR: 2.280, 95% CI: 1.332-3.902, p = .003) as compared to the control site. CONCLUSIONS This study showed that the KOICA MCH project effectively increased the 4+ ANC utilization by reproductive-aged women in Kenge. As the 4+ ANC services are expected to reduce maternal deaths, this project might have contributed to reducing maternal mortality in Kenge. In the future, we expect these findings to inform MCH policies of the MoPH in the DRC.

中文翻译：

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刚果民主共和国基于社区的4+产前保健母婴健康项目：差异分析。

背景知识尽管为实现千年发展目标做出了努力，但刚果民主共和国的孕产妇死亡率在2015年为693/10万，居世界第六位，高于撒哈拉以南非洲地区的平均死亡率（547/10万）。产前保健（ANC）服务是一种经济有效的干预措施，可降低低收入国家的孕产妇死亡率。这项研究旨在确定母婴保健（MCH）项目对使用四个或更多（4+）ANC服务的干预效果。方法2014年至2017年，刚果民主共和国公共卫生部（MoPH）在韩国国际合作署（KOICA）和延世全球卫生中心的技术援助下，利用三延迟模型在肯格市实施了MCH项目。博科市被选为对照组。为了评估该项目的有效性，进行了基线和最终调查。在基线调查和最终调查中，我们分别采访了Kenge的602位和719位参与者以及Boko的150位和614位参与者。我们每年都在这两个城市采访已婚育龄妇女（19-45岁）。研究工具是根据儿童基金会多指标类集调查而开发的。本研究采用同质性检验和二元logistic回归差异分析法。结果与对照组相比，干预地点的育龄妇女使用4+ ANC服务的几率比基线提高了2.280倍（或：2.280，95％CI：1.332-3.902，p = .003）。结论这项研究表明，KOICA MCH项目有效地提高了Kenge育龄妇女4+的ANC利用率。由于预计将有4个以上的ANC服务减少孕产妇死亡，因此该项目可能有助于降低Kenge的孕产妇死亡率。将来，我们希望这些发现可以为MCH政策提供有关DRC中MoPH的信息。