Late recourse to care in case of fatal diseases in women

Mortality among women of childbearing age is high in the Congo and is caused by diseases that could have been controlled. How much of the excess mortality among women aged 15-49 in Kinshasa is due to delays in seeking care? Sixty women aged 18-49 who died between March and April 2004 were selected from two morgues in Kinshasa, excluding those whose death appeared inevitable. Qualitative analysis of the histories of the illnesses based on the files and the accounts of family members and community leaders sought to identify the behaviors related to the illness, the delays in seeking care and their determinants. Five explanatory hypotheses for delays were tested. Different delays were examined: delays in awareness of the danger, in the use of alternatives, in the decision to seek treatment, in referral to health services, and in the management and administration of treatment. The study confirmed that incorrect hazard perception and ineffective services are a major cause of delay. In the case of deaths, it highlights the major role of facility deficiencies. The Ministry of Health must improve the quality of care.