Abstract
BACKGROUND: Maternal mortality remains alarmingly high in the Democratic Republic of Congo (DRC), particularly in rural areas where access to quality prenatal care is limited. Despite global efforts to improve maternal health, systemic gaps persist in the delivery of antenatal services. OBJECTIVE: The objective of this study is to assess the quality of first antenatal consultations in the Malemba Nkulu health zone and identify structural and procedural factors contributing to substandard care. METHODS: A cross-sectional descriptive study was conducted in November 2023 across 8 health facilities selected through simple random sampling. Data were collected from 248 pregnant women attending their first prenatal visit and from 14 health care providers. Quality indicators were assessed using a structured checklist based on World Health Organization (WHO) standards. Variables included provider qualifications, availability of diagnostic tools, and completeness of clinical assessments. RESULTS: Only 2% (5/248) of first antenatal consultations met the minimum quality standards. Major deficiencies included lack of physical examinations 78% (193/248), absence of essential laboratory tests 92% (228/248), and inadequate counseling 85% (212/248). Facilities lacked basic equipment such as blood pressure monitors and hemoglobin tests. Provider training was inconsistent, and community awareness of prenatal care remained low. CONCLUSIONS: The quality of first antenatal consultations in Malemba Nkulu is critically poor, reflecting broader systemic challenges in rural maternal health care. Strengthening provider training, improving infrastructure, and enhancing community engagement are essential to reduce maternal mortality and improve outcomes in resource-limited settings.