Keywords
indigenous knowledge
maternal health
obstetric complications
Sub-Saharan Africa
Kinshasa
systematic review
How to Cite
Abstract
Introduction
Indigenous knowledge significantly shapes healthcare-seeking behaviors among pregnant women across Sub-Saharan Africa. Its interaction with formal antenatal care (ANC) offers a strategic pathway to improving maternal health outcomes. However, synthesized scientific evidence evaluating its specific impact on promoting ANC utilization and preventing obstetric complications remains limited, particularly within the context of Kinshasa, Democratic Republic of the Congo (DRC).
Purpose
To systematically synthesize available evidence on the influence of indigenous knowledge on ANC service utilization and obstetric complication prevention, and to analyze the practical implications of these findings for the health system in Kinshasa, DRC.
Methods
Conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a comprehensive literature search was executed between February 1 and April 30, 2026. The search spanned PubMed, Web of Science, CINAHL, African Journals Online (AJOL), Google Scholar, and grey literature sources for studies published between 2011 and 2025. Out of 45 identified records, 42 underwent screening after duplicate removal, and 11 met all eligibility criteria. Methodological quality was evaluated using the Mixed Methods Appraisal Tool (MMAT, 2018). Due to study design and context heterogeneity, a qualitative thematic synthesis was performed.
Results
The included studies demonstrated overall moderate-to-high methodological quality. Three dominant operational themes emerged: (a) the structural role of community health actors, (b) cultural practices and beliefs surrounding pregnancy, and (c) indigenous recognition of obstetric danger signs. Indigenous knowledge exerted complex facilitating, inhibiting, or context-dependent influences on ANC timing and adherence.
Conclusion
Indigenous knowledge functions as a major determinant of maternal healthcare-seeking decisions in Sub-Saharan Africa. Culturally sensitive integration of beneficial community knowledge into national maternal health policies can enhance ANC uptake and strengthen early complication management. Empirical contextual studies within Kinshasa are urgently required to operationalize these collaborative frameworks locally. Systematic Review Registration: Open Science Framework (OSF) DOI: 10.17605/OSF.IO/XUJGM
References
Byrne, A., Morgan, A., & Soto, E. J. (2016). Engaging traditional birth attendants in maternal health: A systematic review. BMC Pregnancy and Childbirth, 16(1), Article 92. https://doi.org/10.1186/s12884-016-0920-1
Damus, K. (2015). Cultural influences on pregnancy and childbirth practices in African settings. International Journal of Gynecology & Obstetrics, 130(2), 123–127. https://doi.org/10.1016/j.ijgo.2015.03.012
Gora, N., Mavhandu-Mudzusi, A. H., & Sandy, P. T. (2021). The impact of socio-cultural practices on maternal health outcomes in sub-Saharan Africa. BMC Public Health, 21(1), Article 1023. https://doi.org/10.1186/s12889-021-11050-3
Hong, Q. N., Fàbregues, S., Bartlett, G., Boardman, F., Cargo, M., Dagenais, P., Gagnon, M. P., Griffiths, F., Nicolau, B., O'Cathain, A., Rousseau, C., Vedel, I., & Pluye, P. (2018). The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers. Education for Information, 34(4), 285–291. https://doi.org/10.3233/EFI-180221
Kouadio, I. K. (2017). Traditional beliefs and maternal healthcare utilization in West Africa. Health Policy and Planning, 32(8), 1120–1128. https://doi.org/10.1093/heapol/czx080
Leininger, M. (2002). Culture care theory: A major contribution to advance transcultural nursing knowledge and practices. Journal of Transcultural Nursing, 13(3), 189–192. https://doi.org/10.1177/10459602013003005
Markos, D., & Bogale, D. (2014). Maternal health care seeking behavior in Ethiopia: The role of cultural beliefs. Ethiopian Journal of Health Sciences, 24(1), 45–52. https://doi.org/10.4314/ejhs.v24i1.6
Mujinja, P., & Saronga, H. (2021). Integrating traditional medicine into formal health systems in Africa: Challenges and opportunities. African Health Sciences, 21(3), 1345–1353. https://doi.org/10.4314/ahs.v21i3.45
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., ... Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, Article n71. https://doi.org/10.1136/bmj.n71
Palamuleni, M. E. (2011). Socio-economic and cultural determinants of maternal health care in Africa. African Population Studies, 25(2), 347–365. https://doi.org/10.11564/25-2-220
Raymondville, M., Rodriguez, R., & Jean-Baptiste, E. (2020). Cultural barriers to maternal health care in rural Haiti. Global Public Health, 15(6), 879–892. https://doi.org/10.1080/17441692.2019.1704812
Rotheram-Borus, M. J., Tomlinson, M., Le Roux, I., & Stein, A. (2011). A cluster randomized controlled effectiveness trial evaluating perinatal home visiting among South African mothers. American Journal of Public Health, 101(6), 1099–1106. https://doi.org/10.2105/AJPH.2010.300009
UNICEF. (2022). Maternal and newborn health disparities report. United Nations Children's Fund.
Vyagusa, D. B., Mubyazi, G. M., & Masatu, M. C. (2013). Integrating traditional birth attendants into the formal health system in Tanzania. BMC Pregnancy and Childbirth, 13, Article 145. https://doi.org/10.1186/1471-2393-13-145
World Health Organization. (2023). Trends in maternal mortality 2000 to 2020: Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. World Health Organization.
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Copyright (c) 2026 Tshiama, C. R., Diwoto, D. J., Kabambi, T. F., Kulembidila, N. E., Mujinga, T. D., Lulendo, N. S., Amuli, J. J., Lofandjola, J., Mukandu, B. B. L. F.