Impact of Maternal and Neonatal Factors on Mortality in the First Six Weeks of Life: A Comprehensive Cohort Study in Kinshasa City, DR Congo

Abstract Background The Democratic Republic of Congo (DRC) is among the sub-Saharan African countries with a high neonatal mortality rate. Various interventions have been implemented to reduce this mortality rate, including the establishment of free maternity policy. This study evaluated the neonatal and maternal factors influencing infant mortality at 42 days of life. Method A prospective cohort study was conducted on infants recruited between March and July 2024 from maternity wards in Kinshasa, DRC. The cohort was followed for up to 6 weeks with home visits. The statistical analysis used Kaplan-Meier and adjusted Cox models, with proportionality verification. Missing data were imputed using multiple imputation according to Rubin's rules. Results Among a cohort of 2,383 infants followed, 3.2% had a low Apgar score and 96.8% had a normal Apgar score. A total of 52 infants (2.2%) died during the follow-up period. At 6 weeks, the cumulative mortality rate was 19.7% in infants with an Apgar score