Integrating Indigenous Knowledge to Promote Antenatal Care and Prevent Obstetric Complications in Kinshasa: A Systematic Review

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