Abstract
Background Quality antenatal care (ANC) is essential for reducing maternal and neonatal risks. In the Nyarambe health zone of Ituri, Democratic Republic of the Congo (DRC), insecurity, resource shortages, and inadequate provider training undermine service delivery. This study assessed the proportion of facilities providing quality ANC and identified key factors influencing service quality in local maternity units. Methods A cross-sectional analytical study was conducted from March 4 to 30, 2025. Data were collected through structured interviews and direct observations. Logistic regression models were used to identify determinants of ANC quality, with statistical significance set at p < 0.05. Results Only 29.9% of facilities provided ANC classified as good quality. In multivariable analysis, ANC quality was significantly associated with provider training, which improved adherence to protocols (adjusted odds ratio, aOR = 0.58; p = 0.012), and with the performance of diagnostic tests, which enabled timely detection of complications (aOR = 2.14; p = 0.014). Drug availability also emerged as a strong predictor of service quality, with facilities maintaining adequate supplies more likely to deliver effective care (aOR = 0.72; p = 0.001). In contrast, the availability of basic equipment, although significant in bivariate analysis, was no longer associated with quality after adjustment (p = 0.234). Conclusions ANC quality in Nyarambe depends primarily on provider training, diagnostic capacity, and drug availability, while equipment alone appears insufficient. Strengthening professional development, ensuring reliable diagnostic services, and securing consistent drug supplies—supported by improved governance and supervision—are essential to enhance ANC quality in fragile health systems.