Background
Methods
Setting
Identification of maternal deaths
Review of maternal deaths
-
Care received during pregnancy and delivery
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Decision making process regarding seeking health care (if care accessed)
-
History of journey to healthcare facility (if the woman accessed a healthcare facility)
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Referral status and treatment at the referral facility
-
Reasons for seeking care
-
Reasons for not seeking care for those who died at home
Application of the three delays model
Delay 1 – Decision to seek care | Delay 2 – Reaching care | Delay 3 – Receiving care |
---|---|---|
Low status (woman not financially independent or husband not available) | No healthcare facility in the area. (takes more than one hour to reach healthcare facility) | Long waiting time before treatment was received (more than 30 min from the time of arrival to time of being assessed or receiving treatment) |
Lack of awareness of obstetric complications | Long travel time from home to a healthcare facility (more than an hour) | Shortage of equipment and supplies |
Nearest healthcare facility is more than 1 km away | Cost of transportation | Wrong assessment of risk, wrong diagnosis, wrong treatment |
Uneventful previous home delivery | Poor road condition or terrain | Shortage of healthcare providers |
The family has insufficient money | Visited a traditional healer or traditional birth attendant first | Lack of competence or skills among the available healthcare providers |
Poor experience of previous health care received at a healthcare facility | Healthcare provider unavailable | |
Perceived poor quality of care at a the healthcare facility | Inadequate referral system, (ambulances not available, no fuel, breakdown and use of public transport) | |
Avoiding admission and long stay (more than two days) at a healthcare facility | Lack of treatment guidelines e.g. Pre-eclampsia, PPH, manual removal of placenta etc |
Ethical approval
Results
Socio demographic characteristics
Women who died at a healthcare facility
Reasons for type 3 delays
Type of delay | Reason for the delay | Number of women | Percentage (%)a
|
---|---|---|---|
Women who died at a healthcare facility (n = 94) | |||
Type 3 Delay (n = 91) | Long waiting time before treatment at a healthcare facility | 89 | 94.7 |
Shortage of equipment and supplies | 62 | 66 | |
Wrong assessment of risk, wrong diagnosis, wrong treatment | 48 | 51.1 | |
Inadequate referral system | 36 | 40.4 | |
Lack of competence on EmOC among the available personnel | 27 | 28.7 | |
Staff unavailable | 22 | 23.4 | |
Shortage of trained staff | 15 | 16 | |
Lack of treatment guidelines | 12 | 12.7 | |
Type 2 Delay (n = 56) | Long travel time from home to a healthcare facility | 49 | 52.1 |
High cost of transportation | 37 | 39.4 | |
Poor road condition or terrain, difficulty crossing rivers | 17 | 18.1 | |
Visited a traditional healer first or traditional birth attendant | 14 | 25.5 | |
Lack of a healthcare facility in the area | 7 | 7.4 | |
Type 1 Delay (n = 37) | Lack of awareness of obstetric complications | 20 | 21.3 |
Low income of the family | 16 | 17 | |
Visited a traditional healer | 14 | 14.9 | |
Do not want to stay long at a healthcare facility | 13 | 13.8 | |
Low status of a woman (not financially empowered or husband not available) | 11 | 11.7 | |
Long distance to a healthcare facility | 7 | 7.4 | |
Bad experience with previous health care | 5 | 5.3 | |
Uneventful home delivery previously | 4 | 4.2 | |
Perceived poor quality of care at a healthcare facility | 3 | 3.1 | |
Women who had accessed care at a healthcare facility but died at home (n = 32) | |||
Type 3 Delay (n = 30) | Long waiting time before treatment at a healthcare facility | 26 | 81.3 |
Shortage of drugs | 17 | 53.1 | |
Staff unavailable | 13 | 40.6 | |
Shortage of trained staff | 7 | 21.9 | |
Inadequate referral system | 5 | 15.6 | |
Type 2 Delay (n = 11) | Long travel time from home to a healthcare facility | 7 | 21.8 |
Lack of a healthcare facility in the area | 5 | 15.6 | |
Cost of transportation | 4 | 12.5 | |
Poor road condition or terrain, difficulty crossing rivers | 3 | 9.3 | |
Type 1 Delay (n = 9) | Lack of awareness of obstetric complications | 7 | 21.9 |
Low income of the family | 6 | 18.8 | |
Bad experience with previous health care | 6 | 18.8 | |
Perceived poor quality of care at a healthcare facility | 5 | 15.6 | |
Low status of a woman (not financially empowered or husband not available) | 4 | 12.5 | |
Uneventful previous home delivery | 3 | 9.4 | |
Women who did not access care and died at home (n = 25) | |||
Type 1 Delay | Perceived poor quality of care at a healthcare facility | 16 | 64 |
Lack of awareness of obstetric complications | 13 | 52 | |
Uneventful previous home delivery | 9 | 36 | |
Bad experience with the previous health care | 8 | 32 | |
Low status of a woman (not financially empowered or husband not available) | 8 | 32 | |
Long distance to a healthcare facility | 4 | 16 | |
Low financial status of the family | 3 | 12 |
Pattern of delay by healthcare facility level
Reasons for Type 3 Delay | No of women at hospital level | Number of women at health centre level | Totala
|
---|---|---|---|
Long waiting time before treatment at a healthcare facility | 75 | 24 | 89a
|
Shortage of equipment and supplies | 45 | 50 | 62a
|
Wrong assessment of risk, wrong diagnosis, wrong treatment | 20 | 36 | 48a
|
Inadequate referral system | 2 | 34 | 36 |
Lack of competence on EmOC among the available personnel | 3 | 24 | 27 |
Staff unavailable | 4 | 21 | 22a
|
Shortage of trained staff | 9 | 12 | 15a
|
Lack of treatment guidelines | 0 | 12 | 12 |
Reasons for type 2 delays
Reasons for type 1 delays
Women who died at home
Delays experienced by women who sought care and later died at home
Reason | Number of women (%) | Place of care | |
---|---|---|---|
Hospital (%) | Health centre (%) | ||
Foul smelling discharge after delivery | 8 (25) | 1 (10) | 7 (31.8) |
Dizziness during pregnancy | 5 (15.6) | 3 (30) | 2 (9.2) |
Bleeding in pregnancy | 4 (12.5) | 1 (10) | 3 (13.6) |
PPH | 4 (12.5) | 1 (10) | 3 (13.6) |
Delivery | 4 (12.5) | 2 (20) | 2 (9.2) |
Malaria in pregnancy | 2 (6.3) | 0 (0) | 2 (9.2) |
One week postnatal check up | 2 (6.3) | 1 (10) | 1 (4.5) |
Loss of body weight | 1 (3.1) | 1 (10) | 0 (0.0) |
ART supply | 1 (3.1) | 0 (0) | 1 (4.5) |
Antenatal care | 1 (3.1) | 0 | 1 (4.5) |
Total | 32 | 10 (100) | 22 (100) |