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Piecing Together the Maternal Death Puzzle Through Narratives: The Three Delays Model Revisited

By: Kate Mitchell, Manager of the MHTF Knowledge Management System, Women and Health Initiative

PLOS ONE recently published an article, Piecing Together the Maternal Death Puzzle through Narratives: The Three Delays Model Revisited, that explores various socio-cultural and facility-based factors that played a significant role in maternal deaths in the Lilongwe district of Malawi between January 2011 and June 2011.

Take a look at the abstract here:

Background
In Malawi maternal mortality continues to be a major public health challenge. Going beyond the numbers to form a more complete view of why women die is critical to improving access to and quality of emergency obstetric care. The objective of the current study was to identify the socio-cultural and facility-based factors that contributed to maternal deaths in the district of Lilongwe, Malawi.

Methods
Retrospectively, 32 maternal death cases that occurred between January 1, 2011 and June 30, 2011 were reviewed independently by two gynecologists/obstetricians. Interviews were conducted with healthcare staff, family members, neighbors, and traditional birth attendants. Guided by the grounded theory approach, interview transcripts were analyzed manually and continuously. Emerging, recurring themes were identified and excerpts from the transcripts were categorized according to the Three Delays Model (3Ds).

Results
Sixteen deaths were due to direct obstetric complications, sepsis and hemorrhage being most common. Sixteen deaths were due to indirect causes with the main cause being anemia, followed by HIV and heart disease. Lack of recognizing signs, symptoms, and severity of the situation; using traditional Birth Attendant services; low female literacy level; delayed access to transport; hardship of long distance and physical terrain; delayed prompt quality emergency obstetric care; and delayed care while at the hospital due to patient refusal or concealment were observed. According to the 3Ds, the most common delay observed was in receiving treatment upon reaching the facility due to referral delays, missed diagnoses, lack of blood, lack of drugs, or inadequate care, and severe mismanagement.

Read the full article here.

Categories: Maternal Health

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