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Piecing Together the Maternal Death Puzzle through Narratives: The Three Delays Model Revisited
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-cu...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2012
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3526530/ https://www.ncbi.nlm.nih.gov/pubmed/23284882 http://dx.doi.org/10.1371/journal.pone.0052090 |
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author | Combs Thorsen, Viva Sundby, Johanne Malata, Address |
author_facet | Combs Thorsen, Viva Sundby, Johanne Malata, Address |
author_sort | Combs Thorsen, Viva |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-3526530 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-35265302013-01-02 Piecing Together the Maternal Death Puzzle through Narratives: The Three Delays Model Revisited Combs Thorsen, Viva Sundby, Johanne Malata, Address PLoS One Research Article 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. Public Library of Science 2012-12-19 /pmc/articles/PMC3526530/ /pubmed/23284882 http://dx.doi.org/10.1371/journal.pone.0052090 Text en © 2012 Combs Thorsen et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Combs Thorsen, Viva Sundby, Johanne Malata, Address Piecing Together the Maternal Death Puzzle through Narratives: The Three Delays Model Revisited |
title | Piecing Together the Maternal Death Puzzle through Narratives: The Three Delays Model Revisited |
title_full | Piecing Together the Maternal Death Puzzle through Narratives: The Three Delays Model Revisited |
title_fullStr | Piecing Together the Maternal Death Puzzle through Narratives: The Three Delays Model Revisited |
title_full_unstemmed | Piecing Together the Maternal Death Puzzle through Narratives: The Three Delays Model Revisited |
title_short | Piecing Together the Maternal Death Puzzle through Narratives: The Three Delays Model Revisited |
title_sort | piecing together the maternal death puzzle through narratives: the three delays model revisited |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3526530/ https://www.ncbi.nlm.nih.gov/pubmed/23284882 http://dx.doi.org/10.1371/journal.pone.0052090 |
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