Factors associated with maternal mortality in Malawi: application of the three delays model (original) (raw)
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In Zambia, it is estimated that in excess of 398 women every year die from pregnancy related complications out of every 100,000 live births. The lifetime risk of a woman dying from a pregnancy related complication is 1: 20. The largest contributor to this high number of maternal deaths from the national level perspective has long been considered to be the delay in deciding to seek maternal and obstetrical care at both household and community levels with very little attempts to explore on extent to which the third delay factors have contributed to the high numbers of maternal deaths that have continued to occur un averted in facilities serving s referral centres. This study therefore provided an assessment framework based on the Three Delay Model to explore and assess how the third delay was impacting on the current burden of maternal mortality in an urban setting of Kitwe District of Zambia. Method: The study was prospective cross-sectional descriptive study involving case file review of maternal deaths that occurred in the delivery facilities of Kitwe District (Hospital and Clinics). The Study Population included all women that had died from pregnancy related complications in the delivery centres of an urban district (Kitwe) of Zambia in 2014 and 2015. The study investigated 30 maternal deaths (25 reviewed cases and 5 unreviewed cases). Data was collected using an adapted 2004 WHO tool: Beyond the Numbers: Reviewing maternal deaths and complications to make pregnancy safer and the Country's Ministry of Health document: 'Beyond the Numbers; Maternal Death Review Forms. Results: The study revealed majority (56%) came from the low density areas within the age range of 25-29 years (50%). Majority (44%) were referred from health centres within the vicinity hospital, 22% accessed the facilities using their own means of transport. Referral response was poor with 50% of the deceased being evacuated after 3 hours following decision to transfer them from the attending local clinic. Most mothers (55%) came into the facility in a fully conscious state with normal vital signs. Haemorrhage following delivery (PPH) was the leading cause involving 44% of the diseased, followed by hypertensive disorders including eclamptic fits. Sepsis following incomplete abortion led to 22% of deaths with deaths occurring on average of 8hrs following admission to the facility. All attendant staff was skilled birth attendants. Conclusion: The three Delay Model provides such a frame work to explore and identify different barriers women face in accessing quality, timely and effective maternal health care services needed to prevent such deaths. Using this framework, this study has revealed that the burden of maternal deaths occurring in Kitwe District is mainly due to the factors related to the third delay causes of maternal deaths.
Three delay model: to find out the reason for maternal deaths
International Journal of Research in Medical Sciences, 2020
Background: Each year in India, roughly 28 million women experience pregnancy and 26 million have a live birth. Of these, an estimated 67,000 maternal deaths and one million new-born deaths occur each year. A woman dies as a result of complication arising during pregnancy and childbirth every 90 seconds in the world, and every 7 minutes in India. The three delay model can be used to find the causes of delays in relation to maternal deaths.Methods: A retrospective study was carried out in a tertiary care centre. All cases of maternal mortality between July 2010 to June 2016 were included in the study. Then data analysis was done.Results: Out of the total 382 maternal deaths, Majority of maternal deaths 43% were due to type 1 delay. 150 patients had delay in seeking help, 9 patients refused treatment and 5 patients refused admission to health care centre. 13% maternal deaths were due to type 3 delay which include delay in receiving adequate treatment, Delay in diagnosis and interventi...
Nursing Communications
Background: Maternal mortality is a prevalent issue in healthcare provision worldwide. It is particularly common in developing and underdeveloped countries, where maternal deaths during childbirth or pregnancy occur frequently. Various internal and external factors contribute to the high maternal mortality rate in specific regions. One model, known as the three delays model approach, examines three distinct causes that contribute to this problem. The first delay is the lack of awareness in seeking timely healthcare, the second delay involves obstacles in reaching healthcare facilities on time, and the third delay relates to poor or inadequate healthcare provision in tertiary care facilities. These delays are responsible for the elevated maternal mortality rates, with the prevalence of each delay varying across regions. Objective: The objective of this literature review is to examine and critically evaluate existing literature on perceptions and investigations regarding maternal mortality in Southeast Asia, Europe and Africa, utilizing the three delays model approach as a categorization framework. Method: This literature review followed BEME guide No. 3. A total of 18 articles were included in the sample after conducting a thorough search of various databases and search engines. A Prisma flowchart was created, and the articles were critically appraised. Results: A total of 18 articles focusing on different regions were analyzed. The findings revealed that in countries of Southeast Asia, the primary cause of maternal mortality is the first delay, which refers to the lack of awareness in seeking medical care. On the other hand, in Africa and other European countries, the second and third delays are more prominently associated with maternal mortality. Conclusion: Inadequate care is one of the major causes of maternal mortality in majority of regions acrossthe globe. Multiple factors can hinder access to appropriate healthcare. The three delays model plays a significant role in the higher maternal mortality rate. By raising awareness among women and their families about the importance of seeking healthcare, the risk of fatality can be reduced. Similarly, in developing regions, it is crucial to ensure that healthcare facilities are easily accessible and provide high-quality emergency obstetric care to meet the needs of pregnant women in critical situations.
A ten year analysis of maternal deaths in a tertiary hospital using the three delays model
BMC Pregnancy and Childbirth
Background Reducing maternal mortality ratios (MMRs) remain an important public health issue in Egypt. The three delays model distinguished three phases of delay to be associated with maternal mortality: 1) first phase delay is delay in deciding to seek care; 2) second phase delay is delay in reaching health facilities; and 3) third phase delay is delay in receiving care in health facilities. Increased health services’ coverage is thought to be associated with a paradigm shift from first and second phase delays to third phase delay as main factor contributing to MMR. This study aims to examine the contribution of the three delays in relation to maternal deaths. Methods During a 10 year period (2008–2017) 207 maternal deaths were identified in a tertiary hospital in Minia governorate, Egypt. Data were obtained through reviewing medical records and verbal autopsy for each case. Then data analysis was done in the context of the three delays model. Results From 2008 to 2017 MMR in this ...
Third delay of Maternal Mortality in a tertiary hospital
2007
Objective: To assess the magnitude, causes and substandard care factors responsible for the third delay of maternal mortality seen in our unit III, Department of Obstetrics and Gynecology, Civil Hospital, Karachi. Methods: This Cross-sectional, retrospective study was carried out on 152 mothers who died over a period of eight years from 1997 to 2004 at Civil Hospital Karachi. Death summaries of all maternal deaths were reviewed from death registers and were studied for substandard care factors which could have been responsible for the third delay of maternal mortality. Results: The frequency of maternal mortality was 1.3 per 100 deliveries. The mean age was 29±6.49 years and mean parity was 3.24±3.25.The main causes of death were hypertensive disorders in 52/152 (34.21%), hemorrhage in 40/152 (26.31%), unsafe abortion in 16/152 (10.52%), puerperal sepsis in 14/152 (9.21%) and obstructed labor in 11/152 (7.2%) cases. Substandard care factors were present in 76.7% of patients, which i...
Maternal death and delays in accessing emergency obstetric care in Mozambique
Background: Despite declining trends maternal mortality remains an important public health issue in Mozambique. The delays to reach an appropriate health facility and receive care faced by woman with pregnancy related complications play an important role in the occurrence of these deaths. This study aims to examine the contribution of the delays in relation to the causes of maternal death in facilities in Mozambique. Methods: Secondary analysis was performed on data from a national assessment on maternal and neonatal health that included in-depth maternal death reviews, using patient files and facility records with the most comprehensive information available. Statistical models were used to assess the association between delay to reach the health facility that provides emergency obstetric care (delay type II) and delay in receiving appropriate care once reaching the health facility providing emergency obstetric care (delay type III) and the cause of maternal death within the health facility. Results: Data were available for 712 of 2,198 maternal deaths. Delay type II was observed in 40.4% of maternal deaths and delay type III in 14.2%.and 13.9% had both delays. Women who died of a direct obstetric complication were more likely to have experienced a delay type III than women who died due to indirect causes. Women who experienced delay type II were less likely to have also delay type III and vice versa.
Introduction: The third delay is the delay in receiving adequate and appropriate treatment at the healthcare facility by mothers during and after pregnancy. Many factors attribute to this; shortage of staff, insufficient training, antibiotic unavailability and equipment among others. Objectives: The purpose of the study was to ascertain the preparedness of Arua regional referral hospital to handle referred emergency obstetrics cases. Methods: A qualitative contextual descriptive phenomenological design was used. A sample of six (6) carefully selected mothers and four (4) midwives were used. Triangulation of methods was used to enhance quality. Transcriptions of the interviews was analyzed using descriptive thematic analysis Findings: As per WHO criteria, Arua Regional Referral Hospital was rated as a fully functional EmOC facility. Out of the 6 respondent mothers, two had received Emergency Obstetric Care three times from the facility while the rest of them received EmOC more than 5times. When asked about history of having been referred out, non of them was referred out. Again, when asked about the outcome of all their deliveries, four out of 6 had good maternal outcomes whereas 2 had bad maternal outcomes. Conclusion: Arua RRH remains an EmOC Health Facility, falling in keeping with the World Health Organization standard as well as the Uganda national standard, although some improvements are still wanting. Recommendation: The hospital needs to embark on training other surrounding health facilities on EmOC. Keywords: Third delays, Emergency Obstetric Care (Basic and Comprehensive), Signal function, triangulation of methods, phenomenological study design and member checks.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: Maternal deaths are the social indicators of the human development and hence their place in MDGs and now in SDGs. Even though India has made a great stride in reducing maternal deaths, the differentials in the states are huge ranging from 46 to 237 maternal deaths per 100000 live births. The three delay model assesses the issues in the emergency obstetric care and upon which the interventions can be based to improve maternal health indicators.Methods: Retrospective record based observational study was carried out at an obstetrics and gynecology department of a tertiary care hospital located at Northern Maharashtra region. The records of deliveries, maternal deaths, age of the mothers, their time of presentation with obstetric complication, level of delay and the reason for delay were extracted for the period of 2011 to 2016. Three delays being, level I - delay in decision to seek care, level II - delay in identifying and reaching medical facility, level III - delay in re...
Factors associated with maternal delays in utilising emergency obstetric care in Arsi Zone, Ethiopia
South African Journal of Obstetrics and Gynaecology, 2019
Background. Delay to timely healthcare contributes to high maternal mortality and morbidity in developing countries. The so-called 'Three delays' model has been used extensively to investigate factors relating to maternal mortality. Objective. To investigate factors associated with delayed emergency obstetric care in Arsi Zone, Ethiopia. Methods. A cross-sectional study was conducted across 10 public health facilities in Arsi Zone, Ethiopia. The required sample size was calculated as 847, with the number of participants required at each facility determined proportionally. Results. Data from 775 respondents were used in the analysis. Approximately a quarter of respondents (n=203; 26.2%) reported a delayed decision to seek emergency obstetric care. The mean time for delay was 90 minutes (range 30 minutes-18 hours). Maternal age, educational level, monthly household income and antenatal visits were significant predictors of this first maternal delay. Close to a third of the respondents (n=234; 30.2%) reported a transport-related delay in reaching a healthcare facility; some respondents walked at least 30 minutes to reach the facility. Approximately a quarter of respondents (n=198; 25.5%) reported that they did not receive timely care after arriving at the healthcare facility. The mean delay was 42.3 minutes. Conclusion. The most common delay was related to difficulty in reaching the healthcare facility. In approximately half of the cases, the woman's husband took the decision to access medical care. This suggests limited independent decision-making power of women in this context. Such factors should be considered in efforts to reduce maternal morbidity and mortality.