Abstract
BackgroundThe three delays model proposes that maternal mortality is associated with delays in: 1) deciding to seek care; 2) reaching the healthcare facility; and 3) receiving care. Previously, the majority of women who died were reported to have experienced type 1 and 2 delays. With increased coverage of healthcare services, we sought to explore the relative contribution of each type of delay.Method151 maternal deaths were identified during a 12-month reproductive age mortality survey (RAMOS) conducted in Malawi; verbal autopsy and facility-based medical record reviews were conducted to obtain details about the circumstances surrounding each death. Using the three delays framework, data were analysed for women who had; 1) died at a healthcare facility, 2) died at home but had previously accessed care and 3) died at home and had not accessed care.Results62.2% (94/151) of maternal deaths occurred in a healthcare facility and a further 21.2% (32/151) of mothers died at home after they had accessed care at a healthcare facility. More than half of all women who died at a healthcare facility (52.1%) had experienced more than one type of delay. Type 3 delays were the most significant delay for women who died at a healthcare facility or women who died at home after they had accessed care, and was identified in 96.8% of cases. Type 2 delays were experienced by 59.6% and type 1 delays by 39.7% of all women. Long waiting hours before receiving treatment at a healthcare facility, multiple delays at the time of admission, shortage of drugs, non-availability and incompetence of skilled staff were some of the major causes of type 3 delays. Distance to a healthcare facility was the main problem resulting in type 2 delays.ConclusionThe majority of women do try to reach health services when an emergency occurs, but type 3 delays present a major problem. Improving quality of care at healthcare facility level will help reduce maternal mortality.
Highlights
The three delays model proposes that maternal mortality is associated with delays in: 1) deciding to seek care; 2) reaching the healthcare facility; and 3) receiving care
Efforts to reach the Millennium Development Goal (MDG) target in Malawi failed despite a significant increase in institutional deliveries and skilled attendance at birth from 51 and 55% in 1992 to 91 and 90% in 2015, respectively [4], Most maternal deaths are still
Facility-based maternal death reviews in Malawi revealed that 20 out of 28 maternal deaths were associated with healthcare provider factors which were avoidable and administrative failure [25]
Summary
The three delays model proposes that maternal mortality is associated with delays in: 1) deciding to seek care; 2) reaching the healthcare facility; and 3) receiving care. The three delays model developed by Thaddeus and Maine is the most common framework used to evaluate the circumstances surrounding a maternal death [7]. These are 1) delay in deciding to seek care, 2) delay in reaching a healthcare facility 3) delay in receiving care at the healthcare facility. Type 3 delays include factors affecting the speed with which effective care is provided once a woman reaches a healthcare facility; shortages of supplies, equipment, and trained personnel; competence of available personnel and quality of care
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