Reach Health Facility Research Articles

Study of Maternal Mortality Risk Factor 2016 in Aceh Province

The studies goals was determine the cause of death from 3 factor of delaying that are the delaying in decision making, delaying in reaching health facility and delaying of getting adequate service in the health facilities. The study was conducted in 9 district /cities representing eastern, western and central in Aceh province and there was maternal mortality. Research start from April to Oktober 2016. The sample was all the mothers who experience death in 9 district/cities amounted to 45. Research instrument in the form of quistioner given to family, midwife, midwife coordinator and village head. Research design is deskriptif explorative. Maternal deaths 57.7% were used by bleeding during the pregnancy/childbirth. The mayority maternal death sare due to delays that occurring during pregnancy/childbirth, postpartum, either late in decision making (97.8 %), late referral (95.6%) and delayed access to health facilities (91.1%). Decision making by head of family is influenced by traditional beliefs so that it is the main factor of maternal mortality.
 Key word : Maternal death, late in decision making, late referral, delayed access ro health facilities.

Patient satisfaction in health care facility in hilly areas of Uttarakhand

Background: Patient satisfaction is a proxy indicator of the quality of doctor or hospital performance. The present study aimed at to assess the patient satisfaction in the outpatient department of rural and urban health training centre, Uttarakhand, North India.Methods: A hospital based cross sectional study. Simplified questionnaire was used for interviewing patients. For measurement of patient satisfaction in the outpatient department patient satisfaction questionnaire 18 was used with additional indices for nursing and paramedical staff.Results: A total of 200 patients participated in the study. Overall majority of them were females 112 (60%). Mean age of the patients was 40.4±19.5 years. Mean distance travelled to reach health facility was 13.5±21.6 km. The mean score for general satisfaction was 3.96±0.63, for financial aspects was 3.82±0.71, for accessibility and convenience was 3.81±0.65, for interpersonal manner of doctor 4.29±0.78, for communication of doctor 4.38±0.67, for technical quality was 4.05±0.58 and for time spent during the visit was 4.21±0.70. In the hierarchical stepwise multiple linear regression analysis the final model explained 85% of the variance in patient satisfaction.Conclusions: Overall, patients expressed satisfaction with the care provided. These ratings may reflect modest patients' expectations as well as acceptable circumstances and performance.

Introductory Remarks by Frauke Lachenmann and Astrid Wiik

The theme of the 2018 ASIL Annual Meeting was “International Law in Practice,” and nowhere does international law become more practical than in the attempt to rebuild and/or stabilize fragile and post-conflict states through the means of law. Over the last two decades, the rule of law has become a veritable panacea for the international community. As the World Justice Project claimed in 2014, “[w]here the rule of law is weak, medicines fail to reach health facilities, criminal violence goes unchecked, laws are applied unequally across societies, and foreign investments are held back.” The rule of law is no longer just a political ideal of checking power, it is also increasingly “a transnational industry worth multiple billions of dollars.” Multiple state donors, international organizations and nongovernmental organizations are involved in the business of building the rule of law.

Maternal mortality in Ghana: an exploration of partners’ perception about factors that contributed to their wife’s death

Background: Many programmes were put in place internationally and locally to curtail the menace of maternal mortality, but little achievement has been made in certain parts of the world, particularly in sub-Saharan Africa. A number of literatures exist, which investigate into the predisposing factors of maternal mortality in Ghana, however, no published evidence as the time of conducting this study explore the perception of men with respect to maternal mortality. This study aims to explore the perceptions of men who have lost their wives about the factors that contributed to their wife’s death in Accra, Ghana.Methods: A qualitative phenomenological approach was adopted, using an in-depth semi-structured interview conducted via a phone call, which was recorded and transcribed. Ten men participated in the study. The data was analysed using narrative synthesis through identification of themes/sub-themes. Results: It was identified that physical, cultural and socio-economic factors were responsible for the death of men’s wives on the course of pregnancy. The major physical factors include direct causes of maternal mortality notably haemorrhage, delay in reaching health facility and delay from the health facility. The cultural factors mainly include seeking care from unskilled attendants and use of traditional preparations to aid delivery. Lastly, poor socio-economic status was blamed by majority of the participants, which impedes them from accessing quality care within shortest period of time. Conclusions: Men perceived factors predisposing to maternal mortality in Accra, Ghana were avoidable with quality health care services and improved access to the health facilities.

Reasons for delay in decision making and reaching health facility among obstetric fistula and pelvic organ prolapse patients in Gondar University hospital, Northwest Ethiopia

BackgroundObstetric fistula and pelvic organ prolapse remain highly prevalent in sub-Saharan Africa, where women have poor access to modern health care. Women having these problems tend to stay at home for years before getting treatment. However, information regarding the reasons contributing to late presentation to treatment is scarce, especially at the study area.The objective of this study was to assess the reasons whywomen with obstetric fistula and pelvic organ prolapse at Gondar University Hospital delay treatment.MethodA hospital based cross-sectional study was conducted among 384 women. Delay was evaluated by calculating symptom onset and time of arrival to get treatment at Gondar University Hospital. Regression analysis was conducted to elicit predictors of delay for treatment.ResultOf the total 384 participants, 311 (80.9%) had pelvic organ prolapse and 73(19.1%) obstetric fistula. The proportion of women who delayed treatment of pelvic organ prolapse was 82.9% and that of obstetric fistula 60.9%. Fear of disclosing illness due to social stigma (AOR = 2; 1.03, 3.9) and lack of money (AOR = 1.97; 1.01, 3.86) were associated with the delay of treatment for pelvic organ prolapse,while increasing age (AOR =1.12; 1.01, 1.24) and divorce (AOR = 16.9; 1.75, 165.5) were were responsible for delaying treatment forobstetric fistula.ConclusionA large numberof women with pelvic organ prolapse and obstetric fistula delayed treatment. Fear of disclosure due to social stigma and lack of moneywere the major factors that contributed to thedelay to seek treatment for pelvic organ prolapse,while increasing age and divorce were the predictors for delaying treatment for obstetric fistula.

Saving life in the middle of the highway: an experience from rural Nepal

Abstract Among the three delays that play a pivotal role in increasing maternal mortality, delay in transportation is a major challenge for the uptake of services for pregnant women in remote areas of Nepal. Due to difficult terrain and the lack of adequate public transportation, women face difficulties in reaching health facilities and end up giving birth on the way unsafely. Here, I describe the struggle of a pregnant woman who started her journey to deliver at health facility, but never reached it. She remained helpless in the middle of the highway, where our team intervened and conducted her delivery right over there.

Factors that hinder or enable maternal health strategies to reduce delays in rural and pastoralist areas in Ethiopia.

To document factors that hinder or enable strategies to reduce the first and second delays of the Three Delays in rural and pastoralist areas in Ethiopia. A key informant study was conducted with 44 Health Extension Workers in Afar Region, Kafa Zone (Southern Nation, Nationalities and Peoples' Region), and Adwa Woreda (Tigray Region). Health Extension Workers were trained to interview women and ask for stories about their recent experiences of birth. We interviewed the Health Extension Workers about their experiences referring women for Skilled Birth Attendance and Emergency Obstetric and Newborn Care. Data were analysed using thematic analysis. Themes related to reducing the first delay, such as the tradition of home birth, decision-making, distance and unavailability of transport, did not differ between the three locations. Themes related to reducing the second delay differed substantially. Health Extension Workers in Adwa Woreda were more likely to call ambulances due to support from the Health Development Army and a functioning referral system. In Kafa Zone, some Health Extension Workers were discouraged from calling ambulances as they were used for other purposes. In Afar Region, few Health Extension Workers were called to assist women as most women give birth at home with Traditional Birth Attendants unless they need to travel to health facilities for Emergency Obstetric and Newborn Care. Initiatives to reduce delays can improve access to maternal health services, especially when Health Extension Workers are supported by the Health Development Army and a functioning referral system, but district (woreda) health offices should ensure that ambulances are used as intended.

Determinants of Low Maternal and Newborn Health Service Utilization in Haiti: A Community-Based Cross-Sectional Study

Background: Haiti suffers from among the world’s poorest maternal and newborn health (MNH) indicators and utilization of skilled MNH care remains alarmingly low. In 2013, Enfants du Monde (EdM) and Doctors of the World Switzerland initiated a project aiming to empower women and communities to improve MNH and increase demand for skilled care. During 2013 participatory community assessment (PCA) was conducted, followed by a cross-sectional baseline study in 2014 to better understand the situation and lay the groundwork for implementation of interventions. Methods: A cross-sectional design was adopted for the study, using a mixedmethods approach. The quantitative component consisted of a randomized survey of 320 women who had given birth during the previous year living in the intervention area. Qualitative methods included focus groups discussions with women (n=8) and male partners (n=2) and semi-structured interviews (n=10) with health workers. Results: The baseline study revealed a number of factors which contribute to low use of MNH services in Haiti, with lower utilization in rural compared to urban areas. Notably, while use of antenatal care (ANC) remains relatively high, with 83% of women receiving ANC 1, only 34% of women give birth in the presence of a skilled birth attendant. Awareness of maternal health needs remains low, with few respondents able to cite three danger signs during pregnancy (63%), birth (41%) and after birth (39%). FGDs with men revealed low knowledge, as well. Geographic and financial barriers remain important obstacles. In addition, women express low satisfaction regarding health services and interactions with providers. Discussion: These results of the study demonstrate that a number of factors come into play impacting on women’s decision to seek care, reach health facilities and obtain skilled MNH care once at health facilities. While geographic and financial barriers remain important, other obstacles are also critical, including the social status of women, preference of care from matrones—traditional birth attendants (TBA) practicing widely in Haiti, and low perceptions of the quality of care and treatment by health care professionals. Conclusion: These studies revealed a number of factors which contribute to preventing women and newborns from accessing MNH services. Effectively improving MNH in Haiti requires action at both the community- and health services-level to address the multitude of factors contributing to low utilization of services.

Prevalence and determinants of delay in diagnosis of pulmonary tuberculosis in Darjeeling district of West Bengal.

Background:Delayed diagnosis of tuberculosis (TB) is a significant problem both in individual as well as community level. Different studies around globe revealed that these diagnostic delays are attributed to both patient delay and health system-related delay.Aims:This study aims to assess the magnitude of delay in diagnosis and the association with sociodemographic profile among new sputum-positive pulmonary TB patients in Darjeeling district.Materials and Methods:A cross-sectional study was conducted among 374 TB patients from October 2011 to March 2012 using a predesigned pretested schedule by face-to-face interview.Statistical Analysis:Logistic regression analysis, odds ratios (OR), adjusted ORs.Results:Patient delay, health system delay and total diagnostic delay were 27 days, 20.1 days, and 20.6 days; mean delays were 23.64, 5.71, and 29.46 days, and median delays were 25, 5, and 32 days, respectively. Risk factors associated with patient delay were female gender, rural residence, illiteracy, smoking, alcohol consumption, taking two, or more alternate treatments; for health system delay were female sex, rural residence, time to reach health facility, time spent per visit; and for total diagnostic delay were female sex, alcoholism, and seeking more than two alternate treatment.Conclusions:The risk factors for delay identified may be the subject of future interventions.

Evidence-informed policymaking in practice: country-level examples of use of evidence for iCCM policy.

Integrated Community Case Management of Childhood Illness (iCCM) is a policy for providing treatment for malaria, diarrhoea and pneumonia for children below 5 years at the community level, which is generating increasing evidence and support at the global level. As countries move to adopt iCCM, it becomes important to understand how this growing evidence base is viewed and used by national stakeholders. This article explores whether, how and why evidence influenced policy formulation for iCCM in Niger, Kenya and Mozambique, and uses Carol Weiss’ models of research utilization to further explain the use of evidence in these contexts. A documentary review and in-depth stakeholder interviews were conducted as part of retrospective case studies in each study country. Findings indicate that all three countries used national monitoring data to identify the issue of children dying in the community prior to reaching health facilities, whereas international research evidence was used to identify policy options. Nevertheless, policymakers greatly valued local evidence and pilot projects proved critical in advancing iCCM. World Health Organization and United Nations Children's Fund (UNICEF) functioned as knowledge brokers, bringing research evidence and experiences from other countries to the attention of local policymakers as well as sponsoring site visits and meetings. In terms of country-specific findings, Niger demonstrated both Interactive and Political models of research utilization by using iCCM to capitalize on the existing health infrastructure. Both Mozambique and Kenya exhibit Problem-Solving research utilization with different outcomes. Furthermore, the persistent quest for additional evidence suggests a Tactical use of research in Kenya. Results presented here indicate that while evidence from research studies and other contexts can be critical to policy development, local evidence is often needed to answer key policymaker questions. In the end, evidence may not be enough to overcome resistance if the policy is viewed as incompatible with national goals.

Telemedicine implementation and benefits for quality and patient safety in Pakistan

Telemedicine is becoming an important aspect in developing countries to provide better health facilities. Rural areas in developing countries suffer due to lack of health facilities and face difficulties like time to reach health facilities at the faraway places, cost of reaching at a health care facility, and transportation needed to move around for the treatment/consulting purpose. Telemedicine could be used for safe and quality health by specialists at low cost in rural areas in Pakistan. Telemedicine services could be provided through video sharing, image sharing, mobile services or by e-mail. A research study was conducted to analyze the implementation and to explore the benefits of telemedicine in Pakistan. We distributed 150 questionnaires among teaching hospital doctors in city of Lahore, out of which we received 147 completed questionnaires. Three of the questionnaires were rejected due to incomplete information. The questionnaires were given to participants in the scheduled classes and collected at the end of class. Instructors were requested to allow students to complete questionnaires. The results showed 66.32% doctors of teaching hospital agreed to implement telemedicine for rural areas in Pakistan. 78.9% doctors agreed that telemedicine will save travelling time and money for availing expert opinion. However, 30.6% doctors agreed that Telemedicine will be beneficial for urban community – obtained the lowest score. The enhanced link between doctors and telemedicine can contribute to provide better health facilities in rural areas.

Why Do Women Deliver at Home? Multilevel Modeling of Ethiopian National Demographic and Health Survey Data

BackgroundDespite of the existing intensive efforts to improve maternal health in Ethiopia, the proportion of birth delivered at home remains high and is still the top priority among the national health threats.ObjectiveThe study aimed to examine effects of individual women and community-level factors of women’s decision on place of delivery in Ethiopia.MethodsData were obtained from the nationally representative 2011 Ethiopian Demographic and Health Survey (EDHS) which used a two-stage cluster sampling design with rural-urban and regions as strata. The EDHS collected data from a big sample size but our study focused on a sample of 7,908 women whose most recent birth was within five years preceding 2011 and 576 communities in which the women were living in. The data were analyzed using a two-level mixed-effects logistic regression to determine fixed-effects of individual- and community-level factors and random-intercept of between-cluster characteristics.ResultsIn the current study, 6980 out of 7908 deliveries (88.3%) took place at home. Lower educational levels (OR=2.74, 95%CI:1.84,4.70; p<0.0001), making no or only a limited number of ANC visits (OR=3.72,95%CI:2.85, 4.83; p<0.0001), non-exposure to media (OR=1.51, 95%CI 1.13, 2.01; p=0.004), higher parity (OR=2.68, 95%CI:1.96,3.68; p<0.0001), and perceived distance problem to reach health facilities (OR=1.29, 95%CI:1.03,1.62; p=0.022) were positively associated with home delivery. About 75% of the total variance in the odds of giving birth at home was accounted for the between-community differences of characteristics (ICC=0.75, p<0.0001). With regard to community-level characteristics, rural communities (OR=4.67, 95%CI:3.06,7.11; p<0.0001), pastoralist communities (OR=4.53, 95%CI:2.81,7.28; p<0.0001), communities with higher poverty levels (OR=1.49 95%CI:1.08,2.22; p=0.048), with lower levels of ANC utilization (OR=2.01, 95%CI:1.42,2.85; p<0.0001) and problem of distance to a health facility (OR=1.29, 95%CI:1.03,1.62; p=0.004) had a positive influence on women to give birth at home.ConclusionsNot only individual characteristics of women, but also community-level factors determine women’s decision to deliver at home.

Patient's Satisfaction with Health Care: a Questionnaire Study of Different Aspects of Care.

Aim.To determine the influence of sociodemographic factors on patients´ satisfaction with health care system.Methods.In a cross-sectional study, 1,995 patients from 12 municipalities of Zenica-Doboj Canton were interviewed after a visit to the practice. Individual interviews were conducted and the questionnaire was made on the basis of EUROPEP (European Task Force on Patient Evaluations of General Practice Care) standardized questionnaire.Results:Out of the total number patients, 47.1% were females, 47.9% were from urban population and median of age was 42.0 years (IQR = 30.0 to 53.0 years). The rural population was more likely to buy drugs for medical treatment (p < 0.001) and parenteral injections in primary care practice (p < 0.001). Patients with lower level of education were more likely: to be ordered for physical examination (p = 0.001), to buy drugs for medical treatment (p = 0.001), to buy parenteral injections in primary care practice (p < 0.001); to pay unofficially to someone from medical staff (p < 0.001); to feel that they could be better treated (p = 0.032) and they had longer waiting for health service in primary care practice (p < 0.001). Older population had better assessment of secondary (p = 0.040) and tertiary health care practices (p = 0.034); needed more time is needed to reach health facilities (p = 0.016), longer waiting for health service in primary care practice (p < 0.001); more likely to have health problems in the past 12 months but they did not request medical treatment (p = 0.008); more likely to be ordered for physical examination (p < 0.001); more likely to buy drugs for medical treatment (p = 0.004); more likely to buy parenteral injections in primary care practice (p < 0.001).Conclusion:The following variables: gender, age, overall perception of health status and financial status appear to be predictors of patients´ satisfaction.

Health workers' perceptions of facilitators of and barriers to institutional delivery in Tigray, Northern Ethiopia.

BackgroundEvidence shows that the three delays, delay in 1) deciding to seek medical care, 2) reaching health facilities and 3) receiving adequate obstetric care, are still contributing to maternal deaths in low-income countries. Ethiopia is a major contributor to the worldwide death toll of mothers with a maternal mortality ratio of 676 per 100,000 live births. The Ethiopian Ministry of Health launched a community-based health-care system in 2003, the Health Extension Programme (HEP), to tackle maternal mortality. Despite strong efforts, universal access to services remains limited, particularly skilled delivery attendance. With the help of ‘the three delays’ framework, this study explores health-service providers’ perceptions of facilitators and barriers to the utilization of institutional delivery in Tigray, a northern region of Ethiopia.MethodsTwelve in-depth interviews were carried out with eight health extension workers (HEWs) and four midwives. Each interview lasted between 90 and 120 minutes. Data were analysed through a thematic analysis approach.ResultsThree themes emerged from the analysis: the struggle between tradition and newly acquired knowledge, community willingness to deal with geographical barriers, and striving to do a good job with insufficient resources. These themes represent the three steps in the path towards receiving adequate institutional delivery care at a health facility. Of the themes, ‘increased community awareness’, ‘organization of the community’ and ‘hospital with specialized staff’ were recognized as facilitators. On the other hand, ‘delivery as a natural event’, ‘cultural tradition and rituals’, ‘inaccessible transport’, ‘unmet community expectation’ and ‘shortage of skilled human resources’ were represented as barriers to institutional delivery.ConclusionsThe participants in this study gave emphasis to the major barriers to institutional delivery that are closely connected with the three delays model. Despite the initiatives being implemented by the Tigray Regional Health Bureau, much is still needed to enhance the humanization approach of delivery care on a broader level of the region. A quick solution is needed to address the major issue of lack of transport accessibility. The poor capacity of the HEWs to provide delivery services, calls for reconsidering staffing patterns of remote health posts and readdressing the issue of downgraded health facilities would address unmet community needs.

What prevent women for a sustainable use of maternal care in two medical districts of Burkina Faso? A qualitative study.

IntroductionSkilled attendance is one of the major strategies to curtail maternal mortality, specifically in developing countries. Despite the low level of equipment, it is only in health facilities that skilled care are provided during pregnancy and childbirth; but there are some barriers which prevent women to use health facilities for good care.MethodsThis study was carried out in Ouargaye where a skilled care initiative was implemented by Family care International with the aim to increase the skilled attendance at delivery and Diapaga, the control district. Thirty (30) In-depth interviews, 8 Focus group discussions and 6 non participant observations were carried out. Participants were women from 15-49 years. All the interviews were tape-recorded, transcribed and analysed line by line. NVIVO was used to manage the interviews.ResultsFour types of barriers have been described by women; 1) the cultural barriers concern the low status of women in the two districts and some traditional beliefs which mean that women can not always decide to use health facility by themselves. 2) The geographical barrier is about the distance to reach health facility and the lack of transport means. 3) The financial barrier to pay care and drugs. 4) Bad organization of care and poor quality of care provided to women.ConclusionTo minimize the risk of complications during pregnancy and childbirth, it is important that women use health facilities. The barriers described by women are not insurmountable but needed to be integrated in a global comprehensive health policy.

WHAT IS THE CAUSE OF THE DECLINE IN MATERNAL MORTALITY IN INDIA? EVIDENCE FROM TIME SERIES AND CROSS-SECTIONAL ANALYSES

Summary Studies on the causes of maternal mortality in India have focused on institutional deliveries, and the association of socioeconomic and demographic factors with the decline in maternal mortality has not been sufficiently investigated. By using both time series and cross-sectional data, this paper examines the factors associated with the decline in maternal mortality in India. Relative effects estimated by OLS regression analysis reveal that per capita state net domestic product (-1.49611, p<0.05), poverty ratio (0.02426, p<0.05), female literacy rate (-0.05905, p<0.10), infant mortality rate and total fertility rate (0.11755, p<0.05) show statistically significant association with the decline in the maternal mortality ratio in India. The Barro-regression estimate reveals that improvements in economic and demographic conditions such as growth in state income (β=0.35020, p<0.05) and reduction in poverty (β=0.01867, p<0.01) and fertility (β=0.02598, p<0.05) have a greater association with the decline in the maternal mortality ratio in India than institutional deliveries (β=0.00305). The negative β-coefficient (β=-0.69578, p<0.05), showing the effect of the initial maternal mortality ratio on change in maternal mortality ratio in the Barro-regression model, indicates a greater decline in maternal mortality ratio in laggard states compared with advanced states. Overall, comparing the estimates of relative effects, the socioeconomic and demographic factors have a stronger statistically significant association with the maternal mortality ratio than institutional deliveries. Interestingly, the weak association between 'increase in institutional deliveries' and 'decline in maternal mortality ratio' suggests that merely increasing deliveries alone will not help in ensuring maternal survival in India. Quality of services provided by the health facility, birth preparedness and avoiding delay in reaching health facility are also important. Deliveries in health facilities will not necessarily translate into increased survival chances of mothers unless women receive full antenatal care services and delays in reaching health facility are avoided.

Factors Associated With Health System Delay in Accessing Pulmonary Tuberculosis Care in Gezira State, Sudan

Background: Tuberculosis (TB) is still a major cause of morbidity and mortality in both developed and developing countries. Delay in accessing tuberculosis care is associated with the highest densities of Mycobacterium tuberculosis (M. tuberculosis) bacilli on sputum smears. Objectives: The current study aimed to determine the extent of delay, and the major health system contributing factors to delays in the diagnosis and treatment of TB patients in Gezira state, Sudan. Patients and Methods: This study had a case-control design to explore the delay in the diagnosis and treatment of TB in Gezira state, Sudan. A cross-sectional phase was conducted to determine the extent of delay, and afterwards, a nested case-control phase was applied. Patients reporting a total delay which was longer than the median were considered as “cases”, whereas those with the total delay inferior to the median were considered as “controls”. The study population included the newly diagnosed (within 2 weeks) smear-positive pulmonary TB cases aged 15 years old and above, who attended the selected TB management units (TBMUs) during the study period. The sample size included 292 cases. Data were collected by a questionnaire and analyzed with statistical software. Results: The mean duration of total delay in accessing TB care was 65.6 days. Total delay was more prevalent in the general and private hospitals (73.8% and 64.7%, respectively), followed by the health centers (45.7%). Tuberculosis basic management units and chest hospitals showed the least delay in accessing TB care, ranging around 34% and 14.3%, respectively. Total delay in accessing TB care was more prevalent when the time and distance to reach the service was short. Conclusions: Total delay in TB care is too long (65.6 days) in average and occurs more frequently in the general and private hospitals. Total delay in TB care is more prevalent when the time to reach health facilities that provide TB services is short and the location in close proximity.

The Impact of Socio-Economic Conditions and Clinical Characteristics on Improving Childhood Care Seeking Behaviors for Families Living far from the Health Facility

Background: Lack of proper transportation and poor road infrastructure to the health facility act as a strong barrier for the adequate accessibility to healthcare services. There is lack of evidence based information particularly in Bangladesh examining the relationship between health care seeking behavior of mothers for their children with diarrhea and barriers such as distance to be travelled in reaching health facility. Objective: This study explored the factors that determine improving care seeking behaviors by the caregivers of under-5 children with diarrhea and also measured its impact due to living too far from a tertiary health facility in rural Bangladesh. Methodology: From January 2010 to December 2011, a total of 2,324 under-five children with diarrhea received treatment at Kumudini Womens’ Medical College and Hospital, Mirzapur, Tangail. Among them, 1,919 (83%) received treatment at home before coming to the health facility. Based on median value of 4 miles needed to travel, we divided distance into two groups: (i) >4 miles, (ii)≤4 miles. Results: Forty nine percent (n=1,144) of the diarrheal children presented to the facility from a distance of >4 miles and 86% of them received treatment at home before reporting to the hospital. Multivariate analysis revealed that age [aOR=0.72 (95% confidence interval;0.53, 0.99) p-value=0.042], longer distance [1.46 ( 1.15, 1.86) 0.002], onset of diarrhea (≥3days) [3.19 (2.37, 4.30) <0.001], stool frequency (>10 times/24 hours) [2.72 (2.05, 3.60) <0.001], presence of blood in stool [0.41 (0.31, 0.54) <0.001], vomiting [1.78 (1.38, 2.30) <0.001] and rotavirus infection [2.08 (1.49, 2.91) <0.001] were significantly associated with prior healthcare seeking behavior of children after controlling for other confounders. On the other hand, longer distance of the facility from home for children who received prior treatment was associated with children aged <2 years old [1.62 (1.26, 2.09) <0.001], electricity in the household [1.59 (1.23, 2.05) <0.001], vomiting [1.26 (1.03, 1.54) 0.028] and fever [1.42 (1.10, 1.83) 0.007] after adjusting for other co-variates. Conclusions: Longer distance of health facility delays seeking appropriate medical care from the facility rather parent seeks care from facilities to the next door of the locality. Clinical features such as fever, vomiting, and more stool frequency influence parents to get prior treatment before reporting to health facility, whether, presence of blood in stool influence parents in reporting directly to the health facility.

Three ‘Delays’ as a Framework for Critical Analysis of Maternal Near Miss and Maternal Mortality

ABSTRACT Objective The aim of the study was to assess the magnitude and causes of three delays and their possible implications for safe motherhood. Methods The cross-sectional prospective study was carried out over a period of 1 year from January to December 2010. All patients who fulfill the WHO criteria for maternal near miss and all cases of maternal death during this period were included in the study. The various factors responsible for the delays in accessing obstetrics care facilities at all the three levels were analyzed. Results During 1 year period there were 10,553 emergency admissions in labor room and there were 4538 deliveries, out of these 123 patients who fulfilled the WHO criteria for near miss were included in the study. 83% of patients (102) reported first delay in seeking care and the most common reason for delay was inability to judge the graveness of situation. After initial care there was a delay in reaching a facility with comprehensive obstetric care in 62% of cases (76 patients) and this delay was of around 6 to 8 hours. Once the patients reached Jinnah Hospital there was a delay in about 15 (12%) patients. There were 13 maternal deaths during this period of 1 year and there was a delay both at seeking initial care and referral by the initial care providers. Conclusion Delay in deciding to seek care (1st delay) was the major factors responsible for high maternal mortality and morbidity. So the role of community actors such as mothers in law, husbands, local healers and pharmacies and increased access to properly trained birth attendants need to be addressed if delays in reaching health facilities are to be shortened. How to cite this article Yunus S, Kauser S, Ali S. Three ‘Delays’ as a Framework for Critical Analysis of Maternal Near Miss and Maternal Mortality. J South Asian Feder Obst Gynae 2013;5(2):57-59.

Reasons rural Laotians choose home deliveries over delivery at health facilities: a qualitative study.

BackgroundMaternal mortality among poor rural women in the Lao People’s Democratic Republic (Lao PDR) is among the highest in Southeast Asia, in part because only 15% give birth at health facilities. This study explored why women and their families prefer home deliveries to deliveries at health facilities.MethodsA qualitative study was conducted from December 2008 to February 2009 in two provinces of Lao PDR. Data was collected through eight focus group discussions (FGD) as well as through in-depth interviews with 12 mothers who delivered at home during the last year, eight husbands and eight grandmothers, involving a total of 71 respondents. Content analysis was used to analyze the FGD and interview transcripts.ResultsObstacles to giving birth at health facilities included: (1) Distance to the health facilities and difficulties and costs of getting there; (2) Attitudes, quality of care, and care practices at the health facilities, including a horizontal birth position, episiotomies, lack of privacy, and the presence of male staff; (3) The wish to have family members nearby and the need for women to be close to their other children and the housework; and (4) The wish to follow traditional birth practices such as giving birth in a squatting position and lying on a “hot bed” after delivery. The decision about where to give birth was commonly made by the woman’s husband, mother, mother-in-law or other relatives in consultation with the woman herself.ConclusionThis study suggests that the preference in rural Laos for giving birth at home is due to convenience, cost, comfort and tradition. In order to assure safer births and reduce rural Lao PDR’s high maternal mortality rate, health centers could consider accommodating the wishes and traditional practices of many rural Laotians: allowing family in the birthing rooms; allowing traditional practices; and improving attitudes among staff. Traditional birth attendants, women, and their families could be taught and encouraged to recognize the signs of at-risk pregnancies so as to be able to reach health facilities on time.