Mgawadere, Florence 
ORCID: 0000-0003-3341-9118, Unkels, Regine, Kazembe, Abigail and van den Broek, Nynke
(2017)
Factors associated with maternal mortality in Malawi: application of the three delays model.
BMC pregnancy and childbirth, 17 (1).
219-.
Abstract
<h4>Background</h4>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. 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.<h4>Method</h4>151 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.<h4>Results</h4>62.2% (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.<h4>Conclusion</h4>The 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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Humans, Cause of Death, Maternal Mortality, Pregnancy, Adolescent, Adult, Middle Aged, Health Facilities, Maternal Health Services, Health Services Accessibility, Patient Acceptance of Health Care, Malawi, Female, Young Adult, Maternal Death, Surveys and Questionnaires |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Population Health Faculty of Health and Life Sciences > Institute of Population Health > School of Health Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 05 Mar 2024 08:52 |
| Last Modified: | 05 Mar 2024 08:52 |
| DOI: | 10.1186/s12884-017-1406-5 |
| Open Access URL: | http://doi.org/10.1186/s12884-017-1406-5 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3179104 |
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