Transitioning from the "Three Delays" to a focus on continuity of care: a qualitative analysis of maternal deaths in rural Pakistan and Mozambique.
Cause of death
Continuity of patient care
Developing countries
Maternal health
Maternal mortality
Narrative analysis
Postnatal period
Quality of health care
Journal
BMC pregnancy and childbirth
ISSN: 1471-2393
Titre abrégé: BMC Pregnancy Childbirth
Pays: England
ID NLM: 100967799
Informations de publication
Date de publication:
23 Oct 2023
23 Oct 2023
Historique:
received:
10
01
2023
accepted:
07
10
2023
medline:
27
10
2023
pubmed:
24
10
2023
entrez:
23
10
2023
Statut:
epublish
Résumé
The Three Delays Framework was instrumental in the reduction of maternal mortality leading up to, and during the Millennium Development Goals. However, this paper suggests the original framework might be reconsidered, now that most mothers give birth in facilities, the quality and continuity of the clinical care is of growing importance. The paper explores the factors that contributed to maternal deaths in rural Pakistan and Mozambique, using 76 verbal autopsy narratives from the Community Level Interventions for Pre-eclampsia (CLIP) Trial. Qualitative analysis of these maternal death narratives in both countries reveals an interplay of various influences, such as, underlying risks and comorbidities, temporary improvements after seeking care, gaps in quality care in emergencies, convoluted referral systems, and arrival at the final facility in critical condition. Evaluation of these narratives helps to reframe the pathways of maternal mortality beyond a single journey of care-seeking, to update the categories of seeking, reaching and receiving care. There is a need to supplement the pioneering "Three Delays Framework" to include focusing on continuity of care and the "Four Critical Connection Points": (1) between the stages of pregnancy, (2) between families and health care workers, (3) between health care facilities and (4) between multiple care-seeking journeys. NCT01911494, Date Registered 30/07/2013.
Sections du résumé
BACKGROUND
BACKGROUND
The Three Delays Framework was instrumental in the reduction of maternal mortality leading up to, and during the Millennium Development Goals. However, this paper suggests the original framework might be reconsidered, now that most mothers give birth in facilities, the quality and continuity of the clinical care is of growing importance.
METHODS
METHODS
The paper explores the factors that contributed to maternal deaths in rural Pakistan and Mozambique, using 76 verbal autopsy narratives from the Community Level Interventions for Pre-eclampsia (CLIP) Trial.
RESULTS
RESULTS
Qualitative analysis of these maternal death narratives in both countries reveals an interplay of various influences, such as, underlying risks and comorbidities, temporary improvements after seeking care, gaps in quality care in emergencies, convoluted referral systems, and arrival at the final facility in critical condition. Evaluation of these narratives helps to reframe the pathways of maternal mortality beyond a single journey of care-seeking, to update the categories of seeking, reaching and receiving care.
CONCLUSIONS
CONCLUSIONS
There is a need to supplement the pioneering "Three Delays Framework" to include focusing on continuity of care and the "Four Critical Connection Points": (1) between the stages of pregnancy, (2) between families and health care workers, (3) between health care facilities and (4) between multiple care-seeking journeys.
TRIAL REGISTRATION
BACKGROUND
NCT01911494, Date Registered 30/07/2013.
Identifiants
pubmed: 37872504
doi: 10.1186/s12884-023-06055-w
pii: 10.1186/s12884-023-06055-w
pmc: PMC10594808
doi:
Banques de données
ClinicalTrials.gov
['NCT01911494']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
748Subventions
Organisme : Bill and Melinda Gates Foundation
ID : OPP1017337
Investigateurs
Esperança Sevene
(E)
Eusébio Macete
(E)
Khátia Munguambe
(K)
Charfudin Sacoor
(C)
Anifa Vala
(A)
Helena Boene
(H)
Felizarda Amose
(F)
Rosa Pires
(R)
Zefanias Nhamirre
(Z)
Marta Macamo
(M)
Rogério Chiaú
(R)
Analisa Matavele
(A)
Faustino Vilanculo
(F)
Ariel Nhancolo
(A)
Silvestre Cutana
(S)
Ernesto Mandlate
(E)
Salésio Macuacua
(S)
Cassimo Bique
(C)
Sibone Mocumbi
(S)
Emília Gonçálves
(E)
Sónia Maculuve
(S)
Ana Ilda Biz
(AI)
Dulce Mulungo
(D)
Orvalho Augusto
(O)
Paulo Filimone
(P)
Vivalde Nobela
(V)
Corsino Tchavana
(C)
Cláudio Nkumbula
(C)
Rahat Qureshi
(R)
Zulfiqar A Bhutta
(ZA)
Zahra Hoodbhoy
(Z)
Farrukh Raza
(F)
Sana Sheikh
(S)
Javed Memon
(J)
Imran Ahmed
(I)
Amjad Hussain
(A)
Mrutunjaya B Bellad
(MB)
Umesh S Charantimath
(US)
Shivaprasad S Goudar
(SS)
Geetanjali M Katageri
(GM)
Avinash J Kavi
(AJ)
Amit P Revankar
(AP)
Ashalata A Mallapur
(AA)
Umesh Y Ramdurg
(UY)
Shashidhar G Bannale
(SG)
Vaibhav B Dhamanekar
(VB)
Geetanjali I Mungarwadi
(GI)
Narayan V Honnungar
(NV)
Bhalachandra S Kodkany
(BS)
Anjali M Joshi
(AM)
Uday S Kudachi
(US)
Sphoorthi S Mastiholi
(SS)
Chandrappa C Karadiguddi
(CC)
Gudadayya S Kengapur
(GS)
Namdev A Kamble
(NA)
Keval S Chougala
(KS)
Jeffrey Bone
(J)
Dustin T Dunsmuir
(DT)
Sharla K Drebit
(SK)
Chirag Kariya
(C)
Tang Lee
(T)
Jing Li
(J)
Mansun Lui
(M)
Beth A Payne
(BA)
Diane Sawchuck
(D)
Sumedha Sharma
(S)
Domena K Tu
(DK)
Ugochi V Ukah
(U)
Laura A Magee
(LA)
JMark Ansermino
(J)
Ana Pilar Betrán
(AP)
Richard Derman
(R)
Shafik Dharamsi
(S)
France Donnay
(F)
Sharla Drebit
(S)
Guy Dumont
(G)
Susheela M Engelbrecht
(SM)
Veronique Fillipi
(V)
Tabassum Firoz
(T)
William Grobman
(W)
Marian Knight
(M)
Ana Langer
(A)
Simon Lewin
(S)
Craig Mitton
(C)
Nadine Schuurman
(N)
Andrew Shennan
(A)
Joel Singer
(J)
Jim Thornton
(J)
Hubert Wong
(H)
Olalekan O Adetoro
(OO)
Khátia Munguambe
(K)
John O Sotunsa
(JO)
Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
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