Applying the Three Delays Model to understand emergency care seeking and delivery in rural Bangladesh: a qualitative study

Shah, Bansari; Krishnan, Nandita; Kodish, Stephen; Yenokyan, Gayane; Fatema, Kaniz; Uddin, Kazi Burhan; Rahman, Aminur; Razzak, Junaid Abdul

doi:10.1136/bmjopen-2020-042690

Cited by 28 publications

(29 citation statements)

References 21 publications

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“…The three-delay model was developed by Thaddeus and Maine in 1994 to facilitate the identification of indirect factors, from the onset of obstetric complications to the birth of the baby [ 17 , 18 ]. Delay one is related to delay in deciding to seek care, which is commonly influenced by negative past experiences, late recognition of the problem, and financial problems [ 19 ]. Delay two, on the other hand, is related to identifying and reaching care, which is usually determined by the availability of transport and accessibility of the facility [ 20 – 22 ].…”

Section: Introductionmentioning

confidence: 99%

Area of focus to handle delays related to maternal death in Ethiopia

et al. 2022

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Background Maternal delay factors, together with medical factors, have a substantial role in determining maternity outcomes. Although several studies were conducted on delay factors that contribute to maternal death in Ethiopia, the studies were mostly focused either on an individual or at a provincial level factor with a limited number of study participants. In response to this gap, this study is aimed at exploring the magnitude and factors related to delay factors that contribute to maternal death in Ethiopia. Methods The study used maternal death surveillance data collected from different regions of Ethiopia, compiled between 2013 and 2021. A total of 4530 maternal deaths were reviewed during the study period. A Multilevel multinomial logistic regression model was applied to examine factors associated with delays related to maternal death. An adjusted relative risk ratio with a 95% confidence interval was stated and variables with p-values less than 0.05 were declared as significant predictors of maternal delay. Result Delay three (delay in receiving adequate and appropriate care once reached a health facility) has contributed to 36.3% of maternal deaths followed by delay one (delay in deciding to seek care when experiencing an obstetric emergency) and delay two (delay in reaching to an appropriate obstetric facility) where each of them contributed to 36.1% and 27.6% of maternal deaths respectively. In the multivariate multilevel multinomial model, maternal age, education status, and place of death were among the individual level factors associated with both delay two and delay three. Conversely, marital status and ANC follow-up were associated with delay two alone, while the timing of maternal death was associated with delay three. Residence and type of facility were provincial-level factors linked with both delay two and delay three, while the type of region was related to delay three of maternal death. Conclusion Both delay one and three have a major contribution to maternal death in Ethiopia. Individual and provincial level factors played an important role in determining delays related to maternal death. Therefore, it is crucial to account for measures that provide emphasis on the area of raising awareness on the utilization of Antenatal care (ANC) service, improving facility readiness to handle obstetrics emergencies, and narrowing down inequality among regions in service provision.

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Section: Introductionmentioning

confidence: 99%

Area of focus to handle delays related to maternal death in Ethiopia

et al. 2022

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“…Distribution of the mode of delivery among the women with complicated pregnancy was about 83.6% delivered by caesarean section and only 16.4% delivered by normal vaginal delivery. Among the women with complicated pregnancy 61.6% caesarean section were due to pregnancy complications, about 16…”

Section: Resultsmentioning

confidence: 99%

“…The cause of these huge percentage of caesarean sections were due to maximum number of the respondents having history of antenatal complications and many of them were referred from some other hospital after trial for normal vaginal delivery and some cesareans were done due to failed trial in the study place. Some study found that PROM was associated with high rate of caesarean section [16][17][18][19] . The mode of delivery of those study was also similar to this study.…”

Section: Dscussionmentioning

confidence: 99%

Mode of Delivery of Women with Complicated Pregnancy in a Tertiary Level Hospital in Bangladesh

Khan

Алам²,

Abdullah

et al. 2021

J. Armed Forces Med. Coll.

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Introduction: Every year, a great number of women die from pregnancy or childbirth related complications, which can be prevented. In developing countries, they don’t have access to maternal health services and cannot afford high quality care. Maternal death is usually occurs due to three delays: in decision making to seek care, reaching care and receiving care. Right decision at the right time regarding mode of delivery has a direct impact on healthy outcome of pregnancy as well as the maternal wellbeing. Objectives: To find out the outcome of complicated pregnancy. Materials and Methods: This cross-sectional observational study was conducted at obstetrics and gynaecology department of Dhaka Medical College Hospital from January to June 2011. Total 107 mothers who delivered recently with or without pregnancy complications were selected purposively. Data were collected by face to face interview with semi structured questionnaires. Verbal consents were taken prior to interview. Results: Among the respondents about 68.2% had antenatal complications and about 31.8% had no antenatal complication. Among the women having antenatal complications, 83.6% delivered by caesarean section and only 16.4% delivered by normal vaginal delivery. There was significant association of antenatal complications with mode of delivery by caesarean section. Conclusion: Women having antenatal complications had significant association with caesarean section. Though every pregnancy is at risk but early detection of complications, timely referral and timely intervention can save lives of many women during the process of child birth. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 31-34

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“…The model provides a useful framework to examine factors that influence the timely receipt of care at each stage. The Three Delays Model has been applied to understand the delays to care in other settings, including additional areas of maternal health, neonatal mortality, pediatric cancer, and emergency care seeking [16][17][18][19][20][21][22][23]. In each of these settings, the relative contribution of each of the different delays varied [16].…”

Section: Introductionmentioning

confidence: 99%

“…The Three Delays Model has been applied to understand the delays to care in other settings, including additional areas of maternal health, neonatal mortality, pediatric cancer, and emergency care seeking [16][17][18][19][20][21][22][23]. In each of these settings, the relative contribution of each of the different delays varied [16]. The Three Delays Model is a useful tool to map patient experiences and identify site-specific delays.…”

Section: Introductionmentioning

confidence: 99%

Three delays model applied to pediatric injury care seeking in Northern Tanzania: A mixed methods study

Keating

Sakita²,

Mmbaga³

et al. 2022

PLOS Glob Public Health

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Pediatric injuries are a leading cause of morbidity and mortality in low-and middle-income countries. Timely presentation to care is key for favorable outcomes. The goal of this study was to identify and examine delays that children experience between injury and receiving definitive care at a zonal referral hospital in Northern Tanzania. Between November 2020 and October 2021, we enrolled 348 pediatric trauma patients, collecting quantitative data on referral and timing information. In-depth interviews (IDIs) to explain and explore delays to care were completed with a sub-set of 30 family members. Data were analyzed according to the Three Delays Model. 81.0% (n = 290) of pediatric injury patients sought care at an intermediary facility before reaching the referral hospital. Time from injury to presentation at the referral hospital was 10.2 hours [IQR 4.8, 26.5] if patients presented first to clinics, 8.0 hours [IQR 3.9, 40.0] if patients presented first to district/regional hospitals, and 1.4 hours [IQR 0.7, 3.5] if patients presented directly to the referral hospital. In-hospital mortality was 8.2% (n = 30); 86.7% (n = 26) of these children sought care at an intermediary facility prior to reaching the referral hospital. IDIs revealed themes related to each delay. For decision to seek care (Delay 1), delays included emergency recognition, applying first aid, and anticipated challenges. For reaching definitive care (Delay 2), delays included caregiver rationale for using intermediary facilities, the complex referral system, logistical challenges, and intermediary facility delays. For receiving definitive care (Delay 3), wait time and delays due to treatment cost existed at the referral hospital. Factors throughout the healthcare system contribute to delays in receipt of definitive care for pediatric injuries. To minimize delays and improve patient outcomes, interventions are needed to improve caregiver and healthcare worker education, streamline the current trauma healthcare system, and improve quality of care in the hospital setting.

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Applying the Three Delays Model to understand emergency care seeking and delivery in rural Bangladesh: a qualitative study

Cited by 28 publications

References 21 publications

Area of focus to handle delays related to maternal death in Ethiopia

Area of focus to handle delays related to maternal death in Ethiopia

Mode of Delivery of Women with Complicated Pregnancy in a Tertiary Level Hospital in Bangladesh

Three delays model applied to pediatric injury care seeking in Northern Tanzania: A mixed methods study

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