Factors associated with maternal mortality in Malawi: application of the three delays model

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.

Triangulating data sources for further learning from and about the MDSR in Ethiopia: a cross-sectional review of facility based maternal death data from EmONC assessment and MDSR system

“…Delay 2 factors featured prominently as contributing to more than a third of the reviewed maternal deaths in both the MDSR and EmONC assessment. This finding is confirmed by other studies from Ethiopia, Malawi and Nigeria in which Delay 2 was found to contribute to 34.7 to 59.6% of maternal deaths [16,18,25,27]. Although the EmONC data failed to include specific aspects related to Delay 2, lack of transportation was found as the main contributor for Delay 2 according to the MDSR data.…”

Race, ethnicity, and socioeconomic factors in cholangiocarcinoma: What is driving disparities in receipt of treatment?

“…Studies using the Three Delays Model have found delays in reaching and receiving care to be most common, and that appears to be true in our population as well . Patients with Medicaid insurance or who were uninsured or low income were less likely to receive chemotherapy and surgery, and this is illustrative of this point.…”

Determinants of maternal deaths amongst mothers who suffered from post-partum haemorrhage: a community-based case control study

“…Our findings are in line with several other studies which identify these delays as an important cause of maternal death. 9,20 Poor utilization of health care during pregnancy in form of less than 4 ante-natal visits and home delivery are also found to be risk factors for maternal death in several studies. 21 Our study showed that the presence of anemia at the time of development of PPH raised the odds of death by five times.…”