Meeting the community halfway to reduce maternal deaths? Evidence from a community-based maternal death review in Uttar Pradesh, India

Raj, Sunil Saksena; Maine, Deborah; Sahoo, Pratap Kumar; Manthri, Suneedh; Chauhan, Kavita

doi:10.9745/ghsp-d-12-00049

Cited by 11 publications

(13 citation statements)

References 11 publications

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“…Neither time of the emergency, nor location of the pregnant woman, or cost should be factors dissuading families from calling for public referral transport services (31). More than half of the families claim out-of-pocket expenses for transportation and medicines (25). Our study finding corroborates findings such as the reasons given by families for not seeking care; the most common reason was the lack of available transportation.…”

Section: Place Of Death Taken To 1 Facility (%) Taken To 2 Facilitiessupporting

confidence: 82%

“…To address this issues, the government of UP may adopt any of the existing models of public referral transport system. However, it is imperative to upgrade the current emergency transport system based on existing IPHS guidelines and bridge the gap in inter-facility transport as needed for Unnao district and the state (12,16,23,25). More importantly, the context and implementation of the public referral transport system should ensure accessibility, availability and readiness.…”

Section: Way Forward For Creating Better Public Referral Transport Sementioning

confidence: 99%

“…The data was collected by six trained social researchers in the field for about three weeks. A detailed methodology has been reported separately by the authors including detailed sample selection strategy and data collection methods was published elsewhere (25). Descriptive analysis was carried out to represent the facility review data.…”

Section: Data Collection and Analysismentioning

confidence: 99%

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Emergency referral transport for maternal complication: lessons from the community based maternal death audits in Unnao district, Uttar Pradesh, India

Raj

Manthri

Sahoo

2015

Int J Health Policy Manag

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Background: An effective emergency referral transport system is the link between the home of the pregnant woman and a health facility providing basic or comprehensive emergency obstetric care. This study attempts to explore the role of emergency transport associated with maternal deaths in Unnao district, Uttar Pradesh (UP). Methods: A descriptive study was carried out to assess the causes of and factors leading to maternal deaths in Unnao district, UP, through community based Maternal Death Review (MDR) using verbal autopsy, in a sample of 57 maternal deaths conducted between June 1, 2009, and May 31, 2010. A facility review was also conducted in 15 of the 16 block level and district health facilities to collect information on preparedness of the facilities for treating obstetric complications including referral transportation. A descriptive analysis was carried out using ratios and percentages to analyze the availability of basic facilities which may lead to maternal deaths. Results: It was found that there were only 10 ambulances available at 15 facilities against 19 required as per Indian Public Health Standards (IPHS). About 47% of the deaths took place in a facility, 30% enroute to a health facility and 23% at home. Twenty five percent of women were taken to one facility, 32% were taken to two facilities, and 25% were taken to three facilities while 19% were not taken to any facility before their death. Sixteen percent of the pregnant women could not arrange transportation to reach any facility. The mean time to make arrangements for travel from home to facility-1 and facility-2 to facility-3 was 3.1 hours; whereas from facility-1 to facility-2 was 9.9 hours. The mean travel time from home to facility-1 was 1 hour, from facility-1 to facility-2 was 1.4 hours and facility-2 to facility-3 was 1.6 hours. Conclusion:The public health facility review and MDR, clearly indicates that the inter-facility transfers appropriateness and timeliness of referral are major contributing factor for maternal deaths in Unnao district, UP. The UP Government, besides strengthening Emergency Obstetric and Newborn Care (EmONC) and Basic Emergency Obstetric and Newborn Care (BEmONC) services in the district and state as a whole, also needs to focus on developing a functional and effective referral system on a priority basis to reduce the maternal deaths in Unnao district.

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Section: Place Of Death Taken To 1 Facility (%) Taken To 2 Facilitiessupporting

confidence: 82%

Section: Way Forward For Creating Better Public Referral Transport Sementioning

confidence: 99%

Section: Data Collection and Analysismentioning

confidence: 99%

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Emergency referral transport for maternal complication: lessons from the community based maternal death audits in Unnao district, Uttar Pradesh, India

Raj

Manthri

Sahoo

2015

Int J Health Policy Manag

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“…As a result, many women are forced to rely on males or senior family members for health decisions (Firoz et al, 2016;Gabrysch & Campbell, 2009;Kyei-Nimakoh, Carolan-Olah, & McCann, 2017;UNDP, 2011;White, Dynes, Rubardt, Sissoko, & Stephenson, 2013). A study in India found that families of deceased women had spent on average seven hours in deciding to take the woman to a facility (Raj, Maine, Sahoo, Manthri, & Chauhan, 2013). Similarly, in Burkina Faso and Indonesia, male relatives of deceased women delayed health seeking until they were in critical condition (D'Ambruoso, Byass, Qomariyah, & Ouedraogo, 2010).…”

Section: The Three Delaysmentioning

confidence: 99%

“…Similarly, in Burkina Faso and Indonesia, male relatives of deceased women delayed health seeking until they were in critical condition (D'Ambruoso, Byass, Qomariyah, & Ouedraogo, 2010). Perceived costs have also been associated with Phase I delays and maternal deaths, especially when families are expected to cover the majority of costs (D'Ambruoso et al, 2010;De Brouwere, Delvaux, & Leke, 2014;Kongnyuy, Mlava, & van den Broek, 2009;Lee et al, 2009;Merali et al, 2014;Raj et al, 2013).…”

Section: The Three Delaysmentioning

confidence: 99%

Uncovering the stories behind the numbers : a case study of maternal death surveillance and response in Goma, Democratic Republic of Congo.

Muvuka¹

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who provided insightful feedback and scholarly guidance throughout this process. They committed their time to reviewing my work and posed critical questions that challenged me to reflect more deeply. I am forever grateful to Dr. Ryan Combs, who welcomed me into his research team from the beginning of my doctoral program. His mentorship and guidance honed my skills and led to my passion for qualitative research, which was fundamental in completing this study. I also appreciate the Department of Health Promotion and its Chair, Dr. Monica Wendel, for the financial and logistical support towards my data collection in Goma. My sincere gratitude to Dr. Robert Vutsopire from Goma Health Zone, who authorized my research, provided valuable insights, and facilitated my entry into the v study sites for data collection. I am equally grateful to the Ethics Committee at the Université Libre des Pays des Grands Lacs, who conducted an expedited ethical review of this study, in addition to the University of Louisville Institutional Review Board. I also extend my sincere gratitude to all the key informants who participated in this study. My family and friends have been a special part of this journey. I am forever grateful to my dad, Dr. Kambale Karafuli; my mom, Dr. Muteho Kasongo; and my brother, Taji Vuruka, for all they have sacrificed for me to achieve this significant milestone. My parents have instilled in me the passion for learning and invested in my dreams, supporting me every step of the way. To my loving husband, Steven Nwaokolo "SJ", who has shown me unconditional love, endless support, and extraordinary patience over the years. He has encouraged me to dream big and has always seen the glass half full when I saw it half empty. Finally, I am thankful for my friends and colleagues who have made this doctoral journey fun and unforgettable.

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Community Based Maternal Death Review: Lessons Learned from Ten Districts in Andhra Pradesh, India

Singh

Thippaiah

Upadhyaya

et al. 2015

Matern Child Health J

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Maternal death is as much a social phenomenon as a medical event. Maternal death review (MDR), a strategy for monitoring maternal deaths, provides information on medical, social and health system factors that should be addressed to redress gaps in service provision or utilisation. To strengthen MDR implementation in the state of Andhra Pradesh, India. The project involved development of state specific guidelines, technical assistance in operationalization and analysing processes and findings of MDR in ten districts. 284 deaths were recorded over 6 months (April-September 2012) of which 193 (75.4 %) could be reviewed. Post-partum haemorrhage (24 %) and hypertensive disorders (27.4 %) followed by puerperal sepsis in the post-partum period (16.8 %) were the leading causes of maternal deaths. 68.3 % deaths occurred at health facilities. 67 % of mothers dying during the natal or post-natal period, delivered at home, though the death occurred in a health facility. Type 1 delay (58.9 %) was the most common underlying cause of death, followed by type 3 delay (33.3 %). Under or nil reporting from the facilities was observed. Program staff could identify broad areas of intervention but lacked capacity to monitor, analyse, interpret and utilize the generated information to develop feasible actionable plans. Information gathered was incomplete and inaccurate in many cases. Challenges observed showed that it will require more time and continuous committed efforts of health staff for implementation of high quality MDR. Successful implementation will improve the response of the health system and contribute to improved maternal health.

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Meeting the community halfway to reduce maternal deaths? Evidence from a community-based maternal death review in Uttar Pradesh, India

Cited by 11 publications

References 11 publications

Emergency referral transport for maternal complication: lessons from the community based maternal death audits in Unnao district, Uttar Pradesh, India

Emergency referral transport for maternal complication: lessons from the community based maternal death audits in Unnao district, Uttar Pradesh, India

Uncovering the stories behind the numbers : a case study of maternal death surveillance and response in Goma, Democratic Republic of Congo.

Community Based Maternal Death Review: Lessons Learned from Ten Districts in Andhra Pradesh, India

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