Praying until death: revisiting three delays model to contextualize the socio-cultural factors associated with maternal deaths in a region with high prevalence of eclampsia in India

Abstract

Background A disproportionately high proportion of maternal deaths (99 percent) in the world occur in low and middle income countries, of which 90 percent is contributed by Sub-Saharan Africa and South Asia. This study uses the effective "Three Delays" model to assess the socio-cultural barriers associated with maternal mortality in West Bengal, India. Methods It was a retrospective mixed methods study, which used facility-based as well as community-based approaches to explore factors associated with maternal deaths. We reviewed 317 maternal death cases wherein a verbal autopsy technique was applied on 40 cases. The Chi-square test (χ2) and multivariable logistic regression model were employed to accomplish the study objectives. Results The delay in seeking care (Type 1 delay) was the most significant contributor to maternal deaths (48.6 percent, 154/317). The second major impacting contributor to maternal deaths was the delay in reaching first level health facility (Type 2 delay) (33.8 percent, 107/317), while delay in receiving adequate care at the health facility (Type 3 delay) had a role in 18.9 percent maternal deaths. Women staying at long distance from the health facilities have reported [AOR with 95 % CI; 1.7 (1.11-1.96)] higher type 2 delay as compared to their counterparts. The study also exhibited that the women belonged to Muslim community were 2.5 times and 1.6 times more likely to experience type 1 and 2 delays respectively than Hindu women. The verbal autopsies revealed that the type 1 delay is attributed to the underestimation of the gravity of the complications, cultural belief and customs. Recognition of danger signs, knowledge and attitude towards seeking medical care, arranging transport and financial constraints were the main barriers of delay in seeking care and reaching facility. Conclusions The study found that the type-1 and type-2 delays were major contributors of maternal deaths in the study region. Therefore, to prevent the maternal deaths effectively, action will be required in areas like strengthening the functionality of referral networks, expand coverage of healthcare and raising awareness regarding maternal complications and danger signs.

Utility of the three-delays model and its potential for supporting a solution-based approach to accessing intrapartum care in low- and middle-income countries. A qualitative evidence synthesis

“…The synthesis included twenty-five studies which were conducted in Democratic Republic of Congo [ 41 ], Ethiopia [ 32 ], The Gambia [ 33 , 40 ], Ghana [ 7 ], Kenya [ 43 , 46 ], Liberia [ 47 ], Malawi [ 15 , 34 ], Nigeria [ 9 ], Rwanda [ 31 ], Tanzania [ 14 , 44 ], India [ 35 , 37 , 42 ], Timor-Leste [ 30 ], Colombia [ 36 ], Haiti [ 29 , 45 ] and Mexico [ 39 ]. One of the multi-country papers involved Ethiopia, India, Indonesia, Nigeria, Tanzania, Uganda and Nepal [ 38 ]; the other one included Indonesia and Burkina Faso [ 6 ].…”

Perceptions on preeclampsia and eclampsia among older women in rural southwestern Uganda

“…While there are strong religious beliefs in sub Saharan Africa, these may contribute to the delay in seeking care or the first delay. [23,24] Most of the respondents were aware of the dangers of eclampsia and expressed fear for maternal deaths as the ultimate consequence of eclampsia. This awareness of the dangers of eclampsia provides a window of opportunity for interventions to target even the wider challenge of the misconceptions.…”

Perceptions on preeclampsia and eclampsia among older women in rural southwestern Uganda

“…While there are strong religious beliefs in sub Saharan Africa, these may contribute to the delay in seeking care or the rst delay. [39,40] Most of the respondents were aware of the dangers of eclampsia and expressed fear for maternal deaths as the ultimate consequence of eclampsia. This awareness of the dangers of eclampsia provides a window of opportunity for interventions to target even the wider challenge of the misconceptions.…”