학술논문
Transitioning from the 'Three Delays' to a focus on continuity of care: a qualitative analysis of maternal deaths in rural Pakistan and Mozambique
Document Type
Report
Author
Vidler, Marianne; Kinshella, Mai-Lei Woo; Sevene, Esperanca; Lewis, Gwyneth; von Dadelszen, Peter; Bhutta, Zulfiqar; Sevene, Esperança; Macete, Eusébio; Munguambe, Khátia; Sacoor, Charfudin; Vala, Anifa; Boene, Helena; Amose, Felizarda; Pires, Rosa; Nhamirre, Zefanias; Macamo, Marta; Chiaú, Rogério; Matavele, Analisa; Vilanculo, Faustino; Nhancolo, Ariel; Cutana, Silvestre; Mandlate, Ernesto; Macuacua, Salésio; Bique, Cassimo; Mocumbi, Sibone; Gonçálves, Emília; Maculuve, Sónia; Biz, Ana Ilda; Mulungo, Dulce; Augusto, Orvalho; Filimone, Paulo; Nobela, Vivalde; Tchavana, Corsino; Nkumbula, Cláudio; Qureshi, Rahat; Bhutta, Zulfiqar A.; Hoodbhoy, Zahra; Raza, Farrukh; Sheikh, Sana; Memon, Javed; Ahmed, Imran; Hussain, Amjad; Bellad, Mrutunjaya B.; Charantimath, Umesh S.; Goudar, Shivaprasad S.; Katageri, Geetanjali M.; Kavi, Avinash J.; Revankar, Amit P.; Mallapur, Ashalata A.; Ramdurg, Umesh Y.; Bannale, Shashidhar G.; Dhamanekar, Vaibhav B.; Mungarwadi, Geetanjali I.; Honnungar, Narayan V.; Kodkany, Bhalachandra S.; Joshi, Anjali M.; Kudachi, Uday S.; Mastiholi, Sphoorthi S.; Karadiguddi, Chandrappa C.; Kengapur, Gudadayya S.; Kamble, Namdev A.; Chougala, Keval S.; Bone, Jeffrey; Dunsmuir, Dustin T.; Drebit, Sharla K.; Kariya, Chirag; Lee, Tang; Li, Jing; Lui, Mansun; Payne, Beth A.; Sawchuck, Diane; Sharma, Sumedha; Tu, Domena K.; VUkah, Ugochi; Magee, Laura A.; Ansermino, JMark; Betrán, Ana Pilar; Derman, Richard; Dharamsi, Shafik; Donnay, France; Drebit, Sharla; Dumont, Guy; Engelbrecht, Susheela M.; Fillipi, Veronique; Firoz, Tabassum; Grobman, William; Knight, Marian; Langer, Ana; Lewin, Simon; Mitton, Craig; Schuurman, Nadine; Shennan, Andrew; Singer, Joel; Thornton, Jim; Wong, Hubert; Adetoro, Olalekan O.; Sotunsa, John O.
Source
BMC Pregnancy and Childbirth. October 23, 2023, Vol. 23 Issue 1
Subject
Language
English
Abstract
Author(s): Marianne Vidler[sup.1], Mai-Lei Woo Kinshella[sup.1], Esperanca Sevene[sup.2,3], Gwyneth Lewis[sup.4], Peter von Dadelszen[sup.5], Zulfiqar Bhutta[sup.6,7], Esperança Sevene, Eusébio Macete, Khátia Munguambe, Charfudin Sacoor, Anifa Vala, Helena Boene, Felizarda Amose, Rosa [...]
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 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 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 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 NCT01911494, Date Registered 30/07/2013. Keywords: Maternal mortality, Quality of health care, Continuity of patient care, Narrative analysis, Maternal health, Cause of death, Postnatal period, Developing countries
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 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 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 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 NCT01911494, Date Registered 30/07/2013. Keywords: Maternal mortality, Quality of health care, Continuity of patient care, Narrative analysis, Maternal health, Cause of death, Postnatal period, Developing countries