Illness recognition, decision-making, and care-seeking for maternal and newborn complications: a qualitative study in Sarlahi District, Nepal

Abstract

BackgroundIdentification of maternal and newborn illness and the decision-making and subsequent care-seeking patterns are poorly understood in Nepal. We aimed to characterize the process and factors influencing recognition of complications, the decision-making process, and care-seeking behavior among families and communities who experienced a maternal complication, death, neonatal illness, or death in a rural setting of Nepal.MethodsThirty-two event narratives (six maternal/newborn deaths each and 10 maternal/newborn illnesses each) were collected using in-depth interviews and small group interviews. We purposively sampled across specific illness and complication definitions, using data collected prospectively from a cohort of women and newborns followed from pregnancy through the first 28 days postpartum. The event narratives were coded and analyzed for common themes corresponding to three main domains of illness recognition, decision-making, and care-seeking; detailed event timelines were created for each.ResultsWhile signs were typically recognized early, delays in perceiving the severity of illness compromised prompt care-seeking in both maternal and newborn cases. Further, care was often sought initially from informal health providers such as traditional birth attendants, traditional healers, and village doctors. Key decision-makers were usually female family members; husbands played limited roles in decisions related to care-seeking, with broader family involvement in decision-making for newborns. Barriers to seeking care at any type of health facility included transport problems, lack of money, night-time illness events, low perceived severity, and distance to facility. Facility care was often sought only after referral or following treatment failure from an informal provider and private facilities were sought for newborn care. Respondents characterized government facility-based care as low quality and reported staff rudeness and drug type and/or supply stock shortages.ConclusionDelaying the decision to seek skilled care was common in both newborn and maternal cases. Among maternal cases, delays in receiving appropriate care when at a facility were also seen. Improved recognition of danger signs and increased demand for skilled care, motivated through community level interventions and health worker mobilization, needs to be encouraged. Engaging informal providers through training in improved danger sign identification and prompt referral, especially for newborn illnesses, is recommended.Electronic supplementary materialThe online version of this article (10.1186/s41043-017-0123-z) contains supplementary material, which is available to authorized users.

Assessment of facility and health worker readiness to provide quality antenatal, intrapartum and postpartum care in rural Southern Nepal

“…7 Mean percentage score of knowledge on five signs and symptoms of newborn infection (sepsis) namely poor/ no breastfeeding, hypo/hyperthermia, restlessness/irritability, and breathing difficulties. * Fishers exact test p-value < 0.05 further delayed due to shortages of drugs and supplies resulting in referral or the need for the family or patient to purchase the supplies and medicines [32]. Our findings in this study are consistent with these earlier results, confirming that many facilities do not have the basic commodities required to provide essential delivery and newborn services.…”

“…The 2015 NHFS found that centers designated as BEmONC-capable did not necessarily have this capacity due to gaps in drugs and equipment; lack of magnesium sulfate, injectable antibiotics, and MVA/D&C kits were particularly glaring [30]. We have previously reported that in this community women initially seek care for maternal and newborn illnesses from informal providers such as local village doctors, traditional birth attendants and traditional healers [32]. In instances where care was sought at a health facility, adequate care was sometimes Fig.…”

Neonatal care and community-level treatment seeking for possible severe bacterial infection (PSBI) in Amhara, Ethiopia

“…The aims of this study are to describe household neonatal care and decision-making strategies for neonatal PSBI symptoms. Although there are several existing studies on treatment seeking for newborns with illnesses in low-and middle-income countries (LMICs) [6,[22][23][24], this study may be the first to assess the determinants of securing treatment within the community for newborns with PSBI. This qualitative study outlines five key themes for neonatal care and management for PSBI symptoms: maternal responsibility of the newborn; maternal decision-making; environmental, hygiene and nutrition practices as drivers of illness; illness conceptualization based on complexity; and care seeking trajectory.…”

“…Across contexts, recognition of neonatal danger signs are often proposed as a determinant of the types of care methods sought as well as care timeliness [6,23,28]. Symptoms that indicated illness among parental figures most often included fever, lack of breastfeeding and excessive or abnormal crying.…”

The Profile, Health Seeking Behavior, Referral Patterns, and Outcome of Outborn Neonates Admitted to a District and Regional Hospital in the Upper West Region of Ghana: A Cross-Sectional Study

“…Neonates with danger signs, such as fever, distended abdomen, and difficulty in breathing, were more likely not to delay reaching the neonatal unit. Most parents were able to recognize danger sign symptoms as other studies have also demonstrated [8,11,14,25,26]. All these signs can be associated with an infection; although, bleeding in newborns was most commonly caused due to hemorrhagic disease of the newborn [27,28].…”