Maternal Complications and Women's Behavior in Seeking Care from Skilled Providers in North Gondar, Ethiopia

Abstract

BackgroundMaternal complications are morbidities suffered during pregnancy through the postpartum period of 42 days. In Ethiopia, little is known about women's experience of complications and their care-seeking behavior. This study attempted to assess experiences related to obstetric complication and seeking assistance from a skilled provider among women who gave birth in the last 12 months preceding the study.MethodsThis study was a cross-sectional survey of women who gave birth within one year preceding the study regardless of their delivery place. The study was carried out in six selected districts in North Gondar Zone, Amhara Region. Data was collected house-to-house in 12 selected clusters (kebeles) using a pretested Amharic questionnaire. During the survey, 1,668 women were interviewed. Data entry was done using Epi Info version 3.5.3 and was exported to SPSS for analysis. Logistic regression was applied to control confounders.ResultsOut of the total sample, 476 women (28.5%, 95% CI: 26.4%, 30.7%) reported some kind of complication. The most common complications reported were; excessive bleeding and prolonged labor that occurred mostly at the time of delivery and postpartum period. Out of the total women who faced complications, 248 (52.1%, 95% CI: 47.6%, 56.6%) sought assistance from a skilled provider. Inability to judge the severity of morbidities, distance/transport problems, lack of money/cost considerations and use of traditional options at home were the major reasons for not seeking care from skilled providers. Belonging to a wealthier quintile, getting antenatal care from a skilled provider and agreement of a woman in planning for possible complications were significantly associated with seeking assistance from a skilled provider.ConclusionNearly half of the women who faced complications did not use skilled providers at the time of obstetric complications. Cognitive, geographic, economic and cultural barriers were involved in not using skilled maternal care.

Patterns and Determinants of Care-Seeking for Antepartum and Intrapartum Complications in Rural Bangladesh: Results from a Cohort Study

“…Many studies in Bangladesh and elsewhere have shown socio-economic disparities in care seeking [22] with some studies documenting positive association between improved wealth status and seeking trained maternity care [9, 11, 12, 15]. In our study, women in the highest two wealth quintiles were about two times more likely to seek trained care both for reported antepartum and intrapartum complications [15], which was in agreement with findings of earlier studies conducted in Bangladesh and in other countries [13, 15]. …”

“…Also, the care-seeking rate in our study was higher compared to findings of a national survey, conducted 10 years earlier in Bangladesh, where one in three women reported receiving care from a qualified provider for their life threatening antepartum complications [11]. However, the care-seeking rate from a trained provider for obstetric complications that we observed was similar to studies conducted in Bangladesh and Ethiopia [13, 21]. The higher use of trained care in our study population compared to other Bangladesh studies might partly be due to time lag between the studies and partly be the impact of a MNH intervention package that we have been implementing in this population for more than a decade.…”

“…Notable examples of factors shown to be associated with seeking care for maternal complications during antepartum and child birth from trained providers include availability, access and quality of health services [11, 12]. Earlier studies that examined factors associated with care seeking found that women belonging to wealthier households were more likely to seek skilled care for antepartum complications [11, 13]. Factors associated with skilled birth attendants during intrapartum period included mothers’ occupation, higher parity, complications during antepartum period, having antenatal care [14], and closer distance to a health facility [13, 15, 16].…”

“…Earlier studies that examined factors associated with care seeking found that women belonging to wealthier households were more likely to seek skilled care for antepartum complications [11, 13]. Factors associated with skilled birth attendants during intrapartum period included mothers’ occupation, higher parity, complications during antepartum period, having antenatal care [14], and closer distance to a health facility [13, 15, 16]. In addition, access to skilled attendants, availability of quality care and associated medical cost remained major barriers to seeking care [11].…”

Clinical Complications In Pregnancy And The Relationship With Low Birth Weight And Prematurity Of The Newborn

“…Most intercurrences can lead to serious complications and the best way to avoid such complications is through an appropriate and qualified health care [8]. Some studies have identified factors and behaviors that can minimize the effects of pregnancy complications, such as increased educational level, ease of access to the health facility, the availability of the transport system, family support, experience of a previous pregnancy, favorable economic conditions and qualified health care [9,10] In fact, one highlights the importance of ensuring those users a qualified prenatal care, since, through that service, health professionals can perform the monitoring of the main pregnancy complications seeking to avoid major complications for mother and child [2].…”