Maternal mortality in the rural Gambia, a qualitative study on access to emergency obstetric care

Abstract

BACKGROUND: Maternal mortality is the vital indicator with the greatest disparity between developed and developing countries. The challenging nature of measuring maternal mortality has made it necessary to perform an action-oriented means of gathering information on where, how and why deaths are occurring; what kinds of action are needed and have been taken. A maternal death review is an in-depth investigation of the causes and circumstances surrounding maternal deaths. The objectives of the present study were to describe the socio-cultural and health service factors associated with maternal deaths in rural Gambia. METHODS: We reviewed the cases of 42 maternal deaths of women who actually tried to reach or have reached health care services. A verbal autopsy technique was applied for 32 of the cases. Key people who had witnessed any stage during the process leading to death were interviewed. Health care staff who participated in the provision of care to the deceased was also interviewed. All interviews were tape recorded and analyzed by using a grounded theory approach. The standard WHO definition of maternal deaths was used. RESULTS: The length of time in delay within each phase of the model was estimated from the moment the woman, her family or health care providers realized that there was a complication until the decision to seeking or implementing care was made. The following items evolved as important: underestimation of the severity of the complication, bad experience with the health care system, delay in reaching an appropriate medical facility, lack of transportation, prolonged transportation, seeking care at more than one medical facility and delay in receiving prompt and appropriate care after reaching the hospital. CONCLUSION: Women do seek access to care for obstetric emergencies, but because of a variety of problems encountered, appropriate care is often delayed. Disorganized health care with lack of prompt response to emergencies is a major factor contributing to a continued high mortality rate.

Maternal mortality in Jordan: role of substandard care and delays

“…Lack of awareness of danger signs in pregnancy was a crucial factor. This finding is consistent with other studies about lack of awareness of pregnancy danger signs [19,20]. Socioeconomic status, extended family size, health beliefs, access and level of trust in available local medical care may have affected the decision to seek care.…”

“…Socioeconomic status, extended family size, health beliefs, access and level of trust in available local medical care may have affected the decision to seek care. Other studies had reported the notion that different cultures affect women's care-seeking decisions, despite the existence of similar danger signs [14,[19][20][21]. In addition, religious beliefs may have affected the decision of those women who refused pregnancy termination.…”

Midwives’ experience of participating in the Advanced Life Support in Obstetrics® educational program in Rwanda

“…Similarly a study aimed to describe the socio-cultural and health service factors associated with maternal death in rural Gambia showed that women reached the health facilities on time to seek emergency obstetric care, but lack of collaboration between physicians and midwives contributed to the disorganized and delayed health care to respond to obstetric emergencies. [35] Our study findings related to inter-professional collaboration between midwives and physicians concur with previous study results examining the collaboration between midwives, nurses and physicians in maternity services. [36,37] Simpson et al [38] found that nurse-midwives and physicians in maternity services had a common objective of improving maternal and neonatal outcomes; however, they did not always come to an understanding on how to achieve that shared objective.…”

Expenditure on Emergency Obstetric Care in a Federal Tertiary Institution in Nigeria

“…In their survey PRRINN-MNCH (2010) reported respondents as having to pay so much for a unit of blood, this finding was similar to that of other studies [8]. In addition, blood banking systems in most centres are not very efficient [9], and in most instances patients' relations have to look for donors themselves; this could be from among family members or from friends and well-wishers. In other studies patients' relations have had to travel several kilometres away from a health facility in search for a compatible donor because of the inefficiency of the blood banking system in their own health facility [10].…”