Modelling the First Two Delays of the "Three-Delays Model" for Emergency Obstetric Care in Bangladesh: A Choice Model Approach

Barkat, Abul; Rahman, Mati ur; Bose, M; Akhter, Shahida

doi:10.12927/whp..17486

Cited by 14 publications

(10 citation statements)

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“…A study in Nigeria showed that parity has an influence on delay in the use of maternity care [ 32 ]. In inclusion, results of various studies in Bangladesh [ 33 ], Pakistan [ 34 ], Nepal [ 35 ], and Nigeria [ 31 ] showed that education and ANC visits had influence on the first delay. However, in our study, this association was not justified, most likely because the women of the comparison groups had similar characteristics and came from similar socio-environmental background.…”

Section: Discussionmentioning

confidence: 99%

Women-focused development intervention reduces delays in accessing emergency obstetric care in urban slums in Bangladesh: a cross-sectional study

Nahar

Banu

Nasreen

2011

BMC Pregnancy Childbirth

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BackgroundRecognizing the burden of maternal mortality in urban slums, in 2007 BRAC (formally known as Bangladesh Rural Advancement Committee) has established a woman-focused development intervention, Manoshi (the Bangla abbreviation of mother, neonate and child), in urban slums of Bangladesh. The intervention emphasizes strengthening the continuum of maternal, newborn and child care through community, delivery centre (DC) and timely referral of the obstetric complications to the emergency obstetric care (EmOC) facilities. This study aimed to assess whether Manoshi DCs reduces delays in accessing EmOC.MethodsThis cross-sectional study was conducted during October 2008 to January 2009 in the slums of Dhaka city among 450 obstetric complicated cases referred either from DCs of Manoshi or from their home to the EmOC facilities. Trained female interviewers interviewed at their homestead with structured questionnaire. Pearson's chi-square test, t-test and Mann-Whitney test were performed.ResultsThe median time for making the decision to seek care was significantly longer among women who were referred from home than referred from DCs (9.7 hours vs. 5.0 hours, p < 0.001). The median time to reach a facility and to receive treatment was found to be similar in both groups. Time taken to decide to seek care was significantly shorter in the case of life-threatening complications among those who were referred from DC than home (0.9 hours vs.2.3 hours, p = 0.002). Financial assistance from Manoshi significantly reduced the first delay in accessing EmOC services for life-threatening complications referred from DC (p = 0.006). Reasons for first delay include fear of medical intervention, inability to judge maternal condition, traditional beliefs and financial constraints. Role of gender was found to be an important issue in decision making. First delay was significantly higher among elderly women, multiparity, non life-threatening complications and who were not involved in income-generating activities.ConclusionsManoshi program reduces the first delay for life-threatening conditions but not non-life-threatening complications even though providing financial assistance. Programme should give more emphasis on raising awareness through couple/family-based education about maternal complications and dispel fear of clinical care to accelerate seeking EmOC.

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Section: Discussionmentioning

confidence: 99%

Women-focused development intervention reduces delays in accessing emergency obstetric care in urban slums in Bangladesh: a cross-sectional study

Nahar

Banu

Nasreen

2011

BMC Pregnancy Childbirth

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“…Of those who visited a health facility or an informal provider, 79% used some form of transport to reach the service; of those, 57% used three‐wheeled rickshaws and rickshaw vans, 30% used motorized road transport, while only 0.8% used hospital ambulances [20]. Poor economic status unfavorably influences people's decisions to use emergency obstetric care facilities [21].…”

Section: Introductionmentioning

confidence: 99%

The role of transportation to access maternal care services for women in rural Bangladesh and Burkina Faso: A mixed methods study

Alam

Chowdhury

Kouanda

et al. 2016

Intl J Gynecology & Obste

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“…The initial “Three delays” model has in the last two decades been widely expanded and adapted in different areas of health research and practice [21–24] . For the purposes of our study, we have adjusted the original model to investigate factors affecting access to health care services in general and built our questions on participants’ last episode of sickness.…”

Section: Methodsmentioning

confidence: 99%

Factors influencing decision to seek health care: a qualitative study among labour-migrants’ wives in northern Tajikistan

Nabieva

Souares

2019

BMC Pregnancy Childbirth

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BackgroundThis qualitative study aimed to investigate the health seeking behaviour of rural women in northern Tajikistan, with specific focus on antenatal and obstetric complications as a result of delayed access to health services. Due to the unprecedented level of labour migration among men in the border region of Tajikistan, Isfara, the study specifically focused on migrants’ wives residing with their in-laws.MethodsUsing an adapted “Three delays” model which suggests three major causes of delayed access to maternity services - decision to seek care, reaching a healthcare facility and receiving necessary care – we conducted 29 in-depth interviews with labour migrants’ wives, 16 semi-structured interviews with healthcare service providers and 2 focus-group discussions with 16 mothers-in-law in Isfara district.ResultsOur study demonstrated that the most crucial and conditioned factor of access to maternity services for labour migrants’ wives is a decision to seek care. While reaching a healthcare facility (geographical accessibility, time and transportation costs) and receiving necessary care (availability of services, financial affordability and perceived quality of care) were rarely reported as obstacles towards timely access to maternity services, decision to seek care was found to be an intricate interplay of several factors: traditional gender and family roles (particularly in the absence of the husband), the age of the mother-in-law, cultural beliefs and perceptions about pregnancy and maternity, and widely spread myths about certain health conditions and services.ConclusionsOur study concludes that the traditional pattern of seeking health care among women in northern Tajikistan may often cause delays in accessing necessary maternity services and result in adverse health outcomes for women. We suggest that effective strategies to reduce maternal morbidity and mortality in rural Tajikistan should, along with strengthening healthcare structures, embark on community education and awareness raising with special focus on mothers-in-law and other traditional decision-makers in households.

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Modelling the First Two Delays of the "Three-Delays Model" for Emergency Obstetric Care in Bangladesh: A Choice Model Approach

Cited by 14 publications

References 0 publications

Women-focused development intervention reduces delays in accessing emergency obstetric care in urban slums in Bangladesh: a cross-sectional study

Women-focused development intervention reduces delays in accessing emergency obstetric care in urban slums in Bangladesh: a cross-sectional study

The role of transportation to access maternal care services for women in rural Bangladesh and Burkina Faso: A mixed methods study

Factors influencing decision to seek health care: a qualitative study among labour-migrants’ wives in northern Tajikistan

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