Using the three delays model to understand why newborn babies die in eastern Uganda

Abstract

Household and health facility-related delays were the major contributors to newborn deaths, and efforts to improve newborn survival need to address both concurrently. Understanding why newborn babies die can be improved by using the three delays model, originally developed for understanding maternal death.

Using social autopsy to understand maternal, newborn, and child mortality in low-resource settings: a systematic review of the literature

“…[20]2013IndiaCross-sectional28 villages of Comprehensive Rural Health Services Project, All India Institute of Medical Sciences; neonatal deaths in 2010.Caregivers (N not reported) interviewed about 50 neonatal deaths.NeonatalNot reported

Delay in deciding to seek care identified in 44% of cases.

Transportation delay reported in 35% of cases.

Household and transport related delays were top contributors to deaths in newborns.

INDEPTH Network Verbal and Social Autopsy ToolThree Delays Model1.0Waiswa P, Kallander K, Peterson S, Tomson G, Pariyo GW. [21]2010UgandaCross-sectionalMakerere University/Mayuge Health and Demographic Surveillance Site; deaths from Jan. 2005-Dec. 2008.Caregivers (N not reported) surveyed about 64 neonatal deaths.Neonatal4–6 WeeksDelays in problem recognition or deciding to seek care cited in 50% of cases.Delay in receiving quality care at health facility reported in 30% of cases.Transport delay identified in 20% of cases.Median time to seek care was 3 days.Health facilities did not have adequate capacity for newborn care and health workers did not have adequate knowledge of newborn care assessed via survey.INDEPTH Network Verbal Autopsy tool and CHERG Social Autopsy tool.Three Delays Model0.86 …”

“…Twelve of the 16 studies provided glimpses into some of the other reasons families may not be seeking prompt attention. These included perceived low quality of care at the facility [6,9,17,21], attributing illness to spiritual and other non-medical causes [6,8,18,19], thinking that the baby would die anyway or was too sick to travel [12,14], thinking that the baby was not sick enough to seek care [14], not having a family member to accompany the woman to the facility [12,20], and needing husband’s permission to seek care [8]. Specific examples of how such barriers influence care include that in Bangladesh, 18% of mothers said they did not bring the baby for care because they thought it would die anyway [18].…”

“…Social autopsy research relies upon identifying and recruiting family members of individuals who have passed away, often in settings without vital registration systems or other ways to definitively determine the sampling frame. While some studies addressed this challenge by using national mortality surveys to generate a sampling frame, four of the articles included in the review did not report how many of the deaths they identified were included in their data collection efforts [8–10,21]. This limits the ability to determine potential sampling bias.…”

‘Nurture the sprouting bud; do not uproot it’. Using saving groups to save for maternal and newborn health: lessons from rural Eastern Uganda

“…Knowledge about the importance of birth preparedness is important for improving birth preparedness and subsequently improving maternal service accessibility especially when presented as part of a package of interventions that reduce the three delays to seeking maternal and newborn health services [3,26–28]. The transmission of knowledge about birth preparedness by targeting family members and male partners was therefore able to encourage more men to start saving for maternal health.…”

“…As decision-makers and family heads it is indeed critical that men get involved in birth preparedness activities [26,27]. This is likely to shorten delays in making decisions to seek care and to reach care because lack of cash is one of the factors responsible for this delay [3,7,28]. …”