Why gone too soon? Examining social determinants of neonatal deaths in northwest Ethiopia using the three delay model approach

Abstract

BackgroundWithout improving the survival of newborns, meaningful reduction in under-five mortality is difficult. Most neonatal deaths are preventable when appropriate and timely care is sought. In Ethiopia, there is lack of evidence on the type and contribution of delays in treatment seeking to neonatal deaths.MethodsA community based social autopsy (SA) of 39 neonatal deaths was conducted from March 16 to 24, 2016 in Dabat Health and Demographic Surveillance System (HDSS) in northwest Ethiopia. The result was linked with verbal autopsy (VA) information completed for each of the deaths as part of the ongoing HDSS. The SA tool was adapted from INDEPTH Network. Three delay model approach was used to classify the delay types that contributed for the deaths investigated. Descriptive statistics was used to analyze the data.ResultsSA was completed for 37 (94.9%) of the 39 neonatal deaths. Of all the deaths, 51.3% (19/37) of them occurred within the first 24 h, 75.6% (28/37) within the first 6 days and the remaining in 7–28 days. Birth asphyxia was the leading cause of death (34%) followed by bacterial sepsis (31%) and prematurity (16%). The median time from recognition of illness to initiation of modern treatment was 1 day (IQR 1–2.5 days). Delay in treatment seeking outside home (delay one) was associated with 81% of the deaths. Delay in receiving care at a health facility (delay three) and delay in transport (delay two) were associated with 16 and 3% of the deaths, respectively. The major contributors of death for delay one were bacterial sepsis (33.3%), birth asphyxia (30%), unspecified illness (20%) and acute lower respiratory tract illnesses (6.7%). For delay three, the major causes of death included birth asphyxia (50%), prematurity (33.3%) and bacterial sepsis (16.7%).ConclusionsDelays created at home and at health facility were the major delays contributing to the death of newborns. More focus has to be given in improving delays at home and at health facility.

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

“…Another study conducted across Nigeria, Tanzania and Ethiopia finds fathers act as authoritative figures of whom agreeance is needed to follow through with accessing treatment methods, even though these figures may not often directly involve themselves in newborn care [26]. As timing of care is an essential component of ameliorating health conditions and preventing neonatal death [17,27], increasing paternal awareness of neonatal danger signs through acceptable campaign messaging may facilitate transition from illness recognition to facility access.…”

“…Although HEWs may refer those seen during home visits or at health posts to higher facilities for care, significant barriers limit community members in accepting these referrals. Sociocultural factors preventing care at health facilities include differences in gender-based priorities and decision-making dynamics at the household level which may delay seeking care for sick neonates [15][16][17]. Barriers impeding demand of care for newborn treatments include fear of newborn exposure to environmental factors (i.e.…”

“…Barriers impeding demand of care for newborn treatments include fear of newborn exposure to environmental factors (i.e. sunlight), newborn isolation from strangers until the newborn has been religiously blessed and ambiguous newborn personhood [7,14,17]. However, only three known studies assess the determinants of care for sick newborns in Amhara [6,18,19] with no known studies assessing household care seeking for neonatal PSBI in the region.…”

Identifying the barriers to gastric cancer care at safety‐net hospitals: A novel comparison of a safety‐net hospital to a neighboring quaternary referral academic center in the same healthcare system

“…The three‐delays model was developed in 1994 to better characterize factors that contribute to maternal mortality (Figure1) . Since then, the model has been applied to multiple other clinical situations where social and economic factors significantly influence clinical outcomes . The model proposes that delays in care can be classified into three main categories: delays in (i) seeking care, (ii) reaching care, or (iii) receiving care.…”

A Linked Community and Health Facility Intervention to Improve Newborn Health in Cambodia: The NICCI Stepped-Wedge Cluster-Randomized Controlled Trial

“…In one study, delay in treatment-seeking outside home was associated with 81% of newborn deaths [27]. The current trial did not have effect on early referral of newborns; however study data not reported in the tables above indicated that having a means of transportation, e.g., motorcycle, car, did increase likelihood of bringing a sick infant to an appropriate facility (p = 0.004).…”