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

Abstract

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.

<p>Maternal Delays for Institutional Delivery and Associated Factors Among Postnatal Mothers at Public Health Facilities of Gamo Zone, Southern Ethiopia</p>

“…The minimal sample size required for this study was calculated using the Epi Info version 7.02 statistical software package with the assumption of 95% confidence level (Zα/2= 1.96), 80% power (Zβ= 0.84). The magnitude of first, second, and third maternal delays in utilizing institutional delivery service were 37.8%, 14 29.7%, 15 and 34.7% 16 respectively. Considering a 10% nonresponse rate, the maximum sample size requires for this study was found to be 394 postnatal mothers (for first delay), 352 postnatal mothers (second delay), and 383 postnatal mothers (third delay).…”

The Role of Care‐seeking Delays in Intrauterine Fetal Deaths among ‘Near‐miss’ Women in Herat, Afghanistan

“…Nonetheless, maternal and newborn survival programmes could further stress the importance of a woman's support and care from family members during pregnancy and childbirth; this could be done, for example, through mass media campaigns. Interventions through women's groups and income‐generating activity programmes may also be beneficial 34,35 …”

“…Interventions through women's groups and income-generating activity programmes may also be beneficial. 34,35 Conclusion Programmatic efforts are often divided between facility-based and community-based approaches and between maternal and newborn survivals. As a fetus' health is inextricably linked with the mother's health during pregnancy and labour, a more integrated approach to improving a woman's well-beingincluding improving her access to financial and social resources -may be needed to reduce both maternal and fetal mortality.…”

Analisis Faktor yang Berpengaruh terhadap Kemampuan Ibu Hamil dalam Melakukan Deteksi Dini Risiko Perdarahan Pasca Persalinan dan Preeklamsia

“…8 Salah satu alasan penundaan akses kepelayanan kesehatan adalah karena ketidakmampuan ibu hamil dalam mengenali kondisi kehamilannya. 9 Faktor risiko yang mempengaruhi kejadian perdarahan pascapersalinan pada kehamilan, antara lain placenta previa, atonia uteri, infeksi penyakit, gizi buruk, eklamsia, paritas ibu hamil, anemia kehamilan, jarak persalinan, usia kehamilan, umur ibu, riwayat pemeriksaan kehamilan (ANC), dan riwayat persalinan terdahulu. Faktor risiko yang mempengaruhi terhadap kejadian preeklamsia, antara lain hipertensi, jarak kehamilan, paritas, kehamilan ganda, usia ibu hamil < 20 tahun dan > 35 tahun, genetik, obesitas, infeksi, dan status gizi.…”