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. 2017 Jul 12;17(1):219.
doi: 10.1186/s12884-017-1406-5.

Factors associated with maternal mortality in Malawi: application of the three delays model

Florence Mgawadere  1 , Regine Unkels  2 , Abigail Kazembe  3 , Nynke van den Broek  2
Affiliations

Factors associated with maternal mortality in Malawi: application of the three delays model

Florence Mgawadere et al. BMC Pregnancy Childbirth. .

Abstract

Background: The three delays model proposes that maternal mortality is associated with delays in: 1) deciding to seek care; 2) reaching the healthcare facility; and 3) receiving care. Previously, the majority of women who died were reported to have experienced type 1 and 2 delays. With increased coverage of healthcare services, we sought to explore the relative contribution of each type of delay.

Method: 151 maternal deaths were identified during a 12-month reproductive age mortality survey (RAMOS) conducted in Malawi; verbal autopsy and facility-based medical record reviews were conducted to obtain details about the circumstances surrounding each death. Using the three delays framework, data were analysed for women who had; 1) died at a healthcare facility, 2) died at home but had previously accessed care and 3) died at home and had not accessed care.

Results: 62.2% (94/151) of maternal deaths occurred in a healthcare facility and a further 21.2% (32/151) of mothers died at home after they had accessed care at a healthcare facility. More than half of all women who died at a healthcare facility (52.1%) had experienced more than one type of delay. Type 3 delays were the most significant delay for women who died at a healthcare facility or women who died at home after they had accessed care, and was identified in 96.8% of cases. Type 2 delays were experienced by 59.6% and type 1 delays by 39.7% of all women. Long waiting hours before receiving treatment at a healthcare facility, multiple delays at the time of admission, shortage of drugs, non-availability and incompetence of skilled staff were some of the major causes of type 3 delays. Distance to a healthcare facility was the main problem resulting in type 2 delays.

Conclusion: The majority of women do try to reach health services when an emergency occurs, but type 3 delays present a major problem. Improving quality of care at healthcare facility level will help reduce maternal mortality.

Keywords: Contributing factors; Maternal death review; Maternal mortality; Three delays model.

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Conflict of interest statement

Ethics approval and consent to participate

Ethical approval was received from COMREC, the Malawi College of Medicine Research and Ethics Committee (P.06/11/1087) on July 3rd 2011 and the LSTM Ethics Committee (Research Protocol 11.76) on 31st August 2011.

The data was collected in country by the Ministry of Health as part of their routine monitoring. The Ministry allowed the lead author access to the data and permission was granted to analyse the data.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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