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Transitioning from the “Three Delays” to a focus on continuity of care: a qualitative analysis of maternal deaths in rural Pakistan and Mozambique.

Vidler, M., Kinshella, M-L. W., Sevene, E., Lewis, G., von Dadelszen, P., Bhutta, Z. and CLIP Working Group, , 2023. Transitioning from the “Three Delays” to a focus on continuity of care: a qualitative analysis of maternal deaths in rural Pakistan and Mozambique. BMC Pregnancy and Childbirth, 23, 748.

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DOI: 10.1186/s12884-023-06055-w

Abstract

Background: The Three Delays Framework was instrumental in the reduction of maternal mortality leading up to, and during the Millennium Development Goals. However, this paper suggests the original framework might be reconsidered, now that most mothers give birth in facilities, the quality and continuity of the clinical care is of growing importance. Methods: The paper explores the factors that contributed to maternal deaths in rural Pakistan and Mozambique, using 76 verbal autopsy narratives from the Community Level Interventions for Pre-eclampsia (CLIP) Trial. Results: Qualitative analysis of these maternal death narratives in both countries reveals an interplay of various influences, such as, underlying risks and comorbidities, temporary improvements after seeking care, gaps in quality care in emergencies, convoluted referral systems, and arrival at the final facility in critical condition. Evaluation of these narratives helps to reframe the pathways of maternal mortality beyond a single journey of care-seeking, to update the categories of seeking, reaching and receiving care. Conclusions: There is a need to supplement the pioneering “Three Delays Framework” to include focusing on continuity of care and the “Four Critical Connection Points”: (1) between the stages of pregnancy, (2) between families and health care workers, (3) between health care facilities and (4) between multiple care-seeking journeys. Trial registration: NCT01911494, Date Registered 30/07/2013.

Item Type:Article
ISSN:1471-2393
Uncontrolled Keywords:Cause of death; Continuity of patient care; Developing countries; Maternal health; Maternal mortality; Narrative analysis; Postnatal period; Quality of health care; Pregnancy; Female; Humans; Maternal Death; Mozambique; Pakistan; Patient Acceptance of Health Care; Maternal Mortality; Continuity of Patient Care
Group:UNSPECIFIED
ID Code:39166
Deposited By: Symplectic RT2
Deposited On:21 Nov 2023 10:47
Last Modified:21 Nov 2023 10:47

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