A ten year analysis of maternal deaths in a tertiary hospital using the three delays model
| Autor: | Eissa M. Khalifa, Essam Ibrahium Ali, Ahmed Rida Eladwy, Khaled Goma, Ameirr A. Abdallah, Ayman M. Yousef, Hashem Fares, Ahmed K. Abdelhakium, Saad El Gelany, Sahar Amer, Mohamed Khairy, Emad M. Ibrahim, Mahmoud H. Ibrahim, Ahmed R. Abdelraheim, Heba A. Hassan, Mohamed T. Gadelrab, Ahmed Shaban, Mo’men M. Mohammed, Alaa Gamal |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Adult
Data Analysis Maternal mortality medicine.medical_specialty Time Factors Referral Adolescent Context (language use) lcsh:Gynecology and obstetrics Health Services Accessibility Time-to-Treatment Tertiary Care Centers Young Adult Obstetrics and gynaecology Pregnancy Health care medicine Humans lcsh:RG1-991 Group delay and phase delay Retrospective Studies Models Statistical business.industry Medical record Public health Obstetrics and Gynecology Patient Acceptance of Health Care Verbal autopsy Three delays model Emergency medicine Maternal Death Female Egypt business Minia Research Article |
| Zdroj: | BMC Pregnancy and Childbirth, Vol 20, Iss 1, Pp 1-8 (2020) BMC Pregnancy and Childbirth |
| ISSN: | 1471-2393 |
| DOI: | 10.1186/s12884-020-03262-7 |
| Popis: | Background Reducing maternal mortality ratios (MMRs) remain an important public health issue in Egypt. The three delays model distinguished three phases of delay to be associated with maternal mortality: 1) first phase delay is delay in deciding to seek care; 2) second phase delay is delay in reaching health facilities; and 3) third phase delay is delay in receiving care in health facilities. Increased health services’ coverage is thought to be associated with a paradigm shift from first and second phase delays to third phase delay as main factor contributing to MMR. This study aims to examine the contribution of the three delays in relation to maternal deaths. Methods During a 10 year period (2008–2017) 207 maternal deaths were identified in a tertiary hospital in Minia governorate, Egypt. Data were obtained through reviewing medical records and verbal autopsy for each case. Then data analysis was done in the context of the three delays model. Results From 2008 to 2017 MMR in this hospital was 186/100.000 live births. Most frequent causes of maternal mortality were postpartum hemorrhage, hypertensive disorders of pregnancy and sepsis. Third phase delay occurred in 184 deaths (88.9%), second phase delay was observed in 104 deaths (50%), always together with other phases of delay. First phase delay alone was observed in 13 deaths (6.3%) and in 82 deaths (40%) with other phases of delay. One fifth of the women had experienced all three phases of delay together. Major causes of third phase delay were delayed referral from district hospitals, non-availability of skilled staff, lack of blood transfusion facilities and shortage of drugs. Conclusions There is a paradigm shift from first and second phases of delay to the third phase of delay as a major contributor to maternal mortality. Reduction of maternal mortality can be achieved through improving logistics, infrastructure and health care providers’ training. Trial registration This study is a retrospective study registered locally and approved by the ethical committee of the Department of Obstetrics and Gynaecology, Minia University Hospital on 1/4/2016 (Registration number: MUEOB0002). |
| Databáze: | OpenAIRE |
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