Initiative for Maternal Mortality Programme Assessment Immpact, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, United Kingdom.
Soc Sci Med. 2010 Nov;71(10):1728-38. doi: 10.1016/j.socscimed.2010.05.023. Epub 2010 Jun 4.
Maternal mortality in developing countries is characterised by disadvantage and exclusion. Women who die whilst pregnant are typically poor and live in low-income and rural settings where access to quality care is constrained and where deaths, within and outside hospitals, often go unrecorded and unexamined. Verbal autopsy (VA) is an established method of determining cause(s) of death for people who die outside health facilities or without proper registration. This study extended VA to investigate socio-cultural factors relevant to outcomes. Interviews were conducted with relatives of 104 women who died during pregnancy, childbirth or postpartum in two rural districts in Indonesia and for 70 women in a rural district in Burkina Faso. Information was collected on medical signs and symptoms of the women prior to death and an extended section collected accounts of care pathways and opinions on preventability and cause of death. Illustrative quantitative and qualitative analyses were performed and the implications for health surveillance and planning were considered. The cause of death profiles were similar in both settings with infectious diseases, haemorrhage and malaria accounting for half the deaths. In both settings, delays in seeking, reaching and receiving care were reported by more than two-thirds of respondents. Relatives also provided information on their experiences of the emergencies revealing culturally-derived systems of explanation, causation and behaviour. Comparison of the qualitative and quantitative results suggested that the quantified delays may have been underestimated. The analysis suggests that broader empirical frameworks can inform more complete health planning by situating medical conditions within the socio-economic and cultural landscapes in which healthcare is situated and sought. Utilising local knowledge, extended VA has potential to inform the relative prioritisation of interventions that improve technical aspects of life-saving services with those that address the conditions that underlie health, for those whom services typically fail to reach.
发展中国家的孕产妇死亡率具有劣势和排斥的特点。在怀孕时死亡的妇女通常是贫困的，生活在低收入和农村地区，那里获得高质量的护理受到限制，而且在医院内外，死亡往往没有记录和检查。 死因推断（VA）是一种确定在医疗设施外或没有适当登记的人死亡原因的既定方法。本研究扩展了 VA，以调查与结果相关的社会文化因素。对印度尼西亚两个农村地区 104 名在怀孕期间、分娩期间或产后死亡的妇女和布基纳法索一个农村地区 70 名妇女的亲属进行了访谈。收集了妇女死亡前的医疗体征和症状信息，并收集了详细的护理途径信息，并就可预防性和死亡原因征求了意见。进行了说明性的定量和定性分析，并考虑了对卫生监测和规划的影响。这两个地区的死亡原因分布相似，传染病、出血和疟疾占死亡人数的一半。在这两个地区，超过三分之二的受访者报告说在寻求、到达和接受护理方面存在延迟。亲属还提供了他们对紧急情况的经验，揭示了文化衍生的解释、因果关系和行为系统。定性和定量结果的比较表明，量化的延迟可能被低估了。分析表明，更广泛的经验框架可以通过将医疗条件置于医疗保健所在的社会经济和文化背景中，为更完整的卫生规划提供信息，从而使医疗保健更具包容性。利用当地知识，扩展 VA 有可能通过改善挽救生命服务的技术方面的干预措施和解决服务通常无法覆盖的人群的健康状况的干预措施，为相对优先排序提供信息。
