Department of Community Medicine, University of Oslo, Oslo, Norway.
PLoS One. 2012;7(12):e52090. doi: 10.1371/journal.pone.0052090. Epub 2012 Dec 19.
In Malawi maternal mortality continues to be a major public health challenge. Going beyond the numbers to form a more complete view of why women die is critical to improving access to and quality of emergency obstetric care. The objective of the current study was to identify the socio-cultural and facility-based factors that contributed to maternal deaths in the district of Lilongwe, Malawi.
Retrospectively, 32 maternal death cases that occurred between January 1, 2011 and June 30, 2011 were reviewed independently by two gynecologists/obstetricians. Interviews were conducted with healthcare staff, family members, neighbors, and traditional birth attendants. Guided by the grounded theory approach, interview transcripts were analyzed manually and continuously. Emerging, recurring themes were identified and excerpts from the transcripts were categorized according to the Three Delays Model (3Ds).
Sixteen deaths were due to direct obstetric complications, sepsis and hemorrhage being most common. Sixteen deaths were due to indirect causes with the main cause being anemia, followed by HIV and heart disease. Lack of recognizing signs, symptoms, and severity of the situation; using traditional Birth Attendant services; low female literacy level; delayed access to transport; hardship of long distance and physical terrain; delayed prompt quality emergency obstetric care; and delayed care while at the hospital due to patient refusal or concealment were observed. According to the 3Ds, the most common delay observed was in receiving treatment upon reaching the facility due to referral delays, missed diagnoses, lack of blood, lack of drugs, or inadequate care, and severe mismanagement.
在马拉维，孕产妇死亡率仍然是一个主要的公共卫生挑战。要改善紧急产科护理的可及性和质量，除了关注数字外，更全面地了解妇女死亡的原因至关重要。本研究的目的是确定导致马拉维利隆圭区孕产妇死亡的社会文化和医疗机构相关因素。
回顾性分析了 2011 年 1 月 1 日至 6 月 30 日期间发生的 32 例孕产妇死亡病例，由两名妇科医生/产科医生独立审查。对医护人员、家属、邻居和传统助产士进行了访谈。根据扎根理论方法，对访谈记录进行了手工和连续分析。确定了新出现的、反复出现的主题，并根据“三个延迟模型（3D）”将记录中的摘录进行分类。
16 例死亡是由直接产科并发症引起的，其中败血症和出血最为常见。16 例死亡是由间接原因引起的，主要原因是贫血，其次是 HIV 和心脏病。缺乏对症状和病情严重程度的认识、使用传统助产士服务、女性文化程度低、获得交通工具的时间延迟、长途和地形困难、不能及时获得优质紧急产科护理、以及在医院因患者拒绝或隐瞒而延迟治疗的情况都观察到了。根据 3D，在到达医疗机构时接受治疗方面最常见的延迟是由于转诊延迟、漏诊、缺乏血液、缺乏药物或护理不足以及严重管理不善导致的。
