Department of Global REACH, University of Michigan Medical School, Ann Arbor, MI, USA.
Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA.
Trop Med Int Health. 2021 May;26(5):582-590. doi: 10.1111/tmi.13558. Epub 2021 Mar 4.
The Three Delays Model outlines, three common delays that lead to poor newborn outcomes: (i) recognising symptoms and deciding to seek care; (ii) getting to care and; (iii) receiving timely, high-quality care. We gathered data for all newborn deaths within four districts in Ghana to explore how well the Three Delays Model explains outcomes.
In this cross-sectional, observational study, trained field workers conducted verbal and social autopsies with the closest surviving relative (typically mothers) of all neonatal deaths across four districts in northern Ghana from September 2015 until April 2017. Data were collected using Survey CTO and analysed using StataSE 15.0. Frequencies and descriptive statistics were calculated for key variables.
247 newborn deaths were identified. Nearly 77% (190) of newborns who died were born at a health facility, and 48.9% (93) of those who died before discharge. Of the 149 newborns who were discharged or born at home, 71.8% (107) sought care at a facility for illness, and 72.9% (N = 78) of those did so within the same day of illness recognition. Of the 83 respondents who arranged for transportation, 82% (68) did so within 1 h. Newborns received prompt care but insufficient interventions - 25% or fewer received IV fluids, oral medications, antibiotics or oxygen.
These data suggest that women are following recommendations for safe delivery and prompt care-seeking. In rural northern Ghana, behaviour change interventions focused on mothers and families may not be as pressing as interventions focused on the Third Delay - obtaining timely, high-quality care.
三延误模型概述了导致新生儿不良结局的三个常见延误：(i)识别症状并决定寻求医疗；(ii)获得医疗服务；(iii)及时获得高质量的医疗服务。我们收集了加纳四个地区所有新生儿死亡的数据，以探讨三延误模型如何解释这些结果。
在这项横断面观察性研究中，训练有素的现场工作人员对加纳北部四个地区所有新生儿死亡的最近幸存亲属（通常是母亲）进行了口头和社会尸检，调查时间为 2015 年 9 月至 2017 年 4 月。数据通过 Survey CTO 收集，并使用 StataSE 15.0 进行分析。计算了关键变量的频率和描述性统计数据。
共确定了 247 例新生儿死亡。近 77%（190 例）死亡的新生儿在医疗机构出生，48.9%（93 例）在出院前死亡。在 149 例出院或在家中出生的新生儿中，71.8%（107 例）因疾病在医疗机构寻求治疗，其中 72.9%（N=78 例）在疾病识别当天就诊。在 83 名安排交通的受访者中，82%（68 例）在 1 小时内完成。新生儿得到了及时的治疗，但干预措施不足——只有 25%或更少的新生儿接受了静脉输液、口服药物、抗生素或氧气治疗。
这些数据表明，妇女正在遵循安全分娩和及时寻求治疗的建议。在加纳北部农村地区，针对母亲和家庭的行为改变干预措施可能不如针对第三个延误——及时获得高质量医疗服务的干预措施紧迫。
