Division of Pediatric Infectious Diseases, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts;
Department of Pediatrics, School of Medicine and.
Pediatrics. 2021 Apr;147(4). doi: 10.1542/peds.2020-1767. Epub 2021 Mar 4.
In Zambia, a significant number of infants die in the community. It is hypothesized that delays in care contribute to many of these so-called "brought in dead" infants.
We analyzed free-text narratives from verbal autopsies, in which families narrate the final series of events leading to each infant's death. Using the 3-delays model framework and working iteratively to achieve consensus, we coded each narrative using NVivo software to identify, characterize, and quantify the contribution of delays and other factors to the fatal outcome.
Verbal autopsies were collected from 230 families of brought in dead infants younger than 6 months of age. As many as 82.8% of infants had 1 or more delays in care. The most-common delay was in the family's decision to seek care (54.8%), even as severe symptoms were frequently described. Similarly, 27.8% of infants died en route to a health care facility. Delays in receiving adequate care, including infants dying while waiting in line at a clinic or during referral from a clinic to a hospital, occurred in 24.7% of infants. A third of infants had been previously evaluated by a clinician in the days before their death.
Delays in care were the rule rather than the exception in this population of Zambian infants. Accessing care requires families to navigate significant logistic barriers, and balance complex forces in deciding to seek care. Strategies to avoid such delays could save many infants lives.
在赞比亚，大量婴儿在社区中死亡。据推测，护理延误是导致许多所谓的“带进来就死了”婴儿死亡的原因之一。
我们分析了来自口头尸检的自由文本叙述，在这些叙述中，家属叙述了导致每个婴儿死亡的最后一系列事件。我们使用 3 个延误模型框架，并通过反复努力达成共识，使用 NVivo 软件对每个叙述进行编码，以确定、描述和量化延误以及其他因素对致命结果的贡献。
从 230 名年龄在 6 个月以下的“带进来就死了”婴儿的家庭中收集了口头尸检。多达 82.8%的婴儿在护理方面存在 1 次或多次延误。最常见的延误是在家庭决定寻求护理方面（54.8%），尽管经常描述了严重的症状。同样，27.8%的婴儿在前往医疗机构的途中死亡。在接受充分护理方面存在延误，包括婴儿在诊所排队等候时或在从诊所转至医院的过程中死亡，这种情况发生在 24.7%的婴儿中。三分之一的婴儿在死亡前几天曾由临床医生进行过评估。
在赞比亚的这群婴儿中，护理延误是普遍存在的，而非例外。获得护理需要家庭克服重大的后勤障碍，并在决定寻求护理时平衡复杂的力量。避免这种延误的策略可以挽救许多婴儿的生命。
