Hirani Farzeen, Ariff Shabina, Nathwani Apsara Ali, Peerwani Ghazal, Kalbarczyk Anna, Sultana Shazia, Kazi Abdul Momin, Yousuf Farheen, Lefevre Amnesty E, Bhutta Shereen, Winch Peter J, Soofi Sajid, Bhutta Zulfiqar A, Zaidi Anita K M, Mir Fatima
Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Reprod Health. 2025 Apr 16;22(1):55. doi: 10.1186/s12978-025-01981-8.
In Pakistan, the maternal mortality rate is 186/100,000 live births, with postpartum (PP) or maternal sepsis being the third leading cause of maternal deaths. Delays in early identification and timely management of PP sepsis are associated with mortality and severe maternal outcomes, including septicemia, neonatal deaths, infertility, etc. In this study, we aim to explore patterns of care-seeking of maternal health services by recently delivered women (RDW) in semi-urban Karachi, Pakistan. Insights of this study will help in identifying and addressing the barriers in care-seeking to minimize delay to improve clinical outcomes.
We conducted 32 semi-structured qualitative interviews with RDW with PP sepsis, traditional birth attendants (TBAs), health care providers, and family relatives of RDW to characterize the patterns of care-seeking behaviors, sources of care, and treatment modalities. Community interviews were conducted in Bilal Colony, an urban squatter settlement, and facility interviews were conducted at a high-volume tertiary care facility in Karachi, Pakistan. All interviews were conducted face to face by trained data collectors which were then audio recorded. A codebook was developed manually by reviewing all transcripts and identifying emerging themes. Coded transcripts were entered into NVivo software to develop quotation summaries and models that identified subthemes.
This study utilized a 3-delay model to determine care utilization in RDW with PP sepsis. Phase 1 indicated limited awareness about PP symptoms, cultural norms, and lack of decision autonomy led to delayed care-seeking, as women depended on male or older female relatives for approval. Two of the most common symptoms of PP sepsis were high-grade fever and foul-smelling discharge, which were deemed as non-severe. Phase 2 findings implied that women initially sought care from TBAs, chemists, and faith healers, or self-medication and tertiary care was their last resort. Financial constraints were also determining care-seeking; Phase 3 indicated that women who sought care at the hospitals were in critical conditions due to prior unskilled care or traditional treatment choices.
Increasing awareness of PP sepsis and its symptoms via educational programs is essential for not only women but also their family members who play roles in decision-making, Training community health workers and TBAs to recognize signs of PP sepsis and promptly refer women to appropriate facilities could also significantly reduce reliance on inappropriate care sources and ensure timely treatment.
在巴基斯坦，孕产妇死亡率为每10万例活产中有186例死亡，产后（PP）或孕产妇败血症是孕产妇死亡的第三大主要原因。PP败血症的早期识别和及时管理的延迟与死亡率及严重的孕产妇后果相关，包括败血症、新生儿死亡、不孕等。在本研究中，我们旨在探讨巴基斯坦卡拉奇半城市地区近期分娩妇女（RDW）寻求孕产妇保健服务的模式。本研究的见解将有助于识别和解决寻求护理过程中的障碍，以尽量减少延误，改善临床结果。
我们对患有PP败血症的RDW、传统助产士（TBA）、医疗保健提供者以及RDW的家庭成员进行了32次半结构化定性访谈，以描述寻求护理行为的模式、护理来源和治疗方式。在城市棚户区Bilal Colony进行了社区访谈，并在巴基斯坦卡拉奇一家大型三级护理机构进行了机构访谈。所有访谈均由经过培训的数据收集者面对面进行，然后进行录音。通过审查所有笔录并确定新出现的主题，手动编制了一本编码手册。将编码后的笔录输入NVivo软件，以编制引文摘要和识别子主题的模型。
本研究采用三延迟模型来确定患有PP败血症的RDW的护理利用情况。第一阶段表明，对PP症状、文化规范的认识有限以及缺乏决策自主权导致寻求护理的延迟，因为女性依赖男性或年长女性亲属的批准。PP败血症最常见的两种症状是高烧和有异味的分泌物，这些被认为不严重。第二阶段的研究结果表明，女性最初会向传统助产士、药剂师和信仰治疗师寻求护理，或者进行自我治疗，三级护理是她们的最后选择。经济限制也是决定寻求护理的因素；第三阶段表明，由于先前接受的非专业护理或传统治疗选择，在医院寻求护理的女性处于危急状况。
通过教育项目提高对PP败血症及其症状的认识不仅对女性至关重要，对在决策中发挥作用的家庭成员也至关重要。培训社区卫生工作者和传统助产士识别PP败血症的迹象，并及时将女性转介到适当的机构，也可以显著减少对不适当护理来源的依赖，并确保及时治疗。
