Determinants of delays in travelling to an emergency obstetric care facility in Herat, Afghanistan: an analysis of cross-sectional survey data and spatial modelling

BMC Pregnancy and Childbirth

Veronique Filippi²  Ahmad Shah Alkozai¹  Jonathan Cox⁴  Matthias Borchert⁵  Atsumi Hirose³ 

[1] World Vision International, Herat, Afghanistan;Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK;PhD programme, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK;Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK;Institute of Tropical Medicine and International Health, Charité – Universitätsmedizin, Berlin, Germany

关键词: Transportation;    Social network;    Geographic information systems;    Near-miss;    Maternal health;    Referrals;    Emergency obstetric care;    Delays;    Afghanistan;   

Others  :  1125405
DOI  :  10.1186/s12884-015-0435-1

 received in 2014-10-16, accepted in 2015-01-12,  发布年份 2015

【 摘 要 】

Background

Women’s delays in reaching emergency obstetric care (EmOC) facilities contribute to high maternal and perinatal mortality and morbidity in low-income countries, yet few studies have quantified travel times to EmOC and examined delays systematically. We defined a delay as the difference between a woman’s travel time to EmOC and the optimal travel time under the best case scenario. The objectives were to model travel times to EmOC and identify factors explaining delays. i.e., the difference between empirical and modelled travel times.

Methods

A cost-distance approach in a raster-based geographic information system (GIS) was used for modelling travel times. Empirical data were obtained during a cross-sectional survey among women admitted in a life-threatening condition to the maternity ward of Herat Regional Hospital in Afghanistan from 2007 to 2008. Multivariable linear regression was used to identify the determinants of the log of delay.

Results

Amongst 402 women, 82 (20%) had no delay. The median modelled travel time, reported travel time, and delay were 1.0 hour [Q1-Q3: 0.6, 2.2], 3.6 hours [Q1-Q3: 1.0, 12.0], and 2.0 hours [Q1-Q3: 0.1, 9.2], respectively. The adjusted ratio (AR) of a delay of the “one-referral” group to the “self-referral” group was 4.9 [95% confidence interval (CI): 3.8-6.3]. Difficulties obtaining transportation explained some delay [AR 2.1 compared to “no difficulty”; 95% CI: 1.5-3.1]. A husband’s very large social network (> = 5 people) doubled a delay [95% CI: 1.1-3.7] compared to a moderate (3-4 people) network. Women with severe infections had a delay 2.6 times longer than those with postpartum haemorrhage (PPH) [95% CI: 1.4-4.9].

Conclusions

Delays were mostly explained by the number of health facilities visited. A husband’s large social network contributed to a delay. A complication with dramatic symptoms (e.g. PPH) shortened a delay while complications with less-alarming symptoms (e.g. severe infection) prolonged it. In-depth investigations are needed to clarify whether time is spent appropriately at lower-level facilities. Community members need to be sensitised to the signs and symptoms of obstetric complications and the urgency associated with them. Health-enhancing behaviours such as birth plans should be promoted in communities.

【 授权许可】

   
2015 Hirose et al.; licensee BioMed Central.

【 图 表 】

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