Delayed illness recognition and multiple referrals: a qualitative study exploring care-seeking trajectories contributing to maternal and newborn illnesses and death in southern Tanzania

BMC Health Services Research

Tara Tancred¹  Claudia Hanson¹  Fatuma Manzi²  Donat Shamba²  Juddy Wachira³ 

[1] Department of Disease Control, London School of Hygiene and Tropical Medicine;Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute;School of Medicine/AMPATH, Moi University;

关键词: Illness recognition;    Maternal;    Newborn;    Care-seeking, qualitative study;    Tanzania;   

DOI  :  10.1186/s12913-019-4019-z

来源: DOAJ

【 摘 要 】

Abstract Background Maternal and neonatal mortality remain high in southern Tanzania despite an increasing number of births occurring in health facilities. In search for reasons for the persistently high mortality rates, we explored illness recognition, decision-making and care-seeking for cases of maternal and neonatal illness and death. Methods We conducted 48 in-depth interviews (16 participants who experienced maternal illnesses, 16 mothers whose newborns experienced illness, eight mothers whose newborns died, and eight family members of a household with a maternal death), and five focus group discussions with community leaders in two districts of Mtwara region. Thematic analysis was used for interpretation of findings. Results Our data indicated relatively timely illness recognition and decision-making for maternal complications. In contrast, families reported difficulties interpreting newborn illnesses. Decisions on care-seeking involved both the mother and her partner or other family members. Delays in care-seeking were therefore also reported in absence of the husband, or at night. Primary-level facilities were first consulted. Most respondents had to consult more than one facility and described difficulties accessing and receiving appropriate care. Definitive treatment for maternal and newborn complications was largely only available in hospitals. Conclusions Delays in reaching a facility that can provide appropriate care is influenced by multiple referrals from one facility to another. Referral and care-seeking advice should include direct care-seeking at hospitals in case of severe complications and primary facilities should facilitate prompt referral.

【 授权许可】

Unknown