Illness recognition, decision-making, and care-seeking for maternal and newborn complications: a qualitative study in Sarlahi District, Nepal
Abstract Background Identification of maternal and newborn illness and the decision-making and subsequent care-seeking patterns are poorly understood in Nepal. We aimed to characterize the process and factors influencing recognition of complications, the decision-making process, and care-seeking beh...
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| Format: | Article |
| Language: | English |
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BMC
2017-12-01
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| Series: | Journal of Health, Population and Nutrition |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s41043-017-0123-z |
| _version_ | 1818213868411813888 |
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| author | Tsering P. Lama Subarna K. Khatry Joanne Katz Steven C. LeClerq Luke C. Mullany |
| author_facet | Tsering P. Lama Subarna K. Khatry Joanne Katz Steven C. LeClerq Luke C. Mullany |
| author_sort | Tsering P. Lama |
| collection | DOAJ |
| description | Abstract Background Identification of maternal and newborn illness and the decision-making and subsequent care-seeking patterns are poorly understood in Nepal. We aimed to characterize the process and factors influencing recognition of complications, the decision-making process, and care-seeking behavior among families and communities who experienced a maternal complication, death, neonatal illness, or death in a rural setting of Nepal. Methods Thirty-two event narratives (six maternal/newborn deaths each and 10 maternal/newborn illnesses each) were collected using in-depth interviews and small group interviews. We purposively sampled across specific illness and complication definitions, using data collected prospectively from a cohort of women and newborns followed from pregnancy through the first 28 days postpartum. The event narratives were coded and analyzed for common themes corresponding to three main domains of illness recognition, decision-making, and care-seeking; detailed event timelines were created for each. Results While signs were typically recognized early, delays in perceiving the severity of illness compromised prompt care-seeking in both maternal and newborn cases. Further, care was often sought initially from informal health providers such as traditional birth attendants, traditional healers, and village doctors. Key decision-makers were usually female family members; husbands played limited roles in decisions related to care-seeking, with broader family involvement in decision-making for newborns. Barriers to seeking care at any type of health facility included transport problems, lack of money, night-time illness events, low perceived severity, and distance to facility. Facility care was often sought only after referral or following treatment failure from an informal provider and private facilities were sought for newborn care. Respondents characterized government facility-based care as low quality and reported staff rudeness and drug type and/or supply stock shortages. Conclusion Delaying the decision to seek skilled care was common in both newborn and maternal cases. Among maternal cases, delays in receiving appropriate care when at a facility were also seen. Improved recognition of danger signs and increased demand for skilled care, motivated through community level interventions and health worker mobilization, needs to be encouraged. Engaging informal providers through training in improved danger sign identification and prompt referral, especially for newborn illnesses, is recommended. |
| first_indexed | 2024-12-12T06:11:08Z |
| format | Article |
| id | doaj.art-f3ad5b33e6664a4db9f93e8942d0ad09 |
| institution | Directory Open Access Journal |
| issn | 2072-1315 |
| language | English |
| last_indexed | 2024-12-12T06:11:08Z |
| publishDate | 2017-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Health, Population and Nutrition |
| spelling | doaj.art-f3ad5b33e6664a4db9f93e8942d0ad092022-12-22T00:35:10ZengBMCJournal of Health, Population and Nutrition2072-13152017-12-0136S1455810.1186/s41043-017-0123-zIllness recognition, decision-making, and care-seeking for maternal and newborn complications: a qualitative study in Sarlahi District, NepalTsering P. Lama0Subarna K. Khatry1Joanne Katz2Steven C. LeClerq3Luke C. Mullany4Department of International Health, Johns Hopkins Bloomberg School of Public HealthNepal Nutrition Intervention Project—Sarlahi (NNIPS)Department of International Health, Johns Hopkins Bloomberg School of Public HealthNepal Nutrition Intervention Project—Sarlahi (NNIPS)Department of International Health, Johns Hopkins Bloomberg School of Public HealthAbstract Background Identification of maternal and newborn illness and the decision-making and subsequent care-seeking patterns are poorly understood in Nepal. We aimed to characterize the process and factors influencing recognition of complications, the decision-making process, and care-seeking behavior among families and communities who experienced a maternal complication, death, neonatal illness, or death in a rural setting of Nepal. Methods Thirty-two event narratives (six maternal/newborn deaths each and 10 maternal/newborn illnesses each) were collected using in-depth interviews and small group interviews. We purposively sampled across specific illness and complication definitions, using data collected prospectively from a cohort of women and newborns followed from pregnancy through the first 28 days postpartum. The event narratives were coded and analyzed for common themes corresponding to three main domains of illness recognition, decision-making, and care-seeking; detailed event timelines were created for each. Results While signs were typically recognized early, delays in perceiving the severity of illness compromised prompt care-seeking in both maternal and newborn cases. Further, care was often sought initially from informal health providers such as traditional birth attendants, traditional healers, and village doctors. Key decision-makers were usually female family members; husbands played limited roles in decisions related to care-seeking, with broader family involvement in decision-making for newborns. Barriers to seeking care at any type of health facility included transport problems, lack of money, night-time illness events, low perceived severity, and distance to facility. Facility care was often sought only after referral or following treatment failure from an informal provider and private facilities were sought for newborn care. Respondents characterized government facility-based care as low quality and reported staff rudeness and drug type and/or supply stock shortages. Conclusion Delaying the decision to seek skilled care was common in both newborn and maternal cases. Among maternal cases, delays in receiving appropriate care when at a facility were also seen. Improved recognition of danger signs and increased demand for skilled care, motivated through community level interventions and health worker mobilization, needs to be encouraged. Engaging informal providers through training in improved danger sign identification and prompt referral, especially for newborn illnesses, is recommended.http://link.springer.com/article/10.1186/s41043-017-0123-zMaternal mortalityNeonatal mortalityMaternal complicationsNewborn complicationsIllness recognitionCare-seeking |
| spellingShingle | Tsering P. Lama Subarna K. Khatry Joanne Katz Steven C. LeClerq Luke C. Mullany Illness recognition, decision-making, and care-seeking for maternal and newborn complications: a qualitative study in Sarlahi District, Nepal Journal of Health, Population and Nutrition Maternal mortality Neonatal mortality Maternal complications Newborn complications Illness recognition Care-seeking |
| title | Illness recognition, decision-making, and care-seeking for maternal and newborn complications: a qualitative study in Sarlahi District, Nepal |
| title_full | Illness recognition, decision-making, and care-seeking for maternal and newborn complications: a qualitative study in Sarlahi District, Nepal |
| title_fullStr | Illness recognition, decision-making, and care-seeking for maternal and newborn complications: a qualitative study in Sarlahi District, Nepal |
| title_full_unstemmed | Illness recognition, decision-making, and care-seeking for maternal and newborn complications: a qualitative study in Sarlahi District, Nepal |
| title_short | Illness recognition, decision-making, and care-seeking for maternal and newborn complications: a qualitative study in Sarlahi District, Nepal |
| title_sort | illness recognition decision making and care seeking for maternal and newborn complications a qualitative study in sarlahi district nepal |
| topic | Maternal mortality Neonatal mortality Maternal complications Newborn complications Illness recognition Care-seeking |
| url | http://link.springer.com/article/10.1186/s41043-017-0123-z |
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