Methodology for a mixed-methods multi-country study to assess recognition of and response to maternal and newborn illness|
Moran, Allisyn C.; Charlet, Danielle; Madhavan, Supriya; Aruldas, Kumudha; Donaldson, Marie; Manzi, Fatuma; Okuga, Monica; Rosales, Alfonso; Sharma, Vandana; Celone, Michael; Brandes, Neal & Sherry, James M.
Background: Although maternal and newborn mortality have decreased 44 and 46% respectively between 1990
and 2015, achievement of ambitious Sustainable Development Goal targets requires accelerated progress. Mortality
reduction requires a renewed focus on the continuum of maternal and newborn care from the household to the
health facility. Although barriers to accessing skilled care are documented for specific contexts, there is a lack of
systematic evidence on how women and families identify maternal and newborn illness and make decisions and
subsequent care-seeking patterns. The focus of this multi-country study was to identify and describe illness
recognition, decision-making, and care-seeking patterns across various contexts among women and newborns who
survived and died to ultimately inform programmatic priorities moving forward.
Methods: This study was conducted in seven countries—Ethiopia, Tanzania, Uganda, Nigeria, India, Indonesia, and
Nepal. Mixed-methods were utilized including event narratives (group interviews), in-depth interviews (IDIs), focus
group discussions (FDGs), rapid facility assessments, and secondary analyses of existing program data. A common
protocol and tools were developed in collaboration with study teams and adapted for each site, as needed. Sample
size was a minimum of five cases of each type (e.g., perceived postpartum hemorrhage, maternal death, newborn
illness, and newborn death) for each study site, with a total of 84 perceived PPH, 45 maternal deaths, 83 newborn
illness, 55 newborn deaths, 64 IDIs/FGDs, and 99 health facility assessments across all sites. Analysis included coding
within and across cases, identifying broad themes on recognition of illness, decision-making, and patterns of care
seeking, and corresponding contextual factors. Technical support was provided throughout the process for capacity
building, quality assurance, and consistency across sites.
Conclusion: This study provides rigorous evidence on how women and families recognize and respond to maternal
and newborn illness. By using a common methodology and tools, findings not only were site-specific but also allow
for comparison across contexts.
Maternal mortality; Newborn mortality; Developing country; Qualitative research; Care-seeking behavior