Summary findings from a mixed methods study on identifying and responding to maternal and newborn illness in seven countries: implications for programs|
Charlet, Danielle; Moran, Allisyn C. & Madhavan, Supriya
Background: There is a lack of systematic information documenting recognition of potentially life-threatening
complications and decisions to seek care, as well as reaching care and the specific steps in that process. In
response to this gap in knowledge, a multi-country mixed methods study was conducted to illuminate the
dynamics driving Delays 1 and 2 across seven countries for maternal and newborn illness and death.
Methods: A common protocol and tools were developed, adapted by each of seven study teams depending on
their local context (Ethiopia, India, Indonesia, Nigeria, Tanzania, Uganda, and Nepal). Maternal and newborn illness,
and maternal and newborn death cases were included. Trained interviewers conducted event narratives to elicit
and document a detailed sequence of actions, from onset of symptoms to the resolution of the problem. Event
timelines were constructed, and in-depth interviews with key informants in the community were conducted.
Transcripts were coded and analyzed for common themes corresponding to the three main domains of
recognition, decision-making, and care-seeking.
Results: Maternal symptom recognition and decision-making to seek care is faster than for newborns. Perceived
cause of the illness (supernatural vs. biological) influences the type of care sought (spiritual/traditional vs. formal
sector, skilled). Mothers, fathers, and other relatives tend to be the decision-makers for newborns while husbands
and elder females make decisions for maternal cases. Cultural norms such as confinement periods and perceptions
of newborn vulnerability result in care being brought in to the home. Perceived and actual poor quality of care was
repeatedly experienced by families seeking care.
Conclusion: The findings link to three action points: (1) messaging around newborn illness needs to reinforce a
sense of urgency and the need for skilled care regardless of perceived cause; (2) targeted awareness building
around specific maternal danger signs that are not currently recognized and where quality care is available is
needed; and (3) designing appropriate contextualized messages.
This research links to and supports a number of current global initiatives such as Ending Preventable Maternal
Mortality, the Every Newborn Action Plan, the WHO Quality of Care framework, and the WHO guidelines on
simplified management of newborn sepsis at the community level. This type of research is invaluable for designing
programs to improve maternal and newborn survival to achieve ambitious global targets.
Maternal mortality; Newborn mortality; Developing country; Qualitative research; Care-seeking behavior