Maternal danger signs in pregnancy: adoption of a four-delay model in healthcare in Matayos subcounty, Busia, Kenya

Abstract

Background: Over 80 of maternal mortalities and% complications can be prevented if women recognize danger signs during pregnancy and promptly seek healthcare. Despite the timely recognition of maternal danger signs during pregnancy, delays in seeking healthcare are still prevalent in many low-resource settings. Objective: To assess the place and reasons for delays in seeking healthcare and their effect on the use of institutional delivery care by pregnant mothers with danger signs in Matayos subcounty, Busia, Kenya. Methods: A mixed-methods approach employing an ethnographic survey was adopted to assess delays among pregnant mothers seeking healthcare in Matayos subcounty. A total of 348 postpartum women were selected using systematic random sampling. Purposive sampling was employed to select postpartum women for 16 in-depth interviews and seven focus group discussions. Qualitative data were analyzed thematically and presented in vignettes. Quantitative data were analyzed using descriptive and inferential statistics and presented in tables using STATA version 13. Statistical significance was set at p<0.05. Results: The utilization rate of institutional delivery care was 68 . One in four, 25 (86) respondents% % experienced danger signs, of which more than half, 51.2 (44), reported delays. Travel to the hospital% (type 3 delay) was the most common delay reported by 65.3 , followed by delayed decision-making at home% (type 2 delay), delayed recognition at home (type 1 delay), and delays in hospitals (type 4 delay) at 30.7 ,% 1.7 , and 2.3 of all respondents, respectively.% % Delayed decision to initiate travel (30.7 ) and% distance to healthcare (30.7 ), cost of travel (18.2 ),% % and mode of travel (13.2 ) were the reasons for% delays in seeking healthcare. Conclusion: Delayed decision-making rather than recognition of danger signs was associated with delays in healthcare. A four-delay model clearly distinguished between recognition and making the decision to initiate travel and should be adopted in low-resource settings.