Abstract:
Background: To enhance understanding of the roles of community-based initiatives in poor rural societies, we
describe and explore illness recognition, decision-making, and appropriate care-seeking for mothers and newborn
illnesses in two districts in eastern Uganda where in one implementation district, a facility and community quality
improvement approach was implemented.
Methods: This was a cross-sectional study using qualitative methods. We conducted 48 event narratives: eight
maternal and newborn deaths and 16 maternal and newborn illnesses. Additionally, we conducted six FGDs with
women’s saving groups and community leaders. Qualitative data were analyzed thematically using Atlas.ti software.
Results: Women and caretakers reported that community initiatives including the presence of community health
workers and women’s saving groups helped in enhancing illness recognition, decision-making, and care-seeking for
maternal and newborn complications. Newborn illness seemed to be less well understood, and formal care was
often delayed. Care-seeking was complicated by accessing several stations from primary to secondary care, and
often, the hospital was reached too late.
Conclusions: Our qualitative study suggests that community approaches may play a role in illness recognition,
decision-making, and care-seeking for maternal and newborn illness. The role of primary facilities in providing care
for maternal and newborn emergencies might need to be reviewed.
