Using three delays model to understand the social factors responsible for neonatal deaths in rural Haryana, India

J Trop Pediatr. 2013 Apr;59(2):100-5. doi: 10.1093/tropej/fms060. Epub 2012 Nov 21.


Objective: To investigate causes of and contributors to newborn deaths in rural Haryana using a three delays audit approach.

Methods: The study was conducted in 28 villages under the rural field practice area of the Comprehensive Rural Health Services Project, All India Institute of Medical Sciences situated in Ballabgarh, Haryana. Data were collected through house visits and analysed using the three delays model.

Results: Of the 50 newborn deaths investigated, 44% occurred within the first 24 h after birth. The leading causes of death were pre-term/low birthweight (32%), birth asphyxia (28%) and neonatal sepsis (14%). Major contributing delays to neonatal death were caretaker's delay in deciding to seek care (44%, 22/50) and delay in reaching a health care facility, i.e. the transport delay (34%, 17/50).

Conclusions: Household and transport-related delays were the major contributors to newborn deaths, and efforts to improve newborn survival need to address both concurrently.

MeSH terms

  • Attitude to Health*
  • Caregivers / psychology*
  • Cause of Death
  • Cross-Sectional Studies
  • Health Services Accessibility*
  • Humans
  • India / epidemiology
  • Infant Mortality*
  • Infant, Newborn
  • Models, Theoretical
  • Population Surveillance
  • Rural Health Services
  • Rural Population
  • Socioeconomic Factors
  • Time Factors