Methodology for a mixed-methods multi-country study to assess recognition of and response to maternal and newborn illness

J Health Popul Nutr. 2017 Dec 21;36(Suppl 1):51. doi: 10.1186/s41043-017-0119-8.

Abstract

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.

Keywords: Care-seeking behavior; Developing country; Maternal mortality; Newborn mortality; Qualitative research.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Decision Making*
  • Ethiopia
  • Female
  • Humans
  • India
  • Indonesia
  • Infant Health
  • Infant, Newborn
  • Interviews as Topic
  • Maternal Mortality
  • Mothers / psychology*
  • Nepal
  • Nigeria
  • Patient Acceptance of Health Care*
  • Pregnancy
  • Pregnancy Complications / psychology*
  • Program Development
  • Surveys and Questionnaires
  • Tanzania
  • Uganda
  • Young Adult