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, 36 (Suppl 1), 48

Summary Findings From a Mixed Methods Study on Identifying and Responding to Maternal and Newborn Illness in Seven Countries: Implications for Programs


Summary Findings From a Mixed Methods Study on Identifying and Responding to Maternal and Newborn Illness in Seven Countries: Implications for Programs

Danielle Charlet et al. J Health Popul Nutr.


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.

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

Conflict of interest statement

Ethics approval and consent to participate

Not applicable

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.


Fig. 1
Fig. 1
Conceptual framework for recognition and care-seeking for maternal and newborn illness
Fig. 2
Fig. 2
Unavailability of services at facilities

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    1. UNDP. Sustainable Development Goals. Accessed 13 Dec 2016.
    1. Every Woman Every Child . Global Strategy for Women’s, Children’s and Adolescents’ Health. New York: Every Woman Every Child; 2015.
    1. Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38(8):1091–1110. doi: 10.1016/0277-9536(94)90226-7. - DOI - PubMed
    1. Wasiwa P, Kallander K, Peterson S, Tomson G, Pariyo GW. Using the three delays model to understand why newborn babies die in eastern Uganda. Tropical Med Int Health. 2010;15(8):964–972. doi: 10.1111/j.1365-3156.2010.02557.x. - DOI - PubMed
    1. Koblinsky M. On the pathway to maternal health—results from Indonesia. MotherCare Matters. 1995;5(1):1–2.

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