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Factors associated with delay in care-seeking for fatal neonatal illness in the Sylhet district of Bangladesh: results from a verbal and social autopsy study.

Nonyane BA, Kazmi N, Koffi AK, Begum N, Ahmed S, Baqui AH, Kalter HD - J Glob Health (2016)

Bottom Line: Three hundred and thirty-one neonatal deaths were included in the analysis and of these, 91(27.5%) sought formal care first; 26 (7.9%) sought informal care first; 59 (17.8%) sought informal care only, and 155 (46.8%) did not seek any type of care.There were economic and social belief barriers to care-seeking.There is a need for programs that educate caregivers about well-recognized danger signs requiring timely care-seeking, particularly for preterm neonates and those who deliver at home.

View Article: PubMed Central - PubMed

Affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

ABSTRACT

Background: We conducted a social and verbal autopsy study to determine cultural-, social- and health system-related factors that were associated with the delay in formal care seeking in Sylhet district, Bangladesh.

Methods: Verbal and social autopsy interviews were conducted with mothers who experienced a neonatal death between October 2007 and May 2011. We fitted a semi-parametric regression model of the cumulative incidence of seeking formal care first, accounting for competing events of death or seeking informal care first.

Results: Three hundred and thirty-one neonatal deaths were included in the analysis and of these, 91(27.5%) sought formal care first; 26 (7.9%) sought informal care first; 59 (17.8%) sought informal care only, and 155 (46.8%) did not seek any type of care. There was lower cumulative incidence of seeking formal care first for preterm neonates (sub-hazard ratio SHR 0.61, P = 0.025), and those who delivered at home (SHR 0.52, P = 0.010); and higher cumulative incidence for those who reported less than normal activity (SHR 1.95, P = 0.048). The main barriers to seeking formal care reported by 165 mothers included cost (n = 98, 59.4%), believing the neonate was going to die anyway (n = 29, 17.7%), and believing traditional care was more appropriate (n = 26, 15.8%).

Conclusions: The majority of neonates died before formal care could be sought, but formal care was more likely to be sought than informal care. There were economic and social belief barriers to care-seeking. There is a need for programs that educate caregivers about well-recognized danger signs requiring timely care-seeking, particularly for preterm neonates and those who deliver at home.

No MeSH data available.


Related in: MedlinePlus

Cumulative incidence plots.
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Figure 1: Cumulative incidence plots.

Mentions: Table 2 shows some basic characteristics of these 331 participants and the types of care sought for them. The outcome of interest was seeking formal care first; and this was done for 91 (27.5%) neonates while 26 (7.9%) sought informal care before seeking formal care. Informal care only was sought for 59 (17.8%) neonates and 155 (46.8%) died before any care could be sought for them. The cumulative incidence functions for each of these competing events are given in Figure 1. These show that dying without any care sought was the most likely outcome, followed by seeking formal care first and seeking informal care only, while seeking informal care first was the least likely event.


Factors associated with delay in care-seeking for fatal neonatal illness in the Sylhet district of Bangladesh: results from a verbal and social autopsy study.

Nonyane BA, Kazmi N, Koffi AK, Begum N, Ahmed S, Baqui AH, Kalter HD - J Glob Health (2016)

Cumulative incidence plots.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4920004&req=5

Figure 1: Cumulative incidence plots.
Mentions: Table 2 shows some basic characteristics of these 331 participants and the types of care sought for them. The outcome of interest was seeking formal care first; and this was done for 91 (27.5%) neonates while 26 (7.9%) sought informal care before seeking formal care. Informal care only was sought for 59 (17.8%) neonates and 155 (46.8%) died before any care could be sought for them. The cumulative incidence functions for each of these competing events are given in Figure 1. These show that dying without any care sought was the most likely outcome, followed by seeking formal care first and seeking informal care only, while seeking informal care first was the least likely event.

Bottom Line: Three hundred and thirty-one neonatal deaths were included in the analysis and of these, 91(27.5%) sought formal care first; 26 (7.9%) sought informal care first; 59 (17.8%) sought informal care only, and 155 (46.8%) did not seek any type of care.There were economic and social belief barriers to care-seeking.There is a need for programs that educate caregivers about well-recognized danger signs requiring timely care-seeking, particularly for preterm neonates and those who deliver at home.

View Article: PubMed Central - PubMed

Affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

ABSTRACT

Background: We conducted a social and verbal autopsy study to determine cultural-, social- and health system-related factors that were associated with the delay in formal care seeking in Sylhet district, Bangladesh.

Methods: Verbal and social autopsy interviews were conducted with mothers who experienced a neonatal death between October 2007 and May 2011. We fitted a semi-parametric regression model of the cumulative incidence of seeking formal care first, accounting for competing events of death or seeking informal care first.

Results: Three hundred and thirty-one neonatal deaths were included in the analysis and of these, 91(27.5%) sought formal care first; 26 (7.9%) sought informal care first; 59 (17.8%) sought informal care only, and 155 (46.8%) did not seek any type of care. There was lower cumulative incidence of seeking formal care first for preterm neonates (sub-hazard ratio SHR 0.61, P = 0.025), and those who delivered at home (SHR 0.52, P = 0.010); and higher cumulative incidence for those who reported less than normal activity (SHR 1.95, P = 0.048). The main barriers to seeking formal care reported by 165 mothers included cost (n = 98, 59.4%), believing the neonate was going to die anyway (n = 29, 17.7%), and believing traditional care was more appropriate (n = 26, 15.8%).

Conclusions: The majority of neonates died before formal care could be sought, but formal care was more likely to be sought than informal care. There were economic and social belief barriers to care-seeking. There is a need for programs that educate caregivers about well-recognized danger signs requiring timely care-seeking, particularly for preterm neonates and those who deliver at home.

No MeSH data available.


Related in: MedlinePlus