Who are dying and why? A case series study of maternal deaths in Nepal
This study identifies delays and associated factors for maternal deaths in Nepal
Abstract
Objectives
To identify delays and associated factors for maternal deaths in Nepal.
Design
A cross-sectional case series study of maternal deaths. An integrated verbal and social autopsy tool was used to collect quantitative and qualitative information regarding three delays. We recorded death accounts and conducted social autopsy by means of community Focus Group Discussions for each maternal death; and analysed data by framework analysis.
Setting
62 maternal deaths in 6 districts in three provinces of Nepal.
Results
Nearly half of the deceased women (45.2%) were primiparous and one-third had no formal education. About 40% were from Terai/Madhesi and 30.6% from lower caste. The most common place of death was private hospitals (41.9%), followed by public hospitals (29.1%). Nearly three-fourth cases were referred to higher health facilities and median time (IQR) of stay at the lower health facility was 120 (60–180) hours. Nearly half of deaths (43.5%) were attributable to more than one delay while first and third delay each contributed equally (25.8%). Lack of perceived need; perceived cost and low status; traditional beliefs and practices; physically inaccessible facilities and lack of service readiness and quality care were important factors in maternal deaths.
Conclusions
The first and third delays were the equal contributors of maternal deaths. Interventions related to birth preparedness, economic support and family planning need to be focused on poor and marginalised communities. Community management of quick transportation, early diagnosis of pregnancy risks, accommodation facilities near the referral hospitals and dedicated skilled manpower with adequate medicines, equipment and blood supplies in referral hospitals are needed for further reduction of maternal deaths in Nepal.
This research is part of the South Asia Research Fund ‘Understanding the factors contributing to maternal mortality in Nepal’ project which was funded by the South Asia Research Hub, Foreign, Commonwealth & Development Office (FCDO)
Citation
Karkee R, Tumbahangphe KM, Maharjan N, et al Who are dying and why? A case series study of maternal deaths in Nepal BMJ Open 2021;11:e042840. doi: 10.1136/bmjopen-2020-042840
Link
Who are dying and why? A case series study of maternal deaths in Nepal