Journal Article > ResearchFull Text
SSM Qual Res Health. 2023 December 1; Volume 4; 100330.; DOI:10.1016/j.ssmqr.2023.100330
Moore AM, Fetters T, Williams T, Pasquier E, Kantiok J, et al.
SSM Qual Res Health. 2023 December 1; Volume 4; 100330.; DOI:10.1016/j.ssmqr.2023.100330
Maternal near-miss events are a key measure of maternal health; abortion-related complications are one source of near-miss events. To understand the pathway to care of women with severe abortion-related events in a fragile context, we conducted in-depth semi-structured interviews with women who obtained treatment at a referral hospital in Jigawa State, Nigeria, in 2020–2021 (n = 61). We used the Three Delays Model (Thaddeus & Maine, 1994) to examine impediments in reaching care.
The first delay (from the onset of symptoms of the pregnancy loss to the decision to seek care) was characterized by the duration of time it took to recognize the pregnancy and pregnancy loss in addition to religious beliefs that it is the will of a higher power that she lost the pregnancy. The second delay (from the decision to seek care to arriving at a place that could provide adequate care for her complication, i.e. the study site); was due to lack of money, lack of passable roads and transport, use of traditional healers, challenges being seen by providers at lower-level facilities, referrals not being facilitated and misdirection by healthcare providers. The third delay was not present in our results. No respondent said she knowingly interfered with the pregnancy; understanding why these pregnancy losses resulted in near-miss complications is critical to reducing maternal morbidity and mortality in Northern Nigeria. Addressing health literacy as well as social and financial barriers holds the potential to get women to care sooner and avert these near-miss or potentially life-threatening events.
The first delay (from the onset of symptoms of the pregnancy loss to the decision to seek care) was characterized by the duration of time it took to recognize the pregnancy and pregnancy loss in addition to religious beliefs that it is the will of a higher power that she lost the pregnancy. The second delay (from the decision to seek care to arriving at a place that could provide adequate care for her complication, i.e. the study site); was due to lack of money, lack of passable roads and transport, use of traditional healers, challenges being seen by providers at lower-level facilities, referrals not being facilitated and misdirection by healthcare providers. The third delay was not present in our results. No respondent said she knowingly interfered with the pregnancy; understanding why these pregnancy losses resulted in near-miss complications is critical to reducing maternal morbidity and mortality in Northern Nigeria. Addressing health literacy as well as social and financial barriers holds the potential to get women to care sooner and avert these near-miss or potentially life-threatening events.
Journal Article > ResearchFull Text
SSM Qual Res Health. 2022 March 17; Volume 2; 100067.; DOI:https://doi.org/10.1016/j.ssmqr.2022.100067
Burtscher D, Maukner AC, Piatti M, Verschuere J, Aruna TM, et al.
SSM Qual Res Health. 2022 March 17; Volume 2; 100067.; DOI:https://doi.org/10.1016/j.ssmqr.2022.100067
In Sierra Leone, maternal and under-five mortality rates are among the highest in the world. In 2010, the government adopted the Free Healthcare Initiative (FHCI) providing free healthcare for children aged under-five and pregnant and lactating women. However, the FHCI is seriously impeded by the limited availability of health staff, gaps in medication supply, and weak management. In this paper, we present experiences of the Gorama Mende and Wandor (GMW) chiefdom residents in Kenema district, Sierra Leone and how they navigate available options to seek care. We argue that the health-seeking behaviour (HSB) of the population is influenced by interrelated structural and social factors. This qualitative research was conducted in rural GMW chiefdoms in February 2020, using in-depth individual, paired, and group interviews. Contrary to the assumption that traditional healers influence HSB, data suggest that structural factors like proximity, affordability, previous experience, and reception at the health facility were the main determinants. Healthcare providers felt that people went to a traditional healer first; however, the population emphasised that their first choice was always the peripheral health unit (PHU) provided there were no barriers. These barriers include, living in hard-to-reach areas, transportation, unexpected payment for services, and fear of the health staff. The study reveals the complex reality people face in terms of access to healthcare and multiple factors that influence HSB. One community member noted that if people could not afford a PHU, they would turn to alternative forms of healthcare — ‘Where my pocket can afford is where I will take my child’.