Abstract
SOCIAL DETERMINANTS AND CONTRIBUTORS OF MATERNAL DEATHS IN PRAKASAM DISTRICT OF ANDHRA PRADESH, INDIA: AN ASSESSMENT OF HEALTH CARE PATTERN AND USE OF THREE DELAY MODEL

A. Sridevi*, B. T. Rao, Pratistha Sharma, KLS Keerthi, R. Yaswanth Chowdary and D. Prem Kumar

ABSTRACT

Introduction: The standards of Obstetric services in a country are assessed by Maternal and perinatal death rates. The three delays model proposes that maternal mortality is associated with delays in deciding to seek care; reaching the healthcare facility and receiving care. The socio-cultural conditions contribute for delays need to be understood for prevention of maternal Deaths. Objectives: To ascertain the social determinants and specific contributors of maternal deaths, health care seeking pattern and analyze about three delays pertaining to emergency obstetric care practices. Methodology: Retrospective study conducted on maternal deaths case records occurred from January 2017 to March 2019 in Parkasam District. Demographic characteristics, Antenatal Care, booking, delivery details, postnatal visits, causes of death, admission to maternal death time interval and distance from residence to health care facility, and various levels of delay with the reasons were assessed. Data analysis carried out by using latest SPSS Version. Results: Among 64 maternal deaths 50% were illiterate, 29.7% were labourers and 62.4% were SC&ST families. About 52 % were high risk and 31.2% deliveries occurred in Government Tertiary Care hospital and 23% in Private Hospitals and 79.7% were intranatal and postnatal deaths. Only 31% deaths had postnatal visits and 72% postnatal complications. 53% maternal deaths were occurred in Government hospitals, 20.3% in transit, 19% in private hospitals and 8% at houses. PIH and Eclampsia (32.9%) followed by hemorrhage (20.3%) were main causes of maternal deaths and 62.5% were had admission and death duration of more than one day. 45.3% travelled more than 3 hours to reach hospital. Type 1 an 2 delays were most common in comparison with 3rd delay. Conclusions: Early referral, continued skill based training of ANMS and doctors, monitoring of health services can reduce maternal mortality. Special teams of doctors need to be trained to manage complications at periphery level and household level. Maternal deaths can prevent by improving establishment of proper obstetrics services including proper postnatal visits for all.

Keywords: Maternal Death, Social Determinants, Three delay model, Antenatal Care, Birth Planning.


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