A cross-sectional study of the first and the second delays among women admitted to a maternity hospital with severe obstetric complications ('near-mtss') .in Afghanistan

In Afghanistan, the majority of women continue to give birth at home because of poverty, difficult access to health facilities, or gender-based restrictions. Women are often brought into hospitals in moribund conditions after the onset of complications at home. A detailed understanding of the determinants of health care seeking delays is necessary in order to help identify strategies which could reduce the incidence of very severe complications and maternal deaths and improve foetal outcomes in complicated pregnancies. A review of existing studies of care-seeking delays indicated that durations of care-seeking time had not been well explained because of various methodological limitations. The large majority of previous studies were descriptive and fell short in identifying contributing factors that could be eliminated by interventions while analytical studies lacked methodological rigour largely due to sample size limitations associated with rarity of maternal deaths. In this thesis, data from a hospital-based cross-sectional survey conducted among 472 women with severe obstetric complications in Afghanistan were analysed using a refined version of the conceptual framework developed by Thaddeus and Maine (1994). Three types of care-seeking delays were considered: the duration oftime from onset of symptoms to decision to seek care (or 'decision delay'), the duration from the decision to departure for health care facilities, (or 'departure delay') and variation in self-reported travel time from GIS-modelled travel time (or 'travel delay'). The study posited that delayed care-seeking would be best explained by a combination of factors including a woman's health care practice during pregnancy, her family's financial and social resources, geographical accessibility to healthcare and the types of symptoms and signs associated with each complication. It was also postulated that care-seeking delay would be among important determinants of foetal death. Regression techniques were used to identify determinants of the three types of delays, and logistic