Determinants of Health Care Seeking Behaviors in Puerperal Sepsis in Rural Sindh, Pakistan: A Qualitative Study

Background: Puerperal sepsis (PS) is one of the major causes of maternal death, contributing to 26,000 deaths per year in developing countries. Early recognition and treatment are essential to managing PS, but numerous social, cultural and technical barriers prevent or delay access to care and necessary medical attention. Through this qualitative study, we identified barriers to care seeking for puerperal sepsis among recently delivered women in Matiari, Pakistan. Methods: We conducted 20 in-depth interviews among recently delivered women with and without sepsis and their family members in September 2012. Key informant interviews were conducted with 14 healthcare providers and traditional birth attendants. The themes used for content analysis were knowledge of danger signs, factors affecting care seeking and local treatment practices for postpartum sepsis. Results: A total of 34 interviews were conducted. Recently delivered women, their family members and traditional birth attendants were unaware of the word PS or the local translated term for PS. However, they were familiar with most of the individual symptoms associated with PS. Healthcare providers were aware of the condition and the associated symptoms. The healthcare providers’ understanding of the seriousness of PS was directly proportional their age and clinical experience. The most common barriers to care seeking was the division of labor within the household, obtaining permission from the primary decision maker, access to transportation, lack of financial resources and support from family members. Conclusion: To improve maternal care seeking behaviors for PS, interventions focusing on increasing knowledge of PS, addressing gender inequality, implementing an affordable community transport service and enhancing TBA’s knowledge and skills to manage PS need to be implemented.

Perceptions of Health Warning Signs in Seriously Ill Woman of Childbearing Age in Kinshasa

Introduction: For seriously ill women of childbearing age, perceived health warning signs may influence decision of whether or not to seek care. Inaccurate perceptions of patients and those around them may lead to attitudes that delay seeking care. This study analyzes perceptions of danger and related delays to seek care in Kinshasa. Methods: Sixty deceased women who died between March and April 2004 were taken away from two Kinshasa mortuaries. History of disease and deaths were reconstructed through medical records and semi-structured interviews of family members and leaders. The Qualitative Software Research was used to conduct a qualitative analysis. Results: Perceived health warning signs had five manifestations: Specific clinical health warning signs, aggravation of non-specific signs, persistence of signs, indirect danger signs and superstitious signs. The incorrect perception of the signs was an important cause of late awareness of the danger and delayed decision to seek care. Conclusion: Misunderstandings of signs often delayed awareness of danger as well as decisions to seek appropriate care. Educational programs teaching health warning signs should be designed to promote the timely use of facilities.

Factors associated with the extent of care-seeking delay for patients with acute myocardial infarction in Beijing

Background Prehospital delay remains one of the main causes of reduced benefit of reperfusion therapy for patients with acute myocardial infarction (AMI) The largest proportion of prehospital delay involves the interval between the onset of symptoms and the decision to seek medical treatment The purpose of this study was to examine the factors associated with the extent of care seeking delay in Beijing for patients with AMI Methods A structured interview was conducted in 102 patients with AMI in eight hospitals in Beijing Results The mean decision time in patients with AMI was (204±43) minutes, and prehospital delay time was (311±54) minutes Only 34% of patients sought medical care within one hour and a further 36% of patients presented to one of the eight hospitals within two hours after onset Educational level, atypical presentation of AMI, and family members at the site where AMI occurred were associated with longer delay time in seeking medical assistance ( P <0 05, respectively), whereas the intensity of chest pain was inversely related to patients’ delay time ( P <0 01) Patients who perceived their family relationship as good, attributed their symptoms to AMI origin, knew the time dependent nature of reperfusion therapy, or used emergency medical service tended to seek medical care in a more rapid manner ( P <0 05, respectively) Conclusions Patients with AMI in Beijing delay seeking medical care to a great extent Health education to increase the level of awareness of the target population at increased risk of AMI, including patients and their family members, is probably beneficial to reduce patients’ care-seeking delay