Ami L DeWaters, Erin L Miller, Paul Haidet, Jed D Gonzalo
Systems-Based Practice: Expert Perspectives on the Origin and Evolution of an Ambiguous Competency
Academic medicine : journal of the Association of American Medical Colleges
malawi maternal mortality continues major public health challenge going beyond numbers form complete view women die critical improving access quality emergency obstetric care objective current study identify sociocultural facilitybased factors contributed maternal deaths district lilongwe malawiretrospectively 32 maternal death cases occurred january 1 2011 june 30 2011 reviewed independently two gynecologistsobstetricians interviews conducted healthcare staff family members neighbors traditional birth attendants guided grounded theory approach interview transcripts analyzed manually continuously emerging recurring themes identified excerpts transcripts categorized according three delays model 3dssixteen deaths due direct obstetric complications sepsis hemorrhage common sixteen deaths due indirect causes main cause anemia followed hiv heart disease lack recognizing signs symptoms severity situation using traditional birth attendant services low female literacy level delayed access transport hardship long distance physical terrain delayed prompt quality emergency obstetric care delayed care hospital due patient refusal concealment observed according 3ds common delay observed receiving treatment upon reaching facility due referral delays missed diagnoses lack blood lack drugs inadequate care severe mismanagement