Factors associated with delay in care-seeking for fatal neonatal illness in the Sylhet district of Bangladesh: Results from a verbal and social autopsy study

Bareng A.S. Nonyane, Narjis Kazmi, Alain K Koffi, Nazma Begum, Salahuddin Ahmed, Abdullah Baqui, Henry D. Kalter

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Abstract

Background We conducted a social and verbal autopsy study to determine cultural-, social- and health system-related factors that were associated with the delay in formal care seeking in Sylhet district, Bangladesh. Methods Verbal and social autopsy interviews were conducted with mothers who experienced a neonatal death between October 2007 and May 2011. We fitted a semi-parametric regression model of the cumulative incidence of seeking formal care first, accounting for competing events of death or seeking informal care first. Results Three hundred and thirty-one neonatal deaths were included in the analysis and of these, 91(27.5%) sought formal care first; 26 (7.9%) sought informal care first; 59 (17.8%) sought informal care only, and 155 (46.8%) did not seek any type of care. There was lower cumulative incidence of seeking formal care first for preterm neonates (sub-hazard ratio SHR 0.61, P = 0.025), and those who delivered at home (SHR 0.52, P = 0.010); and higher cumulative incidence for those who reported less than normal activity (SHR 1.95, P = 0.048). The main barriers to seeking formal care reported by 165 mothers included cost (n = 98, 59.4%), believing the neonate was going to die anyway (n = 29, 17.7%), and believing traditional care was more appropriate (n = 26, 15.8%). Conclusions The majority of neonates died before formal care could be sought, but formal care was more likely to be sought than informal care. There were economic and social belief barriers to care- seeking. There is a need for programs that educate caregivers about well-recognized danger signs requiring timely care-seeking, particularly for preterm neonates and those who deliver at home.

Original languageEnglish (US)
Article number010605
JournalJournal of Global Health
Volume6
Issue number1
DOIs
StatePublished - 2016

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Bangladesh
Autopsy
Patient Care
Newborn Infant
Incidence
Mothers
Caregivers
Economics
Interviews
Costs and Cost Analysis
Health
Perinatal Death

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

@article{c809404ae6cd453b8a469d1111388221,
title = "Factors associated with delay in care-seeking for fatal neonatal illness in the Sylhet district of Bangladesh: Results from a verbal and social autopsy study",
abstract = "Background We conducted a social and verbal autopsy study to determine cultural-, social- and health system-related factors that were associated with the delay in formal care seeking in Sylhet district, Bangladesh. Methods Verbal and social autopsy interviews were conducted with mothers who experienced a neonatal death between October 2007 and May 2011. We fitted a semi-parametric regression model of the cumulative incidence of seeking formal care first, accounting for competing events of death or seeking informal care first. Results Three hundred and thirty-one neonatal deaths were included in the analysis and of these, 91(27.5{\%}) sought formal care first; 26 (7.9{\%}) sought informal care first; 59 (17.8{\%}) sought informal care only, and 155 (46.8{\%}) did not seek any type of care. There was lower cumulative incidence of seeking formal care first for preterm neonates (sub-hazard ratio SHR 0.61, P = 0.025), and those who delivered at home (SHR 0.52, P = 0.010); and higher cumulative incidence for those who reported less than normal activity (SHR 1.95, P = 0.048). The main barriers to seeking formal care reported by 165 mothers included cost (n = 98, 59.4{\%}), believing the neonate was going to die anyway (n = 29, 17.7{\%}), and believing traditional care was more appropriate (n = 26, 15.8{\%}). Conclusions The majority of neonates died before formal care could be sought, but formal care was more likely to be sought than informal care. There were economic and social belief barriers to care- seeking. There is a need for programs that educate caregivers about well-recognized danger signs requiring timely care-seeking, particularly for preterm neonates and those who deliver at home.",
author = "Nonyane, {Bareng A.S.} and Narjis Kazmi and Koffi, {Alain K} and Nazma Begum and Salahuddin Ahmed and Abdullah Baqui and Kalter, {Henry D.}",
year = "2016",
doi = "10.7189/jogh.06.010605",
language = "English (US)",
volume = "6",
journal = "Journal of Global Health",
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T1 - Factors associated with delay in care-seeking for fatal neonatal illness in the Sylhet district of Bangladesh

T2 - Results from a verbal and social autopsy study

AU - Nonyane, Bareng A.S.

AU - Kazmi, Narjis

AU - Koffi, Alain K

AU - Begum, Nazma

AU - Ahmed, Salahuddin

AU - Baqui, Abdullah

AU - Kalter, Henry D.

PY - 2016

Y1 - 2016

N2 - Background We conducted a social and verbal autopsy study to determine cultural-, social- and health system-related factors that were associated with the delay in formal care seeking in Sylhet district, Bangladesh. Methods Verbal and social autopsy interviews were conducted with mothers who experienced a neonatal death between October 2007 and May 2011. We fitted a semi-parametric regression model of the cumulative incidence of seeking formal care first, accounting for competing events of death or seeking informal care first. Results Three hundred and thirty-one neonatal deaths were included in the analysis and of these, 91(27.5%) sought formal care first; 26 (7.9%) sought informal care first; 59 (17.8%) sought informal care only, and 155 (46.8%) did not seek any type of care. There was lower cumulative incidence of seeking formal care first for preterm neonates (sub-hazard ratio SHR 0.61, P = 0.025), and those who delivered at home (SHR 0.52, P = 0.010); and higher cumulative incidence for those who reported less than normal activity (SHR 1.95, P = 0.048). The main barriers to seeking formal care reported by 165 mothers included cost (n = 98, 59.4%), believing the neonate was going to die anyway (n = 29, 17.7%), and believing traditional care was more appropriate (n = 26, 15.8%). Conclusions The majority of neonates died before formal care could be sought, but formal care was more likely to be sought than informal care. There were economic and social belief barriers to care- seeking. There is a need for programs that educate caregivers about well-recognized danger signs requiring timely care-seeking, particularly for preterm neonates and those who deliver at home.

AB - Background We conducted a social and verbal autopsy study to determine cultural-, social- and health system-related factors that were associated with the delay in formal care seeking in Sylhet district, Bangladesh. Methods Verbal and social autopsy interviews were conducted with mothers who experienced a neonatal death between October 2007 and May 2011. We fitted a semi-parametric regression model of the cumulative incidence of seeking formal care first, accounting for competing events of death or seeking informal care first. Results Three hundred and thirty-one neonatal deaths were included in the analysis and of these, 91(27.5%) sought formal care first; 26 (7.9%) sought informal care first; 59 (17.8%) sought informal care only, and 155 (46.8%) did not seek any type of care. There was lower cumulative incidence of seeking formal care first for preterm neonates (sub-hazard ratio SHR 0.61, P = 0.025), and those who delivered at home (SHR 0.52, P = 0.010); and higher cumulative incidence for those who reported less than normal activity (SHR 1.95, P = 0.048). The main barriers to seeking formal care reported by 165 mothers included cost (n = 98, 59.4%), believing the neonate was going to die anyway (n = 29, 17.7%), and believing traditional care was more appropriate (n = 26, 15.8%). Conclusions The majority of neonates died before formal care could be sought, but formal care was more likely to be sought than informal care. There were economic and social belief barriers to care- seeking. There is a need for programs that educate caregivers about well-recognized danger signs requiring timely care-seeking, particularly for preterm neonates and those who deliver at home.

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