Using the three delays model to understand why newborn babies die in eastern Uganda

Peter Waiswa, Karin Kallander, Stefan Peterson, Goran Tomson, George W. Pariyo

Research output: Contribution to journalArticlepeer-review


SummaryObjectives To investigate causes of and contributors to newborn deaths in eastern Uganda using a three delays audit approach. Methods Data collected on 64 neonatal deaths from a demographic surveillance site were coded for causes of deaths using a hierarchical model and analysed using a modified three delays model to determine contributing delays. A survey was conducted in 16 health facilities to determine capacity for newborn care. Results Of the newborn babies, 33% died in a hospital/health centre, 13% in a private clinic and 54% died away from a health facility. 47% of the deaths occurred on the day of birth and 78% in the first week. Major contributing delays to newborn death were caretaker delay in problem recognition or in deciding to seek care (50%, 32/64); delay to receive quality care at a health facility (30%; 19/64); and transport delay (20%; 13/64). The median time to seeking care outside the home was 3 days from onset of illness (IQR 1-6). The leading causes of death were sepsis or pneumonia (31%), birth asphyxia (30%) and preterm birth (25%). Health facilities did not have capacity for newborn care, and health workers had correct knowledge on only 31% of the survey questions related to newborn care. Conclusions Household and health facility-related delays were the major contributors to newborn deaths, and efforts to improve newborn survival need to address both concurrently. Understanding why newborn babies die can be improved by using the three delays model, originally developed for understanding maternal death.

Original languageEnglish (US)
Pages (from-to)964-972
Number of pages9
JournalTropical Medicine and International Health
Issue number8
StatePublished - Aug 2010
Externally publishedYes


  • Uganda
  • care-seeking
  • delays
  • infant
  • mortality
  • newborn
  • social autopsy
  • three delays
  • verbal autopsy

ASJC Scopus subject areas

  • Parasitology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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