Recognition of and response to postpartum hemorrhage in rural northern India.
This study describes the results of a Morbidity and Performance Assessment (MAP) conducted to provide insight into the medical factors contributing to maternal and newborn morbidity and mortality in a rural district of northern India, and to use these insights to develop a locally appropriate, community-based safe motherhood program The MAP study was based on verbal autopsy method. Five hundred ninety-nine women (or in the case of 9 maternal deaths, a family member) participated in the study. This article describes a subsample of women who reported signs or symptoms suggesting excessive bleeding (n = 159). Findings include a poor knowledge of danger signs; poor problem recognition during labor, birth, and the immediate postpartum period; and a low level of health seeking that was consistent with poor recognition. Maternal sociodemographic characteristics, antenatal care use, and knowledge of danger signs were generally not associated with problem recognition and health seeking. The case fatality rate was 4%. These findings suggest an urgent need to understand the phenomenon of problem recognition and to integrate this into the design of interventions to reduce delays in health seeking.
Lillian Carter Cancer Center for International Nursing, Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. lsibley@emory.edu
Lynn
L
Sibley
Leila
L
Caleb-Varkey
Jayant
J
Upadhyay
Rajendra
R
Prasad
Ekta
E
Saroha
Neerja
N
Bhatla
Vinod K
VK
Paul
D000293:Adolescent; D000328:Adult; D017028:Caregivers / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006701:Home Nursing / Q000379:methods* / Q000706:statistics & numerical data*; D006801:Humans; D007194:India / Q000453:epidemiology; D008427:Maternal Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D006473:Postpartum Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology / Q000451:nursing*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012424:Rural Population / Q000706:statistics & numerical data*; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors