title: Health-seeking patterns among fatally ill Capeverdian women.
abstract: The circumstances of 94 deaths among females aged 15-49 years in Cape Verde were investigated to assess their access to effective care. Persons associated with the deceased women were interviewed (verbal autopsy) to explore contributing causes of death, perceived illnesses and treatment efforts. The certainty of diagnosis and avoidability of the fatal outcome were assessed by a panel ofexperts. A model of health care accessibility is elaborated to identity restricting (delay) factors. Deliberate avoidance of modern medical care and reliance on traditional medicine were major delay factors, while unawareness of the severity of symptoms and affordability limits were minor delay factors in this population. A detailed sorting of cases by health care level is used to identify the effectiveness of diagnosing, referral and care provided. Since a high proportion of avoidable deaths occurred in hospital, the quality of care may have been sub-optimal.
authors.affiliation: Division of International Health (IHCAR), Karolinska Institute, Stockholm, Sweden. hans.wessel@ks.se
authors.forename: Hans
authors.initials: H
authors.lastname: Wessel
authors.forename: Pitt
authors.initials: P
authors.lastname: Reitmaier
authors.forename: Alice
authors.initials: A
authors.lastname: Dupret
authors.forename: Ernesto
authors.initials: E
authors.lastname: Rocha
authors.forename: Sven
authors.initials: S
authors.lastname: Cnattingius
authors.forename: Staffan
authors.initials: S
authors.lastname: Bergström
mesh_terms: D000293:Adolescent; D000328:Adult; D000354:Africa, Western; D002423:Cause of Death; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D016488:Medicine, African Traditional; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011787:Quality of Health Care; D013997:Time Factors