title: Women-focused development intervention reduces delays in accessing emergency obstetric care in urban slums in Bangladesh: a cross-sectional study.
abstract: BACKGROUND
  Recognizing the burden of maternal mortality in urban slums, in 2007 BRAC (formally known as Bangladesh Rural Advancement Committee) has established a woman-focused development intervention, Manoshi (the Bangla abbreviation of mother, neonate and child), in urban slums of Bangladesh. The intervention emphasizes strengthening the continuum of maternal, newborn and child care through community, delivery centre (DC) and timely referral of the obstetric complications to the emergency obstetric care (EmOC) facilities. This study aimed to assess whether Manoshi DCs reduces delays in accessing EmOC.
  
  
  METHODS
  This cross-sectional study was conducted during October 2008 to January 2009 in the slums of Dhaka city among 450 obstetric complicated cases referred either from DCs of Manoshi or from their home to the EmOC facilities. Trained female interviewers interviewed at their homestead with structured questionnaire. Pearson's chi-square test, t-test and Mann-Whitney test were performed.
  
  
  RESULTS
  The median time for making the decision to seek care was significantly longer among women who were referred from home than referred from DCs (9.7 hours vs. 5.0 hours, p < 0.001). The median time to reach a facility and to receive treatment was found to be similar in both groups. Time taken to decide to seek care was significantly shorter in the case of life-threatening complications among those who were referred from DC than home (0.9 hours vs.2.3 hours, p = 0.002). Financial assistance from Manoshi significantly reduced the first delay in accessing EmOC services for life-threatening complications referred from DC (p = 0.006). Reasons for first delay include fear of medical intervention, inability to judge maternal condition, traditional beliefs and financial constraints. Role of gender was found to be an important issue in decision making. First delay was significantly higher among elderly women, multiparity, non life-threatening complications and who were not involved in income-generating activities.
  
  
  CONCLUSIONS
  Manoshi program reduces the first delay for life-threatening conditions but not non-life-threatening complications even though providing financial assistance. Programme should give more emphasis on raising awareness through couple/family-based education about maternal complications and dispel fear of clinical care to accelerate seeking EmOC.
authors.affiliation: National Institute of Preventive and Social Medicine, Mohakhali, Dhaka 1212, Bangladesh.
authors.forename: Shamsun
authors.initials: S
authors.lastname: Nahar
authors.forename: Morsheda
authors.initials: M
authors.lastname: Banu
authors.forename: Hashima E
authors.initials: HE
authors.lastname: Nasreen
mesh_terms: D000328:Adult; D001459:Bangladesh; D016009:Chi-Square Distribution; D003150:Community Health Workers; D003430:Cross-Sectional Studies; D003906:Developing Countries; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006792:House Calls / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D008427:Maternal Health Services / Q000191:economics / Q000706:statistics & numerical data*; D008880:Midwifery; D007744:Obstetric Labor Complications / Q000628:therapy; D009819:Office Visits / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011204:Poverty Areas; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy; D015397:Program Evaluation; D012017:Referral and Consultation; D018709:Statistics, Nonparametric; D013997:Time Factors; D014505:Urban Population; D055815:Young Adult