title: Barriers to emergency obstetric care services: accounts of survivors of life threatening obstetric complications in Malindi District, Kenya.
abstract: BACKGROUND
  Pregnancy-related mortality and morbidity in most low and middle income countries can be reduced through early recognition of complications, prompt access to care and appropriate medical interventions following obstetric emergencies. We used the three delays framework to explore barriers to emergency obstetric care (EmOC) services by women who experienced life threatening obstetric complications in Malindi District, Kenya.
  
  
  METHODS
  A facility-based qualitative study was conducted between November and December 2010. In-depth interviews were conducted with 30 women who experienced obstetric "near miss" at the only public hospital with capacity to provide comprehensive EmOC services in the district.
  
  
  RESULTS
  Findings indicate that pregnant women experienced delays in making decision to seek care and in reaching an appropriate care facility. The "first" delay was due to lack of birth preparedness, including failure to identify a health facility for delivery services regardless of antenatal care and to seek care promptly despite recognition of danger signs. The "second" delay was influenced by long distance and inconvenient transport to hospital. These two delays resulted in some women arriving at the hospital too late to save the life of the unborn baby.
  
  
  CONCLUSIONS
  Delays in making the decision to seek care when obstetric complications occur, combined with delays in reaching the hospital, contribute to ineffective treatment upon arrival at the hospital. Interventions to reduce maternal mortality and morbidity must adequately consider the pre-hospital challenges faced by pregnant women in order to influence decision making towards addressing the three delays.
authors.affiliation: Centre for Public Health Research, Kenya Medical Research Institute (KEMRI) Nairobi, Kenya.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Echoka
authors.affiliation: Department of Food Science Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
authors.forename: Anselimo
authors.initials: A
authors.lastname: Makokha
authors.affiliation: Woman and Child Health Research Center, Department of Public Health Institute of Tropical Medicine Nationalestraat 155, 2000, Antwerpen, Belgium.
authors.forename: Dominique
authors.initials: D
authors.lastname: Dubourg
authors.affiliation: Centre for Public Health Research, Kenya Medical Research Institute (KEMRI) Nairobi, Kenya.
authors.forename: Yeri
authors.initials: Y
authors.lastname: Kombe
authors.affiliation: Centre for Public Health Research, Kenya Medical Research Institute (KEMRI) Nairobi, Kenya.
authors.forename: Lillian
authors.initials: L
authors.lastname: Nyandieka
authors.affiliation: Centre for Health Research and Development, Faculty of Health and Medical Sciences, University of Copenhagen, Thorvaldsensvej 57, Frederiksberg DK 1871, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Byskov
mesh_terms: D000293:Adolescent; D000328:Adult; D003625:Data Collection; D003657:Decision Making; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008427:Maternal Health Services / Q000458:organization & administration / Q000706:statistics & numerical data* / Q000600:supply & distribution; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome; D017741:Survivors; D013997:Time Factors; D055815:Young Adult
keywords: EmOC; Pregnancy; complication; delay; near miss