'The clock keeps ticking'--the role of a community-based intervention in reducing delays in seeking emergency obstetric care in rural Bangladesh: a quasi-experimental study.
OBJECTIVE
To explore the role of a community-based intervention in reducing delays in accessing emergency obstetric care (EmOC) in rural Bangladesh, and the factors associated with delayed decision making, reaching the health facility and receiving treatment.


METHODS
Quasi-experimental study.


METHODS
Multistage random sampling was used to select 540 villages, from which 1200 women who reported obstetric complications in March-April 2010 were interviewed.


RESULTS
The median time taken to make the decision to access health care was significantly lower in the intervention areas compared with the control areas (80 vs 90 min). In addition, the median time taken to reach the health facility was significantly lower in the intervention areas compared with the control areas (110 vs 135 min). However, no difference was found in the median time taken to receive treatment. Multiple linear regressions demonstrated that the community intervention significantly reduced decision making and time taken to reach the health facility when accessing EmOC in rural Bangladesh. However, for women experiencing haemorrhage, the delays were longer in the intervention areas. Protective factors against delayed decision making included access to television, previous medical exposure, knowledge, life-threatening complications during childbirth and use of a primary health facility. Financial constraints and traditional perceptions were associated with delayed decision making. Complications during labour, use of a motorized vehicle and use of a primary health facility were associated with faster access to EmOC, and poverty, distance, transportation difficulties and decision made by male guardian were associated with slower access to EmOC.


CONCLUSIONS
The intervention appeared to reduce the time taken to make the decision to access health care and the time taken to reach the health facility when accessing EmOC. This study provides support for a focus on emergency preparedness for timely referral from the community.
Research and Evaluation Division, BRAC Centre, Dhaka, Bangladesh. Electronic address: morsheda.b@brac.net.
M
M
Banu
Research and Evaluation Division, BRAC Centre, Dhaka, Bangladesh.
M
M
Akter
Research and Evaluation Division, BRAC Centre, Dhaka, Bangladesh.
K
K
Begum
Health Nutrition and Population Programme, BRAC Centre, Dhaka, Bangladesh.
R H
RH
Choudhury
Research and Evaluation Division, BRAC Centre, Dhaka, Bangladesh.
H E
HE
Nasreen
D000328:Adult; D001459:Bangladesh; D003657:Decision Making; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data*; D011203:Poverty; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D036301:Qualitative Research; D012307:Risk Factors; D019035:Rural Health Services / Q000706:statistics & numerical data*; D013997:Time Factors; D055815:Young Adult
Bangladesh; Delay; EmOC; Obstetric complications; Referral; Time