Factors contributing to delays in accessing maternal delivery services in health facilities - Sierra Leone, 2018: A community based cross-sectional study

  • Maternal and child health
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Background:
At 1,360 deaths per 100,000 live-births, Sierra Leone has the highest maternal mortality ratio globally. National data indicates that over 98% of maternal deaths are related to delays in accessing obstetric services, but no empirical study has been conducted to identify associated factors. We identified factors contributing to delays in accessing maternal delivery services as perceived by women in Sierra Leone.

Methods:
We conducted a community-based survey among women who delivered from May 1, 2017 to June 30, 2018 in four of 16 districts. We calculated a sample size of 605. Data on socio-demographics, perceived delays in deciding to seek facility-based delivery services (delay-one), perceived delays in reaching facility-based delivery services (delay-two), and data on the determinants of delays one and two were collected. We calculated frequencies and proportions for factors contributing to the delays as well as Prevalence Odds Ratios (POR) and 95% Confidence Intervals (CI) to identify risk factors for the delays.

Results:
Of the 614 mothers interviewed, the median age was 28 years (range, 14-52 years). The prevalence of delay-one was 23.3 % (143/614), and delay-two was 26.9% (165/614). The significant factors contributing to delay-one were low socio-economic status, costly services, lack of essential medicines, and limited knowledge of pregnancy-related complications. Factors contributing to delay-two were long distances and transport difficulties to health facilities. Bivariate analysis showed an association between perceived delay-two and previous pregnancy-related complications (POR=1.80; 95%CI, 1.13-2.83) and poor condition of roads (POR= 2.34; 95%CI, 1.15-4.77).

Conclusions:
We found a high prevalence of perceived delays one and two for mothers to access obstetric services. Delays were mainly related to transport difficulties, low knowledge of pregnancy-related complications, and costly obstetric services. We recommended health education on pregnancy-related complications; and a practical strategy for birth preparedness as well as improved transportation to health facilities to reduce delays.

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