ArticlePloS one2012
Piecing together the maternal death puzzle through narratives: the three delays model revisited.
Article in PloS one, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 64 papers, 4 of them syntheses that pooled it.
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Who cites it
64 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessments.BMJ global health · 2021Pooled it
- Quality and women's satisfaction with maternal referral practices in sub-Saharan African low and lower-middle income countries: a systematic review.BMC pregnancy and childbirth · 2020Pooled it
- Barriers to access and utilization of emergency obstetric care at health facilities in sub-Saharan Africa: a systematic review of literature.Systematic reviews · 2018Pooled it
- Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis.The Cochrane database of systematic reviews · 2017Pooled it
- The Six Delays Model: expanding the three delays model with evidence from Madagascar for maternal referrals in LMICs.BMJ global health · 2026Review
- Rapid assessment of the factors contributing to the increase in maternal mortality during the COVID-19 pandemic in the Latin American region.BMC pregnancy and childbirth · 2026Article
- An individual-based modelling study estimating the impact of maternity service delivery on health in Malawi.Nature communications · 2025Article
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- Community perspectives on barriers to injury care in Northern Malawi: a three delays framed assessment using focus groups and photovoice.BMC health services research · 2024Article
- Clinical profiles, incidence and predictors of early neonatal mortality at Mbarara Regional Referral Hospital, south-western Uganda.BMC pediatrics · 2024Article
- Factors affecting antenatal care attendance in Soweto, Johannesburg: The three-delay model.African journal of primary health care & family medicine · 2024Article
- Maternal satisfaction with delivery service and associated factors among women who gave birth at public hospitals in Guji Zone, Southern Ethiopia.BMC women's health · 2024Article
- Health system assessment for access to care after injury in low- or middle-income countries: A mixed methods study from Northern Malawi.PLoS medicine · 2024Article
- Transitioning from the "Three Delays" to a focus on continuity of care: a qualitative analysis of maternal deaths in rural Pakistan and Mozambique.BMC pregnancy and childbirth · 2023Article
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- Delays in obtaining hospital care and abortion-related complications within a context of illegality.PloS one · 2023Article
- Barriers and enablers to emergency obstetric and newborn care services use in Wolaita Zone, Southern Ethiopia: a qualitative case study.BMC public health · 2022Article
- Factors Contributing to and Reducing Delays in the Provision of Adequate Care in Ghana: A Qualitative Study of Trauma Care Providers.World journal of surgery · 2022Article
- Maternal Mortality in Africa: Regional Trends (2000-2017).International journal of environmental research and public health · 2022Article
4 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn Malawi maternal mortality continues to be a major public health challenge. Going beyond the numbers to form a more complete view of why women die is critical to improving access to and quality of emergency obstetric care. The objective of the current study was to identify the socio-cultural and facility-based factors that contributed to maternal deaths in the district of Lilongwe, Malawi.
methodsRetrospectively, 32 maternal death cases that occurred between January 1, 2011 and June 30, 2011 were reviewed independently by two gynecologists/obstetricians. Interviews were conducted with healthcare staff, family members, neighbors, and traditional birth attendants. Guided by the grounded theory approach, interview transcripts were analyzed manually and continuously. Emerging, recurring themes were identified and excerpts from the transcripts were categorized according to the Three Delays Model (3Ds).
resultsSixteen deaths were due to direct obstetric complications, sepsis and hemorrhage being most common. Sixteen deaths were due to indirect causes with the main cause being anemia, followed by HIV and heart disease. Lack of recognizing signs, symptoms, and severity of the situation; using traditional Birth Attendant services; low female literacy level; delayed access to transport; hardship of long distance and physical terrain; delayed prompt quality emergency obstetric care; and delayed care while at the hospital due to patient refusal or concealment were observed. According to the 3Ds, the most common delay observed was in receiving treatment upon reaching the facility due to referral delays, missed diagnoses, lack of blood, lack of drugs, or inadequate care, and severe mismanagement.
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