ArticleBMC pregnancy and childbirth2023
Transitioning from the "Three Delays" to a focus on continuity of care: a qualitative analysis of maternal deaths in rural Pakistan and Mozambique.
Article in BMC pregnancy and childbirth, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01911494 (The CLIP), which is not on this map. Cited by 9 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The CLIP (Community Level Interventions for Pre-eclampsia) Cluster Randomized Controlled Trial
Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Exploring parental knowledge, care-seeking, and support strategies for neonatal illness: an integrative review of the African Great Lakes region.Global health action · 2025Pooled it
- Identifying delays impacting maternal and perinatal deaths using a facility-based death audit review system integrated with community engagement: a mixed methods study.Journal of global health · 2026Article
- Supporting the implementation of a Maternal Early Warning System (MEWS) protocol using Human-Centred Design.BMC health services research · 2026Article
- Predictors of delay seeking delivery services at labor onset among pregnant women in the singida region of Tanzania: analytical cross-sectional study.Frontiers in global women's health · 2026Article
- Feasibility of establishing a Canadian Obstetric Survey System (CanOSS) for severe maternal morbidity: results of a nationwide survey.Public health in practice (Oxford, England) · 2025Article
- Maternal Mortality in Pakistan: Demographic, Temporal, and Contextual Insights From the Three Delays Model.Cureus · 2025Article
- Community perspectives on access to maternal health services during the COVID-19 pandemic in rural Western Kenya: a qualitative study.BMC health services research · 2025Article
- Patterns of care-seeking for postpartum symptoms in urban Karachi, Pakistan: implications for intervention design.Reproductive health · 2025Article
- Mixed vulnerabilities: the biological risk of high parity is aggravated by emergency referral in Benin, Malawi, Tanzania and Uganda.International journal for equity in health · 2025Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
backgroundThe Three Delays Framework was instrumental in the reduction of maternal mortality leading up to, and during the Millennium Development Goals. However, this paper suggests the original framework might be reconsidered, now that most mothers give birth in facilities, the quality and continuity of the clinical care is of growing importance.
methodsThe paper explores the factors that contributed to maternal deaths in rural Pakistan and Mozambique, using 76 verbal autopsy narratives from the Community Level Interventions for Pre-eclampsia (CLIP) Trial.
resultsQualitative analysis of these maternal death narratives in both countries reveals an interplay of various influences, such as, underlying risks and comorbidities, temporary improvements after seeking care, gaps in quality care in emergencies, convoluted referral systems, and arrival at the final facility in critical condition. Evaluation of these narratives helps to reframe the pathways of maternal mortality beyond a single journey of care-seeking, to update the categories of seeking, reaching and receiving care.
conclusionsThere is a need to supplement the pioneering "Three Delays Framework" to include focusing on continuity of care and the "Four Critical Connection Points": (1) between the stages of pregnancy, (2) between families and health care workers, (3) between health care facilities and (4) between multiple care-seeking journeys.
trial registrationNCT01911494, Date Registered 30/07/2013.
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