Applying the Three Delays Model to Understand Emergency Care during Pregnancy and Delivery in the Rohingya Refugees Camp Cox's Bazar, Bangladesh

Abstract

Background: Maternal Mortality is a strong indicator of human development that points towards the health of the women, accessibility and the quality of the health services. Maternal mortality remains relatively high in many low- and middle income countries. Every day, approximately 800 women die due to complications of pregnancy and childbirth from preventable causes related to pregnancy and childbirth. Therefore, delays to seek timely care lead to mortality. Aim: This paper aims to study emergency care seeking during pregnancy and delivery by applying the three delays model and identifying the reasons that influence each of the delays in Rohingya Refugee Camp in Cox’s Bazar, Bangladesh. Methods: It is a community based cross-sectional study that has been designed using a mixed methods approach with simple random sampling to select potential participants and interviewed 375 women who have given birth for the last two years in the selected camps. In-depth interviews were done from 25 women to explore the reasons behind the delays to emergency care seeking. Data was analyzed in SPSS version 27 and the results were presented in tabular form as frequencies and percentages. Results: Delays in the decision making to seek care and timely receipt of care on reaching a health facility were most prominent which have a strong influence on emergency care seeking during pregnancy and delivery among the Rohingya women. The reasons influencing care-seeking decisions included ability to recognize symptoms, poor experiences of last visits at facilities, ignorance by providers, lack of transportation, inadequate care, refusal by partner or family members, reliance on traditional medicine, unavailability of service and preference of home delivery. The majority participants responded that they faced first delay to seek emergency care during pregnancy and delivery. Conclusion: This study uses the three delays model framework to identify the reasons behind the delays in emergency care during pregnancy and delivery. The study found that participants are facing mostly first delays. Therefore, training for community members and healthcare providers to recognise danger signs and manage emergency conditions, strengthen health systems and increase health workforce, improve timely and quality of care for emergency seeking care can reduce delays in care emergency seeking.