A lost cause? Extending verbal autopsy to investigate biomedical and socio-cultural causes of maternal death in Burkina Faso and Indonesia

  • Social Science and Medicine, Volume 71, No. 10, Year 2010

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Study Justification:
– Maternal mortality in developing countries is a significant issue, particularly among disadvantaged and excluded women.
– Verbal autopsy (VA) is a method used to determine the cause of death for individuals who die outside of health facilities or without proper registration.
– This study aimed to extend VA to investigate both biomedical and socio-cultural factors contributing to maternal deaths in Burkina Faso and Indonesia.
– By understanding the underlying causes and barriers to care, this study aimed to inform health surveillance and planning efforts.
Study Highlights:
– Interviews were conducted with relatives of women who died during pregnancy, childbirth, or postpartum in rural districts in Burkina Faso and Indonesia.
– Information was collected on medical signs and symptoms prior to death, as well as care pathways and opinions on preventability and cause of death.
– The cause of death profiles were similar in both settings, with infectious diseases, hemorrhage, and malaria accounting for half of the deaths.
– Delays in seeking, reaching, and receiving care were reported by more than two-thirds of respondents in both settings.
– Relatives provided information on culturally-derived systems of explanation, causation, and behavior during emergencies.
– The analysis suggested that the quantified delays may have been underestimated, highlighting the need for a broader understanding of the socio-economic and cultural landscapes in which healthcare is sought.
Recommendations for Lay Readers and Policy Makers:
– The study findings emphasize the importance of addressing both biomedical and socio-cultural factors in efforts to reduce maternal mortality.
– Improving access to quality care, particularly in low-income and rural settings, is crucial for preventing maternal deaths.
– Health surveillance and planning should consider the broader socio-economic and cultural contexts in which healthcare is situated and sought.
– Utilizing local knowledge and understanding cultural beliefs and behaviors can inform the prioritization of interventions that address the underlying conditions contributing to maternal deaths.
Key Role Players:
– Researchers and academics in the field of maternal health and public health.
– Local healthcare providers and policymakers in Burkina Faso and Indonesia.
– Community leaders and organizations working on maternal health issues.
– International organizations and donors supporting maternal health initiatives.
Cost Items for Planning Recommendations:
– Training and capacity building for healthcare providers and researchers.
– Data collection and analysis, including interviews and qualitative and quantitative analyses.
– Community engagement and awareness campaigns.
– Infrastructure improvements to enhance access to quality care.
– Development and implementation of interventions targeting socio-cultural factors.
– Monitoring and evaluation of interventions to assess their effectiveness.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study conducted interviews with relatives of women who died during pregnancy, childbirth, or postpartum in two rural districts in Indonesia and one rural district in Burkina Faso. Information was collected on medical signs and symptoms, care pathways, and opinions on preventability and cause of death. Quantitative and qualitative analyses were performed, revealing similar cause of death profiles in both settings and delays in seeking, reaching, and receiving care. Relatives also provided information on culturally-derived systems of explanation, causation, and behavior. The comparison of qualitative and quantitative results suggests that the quantified delays may have been underestimated. The study suggests that extended verbal autopsy can inform health planning by considering socio-economic and cultural factors. To improve the strength of the evidence, the study could have included a larger sample size and conducted a more comprehensive analysis of the data.

Maternal mortality in developing countries is characterised by disadvantage and exclusion. Women who die whilst pregnant are typically poor and live in low-income and rural settings where access to quality care is constrained and where deaths, within and outside hospitals, often go unrecorded and unexamined. Verbal autopsy (VA) is an established method of determining cause(s) of death for people who die outside health facilities or without proper registration. This study extended VA to investigate socio-cultural factors relevant to outcomes. Interviews were conducted with relatives of 104 women who died during pregnancy, childbirth or postpartum in two rural districts in Indonesia and for 70 women in a rural district in Burkina Faso. Information was collected on medical signs and symptoms of the women prior to death and an extended section collected accounts of care pathways and opinions on preventability and cause of death. Illustrative quantitative and qualitative analyses were performed and the implications for health surveillance and planning were considered. The cause of death profiles were similar in both settings with infectious diseases, haemorrhage and malaria accounting for half the deaths. In both settings, delays in seeking, reaching and receiving care were reported by more than two-thirds of respondents. Relatives also provided information on their experiences of the emergencies revealing culturally-derived systems of explanation, causation and behaviour. Comparison of the qualitative and quantitative results suggested that the quantified delays may have been underestimated. The analysis suggests that broader empirical frameworks can inform more complete health planning by situating medical conditions within the socio-economic and cultural landscapes in which healthcare is situated and sought. Utilising local knowledge, extended VA has potential to inform the relative prioritisation of interventions that improve technical aspects of life-saving services with those that address the conditions that underlie health, for those whom services typically fail to reach. © 2010 Elsevier Ltd.

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The study titled “A lost cause? Extending verbal autopsy to investigate biomedical and socio-cultural causes of maternal death in Burkina Faso and Indonesia” explores the use of verbal autopsy (VA) to determine the causes of maternal deaths in low-income and rural settings. VA is a method used to determine the cause of death for individuals who die outside of health facilities or without proper registration.

The study conducted interviews with relatives of women who died during pregnancy, childbirth, or postpartum in rural districts in Burkina Faso and Indonesia. The interviews collected information on medical signs and symptoms of the women prior to death, as well as accounts of care pathways and opinions on preventability and cause of death. The study found that infectious diseases, hemorrhage, and malaria accounted for half of the deaths in both settings. Delays in seeking, reaching, and receiving care were reported by more than two-thirds of respondents in both countries.

The study also revealed culturally-derived systems of explanation, causation, and behavior related to maternal health emergencies. By incorporating socio-cultural factors into the analysis, the study suggests that the quantified delays in seeking care may have been underestimated. This highlights the importance of considering socio-cultural factors in addressing maternal health and improving access to care.

The findings of this study suggest that by utilizing local knowledge and incorporating socio-cultural factors into the analysis, extended VA has the potential to inform the prioritization of interventions that improve technical aspects of life-saving services and address the underlying conditions that hinder access to healthcare. This approach can contribute to more effective health planning and the development of targeted interventions that address the specific needs of women in low-income and rural settings.

Implementing and expanding the use of extended VA can help bridge the gap in understanding the causes of maternal deaths and inform strategies to improve access to maternal health services. The study provides valuable insights into the barriers and challenges faced by women in accessing quality care, and highlights the importance of considering socio-cultural factors in addressing maternal health.
AI Innovations Description
Based on the information provided, a recommendation to improve access to maternal health could be to implement and expand the use of verbal autopsy (VA) in developing countries. Verbal autopsy is a method used to determine the cause of death for individuals who die outside of health facilities or without proper registration. By extending VA to investigate socio-cultural factors relevant to maternal deaths, a more comprehensive understanding of the barriers and challenges faced by women in accessing quality care can be obtained.

This recommendation is supported by a study conducted in Burkina Faso and Indonesia, where interviews were conducted with relatives of women who died during pregnancy, childbirth, or postpartum. The study found that delays in seeking, reaching, and receiving care were reported by more than two-thirds of respondents. Additionally, culturally-derived systems of explanation, causation, and behavior were identified, highlighting the importance of considering socio-cultural factors in addressing maternal health.

By utilizing local knowledge and incorporating socio-cultural factors into the analysis, extended VA has the potential to inform the prioritization of interventions that not only improve technical aspects of life-saving services but also address the underlying conditions that hinder access to healthcare. This approach can contribute to more effective health planning and the development of targeted interventions that address the specific needs of women in low-income and rural settings.

Implementing and expanding the use of extended VA can help bridge the gap in understanding the causes of maternal deaths and inform strategies to improve access to maternal health services.
AI Innovations Methodology
The methodology used in the study to simulate the impact of the recommendations on improving access to maternal health involved conducting interviews with relatives of women who died during pregnancy, childbirth, or postpartum in rural districts in Burkina Faso and Indonesia. The interviews collected information on medical signs and symptoms of the women prior to death, as well as accounts of care pathways and opinions on preventability and cause of death.

Quantitative and qualitative analyses were performed on the collected data. The cause of death profiles were examined, and it was found that infectious diseases, hemorrhage, and malaria accounted for half of the deaths in both settings. Delays in seeking, reaching, and receiving care were reported by more than two-thirds of the respondents in both settings.

Relatives also provided information on their experiences of the emergencies, revealing culturally-derived systems of explanation, causation, and behavior. A comparison of the qualitative and quantitative results suggested that the quantified delays may have been underestimated.

The analysis of the data suggested that broader empirical frameworks, such as extended VA, can inform more complete health planning by considering the socio-economic and cultural landscapes in which healthcare is sought. By utilizing local knowledge and incorporating socio-cultural factors into the analysis, extended VA has the potential to inform the prioritization of interventions that address both the technical aspects of life-saving services and the underlying conditions that hinder access to healthcare.

Overall, the methodology involved collecting and analyzing data through interviews with relatives of women who died during pregnancy, childbirth, or postpartum, and using this information to understand the causes of maternal deaths and identify barriers to accessing quality care. This approach provided insights into the socio-cultural factors that contribute to maternal mortality and can inform strategies to improve access to maternal health services.

Statistics:
Citations: 32
Authors: 4
Identifiers:
DOI: 10.1016/j.socscimed.2010.05.023
ISSN: 02779536
Research Areas:
Community Interventions, Health System and Policy, Infectious Diseases, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants
Study Countries:
Burkina Faso
Study Approach:
Mixed-methods, Qualitative, Quantitative
Participants Gender:
Female
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