Patterns of care-seeking for postpartum symptoms in urban Karachi, Pakistan: implications for intervention design
Background In Pakistan, the maternal mortality rate is 186/100,000 live births, with postpartum (PP) or maternal sepsis being the third leading cause of maternal deaths. Delays in early identification and timely management of PP sepsis are associated with mortality and severe maternal outcomes, incl...
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| Veröffentlicht in: | Reproductive health Jg. 22; H. 1; S. 55 - 10 |
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| Hauptverfasser: | , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
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BioMed Central
16.04.2025
BMC |
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| ISSN: | 1742-4755, 1742-4755 |
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| Abstract | Background
In Pakistan, the maternal mortality rate is 186/100,000 live births, with postpartum (PP) or maternal sepsis being the third leading cause of maternal deaths. Delays in early identification and timely management of PP sepsis are associated with mortality and severe maternal outcomes, including septicemia, neonatal deaths, infertility, etc. In this study, we aim to explore patterns of care-seeking of maternal health services by recently delivered women (RDW) in semi-urban Karachi, Pakistan. Insights of this study will help in identifying and addressing the barriers in care-seeking to minimize delay to improve clinical outcomes.
Methods
We conducted 32 semi-structured qualitative interviews with RDW with PP sepsis, traditional birth attendants (TBAs), health care providers, and family relatives of RDW to characterize the patterns of care-seeking behaviors, sources of care, and treatment modalities. Community interviews were conducted in Bilal Colony, an urban squatter settlement, and facility interviews were conducted at a high-volume tertiary care facility in Karachi, Pakistan. All interviews were conducted face to face by trained data collectors which were then audio recorded. A codebook was developed manually by reviewing all transcripts and identifying emerging themes. Coded transcripts were entered into NVivo software to develop quotation summaries and models that identified subthemes.
Results
This study utilized a 3-delay model to determine care utilization in RDW with PP sepsis. Phase 1 indicated limited awareness about PP symptoms, cultural norms, and lack of decision autonomy led to delayed care-seeking, as women depended on male or older female relatives for approval. Two of the most common symptoms of PP sepsis were high-grade fever and foul-smelling discharge, which were deemed as non-severe. Phase 2 findings implied that women initially sought care from TBAs, chemists, and faith healers, or self-medication and tertiary care was their last resort. Financial constraints were also determining care-seeking; Phase 3 indicated that women who sought care at the hospitals were in critical conditions due to prior unskilled care or traditional treatment choices.
Conclusion
Increasing awareness of PP sepsis and its symptoms via educational programs is essential for not only women but also their family members who play roles in decision-making, Training community health workers and TBAs to recognize signs of PP sepsis and promptly refer women to appropriate facilities could also significantly reduce reliance on inappropriate care sources and ensure timely treatment.
Plain language summary
Postpartum (PP) sepsis is one of the serious complications after pregnancy resulting from infection of the genital tract occurring at labor or within 42 days of the PP period. Severe cases can lead to organ dysfunction and, ultimately, death. It can also be transferred to newborns, causing early-onset sepsis. PP sepsis is one of the leading causes of death in Pakistan in both hospitals and community settings. These deaths can be prevented by timely care-seeking and treatment. In this study, we explored care-seeking patterns in women who recently delivered in semi-urban Karachi, Pakistan. We conducted semi-structured interviews of recently delivered women (RDW) with PP sepsis, their families, traditional birth attendants, and physicians from the community and a tertiary care hospital. Only physicians were aware of PP sepsis. RDW, their families, and traditional birth attendants were aware of PP complications but couldn’t identify PP sepsis symptoms and were not aware of its severity. One of the major reasons highlighted for the delay in care seeking was that the women were not autonomous in their decisions to visit healthcare facilities and seek care. Husbands and relatives were responsible for decision-making, and their unavailability caused further delay. Trust in services due to previous experience, financial constraints, use of alternate medicine, limited reach, and lack of knowledge were other reasons for not seeking early care. If community healthcare workers are aptly trained to identify early signs of PP sepsis and for timely referral, it can aid in preventing further PP sepsis consequences. |
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| AbstractList | Postpartum (PP) sepsis is one of the serious complications after pregnancy resulting from infection of the genital tract occurring at labor or within 42 days of the PP period. Severe cases can lead to organ dysfunction and, ultimately, death. It can also be transferred to newborns, causing early-onset sepsis. PP sepsis is one of the leading causes of death in Pakistan in both hospitals and community settings. These deaths can be prevented by timely care-seeking and treatment. In this study, we explored care-seeking patterns in women who recently delivered in semi-urban Karachi, Pakistan. We conducted semi-structured interviews of recently delivered women (RDW) with PP sepsis, their families, traditional birth attendants, and physicians from the community and a tertiary care hospital. Only physicians were aware of PP sepsis. RDW, their families, and traditional birth attendants were aware of PP complications but couldn’t identify PP sepsis symptoms and were not aware of its severity. One of the major reasons highlighted for the delay in care seeking was that the women were not autonomous in their decisions to visit healthcare facilities and seek care. Husbands and relatives were responsible for decision-making, and their unavailability caused further delay. Trust in services due to previous experience, financial constraints, use of alternate medicine, limited reach, and lack of knowledge were other reasons for not seeking early care. If community healthcare workers are aptly trained to identify early signs of PP sepsis and for timely referral, it can aid in preventing further PP sepsis consequences. Abstract Background In Pakistan, the maternal mortality rate is 186/100,000 live births, with postpartum (PP) or maternal sepsis being the third leading cause of maternal deaths. Delays in early identification and timely management of PP sepsis are associated with mortality and severe maternal outcomes, including septicemia, neonatal deaths, infertility, etc. In this study, we aim to explore patterns of care-seeking of maternal health services by recently delivered women (RDW) in semi-urban Karachi, Pakistan. Insights of this study will help in identifying and addressing the barriers in care-seeking to minimize delay to improve clinical outcomes. Methods We conducted 32 semi-structured qualitative interviews with RDW with PP sepsis, traditional birth attendants (TBAs), health care providers, and family relatives of RDW to characterize the patterns of care-seeking behaviors, sources of care, and treatment modalities. Community interviews were conducted in Bilal Colony, an urban squatter settlement, and facility interviews were conducted at a high-volume tertiary care facility in Karachi, Pakistan. All interviews were conducted face to face by trained data collectors which were then audio recorded. A codebook was developed manually by reviewing all transcripts and identifying emerging themes. Coded transcripts were entered into NVivo software to develop quotation summaries and models that identified subthemes. Results This study utilized a 3-delay model to determine care utilization in RDW with PP sepsis. Phase 1 indicated limited awareness about PP symptoms, cultural norms, and lack of decision autonomy led to delayed care-seeking, as women depended on male or older female relatives for approval. Two of the most common symptoms of PP sepsis were high-grade fever and foul-smelling discharge, which were deemed as non-severe. Phase 2 findings implied that women initially sought care from TBAs, chemists, and faith healers, or self-medication and tertiary care was their last resort. Financial constraints were also determining care-seeking; Phase 3 indicated that women who sought care at the hospitals were in critical conditions due to prior unskilled care or traditional treatment choices. Conclusion Increasing awareness of PP sepsis and its symptoms via educational programs is essential for not only women but also their family members who play roles in decision-making, Training community health workers and TBAs to recognize signs of PP sepsis and promptly refer women to appropriate facilities could also significantly reduce reliance on inappropriate care sources and ensure timely treatment. In Pakistan, the maternal mortality rate is 186/100,000 live births, with postpartum (PP) or maternal sepsis being the third leading cause of maternal deaths. Delays in early identification and timely management of PP sepsis are associated with mortality and severe maternal outcomes, including septicemia, neonatal deaths, infertility, etc. In this study, we aim to explore patterns of care-seeking of maternal health services by recently delivered women (RDW) in semi-urban Karachi, Pakistan. Insights of this study will help in identifying and addressing the barriers in care-seeking to minimize delay to improve clinical outcomes. We conducted 32 semi-structured qualitative interviews with RDW with PP sepsis, traditional birth attendants (TBAs), health care providers, and family relatives of RDW to characterize the patterns of care-seeking behaviors, sources of care, and treatment modalities. Community interviews were conducted in Bilal Colony, an urban squatter settlement, and facility interviews were conducted at a high-volume tertiary care facility in Karachi, Pakistan. All interviews were conducted face to face by trained data collectors which were then audio recorded. A codebook was developed manually by reviewing all transcripts and identifying emerging themes. Coded transcripts were entered into NVivo software to develop quotation summaries and models that identified subthemes. This study utilized a 3-delay model to determine care utilization in RDW with PP sepsis. Phase 1 indicated limited awareness about PP symptoms, cultural norms, and lack of decision autonomy led to delayed care-seeking, as women depended on male or older female relatives for approval. Two of the most common symptoms of PP sepsis were high-grade fever and foul-smelling discharge, which were deemed as non-severe. Phase 2 findings implied that women initially sought care from TBAs, chemists, and faith healers, or self-medication and tertiary care was their last resort. Financial constraints were also determining care-seeking; Phase 3 indicated that women who sought care at the hospitals were in critical conditions due to prior unskilled care or traditional treatment choices. Increasing awareness of PP sepsis and its symptoms via educational programs is essential for not only women but also their family members who play roles in decision-making, Training community health workers and TBAs to recognize signs of PP sepsis and promptly refer women to appropriate facilities could also significantly reduce reliance on inappropriate care sources and ensure timely treatment. Background In Pakistan, the maternal mortality rate is 186/100,000 live births, with postpartum (PP) or maternal sepsis being the third leading cause of maternal deaths. Delays in early identification and timely management of PP sepsis are associated with mortality and severe maternal outcomes, including septicemia, neonatal deaths, infertility, etc. In this study, we aim to explore patterns of care-seeking of maternal health services by recently delivered women (RDW) in semi-urban Karachi, Pakistan. Insights of this study will help in identifying and addressing the barriers in care-seeking to minimize delay to improve clinical outcomes. Methods We conducted 32 semi-structured qualitative interviews with RDW with PP sepsis, traditional birth attendants (TBAs), health care providers, and family relatives of RDW to characterize the patterns of care-seeking behaviors, sources of care, and treatment modalities. Community interviews were conducted in Bilal Colony, an urban squatter settlement, and facility interviews were conducted at a high-volume tertiary care facility in Karachi, Pakistan. All interviews were conducted face to face by trained data collectors which were then audio recorded. A codebook was developed manually by reviewing all transcripts and identifying emerging themes. Coded transcripts were entered into NVivo software to develop quotation summaries and models that identified subthemes. Results This study utilized a 3-delay model to determine care utilization in RDW with PP sepsis. Phase 1 indicated limited awareness about PP symptoms, cultural norms, and lack of decision autonomy led to delayed care-seeking, as women depended on male or older female relatives for approval. Two of the most common symptoms of PP sepsis were high-grade fever and foul-smelling discharge, which were deemed as non-severe. Phase 2 findings implied that women initially sought care from TBAs, chemists, and faith healers, or self-medication and tertiary care was their last resort. Financial constraints were also determining care-seeking; Phase 3 indicated that women who sought care at the hospitals were in critical conditions due to prior unskilled care or traditional treatment choices. Conclusion Increasing awareness of PP sepsis and its symptoms via educational programs is essential for not only women but also their family members who play roles in decision-making, Training community health workers and TBAs to recognize signs of PP sepsis and promptly refer women to appropriate facilities could also significantly reduce reliance on inappropriate care sources and ensure timely treatment. Plain language summary Postpartum (PP) sepsis is one of the serious complications after pregnancy resulting from infection of the genital tract occurring at labor or within 42 days of the PP period. Severe cases can lead to organ dysfunction and, ultimately, death. It can also be transferred to newborns, causing early-onset sepsis. PP sepsis is one of the leading causes of death in Pakistan in both hospitals and community settings. These deaths can be prevented by timely care-seeking and treatment. In this study, we explored care-seeking patterns in women who recently delivered in semi-urban Karachi, Pakistan. We conducted semi-structured interviews of recently delivered women (RDW) with PP sepsis, their families, traditional birth attendants, and physicians from the community and a tertiary care hospital. Only physicians were aware of PP sepsis. RDW, their families, and traditional birth attendants were aware of PP complications but couldn’t identify PP sepsis symptoms and were not aware of its severity. One of the major reasons highlighted for the delay in care seeking was that the women were not autonomous in their decisions to visit healthcare facilities and seek care. Husbands and relatives were responsible for decision-making, and their unavailability caused further delay. Trust in services due to previous experience, financial constraints, use of alternate medicine, limited reach, and lack of knowledge were other reasons for not seeking early care. If community healthcare workers are aptly trained to identify early signs of PP sepsis and for timely referral, it can aid in preventing further PP sepsis consequences. In Pakistan, the maternal mortality rate is 186/100,000 live births, with postpartum (PP) or maternal sepsis being the third leading cause of maternal deaths. Delays in early identification and timely management of PP sepsis are associated with mortality and severe maternal outcomes, including septicemia, neonatal deaths, infertility, etc. In this study, we aim to explore patterns of care-seeking of maternal health services by recently delivered women (RDW) in semi-urban Karachi, Pakistan. Insights of this study will help in identifying and addressing the barriers in care-seeking to minimize delay to improve clinical outcomes.BACKGROUNDIn Pakistan, the maternal mortality rate is 186/100,000 live births, with postpartum (PP) or maternal sepsis being the third leading cause of maternal deaths. Delays in early identification and timely management of PP sepsis are associated with mortality and severe maternal outcomes, including septicemia, neonatal deaths, infertility, etc. In this study, we aim to explore patterns of care-seeking of maternal health services by recently delivered women (RDW) in semi-urban Karachi, Pakistan. Insights of this study will help in identifying and addressing the barriers in care-seeking to minimize delay to improve clinical outcomes.We conducted 32 semi-structured qualitative interviews with RDW with PP sepsis, traditional birth attendants (TBAs), health care providers, and family relatives of RDW to characterize the patterns of care-seeking behaviors, sources of care, and treatment modalities. Community interviews were conducted in Bilal Colony, an urban squatter settlement, and facility interviews were conducted at a high-volume tertiary care facility in Karachi, Pakistan. All interviews were conducted face to face by trained data collectors which were then audio recorded. A codebook was developed manually by reviewing all transcripts and identifying emerging themes. Coded transcripts were entered into NVivo software to develop quotation summaries and models that identified subthemes.METHODSWe conducted 32 semi-structured qualitative interviews with RDW with PP sepsis, traditional birth attendants (TBAs), health care providers, and family relatives of RDW to characterize the patterns of care-seeking behaviors, sources of care, and treatment modalities. Community interviews were conducted in Bilal Colony, an urban squatter settlement, and facility interviews were conducted at a high-volume tertiary care facility in Karachi, Pakistan. All interviews were conducted face to face by trained data collectors which were then audio recorded. A codebook was developed manually by reviewing all transcripts and identifying emerging themes. Coded transcripts were entered into NVivo software to develop quotation summaries and models that identified subthemes.This study utilized a 3-delay model to determine care utilization in RDW with PP sepsis. Phase 1 indicated limited awareness about PP symptoms, cultural norms, and lack of decision autonomy led to delayed care-seeking, as women depended on male or older female relatives for approval. Two of the most common symptoms of PP sepsis were high-grade fever and foul-smelling discharge, which were deemed as non-severe. Phase 2 findings implied that women initially sought care from TBAs, chemists, and faith healers, or self-medication and tertiary care was their last resort. Financial constraints were also determining care-seeking; Phase 3 indicated that women who sought care at the hospitals were in critical conditions due to prior unskilled care or traditional treatment choices.RESULTSThis study utilized a 3-delay model to determine care utilization in RDW with PP sepsis. Phase 1 indicated limited awareness about PP symptoms, cultural norms, and lack of decision autonomy led to delayed care-seeking, as women depended on male or older female relatives for approval. Two of the most common symptoms of PP sepsis were high-grade fever and foul-smelling discharge, which were deemed as non-severe. Phase 2 findings implied that women initially sought care from TBAs, chemists, and faith healers, or self-medication and tertiary care was their last resort. Financial constraints were also determining care-seeking; Phase 3 indicated that women who sought care at the hospitals were in critical conditions due to prior unskilled care or traditional treatment choices.Increasing awareness of PP sepsis and its symptoms via educational programs is essential for not only women but also their family members who play roles in decision-making, Training community health workers and TBAs to recognize signs of PP sepsis and promptly refer women to appropriate facilities could also significantly reduce reliance on inappropriate care sources and ensure timely treatment.CONCLUSIONIncreasing awareness of PP sepsis and its symptoms via educational programs is essential for not only women but also their family members who play roles in decision-making, Training community health workers and TBAs to recognize signs of PP sepsis and promptly refer women to appropriate facilities could also significantly reduce reliance on inappropriate care sources and ensure timely treatment. |
| ArticleNumber | 55 |
| Author | Yousuf, Farheen Zaidi, Anita K. M. Peerwani, Ghazal Ariff, Shabina Winch, Peter J. Sultana, Shazia Soofi, Sajid Bhutta, Shereen Bhutta, Zulfiqar A. Hirani, Farzeen Mir, Fatima Nathwani, Apsara Ali Lefevre, Amnesty E. Kazi, Abdul Momin Kalbarczyk, Anna |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/40241202$$D View this record in MEDLINE/PubMed |
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| Copyright | The Author(s) 2025 2025. The Author(s). The Author(s) 2025 2025 |
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| Keywords | Care-seeking Postpartum sepsis Qualitative analysis Recently delivered women Pakistan |
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| References | A Geleto (1981_CR20) 2018; 7 M Bauserman (1981_CR10) 2015; 12 1981_CR9 M Vidler (1981_CR16) 2023; 23 M Bonet (1981_CR4) 2020; 8 1981_CR2 B Oiyemhonlan (1981_CR22) 2013; 17 C Sialubanje (1981_CR23) 2015; 12 A Baguiya (1981_CR7) 2024; 4 T Vos (1981_CR3) 2020; 396 F Midhet (1981_CR11) 2025; 20 L Bartlett (1981_CR19) 2016; 13 A Sadia (1981_CR12) 2022; 22 World Health Organization (1981_CR1) 2016 L Chen (1981_CR5) 2021; 21 1981_CR18 K Reinhart (1981_CR13) 2015; 19 V Actis Danna (1981_CR14) 2020; 13 V Brizuela (1981_CR6) 2021; 9 S Omer (1981_CR17) 2021; 18 MM Mutua (1981_CR21) 2015; 15 World Health Organization (1981_CR25) 2014 O Greer (1981_CR8) 2019; 20 F Midhet (1981_CR15) 2023; 18 P Soma-Pillay (1981_CR24) 2016; 106 |
| References_xml | – volume: 21 start-page: 1074 issue: 1 year: 2021 ident: 1981_CR5 publication-title: BMC Infect Dis doi: 10.1186/s12879-021-06779-0 – volume: 17 start-page: 129 issue: 2 year: 2013 ident: 1981_CR22 publication-title: Afr J Reprod Health – volume: 13 start-page: 1 year: 2016 ident: 1981_CR19 publication-title: Reprod Health doi: 10.1186/s12978-016-0124-1 – volume-title: WHO recommendations for prevention and treatment of maternal peripartum infections year: 2016 ident: 1981_CR1 – volume: 7 start-page: 1 year: 2018 ident: 1981_CR20 publication-title: Syst Rev doi: 10.1186/s13643-017-0670-9 – volume: 18 start-page: e0294225 issue: 11 year: 2023 ident: 1981_CR15 publication-title: PLoS ONE doi: 10.1371/journal.pone.0294225 – ident: 1981_CR2 – volume: 12 start-page: 1 year: 2015 ident: 1981_CR23 publication-title: Reprod Health doi: 10.1186/s12978-015-0051-6 – volume-title: Antimicrobial resistance: global report on surveillance year: 2014 ident: 1981_CR25 – volume: 15 start-page: 1 year: 2015 ident: 1981_CR21 publication-title: BMC Pregnancy Childbirth doi: 10.1186/s12884-015-0660-7 – volume: 22 start-page: 192 issue: 1 year: 2022 ident: 1981_CR12 publication-title: BMC Pregnancy Childbirth doi: 10.1186/s12884-022-04516-2 – volume: 396 start-page: 1204 issue: 10258 year: 2020 ident: 1981_CR3 publication-title: The lancet doi: 10.1016/S0140-6736(20)30925-9 – volume: 9 start-page: e1252 issue: 9 year: 2021 ident: 1981_CR6 publication-title: Lancet Glob Health doi: 10.1016/S2214-109X(21)00248-5 – volume: 106 start-page: 1110 issue: 11 year: 2016 ident: 1981_CR24 publication-title: S Afr Med J doi: 10.7196/SAMJ.2016.v106i11.10726 – volume: 4 start-page: e0003109 issue: 4 year: 2024 ident: 1981_CR7 publication-title: PLOS Glob Public Health doi: 10.1371/journal.pgph.0003109 – ident: 1981_CR18 – volume: 8 start-page: e661 issue: 5 year: 2020 ident: 1981_CR4 publication-title: Lancet Glob Health doi: 10.1016/S2214-109X(20)30109-1 – volume: 13 start-page: 1819052 issue: 1 year: 2020 ident: 1981_CR14 publication-title: Glob Health Action doi: 10.1080/16549716.2020.1819052 – volume: 20 start-page: 5388 issue: 21 year: 2019 ident: 1981_CR8 publication-title: Int J Mol Sci doi: 10.3390/ijms20215388 – volume: 23 start-page: 748 issue: 1 year: 2023 ident: 1981_CR16 publication-title: BMC Pregnancy Childbirth doi: 10.1186/s12884-023-06055-w – volume: 20 start-page: e0311730 issue: 1 year: 2025 ident: 1981_CR11 publication-title: PLoS ONE doi: 10.1371/journal.pone.0311730 – volume: 19 start-page: 105 issue: 2 year: 2015 ident: 1981_CR13 publication-title: Anaesth Pain Intensive Care – volume: 18 start-page: 97 issue: 1 year: 2021 ident: 1981_CR17 publication-title: Reprod Health doi: 10.1186/s12978-021-01151-6 – volume: 12 start-page: 1 year: 2015 ident: 1981_CR10 publication-title: Reprod Health doi: 10.1186/1742-4755-12-S2-S5 – ident: 1981_CR9 |
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In Pakistan, the maternal mortality rate is 186/100,000 live births, with postpartum (PP) or maternal sepsis being the third leading cause of... In Pakistan, the maternal mortality rate is 186/100,000 live births, with postpartum (PP) or maternal sepsis being the third leading cause of maternal deaths.... Postpartum (PP) sepsis is one of the serious complications after pregnancy resulting from infection of the genital tract occurring at labor or within 42 days... Abstract Background In Pakistan, the maternal mortality rate is 186/100,000 live births, with postpartum (PP) or maternal sepsis being the third leading cause... |
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| SubjectTerms | Adult Care-seeking Female Health Knowledge, Attitudes, Practice Humans Maternal and Child Health Maternal Health Services - statistics & numerical data Medicine Medicine & Public Health Pakistan Pakistan - epidemiology Patient Acceptance of Health Care - statistics & numerical data Postpartum Period Postpartum sepsis Pregnancy Public Health Qualitative analysis Qualitative Research Recently delivered women Reproductive Medicine Sepsis - diagnosis Sepsis - therapy Urban Population Young Adult |
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| Title | Patterns of care-seeking for postpartum symptoms in urban Karachi, Pakistan: implications for intervention design |
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