A qualitative study of the problem-solving process in obstetric complications: the gap between home and hospital
Objective: Investigate the health care-seeking process in case of obstetric complications, referring to the sequence of events prior to admission in the hospital, and assess the clients' satisfaction with hospital services. Methods: Twenty-two subjects were selected from the list of women with serious obstetrical complications who came to the Thana Health Complex (THC) of Abhoynagar, a thana in Bangladesh with over 200,000 people. In-depth interviews were conducted within four weeks after the women left the hospital. The study period was January through September 1992. Results: Most of the patients sought help from several types of qualified or unqualified people before going to the THC. Recourse to hospital was seen among many as the last resort after a delay ranging from few hours to seven days. The decision to go to the hospital was made mainly by the patient's relatives or by the woman herself, but it was greatly influenced by the advice of "quack" (village doctor), traditional birth attendant, or paramedic. The cost for transport, medicines, and hospital services ranged from Tk 300 to over Tk 4,500 (US$ 7.50 to 112). The vast majority of the patients had to borrow money to cover their expenses. There were mixed feelings about satisfaction with the services provided at the hospital. Reasons for satisfaction and dissatisfaction were investigated. The cost of hospital services and the behaviour of hospital staff discouraged women from going to hospital. Conclusions: Pregnancy remains a major health risk for the women in many developing countries. Deaths and sufferings can be prevented by timely referral to hospital. Women in Bangladesh rely very much on services provided by trained or untrained persons in their neighbourhood. Knowledge of the signs of emergency, requiring timely and adequate services, is lacking in the community. Cost of services and behaviour of hospital staff are also important issues that influence the decision-making process. These findings will help design interventions to reduce the delay between the onset of complications and the arrival at the hospital, and improve quality of care at the THC level.