The Three Delay Model as Framework to Assess the Burden of Maternal Deaths in the Urban District of Kitwe, Zambia

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DOI: 10.21522/TIJPH.2013.04.04.Art049

Authors : Elvis Chipili


In Zambia, it is estimated that in excess of 398 women every year die from pregnancy related complications out of every 100,000 live births. The lifetime risk of a woman dying from a pregnancy related complication is 1: 20. The largest contributor to this high number of maternal deaths from the national level perspective has long been considered to be the delay in deciding to seek maternal and obstetrical care at both household and community levels with very little attempts to explore on extent to which the third delay factors have contributed to the high numbers of maternal deaths that have continued to occur un averted in facilities serving s referral centres. This study therefore provided an assessment framework based on the Three Delay Model to explore and assess how the third delay was impacting on the current burden of maternal mortality in an urban setting of Kitwe District of Zambia.

Method: The study was prospective cross-sectional descriptive study involving case file review of maternal deaths that occurred in the delivery facilities of Kitwe District (Hospital and Clinics). The Study Population included all women that had died from pregnancy related complications in the delivery centres of an urban district (Kitwe) of Zambia in 2014 and 2015. The study investigated 30 maternal deaths (25 reviewed cases and 5 unreviewed cases). Data was collected using an adapted 2004 WHO tool: Beyond the Numbers: Reviewing maternal deaths and complications to make pregnancy safer and the Country’s Ministry of Health document: ‘Beyond the Numbers; Maternal Death Review Forms.

Results: The study revealed majority (56%) came from the low density areas within the age range of 25-29 years (50%). Majority (44%) were referred from health centres within the vicinity hospital, 22% accessed the facilities using their own means of transport. Referral response was poor with 50% of the deceased being evacuated after 3 hours following decision to transfer them from the attending local clinic. Most mothers (55%) came into the facility in a fully conscious state with normal vital signs. Haemorrhage following delivery (PPH) was the leading cause involving 44% of the diseased, followed by hypertensive disorders including eclamptic fits. Sepsis following incomplete abortion led to 22% of deaths with deaths occurring on average of 8hrs following admission to the facility. All attendant staff was skilled birth attendants.

Conclusion: The three Delay Model provides such a frame work to explore and identify different barriers women face in accessing quality, timely and effective maternal health care services needed to prevent such deaths. Using this framework, this study has revealed that the burden of maternal deaths occurring in Kitwe District is mainly due to the factors related to the third delay causes of maternal deaths. 


[1] Central Statistics Office (2010) Zambia Demographic and health Survey. Lusaka. Government Printers

[2] Kitwe Central Hospital (2015) Health information management system; Maternal death and surveillance Report. Kitwe Central Hospital.

[3] Ministry of Health (2010) Campaign for Accelerated Reduction of Maternal Mortality in Africa. Lusaka. Ministry of Health

[4] Ministry of Health (2014) LOT quality Assurance Sampling; facility and household Baseline Study. Lusaka. Ministry of Health.

[5] World Health Organization (2004). Beyond the numbers: Reviewing Maternal Deaths and Complications to make pregnancy safer. Geneva. World Health Organization.