A lost cause?

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

Lucia D'Ambruoso, Peter Byass, Siti Nurul Qomariyah, Moctar Ouédraogo

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

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.
Original languageEnglish
Pages (from-to)1728-1738
Number of pages11
JournalSocial Science & Medicine
Volume71
Issue number10
Early online date4 Jun 2010
DOIs
Publication statusPublished - Nov 2010

Fingerprint

Burkina Faso
Maternal Death
Indonesia
Cause of Death
Autopsy
cause of death
death
Health Planning
cause
health
district
maternal mortality
sociocultural factors
health planning
Maternal Mortality
Quality of Health Care
cultural landscape
Health Facilities
Causality
Postpartum Period

Keywords

  • maternal mortality
  • verbal autopsy
  • health planning
  • Burkina Faso
  • Indonesia
  • interdisciplinarity

Cite this

A lost cause? Extending verbal autopsy to investigate biomedical and socio-cultural causes of maternal death in Burkina Faso and Indonesia. / D'Ambruoso, Lucia; Byass, Peter; Qomariyah, Siti Nurul; Ouédraogo, Moctar.

In: Social Science & Medicine, Vol. 71, No. 10, 11.2010, p. 1728-1738.

Research output: Contribution to journalArticle

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