Table 3 Iterative responses by discussion group or key informant, highlighting emerged major and minor themes
Patient couples | Community health workers | Clinical officers/midwives | ||
|---|---|---|---|---|
Definitions | Length of a normal pregnancy | –9-10 months | –36 weeks, which was considered the equivalent of nine months | –40 weeks |
How due date is known | –Just know the month/not the date | –By last period and first antenatal visit | –LMP with gestational wheel | |
–The midwife tells you from a wheel | –Most know the month but not the week of LMP | –Ultrasound (“best done at 28 weeks so you can tell due date and presentation of baby”) | ||
–Only by coming for antenatal care and being seen by a clinician who palpates abdomen | –Not aware of ultrasound for dating a pregnancy | |||
Earliest age a baby can survive | –6 months if delivered at a health facility (higher chance of baby dying if delivered at home) | –6 months maybe, 7 months yes | –7 months | |
–28 weeks (which was estimated to be 2.3 kg) | ||||
–1.5-1.9 kg | ||||
–1 kg | –1 kg if in an incubator followed by Kangaroo Care | |||
–2 kg | ||||
Explanatory models | Causes of preterm delivery | –Beaten by husband | –Stress | –Twins |
–STIs (AIDS, syphilis, gonorrhea, hepatitis) | –Hard work | –Anemia | ||
–Malnourishment | –Being beaten | –Close spacing of pregnancies | ||
–Placenta problems | –Malaria | –Overwork | ||
–Maternal sickness | –Other sickness | –Infections like malaria and STIs | ||
–Mother too young (<18) or too old (>45) | –Having had many children | –Trauma | ||
–History of abortions | –Young age | |||
–Multiparity | ||||
–Incompetent cervix | ||||
Access to care | Actions to take if preterm contractions | –Go to health center | –Go to health center (though might not tell family they are going if it is not a scheduled visit) | –Refer to district hospital |
–Go to hospital—which could be 12–20 km away (walk or bike or use ox cart or tractor from nearby estate) | –Might call CHW (20-25% of families have phones) | –Refer to central hospital | ||
Reasons not to go to health center or hospital | –Church might not condone going to a health center | –Fear of “being cut with sharp things” | –Women and their families may not be able to arrange or afford transport | |
–Traditional healer might have herbs to stop contractions | –Fear that nurses and clinicians will be harsh | –“Nothing can be done” | ||
–Transportation | ||||
Services available at health facilities to treat preterm labor or prevent recurrent preterm birth | –Kangaroo Care | –Rest | –Referral to district hospital | |
–Medications to stop contractions | –Cesarean to save mother and baby | –Clinical officer: Not aware of availability of steroids to accelerate fetal lung maturity | ||
–Never heard of steroids or progesterone | –Referral to district hospital | –Clinical officer: Give salbutemol (terbutaline) and refer if contractions do not subside | ||
–Never heard of steroids or progesterone | –Referral hospitals offer Kangaroo Care, a nursery, and dexamethasone for mother in preterm labor and cerclage for woman | |||
–Never heard of progesterone | ||||
Openness and acceptability | If progesterone available, route of delivery preference | –Vaginal route (cost of transport to hospital for weekly injection is too high) | –Vaginal route | –Injection (can document adherence to regimen) |
Openness to new concepts | –Would believe that gum disease can cause PTB if given an explanation and the doctor said it was true | –Would believe gum disease can cause PTB “but, first, you have to tell us why” | –“I do not know that gum disease may cause PTB, but if you explain it, maybe I would believe it.” | |
–“We would need ‘community sensitization’ first before women will believe this.” | ||||
–Want to make sure previous studies have been done, no harm is being done, and “Malawians are not being used as guinea pigs” | ||||
Social acceptability of new approaches | –Gum or mints are ok | –Gum or mints are ok | –Gum or mints are ok | |
–Prefer a jar of gum over a package (can use later for storing other things like salt or medicines) | –Packages are easier to keep in a safe place but jars could be used later for storing sugar | –Have heard of some chewing gum reducing tooth decay | ||
Optimal delivery sites if preterm labor | –District or central hospital | –District hospital unless free transport is available to central hospital | –District hospital (they will decided if to refer on to central hospital) |