Health care seeking behaviors in Puerperal sepsis in rural Sindh, Pakistan: a qualitative study

Background Puerperal sepsis (PS) is one of the major causes of maternal death, contributing to 26 000 deaths per year in developing countries. Early recognition and treatment are essential to managing PS but numerous social, cultural and technical barriers prevent or delay access to care and necessary medical attention. Through this qualitative study, we identified barriers to care seeking for puerperal sepsis among recently delivered women in Matiari, Pakistan. Methods We conducted 20 in-depth interviews among recently delivered women with and without sepsis and their family members. Key informant interviews were conducted with 14 healthcare providers and traditional birth attendants. The themes used for content analysis were knowledge of danger signs, factors affecting care seeking and local treatment practices for postpartum sepsis. Results Recently delivered women, their family members and traditional birth attendants were unaware of the word PS or the local translated term for PS. However, they were familiar with most of the individual symptoms associated with PS. Healthcare providers were aware of the condition and the associated symptoms. The healthcare providers understanding of the seriousness of PS was directly proportional their age and clinical experience. The most common barriers to care seeking was the division of labor within the household, obtaining permission from the primary decision maker, access to transportation, lack of financial resources and support from family members. Discussion In rural Pakistan, limited knowledge of PS, division of labor within the household, obtaining permission from primary decision maker and access to transportation and financial resources were identified as barriers to seeking care among recently delivered women. Conclusion To improve maternal care seeking behaviors for PS, interventions focusing on increasing knowledge of PS, addressing gender inequality, implementing an affordable community transport service and enhancing TBAs knowledge and skills to manage PS need to be implemented.