Case review of perinatal deaths at hospitals in Kigali, Rwanda: perinatal audit with application of a three-delays analysis

Table 4 Delays experienced by pregnant women and/or their babies in accessing appropriate care at health facility, as reported by the panellists during perinatal audit at two hospitals in Kigali, Rwanda July 2012–May 2013

Delays	Cases with delays
Phase-one: care-seeking	98
Lack of recognition of danger signs	81
Poor uptake of or compliance to formal care	25
Phase-two: reaching health facility	24
Lack of money	15
Long distance	6
Lack of health insurance	3
Social or family reasons	3
Phase-three: quality of care at health facility	93
Before admission
No or late diagnosis	9
Inadequate management
Delay in the referral^a	13
Inadequate care or monitoring	12
After admission
Late diagnosis	3
Inadequate management
Inadequate monitoring or late intervention	41
Non-adherence to guidelines or best practices	5
After delivery
Inadequate management
Insufficient care	11
Inadequate monitoring	3
Total	197

^a The delays in referrals were observed when women were referred either from a health centre or private clinic to the district hospital or from a private clinic or the district hospital to the tertiary referral hospital. Note that there were more factors contributing to mortality than cases of deaths because several factors categorized as the same or different phases of delay could be identified in one case of death

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