Second and third delays in emergency obstetric care: predictors in Northwest Cameroon

Maternal mortality in Cameroon's conflict-affected Northwest Region remains high, with delays in accessing and receiving emergency obstetric care (EmOC) being a major contributor. Using the Three Delays Model, this study investigated socioeconomic and health system predictors of the second delay (reaching a health facility after deciding to seek care) and third delay (receiving adequate care upon arrival) among postnatal women in referral hospitals.

A hospital-based cross-sectional study was conducted from June 2024 to April 2025 (11 months) among 472 postnatal women across eight high-volume public referral facilities in the Northwest Region. Data were collected using a structured, interviewer-administered questionnaire adapted from validated tools. Delays were defined using a two-stage approach: an initial screening question followed by time thresholds (> 1 h from decision to arrival for the second delay; >1 h from arrival to care for the third delay), with additional contributing barriers assessed via closed-ended yes/no questions. Univariable chi-square analysis and multivariable binary logistic regression were performed in SPSS version 25 to identify independent predictors. Statistical significance was set at p < 0.05.

Second delay affected 124 women (26.3%) and was independently predicted by rural residence (AOR = 2.82, 95% CI: 1.79-4.45, p < 0.001), semi-urban residence (AOR = 2.04, 95% CI: 1.23-3.38, p = 0.005), and low household income (< 25,000 FCFA) (AOR = 3.46, 95% CI: 1.66-7.21, p = 0.001). Third delay affected 154 women (32.6%), with lower odds among women aged 20-29 years (AOR = 0.42, 95% CI: 0.22-0.80, p = 0.008), those aged 30-39 years (AOR = 0.51, 95% CI: 0.28-0.93, p = 0.029), married women (AOR = 0.42, 95% CI: 0.26-0.68, p < 0.001), and women earning 51,000-100,000 FCFA (AOR = 0.39, 95% CI: 0.19-0.80, p = 0.010). Self-reported barriers included staffing shortages (40.2%), poor service quality (50.8%), blood supply issues (33.9%), and long admission processes (33.7%).

Over one-quarter of women experienced delays in reaching EmOC facilities, driven by rural residence and low income, while one-third faced delays in receiving care, associated with lower odds among married women and those with moderate income. Self-reported systemic barriers, including staffing shortages, poor infrastructure, and inefficient referrals, compound socioeconomic vulnerabilities in this conflict-affected zone. Targeted interventions, such as subsidised rural transport, digital referral systems, and enhanced facility readiness, are urgently needed to reduce preventable maternal deaths and advance Cameroon's SDG 3.1 commitments.