Utilization of antenatal care and delivery services in Sagamu, south western Nigeria

A survey of 392 women who had carried at least one pregnancy to term in Sagamu, South-Western Nigeria was conducted to determine the pattern of use of maternity services and assess factors that may influence the observed pattern. Majority of the women received antenatal care (84.6%) during their last pregnancy. Four-fifth of those who received ANC first attended the clinic during the second trimester (79.6%). The places of delivery were government facilities (54.8%), private hospital (24.5%), traditional birth attendants (13.5%) and spiritual healing homes (5.6%). Higher educational status and higher level of income positively affected the pattern of use of these services (p<0.05). Perceived quality of service was the most important factor which influenced the choice of facility for obstetric care. A considerable proportion of those who used traditional birth attendants (36.1%) used it to please their husbands. Our findings suggest that improving the socioeconomic status of men and women in the community is a key factor to improving utilization of maternity care services.

Evaluating the role of the Sure Start Plus Adviser in providing integrated support for pregnant teenagers and young parents

This paper offers a descriptive evaluation of the role and performance of the Sure Start Plus Adviser in providing integrated support for pregnant teenagers and young parents, and focuses on their interprofessional working. The study, based upon interviews and questionnaires with advisers, pregnant and parenting teenagers and mainstream professionals, was conducted within five Local Authorities in the north-east of England. Findings show differences in how the role was undertaken and in terms of its impact within different authorities. The principal contribution was perceived as providing one-to-one advice, personal and emotional support and by networking within agencies to help change the attitudes and role of mainstream professionals, for example, in midwifery, housing and Connexions. The conclusion affirms the adviser as a role model to inform current developments towards creating lead professional status and integrated packages of support for teenage parents.

MOSAIC (MOthers' Advocates In the Community): protocol and sample description of a cluster randomised trial of mentor mother support to reduce intimate partner violence among pregnant or recent mothers

BACKGROUND

Intimate partner violence (IPV) is prevalent globally, experienced by a significant minority of women in the early childbearing years and is harmful to the mental and physical health of women and children. There are very few studies with rigorous designs which have tested the effectiveness of IPV interventions to improve the health and wellbeing of abused women. Evidence for the separate benefit to victims of social support, advocacy and non-professional mentoring suggested that a combined model may reduce the levels of violence, the associated mental health damage and may increase a woman's health, safety and connection with her children. This paper describes the development, design and implementation of a trial of mentor mother support set in primary care, including baseline characteristics of participating women.

METHODS/DESIGN

MOSAIC (MOtherS' Advocates In the Community) was a cluster randomised trial embedded in general practice and maternal and child health (MCH) nursing services in disadvantaged suburbs of Melbourne, Australia. Women who were pregnant or with infants, identified as abused or symptomatic of abuse, were referred by IPV-trained GPs and MCH nurses from 24 general practices and eight nurse teams from January 2006 to December 2007. Women in the intervention arm received up to 12 months support from trained and supported non-professional mentor mothers. Vietnamese health professionals also referred Vietnamese women to bilingual mentors in a sub-study. Baseline and follow-up surveys at 12 months measured IPV (CAS), depression (EPDS), general health (SF-36), social support (MOS-SF) and attachment to children (PSI-SF). Significant development and piloting occurred prior to trial commencement. Implementation interviews with MCH nurses, GPs and mentors assisted further refinement of the intervention. In-depth interviews with participants and mentors, and follow-up surveys of MCH nurses and GPs at trial conclusion will shed further light on MOSAIC's impact.

DISCUSSION

Despite significant challenges, MOSAIC will make an important contribution to the need for evidence of effective partner violence interventions, the role of non-professional mentors in partner violence support services and the need for more evaluation of effective health professional training and support in caring for abused women and children among their populations.

TRIAL REGISTRATION

ACTRN12607000010493.

Public-sector maternal health programmes and services for rural Bangladesh

Achieving Millennium Development Goal 5 in Bangladesh calls for an appreciation of the evolution of maternal healthcare within the national health system to date plus a projection of future needs. This paper assesses the development of maternal health services and policies by reviewing policy and strategy documents since the independence in 1971, with primary focus on rural areas where three-fourths of the total population of Bangladesh reside. Projections of need for facilities and human resources are based on the recommended standards of the World Health Organization (WHO) in 1996 and 2005. Although maternal healthcare services are delivered from for-profit and not-for-profit (NGO) subsectors, this paper is focused on maternal healthcare delivery by public subsector. Maternal healthcare services in the public sector of Bangladesh have been guided by global policies (e.g., Health for All by the Year 2000), national policies (e.g., population and health policy), and plans (e.g., five- or three-yearly). The Ministry of Health and Family Welfare (MoHFW), through its two wings-Health Services and Family Planning-sets policies, develops implementation plans, and provides rural public-health services. Since 1971, the health infrastructure has developed though not in a uniform pattern and despite policy shifts over time. Under the Family Planning wing of the MoHFW, the number of Maternal and Child Welfare Centres has not increased but new services, such as caesarean-section surgery, have been integrated. The Health Services wing of the MoHFW has ensured that all district-level public-health facilities, e.g., district hospitals and medical colleges, can provide comprehensive essential obstetric care (EOC) and have targeted to upgrade 132 of 407 rural Upazila Health Complexes to also provide such services. In 2001, they initiated a programme to train the Government's community workers (Family Welfare Assistants and Female Health Assistants) to provide skilled birthing care in the home. However, these plans have been too meagre, and their implementation is too weak to fulfill expectations in terms of the MDG 5 indicator-increased use of skilled birth attendants, especially for poor rural women. The use of skilled birth attendants, institutional deliveries, and use of caesarean section remain low and are increasing only slowly. All these indicators are substantially lower for those in the lower three socioeconomic quintiles. A wide variation exists in the availability of comprehensive EOC facilities in the public sector among the six divisions of the country. Rajshahi division has more facilities than the WHO 1996 standard (1 comprehensive EOC for 500,000 people) whereas Chittagong and Sylhet divisions have only 64% of their need for comprehensive EOC facilities. The WHO 2005 recommendation (1 comprehensive EOC for 3500 births) suggests that there is a need for nearly five times the existing national number of comprehensive EOC facilities. Based on the WHO standard 2005, it is estimated that 9% of existing doctors and 40% of nurses/midwives were needed just for maternal healthcare in both comprehensive EOC and basic EOC facilities in 2007. While the inability to train and retain skilled professionals in rural areas is the major problem in implementation, the bifurcation of the MoHFW (Health Services and Family Planning wings) has led to duplication in management and staff for service-delivery, inefficiencies as a result of these duplications, and difficulties of coordination at all levels. The Government of Bangladesh needs to functionally integrate the Health Services and Family Planning wings, move towards a facility-based approach to delivery, ensure access to key maternal health services for women in the lower socioeconomic quintiles, consider infrastructure development based on the estimation of facilities using the WHO 1996 recommendation, and undertake a human resource-development plan based on the WHO 2005 recommendation.

The effect of health and nutrition education intervention on women's postpartum beliefs and practices: a randomized controlled trial

BACKGROUND

'Sitting month' is the Chinese tradition for postpartum customs. Available studies indicate that some of the traditional postpartum practices are potentially harmful for women's health. However, no intervention study aiming at postpartum practices has been performed. In this paper we evaluated the effect of a health and nutrition education intervention, which focused on improving postpartum dietary quality and optimal health behaviors.

METHODS

The study design was a randomized controlled trial conducted in both urban and rural area of Hubei between August 2003 and June 2004. A total of 302 women who attended the antenatal clinic during the third trimester with an uncomplicated pregnancy were recruited. Women randomized to the education intervention group in both urban and rural area received two two-hour prenatal education sessions and four postpartum counseling visits. Control group women received usual health care during pregnancy and postpartum period. Women were followed up until 42 days postpartum. Outcome measures were nutrition and health knowledge, dietary behavior, health behavior and health problems during the postpartum period.

RESULTS

Women in the intervention groups exhibited significantly greater improvement in overall dietary behaviors such as consumption of fruits, vegetables, soybean and soybean products as well as nutrition and health knowledge than those in the control groups. Significantly more women in the intervention groups give up the traditional behavior taboos. The incidence of constipation, leg cramp or joint pain and prolonged lochia rubra was significantly lower in the intervention groups as compared with the control groups.

CONCLUSION

The study shows that health and nutrition education intervention enable the women take away some of the unhealthy traditional postpartum practices and decrease the prevalence of postpartum health problems. The intervention has potential for adaptation and development to large-scale implementation.

TRIAL REGISTRATION NUMBER

klACTRN12607000549426.

Labouring to nurse: the work of rural nurses who provide maternity care

INTRODUCTION

This research takes up the standpoint of nurses who provide maternity care to women and families in six different communities of one geographically isolated area of British Columbia, Canada. This first report (phase one of the study) focuses on describing the complexities of rural nursing work and identifies some possibilities for change that would better support nurses in their work.

METHODS

This study was guided by institutional ethnography and included both observations of nursing work and interviews with expert informants about nurses' work of providing maternity care in rural communities and geographically isolated small towns. Nurses were asked to describe their work in as much detail as possible, and chronological accounts were constructed. Analysis focused on painting a complex picture of the work of rural nurses and identifying traces of social organization for further investigation.

RESULTS

Overall, the work of nurses who provide maternity care was characterized as broad in scope, as requiring complex knowledge and skills, with a significant amount of professional responsibility in an environment with limited resources. Rural nursing work was also grounded in nurses knowing their community. An adequate number of skilled nurses was consistently identified by all participants as essential for the safe provision of maternity care. Since opportunities to learn the skills needed to provide maternity care were difficult to obtain in small rural settings, nurses also identified affordable and accessible continuing professional education as the most important strategy for recruiting and retaining rural nurses.

CONCLUSIONS

Phase one of this study has confirmed the complex and contextual nature of rural nursing work. Phase two, which is currently underway, is exploring the institutional discourses, structures and work processes that obscure this complexity and regulate, rather than support, rural nurses' work of providing maternity care.

Cancer in pregnancy: Motherisk on-line question and answer forum

QUESTION

It seems to me that cancer is occurring or being diagnosed more frequently among young women who are or might become pregnant. In the past year, I have seen several such women in my practice and I have had difficulty finding appropriate information in order to counsel them. Is there somewhere I can go for information about cancer during pregnancy so that I can better educate and inform these patients?

ANSWER

The Motherisk Program at the Hospital for Sick Children supports an on-line Cancer in Pregnancy Forum where physicians and other health care professionals can submit questions or details of experiences that they have had with patients who had cancer during pregnancy. Questions about the safety of chemotherapeutic drugs before and during pregnancy and about possible exacerbation of previous cancer by pregnancy are most common.

Emergency obstetric care: Impact on emerging issues

Access to Emergency obstetric care (EmOC) remains a challenge for women. This paper presents a summary of issues and suggestions from one of the working groups at the FIGO precongress workshop on access of sexual and reproductive health care in November, 2006, in Kuala Lumpur.

Feasibility and utility of screening adolescent mothers for Chlamydia at their children's health care visits

PURPOSE

Assess the feasibility of offering and barriers to accepting urine-based screening for Chlamydia trachomatis (CT) among asymptomatic adolescent mothers during their children's health care visits.

METHOD

Providers were automatically cued to offer CT-screening to 13 through 21 year old mothers when they opened the child's medical record. Recording the mothers' screening decisions removed the flag for 6 months. Providers were also prompted to assess the perceived importance of CT prevention, likelihood of having CT, and the worst aspect of having CT.

RESULTS

Mothers usually brought their children to the clinic. Hence, providers could act on 97% of the 318 flags they saw. They responded appropriately 75% of the time. Only 96 (42%) of the 229 mothers who were asked agreed to screening. The primary reasons for declining were "monogamous" and "tested within 6 months". Almost everyone said CT was a top preventive health priority, but that they would be surprised if they were infected. Mothers who agreed to screening were less likely to have a child less than 6 months of age (26.0% vs. 57.1%; P < 0.0001). They were also more likely to rate knowledge of partner infidelity (39.4% vs. 13.6%; P = 0.03) and less likely to rate medical problems (15.2% vs. 40.9%; P = 0.01) the worst aspect of having CT. None of the 21 urine samples obtained within 6 months of delivery were positive for CT. Thereafter, 5 (9.1%) of the 55 urines were positive.

CONCLUSIONS

It is feasible and useful to screen adolescent mothers for CT at their children's health care visits. The best way to increase the efficacy and strengthen the impact of urine-based CT-screening in this setting is to initiate testing after the 6th postpartum month and heighten awareness of STD-risk among adolescent mothers.