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Faktor LM, Wilson AN, Melepia P, Babona D, Wapi P, Suruka R, Hezeri P, Kabiu DD, Vallely LM, Kennedy E, Scoullar MJL, Spotswood N, Homer CSE. "If I am alive, I am happy": Defining quality of care from the perspectives of key maternal and newborn health stakeholders in Papua New Guinea. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002548. [PMID: 38771819 PMCID: PMC11108204 DOI: 10.1371/journal.pgph.0002548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 04/23/2024] [Indexed: 05/23/2024]
Abstract
Quality maternal and newborn healthcare is essential to improve experiences and health outcomes for mothers and babies. In many low to middle income countries, such as Papua New Guinea, there are initiatives to increase antenatal care attendance and facility births. To develop and implement initiatives that are appropriate, relevant, and contextualised to a community, it is important to understand how quality of care is perceived and defined by different maternal and newborn healthcare stakeholders. The aim of this study was to understand how women, their partners, healthcare professionals, healthcare managers, and provincial health administrators in East New Britain, Papua New Guinea define quality of pregnancy, childbirth, and immediate postnatal care. An exploratory qualitative study underpinned by a partnership-defined quality approach was undertaken. In total, 42 participants from five different healthcare facilities in East New Britain, Papua New Guinea, were interviewed. These included women, partners, healthcare professionals, healthcare managers, and provincial health administrators. Interviews were analysed using thematic analysis, assisted by NVivo computer software. Four themes were identified aligning with the journey a woman takes throughout the health system. These included (I) Ensuring Access: Arriving at the health centre, (II) Experiencing Positive Care: What the staff do, (III) Having the Bare Minimum: Resources available to the service, and (IV) Meeting Expectations: Outcomes of care. Stakeholder groups had significant overlap in how quality of care was defined, however women and partners focussed more on elements relating to experience of care, while clinical stakeholders focussed on elements relating to provision of care. There is a gap in how stakeholders define quality maternal and newborn healthcare, and the quality of the care which is administered and received.
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Affiliation(s)
- Lachlan M. Faktor
- Maternal, Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Alyce N. Wilson
- Maternal, Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
| | - Pele Melepia
- Healthy Mothers, Healthy Babies Program, Burnet Institute, Kokopo, Papua New Guinea
| | - Delly Babona
- Maternal, Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
- St Mary’s Hospital Vunapope, Kokopo, East New Britain Province, Papua New Guinea
| | - Pinip Wapi
- Nonga General Hospital, Rabaul, Papua New Guinea
| | - Rose Suruka
- Healthy Mothers, Healthy Babies Program, Burnet Institute, Kokopo, Papua New Guinea
| | - Priscah Hezeri
- Healthy Mothers, Healthy Babies Program, Burnet Institute, Kokopo, Papua New Guinea
| | - Duk Duk Kabiu
- Healthy Mothers, Healthy Babies Program, Burnet Institute, Kokopo, Papua New Guinea
| | - Lisa M. Vallely
- Papua New Guinea Institute for Medical Research, Goroka, Papua New Guinea
- Kirby Institute, University of New South Wales, Kensington, Australia
| | - Elissa Kennedy
- Maternal, Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
| | - Michelle J. L. Scoullar
- Maternal, Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
| | - Naomi Spotswood
- Maternal, Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
- Royal Hobart Hospital, Hobart, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Caroline S. E. Homer
- Maternal, Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
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Rhodes EC, Zahid M, Abuwala N, Damio G, LaPlant HW, Crummett C, Surprenant R, Pérez-Escamilla R. Experiences of breastfeeding peer counseling among women with low incomes in the US: a qualitative evaluation. BMC Pregnancy Childbirth 2024; 24:120. [PMID: 38336607 PMCID: PMC10854050 DOI: 10.1186/s12884-023-06213-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 12/17/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Person-centered breastfeeding counseling is a key but often overlooked aspect of high-quality services. We explored women's experiences of the Breastfeeding Heritage and Pride™ program, an evidence-based breastfeeding peer counseling program serving women with low incomes in the United States. METHODS This study was conducted through an equitable community-clinical-academic partnership and guided by the World Health Organization (WHO) quality of care framework for maternal and newborn health, which highlights three domains of positive experiences of care: effective communication; respect and dignity; and emotional support. In-depth interviews were conducted with a purposive sample of women participating in the Breastfeeding Heritage and Pride™ program. Women were asked to describe their experiences with the program including examples of when good quality counseling was or was not provided. Each interview was conducted in English or Spanish, audio-recorded, and transcribed verbatim. Data were analyzed using reflexive thematic analysis. Once themes were generated, they were organized according to the three care experience domains in the WHO quality of care framework. RESULTS Twenty-eight in-depth interviews were conducted with a racially/ethnically and socio-economically diverse sample of women. Three themes described effective communication practices of peer counselors: tailoring communication to meet women's individual needs; offering comprehensive and honest information about infant feeding; and being timely, proactive, and responsive in all communications across the maternity care continuum. Two themes captured why women felt respected. First, peer counselors were respectful in their interactions with women; they were courteous, patient, and non-judgmental and respected women's infant feeding decisions. Second, peer counselors showed genuine interest in the well-being of women and their families, beyond breastfeeding. The key theme related to emotional support explored ways in which peer counselors offered encouragement to women, namely by affirming women's efforts to breastfeed and by providing reassurance that alleviated their worries about breastfeeding. These positive experiences of counseling were appreciated by women. CONCLUSIONS Women described having and valuing positive experiences in their interactions with peer counselors. Efforts to expand access to high-quality, person-centered breastfeeding counseling should, as part of quality assurance, include women's feedback on their experiences of these services.
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Affiliation(s)
- Elizabeth C Rhodes
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
- Yale School of Public Health, 135 College Street, New Haven, CT, 06510, USA.
| | - Mahrukh Zahid
- Yale School of Public Health, 135 College Street, New Haven, CT, 06510, USA
| | - Nafeesa Abuwala
- Yale School of Public Health, 135 College Street, New Haven, CT, 06510, USA
| | - Grace Damio
- Hispanic Health Council, 175 Main Street, Hartford, CT, 06106, USA
| | | | - Carrianne Crummett
- Saint Francis Hospital and Medical Center, Trinity Health Of New England, 114 Woodland Street, Hartford, CT, 06105, USA
| | - Rebecca Surprenant
- Saint Francis Hospital and Medical Center, Trinity Health Of New England, 114 Woodland Street, Hartford, CT, 06105, USA
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Rauschendorf P, Nume R, Bruchhausen W. Acceptability of surgical care in Uganda: a qualitative study on users and providers. BMJ Open 2023; 13:e070479. [PMID: 37524548 PMCID: PMC10391825 DOI: 10.1136/bmjopen-2022-070479] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVES This study was conducted to assess acceptability of surgical care in Eastern Uganda and enable better allocation of resources, and to guide health policy towards increased surgical care seeking. DESIGN This qualitative study used semistructured in-depth interviews that were transcribed and analysed by coding according to grounded theory. SETTING The study was set in Eastern Uganda in the districts of Jinja, Mayuge, Kamuli, Iganga, Luuka, Buikwe and Buvuma. PARTICIPANTS Interviews were conducted with 32 past surgical patients, 16 community members who had not undergone surgery, 17 healthcare professionals involved in surgical treatment and 7 district health officers or their deputies. RESULTS The five intersecting categories that emerged were health literacy, perceptions, risks and fears, search for alternatives, care/treatment and trust in healthcare workers. It was also demonstrated that considering the user and provider side at the same time is very useful for a more extensive understanding of surgical care-seeking behaviour and the impact of user-provider interactions or lack thereof. CONCLUSION While affordability and accessibility are well defined and therefore easier to assess, acceptability is a much less quantifiable concept. This study breaks it down into tangible concepts in the form of five categories, which provide guidance for future interventions targeting acceptability of surgical care. We also demonstrated that multiple perspectives are beneficial to understanding the multifactorial nature of healthcare seeking and provision.
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Affiliation(s)
- Paula Rauschendorf
- Section Global Health, Institute of Hygiene and Public Health, University of Bonn, Bonn, Germany
| | - Rosette Nume
- School of Women and Gender Studies, Makerere University, Kampala, Uganda
| | - Walter Bruchhausen
- Section Global Health, Institute of Hygiene and Public Health, University of Bonn, Bonn, Germany
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Wanduru P, Hanson C, Waiswa P, Kakooza-Mwesige A, Alvesson HM. Mothers' perceptions and experiences of caring for sick newborns in Newborn Care Units in public hospitals in Eastern Uganda: a qualitative study. Reprod Health 2023; 20:106. [PMID: 37474965 PMCID: PMC10360301 DOI: 10.1186/s12978-023-01649-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION Mothers' participation in the care of their sick newborns in Newborn Care Units (NCUs) has been linked to several advantages including earlier discharge, fewer complications, better mother-baby bonding, and an easier transition to home after discharge. This study aimed to understand mothers' perceptions and experiences while participating in the care of their sick newborns in the NCUs to inform interventions promoting mothers' participation in public health facilities in Uganda. METHODS We conducted an exploratory qualitative study comprised of 18 in-depth interviews with mothers caring for their newborns in two NCUs at a Regional Referral and General hospital in Eastern Uganda between April and May 2022. The interviews were audio-recorded and then transcribed. For analysis, we used a thematic analysis approach. RESULTS The fear of losing their baby was an overarching theme that underlay mothers' perceptions, actions, and experiences in the NCU. Mothers' confidence in the care provided to their babies was based on their baby's outcomes. For example, when mothers saw almost immediate improvement after treatment, they felt more confident in the care than when this was not the case. Furthermore, mothers considered it essential that health care providers responded quickly in an emergency. Moreover, they expressed concerns about a lack of control over their personal space in the crowded NCU. Additionally, caring for babies in these settings is physically and financially taxing, with mothers requiring the combined efforts of family members to help them cope. CONCLUSION This study shows that for mothers of sick newborns in the NCU, the baby's survival is the first concern and the basis of mothers' confidence in the quality of care provided. Efforts to improve parental participation in NCUs must focus on lowering the costs incurred by families in caring for a baby in the NCU, addressing privacy and space concerns, leveraging the family's role, and avoiding compromising the quality of care in the process of participation.
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Affiliation(s)
- Phillip Wanduru
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Department of Health Policy, Planning, and Management, School of Public Health, Makerere University, Kampala, Uganda.
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, England
| | - Peter Waiswa
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Health Policy, Planning, and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Angelina Kakooza-Mwesige
- Department of Paediatrics and Child Health, School of Medicine, Makerere University, Kampala, Uganda
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Naito YT, Fukuzawa R, Ganchimeg T, Afulani PA, Aiga H, Kim R, Katsumata AT. Validation of the person-centered maternity care scale at governmental health facilities in Cambodia. PLoS One 2023; 18:e0288051. [PMID: 37410783 DOI: 10.1371/journal.pone.0288051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 06/18/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Women's childbirth experience of interpersonal care is a significant aspect of quality of care. Due to the lack of a reliable Cambodian version of a measurement tool to assess person-centered maternity care, the present study aimed to adapt the "Person-Centered Maternity Care (PCMC) scale" to the Cambodian context and further determine its psychometric properties. METHODS The PCMC scale was translated into Khmer using the team translation approach. The Khmer version of PCMC (Kh-PCMC) scale was pretested among 20 Cambodian postpartum women using cognitive interviewing. Subsequently, the Kh-PCMC scale was administered in a survey with 300 Cambodian postpartum women at two governmental health facilities. According to the COnsensus-based Standards for the Selection of health status Measurement Instruments (COSMIN) standard, we performed psychometric analysis, including content validity, construct validity, criterion validity, cross-cultural validity, and internal consistency. RESULTS The preliminary processes of Kh-PCMC scale development including cognitive interviewing and expert review ensured appropriate levels of content validity and acceptable levels of cross-cultural validity of the Kh-PCMC scale with four-point frequency responses. The Scale-level Content Validity Index, Average (S-CVI/Avg) of 30-item Kh-PCMC scale was 0.96. Twenty items, however, performed optimally in the psychometric analysis from the data in Cambodia. The 20-item Kh-PCMC scale produced Cronbach's alpha of 0.86 for the full scale and 0.76-0.91 for the subscales, indicating adequately high internal consistency. Hypothesis testing found positive correlations between the 20-item Kh-PCMC scale and reference measures, which implies acceptable criterion validity. CONCLUSIONS The present study produced the Kh-PCMC scale that enables women's childbirth experiences to be quantitatively measured. The Kh-PCMC scale can identify intrapartum needs from women's perspectives for quality improvement in Cambodia. However, dynamic changes in and diverse differences of cultural context over time across provinces in Cambodia require the Kh-PCMC scale to be regularly reexamined and, when needed, to be further adjusted.
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Affiliation(s)
- Yuko Takahashi Naito
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Rieko Fukuzawa
- Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | | | - Patience A Afulani
- Departments of Epidemiology & Biostatistics and Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
| | - Hirotsugu Aiga
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Rattana Kim
- National Maternal and Child Health Center, Phnom Penh, Cambodia
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Pazandeh F, Moridi M, Safari K. Labouring women perspectives on mistreatment during childbirth: a qualitative study. Nurs Ethics 2023; 30:513-525. [PMID: 36921625 DOI: 10.1177/09697330231158732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
BACKGROUND Respectful care during labour and childbirth, which has recently received a great deal of attention around the world, is vital for providing high-quality maternity care. However, this area has been underexplored in developing countries including Iran. RESEARCH AIM This study aimed to assess postpartum women's views regarding disrespect and abuse during labour and childbirth in Iran. METHODS A qualitative study that involved a purposive sample of 21 postpartum women was conducted in Tehran, Iran, between 2019 and 2020. Following the semi-structured individual interviews, a conventional content analysis was performed. ETHICAL CONSIDERATIONS This research approved by Shahid Beheshti University of Medical Sciences in Tehran, Iran, with the ethical approval number 1396.810. Following explanation of the study's objectives, eligible women consented to participate in the study. The confidentiality of the participants' information and the anonymity of the analysis were maintained at all stage of the study. All data was stored on the password protected file in the researcher computer The findings were only disseminated in summary form, with no identifying of individual participants. RESULTS Analysis of the data resulted in two main themes: 'inappropriate interaction' and 'inadequate quality care'. The 'inappropriate interaction' theme includes 'lack of empathy' and 'verbal abuse'. The second theme includes five sub-themes 'lack of participation in decision-making', 'lack of privacy', 'ignorance of women's pain and medical needs', 'rushed labour and painful procedures', and "unsatisfying facilities'. CONCLUSION Providing supportive care, respectful communication, adequate participation in decision-making, maintaining privacy, attending to women's labour pain and medical needs, and improving the quality of the physical birth environment are all examples of what labouring women consider to be respectful maternity care. To minimise disrespect and maltreatment of women during childbirth, an all-inclusive strategy engaging women, communities, healthcare professionals, managers, and educators is required.
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Affiliation(s)
| | - Maryam Moridi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Kolsoom Safari
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
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Ahmed SAE, Mahimbo A, Dawson A. Quality intrapartum care expectations and experiences of women in sub-Saharan African Low and Low Middle-Income Countries: a qualitative meta-synthesis. BMC Pregnancy Childbirth 2023; 23:27. [PMID: 36641424 PMCID: PMC9840253 DOI: 10.1186/s12884-022-05319-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Woman-centred maternity care is respectful and responsive to women's needs, values, and preferences. Women's views and expectations regarding the quality of health services during pregnancy and childbirth vary across settings. Despite the need for context-relevant evidence, to our knowledge, no reviews focus on what women in sub-Saharan African Low and Low Middle-Income Countries (LLMICs) regard as quality intrapartum care that can inform quality guidelines in countries. METHODS We undertook a qualitative meta-synthesis using a framework synthesis to identify the experiences and expectations of women in sub-Saharan African LLMICs with quality intrapartum care. Following a priori protocol, we searched eight databases for primary articles using keywords. We used Covidence to collate citations, remove duplicates, and screen articles using a priori set inclusion and exclusion criteria. Two authors independently screened first the title and abstracts, and the full texts of the papers. Using a data extraction excel sheet, we extracted first-order and second-order constructs relevant to review objectives. The WHO framework for a positive childbirth experience underpinned data analysis. RESULTS Of the 7197 identified citations, 30 articles were included in this review. Women's needs during the intrapartum period resonate with what women want globally, however, priorities regarding the components of quality care for women and the urgency to intervene differed in this context given the socio-cultural norms and available resources. Women received sub-quality intrapartum care and global standards for woman-centred care were often compromised. They were mistreated verbally and physically. Women experienced poor communication with their care providers and non-consensual care and were rarely involved in decisions concerning their care. Women were denied the companion of choice due to cultural and structural factors. CONCLUSION To improve care seeking and satisfaction with health services, woman-centred care is necessary for a positive childbirth experience. Women must be meaningfully engaged in the design of health services, accountability frameworks, and evaluation of maternal services. Research is needed to set minimum indicators for woman-centred outcomes for low-resource settings along with actionable strategies to enhance the quality of maternity care based on women's needs and preferences.
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Affiliation(s)
- Salma A E Ahmed
- Faculty of Health, University of Technology Sydney, Sydney, Australia.
| | - Abela Mahimbo
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Angela Dawson
- Faculty of Health, University of Technology Sydney, Sydney, Australia
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Namutebi M, Nalwadda GK, Kasasa S, Muwanguzi PA, Ndikuno CK, Kaye DK. Readiness of rural health facilities to provide immediate postpartum care in Uganda. BMC Health Serv Res 2023; 23:22. [PMID: 36627623 PMCID: PMC9830711 DOI: 10.1186/s12913-023-09031-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Nearly 60% of maternal and 45% of newborn deaths occur within 24 h after delivery. Immediate postpartum monitoring could avert death from preventable causes including postpartum hemorrhage, and eclampsia among mothers, and birth asphyxia, hypothermia, and sepsis for babies. We aimed at assessing facility readiness for the provision of postpartum care within the immediate postpartum period. METHODS A cross-sectional study involving 40 health facilities within the greater Mpigi region, Uganda, was done. An adapted health facility assessment tool was employed in data collection. Data were double-entered into Epi Data version 4.2 and analyzed using STATA version 13 and presented using descriptive statistics. RESULTS Facility readiness for the provision of postpartum care was low (median score 24% (IQR: 18.7, 26.7). Availability, and use of up-to-date, policies, guidelines and written clinical protocols for identifying, monitoring, and managing postpartum care were inconsistent across all levels of care. Lack of or non-functional equipment poses challenges for screening, diagnosing, and treating postnatal emergencies. Frequent stock-outs of essential drugs and supplies, particularly, hydralazine, antibiotics, oxygen, and blood products for transfusions were more common at health centers compared to hospitals. Inadequate human resources and sub-optimal supplies inhibit the proper functioning of health facilities and impact the quality of postpartum care. Overall, private not-for-profit health facilities had higher facility readiness scores. CONCLUSIONS Our findings suggest sub-optimal rural health facility readiness to assess, monitor, and manage postpartum emergencies to reduce the risk of preventable maternal/newborn morbidity and mortality. Strengthening health system inputs and supply side factors could improve facility capacity to provide quality postpartum care.
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Affiliation(s)
- Mariam Namutebi
- grid.11194.3c0000 0004 0620 0548Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Gorrette K. Nalwadda
- grid.11194.3c0000 0004 0620 0548Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Simon Kasasa
- grid.11194.3c0000 0004 0620 0548Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Patience A. Muwanguzi
- grid.11194.3c0000 0004 0620 0548Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Cynthia Kuteesa Ndikuno
- grid.11194.3c0000 0004 0620 0548Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Dan K. Kaye
- grid.11194.3c0000 0004 0620 0548Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Nalwadda C, Tusubira AK, Nambuya H, Namazzi G, Muwanguzi D, Waiswa P, Kurinczuk J, Kelley M, Nair M. Transition from hospital to home care for preterm babies: A qualitative study of the experiences of caregivers in Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000528. [PMID: 37155601 PMCID: PMC10166523 DOI: 10.1371/journal.pgph.0000528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/14/2023] [Indexed: 05/10/2023]
Abstract
Improving care for preterm babies could significantly increase child survival in low-and middle income countries. However, attention has mainly focused on facility-based care with little emphasis on transition from hospital to home after discharge. Our aim was to understand the experiences of the transition process among caregivers of preterm infants in Uganda in order to improve support systems. A qualitative study among caregivers of preterm infants in Iganga and Jinja districts in eastern Uganda was conducted in June 2019 through February 2020, involving seven focus group discussions and five in-depth interviews. We used thematic-content analysis to identify emergent themes related to the transition process. We included 56 caregivers, mainly mothers and fathers, from a range of socio-demographic backgrounds. Four themes emerged: caregivers' experiences through the transition process from preparation in the hospital to providing care at home; appropriate communication; unmet information needs; and managing community expectations and perceptions. In addition, caregivers' views on 'peer-support' was explored. Caregivers' experiences, and their confidence and ability to provide care were related to preparation in the hospital after birth and until discharge, the information they received and the manner in which healthcare providers communicated. Healthcare workers were a trusted source of information while in the hospital, but there was no continuity of care after discharge which increased their fears and worries about the survival of their infant. They often felt confused, anxious and discouraged by the negative perceptions and expectations from the community. Fathers felt left-out as there was very little communication between them and the healthcare providers. Peer-support could enable a smooth transition from hospital to home care. Interventions to advance preterm care beyond the health facility through a well-supported transition from facility to home care are urgently required to improve health and survival of preterm infants in Uganda and other similar settings.
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Affiliation(s)
- Christine Nalwadda
- Makerere University College of Health Sciences, School of Public Health, Makerere University, Kampala, Uganda
| | - Andrew K Tusubira
- Makerere University College of Health Sciences, School of Public Health, Makerere University, Kampala, Uganda
| | | | - Gertrude Namazzi
- Makerere University College of Health Sciences, School of Public Health, Makerere University, Kampala, Uganda
| | | | - Peter Waiswa
- Makerere University College of Health Sciences, School of Public Health, Makerere University, Kampala, Uganda
| | - Jenny Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Maureen Kelley
- The Ethox Centre and Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Mohammadi S, Shojaei K, Maraghi E, Motaghi Z. Quality of perinatal care for women with high-risk pregnancies during the COVID-19 pandemic in Iran. J Int Med Res 2022; 50:3000605221106723. [PMID: 35850546 PMCID: PMC9309783 DOI: 10.1177/03000605221106723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background COVID-19 has had a catastrophic effect on the healthcare system. Healthcare
quality assessment measures the difference between expected and actual
performances to identify gaps in the healthcare system. This study aimed to
evaluate the quality of perinatal care for women with high-risk pregnancies
(HPR) during the COVID-19 pandemic. Materials and Methods This cross-sectional study enrolled 450 women with HPR from health centers in
Ahvaz, Iran, from December 2020 to May 2021, using a multi-stage sampling
method. Quality of care was assessed using an observational checklist
adapted from Ministry of Health guidelines. Data were analyzed using
descriptive and statistical methods. Results The quality of the assessed aspect in comprehensive health centers and in
peripartum, perinatal, and postpartum wards was moderate. The overall score
for peripartum care was significantly positively correlated with the length
of the retraining period, and the quality of perinatal care was
significantly related to the proportion of elective cesarean sections and
preterm delivery. Conclusion The development of care practices in health centers in Iran should focus on
education and counseling. Practices in peripartum wards should emphasize the
use of partographs, physical/mental support, and privacy for mothers, while
perinatal wards should focus on timely counseling.
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Affiliation(s)
- Solmaz Mohammadi
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Kobra Shojaei
- Fertility, Infertility and Perinatology Research Center, Department of Obstetrics and Gynecology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Elham Maraghi
- Department of Biostatistics and Epidemiology, Faculty of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zahra Motaghi
- Reproductive Health Department, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
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Gélinas É, Mallé Samb O. [The impact of a humanized childbirth intervention on women's experience of care in Senegal]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2022; Vol. 33:695-704. [PMID: 35485126 DOI: 10.3917/spub.215.0695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Violence against women during institutional childbirth is recognized as a major barrier to the quality of care. In recent years, several countries have implemented interventions aimed at improving the childbirth experience of women through humanized care. However, the literature on the effectiveness of these interventions remains weak. PURPOSE OF RESEARCH The aim of this study is therefore to analyze the experience of care of women regarding the intervention of humanized childbirth in Senegal. Qualitative research based on a multiple case study was done. Three collection methods were used: observation, individual interview, and document analysis. Individual interview were carried out with 20 women. RESULTS In general, women who gave birth following the intervention appreciated their experience due to changes such as the opportunity to eat and drink, to be accompanied by a trusted person and to choose their position during childbirth. However, it was the way in which women were received at the health facility and the attitude of health professionals that were decisive in their level of satisfaction with care. Few women benefited from all the components of the intervention. The difficulties encountered in the implementation such as non-functional delivery rooms, the lack of qualified human resources and the lack of awareness of the intervention explain this. CONCLUSIONS Our results therefore suggest that improving the quality of care at birth, for a “humanized” (or natural, respectful) birth, is only possible when certain materials and medical conditions are met and prepared in advance, during the prenatal period.
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Gwacham-Anisiobi U, Banke-Thomas A. Experiences of Health Facility Childbirth in Sub-Saharan Africa: A Systematic Review of Qualitative Evidence. Matern Child Health J 2022; 26:481-492. [PMID: 35218462 PMCID: PMC8917011 DOI: 10.1007/s10995-022-03383-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Access to skilled birth attendance has been prioritised as an intervention to minimise burden of maternal deaths in sub-Saharan Africa (SSA). However, poor experience of care (EoC) is impeding progress. We conducted a systematic review to holistically explore EoC patterns of facility-based childbirth in SSA. METHODS PubMed, Embase and Scopus databases were searched to identify SSA EoC studies conducted between January 2000 and December 2019. Studies meeting our pre-defined inclusion criteria were quality assessed and relevant data extracted. We utilised the EoC quality standards (defined by the World Health Organization) to summarise and analyse findings while highlighting patterns. RESULTS Twenty-two studies of varying quality from 11 SSA countries were included for review. Overall, at least one study from all included countries reported negative EoC in one or more domains of the WHO framework. Across SSA, 'respect and preservation of dignity' was the most reported domain of EoC. While most women deemed the pervasive disrespect as unacceptable, studies in West Africa suggest a "normalisation" of disrespect, if the intent is to save their lives. Women often experienced sub-optimal communication and emotional support with providers in public facilities compared to non-public ones in the region. These experiences had an influence on future institutional deliveries. DISCUSSION Sub-optimal EoC is widespread in SSA, more so in public facilities. As SSA heath systems explore approaches make progress towards the Sustainable Development Goal 3, emphasis needs to be placed on ensuring women in the region have access to both high-quality provision and experience of care.
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Affiliation(s)
- Uchenna Gwacham-Anisiobi
- Department of Population Health, University of Oxford, Oxford, UK.
- Department of Public Health, University of Liverpool, Liverpool, UK.
| | - Aduragbemi Banke-Thomas
- Department of Public Health, University of Liverpool, Liverpool, UK
- Department of Health Policy, London School of Economics and Political Science, London, UK
- School of Human Sciences, University of Greenwich, Greenwich, London, UK
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“I just have to hope that this abortion should go well”: Perceptions, fears, and experiences of abortion clients in Nigeria. PLoS One 2022; 17:e0263072. [PMID: 35130269 PMCID: PMC8820635 DOI: 10.1371/journal.pone.0263072] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/10/2022] [Indexed: 01/23/2023] Open
Abstract
This qualitative study aimed to examine how abortion clients in Nigeria perceive abortion and explore the role their beliefs and fears play in their care-seeking experiences and interactions with providers. Abortion is severely legally restricted in Nigeria but remains common. We conducted in-depth interviews with 25 people who obtained abortion services through three distinct models of care. We coded interview transcripts and conducted thematic analysis. Clients perceived negative attitudes toward abortion in their communities, though clients’ own beliefs were more nuanced. Clients recounted a range of fears, and nearly all mentioned worrying that they might die as a result of their abortion. Despite their concerns, clients relied on social networks and word-of-mouth recommendations to identify providers they perceived as trustworthy and safe. Kind and non-judgmental treatment, clear instructions, open communication, and reassurance of privacy and confidentiality by providers alleviated client fears and helped clients feel supported throughout their abortion process. Within restrictive contexts, the mobilization of information networks, provision of high-quality care through innovative models, and personalization of care to individual needs can assuage fears and contribute to reducing stigma and increasing access to safe abortion services.
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Wanyenze EW, Byamugisha JK, Tumwesigye NM, Muwanguzi PA, Nalwadda GK. A qualitative exploratory interview study on birth companion support actions for women during childbirth. BMC Pregnancy Childbirth 2022; 22:63. [PMID: 35073861 PMCID: PMC8785438 DOI: 10.1186/s12884-022-04398-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background The World Health Organization recommends that women are supported continuously throughout labor by a companion of their choice. And, that companions have clearly designated roles and responsibilities to ensure that their presence is beneficial to both the woman and her health care providers. Presently, there is lack of strong evidence regarding specific support actions in relation to women’s needs of care. Thus, we aimed to explore birth companion support actions for women during childbirth. Methods This was an exploratory descriptive qualitative study conducted between August 2019 and December 2019; at a referral hospital in the Eastern part of Uganda. Ten women were purposively selected: those who were admitted in early labor, expecting a normal delivery, and had fulltime birth companion. Nonparticipant direct observation and in-depth interviews were used to collect data. Latent content analysis was used. Results Three themes were identified: “Support actions aiding a good childbirth experience”, “Support actions hindering coping with labor”, and “Women’s needs and expectations of care”. Support actions aiding a good experience described were; emotional presence, motivation, providing nourishments, messenger activities, body massage for pain relief, assisting in ambulation and coaching. Companion fearful behaviors and disrespectful care in form of unacknowledged needs and hostility from birth companions were reported to hinder coping. The women desired thoughtful communication, trust, for birth companions to anticipate their needs and recognize non perceptive phases of labor to allow them focus on themselves. Conclusion Birth companions from this study largely supported women emotionally, and attended to their physical needs. The greater part of support actions provided were esteemed by the women. Presence of birth companion will be of benefit when individual needs of women are put into consideration. Also, more guidance for birth companions is necessary to boost their role and mitigate shortcomings of their presence during childbirth.
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Hagaman A, Rodriguez HG, Barrington C, Singh K, Estifanos AS, Keraga DW, Alemayehu AK, Abate M, Bitewulign B, Barker P, Magge H. "Even though they insult us, the delivery they give us is the greatest thing": a qualitative study contextualizing women's experiences with facility-based maternal health care in Ethiopia. BMC Pregnancy Childbirth 2022; 22:31. [PMID: 35031022 PMCID: PMC8759250 DOI: 10.1186/s12884-022-04381-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/22/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Globally, amidst increased utilization of facility-based maternal care services, there is continued need to better understand women's experience of care in places of birth. Quantitative surveys may not sufficiently characterize satisfaction with maternal healthcare (MHC) in local context, limiting their interpretation and applicability. The purpose of this study is to untangle how contextual and cultural expectations shape women's care experience and what women mean by satisfaction in two Ethiopian regions. METHODS Health center and hospital childbirth care registries were used to identify and interview 41 women who had delivered a live newborn within a six-month period. We used a semi-structured interview guide informed by the Donabedian framework to elicit women's experiences with MHC and delivery, any prior delivery experiences, and recommendations to improve MHC. We used an inductive analytical approach to compare and contrast MHC processes, experiences, and satisfaction. RESULTS Maternal and newborn survival and safety were central to women's descriptions of their MHC experiences. Women nearly exclusively described healthy and safe deliveries with healthy outcomes as 'satisfactory'. The texture behind this 'satisfaction', however, was shaped by what mothers bring to their delivery experiences, creating expectations from events including past births, experiences with antenatal care, and social and community influences. Secondary to the absence of adverse outcomes, health provider's interpersonal behaviors (e.g., supportive communication and behavioral demonstrations of commitment to their births) and the facility's amenities (e.g., bathing, cleaning, water, coffee, etc) enhanced women's experiences. Finally, at the social and community levels, we found that family support and material resources may significantly buffer against negative experiences and facilitate women's overall satisfaction, even in the context of poor-quality facilities and limited resources. CONCLUSION Our findings highlight the importance of understanding contextual factors including past experiences, expectations, and social support that influence perceived quality of MHC and the agency a woman has to negotiate her care experience. Our finding that newborn and maternal survival primarily drove women's satisfaction suggests that quantitative assessments conducted shortly following delivery may be overly influenced by these outcomes and not fully capture the complexity of women's care experience.
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Affiliation(s)
- Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA.
- Center for Methods in Implementation and Prevention Sciences, Yale University, New Haven, CT, USA.
| | - Humberto Gonzalez Rodriguez
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St, Chapel Hill, NC, 27516, USA
| | - Kavita Singh
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St, Chapel Hill, NC, 27516, USA
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Abiy Seifu Estifanos
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Zambia Street, Tikur Anbessa Hospital Building, Lideta Sub-city, Addis Ababa, Ethiopia
| | - Dorka Woldesenbet Keraga
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Zambia Street, Tikur Anbessa Hospital Building, Lideta Sub-city, Addis Ababa, Ethiopia
| | | | - Mehiret Abate
- Institute for Healthcare Improvement, Addis Ababa, Ethiopia
| | | | - Pierre Barker
- Institute for Healthcare Improvement, Boston, MA, USA
| | - Hema Magge
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Zambia Street, Tikur Anbessa Hospital Building, Lideta Sub-city, Addis Ababa, Ethiopia
- Bill & Melinda Gates Foundation, Seattle, USA
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Milton R, Alkali FI, Modibbo F, Sanders J, Mukaddas AS, Kassim A, Sa'ad FH, Tukur FM, Pell B, Hood K, Ghazal P, Iregbu KC. A qualitative focus group study concerning perceptions and experiences of Nigerian mothers on stillbirths. BMC Pregnancy Childbirth 2021; 21:830. [PMID: 34906118 PMCID: PMC8670111 DOI: 10.1186/s12884-021-04207-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To explore the experiences and perceptions of stillbirth among mothers from a tertiary medical centre in Kano, Northern Nigeria. Design Qualitative, interpretative. Setting Tertiary healthcare facility, Murtala Muhammad Specialist Hospital (MMSH), Kano, Northern Nigeria. Sample Mothers who had given birth to a liveborn baby at the MMSH in the prior 6 months (n = 31). In order to capture the experiences and perception of stillbirth within this cohort we approached mothers who had in a previous pregnancy experienced a stillbirth. Of the 31 who attended 16 had a previous stillbirth. Methods Semi-structured Focus Group Discussions, consisting of open-ended questions about stillbirth, beliefs, experiences and influences were held in MMSH, conducted over 1 day. Results Our findings highlight that this is a resource-poor tertiary facility serving an ever-growing population, increasing strain on the hospital and healthcare workers. Many of the participants highlighted needing permission from certain family members before accessing healthcare or medical treatment. We identified that mothers generally have knowledge on self-care during pregnancy, yet certain societal factors prevented that from being their priority. Judgement and blame was a common theme, yet a complex area entwined with traditions, superstitions and the pressure to procreate with many mothers described being made to feel useless and worthless if they did not birth a live baby. Conclusions As access to healthcare becomes easier, there are certain traditions, family and social dynamics and beliefs which conflict with scientific knowledge and act as a major barrier to uptake of healthcare services. The findings highlight the need for investment in maternity care, appropriate health education and public enlightenment; they will help inform appropriate interventions aimed at reducing stigma around stillbirth and aide in educating mothers about the importance of appropriate health seeking behaviour. Stillbirths are occurring in this area of the world unnecessarily, globally there has been extensive research conducted on stillbirth prevention. This research has highlighted some of the areas which can be tackled by modifying existing successful interventions to work towards reducing preventable stillbirths. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04207-4.
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Affiliation(s)
- R Milton
- Centre for Trials Research, Cardiff University, Cardiff, UK.
| | - F I Alkali
- Department of Biochemistry, Bayero University, Kano, Nigeria
| | - F Modibbo
- Murtala Muhammad Specialist Hospital, Kano, Nigeria
| | - J Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - A S Mukaddas
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - A Kassim
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - F H Sa'ad
- Department of Medical Microbiology and Parasitology, Bayero University, Kano, Nigeria
| | - F M Tukur
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - B Pell
- Centre for the Development and Evaluation of Complex Intervention for Public Health Improvement, Cardiff University, Cardiff, UK
| | - K Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - P Ghazal
- Systems Immunity Research Institute, School of Medicine, Cardiff University, Cardiff, UK
| | - K C Iregbu
- Department of Medical Microbiology, National Hospital, Abuja, Nigeria
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Lattof SR, Moran AC, Kidula N, Moller AB, Jayathilaka CA, Diaz T, Tunçalp Ö. Implementation of the new WHO antenatal care model for a positive pregnancy experience: a monitoring framework. BMJ Glob Health 2021; 5:bmjgh-2020-002605. [PMID: 32565442 PMCID: PMC7307532 DOI: 10.1136/bmjgh-2020-002605] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 11/26/2022] Open
Abstract
Monitoring the implementation and impact of routine antenatal care (ANC), as described in the new World Health Organization (WHO) ANC model, requires indicators that go beyond the previously used global benchmark indicator of four or more ANC visits. To enable consistent monitoring of ANC content and care processes and to provide guidance to countries and health facilities, WHO developed an ANC monitoring framework. This framework builds on a conceptual framework for quality ANC and a scoping review of ANC indicators that mapped existing indicators related to recommendations in the new WHO ANC model. Based on the scoping review and following an iterative and consultative process, we developed a monitoring framework consisting of core indicators recommended for monitoring ANC recommendations in all settings, as well as a menu of additional measures. Finally, a research agenda highlights areas where ANC recommendations exist, but measures require further development. Nine core indicators can already be monitored globally and/or nationally, depending on the preferred data sources. Two core indicators (experience of care, ultrasound scan before 24 weeks) are included as placeholders requiring priority by the research agenda. Six context-specific indicators are appropriate for national and subnational monitoring in various settings based on specific guidance. Thirty-five additional indicators may be relevant and desirable for monitoring, depending on programme priorities. Monitoring implementation of the new WHO ANC model and the outcomes of routine ANC require greater attention to the measurement of ANC content and care processes as well as women’s experience of ANC.
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Affiliation(s)
- Samantha R Lattof
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Allisyn C Moran
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Nancy Kidula
- Intercountry Support Team for East and Southern Africa, WHO Regional Office for Africa, Harare, Zimbabwe
| | - Ann-Beth Moller
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Chandani Anoma Jayathilaka
- Department of Family Health, Gender and Life Course, WHO Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Theresa Diaz
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
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Anger HA, Durocher J, Dabash R, Hassanein N, Ononge S, Burkhardt G, Frye LJ, Diop A, Beye Diop SBM, Darwish E, Ramadan MC, Kayaga J, Charles D, Gaye A, Eckardt M, Winikoff B. Postpartum infection, pain and experiences with care among women treated for postpartum hemorrhage in three African countries: A cohort study of women managed with and without condom-catheter uterine balloon tamponade. PLoS One 2021; 16:e0245988. [PMID: 33556104 PMCID: PMC7869979 DOI: 10.1371/journal.pone.0245988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 01/11/2021] [Indexed: 11/29/2022] Open
Abstract
Objective We aimed to determine the risk of postpartum infection and increased pain associated with use of condom-catheter uterine balloon tamponade (UBT) among women diagnosed with postpartum hemorrhage (PPH) in three low- and middle-income countries (LMICs). We also sought women’s opinions on their overall experience of PPH care. Methods This prospective cohort study compared women diagnosed with PPH who received and did not receive UBT (UBT group and no-UBT group, respectively) at 18 secondary level hospitals in Uganda, Egypt, and Senegal that participated in a stepped wedge, cluster-randomized trial assessing UBT introduction. Key outcomes were reported pain (on a scale 0–10) in the immediate postpartum period and receipt of antibiotics within four weeks postpartum (a proxy for postpartum infection). Outcomes related to satisfaction with care and aspects women liked most and least about PPH care were also reported. Results Among women diagnosed with PPH, 58 were in the UBT group and 2188 in the no-UBT group. Self-reported, post-discharge antibiotic use within four weeks postpartum was similar in the UBT (3/58, 5.6%) and no-UBT groups (100/2188, 4.6%, risk ratio = 1.22, 95% confidence interval [CI]: 0.45–3.35). A high postpartum pain score of 8–10 was more common among women in the UBT group (17/46, 37.0%) than in the no-UBT group (360/1805, 19.9%, relative risk ratio = 3.64, 95% CI:1.30–10.16). Most women were satisfied with their care (1935/2325, 83.2%). When asked what they liked least about care, the most common responses were that medications (580/1511, 38.4%) and medical supplies (503/1511, 33.3%) were unavailable. Conclusion UBT did not increase the risk of postpartum infection among this population. Women who receive UBT may experience higher degrees of pain compared to women who do not receive UBT. Women’s satisfaction with their care and stockouts of medications and other supplies deserve greater attention when introducing new technologies like UBT.
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Affiliation(s)
- Holly A. Anger
- Gynuity Health Projects, New York, New York, United States of America
- * E-mail:
| | - Jill Durocher
- Gynuity Health Projects, New York, New York, United States of America
| | - Rasha Dabash
- Gynuity Health Projects, New York, New York, United States of America
| | | | - Sam Ononge
- Makerere University School of Health Sciences, Kampala, Uganda
| | - Gillian Burkhardt
- Gynuity Health Projects, New York, New York, United States of America
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Laura J. Frye
- Gynuity Health Projects, New York, New York, United States of America
| | - Ayisha Diop
- Gynuity Health Projects, New York, New York, United States of America
| | | | - Emad Darwish
- Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | | | - Dyanna Charles
- Gynuity Health Projects, New York, New York, United States of America
| | - Alioune Gaye
- Obstetrician/Gynecologist Consultant, Dakar, Senegal
| | - Melody Eckardt
- Global Health Innovation Lab, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Beverly Winikoff
- Gynuity Health Projects, New York, New York, United States of America
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Provision of respectful maternal care by midwives during childbirth in health facilities in Lagos State, Nigeria: A qualitative exploratory inquiry. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Gwacham-Anisiobi UC, Banke-Thomas A. There is no ideal place, but it is best to deliver in a hospital: expectations and experiences of health facility-based childbirth in Imo State, Nigeria. Pan Afr Med J 2020; 36:317. [PMID: 33193971 PMCID: PMC7603830 DOI: 10.11604/pamj.2020.36.317.22728] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION annually, about 67,000 of the 196,000 maternal deaths in sub-Saharan Africa occur in Nigeria, second only to India. Though health facility childbirths have been linked with improved health outcomes, evidence suggests that experiences of care influence future use. This study explored the expectations and experiences of health facility childbirths for mothers in Imo State, Nigeria. METHODS this qualitative study utilised in-depth interviews with 22 purposively sampled mothers who delivered in different types (private and public) and levels (primary, secondary, tertiary) of health facilities in Imo State. Interviews were digitally recorded, transcribed verbatim and analysed following Braun and Clarke´s six-stage thematic analysis. RESULTS four key themes emerged from the analysis. Generally, women saw value in facility-based delivery. However, they had varying expectations for seeking care with different care providers. For those who sought care from public hospitals, the availability of "experts" was a key driver. While those who used private facilities went there because of their perceived empathy and dignity. However, while experiences of disrespect, abuse and health worker expectation for them to cooperate were reported in both public and private facilities, long waiting times, unconducive environments, and lack of privacy were experienced in public facilities. CONCLUSION every woman deserves a positive experience of childbirth. To achieve this, mothers´ perceptions of different providers need to be heard. Going forward, strategies ensuring that both public and private sector providers can guarantee holistic care for every woman will be key to realising the maternal mortality target of the Sustainable Development Goal 3.
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Affiliation(s)
- Uchenna Chinenye Gwacham-Anisiobi
- Health Strategy and Delivery Foundation, Owerri, Imo State, Nigeria
- Department of Public Health, University of Liverpool, Liverpool, United Kingdom
| | - Aduragbemi Banke-Thomas
- Department of Public Health, University of Liverpool, Liverpool, United Kingdom
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
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Bulto GA, Demissie DB, Tasu TL, Demisse GA. Mother's satisfaction with the existing labor and delivery care services at public health facilities in West Shewa zone, Oromia region, Ethiopia. BMC Pregnancy Childbirth 2020; 20:303. [PMID: 32429878 PMCID: PMC7236095 DOI: 10.1186/s12884-020-02998-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/07/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Mothers' satisfaction with care during childbirth is indicators of the quality care which affects skilled birth attendance. Negative client's experiences at health facilities cause them to delay or avoid seeking care, which highlights services providers should consider and act on the expectations and experiences of women and their families. Though there are few studies conducted in Ethiopia on maternal satisfaction with Labor and Delivery (LAD) services, there is no study conducted in the study area. Therefore the study aims to assess the mother's satisfaction with existing LAD services and associated factors at all levels of health care in the West Shewa zone. METHODS An institution-based cross-sectional study was conducted at public health facilities in West Shewa zone, Central Ethiopia. A systematic sampling technique was used to select 560 respondents by using their delivery registration number and data were collected through face to face interview. Mothers were considered satisfied if they responded satisfied/very satisfied with 75% or more of the questions assessing satisfaction. Binary and multivariable logistic regression analysis was used to identify associated factors. RESULTS The overall proportion of mothers who were satisfied with the current LAD care services were 60.8%. The main areas of dissatisfaction were; accessibility and cleanness of toilets/shower 72.6%, overall cleanness of the facility/including waiting-area 40.1% and presence of support a person during birth 38.0%. The presence of cultural practices (AOR = 2.5), discussion on the place of delivery with health worker during ANC (AOR = 1.75), providers asks for consent before procedure (AOR = 2.77), encouraging companion to remain with mother (AOR = 2.22), never leave mother alone or unattended (AOR = 2.56), giving periodic updates on status and progress of labor (AOR = 2.04) and explaining what is being done and to expect during LAD (AOR = 2.20) were factors identified to be significantly associated with satisfaction on LAD services. CONCLUSION The overall satisfaction of mothers with LAD services at public health facilities in the West-Shewa zone was relatively low. Presence of cultural practices, discussion on the place of delivery, asking for consent before the procedure, encouraging companion to remain with mothers and explaining what is being done were factors identified. Therefore, all stakeholders have to emphatically work on those identified factors to improve mothers' satisfaction with LAD services.
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Affiliation(s)
- Gizachew Abdissa Bulto
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Dereje Bayissa Demissie
- Department of Neonatal Nursing, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tefera Likasa Tasu
- Department of Nursing, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Getu Alemu Demisse
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
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WHO's quality of maternal and newborn care framework: is harmonisation of tools best? LANCET GLOBAL HEALTH 2020; 7:e841. [PMID: 31200882 DOI: 10.1016/s2214-109x(19)30203-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/18/2019] [Indexed: 11/20/2022]
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Moridi M, Pazandeh F, Hajian S, Potrata B. Midwives' perspectives of respectful maternity care during childbirth: A qualitative study. PLoS One 2020; 15:e0229941. [PMID: 32150593 PMCID: PMC7062245 DOI: 10.1371/journal.pone.0229941] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/17/2020] [Indexed: 11/28/2022] Open
Abstract
The adoption of respectful maternity care during labor and birth is a complex process which needs both scientific and interpersonal skills of providers. In this regard, identifying the potential barriers and applying effective strategies for implementing respectful maternity care are essential. This study aimed to explore the perceptions of Iranian midwives regarding respectful maternity care during labor and childbirth. This was a qualitative study which was conducted from September-December 2018 in two non-teaching public hospitals in Tehran, Iran. Twenty-four semi-structured interviews were conducted with midwives, who had more than one year work experience in labor and childbirth units, through a purposive sampling method. A content analysis approach was used to analyze the data and identify themes. Three themes were extracted including “showing empathy”, “women-centered care” and “protecting rights”. Showing empathy reflects that “establishing a friendly relationship” and “being with women”. Women-centered care encompassed “keeping women safe” and “participating in decision making”. Protecting rights reflected a need for “safeguarding dignity” as well as “giving equal care” and “preparing appropriate environment”. Iranian midwives considered respectful maternity care a broader concept than just preventing mistreatment. Providing supportive care through friendly interaction with women was the first step for providing respectful maternity care. Respectful care is also promoted by providing safe care, implementing evidence-based care and involving women in their care as well as by providing an appropriate environment for women, families and caregivers.
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Affiliation(s)
- Maryam Moridi
- Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh Pazandeh
- Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- * E-mail:
| | - Sepideh Hajian
- Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ayoubi S, Pazandeh F, Simbar M, Moridi M, Zare E, Potrata B. A questionnaire to assess women's perception of respectful maternity care (WP-RMC): Development and psychometric properties. Midwifery 2020; 80:102573. [DOI: 10.1016/j.midw.2019.102573] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
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Horwood C, Haskins L, Luthuli S, McKerrow N. Communication between mothers and health workers is important for quality of newborn care: a qualitative study in neonatal units in district hospitals in South Africa. BMC Pediatr 2019; 19:496. [PMID: 31842824 PMCID: PMC6913017 DOI: 10.1186/s12887-019-1874-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 12/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background There is a high global burden of neonatal mortality, with many newborn babies dying of preventable and treatable conditions, particularly in low and middle-income countries. Improving quality of newborn care could save the lives of many thousands of babies. Quality of care (QoC) is a complex and multifaceted construct that is difficult to measure, but patients’ experiences of care are an important component in any measurement of QoC. We report the findings of a qualitative study exploring observations and experiences of health workers (HWs) and mothers of babies in neonatal units in South Africa. Methods A qualitative case study approach was adopted to explore care of newborn babies admitted to neonatal units in district hospitals. Observation data were collected by a registered nurse during working hours over a continuous five-day period. Doctors and nurses working in the neonatal unit and mothers of babies admitted during the observation period were interviewed using a semi-structured interview guide. All interviews were audio recorded. Observation data were transcribed from hand written notes. Audiotapes of interviews were transcribed verbatim and, where necessary, translated into English. A thematic content analysis was used to analyse the data. Results Observations and interviews were conducted in seven participating hospitals between November 2015 and May 2016. Our findings highlight the importance of information sharing between HWs and mothers of babies, contrasting the positive communication reported by many mothers which led to them feeling empowered and participating actively in the care of their babies, with incidents of poor communication. Poor communication, rudeness and disrespectful behaviour of HWs was frequently described by mothers, and led to mothers feeling anxious, unwilling to ask questions and excluded from their baby’s care. In some cases poor communication and misunderstandings led to serious mismanagement of babies with HWs delaying or withholding care, or to mothers putting their babies at risk by not following instructions. Conclusion Good communication between mothers and HWs is critical for building mothers’ confidence, promoting bonding and participation of mothers in the care of their baby and may have long term benefits for the health and well-being of the mother and her baby.
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Affiliation(s)
- Christiane Horwood
- Centre for Rural Health, University of KwaZulu-Natal, George Campbell Building, Howard College Campus, Durban, South Africa
| | - Lyn Haskins
- Centre for Rural Health, University of KwaZulu-Natal, George Campbell Building, Howard College Campus, Durban, South Africa.
| | - Silondile Luthuli
- Centre for Rural Health, University of KwaZulu-Natal, George Campbell Building, Howard College Campus, Durban, South Africa
| | - Neil McKerrow
- KwaZulu-Natal Department of Health, Durban, South Africa.,Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
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Lappeman M, Swartz L. Rethinking obstetric violence and the "neglect of neglect": the silence of a labour ward milieu in a South African district hospital. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2019; 19:30. [PMID: 31666133 PMCID: PMC6822362 DOI: 10.1186/s12914-019-0218-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 10/20/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Research into the mistreatment of women during childbirth has increased over recent years. Overt violence is an important focus of research, but recently there has been increasing recognition that there are other ways in which women in labour may be uncared for or even hurt. As part of a larger study focussing on staff responses to stillbirths, we wanted to gain contextual information on how high risk pregnancies are handled in general in Khayelitsha Hospital, a district hospital in an impoverished urban setting in the Western Cape Province of South Africa. This health care system experiences an immense patient load, the poverty of the community it serves, and the numerous traumas affecting both patients and staff. METHODS In order to obtain rich exploratory data, a qualitative research methodology was used. The primary data source was observations in the labour ward, interviewing labour ward staff (doctors, nurse, and cleaners). The secondary data source was the analysis of hospital documents, specifically those related to labour ward policy. RESULTS From our numerous observations and discussions, it is clear that no one is being overtly mistreated in this hospital and patients are medically well attended to. Although we saw no physical abuse, we noted the silence in the ward. Beside medical related interactions, we also noted that there were limited interactions between the women and the health care providers. CONCLUSIONS Silence can be a form of neglect as it leaves the women feeling uncared for and not seen. In an overburdened health care system where both staff and patients are often overwhelmed or traumatised, silence can be a way in which a system defends itself against what it knows it cannot provide.
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Affiliation(s)
- Maura Lappeman
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7602 South Africa
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7602 South Africa
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Brizuela V, Leslie HH, Sharma J, Langer A, Tunçalp Ö. Measuring quality of care for all women and newborns: how do we know if we are doing it right? A review of facility assessment tools. LANCET GLOBAL HEALTH 2019; 7:e624-e632. [DOI: 10.1016/s2214-109x(19)30033-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/10/2018] [Accepted: 01/17/2019] [Indexed: 12/27/2022]
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Lattof SR, Tunçalp Ö, Moran AC, Bucagu M, Chou D, Diaz T, Gülmezoglu AM. Developing measures for WHO recommendations on antenatal care for a positive pregnancy experience: a conceptual framework and scoping review. BMJ Open 2019; 9:e024130. [PMID: 31023748 PMCID: PMC6502222 DOI: 10.1136/bmjopen-2018-024130] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES In response to the newest WHO recommendations on routine antenatal care (ANC) for pregnant women and adolescent girls, this paper identifies the literature on existing ANC measures, presents a conceptual framework for quality ANC, maps existing measures to specific WHO recommendations, identifies gaps where new measures are needed to monitor the implementation and impact of routine ANC and prioritises measures for capture. METHODS We conducted searches in four databases and five websites. Searches and application of inclusion/exclusion criteria followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow approach for scoping reviews. Data were extracted on measure information, methodology, methodological work and implementation. We adapted and refined a conceptual framework for routine ANC based on these measures. RESULTS This scoping review uncovered 58 resources describing 46 existing measures that align with WHO recommendations and good clinical practices for ANC. Of the 42 WHO-recommended ANC interventions and four good clinical practices included in this scoping review, only 14 WHO-recommended interventions and three established good clinical practices could potentially be measured immediately using existing measures. Recommendations addressing the integration of ANC with allied fields are likelier to have existing measures than recommendations that focus on maternal health. When mapped to our conceptual framework, existing measures prioritise content of care and health systems; measures for girls' and women's experiences of care are notably lacking. Available data sources for non-existent measures are currently limited. CONCLUSION Our research updates prior efforts to develop comprehensive measures of quality ANC and raises awareness of the need to better assess experiences of ANC. Given the inadequate number and distribution of existing ANC measures across the quality of care conceptual framework domains, new standardised measures are required to assess quality of routine ANC. Girls' and women's voices deserve greater acknowledgement when measuring the quality and delivery of ANC.
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Affiliation(s)
- Samantha R Lattof
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Özge Tunçalp
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Allisyn C Moran
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Maurice Bucagu
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Doris Chou
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Theresa Diaz
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Ahmet Metin Gülmezoglu
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Oladapo OT, Bohren MA, Fawole B, Mugerwa K, Ojelade OA, Titiloye MA, Alu FE, Mambya MO, Oyeneyin L, Bataale S, Akintan A, Alabi O, Adebayo A, Okike O, Idris HA, Wilfred S, Bello H, Kyaddondo D, Olutayo AO, Byamugisha J, Souza JP, Gülmezoglu AM. Negotiating quality standards for effective delivery of labor and childbirth care in Nigeria and Uganda. Int J Gynaecol Obstet 2017; 139 Suppl 1:47-55. [PMID: 29230800 DOI: 10.1002/ijgo.12398] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE "Negotiated standards" describe a level of quality of care that is acceptable and achievable within a specific health system, based on consensus between key stakeholders. This paper presents the development of negotiated standards for effective labor and childbirth care in selected hospitals and communities in Nigeria and Uganda. METHODS A four-step development process involving different methodologies. The process included: (1) review and synthesis of internationally recognized intrapartum clinical principles and practices; (2) primary qualitative research to assess values and preferences of women and healthcare providers, and practices that align with these preferences; (3) draft contextualization of effective and ineffective behaviors to reflect values and preferences; and (4) WHO-mediated negotiations between relevant stakeholders, including community members, providers, and administrators. RESULTS The primary outcomes of this process were a comprehensive set of effective behaviors and clinical practices covering the main domains of quality of care, which are practical and easy to communicate, implement, and audit across all levels of healthcare delivery. CONCLUSION The process demonstrates that health facilities and providers can be motivated to adopt standards of care that uphold the values and preferences of both service users and providers, while adhering to international best practices.
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Affiliation(s)
- Olufemi T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Meghan A Bohren
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Bukola Fawole
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Kidza Mugerwa
- Department of Obstetrics and Gynecology, Makerere University, Kampala, Uganda
| | - Olubunmi A Ojelade
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Musibau A Titiloye
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Francis E Alu
- Department of Obstetrics and Gynecology, Maitama District Hospital, Abuja, FCT, Nigeria
| | - Musana O Mambya
- Department of Obstetrics and Gynecology, St Francis Hospital Nsambya, Kampala, Uganda
| | - Lawal Oyeneyin
- Department of Obstetrics and Gynecology, Mother and Child Hospital, Ondo, Ondo State, Nigeria
| | - Salim Bataale
- Department of Obstetrics and Gynecology, Lubaga Hospital, Kampala, Uganda
| | - Adesina Akintan
- Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure, Ondo State, Nigeria
| | - Olubunmi Alabi
- Department of Obstetrics and Gynecology, Wuse District General Hospital, Abuja, FCT, Nigeria
| | - Amos Adebayo
- Department of Obstetrics and Gynecology, Asokoro District Hospital, Abuja, FCT, Nigeria
| | - Ola Okike
- Department of Obstetrics and Gynecology, Karshi General Hospital, Abuja, FCT, Nigeria
| | - Hadiza A Idris
- Department of Obstetrics and Gynecology, Nyanya General Hospital, Abuja, FCT, Nigeria
| | - Sanni Wilfred
- Department of Obstetrics and Gynecology, Kubwa General Hospital, Abuja, FCT, Nigeria
| | - Halima Bello
- Department of Obstetrics and Gynecology, Gwarinpa General Hospital, Abuja, FCT, Nigeria
| | - David Kyaddondo
- Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Akinpelu O Olutayo
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynecology, Makerere University, Kampala, Uganda
| | - Joao Paulo Souza
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - A Metin Gülmezoglu
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
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Kyaddondo D, Mugerwa K, Byamugisha J, Oladapo OT, Bohren MA. Expectations and needs of Ugandan women for improved quality of childbirth care in health facilities: A qualitative study. Int J Gynaecol Obstet 2017; 139 Suppl 1:38-46. [PMID: 29226329 DOI: 10.1002/ijgo.12405] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To describe the experiences, expectations, and needs of urban Ugandan women in relation to good-quality facility childbirth. METHODS Women who had given birth in the 12 months prior to the study were purposively sampled and interviewed, or included in focus groups. Thematic analysis was used, and the data were interpreted within the context of an existing quality of care framework. RESULTS Forty-five in-depth interviews and six focus group discussions were conducted. Respect and dignity, timely communication, competent skilled staff, and availability of medical supplies were central to women's accounts of quality care, or a lack of it. The hope for a live baby motivated women to seek facility-based childbirth. They expected to encounter competent, respectful, and caring staff with appropriate skills. In some cases, they could only fulfill these expectations through additional personal financial payments to staff, for clinical supplies, or to guarantee that they would be attended by someone with suitable skills. CONCLUSION Long-term improvement in quality of maternity care in Uganda requires enhancement of the interaction between women and health staff in facilities, and investment in staff and resources to ensure that safe, respectful care is not dependent on willingness and/or capacity to pay.
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Affiliation(s)
- David Kyaddondo
- Child Health and Development Center, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Kidza Mugerwa
- Department of Obstetrics and Gynecology, Makerere University, Kampala, Uganda
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynecology, Makerere University, Kampala, Uganda
| | - Olufemi T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Meghan A Bohren
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
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Downe S, Gülmezoglu AM. Turning local knowledge and experience into innovative tools for quality care during labor and childbirth: The BOLD project experience. Int J Gynaecol Obstet 2017; 139 Suppl 1:1-3. [PMID: 29218710 DOI: 10.1002/ijgo.12377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Soo Downe
- Research in Childbirth and Health (ReaCH) Group, University of Central Lancashire, Preston, UK
| | - A Metin Gülmezoglu
- UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
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Ojelade OA, Titiloye MA, Bohren MA, Olutayo AO, Olalere AA, Akintan A, Oladapo OT, Fawole B. The communication and emotional support needs to improve women's experience of childbirth care in health facilities in Southwest Nigeria: A qualitative study. Int J Gynaecol Obstet 2017; 139 Suppl 1:27-37. [PMID: 29218719 DOI: 10.1002/ijgo.12380] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To improve women's childbirth experiences in health facilities, their psychosocial and communication needs have to be met. However, what constitutes these specific needs is poorly understood, particularly in Sub-Saharan Africa. This paper explores women's needs for communication and emotional support during facility-based childbirth. METHODS Qualitative research was conducted in a large referral maternity hospital and its catchment communities in Akure, Nigeria. In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted among women of reproductive age, midwives, doctors, and facility administrators. Thematic analysis was used to synthesize findings, and then interpreted within the context of this study and existing quality of care framework. RESULTS Forty-two IDIs and 10 FGDs are included in this analysis. Participants reported such needs as communication in simple words in local language by healthcare staff, having their husbands as birth companions, spiritual support, and prayers from family members and healthcare providers. CONCLUSION To increase, improve, and sustain facility-based childbirth in Nigeria, health systems should appreciate the uniqueness and importance of each woman's needs during childbirth. Practical and sustainable actions should be taken to meet these needs, within the confines of the acceptable sociocultural norms.
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Affiliation(s)
- Olubunmi A Ojelade
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Musibau A Titiloye
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Meghan A Bohren
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Akinpelu O Olutayo
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria
| | - Adebimpe A Olalere
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Olufemi T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Bukola Fawole
- Department of Obstetrics and Gynecology, National Institute of Maternal and Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Yang F, Bohren MA, Kyaddondo D, Titiloye MA, Olutayo AO, Oladapo OT, Souza JP, Gülmezoglu AM, Mugerwa K, Fawole B. Healthcare providers’ perspectives on labor monitoring in Nigeria and Uganda: A qualitative study on challenges and opportunities. Int J Gynaecol Obstet 2017; 139 Suppl 1:17-26. [DOI: 10.1002/ijgo.12379] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Fan Yang
- Department of International Health, Social and Behavioral Interventions Program Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - Meghan A. Bohren
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction Department of Reproductive Health and Research WHO Geneva Switzerland
| | - David Kyaddondo
- Child Health and Development Centre Makerere University Kampala Uganda
| | - Musibau A. Titiloye
- Department of Health Promotion and Education College of Medicine University of Ibadan Ibadan Nigeria
| | - Akinpelu O. Olutayo
- Department of Sociology Faculty of Social Sciences University of Ibadan Ibadan Nigeria
| | - Olufemi T. Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction Department of Reproductive Health and Research WHO Geneva Switzerland
| | - João Paulo Souza
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction Department of Reproductive Health and Research WHO Geneva Switzerland
| | - A. Metin Gülmezoglu
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction Department of Reproductive Health and Research WHO Geneva Switzerland
| | - Kidza Mugerwa
- Department of Obstetrics and Gynecology Makerere University Kampala Uganda
| | - Bukola Fawole
- Department of Obstetrics and Gynecology College of Medicine University of Ibadan Ibadan Nigeria
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