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Rathi N, Kansal S, Worsley A. Indian fathers are involved in nurturing healthy behaviours in adolescents: A qualitative inquiry. BMC Public Health 2024; 24:88. [PMID: 38178085 PMCID: PMC10768344 DOI: 10.1186/s12889-024-17634-7] [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] [Received: 08/31/2023] [Accepted: 01/01/2024] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Indian adolescents exhibit unhealthy food behaviours and inactive lifestyles which increase their risk of developing obesity and associated negative health consequences. The family food environment represents a vital setting to nurture healthy lifestyle behaviours in adolescents, with parents influencing their adolescents' dietary and physical activity behaviours. Yet, much of the existing evidence exploring parental influences predominantly focuses on mothers while fathers' engagement in instilling healthy dietary and physical activity behaviours is understudied, more so in the context of developing economies like India. Therefore, this qualitative study was designed to understand Indian fathers' views on instilling healthy behaviours in their children. METHODS Convenience sampling along with snowball sampling techniques were employed to recruit fathers of adolescents aged 10-19 years from Kolkata city, India. Informed by the research aim and review of literature, an interview guide was developed and pre-tested. Interviews were carried out either in person or virtually (Zoom/telephone) in English/Hindi/Bengali as per the preference of the participants. All interactions were audio recorded, transcribed verbatim, and translated to English for the purpose of data analysis. The transcripts were analysed thematically using NVivo software program. Themes were identified using both inductive and deductive approaches. RESULTS A total 36 fathers participated in the interviews. Seven main themes were identified: (i) Involvement of fathers in adolescent upbringing (i.e. engagement in meal preparation, food shopping, educational activities, physical activity); (ii) Family food environment (i.e. setting food rules, having meals with children, making food available); (iii) Challenges to instilling healthy behaviours in adolescents (i.e. adolescents' sedentary lifestyle and liking for unhealthy foods); (iv) Barriers to routine involvement in adolescent upbringing (i.e. time constraints due to paid employment, poor socio-economic status); (v) Adolescent nutrition education: (vi) Dual burden of malnutrition (i.e. awareness of malnutrition, no knowledge about government-led health programs for adolescents); (vii) Paternal knowledge. CONCLUSIONS The emerging themes reveal that Indian fathers played a crucial role in instilling healthy dietary and physical activity behaviour in their adolescents through various parenting practices such as purchasing nutritious food, enforcing food rules, disseminating nutrition-related knowledge, and encouraging adolescents to participate in moderate-to-vigorous intensity outdoor sports. This provides strong support for the inclusion of fathers in sustainable family-focused lifestyle interventions to maximise the nurturing care required by adolescents as well as assist in normalising the representation of fathers in health and welfare policies designed for adolescents.
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Affiliation(s)
- Neha Rathi
- Department of Home Science, Mahila Maha Vidyalaya, Banaras Hindu University, 221005, Varanasi, Uttar Pradesh, India.
| | - Sangeeta Kansal
- Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, 221005, Varanasi, Uttar Pradesh, India
| | - Anthony Worsley
- School of Exercise and Nutrition Sciences, Deakin University, 3220, Geelong, VIC, Australia
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August F, Nyamhanga TM, Kakoko DCV, Sirili NS, Frumence GM. Facilitators for and Barriers to the Implementation of Performance Accountability Mechanisms for Quality Improvement in the Delivery of Maternal Health Services in a District Hospital in Pwani Region, Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6366. [PMID: 37510598 PMCID: PMC10379119 DOI: 10.3390/ijerph20146366] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 07/30/2023]
Abstract
Tanzania experiences a burden of maternal mortality and morbidity. Despite the efforts to institute accountability mechanisms, little is known about quality improvement in the delivery of maternal health services. This study aimed at exploring barriers and facilitators to enforcing performance accountability mechanisms for quality improvement in maternal health services. A case study design was used to conduct semi-structured interviews with thirteen key informants. Data were analyzed using thematic analyses. The findings were linked to two main performance accountability mechanisms: maternal and perinatal death reviews (MPDRs) and monitoring and evaluation (M&E). Prioritization of the maternal health agenda by the government and the presence of maternal death review committees were the main facilitators for MPDRs, while negligence, inadequate follow-up, poor record-keeping, and delays were the main barriers facing MPDRs. M&E was facilitated by the availability of health management information systems, day-to-day ward rounds, online ordering of medicines, and the use of biometrics. Non-use of data for decision-making, supervision being performed on an ad hoc basis, and inadequate health workforce were the main barriers to M&E. The findings underscore that barriers to the performance accountability mechanisms are systemic and account for limited effectiveness in the improvement of quality of care.
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Affiliation(s)
- Francis August
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65015, Tanzania
| | - Tumaini Mwita Nyamhanga
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65015, Tanzania
| | - Deodatus Conatus Vitalis Kakoko
- Department of Behavioral Sciences, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65015, Tanzania
| | - Nathanael Shauri Sirili
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65015, Tanzania
| | - Gasto Msoffee Frumence
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65015, Tanzania
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Finlayson K, Sacks E, Brizuela V, Crossland N, Cordey S, Ziegler D, Langlois EV, Javadi D, Comrie-Thomson L, Downe S, Bonet M. Factors that influence the uptake of postnatal care from the perspective of fathers, partners and other family members: a qualitative evidence synthesis. BMJ Glob Health 2023; 8:e011086. [PMID: 37137532 PMCID: PMC10163465 DOI: 10.1136/bmjgh-2022-011086] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/14/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Postnatal care (PNC) is a key component of maternity provision and presents opportunities for healthcare providers to optimise the health and well-being of women and newborns. However, PNC is often undervalued by parents, family members and healthcare providers. As part of a larger qualitative review exploring the factors that influence PNC uptake by relevant stakeholders, we examined a subset of studies highlighting the views of fathers, partners and family members of postpartum women. METHODS We undertook a qualitative evidence synthesis using a framework synthesis approach. We searched multiple databases and included studies with extractable qualitative data focusing on PNC utilisation. We identified and labelled a subset of articles reflecting the views of fathers, partners and other family members. Data abstraction and quality assessment were carried out using a bespoke data extraction form and established quality assessment tools. The framework was developed a priori based on previous research on the topic and adapted accordingly. Findings were assessed for confidence using the GRADE-CERQual approach and are presented by country income group. RESULTS Of 12 678 papers identified from the original search, 109 were tagged as 'family members views' and, of these, 30 were eligible for this review. Twenty-nine incorporated fathers' views, 7 included the views of grandmothers or mothers-in-law, 4 incorporated other family member views and 1 included comothers. Four themes emerged: access and availability; adapting to fatherhood; sociocultural influences and experiences of care. These findings highlight the significant role played by fathers and family members on the uptake of PNC by women as well as the distinct concerns and needs of fathers during the early postnatal period. CONCLUSION To optimise access to postnatal care, health providers should adopt a more inclusive approach incorporating flexible contact opportunities, the availability of more 'family-friendly' information and access to psychosocial support services for both parents.
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Affiliation(s)
- Kenneth Finlayson
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Vanessa Brizuela
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Nicola Crossland
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Sarah Cordey
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Daniela Ziegler
- Direction de l'enseignement et l'Académie CHUM | Bibliothèque du CHUM, Centre Hospitalier de l'Universite de Montreal, Montreal, Québec, Canada
| | - Etienne V Langlois
- Partnership for Maternal, Newborn and Child Health (PMNCH), World Health Organization, Geneva, Switzerland
| | - Dena Javadi
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Liz Comrie-Thomson
- Global Women's and Newborn's Health Group, Burnet Institute, Melbourne, Victoria, Australia
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Mercedes Bonet
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Kakaşçı ÇG, Potur DC, Abbasoğlu DE, Karabulut Ö, Merih YD, Demirci N. Is participation in antenatal classes associated with fathers' mental health? A quasi-experimental and prospective study. Infant Ment Health J 2022; 43:938-950. [PMID: 36260029 DOI: 10.1002/imhj.22015] [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: 06/11/2020] [Accepted: 08/20/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND In comparison to those conducted with women, studies about the transition of men to parenthood are limited in numbers, especially in developing countries. Moreover, in Turkey, along with gender roles and sociocultural changes, the roles of fathers are also changing. This change highlights the need to understand early parenthood for fathers. METHODS A quasi-experimental, non-randomized prospective study with a pre- and post-training model was conducted in a hospital in Istanbul, Turkey. Men in the antenatal education group (EG = 55) and their pregnant wives participated in 6 weeks of training during pregnancy (24th-28th weeks gestation). Men in the care-as-usual group (CG = 55) attended routine check-ups and follow-ups with their wives. GHQ-28 (General Health Questionnaire-28) was administered three times in total at study enrolment, immediately following the 6-week intervention period, and at the 6th postpartum week. RESULTS There was no significant difference between the groups' GHQ-28 scores before and after the training. In the 6th week of postpartum follow-up, the GHQ-28 scores were significantly higher for the fathers who participated in the educational intervention. CONCLUSIONS Antenatal education classes were found to be associated with the mental health of fathers. Further research evaluating family-centered parenting support programs is warranted to better understand how to support fathers in the transition to parenthood, particularly in countries in which fathers' roles in pregnancy and early parenthood are changing.
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Affiliation(s)
- Çiğdem Gün Kakaşçı
- Faculty of Health Sciences, Division of Midwifery, Suleyman Demirel University, Isparta, Turkey
| | - Dilek Coşkuner Potur
- Faculty of Health Sciences, Department of Obstetrics and Gynecology Nursing, Division of Nursing, Marmara University, Istanbul, Turkey
| | | | - Özlem Karabulut
- Zeynep Kamil Women and Child Disease Training and Research Hospital, Istanbul, Turkey
| | - Yeliz Doğan Merih
- Faculty of Hamidiye, Division on Nursing, Department of Obstetrics Gynecology Nursing, Sağlık Bilimleri University, Istanbul, Turkey
| | - Nurdan Demirci
- Faculty of Health Sciences, Department of Obstetrics and Gynecology Nursing, Division of Nursing, Marmara University, Istanbul, Turkey
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Leahy-Warren P, Philpott L, Elmir R, Schmied V. Fathers' perceptions and experiences of support to be a parenting partner during the perinatal period: A scoping review. J Clin Nurs 2022. [PMID: 35898120 DOI: 10.1111/jocn.16460] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/13/2022] [Accepted: 07/05/2022] [Indexed: 10/16/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to explore fathers' perceptions and experiences of support in the perinatal period. Change in society has seen the increased visibility of fathers being involved during pregnancy and engaging in their infants' lives and the expectation and benefits of men playing an equal and direct role in caring for their children. However, less is known about the nature of support that fathers require to facilitate this role transition. DESIGN A scoping review was conducted in accordance with Arksey and O'Malley's six-step scoping review framework and the PRISMA-ScR guidelines. METHODS A systematic search of CINAHL Plus, MEDLINE, the Cochrane Library, PsycARTICLES, PsycINFO, Psychology, Soc INDEX and Behavioural Sciences Collections databases for qualitative or mixed methods studies with qualitative data was undertaken. Qualitative data were extracted from original studies for coding and theme generation. Thematic synthesis was employed for the final stages of analysis. RESULTS Overall, 23 papers were included. Men desired to fulfil their rite of passage to be an involved father to their child. This transitional process commenced with men articulating their commitment to creating a role as an involved father and to be a role model for their children. Becoming a father is seen as having a significant status in society which contributes to their self-efficacy as fathers. CONCLUSION Fathers require support from all levels of the 'ecosystem' including policy, socio-cultural and workplace changes as well as recognition and support from partners, family, peers and in particular from health service providers. Developing the parenting partnership requires a co-production approach and commitment at macro, meso and micro levels. RELEVANCE TO CLINICAL PRACTICE Supporting men to be engaged fathers requires policy, socio-cultural and workplace changes; however, maternity services and particularly midwives have an important role in this change.
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Affiliation(s)
| | - Lloyd Philpott
- School of Nursing and Midwifery, University College, Cork, Ireland
| | - Rakime Elmir
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
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Chang YS, Li KMC, Li KYC, Beake S, Lok KYW, Bick D. Relatively speaking? Partners' and family members' views and experiences of supporting breastfeeding: a systematic review of qualitative evidence. Philos Trans R Soc Lond B Biol Sci 2021; 376:20200033. [PMID: 33938280 PMCID: PMC8090822 DOI: 10.1098/rstb.2020.0033] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2021] [Indexed: 12/30/2022] Open
Abstract
This review aimed to synthesize qualitative evidence of views and experiences of partners and other family members who provided breastfeeding support for a relative. The Joanna Briggs Institute (JBI) methodology for systematic reviews of qualitative evidence was followed. Seven databases: CINAHL, MEDLINE, EMBASE, PsycINFO, Scopus, Maternal and Infant Care, and Web of Science were searched. Partners and other family members (e.g. grandmothers, siblings) of women in any countries were included. Included papers were critically appraised. The JBI meta-aggregative approach was used to analyze data and form synthesized findings. Seventy-six papers from 74 studies were included. Five synthesized findings were: (i) spectrum of family members' breastfeeding knowledge, experiences and roles; (ii) the complexity of infant feeding decision making; (iii) the controversy of breastfeeding in front of others; (iv) impact of breastfeeding on family; and (v) it takes more than just family members: support for family members. Partners' and family members' views and experiences of breastfeeding support reflected multi-faceted personal, social, financial, cultural, religious, emotional, psychological, and societal factors of the support they provided (or not). Healthcare professionals should engage them in breastfeeding discussions with the woman, and offer tailored and practical guidance relevant to help them to appropriately support the woman. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.
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Affiliation(s)
- Yan-Shing Chang
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | | | - Kan Yan Chloe Li
- Institute of Cardiovascular Science, University College London, London, UK
| | - Sarah Beake
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | | | - Debra Bick
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
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Erfanian Arghavanian F, Heydari A, Noghani Dokht Bahmani M, Latifnejad Roudsari R. An Ethno-phenomenological Study of Pregnant Women's Experiences regarding Household Roles. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2020; 8:282-294. [PMID: 33178851 PMCID: PMC7648856 DOI: 10.30476/ijcbnm.2020.84685.1228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Household labor has been indicated as a feminine role even in the present millennium, in which gender role orientations have been changed. As pregnancy is an important time for studying the division of household labor, this study aimed to discover the meaning of the pregnant women's experiences of household roles. Methods An ethno-phenomenological study, in which van Manen approach to phenomenology was its core and focused ethnographic approach was its supplementary component, was used to conduct this study. 25 pregnant women with maximum variation were recruited via the purposeful sampling during 2016-2017 in Mashhad, Iran. In-depth semi-structured interviews, vignette interviews as well as observations were used for data collection. Six-step van Manen's descriptive-interpretive phenomenological approach was used for concurrent data collection and analysis. MAXQDA, version 10, was used for data organization. Results Data analysis led to the emergence of an overarching theme entitled: "couples' preservation, keeping up and protection of the household roles". This was derived from two subthemes including the mother's efforts to play the household roles and spouse confrontation with the household chores. Conclusion The consequence of all endeavors of pregnant women along with their husbands develops the experience of preserving and maintaining the importance of household roles. As pregnancy is an important period for considering division of household responsibilities, it is necessary to design and implement gender sensitive programs to empower pregnant women and their families as well.
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Affiliation(s)
- Fatemeh Erfanian Arghavanian
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Heydari
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Robab Latifnejad Roudsari
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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Mehran N, Hajian S, Simbar M, Alavi Majd H. Spouse's participation in perinatal care: a qualitative study. BMC Pregnancy Childbirth 2020; 20:489. [PMID: 32842984 PMCID: PMC7448314 DOI: 10.1186/s12884-020-03111-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 07/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background Pregnancy is one of the most important periods of any woman’s life, wherein the support of her relatives, especially her spouse, enables her to tolerate the difficulties with good memories. However, in Iran, there are very few studies on the participation of spouses in the perinatal period. Therefore, the present study aimed to explain the concept of spouse participation in perinatal care. Methods This is a qualitative study that was carried out in 2018 on spouse participation in perinatal care in Qom, Iran. Purposive sampling from pregnant or postpartum women, spouses, midwifery care providers, and key informants was performed according to study inclusion criteria. Semi-structured in-depth interviews were carried out until the data saturation was met. Also, the data analysis was performed based on a conventional content analysis approach according to Graneheim & Lundman steps using MAXQDA software (v.10). Five Guba and Lincoln criteria were applied to ensure the trustworthiness of data. Results Fifty-three final codes were classified into 18 sub-categories, 7 categories, and 3 themes including empathy (emotional and cognitive understanding), accountability (supporting, position management, compassion), and consequences (help improvement of family function, improvement of maternal-neonatal health). Conclusions Based on the findings of this study, the concept of men’s participation in this period has been defined as a set of empathic and responsive behaviors that can lead to improvement of the family function and mother and baby health.
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Affiliation(s)
- Nahid Mehran
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepideh Hajian
- Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Masoumeh Simbar
- Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Alavi Majd
- Department of Biostatistic, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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The Effect of Positivity Approach Counseling on Acceptance and Adaptation to Parental Role in Husbands of First-Time Mothers. PREVENTIVE CARE IN NURSING AND MIDWIFERY JOURNAL 2020. [DOI: 10.52547/pcnm.10.3.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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10
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Mchome Z, Bailey A, Kessy F, Darak S, Haisma H. Postpartum sex taboos and child growth in Tanzania: Implications for child care. MATERNAL AND CHILD NUTRITION 2020; 16:e13048. [PMID: 32633462 PMCID: PMC7507495 DOI: 10.1111/mcn.13048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 05/24/2020] [Accepted: 06/02/2020] [Indexed: 12/04/2022]
Abstract
The social context and cultural meaning systems shape caregivers' perceptions about child growth and inform their attention to episodes of poor growth. Thus, understanding community members' beliefs about the aetiology of poor child growth is important for effective responses to child malnutrition. We present an analysis of caregivers' narratives on the risks surrounding child growth during postpartum period and highlight how the meanings attached to these risks shape child care practices. We collected data using 19 focus group discussions, 30 in‐depth interviews and five key informant interviews with caregivers of under‐five children in south‐eastern Tanzania. Parental non‐adherence to postpartum sexual abstinence norms was a dominant cultural explanation for poor growth and development in a child, including different forms of malnutrition. In case sexual abstinence is not maintained or when a mother conceives while still lactating, caregivers would wean their infants abruptly and completely to prevent poor growth. Mothers whose babies were growing poorly were often stigmatized for breaking sex taboos by the community and by health care workers. The stigma that mothers face reduced their self‐esteem and deterred them from taking their children to the child health clinics. Traditional rather than biomedical care was often sought to remedy growth problems in children, particularly when violation of sexual abstinence was suspected. When designing culturally sensitive interventions aimed at promoting healthy child growth and effective breastfeeding in the community, it is important to recognize and address people's existing misconceptions about early resumption of sexual intercourse and a new pregnancy during lactation period.
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Affiliation(s)
- Zaina Mchome
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands.,National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Ajay Bailey
- Department of Human Geography and Spatial Planning, International Development Studies, Utrecht University, Utrecht, The Netherlands.,Manipal Academy of Higher Education, Manipal, India
| | - Flora Kessy
- Tanzania Training Center for International Health, Morogoro, Tanzania
| | | | - Hinke Haisma
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands.,International Union for Nutrition Sciences Task Force 'Toward Multi-dimensional Indicators of Child Growth and Development, London, UK
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11
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Ngai F, Lam W. The experience of first‐time Hong Kong Chinese fatherhood: A qualitative exploratory study. Nurs Health Sci 2020; 22:723-731. [DOI: 10.1111/nhs.12719] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Fei‐Wan Ngai
- School of Nursing The Hong Kong Polytechnic University Kowloon Hong Kong
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12
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Greenspan JA, Chebet JJ, Mpembeni R, Mosha I, Mpunga M, Winch PJ, Killewo J, Baqui AH, McMahon SA. Men's roles in care seeking for maternal and newborn health: a qualitative study applying the three delays model to male involvement in Morogoro Region, Tanzania. BMC Pregnancy Childbirth 2019; 19:293. [PMID: 31409278 PMCID: PMC6693212 DOI: 10.1186/s12884-019-2439-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 07/29/2019] [Indexed: 01/08/2023] Open
Abstract
Background Increasing the utilization of facility-based care for women and newborns in low-resource settings can reduce maternal and newborn morbidity and mortality. Men influence whether women and newborns receive care because they often control financial resources and household decisions. This influence can have negative effects if men misjudge or ignore danger signs or are unwilling or unable to pay for care. Men can also positively affect their families’ health by helping plan for delivery, supplementing women’s knowledge about danger signs, and supporting the use of facility-based care. Because of these positive implications, researchers have called for increased male involvement in maternal and newborn health. However, data gathered directly from men to inform programs are lacking. Methods This study draws on in-depth interviews with 27 men in Morogoro Region, Tanzania whose partners delivered in the previous 14 months. Debriefings took place throughout data collection. Interview transcripts were analyzed inductively to identify relevant themes and devise an analysis questionnaire, subsequently applied deductively to all transcripts. Results Study findings add a partner-focused dimension to the three delays model of maternal care seeking. Men in the study often, though not universally, described facilitating access to care for women and newborns at each point along this care-seeking continuum (deciding to seek care, reaching a facility, and receiving care). Specifically, men reported taking ownership of their role as decision makers and described themselves as supportive of facility-based care. Men described arranging transport and accompanying their partners to facilities, especially for non-routine care. Men also discussed purchasing supplies and medications, acting as patient advocates, and registering complaints about health services. In addition, men described barriers to their involvement including a lack of knowledge, the need to focus on income-generating activities, the cost of care, and policies limiting male involvement at facilities. Conclusion Men can leverage their influence over household resources and decision making to facilitate care seeking and navigate challenges accessing care for women and newborns. Examining these findings from men and understanding the barriers they face can help inform interventions that encourage men to be positively and proactively involved in maternal and newborn health.
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Affiliation(s)
- Jesse A Greenspan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, USA.,Partners In Health, 800 Boylston Street, Suite 300, Boston, MA, USA
| | - Joy J Chebet
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, USA.,Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Rose Mpembeni
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar-Es-Salaam, Tanzania.
| | - Idda Mosha
- Department of Behavioural Sciences, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar-Es-Salaam, Tanzania
| | - Maurus Mpunga
- Department of Labour Studies, Institute of Social Work, P.O. Box 3375, Dar-es-Salaam, Tanzania
| | - Peter J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, USA
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar-Es-Salaam, Tanzania
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, USA
| | - Shannon A McMahon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, USA.,Institute of Public Health, Ruprecht-Karls-Universität, Heidelberg, Germany
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Matare CR, Craig HC, Martin SL, Kayanda RA, Chapleau GM, Kerr RB, Dearden KA, Nnally LP, Dickin KL. Barriers and Opportunities for Improved Exclusive Breast-Feeding Practices in Tanzania: Household Trials With Mothers and Fathers. Food Nutr Bull 2019; 40:308-325. [PMID: 31067996 DOI: 10.1177/0379572119841961] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Effective promotion of exclusive breast-feeding (EBF) is needed to improve child nutrition and survival. OBJECTIVE We explored barriers and facilitators to EBF in rural Tanzania and assessed parents' willingness and ability to try specific recommended EBF practices plus strategies for men to support breast-feeding. METHODS We conducted Trials of Improved Practices in 36 households with infants <6 months. Fathers participated in focus group discussions on ways to support breast-feeding. Fathers and mothers were individually interviewed 2 and 3 times, respectively, about their willingness to try and experience with selected new practices. We analyzed data thematically. RESULTS Common barriers to EBF were (1) use of gripe water and traditional medicines for perceived symptoms of infantile distress; (2) mothers' workloads and time away from infants, limiting availability for EBF; and (3) water given for perceived thirst. Although several mothers expressed concerns about breast-milk insufficiency, few were giving other foods. After counseling, most mothers reported breast-feeding more optimally. Some reported improved breast-milk supply. Fathers saw their roles as providing food to mothers to ensure sufficient breast-milk and encouraging new practices. Dominant gender roles and work away from home were barriers even if fathers were willing to help with household chores. Fathers mostly provided emotional support or encouraged others to help with chores. CONCLUSION Exclusive breast-feeding promotion needs to address concerns about infantile distress and help parents develop effective soothing techniques while avoiding nonprescribed medicines. Engaging men in EBF interventions could help change social norms and facilitate men's involvement in improving breast-feeding practices.
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Affiliation(s)
- Cynthia R Matare
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Hope C Craig
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Stephanie L Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | | | - Gina M Chapleau
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Rachel Bezner Kerr
- Department of Development Sociology, Cornell University, Ithaca, NY, USA
| | | | - Luitfrid P Nnally
- Tanzania Food and Nutrition Center, Ministry of Health Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Katherine L Dickin
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
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Shorey S, Ang L. Experiences, needs, and perceptions of paternal involvement during the first year after their infants' birth: A meta-synthesis. PLoS One 2019; 14:e0210388. [PMID: 30615672 PMCID: PMC6322761 DOI: 10.1371/journal.pone.0210388] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 12/21/2018] [Indexed: 12/04/2022] Open
Abstract
Objectives Fatherhood has evolved in recent decades from ‘a moral teacher’ to ‘an involved father’. However, fatherhood experiences have not been examined in detail. This meta-synthesis aimed to examine fathers’ experiences, needs, and perceptions of their involvement with their infants during the first 12 months of birth. Method Six electronic databases were systematically searched: PubMed, CINAHL, Embase, Scopus, PsycINFO, ProQuest (grey literature). The search resulted in 13 studies that met the inclusion criteria. Quality appraisal was conducted using the Critical Appraisal Skills Programme Checklist. All 13 studies met the appraisal criteria and were included in the meta-synthesis. The findings of the 13 studies were synthesized using the steps of Sandelowski and Barroso in conducting meta-synthesis. Results The 13 included studies comprised studies conducted in the West, Africa, and Asia. Fatherhood experiences differed according to different sociocultural contexts. Three themes were identified: (1) trajectory of the father-infant relationship, (2) reinforcements and hindrances to involvement, and (3) change from self-oriented to family-oriented behavior. Changes in a father’s relationship with his infant were influenced by relationships with his spouse and family members after the birth of the infant. Reinforcements, hindrances, and needs to fathers’ involvement were identified. Fathering responsibility and parenting satisfaction that developed overtime influenced a father’s behavior, changing from self-oriented to family-oriented. Significance This is the first meta-synthesis that examined fathers’ experiences, needs, and perceptions of their involvement with their infants during the first 12 months of birth. Multiple factors were found to influence the socially-defined fathering ideology. Cultural practices of fatherhood and fathers’ own perceptions shaped their actual fathering behaviors. The findings of this study may guide healthcare professionals as frontline personnel to understand fathers’ needs and experiences in order to promote fathers’ involvement in the early days after their infants’ birth.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
- * E-mail:
| | - Lina Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
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Reuben Mahiti G, Mbekenga CK, Dennis Kiwara A, Hurtig AK, Goicolea I. Perceptions about the cultural practices of male partners during postpartum care in rural Tanzania: a qualitative study. Glob Health Action 2018; 10:1361184. [PMID: 28882101 PMCID: PMC5645690 DOI: 10.1080/16549716.2017.1361184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Men play an important role in maternal health. The postpartum period is a critical stage, yet there is a scarcity of research that explores men’s involvement during this stage. Objective: The aim of the study was to explore male partners’ perceptions of the cultural practices during postpartum care in rural Tanzania. Methods: Fourteen focus group discussions were conducted with 93 men, with an age range of 19–65 years, in August 2013. The study was conducted in the Kongwa District, located in the Dodoma region in central Tanzania. Qualitative data were digitally recorded, transcribed verbatim and analyzed using content analysis. Results: Four categories emerged, namely: ‘Men as providers and, occasionally, care takers’, ‘Men as decision makers’, ‘Diverse perceptions of sexual abstinence’ and ‘Barriers for men in using/accompanying partners to use reproductive and child healthcare services’. The cross-category theme ‘Men during postpartum: remaining powerful but excluded’ refers to how men are in a powerful position above women in different aspects of life. Elderly women played an important role in caring for postpartum mothers and their newborns, but men were the ones making the final decision about where to seek care. Traditional practices isolated men from their partners for a certain period, and enforced sexual abstinence for the women during the postpartum period. However, cultural norms permitted men to engage in extramarital relations. Reproductive and child healthcare services were perceived by men as not welcoming the male partners, and local gender norms discouraged men from accompanying their partners to seek services. Conclusions: In this study, we found that men perceived their role during the postpartum period as financial providers, decision makers and, occasionally, care givers. Men also held diverse perceptions with regard to sexual abstinence and felt excluded from participating in maternal healthcare services.
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Affiliation(s)
- Gladys Reuben Mahiti
- a Department of Development Studies, School of Public Health and Social Sciences , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania
| | - Columba K Mbekenga
- b School of Nursing and Midwifery , Agakhan University , Dar es Salaam , Tanzania
| | - Angwara Dennis Kiwara
- a Department of Development Studies, School of Public Health and Social Sciences , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania
| | - Anna-Karin Hurtig
- c Division of Epidemiology and Global Health, Faculty of Medicine , Umeå University , Umeå , Sweden
| | - Isabel Goicolea
- c Division of Epidemiology and Global Health, Faculty of Medicine , Umeå University , Umeå , Sweden
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Macdonald D, Aston M, Murphy GT, Jefferies K, Mselle LT, Price S, O'Hearn S, White M, Mbekenga C, Kohi TW. Providing postpartum care with limited resources: Experiences of nurse-midwives and obstetricians in urban Tanzania. Women Birth 2018; 32:e391-e398. [PMID: 30100194 DOI: 10.1016/j.wombi.2018.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Tanzania has high maternal and neonatal mortality rates. Comprehensive guidelines for postpartum care have been developed by the government as a means to improve health outcomes during the perinatal period. Despite the creation of these guidelines and the government's commitment to universal perinatal care for women and neonates, there is concern that the delivery of postpartum services may not be meeting the needs of mothers and neonates. AIM The purpose of this feminist poststructuralist study was to explore nurse-midwives' and obstetricians' experiences of providing postpartum care in Tanzania. METHODS This qualitative study used feminist poststructuralism to explore the personal, social, and institutional discourses of postpartum care. We individually interviewed ten nurse-midwives and three obstetricians in Dar es Salaam, Tanzania. Feminist poststructuralist discourse analysis was used to analyze the transcribed interviews after their translation from Kiswahili to English. FINDINGS Four main themes were identified. In this paper, we present the main theme of availability of resources, and its four corresponding subthemes; (1) space, (2) equipment, (3) staffing, and (4) government responsibility. DISCUSSION The findings from our study illustrate the need for health workforce planning to be addressed in a comprehensive manner that accounts for context, required resources and systemic challenges. These findings are consistent with findings from other studies. CONCLUSION Understanding the resource challenges that nurse-midwives and obstetricians are facing in one low-and-middle-income-country will assist researchers, decision makers, and politicians as they address issues of mortality, morbidity, and disrespectful maternity care.
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Affiliation(s)
- Danielle Macdonald
- School of Nursing, Dalhousie University, 5869 University Avenue, PO Box 15000, Halifax, Nova Scotia B3H 4R2, Canada.
| | - Megan Aston
- School of Nursing, Dalhousie University, 5869 University Avenue, PO Box 15000, Halifax, Nova Scotia B3H 4R2, Canada.
| | - Gail Tomblin Murphy
- School of Nursing, Dalhousie University, 5869 University Avenue, PO Box 15000, Halifax, Nova Scotia B3H 4R2, Canada.
| | - Keisha Jefferies
- School of Nursing, Dalhousie University, 5869 University Avenue, PO Box 15000, Halifax, Nova Scotia B3H 4R2, Canada.
| | - Lilian T Mselle
- Muhimbili University of Health and Allied Sciences, School of Nursing, PO Box 65004, Dar es Salaam, Tanzania.
| | - Sheri Price
- School of Nursing, Dalhousie University, 5869 University Avenue, PO Box 15000, Halifax, Nova Scotia B3H 4R2, Canada.
| | - Shawna O'Hearn
- Global Health Office, Dalhousie University, 5849 University Avenue, PO Box 15000, Halifax, Nova Scotia B3H 4R2, Canada.
| | - Maureen White
- School of Nursing, Dalhousie University, 5869 University Avenue, PO Box 15000, Halifax, Nova Scotia B3H 4R2, Canada.
| | - Columba Mbekenga
- Muhimbili University of Health and Allied Sciences, School of Nursing, PO Box 65004, Dar es Salaam, Tanzania.
| | - Thecla W Kohi
- Muhimbili University of Health and Allied Sciences, School of Nursing, PO Box 65004, Dar es Salaam, Tanzania.
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Pallangyo E, Mbekenga C, Olsson P, Eriksson L, Bergström A. Implementation of a facilitation intervention to improve postpartum care in a low-resource suburb of Dar es Salaam, Tanzania. Implement Sci 2018; 13:102. [PMID: 30055638 PMCID: PMC6064049 DOI: 10.1186/s13012-018-0794-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/12/2018] [Indexed: 12/05/2022] Open
Abstract
Background Implementation of evidence into practice is inadequate in many low-income countries, contributing to the low-quality care of mothers and newborns. This study explored strategies used in a facilitation intervention to improve postpartum care (IPPC) in a low-resource suburb in Dar es Salaam, Tanzania. The intervention was conducted during 1 year in government-owned health institutions providing reproductive and child health services. The institutions were divided into six clusters based on geographic proximity, and the healthcare providers of postpartum care (PPC) (n = 100) in these institutions formed IPPC teams. Each team was supported by a locally recruited facilitator who was trained in PPC, group dynamics, and quality improvement. The IPPC teams reflected on their practices, identified problems and solutions for improving PPC, enacted change, and monitored the adopted actions. Methods A qualitative design was employed using data from focus group discussions with healthcare providers (n = 8) and facilitators (n = 2), and intervention documentation. The discussions were conducted in Kiswahili, lasted for 45–90 min, were audio-recorded, transcribed verbatim, and translated into English. Thematic analysis guided the analysis. Results Four main strategies were identified in the data: (1) Increasing awareness and knowledge of PPC by HCPs and mothers was an overarching strategy applied in training, meetings, and clinical practice; (2) The mobilization of professional and material resources was achieved through unleashing of the IPPC teams’ own potential to conduct PPC and act as change agents; (3) Improving documentation and communication; and (4) Promoting an empowering and collaborative working style were other strategies applied to improve daily care routines. The facilitators encouraged teamwork and networking among IPPC teams within and between institutions. Conclusion This facilitation intervention is a promising approach for implementing evidence and improving quality of PPC in a low-resource setting. Context-specific actions taken by the facilitators and healthcare providers are likely integral to the successfulness of implementing evidence into practice. The results contribute to increasing the understanding of facilitation as an intervention and can be useful for researchers, HCPs, and policymakers when improving quality of postpartum care, particularly in low-income settings. Electronic supplementary material The online version of this article (10.1186/s13012-018-0794-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E Pallangyo
- School of Nursing and Midwifery, Aga Khan University, Salama House, 344 Urambo Street, P.O.BOX 38129, Dar es Salaam, Tanzania. .,Women's and Children's Health, Akademiska sjukhuset, Uppsala University, SE-751 85, Uppsala, Sweden.
| | - C Mbekenga
- School of Nursing and Midwifery, Aga Khan University, Salama House, 344 Urambo Street, P.O.BOX 38129, Dar es Salaam, Tanzania
| | - P Olsson
- Women's and Children's Health, Akademiska sjukhuset, Uppsala University, SE-751 85, Uppsala, Sweden
| | - L Eriksson
- Women's and Children's Health, Akademiska sjukhuset, Uppsala University, SE-751 85, Uppsala, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden
| | - A Bergström
- Women's and Children's Health, Akademiska sjukhuset, Uppsala University, SE-751 85, Uppsala, Sweden.,Institute for Global Health, University College London, Gower Street, London, WC1E 6BT, UK
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LeFevre A, Mpembeni R, Kilewo C, Yang A, An S, Mohan D, Mosha I, Besana G, Lipingu C, Callaghan-Koru J, Silverman M, Winch PJ, George AS. Program assessment of efforts to improve the quality of postpartum counselling in health centers in Morogoro region, Tanzania. BMC Pregnancy Childbirth 2018; 18:282. [PMID: 29973185 PMCID: PMC6031177 DOI: 10.1186/s12884-018-1906-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 06/18/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The postpartum period represents a critical window where many maternal and child deaths occur. We assess the quality of postpartum care (PPC) as well as efforts to improve service delivery through additional training and supervision in Health Centers (HCs) in Morogoro Region, Tanzania. METHODS Program implementers purposively selected nine program HCs for assessment with another nine HCs in the region remaining as comparison sites in a non-randomized program evaluation. PPC quality was assessed by examining structural inputs; provider and client profiles; processes (PNC counselling) and outcomes (patient knowledge) through direct observations of equipment, supplies and infrastructure (n = 18) and PPC counselling (n = 45); client exit interviews (n = 41); a provider survey (n = 62); and in-depth provider interviews (n = 10). RESULTS While physical infrastructure, equipment and supplies were comparable across study sites (with water and electricity limitations), program areas had better availability of drugs and commodities. Overall, provider availability was also similar across study sites, with 63% of HCs following staffing norms, 17% of Reproductive and Child Health (RCH) providers absent and 14% of those providing PPC being unqualified to do so. In the program area, a median of 4 of 10 RCH providers received training. Despite training and supervisory inputs to program area HCs, provider and client knowledge of PPC was low and the content of PPC counseling provided limited to 3 of 80 PPC messages in over half the consultations observed. Among women attending PPC, 29 (71%) had delivered in a health facility and sought care a median of 13 days after delivery. Barriers to PPC care seeking included perceptions that PPC was of limited benefit to women and was primarily about child health, geographic distance, gaps in the continuity of care, and harsh facility treatment. CONCLUSIONS Program training and supervision activities had a modest effect on the quality of PPC. To achieve broader transformation in PPC quality, client perceptions about the value of PPC need to be changed; the content of recommended PPC messages reviewed along with the location for PPC services; gaps in the availability of human resources addressed; and increased provider-client contact encouraged.
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Affiliation(s)
- Amnesty LeFevre
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
- School of Public Health and Family Medicine, Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa
| | - Rose Mpembeni
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania
| | - Charles Kilewo
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Ann Yang
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Selena An
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Idda Mosha
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania
| | - Giulia Besana
- Jhpiego Tanzania, Box 9170, Dar es Salaam, PO Tanzania
| | | | - Jennifer Callaghan-Koru
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Marissa Silverman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Peter J. Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Asha S. George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
- School of Public Health, University of the Western Cape, Bellville, South Africa
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Jacques-Aviñó C, García de Olalla P, González Antelo A, Fernández Quevedo M, Romaní O, Caylà JA. The theory of masculinity in studies on HIV. A systematic review. Glob Public Health 2018; 14:601-620. [PMID: 29972098 DOI: 10.1080/17441692.2018.1493133] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study aimed to describe the methodological characteristics of publications on HIV and masculinity, to identify possible information gaps and determine the main thematic areas. A systematic review was conducted of gender, masculinity, HIV infection and other sexually-transmitted infections in original articles published between 1992 and 2015. Original studies published from Pubmed and Scopus were included. A total of 303 articles were identified, of which 187 were selected. Most of the studies were qualitative and the most widely used technique was the interview. Twenty-nine-point five percent of studies were performed in South Africa, 20.8% in the USA, and 3.2% in Europe. Fifteen percent of the studies were performed in heterosexuals, 12.8% in men who have sex with men, and 60% did not specify the sexual orientation of the population. Eight thematic areas were defined, the most frequent being sexuality and risk behaviours, defined by men's need to demonstrate they were sexually active and a breadwinner. Most studies on HIV and masculinity show a gender bias by not specifying the sexual identity of the population. Studies should consider diversity in sexual and cultural identity in different contexts, including in Europe, to carry out more effective HIV interventions from a masculinity perspective.
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Affiliation(s)
- Constanza Jacques-Aviñó
- a Servicio de Epidemiología , Agència de Salud Pública de Barcelona , Barcelona , Spain.,b Universitat Rovira i Virgili (URV) , Tarragona , Spain
| | - Patricia García de Olalla
- a Servicio de Epidemiología , Agència de Salud Pública de Barcelona , Barcelona , Spain.,c Epidemiología y Salud Pública , CIBER , Spain
| | - Alicia González Antelo
- d Servicio Medicina Preventiva y Epidemiología , Hospital Vall d'Hebrón , Barcelona , Spain
| | | | - Oriol Romaní
- c Epidemiología y Salud Pública , CIBER , Spain.,e Medical Anthropology Research Center (MARC- URV) , Tarragona , Spain
| | - Joan A Caylà
- a Servicio de Epidemiología , Agència de Salud Pública de Barcelona , Barcelona , Spain.,c Epidemiología y Salud Pública , CIBER , Spain
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Shimpuku Y, Madeni FE, Horiuchi S, Kubota K, Leshabari SC. Evaluation of a family-oriented antenatal group educational program in rural Tanzania: a pre-test/post-test study. Reprod Health 2018; 15:117. [PMID: 29954398 PMCID: PMC6025829 DOI: 10.1186/s12978-018-0562-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 06/18/2018] [Indexed: 11/18/2022] Open
Abstract
Background To increase births attended by skilled birth attendants in Tanzania, studies have identified the need for involvement of the whole family in pregnancy and childbirth education. This study aimed to develop, implement, and evaluate a family-oriented antenatal group educational program to promote healthy pregnancy and family involvement in rural Tanzania. Methods This was a quasi-experimental 1 group pre-test/post-test study with antenatal education provided to pregnant women and their families in rural Tanzania. Before and after the educational program, the pre-test/post-test study was conducted using a 34-item Birth Preparedness Questionnaire. Acceptability of the educational program was qualitatively assessed. Results One-hundred and thirty-eight participants (42 pregnant women, 96 family members) attended the educational program, answered the questionnaire, and participated in the feasibility inquiry. The mean knowledge scores significantly increased between the pre-test and the post-test, 7.92 and 8.33, respectively (p = 0.001). For both pregnant women and family members, the educational program improved Family Support (p = 0.001 and p = 0.000) and Preparation of Money and Food (p = 0.000 and p = 0.000). For family members, the scores for Birth Preparedness (p = 0.006) and Avoidance of Medical Intervention (reversed item) (p = 0.002) significantly increased. Despite the educational program, the score for Home-based Value (reversed item) (p = 0.022) and References of SBA (p = 0.049) decreased in pregnant women. Through group discussions, favorable comments about the program and materials were received. The comments of the husbands reflected their better understanding and appreciation of their role in supporting their wives during the antenatal period. Conclusions The family-oriented antenatal group educational program has potential to increase knowledge, birth preparedness, and awareness of the need for family support among pregnant women and their families in rural Tanzania. As the contents of the program can be taught easily by reading the picture drama, lay personnel, such as community health workers or traditional birth attendants, can use it in villages. Further development of the Birth Preparedness Questionnaire is necessary to strengthen the involved factors. A larger scale study with a more robust Birth Preparedness Questionnaire and documentation of skilled care use is needed for the next step. Trial registration No.2013–273-NA-2013-101. Registered 12 August 2013.
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Affiliation(s)
- Yoko Shimpuku
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin-kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Frida E Madeni
- Magunga District Hospital, P. O. Box 430, Old-Korogwe, Tanga, Tanzania
| | - Shigeko Horiuchi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin-kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kazumi Kubota
- Department of Biostatistics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Sebalda C Leshabari
- School of Nursing, Muhimbili University of Health and Allied Sciences, P. O. Box 65169, Dar es Salaam, Tanzania
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How Tanzanian Nurse-Midwives and Obstetricians Develop Postpartum Relationships With Women. INTERNATIONAL JOURNAL OF CHILDBIRTH 2018. [DOI: 10.1891/2156-5287.8.1.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nurse-midwives and obstetricians are the primary postpartum health-care providers for mothers and babies in Tanzania. It is imperative that mothers and babies receive adequate information and support in order to save lives. Feminist poststructuralism and discourse analysis were used to conduct and analyze 13 semi-structured interviews from nurse-midwives and obstetricians at three clinics in Dar es Salaam, Tanzania. Establishing friendly supportive relationships enabled nurse-midwives and obstetricians to work effectively with mothers postpartum. Participants explained the importance of including family members in postpartum care and about the strategies they used in a clinic environment that was not always supportive of including family. Effective relational maternity care focused on families during the postpartum period can facilitate the delivery of information and save lives.
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Kohi TW, Aston M, Mselle LT, Macdonald D, Mbekenga C, Murphy GT, White M, OHearn S, Price S, Jefferies K. Saving lives with caring assessments: How Tanzanian nurse-midwives and obstetricians negotiate postpartum practices. J Clin Nurs 2017; 26:5004-5015. [PMID: 28793365 DOI: 10.1111/jocn.14000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2017] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore the nurse-midwives' and obstetricians' experiences delivering postpartum care assessments and how it was constructed through personal, social and institutional discourses. INTRODUCTION The Tanzanian Government has prioritised maternal and child health as an urgent healthcare issue. Nurse-midwives and obstetricians are the two main providers of care throughout the prenatal and postpartum periods. DESIGN A qualitative design guided by a feminist poststructuralist methodology. METHODS Ten nurse-midwives and three obstetricians from three Regional Hospitals in Dar es Salaam participated in individual semi-structured in-depth interviews. RESULTS Assessment emerged as a significant theme with three subthemes. Nurse-midwives shared their beliefs and values about assessments that focused on the safety of mothers and babies. They felt proud working with mothers and babies and shared their frustrations having to deal with inadequate working conditions. Guidelines and practices were part of the institutional discourse that impacted the day-to-day experiences of nurse-midwives and obstetricians. The nurse-midwives held the belief that it was vital to complete a comprehensive assessment to identify danger signs, keep mothers and babies safe and look for any abnormalities. They were concerned that mothers were being sent home too early. CONCLUSIONS Nurse-midwives' experiences in the provision of postpartum care portray that these health providers work heartedly to make sure that the mothers and their newborns receive the best care they can provide. The health system is challenged to address the needed supplies and equipment for reproductive health in particular postpartum care services. RELEVANCE TO CLINICAL PRACTICE Institutional health discourses significantly affect the practice of nurse-midwives and obstetricians to deliver timely and effective postpartum assessments. Immediate and ongoing postpartum assessments conducted by nurse-midwives and obstetricians can save lives. This study presents the first theme of the study: Caring assessments save lives.
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Affiliation(s)
- Thecla W Kohi
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Megan Aston
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lilian T Mselle
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Columba Mbekenga
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Maureen White
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shawna OHearn
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sheri Price
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Keisha Jefferies
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
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Women’s experiences of having had, and recovered from, eclampsia at a tertiary hospital in Tanzania. Women Birth 2017; 30:114-120. [DOI: 10.1016/j.wombi.2016.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 08/21/2016] [Accepted: 09/11/2016] [Indexed: 11/17/2022]
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Story WT, Barrington C, Fordham C, Sodzi-Tettey S, Barker PM, Singh K. Male Involvement and Accommodation During Obstetric Emergencies in Rural Ghana: A Qualitative Analysis. INTERNATIONAL PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2016; 42:211-219. [PMID: 28825900 PMCID: PMC6771418 DOI: 10.1363/42e2616] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
CONTEXT Although men potentially play an important role in emergency obstetric care in Sub-Saharan Africa, few studies have examined the ways in which men are involved in such emergencies, the consequences of their involvement or the degree to which health facilities accommodate men. METHODS Qualitative interviews were conducted with 39 mothers and fathers in two districts in Northern and Central Ghana who had experienced obstetric emergencies, such as severe birth complications, to obtain narratives about those experiences. In addition, interviews with six health facility workers and eight focus group discussions with community members were conducted. Transcripts were analyzed using an inductive analytic approach. RESULTS Although some men had not been involved at all during their partner's obstetric emergency, two-thirds had provided some combination of financial, emotional and instrumental support. On the other hand, several men had acted as gatekeepers, and their control of resources and decisions had resulted in care-seeking delays. Although many respondents reported that health facilities accommodated male partners (e.g., by providing an appropriate space for men during delivery), others found that facilities were not accommodating, in some cases ignoring or disrespecting men. A few respondents had encountered improper staff expectations, notably that men would accompany their partner to the facility, a requirement that limits women's autonomy and delays care. CONCLUSIONS Policies and programs should promote supportive behavior by men during obstetric emergencies while empowering women. Health facility policies regarding accommodation of men during obstetric emergencies need to consider women's and men's preferences. Research should examine whether particular forms of support improve maternal and newborn health outcomes.
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Affiliation(s)
- William T Story
- assistant professor, Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA,
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Eskandari N, Simbar M, Vedadhir A, Baghestani AR. Paternal adaptation in first-time fathers: a phenomenological study. J Reprod Infant Psychol 2016. [PMID: 29517289 DOI: 10.1080/02646838.2016.1233480] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to explore men's experiences of paternal adaptation during their first year of transition to parenthood. BACKGROUND Stepping into fatherhood is one of the most important events that may occur in a man's life and can lead to fundamental changes in their identity and lifestyle. However, to our knowledge, no studies have been conducted on men's experiences of paternal adaptation in an Iranian context. METHODS In this phenomenological study, 15 Iranian men who had the experience of parenting for the first time were recruited using the purposeful sampling method. In-depth semi-structured interviews guided by a questionnaire were used to collect data. The data were analysed using interpretative phenomenological analysis. RESULTS The data analysis resulted in the development of 26 themes, 8 subordinate themes and 3 superordinate themes. The superordinate themes included 'steps toward adaptation', 'obstacles to the path of adaptation' and 'stabilisation in the paternal position'. CONCLUSION Perceived self-efficacy and satisfaction in fatherhood means an adaptation to the paternal role. Factors influencing paternal adaptation can be classified into the domains of 'facilitating factors' and 'inhibiting factors'.
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Affiliation(s)
- Narges Eskandari
- a Department of Midwifery, School of Nursing and Midwifery , Qom University of Medical Science , Qom , Iran
| | - Masoumeh Simbar
- b Department of Midwifery and Reproductive Health, School of Nursing & Midwifery, Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences , Shahid Beheshti University of Medical Science , Tehran , Iran
| | - AbouAli Vedadhir
- c Department of Anthropology, Faculty of Social Sciences , University of Tehran , Tehran , Iran.,d HRA, UCL Department of Science and Technology Studies (STS) , University College London , London , UK
| | - Ahmad Reza Baghestani
- e Department of Biostatistics, School of Paramedical Sciences , Shahid Beheshti University of Medical Sciences , Tehran , Iran
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Pallangyo EN, Mbekenga C, Källestål C, Rubertsson C, Olsson P. "If really we are committed things can change, starting from us": Healthcare providers' perceptions of postpartum care and its potential for improvement in low-income suburbs in Dar es Salaam, Tanzania. SEXUAL & REPRODUCTIVE HEALTHCARE 2016; 11:7-12. [PMID: 28159132 DOI: 10.1016/j.srhc.2016.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 06/02/2016] [Accepted: 09/05/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore healthcare providers' perceptions of the current postpartum care (PPC) practice and its potential for improvement at governmental health institutions in low-resource suburbs in Dar es Salaam, Tanzania. DESIGN Qualitative design, using focus group discussions (8) and qualitative content analysis. SETTING Healthcare institutions (8) at three levels of governmental healthcare in Ilala and Temeke suburbs, Dar es Salaam. PARTICIPANTS Registered, enrolled and trained nurse-midwives (42); and medical and clinical officers (13). RESULTS The healthcare providers perceived that PPC was suboptimal and that they could have prevented maternal deaths. PPC was fragmented at understaffed institutions, lacked guidelines and was organized in a top-down structure of leadership. The participants called for improvement of: organization of space, time, resources, communication and referral system; providers' knowledge; and supervision and feedback. Their motivation to enhance PPC quality was high. KEY CONCLUSIONS The HCP awareness of the suboptimal quality of PPC, its potential for promoting health and their willingness to engage in improving care are promising for the implementation of interventions to improve quality of care. Provision of guidelines, sensitization of providers to innovate and maximize utilization of existing resources, and supportive supervision and feedback are likely to contribute to the sustainability of any improvement.
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Affiliation(s)
- Eunice N Pallangyo
- School of Nursing and Midwifery/TIHE, Aga Khan University, P.O. Box 38129, Ufukoni Road, Dar es Salaam, Tanzania; International Maternal and Child Health/IMCH, Department of Women's and Children's Health, Uppsala University, Akademiska Sjukhuset, SE 751 85 Uppsala, Sweden.
| | - Columba Mbekenga
- School of Nursing, Department of Community Health, Muhimbili University of Health and Allied Sciences/MUHAS, Dar es Salaam, Tanzania
| | - Carina Källestål
- International Maternal and Child Health/IMCH, Department of Women's and Children's Health, Uppsala University, Akademiska Sjukhuset, SE 751 85 Uppsala, Sweden
| | - Christine Rubertsson
- International Maternal and Child Health/IMCH, Department of Women's and Children's Health, Uppsala University, Akademiska Sjukhuset, SE 751 85 Uppsala, Sweden
| | - Pia Olsson
- International Maternal and Child Health/IMCH, Department of Women's and Children's Health, Uppsala University, Akademiska Sjukhuset, SE 751 85 Uppsala, Sweden
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Eskandari N, Simbar M, Vadadhir AA, Baghestani AR. Exploring the Lived Experience, Meaning and Imperatives of Fatherhood: An Interpretative Phenomenological Analysis. Glob J Health Sci 2016; 8:52667. [PMID: 27157163 PMCID: PMC5064072 DOI: 10.5539/gjhs.v8n9p139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/16/2015] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION There have been considerable changes in the concept and meaning of fatherhood in the past few decades and a lot of studies has down in this area, but there is no information about fathering and fatherhood from Iranian perspective, thus present study designed to explore the men's understanding of fathering and paternal role during their first year of transition to parenthood. METHOD This phenomenological study included accounts of 17 Iranian fathers, who had experienced fathering for the first time. Data was analyzed using the Interpretative Phenomenological Analysis (IPA) approach. RESULTS The results reveal that a father is a man who reproduces a child and accepts the responsibility for supporting his family as the fulcrum. A father is a good-tempered, faithful, patient and hardworking man with essential knowledge and proficiency. A father should accept his role as the father. He is also expected to participate actively in dealing with family daily issues, value and promote the health and well-being of his children, and have skills of self-management and self-care. CONCLUSION Iranian fathers not only committed to play their traditional roles and responsibilities, but also welcome new roles such as constantly being with their children and providing emotional support to them.
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Påfs J, Rulisa S, Musafili A, Essén B, Binder-Finnema P. 'You try to play a role in her pregnancy' - a qualitative study on recent fathers' perspectives about childbearing and encounter with the maternal health system in Kigali, Rwanda. Glob Health Action 2016; 9:31482. [PMID: 27566715 PMCID: PMC5002034 DOI: 10.3402/gha.v9.31482] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/11/2016] [Accepted: 06/16/2016] [Indexed: 11/24/2022] Open
Abstract
Background Rwanda has raised gender equality on the political agenda and is, among other things, striving for involving men in reproductive health matters. With these structural changes taking place, traditional gender norms in this setting are challenged. Deeper understanding is needed of men's perceptions about their gendered roles in the maternal health system. Objective To explore recent fathers’ perspectives about their roles during childbearing and maternal care-seeking within the context of Rwanda's political agenda for gender equality. Design Semi-structured interviews were conducted with 32 men in Kigali, Rwanda, between March 2013 and April 2014. A framework of naturalistic inquiry guided the overall study design and analysis. In order to conceptualize male involvement and understand any gendered social mechanisms, the analysis is inspired by the central principles from relational gender theory. Results The participants in this study appeared to disrupt traditional masculinities and presented ideals of an engaged and caring partner during pregnancy and maternal care-seeking. They wished to carry responsibilities beyond the traditional aspects of being the financial provider. They also demonstrated willingness to negotiate their involvement according to their partners’ wishes, external expectations, and perceived cultural norms. While the men perceived themselves as obliged to accompany their partner at first antenatal care (ANC) visit, they experienced several points of resistance from the maternal health system for becoming further engaged. Conclusions These men perceived both maternal health system policy and care providers as resistant toward their increased engagement in childbearing. Importantly, perceiving themselves as estranged may consequently limit their engagement with the expectant partner. Our findings therefore recommend maternity care to be more responsive to male partners. Given the number of men already taking part in ANC, this is an opportunity to embrace men's presence and promote behavior in favor of women's health during pregnancy and childbirth – and may also function as a cornerstone in promoting gender-equitable attitudes.
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Affiliation(s)
- Jessica Påfs
- Department of Women's and Children's Health/IMCH, Uppsala University, Uppsala, Sweden;
| | - Stephen Rulisa
- Department of Obstetrics & Gynecology, School of Medicine, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.,Department of Clinical Research, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Aimable Musafili
- Department of Women's and Children's Health/IMCH, Uppsala University, Uppsala, Sweden.,Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda
| | - Birgitta Essén
- Department of Women's and Children's Health/IMCH, Uppsala University, Uppsala, Sweden
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Eskandari N, Simbar M, Vadadhir A, Baghestani AR. Design and Evaluation of the Psychometric Properties of a Paternal Adaptation Questionnaire. Am J Mens Health 2016; 12:2018-2028. [PMID: 27456705 DOI: 10.1177/1557988316660071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The present study aimed to design and evaluate the psychometric properties of the Paternal Adaptation Questionnaire (PAQ). The study was a mixed (qualitative and quantitative) sequential exploratory study. In the qualitative phase, a preliminary questionnaire with 210 items emerged from in-depth interviews with 17 fathers and 15 key informants. In the quantitative phase, psychometric properties of the PAQ were assessed. Considering cutoff points as 1.5 for item impact, 0.49 for content validity ratio (CVR), and 0.7 for content validity index (CVI), items of the questionnaire were reduced from 210 to 132. Assessment of the content validity of the questionnaire demonstrated S-CVR = 0.68 and S-CVI = 0.92. Exploratory factor analysis resulted in the development of a PAQ with 38 items classified under five factors (ability in performing the roles and responsibilities; perceiving the parental development; stabilization in paternal position; spiritual stability and internal satisfaction; and challenges and concerns), which explained 52.19% of cumulative variance. Measurement of internal consistency reported a Cronbach's α of .89 for PAQ (.61-.86 for subscales), and stability assessment of the PAQ through the test-retest demonstrated Spearman's correlation coefficients and intraclass correlation coefficient of .96 (.81-.97 for subscales). It was identified that the PAQ is a valid and reliable instrument that could be used to assess fatherhood adaptation with the paternal roles and fathers' needs, as well as to design appropriate interventions and to evaluate their effectiveness.
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Affiliation(s)
| | - Masoumeh Simbar
- 2 Shahid Beheshti University of Medical Science, Tehran, Iran
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Mukuria AG, Martin SL, Egondi T, Bingham A, Thuita FM. Role of Social Support in Improving Infant Feeding Practices in Western Kenya: A Quasi-Experimental Study. GLOBAL HEALTH: SCIENCE AND PRACTICE 2016; 4:55-72. [PMID: 27016544 PMCID: PMC4807749 DOI: 10.9745/ghsp-d-15-00197] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 01/06/2016] [Indexed: 11/15/2022]
Abstract
Fathers and grandmothers who participated in separate nutrition dialogue groups supported mothers to improve infant feeding practices including dietary diversity, food consistency, and use of animal-source foods. Future studies should explore using a family-centered approach that engages mothers together with key household influencers. Background: We designed and tested an intervention that used dialogue-based groups to engage infants’ fathers and grandmothers to support optimal infant feeding practices. The study’s aim was to test the effectiveness of increased social support by key household influencers on improving mothers’ complementary feeding practices. Methods: Using a quasi-experimental design, we enrolled mothers, fathers, and grandmothers from households with infants 6–9 months old in 3 rural communities (1 intervention arm with fathers, 1 intervention arm with grandmothers, and 1 comparison arm) in western Kenya. We engaged 79 grandmothers and 85 fathers in separate dialogue groups for 6 months from January to July 2012. They received information on health and nutrition and were encouraged to provide social support to mothers (defined as specific physical actions in the past 2 weeks or material support actions in the past month). We conducted a baseline household survey in December 2011 in the 3 communities and returned to the same households in July 2012 for an endline survey. We used a difference-in-difference (DiD) approach and logistic regression to evaluate the intervention. Results: We surveyed 554 people at baseline (258 mothers, 165 grandmothers, and 131 fathers) and 509 participants at endline. The percentage of mothers who reported receiving 5 or more social support actions (of a possible 12) ranged from 58% to 66% at baseline in the 3 groups. By endline, the percentage had increased by 25.8 percentage points (P=.002) and 32.7 percentage points (P=.001) more in the father and the grandmother intervention group, respectively, than in the comparison group. As the number of social support actions increased in the 3 groups, the likelihood of a mother reporting that she had fed her infant the minimum number of meals in the past 24 hours also increased between baseline and endline (odds ratio [OR], 1.14; confidence interval [CI], 1.00 to 1.30; P=.047). When taking into account the interaction effects of intervention area and increasing social support over time, we found a significant association in the grandmother intervention area on dietary diversity (OR, 1.19; CI, 1.01 to 1.40; P=.04). No significant effects were found on minimum acceptable diet. Conclusion: Engaging fathers and grandmothers of infants to improve their knowledge of optimal infant feeding practices and to encourage provision of social support to mothers could help improve some feeding practices. Future studies should engage all key household influencers in a family-centered approach to practice and support infant feeding recommendations.
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Affiliation(s)
- Altrena G Mukuria
- United States Agency for International Development (USAID) Infant and Young Child Nutrition Project., Washington, DC, USA. Now with USAID Strengthening Partnerships, Results and Innovations in Nutrition Globally (SPRING) Project, Arlington, VA, USA
| | - Stephanie L Martin
- USAID Infant and Young Child Nutrition Project, Washington, DC, USA. Now with Cornell University, Division of Nutritional Sciences, Ithaca, NY, USA
| | - Thaddeus Egondi
- African Population and Health Research Center, Nairobi, Kenya
| | | | - Faith M Thuita
- University of Nairobi, School of Public Health, Nairobi, Kenya
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Rwakarema M, Premji SS, Nyanza EC, Riziki P, Palacios-Derflingher L. Antenatal depression is associated with pregnancy-related anxiety, partner relations, and wealth in women in Northern Tanzania: a cross-sectional study. BMC WOMENS HEALTH 2015; 15:68. [PMID: 26329331 PMCID: PMC4557331 DOI: 10.1186/s12905-015-0225-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 08/17/2015] [Indexed: 01/11/2023]
Abstract
Background Psychosocial health problems, specifically depression during pregnancy, can have negative impact on birth outcomes, postnatal mental health of the mother, and infant health. Antenatal depression is more prevalent among women in low- and middle-income countries than among women in high-income countries. Risk factors for antenatal depression reported in the literature relate to pregnant women in South Asia. Consequently, this study assessed depression in pregnancy and related psychosocial risk factors among select pregnant women residing in Mwanza region, Northern Tanzania. Methods We analysed data from 397 pregnant women recruited from three antenatal clinics for the period June—August 2013 for this cross-sectional study. Women provided data at one time point during their pregnancy by completing the Edinburgh Postnatal Depression Scale and a structured questionnaire assessing psychosocial, demographic, and behavioural risk factors related to antenatal depression. Multiple logistic regression analysis was performed to determine the relationship between risk factors examined and antenatal depression. Results Overall, 33.8 % (n = 134) of pregnant women had antenatal depression. Pregnancy-related anxiety was associated with antenatal depression (odds ratio (OR) 1.36, 95 % confidence interval (CI) 1.23 to 1.5). Pregnant women with poor relationship with partner and low/moderate socio-economic status had the highest OR for antenatal depression (82.34, 95 % CI 4.47, 1516.60) after adjusting for other covariates. Pregnant women with poor relationship with partner and high socio-economic status had an OR of 13.48 (95 % CI 1.71, 106.31) for antenatal depression. “Reference” pregnant women were those with very good relationship with partner and high socio-economic status. Conclusions High proportion of self-reported depression among select pregnant women attending antenatal clinics in Mwanza, Tanzania merit integrating depression assessment into existing antenatal care services. Health care providers need to assess pregnancy-related risk factors (pregnancy-related anxiety), socio-demographic factors (socio-economic status), and interpersonal risk factors (relationship with partner). Future research should appraise effectiveness of interventions that enhance partner relationships in reducing antenatal depression across all wealth distributions.
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Affiliation(s)
- Mechtilda Rwakarema
- St. Augustine University of Tanzania, P.O. Box 307, Mwanza, Tanzania. .,School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Bugando Area, Mwanza, Tanzania.
| | - Shahirose S Premji
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada. .,Faculty of Medicine, Department of Community Health Sciences, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada.
| | - Elias Charles Nyanza
- School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Bugando Area, Mwanza, Tanzania.
| | - Ponsiano Riziki
- Elizabeth Glaser Pediatric AID Foundation (EGPAF), P.O. Box 8822, Moshi, Tanzania.
| | - Luz Palacios-Derflingher
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada.
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Sansiriphun N, Kantaruksa K, Klunklin A, Baosuang C, Liamtrirat S. The journey into fatherhood: A grounded theory study. Nurs Health Sci 2015; 17:460-6. [DOI: 10.1111/nhs.12216] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 02/11/2015] [Accepted: 02/13/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Nantaporn Sansiriphun
- Obstetrics and Gynecology Nursing; Faculty of Nursing; Chiang Mai University; Chiang Mai Thailand
| | - Kannika Kantaruksa
- Obstetrics and Gynecology Nursing; Faculty of Nursing; Chiang Mai University; Chiang Mai Thailand
| | - Areewan Klunklin
- Obstetrics and Gynecology Nursing; Faculty of Nursing; Chiang Mai University; Chiang Mai Thailand
| | - Chavee Baosuang
- Obstetrics and Gynecology Nursing; Faculty of Nursing; Chiang Mai University; Chiang Mai Thailand
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Kaye DK, Kakaire O, Nakimuli A, Osinde MO, Mbalinda SN, Kakande N. Male involvement during pregnancy and childbirth: men's perceptions, practices and experiences during the care for women who developed childbirth complications in Mulago Hospital, Uganda. BMC Pregnancy Childbirth 2014; 14:54. [PMID: 24479421 PMCID: PMC3916059 DOI: 10.1186/1471-2393-14-54] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 01/24/2014] [Indexed: 11/11/2022] Open
Abstract
Background Development of appropriate interventions to increase male involvement in pregnancy and childbirth is vital to strategies for improving health outcomes of women with obstetric complications. The objective was to gain a deeper understanding of their experiences of male involvement in their partners’ healthcare during pregnancy and childbirth. The findings might inform interventions for increasing men’s involvement in reproductive health issues. Methods We conducted 16 in-depth interviews with men who came to the hospital to attend to their spouses/partners admitted to Mulago National Referral Hospital. All the spouses/partners had developed severe obstetric complications and were admitted in the high dependency unit. We sought to obtain detailed descriptions of men’s experiences, their perception of an ideal “father” and the challenges in achieving this ideal status. We also assessed perceived strategies for increasing male participation in their partners’ healthcare during pregnancy and childbirth. Data was analyzed by content analysis. Results The identified themes were: Men have different descriptions of their relationships; responsibility was an obligation; ideal fathers provide support to mothers during childbirth; the health system limits male involvement in childbirth; men have no clear roles during childbirth, and exclusion and alienation in the hospital environment. The men described qualities of the ideal father as one who was available, easily reached, accessible and considerate. Most men were willing to learn about their expected roles during childbirth and were eager to support their partners/wives/spouses during this time. However, they identified personal, relationship, family and community factors as barriers to their involvement. They found the health system unwelcoming, intimidating and unsupportive. Suggestions to improve men’s involvement include creating more awareness for fathers, male-targeted antenatal education and support, and changing provider attitudes. Conclusions This study generates information on perceived roles, expectations, experiences and challenges faced by men who wish to be involved in maternal health issues, particularly during pregnancy and childbirth. There is discord between the policy and practice on male involvement in pregnancy and childbirth. Health system factors that are critical to promoting male involvement in women’s health issues during pregnancy and childbirth need to be addressed.
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Affiliation(s)
- Dan K Kaye
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, P,O, Box 7072 Kampala, Uganda.
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Chimphamba Gombachika B, Chirwa E, Malata A, Sundby J, Fjeld H. Reproductive decisions of couples living with HIV in Malawi: what can we learn for future policy and research studies? Malawi Med J 2013; 25:65-71. [PMID: 24358422 PMCID: PMC3859991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The rapid scale-up of free antiretroviral therapy has lead to decline in adult mortality at the population level and reduction of vertical transmission. Consequently, some couples living with HIV are maintaining their reproductive decisions; marrying and having children. This paper analyses policies and guidelines on HIV, AIDS and sexual and reproductive health in Malawi for content on marriage and childbearing for couples living with HIV. METHODS A qualitative study using interpretive policy analysis approach was conducted from July to December 2010 in two phases. First, data on access to HIV, AIDS and sexual and reproductive health services were collected using in-depth interviews with twenty couples purposively sampled in matrilineal Chiradzulu and patrilineal Chikhwawa communities. Secondly, data were collected from Malawi policies and guidelines on HIV, AIDS and sexual and reproductive health. The documents were reviewed for content on marriage and childbearing for couples living with HIV. Data were analysed using framework approach for applied policy analysis. RESULTS Four categories emerged from each phase. From the study, we extracted health workers attitudes, weak linkage between HIV, AIDS and sexual and reproductive health services, contradictory messages between media and the hospitals and lack of information as factors directly related to guidelines and policies. Analysis of guidelines and policies showed non-prescriptiveness on issues of HIV, AIDS and reproduction: they do not reflect the social cultural experiences of couples living with HIV. In addition, there is; lack of clinical guidelines, external influence on adoption of the policies and guidelines and weak linkages between HIV and AIDS and sexual and reproductive health services. CONCLUSION This synthesis along with more detailed findings which are reported in other published articles, provide a strong basis for updating the policies and development of easy-to-follow guidelines in order to effectively provide services to couples living with HIV in Malawi.
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Affiliation(s)
- B Chimphamba Gombachika
- Faculty of Nursing, Kamuzu College of Nursing, University of Malawi, Blantyre Campus, P.O. Box 415, Blantyre, Malawi
| | - E Chirwa
- Faculty of Nursing, Kamuzu College of Nursing, University of Malawi, Blantyre Campus, P.O. Box 415, Blantyre, Malawi
| | - A Malata
- Faculty of Nursing, Kamuzu College of Nursing, University of Malawi, Lilongwe Campus, Private Bag 1, Lilongwe, Malawi
| | - J Sundby
- University of Oslo, Institute of Health and Society, Department of Community Medicine, Oslo, Norway, P.O. Box 1130 Blindern, 0318 Oslo. , Mobile (+47) 45 7743 70. Telefax: (+47) 22 85 05 90
| | - H Fjeld
- University of Oslo, Institute of Health and Society, Department of Community Medicine, Oslo, Norway, P.O. Box 1130 Blindern, 0318 Oslo. , Mobile (+47) 45 7743 70. Telefax: (+47) 22 85 05 90
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Gombachika BC, Chirwa E, Malata A, Maluwa A. Sources of Information on HIV and Sexual and Reproductive Health for Couples Living with HIV in Rural Southern Malawi. AIDS Res Treat 2013; 2013:235902. [PMID: 23662206 PMCID: PMC3639705 DOI: 10.1155/2013/235902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 03/13/2013] [Accepted: 03/27/2013] [Indexed: 11/17/2022] Open
Abstract
WITH WIDER ACCESS TO ANTIRETROVIRAL THERAPY, PEOPLE LIVING WITH HIV ARE RECONSIDERING THEIR REPRODUCTIVE DECISIONS: remarrying and having children. The purpose of the paper is to explore sources of information for reproductive decision used by couples living with HIV in patrilineal and matrilineal districts of Malawi. Data were collected from forty couples from July to December 2010. Our results illuminate five specific issues: some of the informants (1) remarry after divorce/death of a spouse, (2) establish new marriage relationship with spouses living with HIV, and (3) have children hence the need for information to base their decisions. There are (4) shared and interactive couple decisions, and (5) informal networks of people living with HIV are the main sources of information. In addition, in matrilineal community, cultural practices about remarriage set up structures that constrained information availability unlike in patrilineal community where information on sexual and reproductive health, HIV, and AIDS was disseminated during remarriage counselling. However, both sources are not able to provide comprehensive information due to complexity and lack of up to date information. Therefore, health workers should, offer people living with HIV comprehensive information that takes into consideration the cultural specificity of groups, and empower already existing and accepted local structures with sexual and reproductive health, HIV, and AIDS knowledge.
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Affiliation(s)
- Belinda Chimphamba Gombachika
- Department of Community Medicine, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, 0318 Oslo, Norway
- Faculty of Nursing, Kamuzu College of Nursing, University of Malawi, Blantyre Campus, P.O. Box 415, Blantyre, Malawi
| | - Ellen Chirwa
- Faculty of Nursing, Kamuzu College of Nursing, University of Malawi, Blantyre Campus, P.O. Box 415, Blantyre, Malawi
| | - Address Malata
- Faculty of Nursing, Kamuzu College of Nursing, University of Malawi, Lilongwe Campus, Private Bag 1, Lilongwe, Malawi
| | - Alfred Maluwa
- Faculty of Nursing, Kamuzu College of Nursing, University of Malawi, Lilongwe Campus, Private Bag 1, Lilongwe, Malawi
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Raman S, Srinivasan K, Kurpad A, Dwarkanath P, Ritchie J, Worth H. 'My mother…my sisters… and my friends': sources of maternal support in the perinatal period in urban India. Midwifery 2013; 30:130-7. [PMID: 23561829 DOI: 10.1016/j.midw.2013.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 02/13/2013] [Accepted: 03/03/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE to explore the wide-ranging sources of support that the maternal-infant dyad need or expect throughout the perinatal period in urban India. DESIGN qualitative interviews and ethnographic approach. SETTING homes and community settings in greater metropolitan Bangalore, South India. PARTICIPANTS using in-depth interviews of 36 mothers from different socio-cultural and socio-economic backgrounds who had given birth within the past two years in a tertiary hospital, we explored the nature of support, advice and emotional sustenance through pregnancy, childbirth and the early child rearing period available to these women. FINDINGS the overwhelming importance of women's own mothers in practical and emotional terms, the connectedness to 'native' place or 'ooru', the role of the diverse, extensive female network and the more contingent role of the husband emerged as major themes. The family was a major source of support as well as distress. While the support from their own mother was a constant, women used various forms of support throughout the perinatal continuum. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE we call for a more nuanced understanding of what women in urban India expect and need in terms of support throughout the perinatal period. Clinicians and policy makers need to understand the various players, their different roles at critical times through the perinatal continuum and be able to identify those who are vulnerable and in need of enhanced support. Although the health sector is not a strong player in the socio-cultural milieu in the perinatal period, their role as facilitators of this support is crucial.
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Affiliation(s)
- Shanti Raman
- Department of Community Paediatrics, South Western Sydney and Sydney Local Health Districts, Liverpool Hospital, Liverpool, NSW 2170, Australia.
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Christianson M, Boman J, Essén B. ‘Let men into the pregnancy’—Men's perceptions about being tested for Chlamydia and HIV during pregnancy. Midwifery 2013; 29:351-8. [DOI: 10.1016/j.midw.2012.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 01/12/2012] [Accepted: 02/05/2012] [Indexed: 11/29/2022]
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Shimpuku Y, Patil CL, Norr KF, Hill PD. Women's perceptions of childbirth experience at a hospital in rural Tanzania. Health Care Women Int 2013; 34:461-81. [PMID: 23470119 DOI: 10.1080/07399332.2012.708374] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Tanzania's health care provider shortage, especially in rural areas, makes it challenging to meet women's support needs in hospitals. We describe women's perceptions of childbirth support at a hospital in rural Tanzania. We interviewed 25 women within 24 hours after delivery using semistructured interviews. Most women sought life-saving technological support in case of complications. They also valued having family present to provide care and affection. Women's needs, however, were difficult to fulfill at this busy facility. Increasing women-centered childbirth support and recognizing family as important contributors may provide a strategy to meet the needs of both women and providers.
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Mbekenga CK, Pembe AB, Darj E, Christensson K, Olsson P. Prolonged sexual abstinence after childbirth: gendered norms and perceived family health risks. Focus group discussions in a Tanzanian suburb. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2013; 13:4. [PMID: 23316932 PMCID: PMC3626895 DOI: 10.1186/1472-698x-13-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 01/09/2013] [Indexed: 11/10/2022]
Abstract
Background Prolonged sexual abstinence after childbirth is a socio-cultural practice with health implications, and is described in several African countries, including Tanzania. This study explored discourses on prolonged postpartum sexual abstinence in relation to family health after childbirth in low-income suburbs of Dar es Salaam, Tanzania. Methods Data for the discourse analysis were collected through focus group discussions with first-time mothers and fathers and their support people in Ilala, Dar es Salaam, Tanzania. Results In this setting, prolonged sexual abstinence intended at promoting child health was the dominant discourse in the period after childbirth. Sexual relations after childbirth involved the control of sexuality for ensuring family health and avoiding the social implications of non-adherence to sexual abstinence norms. Both abstinence and control were emphasised more with regard to women than to men. Although the traditional discourse on prolonged sexual abstinence for protecting child health was reproduced in Ilala, some modern aspects such as the use of condoms and other contraceptives prevailed in the discussion. Conclusion Discourses on sexuality after childbirth are instrumental in reproducing gender-power inequalities, with women being subjected to more restrictions and control than men are. Thus, interventions that create openness in discussing sexual relations and health-related matters after childbirth and mitigate gendered norms suppressing women and perpetuating harmful behaviours are needed. The involvement of males in the interventions would benefit men, women, and children through improving the gender relations that promote family health.
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Affiliation(s)
- Columba K Mbekenga
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
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Mbekenga CK, Pembe AB, Christensson K, Darj E, Olsson P. Informal support to first-parents after childbirth: a qualitative study in low-income suburbs of Dar es Salaam, Tanzania. BMC Pregnancy Childbirth 2011; 11:98. [PMID: 22126899 PMCID: PMC3252242 DOI: 10.1186/1471-2393-11-98] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 11/29/2011] [Indexed: 11/12/2022] Open
Abstract
Background In Tanzania, and many sub-Saharan African countries, postpartum health programs have received less attention compared to other maternity care programs and therefore new parents rely on informal support. Knowledge on how informal support is understood by its stakeholders to be able to improve the health in families after childbirth is required. This study aimed to explore discourses on health related informal support to first-time parents after childbirth in low-income suburbs of Dar es Salaam, Tanzania. Methods Thirteen focus group discussions with first-time parents and female and male informal supporters were analysed by discourse analysis. Results The dominant discourse was that after childbirth a first time mother needed and should be provided with support for care of the infant, herself and the household work by the maternal or paternal mother or other close and extended family members. In their absence, neighbours and friends were described as reconstructing informal support. Informal support was provided conditionally, where poor socio-economic status and non-adherence to social norms risked poor support. Support to new fathers was constructed as less prominent, provided mainly by older men and focused on economy and sexual matters. The discourse conveyed stereotypic gender roles with women described as family caretakers and men as final decision-makers and financial providers. The informal supporters regulated the first-time parents' contacts with other sources of support. Conclusions Strong and authoritative informal support networks appear to persist. However, poverty and non-adherence to social norms was understood as resulting in less support. Family health in this context would be improved by capitalising on existing informal support networks while discouraging norms promoting harmful practices and attending to the poorest. Upholding stereotypic notions of femininity and masculinity implies great burden of care for the women and delimited male involvement. Men's involvement in reproductive and child health programmes has the potential for improving family health after childbirth. The discourses conveyed contradicting messages that may be a source of worry and confusion for the new parents. Recognition, respect and raising awareness for different social actors' competencies and limitations can potentially create a health-promoting environment among families after childbirth.
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Affiliation(s)
- Columba K Mbekenga
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
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Mbekenga CK, Christensson K, Lugina HI, Olsson P. Joy, struggle and support: postpartum experiences of first-time mothers in a Tanzanian suburb. Women Birth 2010; 24:24-31. [PMID: 20674528 DOI: 10.1016/j.wombi.2010.06.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 06/24/2010] [Accepted: 06/25/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To explore and describe postpartum experiences of first-time mothers in a Tanzanian, multiethnic, low-income suburb. METHODS Individual qualitative interviews with 10 first-time mothers, 4-10 weeks postpartum in Ilala suburb, Dar es Salaam, Tanzania. RESULTS The first-time mothers enjoyed motherhood and the respectful status it implied. To understand and handle the infant's needs and own bodily changes were important during postpartum. The tradition of abstaining from sex up to 4 years during breastfeeding was a concern as male's faithfulness was questioned and with HIV a threat to family health. Partner relationship changed towards shared parental and household work and the man's active participation was appreciated. Support from family members and others in the neighbourhood were utilised as a resource by the mothers. In instances of uncertainties on how to handle things, their advice was typically followed. The new mothers generally had good experiences of health care during the childbearing period. However, they also experienced insufficiencies in knowledge transfer, disrespectful behaviour, and unofficial fees. KEY CONCLUSIONS AND IMPLICATION FOR PRACTICE: The mothers' perspective of postpartum revealed that they actively searched for ways to attain infants' and own health needs, and family health in general. Prolonged sexual abstinence was considered a risk for the partner having other sexual partners and contracting HIV. The mothers relied heavily on the informal support network, which sometimes meant risking family health due to misinformation and harmful practices. Health care and informal support systems should complement each other to attain adequate support for the families postpartum.
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Affiliation(s)
- Columba K Mbekenga
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
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