How do pregnant women and new mothers navigate and respond to challenges in accessing health care? Perspectives from rural South Africa

Children and young women in eastern and southern Africa are key to meeting 2030 HIV targets: time to accelerate action

New HIV infections and AIDS-related deaths among children and adolescent girls and young women (aged 15-24 years) in eastern and southern Africa continue to occur at unacceptably high rates. The COVID-19 pandemic has also severely undermined ongoing initiatives for HIV prevention and treatment, threatening to set the region back further in its efforts to end AIDS by 2030. Major impediments exist to attaining the UNAIDS 2025 targets among children, adolescent girls, young women, young mothers living with HIV, and young female sex workers residing in eastern and southern Africa. Each population has specific but overlapping needs with regard to diagnosis and linkage to and retention in care. Urgent action is needed to intensify and improve programmes for HIV prevention and treatment, including sexual and reproductive health services for adolescent girls and young women, HIV-positive young mothers, and young female sex workers.

Are we listening to community health workers? Experiences of the community health worker journey in rural South Africa

Access to healthcare in developing countries remains a challenge. As a result, task-shifting to community health workers (CHWs) is increasingly used to mitigate healthcare worker shortages. Although there is solid evidence of CHW program effectiveness, less is known about CHWs' experiences of becoming and then working daily as CHWs-information that should play an important role in the design of CHW programs. We examined the experiences of a group of CHWs working in a government-run CHW program in South Africa's rural Eastern Cape Province. Semistructured qualitative interviews (N = 9) and focus groups (N = 2) focusing on motivations for becoming a CHW and experiences of working as CHWs were conducted and thematically analyzed. Three themes were identified: (1) becoming a CHW, (2) facing challenges in the field, and (3) gaining community acceptance through respect and legitimacy. In this study, CHWs were motivated by altruism and a desire to help their community. They faced a range of challenges such as limited training, lack of supervision, equipment shortages, logistical issues, and clinics with limited services. Respect and legitimacy through community acceptance and trust is crucial for effective CHW work. CHWs in this study described how confidentiality and their own persistence facilitated the process of gaining respect and legitimacy. CHWs have a unique knowledge of contexts and requirements for successful programs and greater efforts are needed to include their perspectives to improve and develop programs. Recognition is needed to acknowledge the significant personal input required by CHWs for programs to be successful.

Spousal support during pregnancy in the Nigerian rural context: a mixed methods study

BACKGROUND

Pregnancy constitutes a global health concern, thus the need for spousal support during this period cannot be overemphasized. This study examined the kinds of support pregnant women expected and received from their spouses as well as the effect of such supports during pregnancy, labour, and delivery.

METHODS

The study adopted both quantitative and qualitative methods of data collection. The respondents were selected using multistage and simple random sampling techniques.

RESULTS

Findings showed that respondents expected and received maximum support from their spouses during pregnancy, labour, and delivery. Spiritual support such as praying and fasting was top of the kinds of support pregnant women expected and received from their husbands during pregnancy and delivery. Others include helping in house chores, financial provision, taking care of other children, accompanying to labour room, and sexual support. More than three-quarters of the respondents stated that maximum support from their husbands made pregnancy, labour, and delivery easier. Cramer's V showed that the association between support and husbands' occupation was 0.233 and Pearson Chi-square showed that the association was statistically significant χ2(2) = 27.894,p < .001.

CONCLUSION

The study concluded that spousal support during pregnancy was high among rural women in Southwestern Nigeria, and it impacted positively on their wife's period of pregnancy, labour, and delivery. A high level of spousal support should be sustained to promote family bonding and development as well as reduce maternal and child mortality.

Instructive roles and supportive relationships: client perspectives of their engagement with community health workers in a rural south African home visiting program

Background

Community health worker (CHW) programs have been positioned as a way to meet the needs of those who experience marginalization and inequitable access to health care, and current global health narratives also emphasize their adaptable nature to meet growing health burdens in low-income settings. However, as CHW programs adopt more technical roles, the value of CHWs in building relationships with clients tends to be overlooked. More importantly, these programs are often reframed and redeployed without attending to the interests and needs of program clients themselves. We set out to gather perspectives of program and CHW engagement from clients of a maternal and child health program in rural South Africa.

Methods

We conducted 26 interviews with pregnant or recently-delivered clients of the Enable Mentor Mother program between February–March 2018. After obtaining informed consent, a trained research assistant conducted all interviews in the clients’ home language, isiXhosa. Interviews, translated and transcribed into English, were organized and coded using ATLAS.ti software and thematically analyzed.

Results

We found that clients’ home-based interactions with Mentor Mothers were generally positive, and that these engagements were characterized by two core themes, instructive roles and supportive relationships.. Instructive roles facilitated the transfer of knowledge and uptake of new information for behavior change. Relationships were developed within the home visit setting, but also extended beyond routine visits, especially when clients required further instrumental support. Clients further discussed a sense of agency gained through these interactions, even in cases where they chose not to, or were unable to, heed their Mentor Mother’s advice.

Conclusions

These findings highlight the important roles that CHWs can assume in providing both instructive and supportive care to clients; as deepening relationships may be key for encouraging behavior change, these findings pinpoint the need to bolster training and support for CHWs in similar programs. They also emphasize the importance of integrating more channels for client feedback into existing programs, to ensure that clients’ voices are heard and accounted for in shaping ongoing engagement within the communities in which these programs operate.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-020-01377-z.

Gestational gigantomastia with fatal outcome

Gigantomastia is a rare disease defined by an extreme and rapid enlargement of the breast, generally bilateral. The majority of cases are reported in pregnant women. Ninety-eight cases of gestational gigantomastia have been identified in electronic databases, and those with fatal outcomes comprised only 2 cases (2%). Despite its benign nature, it can lead to severe complications and even death. Its etiology has not been fully elucidated, but it has been speculated that a hormonal component may play a role in the pathogenesis. Currently, treatment options are limited, and surgery is gaining importance, but it is often not feasible in low-resource settings. Herein, we describe a case of a 30-year-old HIV-positive female with no relevant past medical history, who died due to the complications of gestational gigantomastia at the Maputo Central Hospital, in Mozambique.