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Nambile Cumber S, Williams A, Elden H, Bogren M. Fathers' involvement in pregnancy and childbirth in Africa: an integrative systematic review. Glob Health Action 2024; 17:2372906. [PMID: 38993149 PMCID: PMC11249146 DOI: 10.1080/16549716.2024.2372906] [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: 04/22/2024] [Accepted: 06/24/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND As notions of masculinity evolve globally, it is important to understand their dimensions within geographic regions and life contexts. African men's involvement in their partners'pregnancy and childbirth has been explored to a limited extent in the peer-reviewed literature. This analysis provides a comprehensive examination of the existing literature on the diverse experiences of fathers across the African continent. AIM This study aims to provide an overview of fathers' experience of involvement in their partners' pregnancies andchildbirth in Africa. METHODS A systematic integrative literature review guided the process. The review comprised problem identification, literature search, data evaluation, data analysis and presentation of results. Systematic searches were conducted in the Cinahl, PubMed and Scopus databases. RESULTS The search identified 70 articles of which 31, relating to 11 African countries, were used. Of these, 20 were qualitative, 9 were quantitative and 2 were mixed-methods studies. Men's alienation from health services, and traditional gender norms that discourage fathers' supportive role during pregnancy were prevalent themes. Financial pressures also dominated fathers'experiences. At the same time, in 18 studies fathers expressed motivation to be involved partners and supportive fathers, despite stigma and exclusion from maternity services. CONCLUSION This integrative review shows that fathers' experiences of their involvement in their partners' pregnancy and childbirth across African countries are influenced by multiple factors. While unwelcoming health services, traditional gender norms, and low income are barriers to male involvement, education, younger age, and modern gender norms are associated with greater male involvement.
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Affiliation(s)
- Samuel Nambile Cumber
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Helen Elden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Moyo E, Dzinamarira T, Moyo P, Murewanhema G, Ross A. Men's involvement in maternal health in sub-Saharan Africa: A scoping review of enablers and barriers. Midwifery 2024; 133:103993. [PMID: 38626505 DOI: 10.1016/j.midw.2024.103993] [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: 11/18/2023] [Revised: 03/17/2024] [Accepted: 04/05/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Globally, there are about 800 maternal deaths every day, with low-to-middle-income countries accounting for most of these deaths. A lack of access to maternal healthcare services is one of the main causes of these deaths. In sub-Saharan Africa (SSA), one of the barriers to accessing maternal healthcare services by women is a lack of their male partners' involvement. This scoping review aimed to assess the enablers and barriers to men's involvement in maternal healthcare services. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist was used as a guide for this review. We searched for peer-reviewed articles published between 2013 and 2023 in the English language from SCOPUS, ScienceDirect, PubMed, Africa Journals Online (AJOL), and Google Scholar databases. Two reviewers independently conducted the data extraction and article selection. All of the authors discussed and decided on the codes and categories for enablers and barriers after using NVivo to generate them. RESULTS Twenty-seven articles were used in this review. Of these, seventeen were qualitative studies, six were quantitative studies, and four were mixed-methods studies. The enablers of men's involvement in maternal healthcare were grouped into sociodemographic factors, health system factors, and policy factors, while barriers were grouped into sociodemographic, cultural, economic, and health system barriers. The lack of maternal health knowledge, insufficient economic resources, and unfriendly staff at healthcare facilities all contributed to a lack of involvement by men. CONCLUSION To improve men's involvement in maternal healthcare in SSA, there should be economic empowerment of both men and women, health education, and the provision of adequate infrastructure in healthcare facilities to accommodate men.
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Affiliation(s)
- Enos Moyo
- University of Kwa-Zulu Natal, College of Health Sciences, School of Nursing & Public Health, Durban, South Africa.
| | - Tafadzwa Dzinamarira
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.
| | | | - Grant Murewanhema
- University of Zimbabwe, Faculty of Medicine and Health Sciences, Unit of Obstetrics and Gynaecology, Harare, Zimbabwe
| | - Andrew Ross
- University of Kwa-Zulu Natal, College of Health Sciences, School of Nursing & Public Health, Durban, South Africa
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Asefa A, Gebremedhin S, Marthias T, Nababan H, Christou A, Semaan A, Banke-Thomas A, Tabana H, Al-beity FMA, Dossou JP, Gutema K, Delvaux T, Birabwa C, Dennis M, Grovogui FM, McPake B, Beňová L. Wealth-based inequality in the continuum of maternal health service utilisation in 16 sub-Saharan African countries. Int J Equity Health 2023; 22:203. [PMID: 37784140 PMCID: PMC10544383 DOI: 10.1186/s12939-023-02015-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Persistent inequalities in coverage of maternal health services in sub-Saharan Africa (SSA), a region home to two-thirds of global maternal deaths in 2017, poses a challenge for countries to achieve the Sustainable Development Goal (SDG) targets. This study assesses wealth-based inequalities in coverage of maternal continuum of care in 16 SSA countries with the objective of informing targeted policies to ensure maternal health equity in the region. METHODS We conducted a secondary analysis of Demographic and Health Survey (DHS) data from 16 SSA countries (Angola, Benin, Burundi, Cameroon, Ethiopia, Gambia, Guinea, Liberia, Malawi, Mali, Nigeria, Sierra Leone, South Africa, Tanzania, Uganda, and Zambia). A total of 133,709 women aged 15-49 years who reported a live birth in the five years preceding the survey were included. We defined and measured completion of maternal continuum of care as having had at least one antenatal care (ANC) visit, birth in a health facility, and postnatal care (PNC) by a skilled provider within two days of birth. We used concentration index analysis to measure wealth-based inequality in maternal continuum of care and conducted decomposition analysis to estimate the contributions of sociodemographic and obstetric factors to the observed inequality. RESULTS The percentage of women who had 1) at least one ANC visit was lowest in Ethiopia (62.3%) and highest in Burundi (99.2%), 2) birth in a health facility was less than 50% in Ethiopia and Nigeria, and 3) PNC within two days was less than 50% in eight countries (Angola, Burundi, Ethiopia, Gambia, Guinea, Malawi, Nigeria, and Tanzania). Completion of maternal continuum of care was highest in South Africa (81.4%) and below 50% in nine of the 16 countries (Angola, Burundi, Ethiopia, Guinea, Malawi, Mali, Nigeria, Tanzania, and Uganda), the lowest being in Ethiopia (12.5%). There was pro-rich wealth-based inequality in maternal continuum of care in all 16 countries, the lowest in South Africa and Liberia (concentration index = 0.04) and the highest in Nigeria (concentration index = 0.34). Our decomposition analysis showed that in 15 of the 16 countries, wealth index was the largest contributor to inequality in primary maternal continuum of care. In Malawi, geographical region was the largest contributor. CONCLUSIONS Addressing the coverage gap in maternal continuum of care in SSA using multidimensional and people-centred approaches remains a key strategy needed to realise the SDG3. The pro-rich wealth-based inequalities observed show that bespoke pro-poor or population-wide approaches are needed.
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Affiliation(s)
- Anteneh Asefa
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Tiara Marthias
- School of Population and Global Health, Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
- Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Herfina Nababan
- Institut für Public Health und Pflegeforschung, Universität Bremen, Bremen, Germany
| | - Aliki Christou
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Aduragbemi Banke-Thomas
- School of Human Sciences, University of Greenwich, London, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Hanani Tabana
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Fadhlun M. Alwy Al-beity
- Department of Obstetrcis/Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jean-Paul Dossou
- Centre de Recherche en Reproduction Humaine Et en Démographie, Cotonou, Bénin
| | - Keneni Gutema
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - Fassou Mathias Grovogui
- Centre National de Formation Et de Recherche en Santé Rurale (CNFRSR), Maferinyah, Forécariah Guinea
| | - Barbara McPake
- School of Population and Global Health, Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Parrish S, Vasan SK, Karpe F, Hardy-Johnson P, Jarjou O, Bittaye M, Prentice AM, Ulijaszek S, Jobe M. Concealed pregnancy as an act of care? A qualitative analysis of motivations for concealing and non-disclosure of early pregnancy in The Gambia. BMC Pregnancy Childbirth 2023; 23:374. [PMID: 37226126 PMCID: PMC10207755 DOI: 10.1186/s12884-023-05710-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 05/16/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND A barrier to achieving first trimester antenatal care (ANC) attendance in many countries has been the widespread cultural practice of not discussing pregnancies in the early stages. Motivations for concealing pregnancy bear further study, as the interventions necessary to encourage early ANC attendance may be more complicated than targeting infrastructural barriers to ANC attendance such as transportation, time, and cost. METHODS Five focus groups with a total of 30 married, pregnant women were conducted to assess the feasibility of conducting a randomised controlled trial to evaluate the effectiveness of early initiation of physical activity and/or yoghurt consumption in reducing Gestational Diabetes Mellitus in pregnant women in The Gambia. Focus group transcripts were coded through a thematic analysis approach, assessing themes as they arose in relation to failure to attend early ANC. RESULTS Two reasons for the concealment of pregnancies in the first trimester or ahead of a pregnancy's obvious visibility to others were given by focus group participants. These were 'pregnancy outside of marriage' and 'evil spirits and miscarriage.' Concealment on both grounds was motivated through specific worries and fears. In the case of a pregnancy outside of marriage, this was worry over social stigma and shame. Evil spirits were widely considered to be a cause of early miscarriage, and as such, women may choose to conceal their pregnancies in the early stages as a form of protection. CONCLUSION Women's lived experiences of evil spirits have been under-explored in qualitative health research as they relate specifically to women's access to early antenatal care. Better understanding of how such sprits are experienced and why some women perceive themselves as vulnerable to related spiritual attacks may help healthcare workers or community health workers to identify in a timely manner the women most likely to fear such situations and spirits and subsequently conceal their pregnancies.
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Affiliation(s)
- Sabine Parrish
- School of Anthropology and Museum Ethnography, University of Oxford, 51/53 Banbury Road, Oxford, OX2 6PE, UK.
| | - Senthil K Vasan
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Fredrik Karpe
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, OUH Trust, Oxford, UK
| | | | | | - Mustapha Bittaye
- Department of Obstetrics and Gynaecology, Edward Francis Small Teaching Hospital, Banjul, The Gambia
- University of The Gambia, Banjul, The Gambia
| | | | - Stanley Ulijaszek
- School of Anthropology and Museum Ethnography, University of Oxford, 51/53 Banbury Road, Oxford, OX2 6PE, UK
| | - Modou Jobe
- MRC Unit The Gambia at LSHTM, Banjul, The Gambia
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Roudsari RL, Sharifi F, Goudarzi F. Barriers to the participation of men in reproductive health care: a systematic review and meta-synthesis. BMC Public Health 2023; 23:818. [PMID: 37143008 PMCID: PMC10158256 DOI: 10.1186/s12889-023-15692-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 04/17/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Despite emphasizing the importance and benefits of men's active engagement in reproductive health programs, their engagement in reproductive health care is low. Researchers have identified different barriers to men's avoidance of participation in various aspects of reproductive health in different parts of the world. This study provided an in-depth review of the hindrances to men's non-participation in reproductive health. METHODS This meta-synthesis was conducted using keyword searches in databases including PubMed, Scopus, Web of Science, Cochrane, and ProQuest until January 2023. Qualitative English-language studies that investigated barriers to men's participation in reproductive health were included in the study. The critical appraisal skills program (CASP) checklist was used to assess the articles' quality. Data synthesis and thematic analysis were done using the standard method. RESULT This synthesis led to the emergence of four main themes such as failure to access all inclusive and integrated quality services, economic issues, couples' personal preferences and attitudes, and sociocultural considerations to seek reproductive healthcare services. CONCLUSION Healthcare system programs and policies, economic and sociocultural issues, and men's attitudes, knowledge, and preferences, influence men's participation in reproductive healthcare. Reproductive health initiatives should focus on eliminating challenges to men's supportive activities to increase practical men's involvement in reproductive healthcare.
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Affiliation(s)
- 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
| | - Farangis Sharifi
- Community-Oriented Nursing Midwifery Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Fatemeh Goudarzi
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran.
- Department of Midwifery, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran.
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Asim M, Hameed W, Khan B, Saleem S, Avan BI. Applying the COM-B Model to Understand the Drivers of Mistreatment During Childbirth: A Qualitative Enquiry Among Maternity Care Staff. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:GHSP-D-22-00267. [PMID: 36853644 PMCID: PMC9972373 DOI: 10.9745/ghsp-d-22-00267] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/28/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Respectful maternity care (RMC) during childbirth is an integral component of quality of care. However, women's experiences of mistreatment are prevalent in many low- and middle-income countries. This is a complex phenomenon that has not been well explored from a behavioral science perspective. We aimed to understand the behavioral drivers of mistreatment during childbirth among maternity care staff at public health facilities in the Sindh province of Pakistan. METHODS Applying the COM-B (capability-opportunity-motivation that leads to behavior change) model, we conducted semistructured in-depth interviews among clinical and nonclinical staff in public health facilities in Thatta and Sujawal, Sindh, Pakistan. Data were analyzed using thematic deductive analysis, and findings were synthesized using the COM-B model. RESULTS We identified several behavioral drivers of mistreatment during childbirth: (1) institutional guidelines on RMC and training opportunities were absent, resulting in a lack of providers' knowledge and skills; (2) facilities lacked the infrastructure to maintain patient privacy and confidentiality and did not permit males as birth companions; (3) lack of provider performance monitoring system and patient feedback mechanism contributed to providers not feeling appreciated or recognized. Staff bias against patients from lower castes contributed to patient abuse and mistreatment. The perspectives of clinical and nonclinical staff overlapped regarding potential drivers of mistreatment during childbirth. CONCLUSIONS Addressing mistreatment during childbirth requires improving the knowledge and capacity of maternity staff on RMC and psychosocial support to enhance their understanding of RMC. At the health facility level, governance and accountability mechanisms in routine supervision and monitoring of staff need to be improved. Patients' feedback should be incorporated for continuous improvement in providing maternity care services that meet patients' preferences and needs.
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Affiliation(s)
- Muhammad Asim
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Waqas Hameed
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Bushra Khan
- Department of Psychology, University of Karachi, Karachi, Pakistan
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Bilal Iqbal Avan
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Mekonen M, Shifera N, Bogale B, Assefa A. Extent of male involvement and associated factors in antenatal care service utilization in Bench Sheko zone, Southwest Ethiopia: A community-based cross-sectional study. Front Glob Womens Health 2022; 3:938027. [PMID: 36532955 PMCID: PMC9755574 DOI: 10.3389/fgwh.2022.938027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 11/07/2022] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND In many low- and middle-income countries (LMIC), men are the key decision-makers and chief providers, often determining women's access to economic resources and maternal health services. Despite the important role of men in maternal healthcare, the involvement of male partners in maternal and child health in LMIC, including Ethiopia, is low. OBJECTIVES This study aims to assess the extent of male involvement and associated factors in antenatal care (ANC) service utilization in the Bench Sheko zone, Southwest, Ethiopia. METHODS A community-based, cross-sectional study was conducted in the Bench Sheko zone from February to May 2021. A multistage sampling technique was employed to select study participants. Variables with p-values <0.25 in binary logistic regression were selected as candidates for multiple logistic regression to determine independent factors associated with male involvement adjusting for sociodemographic, health service, personal, environmental, and knowledge-related factors. RESULTS A total of 816 men took part in the study, with a 98.2% response rate. The prevalence of male involvement in ANC utilization was 38.2%. In multivariate analyses, residence (urban), age (25-34), education (diploma and above), income (≥2,500 Ethiopian Birr, ETB), and high knowledge of the advantages of ANC were shown to be positively associated with male involvement in ANC utilization. CONCLUSION Male involvement in ANC utilization was low. Considering the importance of male involvement in maternal healthcare, we advocate for policies and strategies that can improve knowledge of the advantages of ANC among men and can enhance their engagement in maternal care. Special attention should be given to younger partners and those partners who live in rural areas.
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Affiliation(s)
- Mengistu Mekonen
- Department of Public Health, School of Public Health, College of Medicine and Health Science, Mizan Tepi University, Mizan Aman, Ethiopia
| | - Nigusie Shifera
- Department of Public Health, School of Public Health, College of Medicine and Health Science, Mizan Tepi University, Mizan Aman, Ethiopia
| | - Biruk Bogale
- Department of Public Health, School of Public Health, College of Medicine and Health Science, Mizan Tepi University, Mizan Aman, Ethiopia
| | - Ashenafi Assefa
- Department of Nursing, College of Medicine and Health Science, Mizan Tepi University, Mizan Aman, Ethiopia
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Morgan AK, Awafo BA, Quartey T, Cobbold J. [Husbands' involvement in antenatal-related care in the Bosomtwe District of Ghana: inquiry into the facilitators and barriers]. Reprod Health 2022; 19:216. [PMID: 36456980 PMCID: PMC9714231 DOI: 10.1186/s12978-022-01506-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 09/13/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND This paper explored the facilitators and barriers to husbands' involvement in antenatal-related care in the Bosomtwe District of Ghana from the perspectives of husbands, pregnant women with and without delivery experience, nursing mothers, midwives and traditional birth attendants. METHODS The study relied on the qualitative research design to collect and analyse data on the facilitators and barriers to husbands' involvement in antenatal-related care. The unit of analysis was made up of 36 participants-husbands (14), pregnant women with delivery experience and, nursing mothers (8), pregnant women without delivery experience (6), male and female midwives (6) and traditional birth attendants (2) who were purposively selected. The study's data was gathered using in-depth interviews and analysed through the content approach. RESULTS Various economic [work and time constraint], cultural [the association of childbearing and its allied duties to women] and health-system factors [lack of antenatal services targeted at husbands and health professionals' attitude] hinder husbands' active participation in antenatal care. Despite these, some husbands participated in antenatal care owing to the importance they accord to the health and safety of their wives and the foetus; changing gender roles and preferential treatments received by their wives at antenatal clinics [as a result of the involvement of their husbands in prenatal care]. CONCLUSION The implementation of alternative strategies, like, couple counselling, prolonging operating times of health centres to accommodate working men are recommended to provide a more accommodative and attractive avenue for husbands to support their wives during pregnancy. These efforts must be reinforced by the entire society through modifying the "ill-held view" that pregnancy and childcare is the sole duty of a woman.
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Affiliation(s)
- Anthony Kwame Morgan
- grid.9829.a0000000109466120Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana ,grid.9829.a0000000109466120Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Beatrice Aberinpoka Awafo
- grid.9829.a0000000109466120Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Theophilus Quartey
- grid.9829.a0000000109466120Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Justin Cobbold
- grid.9829.a0000000109466120Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Chiang RKQ, Shorey S. Men's experiences of antenatal care services in low-income and middle-income countries: A qualitative systematic review. Birth 2022; 50:276-286. [PMID: 36309934 DOI: 10.1111/birt.12688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 08/17/2022] [Accepted: 10/13/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Men's involvement in antenatal care is critical for the family's overall well-being, yet remains low in many low-income and middle-income countries. The goal of this study was to consolidate and synthesize currently available literature on men's experiences of antenatal care services in low-income and middle-income countries. METHODS PubMed, CINAHL, Embase, PsycINFO, and Scopus were searched through December 2020. Qualitative studies were included exploring the antenatal care experiences of men whose pregnant partners utilized antenatal care services, regardless of ethnicity, race, and education levels. Studies examining men's participation in antenatal care that specifically focused on certain conditions such as the human immunodeficiency virus, known pregnancy complications, as well as contraception/fertility treatment, were excluded. Quality appraisal of the included studies was conducted using the Critical Appraisal Skills Program checklist, and Sandelowski and Barroso's two-step approach was used to meta-summarize and meta-synthesize the extracted data. RESULTS Four themes were derived from the 27 studies included: (a) Factors enabling men's participation in antenatal care; (b) Barriers affecting men's participation in antenatal care; (c) Men's self-perceived care roles; and (d) Recommendations to improve men's involvement. CONCLUSIONS Men's involvement in antenatal care depended on community perceptions, traditional gender roles, and work commitments. Although men often regarded antenatal care services as exclusive to women, some expressed their willingness to participate. Current findings highlight the need for community educational programs, male role models, and training of healthcare providers to improve men's participation.
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Affiliation(s)
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Tesfay N, Tariku R, Zenebe A, Mohammed F, Woldeyohannes F. Area of focus to handle delays related to maternal death in Ethiopia. PLoS One 2022; 17:e0274909. [PMID: 36121828 PMCID: PMC9484697 DOI: 10.1371/journal.pone.0274909] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Maternal delay factors, together with medical factors, have a substantial role in determining maternity outcomes. Although several studies were conducted on delay factors that contribute to maternal death in Ethiopia, the studies were mostly focused either on an individual or at a provincial level factor with a limited number of study participants. In response to this gap, this study is aimed at exploring the magnitude and factors related to delay factors that contribute to maternal death in Ethiopia.
Methods
The study used maternal death surveillance data collected from different regions of Ethiopia, compiled between 2013 and 2021. A total of 4530 maternal deaths were reviewed during the study period. A Multilevel multinomial logistic regression model was applied to examine factors associated with delays related to maternal death. An adjusted relative risk ratio with a 95% confidence interval was stated and variables with p-values less than 0.05 were declared as significant predictors of maternal delay.
Result
Delay three (delay in receiving adequate and appropriate care once reached a health facility) has contributed to 36.3% of maternal deaths followed by delay one (delay in deciding to seek care when experiencing an obstetric emergency) and delay two (delay in reaching to an appropriate obstetric facility) where each of them contributed to 36.1% and 27.6% of maternal deaths respectively. In the multivariate multilevel multinomial model, maternal age, education status, and place of death were among the individual level factors associated with both delay two and delay three. Conversely, marital status and ANC follow-up were associated with delay two alone, while the timing of maternal death was associated with delay three. Residence and type of facility were provincial-level factors linked with both delay two and delay three, while the type of region was related to delay three of maternal death.
Conclusion
Both delay one and three have a major contribution to maternal death in Ethiopia. Individual and provincial level factors played an important role in determining delays related to maternal death. Therefore, it is crucial to account for measures that provide emphasis on the area of raising awareness on the utilization of Antenatal care (ANC) service, improving facility readiness to handle obstetrics emergencies, and narrowing down inequality among regions in service provision.
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Affiliation(s)
- Neamin Tesfay
- Center of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
- * E-mail:
| | - Rozina Tariku
- Center of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Alemu Zenebe
- Center of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Fetiya Mohammed
- Center of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Fitsum Woldeyohannes
- Health Financing Program, Clinton Health Access Initiative, Addis Ababa, Ethiopia
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Mulatu T, Sintayehu Y, Dessie Y, Dheresa M. Male involvement in family planning use and associated factors among currently married men in rural Eastern Ethiopia. SAGE Open Med 2022; 10:20503121221094178. [PMID: 35492884 PMCID: PMC9047782 DOI: 10.1177/20503121221094178] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 03/23/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction/Objectives: Male involvement in family planning refers to all organizational actions
focused on men as a distinct group to increase the acceptability and uptake
of family planning among either sex. Despite the growing evidence of male
involvement in increasing family planning uptake among couples, a little
success has been achieved in Ethiopia, especially in rural areas. Hence,
this study aimed to assess male involvement in family planning and its
associated factors among currently married men in selected rural areas of
Eastern Ethiopia. Methods: A community-based cross-sectional survey was conducted among 577 randomly
selected currently married men, using a simple random sampling method in
randomly selected rural districts of Eastern Ethiopia. Data were collected
using a pretested interviewer-administered questionnaire. The collected data
were entered into a computer using Epi-Data Version 3.1. The analysis was
performed using the Statistical Package for the social sciences software
version 21. Logistic regression analysis was used to analyze the association
between the dependent and independent variables. Finally, adjusted odds
ratio with 95% confidence intervals at P-value < 0.05
was considered to be significantly associated with the outcome variable. Results: Out of 577, a total of, 555 married men were included in the study, resulting
in a response rate of 96.2%. The magnitude of male involvement in family
planning use was 59.3% (95% confidence interval: 47.1, 68. 2). Ever use of
family planning by a spouse (adjusted odds ratio: 2.37; 95% confidence
interval: 1.59, 3.52), ever discussion of spouse on sexual and reproductive
health/family planning issues (adjusted odds ratio: 2.05; 95% confidence
interval: 1.40, 3.02), and the husband’s approval of family planning
(adjusted odds ratio: 2.45; 95% confidence interval: 1.34, 4.96) were
significantly associated with higher odds of male involvement in family
planning use than their counterparts. Conclusion: The number of men involved in the family planning was low. Ever use of family
planning methods by a spouse, ever discussion of spouse on sexual and
reproductive health/family planning issues, and husband approval on family
planning use were found to be important predictors of male involvement in
family planning use. To improve modern family planning uptake among men and
women, it is imperative to include men in family planning programs, such as
family planning messaging, sensitizations, and services.
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Affiliation(s)
- Teshale Mulatu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yitagesu Sintayehu
- Department of Midwifery, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Bain LE, Aboagye RG, Dowou RK, Kongnyuy EJ, Memiah P, Amu H. Prevalence and determinants of maternal healthcare utilisation among young women in sub-Saharan Africa: cross-sectional analyses of demographic and health survey data. BMC Public Health 2022; 22:647. [PMID: 35379198 PMCID: PMC8981812 DOI: 10.1186/s12889-022-13037-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 03/21/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Maternal health constitutes high priority agenda for governments across the world. Despite efforts by various governments in sub-Saharan Africa (SSA), the sub-region still records very high maternal mortality cases. Meanwhile, adequate utilization of maternal healthcare (antenatal care [ANC], skilled birth attendance [SBA], and Postnatal care [PNC]) plays a vital role in achieving improved maternal health outcomes. We examined the prevalence and determinants of maternal healthcare utilization among young women in 28 sub-Saharan African countries using data from demographic and health surveys. METHODS This was a cross-sectional study of 43,786 young women aged 15-24 years from the most recent demographic and health surveys of 28 sub-Saharan African countries. We adopted a multilevel logistic regression analysis in examining the determinats of ANC, SBA, and PNC respectively. The results are presented as adjusted Odds Ratios (aOR) for the logistic regression analysis. Statistical significance was set at p < 0.05. RESULTS The prevalence of maternal healthcare utilisation among young women in SSA was 55.2%, 78.8%, and 40% for ANC, SBA, and PNC respectively with inter-country variations. The probability of utilising maternal healthcare increased with wealth status. Young women who were in the richest wealth quintile were, for instance, 2.03, 5.80, and 1.24 times respectively more likely to utilise ANC (95% CI = 1.80-2.29), SBA (95% CI = 4.67-7.20), and PNC (95% CI = 1.08-1.43) than young women in the poorest wealth quintile. Young women who indicated having a barrier to healthcare utilisation were, however, less likely to utilise maternal healthcare (ANC: aOR = 0.83, 95% CI = 0.78-0.88; SBA: aOR = 0.82, 95% CI = 0.75-0.88; PNC: aOR = 0.88, 95% CI = 0.83-0.94). CONCLUSION While SBA utilisation was high, we found ANC and PNC utilisation to be quite low among young women in SSA with inter-country variations. To accelerate progress towards the attainment of the Sustainable Development Goal (SDG) targets on reducing maternal mortality and achieving universal health coverage, our study recommends the adoption of interventions which have proven effective in some countries, by countries which recorded low maternal healthcare utilisation. The interventions include the implementation of free delivery services, training and integration of TBAs into orthodox maternal healthcare, improved accessibility of facilities, and consistent public health education. These interventions could particularly focus on young women in the lowest wealth quintile, those who experience barriers to maternal healthcare utilisation, uneducated women, and young women from rural areas.
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Affiliation(s)
- Luchuo Engelbert Bain
- College of Social Science, Lincoln International Institute for Rural Health (LIIRH), University of Lincoln, Lincoln, UK
| | - Richard Gyan Aboagye
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Robert Kokou Dowou
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | | | - Peter Memiah
- Division of Epidemiology and Prevention: Institute of Human Virology, University of Maryland School of Medicine, Baltimore Maryland, USA
| | - Hubert Amu
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
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Gyan EK, Dugle G, Abiiro GA. Promoting male participation in maternal healthcare in the Jaman North District in Ghana: Strategies and implementation challenges. Int J Health Plann Manage 2022; 37:1754-1768. [PMID: 35178753 DOI: 10.1002/hpm.3441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/03/2022] [Accepted: 02/08/2022] [Indexed: 11/07/2022] Open
Abstract
Promoting male participation in maternal healthcare is essential for improved maternal health outcomes. This study explored existing strategies to promote male participation in maternal healthcare and assessed their implementation challenges within healthcare facilities in the Jaman North District in Ghana. A qualitative approach was implemented in April 2020. Interviews were administered to a stratified purposive sample of 18 respondents comprising six midwives and 12 male partners of postnatal mothers. All interviews were audio-recorded, transcribed, and manually analysed using thematic analysis. The findings revealed early service, male partner invitation, male partner incentivisation, public sensitization, and male informed education, as strategies to promote male participation in the district. The implementation of these strategies has been constrained by socio-cultural and health system factors, namely, perception of pregnancy as non-illness, perceived experiences gained by women during previous births, cultural stereotypes, unconducive environment of healthcare facilities, inappropriate timing of facility attendance and unexpected costs associated with male participation. Promoting male participation, therefore, requires dedicated policy attention to the existing socio-cultural and health system constraints. The Ghana Health Service and other stakeholders should consider both community-level and targeted sensitization on the benefits of male participation in maternal healthcare and a general improvement in maternal healthcare infrastructure.
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Affiliation(s)
- Emmanuel Kofi Gyan
- Graduate School (MPhil Candidate), University for Development Studies, Tamale, Ghana
| | - Gordon Dugle
- Department of Management Studies, School of Business, SD-Dombo University of Business and Integrated Development Studies, Wa, Ghana
| | - Gilbert Abotisem Abiiro
- Department of Health Services, Policy, Planning, Management and Economics, School of Public Health, University for Development Studies, Tamale, Ghana.,Department of Population and Reproductive Health, School of Public Health, University for Development Studies, Tamale, Ghana
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Boniphace M, Matovelo D, Laisser R, Yohani V, Swai H, Subi L, Masatu Z, Tinka S, Mercader HFG, Brenner JL, Mitchell JL. The fear of social stigma experienced by men: a barrier to male involvement in antenatal care in Misungwi District, rural Tanzania. BMC Pregnancy Childbirth 2022; 22:44. [PMID: 35039002 PMCID: PMC8764782 DOI: 10.1186/s12884-022-04383-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 12/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Evidence has shown that male involvement is associated with improved maternal health outcomes. In rural Tanzania, men are the main decision makers and may determine women’s access to health services and ultimately their health outcomes. Despite efforts geared towards enhancing male participation in maternal health care, their involvement in antenatal care (ANC) remains low. One barrier that impacts men’s participation is the fear and experience of social stigma. This study, builds on previous findings about men’s perspectives in attending antenatal care appointments in Misungwi district in Tanzania, examining more closely the fear of social stigma amongst men attending ANC together with their partners. Methods Twelve individual interviews and five focus group discussions were conducted using semi-structured questionnaires with fathers and expectant fathers. In-depth interviews were conducted with health providers, volunteer community health workers and village leaders. Interviews were audiotaped, and transcripts were transcribed and translated to English. Transcripts were organized in NVivo V.12 then analyzed using thematic approach. Results Three main themes were found to create fear of social stigma for men: 1. Fear of HIV testing; 2. Traditional Gender Norms and 3. Insecurity about family social and economic status. Conclusion Respondent’s experiences reveal that fear of social stigma is a major barrier to attend ANC services with their partners. Attention must be given to the complex sociocultural norms and social context that underly this issue at the community level. Strategies to address fear of social stigma require an understanding of the real reasons some men do not attend ANC and require community engagement of community health workers (CHWs), government officials and other stakeholders who understand the local context.
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Affiliation(s)
- Maendeleo Boniphace
- Catholic University of Health and Allied Sciences (CUHAS), P. O. Box 1364, Mwanza, Tanzania
| | - Dismas Matovelo
- Catholic University of Health and Allied Sciences (CUHAS), P. O. Box 1364, Mwanza, Tanzania.
| | - Rose Laisser
- Catholic University of Health and Allied Sciences (CUHAS), P. O. Box 1364, Mwanza, Tanzania
| | - Victoria Yohani
- Catholic University of Health and Allied Sciences (CUHAS), P. O. Box 1364, Mwanza, Tanzania
| | - Hadija Swai
- Bugando Medical Centre (BMC), P. O. Box 1464, Mwanza, Tanzania
| | - Leonard Subi
- Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC), Mwanza, Tanzania
| | - Zabroni Masatu
- Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC), Mwanza, Tanzania
| | - Sylvia Tinka
- Catholic University of Health and Allied Sciences (CUHAS), P. O. Box 1364, Mwanza, Tanzania
| | - Hannah Faye G Mercader
- Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC), Mwanza, Tanzania
| | - Jennifer L Brenner
- Cumming School of Medicine, University of Calgary in Canada, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Jennifer L Mitchell
- Cumming School of Medicine, University of Calgary in Canada, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
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15
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Al-Mujtaba M, Sam-Agudu NA, Torbunde N, Aliyu MH, Cornelius LJ. Access to maternal-child health and HIV services for women in North-Central Nigeria: A qualitative exploration of the male partner perspective. PLoS One 2020; 15:e0243611. [PMID: 33301478 PMCID: PMC7728451 DOI: 10.1371/journal.pone.0243611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 11/24/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In much of sub-Saharan Africa, male partners play influential roles in women's access to maternal-child healthcare, including prevention of mother-to-child transmission of HIV services. We explored male partner perspectives on women's access to maternal-child healthcare in North-Central Nigeria. METHODS Three focus groups were conducted with 30 men, purposefully-selected on the basis of being married, and rural or urban residence. Major themes explored were men's maternal-child health knowledge, gender power dynamics in women's access to healthcare, and peer support for pregnant and postpartum women. Data were manually analyzed using Grounded Theory, which involves constructing theories out of data collected, rather than applying pre-formed theories. RESULTS Mean participant age was 48.3 years, with 36.7% aged <40 years, 46.7% between 41 and 60 years, and 16.6% over 60 years old. Religious affiliation was self-reported; 60% of participants were Muslim and 40% were Christian. There was consensus on the acceptability of maternal-child health services and their importance for optimal maternal-infant outcomes. Citing underlying patriarchal norms, participants acknowledged that men had more influence in family health decision-making than women. However, positive interpersonal couple relationships were thought to facilitate equitable decision-making among couples. Financial constraints, male-unfriendly clinics and poor healthcare worker attitudes were major barriers to women's access and male partner involvement. The provision of psychosocial and maternal peer support from trained women was deemed highly acceptable for both HIV-positive and HIV-negative women. CONCLUSIONS Strategic engagement of community leaders, including traditional and religious leaders, is needed to address harmful norms and practices underlying gender inequity in health decision-making. Gender mainstreaming, where the needs and concerns of both men and women are considered, should be applied in maternal-child healthcare education and delivery. Clinic fee reductions or elimination can facilitate service access. Finally, professional organizations can do more to reinforce respectful maternity care among healthcare workers.
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Affiliation(s)
- Maryam Al-Mujtaba
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Nadia A. Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Pediatric and Adolescent HIV Unit, Prevention, Care and Treatment Department, Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Nguavese Torbunde
- Pediatric and Adolescent HIV Unit, Prevention, Care and Treatment Department, Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Muktar H. Aliyu
- Department of Health Policy and Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Llewellyn J. Cornelius
- School of Social Work and College of Public Health, University of Georgia Athens, Athens, Georgia, United States of America
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Arnaert A, Ponzoni N, Debe Z, Meda MM, Nana NG, Arnaert S. Experiences of women receiving mhealth-supported antenatal care in the village from community health workers in rural Burkina Faso, Africa. Digit Health 2019; 5:2055207619892756. [PMID: 31832224 PMCID: PMC6891107 DOI: 10.1177/2055207619892756] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 11/11/2019] [Indexed: 12/17/2022] Open
Abstract
Objective This qualitative study explored the experiences of women receiving
mhealth-supported antenatal care in a village, from community health workers
(CHWs) in rural Burkina Faso, Africa. Intervention CHWs entered patient clinical data manually in their smartphone during their
home visits. All wireless transferred data was monitored by the midwives in
the community clinic for arising medical complications. Methods Semi-structured interviews were conducted with 19 pregnant women, who were
housewives, married and their age ranged from 18 to 39 years. None had
completed their formal education. Depending on the weeks of gestation during
their first antenatal care visit, length of enrollment in the project varied
between three and eight months. Transcripts were content-analyzed. Results Despite the fact that mhealth was a novel service for all participants, they
expressed appreciation for these interventions, which they found beneficial
on three levels: 1) it allowed for early detection of pregnancy-related
complications, 2) it was perceived as promoting collaboration between CHWs
and midwives, and 3) it was a source of reassurance during a time when they
are concerned about their health. Although not unanimous, certain
participants said their husbands were more interested in their antenatal
care as a result of these services. Conclusion Findings suggested that mhealth-supported visits of the CHWs have the
potential to increase mothers’ knowledge about their pregnancy and, as such,
motivate them to attend more ANC visits. In response to this increased
patient engagement, midwives approached women differently, which led to the
mothers’ perception of improvement in the patient–provider relationship.
Results also indicated that mhealth may increase spousal involvement, as
services are offered at home, which is an environment where spouses feel
more comfortable.
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Affiliation(s)
- Antonia Arnaert
- Ingram School of Nursing, McGill University, Montreal, Canada
| | - Norma Ponzoni
- Ingram School of Nursing, McGill University, Montreal, Canada
| | - Zoumanan Debe
- Ingram School of Nursing, McGill University, Montreal, Canada
| | - Mouoboum M Meda
- Institut de Formation et de Recherche Interdisciplinaire en Santé (IFRIS), Burkina Faso
| | - Noufou G Nana
- Institut de Formation et de Recherche Interdisciplinaire en Santé (IFRIS), Burkina Faso
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Ongolly FK, Bukachi SA. Barriers to men's involvement in antenatal and postnatal care in Butula, western Kenya. Afr J Prim Health Care Fam Med 2019; 11:e1-e7. [PMID: 31368318 PMCID: PMC6676928 DOI: 10.4102/phcfm.v11i1.1911] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/10/2018] [Accepted: 12/20/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Men have a lot of influence on their partners' and children's health. However, studies have shown their involvement in antenatal care (ANC) and postnatal care (PNC) is relatively low owing to several factors. AIM To explore the barriers to men's involvement in ANC and PNC in Butula sub-county, western Kenya. SETTING Butula sub-county, Busia county, western Kenya. METHODS A mixed methods study design, descriptive in nature, was used to collect both quantitative and qualitative data. A total of 96 men were selected to participate in the surveys. Also, four focus group discussions and four key informant interviews were conducted. RESULTS We found out that some men still participate in ANC and PNC despite the barriers. The perception that maternal health is a women's domain and existence of alternative traditional maternal services were key cultural barriers. The men's nature of work, low income and expenses incurred at ANC/PNC clinics were significant economic barriers. The lack of services targeting men, provider attitude, non-invitation to the clinic, time spent at the clinic and lack of privacy at the clinics were key facility-based barriers. CONCLUSION A myriad of cultural, economic and health-facility barriers hinder men from active involvement in ANC and PNC. Awareness creation among men on ANC and PNC services and creating a client-friendly environment at the clinics is key in enhancing their involvement. This should be a concerted effort of all stake holders in maternal health services, as male involvement is a strong influencer to their partners' and children's health outcomes.
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Affiliation(s)
- Fernandos K Ongolly
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya; and, Institute of Anthropology, Gender and African Studies, University of Nairobi, Nairobi.
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18
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Moshi FV, Kibusi SM, Fabian F. Using the Theory of Planned Behaviour to Describe Male Involvement Intention During Childbirth Among Expecting Couples in a Rural Setting: A Cross-Sectional Study From Rukwa Region, Southern Tanzania. East Afr Health Res J 2019; 3:31-41. [PMID: 34308193 PMCID: PMC8279251 DOI: 10.24248/eahrj-d-18-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/08/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Male involvement during childbirth can increase utilisation of maternal services and reduce maternal and neonatal mortality. An individual's intention towards such male involvement can be understood through the theory of planned behaviour, which postulates that such intention is influenced by 3 domains: 1) attitudes, 2) perceptions of social approval (subjective norms) and 3) feelings about control over the intended behaviour. In sub-Saharan Africa, rates of male involvement in childbirth birth are low, and little is known about the predictors of intention for such involvement among expecting couples in rural Africa. This study aimed to determine the influence of the 3 domains of intention on male involvement intention during childbirth among expecting couples in Rukwa Region, Tanzania. METHODS We conducted a community-based, cross-sectional study of pregnant women and their partners from June until October 2017. In total, 546 couples (n=1,092 participants) were identified through 3-stage probability sampling. A structured questionnaire based on the theory of planned behaviour was used to elicit information on the 3 domains of intention. RESULTS Most pregnant women (71.6%) and their male partners (77.3%) intended to have male involvement during childbirth. Among women, only positive attitude (odds ratio [OR] 0.2, 95% CI, 0.1 to 0.7; P=.012) was significantly associated with intention, though in an unexpected direction. In adjusted analysis, men's positive attitude (adjusted odds ratio [AOR] 9.0, 95% CI, 1.9 to 40.9; P=.004) and positive subjective norms (AOR 4.4, 95% CI, 1.1 to 18.6; P=.041) were significantly associated with an increased likelihood of intention to accompany their partners during childbirth. CONCLUSION More male partners had the intention to accompany their spouses during childbirth compared to their female partners. Male attitudes and subjective norms may be influential in determining male involvement during childbirth in rural African settings.
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Affiliation(s)
- Fabiola V Moshi
- School of Nursing and Public Health, University of Dodoma, Dodoma, Tanzania,Correspondence to Fabiola V Moshi ()
| | - Stephen M Kibusi
- School of Nursing and Public Health, University of Dodoma, Dodoma, Tanzania
| | - Flora Fabian
- School of Medicine and Dentistry, University of Dodoma, Dodoma, Tanzania
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Changole J, Thorsen VC, Kafulafula U. A road to obstetric fistula in Malawi: capturing women's perspectives through a framework of three delays. Int J Womens Health 2018; 10:699-713. [PMID: 30464646 PMCID: PMC6223335 DOI: 10.2147/ijwh.s171610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction Obstetric fistula (OF) is a devastating birth injury, which leaves a woman with leaking urine and/or feces accompanied by bad smell, a situation that has been likened to death itself. The condition is caused by neglected obstructed labor. Many factors underlie fistula formation, most of which are preventable. The main purpose of this study was to explore labor and childbirth experiences of women who developed OF with a focus on accessibility of care in the central region of Malawi. Methods We conducted semi-structured interviews with 25 women with OF at Bwaila Fistula Care Center in Lilongwe and in its surrounding districts. We interviewed 20 women at Bwaila Fistula Care Center; additional five women were identified through snowball sampling and were interviewed in their homes. Data were categorized using Nvivo 11 and were analyzed using thematic analysis. The three delays model by Thaddeus and Maine was used for data analysis. Findings The majority of women in our study suffered from OF with their subsequent pregnancies. All women experienced delays in one form or another consistent with the three-phase delays described by Thaddeus and Maine. Most of the participants (16) experienced two delays and 15 experienced second-phase delay, which was always coupled with the other; nine participants experienced delay while at the hospital. None of the participants experienced all three delays. Most decisions to seek health care when labor was complicated were made by mothers-in-law and traditional birth attendants. All but two delivered stillborn babies. Conclusion Testimonies by women in our study suggest the complexity of the journey to developing fistula. Poverty, illiteracy, inaccessible health facilities, negligence, lack of male involvement in childbirth issues, and shortage of staff together conspire to fistula formation. To prevent new cases of OF in Malawi, the above mentioned issues need to be addressed, more importantly, increasing access to skilled attendance at birth and emergency obstetric care and promoting girls’ education to increase their financial autonomy and decision-making power about their reproductive lives. Also men need to be educated and be involved in maternal and women’s reproductive health issues to help them make informed decisions when their spouses end up with a complicated labor or delivery.
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Affiliation(s)
- Josephine Changole
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway,
| | - Viva Combs Thorsen
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway,
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Fetene K, Chanyalew W, Abebaw N, Gemechu G. Prevalence of male attendance and associated factors at their partners antenatal visits among antenatal care attendees in Bale Zone, South East Ethiopia. ACTA ACUST UNITED AC 2018. [DOI: 10.5897/ijnm2018.0323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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