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Faktor LM, Wilson AN, Melepia P, Babona D, Wapi P, Suruka R, Hezeri P, Kabiu DD, Vallely LM, Kennedy E, Scoullar MJL, Spotswood N, Homer CSE. "If I am alive, I am happy": Defining quality of care from the perspectives of key maternal and newborn health stakeholders in Papua New Guinea. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002548. [PMID: 38771819 PMCID: PMC11108204 DOI: 10.1371/journal.pgph.0002548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 04/23/2024] [Indexed: 05/23/2024]
Abstract
Quality maternal and newborn healthcare is essential to improve experiences and health outcomes for mothers and babies. In many low to middle income countries, such as Papua New Guinea, there are initiatives to increase antenatal care attendance and facility births. To develop and implement initiatives that are appropriate, relevant, and contextualised to a community, it is important to understand how quality of care is perceived and defined by different maternal and newborn healthcare stakeholders. The aim of this study was to understand how women, their partners, healthcare professionals, healthcare managers, and provincial health administrators in East New Britain, Papua New Guinea define quality of pregnancy, childbirth, and immediate postnatal care. An exploratory qualitative study underpinned by a partnership-defined quality approach was undertaken. In total, 42 participants from five different healthcare facilities in East New Britain, Papua New Guinea, were interviewed. These included women, partners, healthcare professionals, healthcare managers, and provincial health administrators. Interviews were analysed using thematic analysis, assisted by NVivo computer software. Four themes were identified aligning with the journey a woman takes throughout the health system. These included (I) Ensuring Access: Arriving at the health centre, (II) Experiencing Positive Care: What the staff do, (III) Having the Bare Minimum: Resources available to the service, and (IV) Meeting Expectations: Outcomes of care. Stakeholder groups had significant overlap in how quality of care was defined, however women and partners focussed more on elements relating to experience of care, while clinical stakeholders focussed on elements relating to provision of care. There is a gap in how stakeholders define quality maternal and newborn healthcare, and the quality of the care which is administered and received.
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Affiliation(s)
- Lachlan M. Faktor
- Maternal, Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Alyce N. Wilson
- Maternal, Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
| | - Pele Melepia
- Healthy Mothers, Healthy Babies Program, Burnet Institute, Kokopo, Papua New Guinea
| | - Delly Babona
- Maternal, Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
- St Mary’s Hospital Vunapope, Kokopo, East New Britain Province, Papua New Guinea
| | - Pinip Wapi
- Nonga General Hospital, Rabaul, Papua New Guinea
| | - Rose Suruka
- Healthy Mothers, Healthy Babies Program, Burnet Institute, Kokopo, Papua New Guinea
| | - Priscah Hezeri
- Healthy Mothers, Healthy Babies Program, Burnet Institute, Kokopo, Papua New Guinea
| | - Duk Duk Kabiu
- Healthy Mothers, Healthy Babies Program, Burnet Institute, Kokopo, Papua New Guinea
| | - Lisa M. Vallely
- Papua New Guinea Institute for Medical Research, Goroka, Papua New Guinea
- Kirby Institute, University of New South Wales, Kensington, Australia
| | - Elissa Kennedy
- Maternal, Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
| | - Michelle J. L. Scoullar
- Maternal, Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
| | - Naomi Spotswood
- Maternal, Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
- Royal Hobart Hospital, Hobart, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Caroline S. E. Homer
- Maternal, Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
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Okeny PK, Pittalis C, Monaghan CF, Brugha R, Gajewski J. Dimensions of patient-centred care from the perspective of patients and healthcare workers in hospital settings in sub-Saharan Africa: A qualitative evidence synthesis. PLoS One 2024; 19:e0299627. [PMID: 38626224 PMCID: PMC11020865 DOI: 10.1371/journal.pone.0299627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 02/14/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION The United States Institute of Medicine defines patient centred care (PCC), a core element of healthcare quality, as care that is holistic and responsive to individual needs. PCC is associated with better patient satisfaction and improved clinical outcomes. Current conceptualizations of PCC are mainly from Europe and North America. This systematic review summarises the perceived dimensions of PCC among patients and healthcare workers within hospitals in sub-Saharan Africa (SSA). METHODS Without date restrictions, searches were done on databases of the Web of Science, Cochrane Library, PubMed, Embase, Global Health, and grey literature, from their inception up to 11th August 2022. Only qualitative studies exploring dimensions or perceptions of PCC among patients, doctors and/or nurses in hospitals in (SSA) were included. Review articles and editorials were excluded. Two independent reviewers screened titles and abstracts, and conducted full-text reviews with conflicts resolved by a third reviewer. The CASP (critical appraisal skills program) checklist was utilised to assess the quality of included studies. The framework synthesis method was employed for data synthesis. RESULTS 5507 articles were retrieved. Thirty-eight studies met the inclusion criteria, of which 17 were in the specialty of obstetrics, while the rest were spread across different fields. The perceived dimensions reported in the studies included privacy and confidentiality, communication, shared decision making, dignity and respect, continuity of care, access to care, adequate infrastructure and empowerment. Separate analysis of patients' and providers' perspective revealed a difference in the practical understanding of shared-decision making. These dimensions were summarised into a framework consisting of patient-as-person, access to care, and integrated care. CONCLUSION The conceptualization of PCC within SSA was largely similar to findings from other parts of the world, although with a stronger emphasis on access to care. In SSA, both relational and structural aspects of care were significant elements of PCC. Healthcare providers mostly perceived structural aspects such as infrastructure as key dimensions of PCC. TRIAL REGISTRATION PROSPERO Registration number CRD42021238411.
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Affiliation(s)
- Paul K. Okeny
- Institute of Global Surgery, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Surgery, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Chiara Pittalis
- Institute of Global Surgery, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Celina Flocks Monaghan
- Institute of Global Surgery, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Ruairi Brugha
- Institute of Global Surgery, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jakub Gajewski
- Institute of Global Surgery, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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A qualitative analysis of obstetric violence in rural Madagascar. Heliyon 2023; 9:e13905. [PMID: 36895360 PMCID: PMC9988542 DOI: 10.1016/j.heliyon.2023.e13905] [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: 09/28/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023] Open
Abstract
In Madagascar, a country where maternal mortality remains high, the quality of obstetric care as perceived by users has been little explored. In this paper, we examine the perception of the quality of care in rural areas, by identifying women's experiences and expectations for basic and emergency obstetric care and how providers are meeting them. Data were collected in 2020, in three rural regions (Fenerive-Est, Manakara and Miandrivazo). 58 semi-structured interviews were conducted with women who had given birth in basic health centers or at home, and with other key informants including caregivers, birth attendants (known as matrones), grandmothers and community agents. 6 focus groups took place with mothers who had given birth at home and at a basic health centers and 6 observations took place during prenatal consultations. This article highlights the major dysfunctions perceived in the services offered and their influence on healthcare use. The women highlighted a lack of consideration of their expectations in obstetric care, with a defective caregiver/patient relationship, unforeseen costs and inadequate infrastructures incapable of guaranteeing intimacy. The women also complained of a lack of consideration of their fady (cultural prohibitions that can lead to misfortune) that surround pregnancy. These local practices conflict with the medical requirements of priority interventions in maternal care, and the respect of these practices by the women leads to reprimands and humiliation from caregivers. This obstetric violence, which emanates from the structure of society, gender relations and the biomedical practices governing pregnancy and childbirth in health facilities in Madagascar, constitutes an obstacle to the use of obstetric services. We hope that this description of the various dimensions of obstetric violence in Madagascar will make it possible to identify the structural obstacles limiting the capacity to provide quality care and to engender positive improvements in obstetric care in Madagascar.
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Ahmed SAE, Mahimbo A, Dawson A. Quality intrapartum care expectations and experiences of women in sub-Saharan African Low and Low Middle-Income Countries: a qualitative meta-synthesis. BMC Pregnancy Childbirth 2023; 23:27. [PMID: 36641424 PMCID: PMC9840253 DOI: 10.1186/s12884-022-05319-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Woman-centred maternity care is respectful and responsive to women's needs, values, and preferences. Women's views and expectations regarding the quality of health services during pregnancy and childbirth vary across settings. Despite the need for context-relevant evidence, to our knowledge, no reviews focus on what women in sub-Saharan African Low and Low Middle-Income Countries (LLMICs) regard as quality intrapartum care that can inform quality guidelines in countries. METHODS We undertook a qualitative meta-synthesis using a framework synthesis to identify the experiences and expectations of women in sub-Saharan African LLMICs with quality intrapartum care. Following a priori protocol, we searched eight databases for primary articles using keywords. We used Covidence to collate citations, remove duplicates, and screen articles using a priori set inclusion and exclusion criteria. Two authors independently screened first the title and abstracts, and the full texts of the papers. Using a data extraction excel sheet, we extracted first-order and second-order constructs relevant to review objectives. The WHO framework for a positive childbirth experience underpinned data analysis. RESULTS Of the 7197 identified citations, 30 articles were included in this review. Women's needs during the intrapartum period resonate with what women want globally, however, priorities regarding the components of quality care for women and the urgency to intervene differed in this context given the socio-cultural norms and available resources. Women received sub-quality intrapartum care and global standards for woman-centred care were often compromised. They were mistreated verbally and physically. Women experienced poor communication with their care providers and non-consensual care and were rarely involved in decisions concerning their care. Women were denied the companion of choice due to cultural and structural factors. CONCLUSION To improve care seeking and satisfaction with health services, woman-centred care is necessary for a positive childbirth experience. Women must be meaningfully engaged in the design of health services, accountability frameworks, and evaluation of maternal services. Research is needed to set minimum indicators for woman-centred outcomes for low-resource settings along with actionable strategies to enhance the quality of maternity care based on women's needs and preferences.
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Affiliation(s)
- Salma A. E. Ahmed
- grid.117476.20000 0004 1936 7611Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Abela Mahimbo
- grid.117476.20000 0004 1936 7611Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Angela Dawson
- grid.117476.20000 0004 1936 7611Faculty of Health, University of Technology Sydney, Sydney, Australia
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Reddy B, Thomas S, Karachiwala B, Sadhu R, Iyer A, Sen G, Mehrtash H, Tunçalp Ö. A scoping review of the impact of organisational factors on providers and related interventions in LMICs: Implications for respectful maternity care. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001134. [PMID: 36962616 PMCID: PMC10021694 DOI: 10.1371/journal.pgph.0001134] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/14/2022] [Indexed: 11/05/2022]
Abstract
We have limited understanding of the organisational issues at the health facility-level that impact providers and care as it relates to mistreatment in childbirth, especially in low- and middle-income countries (LMICs). By extension, it is not clear what types of facility-level organisational changes or changes in working environments in LMICs could support and enable respectful maternity care (RMC). While there has been relatively more attention to health system pressures related to shortages of staff and other resources as key barriers, other organisational challenges may be less explored in the context of RMC. This scoping review aims to consolidate evidence to address these gaps. We searched literature published in English between 2000-2021 within Scopus, PubMed, Google Scholar and ScienceDirect databases. Study selection was two-fold. Maternal health articles articulating an organisational issue at the facility- level and impact on providers and/or care in an LMIC setting were included. We also searched for literature on interventions but due to the limited number of related intervention studies in maternity care specifically, we expanded intervention study criteria to include all medical disciplines. Organisational issues captured from the non-intervention, maternal health studies, and solutions offered by intervention studies across disciplines were organised thematically and to establish linkages between problems and solutions. Of 5677 hits, 54 articles were included: 41 non-intervention maternal healthcare studies and 13 intervention studies across all medical disciplines. Key organisational challenges relate to high workload, unbalanced division of work, lack of professional autonomy, low pay, inadequate training, poor feedback and supervision, and workplace violence, and these were differentially influenced by resource shortages. Interventions that respond to these challenges focus on leadership, supportive supervision, peer support, mitigating workplace violence, and planning for shortages. While many of these issues were worsened by resource shortages, medical and professional hierarchies also strongly underpinned a number of organisational problems. Frontline providers, particularly midwives and nurses, suffer disproportionately and need greater attention. Transforming institutional leadership and approaches to supervision may be particularly useful to tackle existing power hierarchies that could in turn support a culture of respectful care.
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Affiliation(s)
- Bhavya Reddy
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Sophia Thomas
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Baneen Karachiwala
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Ravi Sadhu
- T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Aditi Iyer
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Gita Sen
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Hedieh Mehrtash
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Mbuthia F, Reid M, Fichardt A. Experiences of Postnatal Mothers with Healthcare Providers in Rural Kenya: Insights from Applying the Mmogo Method. J Community Health Nurs 2022; 39:40-49. [PMID: 35191789 DOI: 10.1080/07370016.2022.2028064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To explore the experiences of postnatal mothers with health care providers during postnatal care in rural Kenya. DESIGN This was a visual-based narrative inquiry study that applied the Mmogo method® - a visual projective data-collection method. METHODS The participants were women (n=26) receiving postnatal care at purposively sampled rural health facilities (n=4) in Laikipia County Kenya. FINDINGS Two themes emerged from this study. First, the mothers had positive experiences with health care providers. Secondly, the mothers expressed expectations to enhance future experiences with health care providers. CONCLUSIONS Mothers had positive experiences and various expectations to enhance future experiences with health care providers that related to their postnatal needs. The mothers proposed the possible use of mobile phones by health care providers to meet their health education needs as well as receive psychological support. CLINICAL EVIDENCE Health care providers can use mobile phone devices to call and address some of the postnatal needs during the postnatal period.
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Affiliation(s)
- Florence Mbuthia
- School of Nursing, Dedan Kimathi University of Technology, Nyeri, Kenya
| | - Marianne Reid
- School of Nursing, Faculty of Health Sciences, University of the Free State, Bloemfontein, Republic of South Africa
| | - Annali Fichardt
- School of Nursing, Faculty of Health Sciences, University of the Free State, Bloemfontein, Republic of South Africa
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van den Broek N. Keep it simple - Effective training in obstetrics for low- and middle-income countries. Best Pract Res Clin Obstet Gynaecol 2021; 80:25-38. [PMID: 34872860 DOI: 10.1016/j.bpobgyn.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/30/2022]
Abstract
In low-and middle-income countries, the burden of disease related to pregnancy and childbirth remains high. The health of the mother is intricately linked to that of the baby. Neonatal mortality is most likely to occur in the first week of life accounting for almost half of all deaths among children under 5-year old. Many babies are stillborn each year. It is important that healthcare is accessible, available, and of good quality. This requires a functioning health system with motivated, competent healthcare providers who were able to provide the continuum of care for mothers and babies. Pre- and in-service training is effective if it uses adult learning approaches, includes all members of the maternity team, and is focused on the core content of the care packages that are agreed for each setting. Most programmes that seek to build the capacity of the health system include training as one of the interventions to be implemented.
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Affiliation(s)
- Nynke van den Broek
- Maternal and Newborn Health, Independent Consultant Global Health, 5 Newcroft Road, Liverpool, L25 6EP, United Kingdom.
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Nakphong MK, Sacks E, Opot J, Sudhinaraset M. Association between newborn separation, maternal consent and health outcomes: findings from a longitudinal survey in Kenya. BMJ Open 2021; 11:e045907. [PMID: 34588231 PMCID: PMC8479975 DOI: 10.1136/bmjopen-2020-045907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Disrespectful and poor treatment of newborns such as unnecessary separation from parents or failure to obtain parental consent for medical procedures occurs at health facilities across contexts, but little research has investigated the prevalence, risk factors or associated outcomes. This study examined these experiences and associations with healthcare satisfaction, use and breast feeding. DESIGN Prospective cohort study. SETTING 3 public hospitals, 2 private hospitals, and 1 health centre/dispensary in Nairobi and Kiambu counties in Kenya. PARTICIPANTS Data were collected from women who delivered in health facilities between September 2019 and January 2020. The sample included 1014 women surveyed at baseline and at least one follow-up at 2-4 or 10 weeks post partum. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Outcomes related to satisfaction with care and care utilisation; (2) continuation of post-discharge newborn care practices such as breast feeding. RESULTS 17.6% of women reported newborn separation at the facility, of whom 71.9% were separated over 10 min. 44.9% felt separation was unnecessary and 8.4% reported not knowing the reason for separation. 59.9% reported consent was not obtained for procedures on their newborn. Women separated from their newborn (>10 min) were 44% less likely to be exclusively breast feeding at 2-4 weeks (adjusted OR (aOR)=0.56, 95% CI: 0.40 to 0.76). Obtaining consent for newborn procedures corresponded with 2.7 times greater likelihood of satisfaction with care (aOR=2.71, 95% CI: 1.67 to 4.41), 27% greater likelihood of postpartum visit attendance for self or newborn (aOR=1.27, 95% CI: 1.05 to 1.55), and 33% greater likelihood of exclusive breast feeding at 10 weeks (aOR=1.33, 95% CI: 1.10 to 1.62). CONCLUSIONS Newborns, mothers and families have a right to high-quality, respectful care, including the ability to stay together, be informed and properly consent for care. The implications of these experiences on health outcomes a month or more after discharge illustrate the importance of a positive experience of postnatal care.
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Affiliation(s)
- Michelle Kao Nakphong
- Department of Community Health Sciences, University of California Los Angeles, Los Angeles, California, USA
- California Center for Population Research, University of California Los Angeles, Los Angeles, California, USA
| | - Emma Sacks
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - James Opot
- Innovations for Poverty Action, Nairobi, Kenya
| | - May Sudhinaraset
- Department of Community Health Sciences, University of California Los Angeles, Los Angeles, California, USA
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Chodzaza E, Mbiza C, Gadama L, Kafulafula U. Midwives' and Medical professionals' perspectives of collaborative practice at Queen Elizabeth Central Hospital Maternity Unit, Malawi: The discovery phase of an appreciative inquiry project. Malawi Med J 2020; 32:13-18. [PMID: 32733654 PMCID: PMC7366164 DOI: 10.4314/mmj.v32i1.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background This paper reports on part of a larger study, the aim of which was to develop an intervention to collaboratively develop innovative strategies to promote effective collaborative practices among midwives and medical professionals working in intrapartum care unit. Collaborative practice is a critical marker for success in improving quality of maternity care. To date, there has been limited exploration of collaborative practices between midwives and medical professionals working in intrapartum care from the African perspective. Aim This paper reports findings of the discovery phase of appreciative inquiry (AI) set out to understand the perspectives of midwives and medical professionals on collaborative practices at Queen Elizabeth Central Hospital labour and delivery ward in Malawi. Methods The study used an exploratory qualitative approach framed in an Appreciative Inquiry theoretical perspective. Appreciative Inquiry consists of four phases :(discovery, dream, design and destiny).The discovery phase consisted of 16 in-depth interviews and 2 focus group discussions among purposively selected midwives (4 nurse midwives, 2 midwifery unit matrons) and medical professionals (2 obstetricians, 4 registrars, 2 intern doctors, 2 clinical officers) working in the labour ward. All interviews and discussions were audiotaped and transcribed verbatim. Data were analysed using thematic analysis. Results Five dominant themes emerged: collaborative breakdown, benefits of collaboration, the importance of positive and respectful attitude, barriers to effective collaborative practices and strategies to improve collaborative practice. Conclusion/Recommendations Aligning the perspectives of the members of the two disciplines is significant to effective implementation of collaborative intrapartum care. Participants demonstrated that there is increased parallel working of midwives and doctors at QECH. This is not professionally healthy. Therefore, putting together the viewpoints of the professions to create a mutually agreeable professional framework of collaborative intrapartum practice is significant. Additionally, there is an obvious need to address the professional concerns of both disciplines.
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Affiliation(s)
- Elizabeth Chodzaza
- University of Malawi Kamuzu College of Nursing, Faculty of Midwifery, Neonatal and Reproductive Health Studies, Blantyre, Malawi
| | - Christina Mbiza
- Queen Elizabeth Central Hospital, Department of Obstetrics and Gynecology, Blantyre, Malawi
| | - Luis Gadama
- University of Malawi, College of Medicine, School of Medicine, Blantyre, Malawi
| | - Ursula Kafulafula
- University of Malawi Kamuzu College of Nursing, Faculty of Midwifery, Neonatal and Reproductive Health Studies, Blantyre, Malawi
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de Kok BC, Uny I, Immamura M, Bell J, Geddes J, Phoya A. From Global Rights to Local Relationships: Exploring Disconnects in Respectful Maternity Care in Malawi. QUALITATIVE HEALTH RESEARCH 2020; 30:341-355. [PMID: 31642387 DOI: 10.1177/1049732319880538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Widespread reports of "disrespect and abuse" in maternity wards in low- and middle-income countries have triggered the development of rights-based respectful maternity care (RMC) standards and initiatives. To explore how international standards translate into local realities, we conducted a team ethnography, involving observations in labor wards in government facilities in central Malawi, and interviews and focus groups with midwives, women, and guardians. We identified a dual disconnect between, first, universal RMC principles and local notions of good care and, second, between midwives and women and guardians. The latter disconnect pertains to fraught relationships, reproduced by and manifested in mechanistic care, mutual responsibilization for trouble, and misunderstandings and distrust. RMC initiatives should be tailored to local contexts and midwife-client relationships. In a hierarchical, resource-strapped context like Malawi, promoting mutual love, understanding, and collaboration may be a more productive way to stimulate "respectful" care than the current emphasis on formal rights and respect.
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Affiliation(s)
| | - Isabelle Uny
- University of Stirling, Stirling, United Kingdom
| | | | | | - Jane Geddes
- Edinburgh Napier University, Edinburgh, United Kingdom
| | - Ann Phoya
- The Association of Malawian Midwives, Lilongwe, Malawi
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van den Broek N. Happy Mother's Day? Maternal and neonatal mortality and morbidity in low- and middle-income countries. Int Health 2019; 11:353-357. [PMID: 31529113 PMCID: PMC6748767 DOI: 10.1093/inthealth/ihz058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/03/2019] [Accepted: 07/12/2019] [Indexed: 11/24/2022] Open
Abstract
At least 800 women die each day during pregnancy or birth and more than 15 000 babies each day are stillborn or die in the first month of life. Almost all of these deaths occur in low- and middle-income countries. Many more women and babies are known to suffer morbidity as a result of pregnancy and childbirth. However, reliable estimates of the burden of physical, psychological and social morbidity and comorbidity during and after pregnancy are not available. Although there is no single intervention or ‘magic bullet’ that would reduce mortality and improve health, there are evidence-based care packages which are defined and agreed internationally. A functioning health system with care available and accessible for everyone at all times is required to ensure women and babies survive and thrive.
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Affiliation(s)
- Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
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Mgawadere F, Smith H, Asfaw A, Lambert J, Broek NVD. "There is no time for knowing each other": Quality of care during childbirth in a low resource setting. Midwifery 2019; 75:33-40. [PMID: 30986692 DOI: 10.1016/j.midw.2019.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/28/2019] [Accepted: 04/08/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore women's and healthcare provider's perspectives of what quality of care during childbirth means to them and how this can be improved. DESIGN 14 Focus Group Discussions (FGD) with women and 27 Key Informant Interviews (KII) with healthcare providers. Thematic framework analysis was used. SETTING 14 public healthcare facilities across two districts in Malawi. Mothers who had given birth at a healthcare facility within the last 7-42 days and healthcare providers who were directly involved in maternity care. FINDINGS Perceptions of what constitutes good quality of care differed substantially. For healthcare providers, the most important characteristics of good quality care included structural aspects of care such as availability of materials, and sufficient human resources. For women, patient-centred care including a positive relationship and experience was prioritised. However, both groups had similar views on what constitutes poor quality of care; unwelcoming reception on admission, non-consented care, physical and verbal abuse were described as examples of poor care. Shortage of staff, poor labour room design and a non-functional referral system were key barriers identified. KEY CONCLUSIONS Women as well as healthcare providers want good quality, professional care at birth and are disappointed if this is not in place. IMPLICATION FOR PRACTICE There is a need to incorporate women as well as healthcare provider's views when designing, implementing, monitoring and evaluating maternal health programmes. For a positive birth experience, a healthcare facility needs to have an enabling environment and good communication between healthcare providers and women should be actively promoted.
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Affiliation(s)
- Florence Mgawadere
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
| | - Helen Smith
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Atnafu Asfaw
- UNICEF Malawi, Mantino Complex, Area 40/31, Lilongwe 3, Malawi
| | - Jaki Lambert
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
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Danhoundo G, Pilkington B, Nasiri K. What happens during antenatal visits? An ethnographic study of pregnant women's experiences with midwives in Benin. Women Health 2019; 59:1172-1184. [PMID: 30917777 DOI: 10.1080/03630242.2019.1590494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Pregnancy and childbirth place women at risk of morbidity and mortality, particularly in Benin where the health system is fragile. This study aimed to understand women's experiences concerning their interactions with midwives during antenatal visits and to explore contextual factors influencing these interactions and the quality of care received. A qualitative study was conducted from June to August 2015 in two primary health facilities in So-Ava, Benin. One hundred seven individual in-depth interviews with 100 pregnant women, five midwives, and two physicians and one focus group discussion with seven government decision-makers were conducted. Despite midwives' good intentions, most pregnant women reported absenteeism, delays, cold attitudes, fear-based communication, and arbitrary and non-consensual interventions during antenatal visits and believed midwives would interfere with their family relationships. The suboptimal quality of care provided by midwives was interpreted as due to several factors, including lack of accountability of midwives in health facilities. The communication of midwives with pregnant women needs improvement. Results of this study highlight the importance of understanding the problem from the perspective of the political economy of the Benin health system to address its structural and systemic failures with open dialogue, including implementation of accountability measures.
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Affiliation(s)
- Georges Danhoundo
- Division of Community Engagement, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Beryl Pilkington
- School of Nursing, Global Health, Faculty of Health, York University, Toronto, Canada
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Jolly Y, Aminu M, Mgawadere F, van den Broek N. "We are the ones who should make the decision" - knowledge and understanding of the rights-based approach to maternity care among women and healthcare providers. BMC Pregnancy Childbirth 2019; 19:42. [PMID: 30764788 PMCID: PMC6376786 DOI: 10.1186/s12884-019-2189-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 01/14/2019] [Indexed: 11/10/2022] Open
Abstract
Background Experiences and perceptions of poor quality of care is a powerful determinant of utilisation of maternity services. With many reports of disrespect and abuse in healthcare facilities in low-resource settings, women’s and healthcare providers’ understanding and perception of disrespect and abuse are important in eliminating disrespect and abuse, but these are rarely explored together. Methods This was a qualitative study assessing the continuum of maternity care (antenatal, intrapartum and postnatal care) at the Maternity Unit of Bwaila Hospital in Lilongwe, Malawi. Focus group discussions (FGDs) were conducted separately for mothers attending antenatal clinic and those attending postnatal clinic. For women who accessed intrapartum care services, in-depth interviews were used. Participants were recruited purposively. Key informant interviews were conducted with healthcare providers involved in the delivery of maternal and newborn health services. Topic guides were developed based on the seven domains of the Respectful Maternity Care (RMC) Charter. Data was transcribed verbatim, coded and analysed using the thematic framework approach. Results A total of 8 focus group discussions and 9 in-depth interviews involving 64 women and 9 key informant interviews with health care providers were conducted. Important themes that emerged included: the importance of a valued patient-provider relationship as determined by a good attitude and method of communication, the need for more education of women regarding the stages of pregnancy and labour, what happens at each stage and which complications could occur, the importance of a woman’s involvement in decision-making, the need to maintain confidentiality when required and the problem of insufficient human resources. Prompt and timely service was considered a priority. Neither women accessing maternity care nor trained healthcare providers providing this care were aware of the RMC Charter. Conclusions This study has highlighted the most essential aspects of respectful maternity care from the viewpoint of both women accessing maternity care and healthcare providers. Although RMC components are in place, healthcare providers were not aware of them. There is the need to promote the RMC Charter among both women who seek care and healthcare providers. Electronic supplementary material The online version of this article (10.1186/s12884-019-2189-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yasmin Jolly
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Mamuda Aminu
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Florence Mgawadere
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
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Madula P, Kalembo FW, Yu H, Kaminga AC. Healthcare provider-patient communication: a qualitative study of women's perceptions during childbirth. Reprod Health 2018; 15:135. [PMID: 30103766 PMCID: PMC6090736 DOI: 10.1186/s12978-018-0580-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 07/31/2018] [Indexed: 11/22/2022] Open
Abstract
Background There is limited information on the impact of effective healthcare provider-patient communication on facility-based delivery in Malawi. The purpose of this study was to examine the nature of communication in the maternity ward, identify facilitators and barriers to healthcare provider-patient communication, and understand how they affect maternal healthcare. Methods This was a descriptive study that used qualitative data collection and analysis methods. Data were collected through face-to-face in-depth interviews using a semi-structured interview guide to collect information about women’s perceptions of their communication with healthcare providers. A total of 30 in-depth interviews were conducted with women admitted for delivery in six health facilities drawn from three administrative regions in Malawi. The information collected focused on the communication that pregnant women had with healthcare providers, their perception of that communication, and the barriers to effective communication. A thematic approach was used for data analysis. Results The main themes that emerged regarding the nature of communication between healthcare providers and patients were: 1) good healthcare provider-patient interaction; 2) verbal abuse and lack of respect; 3) failure by healthcare providers to answer or entertain questions; 4) linguistic barriers to communication and lack of competency in non-verbal communication; and 5) discrimination due to one’s status. Conclusion This study has revealed the existence of some communication barriers such as disrespecting and verbally abusing pregnant women, language limitations by some healthcare providers and discrimination due to one’s status which are affecting maternal service delivery in some health facilities in Malawi. The study has also shown that pregnant women who are happy with the way healthcare providers communicate with them have the motivation to deliver at a health facility. There is a need, therefore, to develop an intervention that could help healthcare providers to communicate better with their patients.
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Affiliation(s)
- Precious Madula
- School of Journalism and Information Communication, Huazhong University of Science and Technology, 1037 Luoyu, Road, Wuhan, 430074, People's Republic of China. .,Mzuzu University, Private Bag 201, Luwinga, Mzuzu, 2, Malawi.
| | | | - Hong Yu
- School of Journalism and Information Communication, Huazhong University of Science and Technology, 1037 Luoyu, Road, Wuhan, 430074, People's Republic of China
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Lambert J, Etsane E, Bergh AM, Pattinson R, van den Broek N. 'I thought they were going to handle me like a queen but they didn't': A qualitative study exploring the quality of care provided to women at the time of birth. Midwifery 2018; 62:256-263. [PMID: 29730166 DOI: 10.1016/j.midw.2018.04.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/16/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To explore experiences of care during labour and birth from the perspectives of both the healthcare provider and women receiving care, to inform recommendations for how the quality of care can be improved and monitored, and, to identify the main aspects of care that are important to women. DESIGN A descriptive phenomenological approach. 53 interviews and 10KII as per table 1 took place including in-depth interviews (IDI), focus group discussions (FGD) and key informant interviews (KII) conducted with women, healthcare providers, managers and policy makers. Following verbatim transcription thematic framework analysis was used to describe the lived experience of those interviewed. SETTING 11 public healthcare facilities providing maternity care in urban Tshwane District, Gauteng Province (n = 4) and rural Waterberg District, Limpopo Province (n = 7), South Africa. PARTICIPANTS Women who had given birth in the preceding 12 weeks (49 women, 7 FGD and 23 IDI); healthcare providers working in the labour wards (33 healthcare providers; nurses, midwives, medical staff, 5 FGD, 18 IDI; managers and policy makers (10 KII). FINDINGS Both women and healthcare providers largely feel alone and unsupported. There is mutual distrust between women and healthcare providers exacerbated by word of mouth and the media. A lack of belief in women's ability to make appropriate choices negates principles of choice and consent. Procedure- rather than patient-centred care is prioritised by healthcare providers. Although healthcare providers know the principles of good quality care, this was not reflected in the care women described as having received. Beliefs and attitudes as well as structural and organisational problems make it difficult to provide good quality care. Caring behaviour and environment as well as companionship are the most important needs highlighted by women. Professional hierarchy is rarely seen as supportive by healthcare providers but when present, good leadership changes the culture and experience of women and care providers. The use of mobile phones to provide feedback regarding care was positively viewed by women. CONCLUSION Clarity regarding what a healthcare facility can (or cannot provide) is important in order to separate practice issues from structural and organisational constraints. Improvements in quality that focus on caring as well as competence should be prioritised. Increased dialogue between healthcare providers and users should be encouraged and prioritised. IMPLICATIONS FOR PRACTICE A renewed focus is needed to ensure companionship during labour and birth is facilitated. Training in respectful maternity care needs to prioritise caring behaviour and supportive leadership.
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Affiliation(s)
- Jaki Lambert
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Elsie Etsane
- SAMRC Unit for Maternal and Infant Health Care Strategies, University of Pretoria, Pretoria, South Africa
| | - Anne-Marie Bergh
- SAMRC Unit for Maternal and Infant Health Care Strategies, University of Pretoria, Pretoria, South Africa
| | - Robert Pattinson
- SAMRC Unit for Maternal and Infant Health Care Strategies, University of Pretoria, Pretoria, South Africa
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
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17
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Shakibazadeh E, Namadian M, Bohren MA, Vogel JP, Rashidian A, Nogueira Pileggi V, Madeira S, Leathersich S, Tunçalp Ӧ, Oladapo OT, Souza JP, Gülmezoglu AM. Respectful care during childbirth in health facilities globally: a qualitative evidence synthesis. BJOG 2017; 125:932-942. [PMID: 29117644 PMCID: PMC6033006 DOI: 10.1111/1471-0528.15015] [Citation(s) in RCA: 208] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 11/26/2022]
Abstract
Background What constitutes respectful maternity care (RMC) operationally in research and programme implementation is often variable. Objectives To develop a conceptualisation of RMC. Search strategy Key databases, including PubMed, CINAHL, EMBASE, Global Health Library, grey literature, and reference lists of relevant studies. Selection criteria Primary qualitative studies focusing on care occurring during labour, childbirth, and/or immediately postpartum in health facilities, without any restrictions on locations or publication date. Data collection and analysis A combined inductive and deductive approach was used to synthesise the data; the GRADE CERQual approach was used to assess the level of confidence in review findings. Main results Sixty‐seven studies from 32 countries met our inclusion criteria. Twelve domains of RMC were synthesised: being free from harm and mistreatment; maintaining privacy and confidentiality; preserving women's dignity; prospective provision of information and seeking of informed consent; ensuring continuous access to family and community support; enhancing quality of physical environment and resources; providing equitable maternity care; engaging with effective communication; respecting women's choices that strengthen their capabilities to give birth; availability of competent and motivated human resources; provision of efficient and effective care; and continuity of care. Globally, women's perspectives of what constitutes RMC are quite consistent. Conclusions This review presents an evidence‐based typology of RMC in health facilities globally, and demonstrates that the concept is broader than a reduction of disrespectful care or mistreatment of women during childbirth. Innovative approaches should be developed and tested to integrate RMC as a routine component of quality maternal and newborn care programmes. Tweetable abstract Understanding respectful maternity care – synthesis of evidence from 67 qualitative studies. Understanding respectful maternity care – synthesis of evidence from 67 qualitative studies.
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Affiliation(s)
- E Shakibazadeh
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - M Namadian
- Social Determinants of Health Research Centre, Zanjan University of Medical Sciences, Zanjan, Iran
| | - M A Bohren
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - J P Vogel
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - A Rashidian
- Department of Information, Evidence and Research, Eastern Mediterranean Region, World Health Organization, Cairo, Egypt.,Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - V Nogueira Pileggi
- GLIDE Technical Cooperation and Research, Ribeirão Preto, São Paulo, Brazil.,Department of Paediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - S Madeira
- Social Department of Ribeirão Preto, Medical School, University of São Paulo, São Paulo, Brazil
| | - S Leathersich
- King Edward Memorial Hospital for Women, Subiaco, WA, Australia
| | - Ӧ Tunçalp
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - O T Oladapo
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - J P Souza
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - A M Gülmezoglu
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
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Mehata S, Paudel YR, Dariang M, Aryal KK, Paudel S, Mehta R, King S, Barnett S. Factors determining satisfaction among facility-based maternity clients in Nepal. BMC Pregnancy Childbirth 2017; 17:319. [PMID: 28946851 PMCID: PMC5613378 DOI: 10.1186/s12884-017-1532-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 09/21/2017] [Indexed: 11/23/2022] Open
Abstract
Background With an increasing number of institutional deliveries, the Nepalese health system faces a challenge to ensure a quality of service provision. This paper aims to identify the determinants of client satisfaction with maternity care in Nepal using data from a nationally representative health facility survey. Methods A total of 447 exit interviews, with women who had either recently delivered or who had experienced obstetric complications, were conducted across 13 districts in Nepal (87% in hospitals, 8% in Primary Health Care Centres (PHCCs), and 5% in Sub/Health Posts(S/HPs). Client satisfaction was measured using an eight item scale that covered accessibility, interpersonal communication, physical environment, technical aspect of care and decision making. A client satisfaction index was computed using ordinal principal component analysis. A multivariate probit model was used to assess the net effect of explanatory variables on client satisfaction. Results Longer waiting times and overcrowding increased the likelihood of dissatisfaction. Having an opportunity to ask questions was positively associated with client satisfaction. Respondents from hill districts and rural areas were more likely to be satisfied in comparison to respondents from mountain, terai and urban areas. Socio-demographic factors (age, parity, caste/ethnicity, education, and ecological zone) and supply side factors (the time taken to reach a facility, type of facility, payment for services, and unknown heath worker or anyone entering the delivery room) were not statistically associated with satisfaction. Conclusions The findings suggest client satisfaction with the quality of maternity services in Nepal could be improved by reducing waiting times and overcrowding, and giving the mothers adequate time to ask questions. If clients are more satisfied they are more likely to use the facility again/recommend to a friend.
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Affiliation(s)
- Suresh Mehata
- Nepal Health Sector Support Program, Ministry of Health and Population, Ramshaha Path, GPO Box: 7830, Kathmandu, 44600, Nepal.
| | - Yuba Raj Paudel
- Nepal Health Sector Support Program, Ministry of Health and Population, Ramshaha Path, GPO Box: 7830, Kathmandu, 44600, Nepal
| | - Maureen Dariang
- Nepal Health Sector Support Program, Ministry of Health and Population, Ramshaha Path, GPO Box: 7830, Kathmandu, 44600, Nepal
| | - Krishna Kumar Aryal
- Nepal Health Research Council, Ministry of Health and Population, Kathmandu, 44600, Nepal
| | - Susan Paudel
- Institute of Medicine Tribhuvan University Maharajgunj, Kathmandu, 4600, Nepal
| | - Ranju Mehta
- Institute of Medicine Tribhuvan University Maharajgunj, Kathmandu, 4600, Nepal
| | - Stuart King
- Nepal Health Sector Support Program, Ministry of Health and Population, Ramshaha Path, GPO Box: 7830, Kathmandu, 44600, Nepal
| | - Sarah Barnett
- Options Consultancy Services Limited, Devon House, 58 St Katharine's Way, London, E1W1LB, UK
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Kyei-Nimakoh M, Carolan-Olah M, McCann TV. Access barriers to obstetric care at health facilities in sub-Saharan Africa-a systematic review. Syst Rev 2017; 6:110. [PMID: 28587676 PMCID: PMC5461715 DOI: 10.1186/s13643-017-0503-x] [Citation(s) in RCA: 178] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 05/19/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Since 2000, the United Nations' Millennium Development Goals, which included a goal to improve maternal health by the end of 2015, has facilitated significant reductions in maternal morbidity and mortality worldwide. However, despite more focused efforts made especially by low- and middle-income countries, targets were largely unmet in sub-Saharan Africa, where women are plagued by many challenges in seeking obstetric care. The aim of this review was to synthesise literature on barriers to obstetric care at health institutions in sub-Saharan Africa. METHODS This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases were electronically searched to identify studies on barriers to health facility-based obstetric care in sub-Saharan Africa, in English, and dated between 2000 and 2015. Combinations of search terms 'obstetric care', 'access', 'barriers', 'developing countries' and 'sub-Saharan Africa' were used to locate articles. Quantitative, qualitative and mixed-methods studies were considered. A narrative synthesis approach was employed to synthesise the evidence and explore relationships between included studies. RESULTS One hundred and sixty articles met the inclusion criteria. Currently, obstetric care access is hindered by several demand- and supply-side barriers. The principal demand-side barriers identified were limited household resources/income, non-availability of means of transportation, indirect transport costs, a lack of information on health care services/providers, issues related to stigma and women's self-esteem/assertiveness, a lack of birth preparation, cultural beliefs/practices and ignorance about required obstetric health services. On the supply-side, the most significant barriers were cost of services, physical distance between health facilities and service users' residence, long waiting times at health facilities, poor staff knowledge and skills, poor referral practices and poor staff interpersonal relationships. CONCLUSION Despite similarities in obstetric care barriers across sub-Saharan Africa, country-specific strategies are required to tackle the challenges mentioned. Governments need to develop strategies to improve healthcare systems and overall socioeconomic status of women, in order to tackle supply- and demand-side access barriers to obstetric care. It is also important that strategies adopted are supported by research evidence appropriate for local conditions. Finally, more research is needed, particularly, with regard to supply-side interventions that may improve the obstetric care experience of pregnant women. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2014 CRD42014015549.
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Affiliation(s)
- Minerva Kyei-Nimakoh
- Disciplines of Nursing and Midwifery, Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, PO Box 14428, Melbourne, Victoria 8001 Australia
| | - Mary Carolan-Olah
- Disciplines of Nursing and Midwifery, Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, PO Box 14428, Melbourne, Victoria 8001 Australia
| | - Terence V. McCann
- Disciplines of Nursing and Midwifery, Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, PO Box 14428, Melbourne, Victoria 8001 Australia
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Otogara M, Karimi-Shahanjarini A, Hazavehei SMM, Poorolajal J, Radnia N, Akrami F, Bagheri F. Exploring perceptions of instructors about childbirth preparation training courses: A qualitative study. Electron Physician 2017; 9:4215-4224. [PMID: 28607658 PMCID: PMC5459295 DOI: 10.19082/4215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 02/14/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Childbirth preparation training courses on maternal and neonatal health increase awareness, and capability of pregnant women in overcoming fear and anxiety and managing labor pains. OBJECTIVE To identify the affecting factors and barriers of these courses from the perspective of their instructors. METHODS This qualitative study of the content analysis type, has been conducted on 16 certified teachers of the training courses of the Hamadan city in 2015. Data were collected by semi-structured in-depth interviews and were then analyzed by using MAXQDA10 application. RESULTS Participants' experiences are indicated on three main themes including the objectives of the course, facilitators and barriers. The main objectives of the course were reported as to improve maternal and newborn health, promote natural childbirth and preparedness for parenting and breastfeeding. The main facilitators of the successful implementation include observing educational standards, strengthening the communication and relationship between mothers and staff, mobilization, and the role of instructor. The major barriers are reported as inadequate support from management system, insufficient intra-sector collaboration, poor attitude of obstetricians and physicians, inadequate access, theory-practice gap and not intended to labor naturally. CONCLUSION The results of our study show that multiple factors are involved in the participation of pregnant women in antenatal classes. Promoting natural childbirth requires intra-sector and inter-sectoral collaboration, as well as the community participation.
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Affiliation(s)
- Marzieh Otogara
- Ph.D. Student of Health Education and Promotion, Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Akram Karimi-Shahanjarini
- Ph.D. of Health Education, Associate Professor, Social Determinates of Health Research Center and Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyed Mohammad Mehdi Hazavehei
- Ph.D. of Health Education, Professor, Research Center for Health Sciences and Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Jalal Poorolajal
- Ph.D. of Epidemiology, Associate Professor, Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Nahid Radnia
- M.D., Gynecologist, Assistant Professor, Department of Gynecology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Forouzan Akrami
- Ph.D. by Research Student, Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Bagheri
- Ph.D. Student of Health Education and Promotion, Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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Tancred T, Schellenberg J, Marchant T. Using mixed methods to evaluate perceived quality of care in southern Tanzania. Int J Qual Health Care 2016; 28:233-9. [PMID: 26823050 PMCID: PMC4833203 DOI: 10.1093/intqhc/mzw002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2015] [Indexed: 11/09/2022] Open
Abstract
Objective To compare perceived quality of maternal and newborn care using quantitative and qualitative methods. Design A continuous household survey (April 2011 to November 2013) and in-depth interviews and birth narratives. Setting Tandahimba district, Tanzania. Participants Women aged 13–49 years who had a birth in the previous 2 years were interviewed in a household survey. Recently delivered mothers and their partners participated in in-depth interviews and birth narratives. Intervention None. Main Outcome Measures Perceived quality of care. Results Quantitative: 1138 women were surveyed and 93% were confident in staff availability and 61% felt that required drugs and equipment would be available. Drinking water was easily accessed by only 60% of respondents using hospitals. Measures of interaction with staff were very positive, but only 51% reported being given time to ask questions. Unexpected out-of-pocket payments were higher in hospitals (49%) and health centres (53%) than in dispensaries (31%). Qualitative data echoed the lack of confidence in facility readiness, out-of-pocket payments and difficulty accessing water, but was divergent in responses about interactions with health staff. More than half described staff interactions that were disrespectful, not polite, or not helpful. Conclusion Both methods produced broadly aligned results on perceived readiness, but divergent results on perceptions about client–staff interactions. Benefits and limitations to both quantitative and qualitative approaches were observed. Using mixed methodologies may prove particularly valuable in capturing the user experience of maternal and newborn health services, where they appear to be little used together.
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Affiliation(s)
- Tara Tancred
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Tanya Marchant
- London School of Hygiene and Tropical Medicine, London, UK
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