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Sangy MT, Duaso M, Feeley C, Walker S. Barriers and facilitators to the implementation of midwife-led care for childbearing women in low- and middle-income countries: A mixed-methods systematic review. Midwifery 2023; 122:103696. [PMID: 37099826 DOI: 10.1016/j.midw.2023.103696] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/22/2023] [Accepted: 04/11/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Evidence from high-income countries demonstrate improvements in maternal and neonatal health with midwife-led care. Midwife-led care is pivotal to meet the United Nations' Sustainable Development Goals. Despite this, successful implementation of midwife-led care in low- and middle-income countries (LMICs) has been limited. It is therefore necessary to understand the factors that influence the implementation of midwife-led care. AIM This systematic review aimed to synthesize the evidence on barriers and facilitators to the implementation of midwife-led care for childbearing women in LMICs from the perspectives of care recipients, providers and wider stakeholders. METHODS A mixed-methods systematic review was conducted of primary research studies that expressed the views of those involved in or affected by the implementation of midwife-led care in LMICs. Reporting followed PRISMA guidelines. MEDLINE, EMBASE, PsychINFO, CINAHL, Maternity and Infant Care database (MIDIRS), Global Health and Web of Science databases were systematically searched. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Data was analysed and synthesized using the Supporting the Use of Research Evidence (SURE) framework to identify barriers and enabling factors to implementing midwife-led care. FINDINGS A total of 31 studies from 21 LMICs were included. At the care recipient level, women need adequate knowledge and confidence about midwife-led care to utilise services. At the care provider level, strengthening midwifery education and practice by employing experienced educators and supervisors is essential. Findings also suggest that increased collaboration between funders, professional organisations, practitioners, communities, and the government is necessary for successful implementation. However, adequate and sustained funding for midwife-led care programs is often lacking and political instability contributes to poor implementation in LMICs. CONCLUSION AND IMPLICATIONS FOR PRACTICE AND RESEARCH There are several enabling factors which increase the success and sustainability of the midwife-led model of care in LMICs. However, current practice guidelines and strategic frameworks need to better reflect the infrastructure and resource limitations of health settings in LMICs.
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Affiliation(s)
- Marie Therese Sangy
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings' College, London, UK.
| | - Maria Duaso
- Senior Lecturer, Florence Nightingale Faculty of Nursing, Midwifery and Palliative care, Kings' College, London, UK
| | - Claire Feeley
- Lecturer (Research & Teaching), Florence Nightingale Faculty of Nursing, Midwifery and Palliative care, Kings' College, London, UK
| | - Shawn Walker
- Senior Research Fellow, Florence Nightingale Faculty of Nursing, Midwifery and Palliative care, Kings' College, London, UK
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Essis EML, Yaméogo WME, Sossa OG, Doukouré D, Compaoré R, Kpebo DOD, Agbré-Yacé ML, Aka J, Tiembré I, Sondo B, Kouanda S. Development of Monitoring and Evaluation Systems in Four National Programs Addressing Mother and Child Health in Cote d'Ivoire: Qualitative Analysis of the Emergence and Formulation Process. Risk Manag Healthc Policy 2023; 16:699-709. [PMID: 37073282 PMCID: PMC10106087 DOI: 10.2147/rmhp.s377617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 03/24/2023] [Indexed: 04/20/2023] Open
Abstract
Background Monitoring and evaluation were introduced into the management of national health programs to ensure that results were attained, and that donors' funds were used transparently. This study aims to describe the process of the emergence and formulation of monitoring and evaluation (M&E) systems in national programs addressing maternal and child health in Cote d'Ivoire. Methods We conducted a multilevel case study combining a qualitative investigation and a literature review. This study took place in the city of Abidjan, where in-depth interviews were conducted with twenty-four (24) former officials who served at the central level of the health system and with six (06) employees from the technical and financial partners' agencies. A total of 31 interviews were conducted from January 10 to April 20, 2020. Data analysis was conducted according to the Kingdon conceptual framework modified by Lemieux and adapted by Ridde. Results The introduction of M&E in national health programs was due to the will of the technical and financial partners and the political and technical decision-makers at the central level of the national health system, who were concerned with accountability and convincing results in these programs. However, its formulation through a top-down approach was sketchy and lacked content to guide its implementation and future evaluation in the absence of national expertise in M&E. Conclusion The emergence of M&E systems in national health programs was originally endogenous and exogenous but strongly recommended by donors. Its formulation in the context of limited national expertise was marked by the absence of standards and guidelines that could codify the development of robust M&E systems.
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Affiliation(s)
- Esme Marie Laure Essis
- National Institute of Public Health, Abidjan, Cote d’Ivoire
- Reproductive Health Research Unit of Cote d’Ivoire, Abidjan, Cote d'Ivoire
- Doctoral School in Science, Health, and Technology, Saint Thomas Aquinas University, Ouagadougou, Burkina Faso
- Correspondence: Esme Marie Laure Essis, National Institute of Public Health, Abidjan, BP V 47, Cote d’Ivoire, Tel +225 07 07 88 72 13, Fax +225 20 22 44 02, Email
| | | | - Olivier Gbènamblo Sossa
- Department of Economics and Management, Thomas Sankara University, Ouagadougou, Burkina Faso
| | - Daouda Doukouré
- National Institute of Public Health, Abidjan, Cote d’Ivoire
- Reproductive Health Research Unit of Cote d’Ivoire, Abidjan, Cote d'Ivoire
| | - Rachidatou Compaoré
- African Institute of Public Health, Saint Thomas Aquinas University, Saaba, Burkina Faso
- Research Institute of Health Sciences, Ouagadougou, Burkina Faso
| | - Djoukou Olga Denise Kpebo
- National Institute of Public Health, Abidjan, Cote d’Ivoire
- Reproductive Health Research Unit of Cote d’Ivoire, Abidjan, Cote d'Ivoire
- Department of Public Health, Felix Houphouët Boigny University, Abidjan, Cote d’Ivoire
| | - Marie Laurette Agbré-Yacé
- National Institute of Public Health, Abidjan, Cote d’Ivoire
- Reproductive Health Research Unit of Cote d’Ivoire, Abidjan, Cote d'Ivoire
| | - Joseph Aka
- National Institute of Public Health, Abidjan, Cote d’Ivoire
- Department of Public Health, Felix Houphouët Boigny University, Abidjan, Cote d’Ivoire
| | - Issiaka Tiembré
- Department of Public Health, Felix Houphouët Boigny University, Abidjan, Cote d’Ivoire
- National Institute of Public Hygiene, Abidjan, Cote d’Ivoire
| | - Blaise Sondo
- African Institute of Public Health, Saint Thomas Aquinas University, Saaba, Burkina Faso
| | - Seni Kouanda
- African Institute of Public Health, Saint Thomas Aquinas University, Saaba, Burkina Faso
- Research Institute of Health Sciences, Ouagadougou, Burkina Faso
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Hajra Mukasa C, Nankanja M, Mugisa M, Valentine O, Kagurusi P. Evaluation of a WASH/MNCH targeted primary health care program in Uganda; a mixed methods study. Health Psychol Behav Med 2023; 11:2185245. [PMID: 36925760 PMCID: PMC10013331 DOI: 10.1080/21642850.2023.2185245] [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: 03/16/2023] Open
Abstract
Background Evidence on the impact of Maternal Newborn and child health (MNCH) and Water, Sanitation and Hygiene (WASH) interventions on skilled birth attendance (SBA) and neonatal sepsis remains unclear. We conducted this study in Amuru district to generate evidence. Methods A before-and-after study design was conducted. Interventions implemented included; training of HCWs, construction of WASH facilities, and health education of communities. A digitized structured questionnaire was used to obtain data on ANC and SBA, WASH practices and prevalence of pneumonia and diarrhea among 466 expectant mothers and caretakers of under-fives at baseline, midterm and endline. Data on sepsis incidence, ANC, SBA and WASH status was obtained from six healthcare facilities. A total of 12 KIIs and 12 FGDs were conducted. Data were analyzed using STATA 15. Two sample tests of proportions were used to compare findings at baseline and endline. Qualitative data were analyzed using thematic content analysis. Results The number of women delivering at HCFs significantly increased from 41.4% to 63.0% (p < .0001). Incidence of neonatal sepsis reduced from 0.6% to 0.2% (p = .0687), although the difference was not significant. Community-level findings also indicated a decline in cases of water-borne illnesses; cases of dysentery decreased from 10.0% to 0.6%, cases of cholera decreased from 8.9% to 1.9% at endline, cases of typhoid decreased from 26.5% to 12.7% at endline. Conclusion This study revealed that integrated WASH/MNCH interventions can significantly increase ANC and SBA, reduce incidences of neonatal sepsis, diarrhea, pneumonia, and other related diseases and improve WASH practices in communities. Significant improvements in WASH/IPC and the capacity of HCWs to deliver safe MNCH services are realized.
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Tusabe F, Lamorde M, Medley A, Kesande M, Lozier MJ, Yapswale S, Ociti F, Isabirye H, Nuwamanya E, Nanyondo J, Boore A, Vosburgh W, Kasule JN, Pratt C, Berendes D. Establishment of District-Led Production of WHO-Recommended Alcohol-based Hand Rub (ABHR) during the COVID-19 Pandemic: A Model for Improving Access to ABHR during Health Emergencies. JOURNAL OF WATER, SANITATION, AND HYGIENE FOR DEVELOPMENT : A JOURNAL OF THE INTERNATIONAL WATER ASSOCIATION 2023; 13:847-856. [PMID: 38410156 PMCID: PMC10896262 DOI: 10.2166/washdev.2023.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
In response to the COVID-19 pandemic, we established and sustained local production of alcohol-based handrub (ABHR) at district scale for healthcare facilities and community, public locations in four districts in Uganda. District officials provided space and staff for production units. The project renovated space for production, trained staff on ABHR production, and transported ABHR to key locations. The production officer conducted internal ABHR quality assessments while trained district health inspectors conducted external quality assessments prior to distribution. Information, education, and communication materials accompanied ABHR distribution. Onsite ABHR consumption was monitored by site staff using stock cards. On average, it took 11 days (range: 8-14) and 5,760 USD (range: 4,400-7,710) to set up a production unit. From March-December 2021, 21,600L of quality-controlled ABHR were produced for 111 healthcare facilities and community locations at an average cost of 4.30 USD/L (range: 3.50-5.76). All ABHR passed both internal and external quality control (average ethanol concentration of 80%, range: 78-81%). This case study demonstrated that establishing centralized, local production of quality-controlled, affordable ABHR at a district-wide scale is feasible and strengthens the ability of healthcare workers and community locations to access and use ABHR during infectious disease outbreaks in low-resource countries.
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Affiliation(s)
- Fred Tusabe
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Alexandra Medley
- Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd. Mailstop H24-11, Atlanta, GA, USA, 30329
| | - Maureen Kesande
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Matthew J. Lozier
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd. Mailstop H24-11, Atlanta, GA, USA, 30329
| | - Sauda Yapswale
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Francis Ociti
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Herbert Isabirye
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Elly Nuwamanya
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Judith Nanyondo
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Amy Boore
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention (CDC), Country Office Kampala, Uganda
| | - Waverly Vosburgh
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention (CDC), Country Office Kampala, Uganda
| | - Juliet N. Kasule
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention (CDC), Country Office Kampala, Uganda
| | - Caroline Pratt
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd. Mailstop H24-11, Atlanta, GA, USA, 30329
| | - David Berendes
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd. Mailstop H24-11, Atlanta, GA, USA, 30329
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Anaba EA, Alangea DO, Addo-Lartey A, Modey EJ, Manu A, Alor SK, Torpey K. Determinants of health facility delivery among young mothers in Ghana; insights from the 2014 Ghana Demographic and Health Survey. BMC Pregnancy Childbirth 2022; 22:656. [PMID: 35987562 PMCID: PMC9392919 DOI: 10.1186/s12884-022-04985-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Globally, young women deliver at home, often under unhygienic conditions and without skilled birth attendants. This study identified the determinants of health facility delivery among young mothers in Ghana.
Methods
We analysed secondary data from the 2014 Ghana Demographic and Health Survey, which collected data across the former ten administrative regions of Ghana. This study analysed data from the ‘women file’ by adjusting for the sample weight. STATA/SE version 16 was employed to analyse the data by computing descriptive statistics, Chi-square, and Binary Logistic Regression.
Results
Seven in ten young mothers gave birth in a health facility. Young mothers who had secondary school education were over three-fold more likely to deliver in a health facility (AOR = 3.5, 95% CI: 1.33–9.23) compared with young mothers with no formal education. Young mothers who resided in rural areas had lower odds (73%) of delivering in a health facility (AOR = 0.27; 95% CI: 0.14–0.514) compared with those in urban areas. Young mothers within the richest wealth quintile also had higher odds (8 times) of delivering in a health facility (AOR = 8.24; 95% CI: 0.95–71.77) compared with those within the poorest wealth quintile. Young mothers who obtained four to seven antenatal visits (AOR = 0.53; 95% CI: 0.27–1.03) had lower odds of delivering in a health facility compared with those who obtained eight or more antenatal visits.
Conclusion
The majority of young mothers in Ghana gave birth in a health facility. The likelihood of delivering in a health facility was influenced by socio-demographic factors, economic factors and utilization of antenatal care services. Therefore, interventions aimed at increasing utilization of skilled delivery among young women should focus on promoting girl child education, economic status and antenatal care visits.
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Ali S, Kabajaasi O, Kawooya MG, Byamugisha J, Zakus D, Papageorghiou AT, Klipstein-Grobusch K, Rijken MJ. Antenatal Doppler ultrasound implementation in a rural sub-Saharan African setting: exploring the perspectives of women and healthcare providers. Reprod Health 2021; 18:199. [PMID: 34620186 PMCID: PMC8499453 DOI: 10.1186/s12978-021-01233-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background The World Health Organization recommends research to evaluate the effects of a single third trimester Doppler ultrasound examination on preventable deaths in unselected-risk pregnancies, particularly in low- and middle-income countries (LMICs) where the evidence base is scarce. While evaluating such technologies, researchers often ignore women and health care provider perspectives. This study explored the views and experiences of women and healthcare providers regarding the use of advanced ultrasound technology to optimize the health of mothers and their babies in a rural community in mid-western Uganda. Methods We enrolled 53 mothers and 10 healthcare providers, and captured data on their perceptions, barriers, and facilitators to the use of Doppler ultrasound technology using focus group discussions, semi-structured interviews and observations. Using qualitative content analysis, we inductively coded the transcripts in ATLAS.ti 8.0, detecting emerging themes. Results Women were afraid that ultrasound would harm them or their fetuses and many of them had never seen an ultrasound scan. The majority of the women found their partners supportive to attend antenatal care and use ultrasound services. Healthcare providers in Kagadi Hospital were unfamiliar with Doppler technology and using it to guide clinical decisions. Other barriers to the implementation of Doppler ultrasound included shortage of trained local staff, insufficient equipment, long distance to and from the hospital, and frequent power cuts. Conclusions We found limited exposure to Doppler ultrasound technology among women and healthcare providers in mid-western Uganda. Engaging male partners may potentially influence the likelihood of accepting and using it to improve the health of women and their fetuses while wide spread myths and misconceptions about it may be changed by community engagement. Healthcare workers experienced difficulties in offering follow-up care to mothers detected with complications and Doppler ultrasound required a high level of training. While introducing advanced ultrasound machines to weak health systems, it is important to adequately train healthcare providers to avoid inappropriate interventions based on misinterpretation of the findings, consider where it is likely to be most beneficial, and embed it with realistic clinical practice guidelines. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01233-5. Globally, nearly three million babies are stillborn every year, but most especially in low- and middle-income countries like Uganda. One of the factors contributing to a high number of stillbirths in low-income countries is the difficulty in identifying complications and accessing high quality care during pregnancy. Although antenatal Doppler scans are being widely used to diagnose complications in high-risk pregnancies in developed countries, studies evaluating it in LMICs are needed before it is implemented on a wide scale. We engaged 53 mothers, eight health workers from a hospital and two healthcare managers from a local government in Uganda to attain their opinions about Doppler ultrasound. We found that spousal involvement may promote acceptance and use of ultrasound services. However, the health workers did not have adequate knowledge about Doppler technology and using it for the benefit of mothers and the mothers feared that ultrasound procedures might harm them or their unborn babies. Making matters worse, the hospital faced frequent power cuts that affected the use of the equipment. Further, mothers must cover a long distance to access the hospital and its services. To reduce the number of babies dying during pregnancy or a few days after birth in Uganda and similar low-resource settings using Doppler technology, it is essential to strengthen the health systems. Starting with the training of healthcare providers to equipping and stabilizing power supply in health facilities, and educating the public about critical health procedures to break myths and misconceptions.
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Affiliation(s)
- Sam Ali
- Department of Research, Ernest Cook Ultrasound Research and Education Institute (ECUREI), Mengo Hospital, Sir Albert Cook Building, Albert Cook Road, P.O. Box 7161, Kampala, Uganda. .,School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda. .,Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | | | - Michael G Kawooya
- Department of Research, Ernest Cook Ultrasound Research and Education Institute (ECUREI), Mengo Hospital, Sir Albert Cook Building, Albert Cook Road, P.O. Box 7161, Kampala, Uganda
| | - Josaphat Byamugisha
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Zakus
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Aris T Papageorghiou
- Nuffield Department of Women's and Reproductive Health, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Marcus J Rijken
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Mukuru M, Kiwanuka SN, Gibson L, Ssengooba F. Challenges in implementing emergency obstetric care (EmOC) policies: perspectives and behaviours of frontline health workers in Uganda. Health Policy Plan 2021; 36:260-272. [PMID: 33515014 DOI: 10.1093/heapol/czab001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/29/2020] [Accepted: 01/04/2021] [Indexed: 12/12/2022] Open
Abstract
Uganda is among the sub-Saharan African Countries which continue to experience high preventable maternal mortality due to obstetric emergencies. Several Emergency Obstetric Care (EmOC) policies rolled out have never achieved their intended targets to date. To explore why upstream policy expectations were not achieved at the frontline during the MDG period, we examined the implementation of EmOC policies in Uganda by; exploring the barriers frontline implementers of EmOC policies faced, their coping behaviours and the consequences for maternal health. We conducted a retrospective exploratory qualitative study between March and June 2019 in Luwero, Iganga and Masindi districts selected based on differences in maternal mortality. Data were collected using 8 in-depth interviews with doctors and 17 midwives who provided EmOC services in Uganda's public health facilities during the MDG period. We reviewed two national maternal health policy documents and interviewed two Ministry of Health Officials on referral by participants. Data analysis was guided by the theory of Street-Level Bureaucracy (SLB). Implementation of EmOC was affected by the incompatibility of policies with implementation systems. Street-level bureaucrats were expected to offer to their continuously increasing clients, sometimes presenting late, ideal EmOC services using an incomplete and unreliable package of inputs, supplies, inadequate workforce size and skills mix. To continue performing their duties and prevent services from total collapse, frontline implementers' coping behaviours oftentimes involved improvization leading to delivery of incomplete and inconsistent EmOC service packages. This resulted in unresponsive EmOC services with mothers receiving inadequate interventions sometimes after major delays across different levels of care. We suggest that SLB theory can be enriched by reflecting on the consequences of the coping behaviours of street-level bureaucrats. Future reforms should align policies to implementation contexts and resources for optimal results.
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Affiliation(s)
- Moses Mukuru
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Suzanne N Kiwanuka
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Linda Gibson
- School of Social Sciences, Nottingham Trent University, 50 Shakespeare Street, Nottingham NG1 4FQ, UK
| | - Freddie Ssengooba
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
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Ssegujja E, Andipatin M. Building on momentum from the global campaigns: an exploration of factors that influenced prioritization of stillbirth prevention at the national level in Uganda. Global Health 2021; 17:66. [PMID: 34174919 PMCID: PMC8236146 DOI: 10.1186/s12992-021-00724-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 06/15/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Of the close to 2.6 million stillbirths that happen annually, most are from low-income countries where until recently policies rarely paid special attention to addressing them. The global campaigns that followed called on countries to implement strategies addressing stillbirths and the adoption of recommendations varied according to contexts. This study explored factors that influenced the prioritization of stillbirth reduction in Uganda. METHODS The study employed an exploratory qualitative design adopting Shiffman's framework for political prioritization. Data collection methods included a document review and key informants' interviews with a purposively selected sample of 20 participants from the policy community. Atlas. Ti software was used for data management while thematic analysis was conducted to analyze the findings. FINDINGS Political prioritization of stillbirth interventions gained momentum following norm promotion from the global campaigns which peaked during the 2011 Lancet stillbirth series. This was followed by funding and technical support of various projects in Uganda. A combination of domestic advocacy factors such as a cohesive policy community converging around the Maternal and Child Health cluster accelerated the process by vetting the evidence and refining recommendations to support the adoption of the policy. The government's health systems strengthening aspirations and integration of interventions to address stillbirths within the overall Maternal and Child Health programming resonated well. CONCLUSIONS The transnational influence played a key role during the initial stages of raising attention to the problem and provision of technical and financial support. The success and subsequent processes, however, relied heavily on domestic advocacy and the national political environment, and the cohesive policy community.
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Affiliation(s)
- Eric Ssegujja
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda.
- School of Public Health, University of the Western Cape, Cape Town, South Africa.
| | - Michelle Andipatin
- Department of Psychology, University of the Western Cape, Cape Town, South Africa
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Dey T, Ononge S, Weeks A, Benova L. Immediate postnatal care following childbirth in Ugandan health facilities: an analysis of Demographic and Health Surveys between 2001 and 2016. BMJ Glob Health 2021; 6:bmjgh-2020-004230. [PMID: 33888487 PMCID: PMC8070850 DOI: 10.1136/bmjgh-2020-004230] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/27/2021] [Accepted: 03/30/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Progress in reducing maternal and neonatal mortality, particularly in sub-Saharan Africa, is insufficient to achieve the Sustainable Developmental Goals by 2030. The first 24 hours following childbirth (immediate postnatal period), where the majority of morbidity and mortality occurs, is critical for mothers and babies. In Uganda,<50% of women reported receiving such care. This paper describes the coverage, changes over time and determinants of immediate postnatal care in Uganda after facility births between 2001 and 2016. Methods We analysed the 2006, 2011 and 2016 Ugandan Demographic and Health Surveys, including women 15–49 years with most recent live birth in a healthcare facility during the survey 5-year recall period. Immediate postnatal care coverage and changes over time were presented descriptively. Multivariable logistic regression was used to examine determinants of immediate postnatal care. Results Data from 12 872 mothers were analysed. Between 2006 and 2016, births in healthcare facilities increased from 44.6% (95% CI: 41.9% to 47.3%) to 75.2% (95% CI: 73.4% to 77.0%) and coverage of immediate maternal postnatal care from 35.7% (95% CI 33.4% to 38.1%) to 65.0% (95% CI: 63.2% to 66.7%). The majority of first checks occurred between 1 and 4 hours post partum; the median time reduced from 4 hours to 1 hour. The most important factor associated with receipt of immediate postnatal care was women having a caesarean section birth adjusted OR (aOR) 2.93 (95% CI: 2.28 to 3.75). Other significant factors included exposure to mass media aOR 1.38 (95% CI: 1.15 to 1.65), baby being weighed at birth aOR 1.84 (95% CI: 1.58 to 2.14) and receipt of antenatal care with 4+Antenatal visits aOR 2.34 (95% CI: 1.50 to 3.64). Conclusion In Uganda, a large gap in coverage remains and universal immediate postnatal care has not materialised through increasing facility-based births or longer length of stay. To ensure universal coverage of high-quality care during this critical time, we recommend that maternal and newborn services should be integrated and actively involve mothers and their partners.
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Affiliation(s)
- Teesta Dey
- Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Sam Ononge
- Department of Obstetrics and Gynaecology, Makerere University, Kampala, Uganda
| | - Andrew Weeks
- Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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Kabiri N, Khodayari‐zarnaq R, Khoshbaten M, Janati A. Policy Analysis of Gastrointestinal Cancer Prevention in Iran: A Framework Based on a Qualitative Study. WORLD MEDICAL & HEALTH POLICY 2021. [DOI: 10.1002/wmh3.389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Zhou D, Zhou Z, Yang C, Ji L, Ghose B, Tang S. Sociodemographic characteristics associated with the utilization of maternal health services in Cambodia. BMC Health Serv Res 2020; 20:781. [PMID: 32831074 PMCID: PMC7444029 DOI: 10.1186/s12913-020-05652-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/13/2020] [Indexed: 11/16/2022] Open
Abstract
Background Cambodia is a Southeast Asian country and has one the highest rates of maternal and child mortality with inadequate use of maternal healthcare services in the region. The present study aimed to analyse the progress made in terms of using maternal healthcare services since 2000. Methods Two rounds of Demographic and Health Surveys (DHS 2000 and DHS 2014) were used in the study. Sample population consisted 11,961 women aged between 15 and 49 years. The outcome measures were: Timing of first antenatal care (ANC) attendance, adequacy of ANC attendance, place of delivery and postnatal checkup. WHO guidelines were used to set the cut-off/define these measures. Data were analyzed in Stata version 14 using descriptive and multivariate regression analyses. Results Findings indicated that the overall prevalence of making the first ANC visit in the first trimester was 64.19% [95%CI = 62.22,66.11], and that of having at least four ANC visits was 43.80% [95%CI = 41.89,45.73]. Prevalence of health facility delivery was 48.76% [46.62,50.90] and that of postnatal checkup was 71.14% [95%CI = 69.21,73.01]. Between 2000 and 2014, the percentage of timely and adequate use of ANC increased by respectively 61.8 and 65.3%, while that of health facility delivery and postnatal care increased by respectively 74.5 and 43.9%. Important demographic, socioeconomic and geographic disparities were observed in the utilization of ANC, health facility delivery and postnatal care services. Urban residency, having better educational status, white collar job, access to electronic media showed positive association, whereas higher parity (having > 2 children) and unwanted pregnancy showed negative association with the use of maternal healthcare services. Having at least four ANC visits was associated with significantly increased higher odds of using health facility delivery and postnatal care. Conclusion There has a been a remarkable increase in the prevalence of women who are using the maternal healthcare services since 2000. The current findings provide important insights regarding the sociodemographic factors associated with the utilization of maternal health services in Cambodia that could contribute to evidence-based health policy making and designing intervention programs.
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Affiliation(s)
- Donghua Zhou
- School of Physical Education, Research Center of Sports and Health, Wuhan Business University, Wuhan, 430056, Hubei, P. R. China
| | - Zhonghe Zhou
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, 110840, Liaoning, China
| | - Cheng Yang
- School of Physical Education, Wuhan Business University, Wuhan, 430056, Hubei, P. R. China
| | - Lu Ji
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, P. R. China
| | - Bishwajit Ghose
- Faculty of Social Sciences, University of Ottawa, Ottawa, Canada
| | - Shangfeng Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, P. R. China.
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Ismainar H, Subagio HW, Widjanarko B, Hadi C. To What Extent Do Ecological Factors of Behavior Contribute to the Compliance of the Antenatal Care Program in Dumai City, Indonesia? Risk Manag Healthc Policy 2020; 13:1007-1014. [PMID: 32801974 PMCID: PMC7414976 DOI: 10.2147/rmhp.s242724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 07/21/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Maternal mortality rate (MMR) in Indonesia is still relatively high, at 305 per 100.000 live births (2015). Routine visit to antenatal care is the best way to reduce MMR. Inspite of this, the number of antenatal care visits among pregnant women is still low. This study aimed to measure the influence of behavioral ecological factors with the compliance of pregnant women to visit antenatal care. Patients and Methods Study population was pregnant women living in Dumai City, Indonesia. This study was a quantitative research design with a cross-sectional. We used the cluster system to select participants. A total of 369 subjects participated with a gestation age between >12 until 40 weeks. The data were collected by face-to-face interviews using validated questioners. The analysis was done by bivariate analysis using the Spearman correlation test. Multivariate using multiple linear regression. Results This study showed that factors of the ecological model of behavior were related to antenatal care compliance (p value<0.05) with a coefficient correlation (0.330-0.569). Multivariate analysis showed that all variables associated significantly (adjusted R2; 0.104-0.311). Five variables were dominant; knowledge, cultural beliefs, family support, friend support, and health facilities with adjusted R2= 0.518. Conclusion Five factors in an ecological model of behavior, such as knowledge, cultural beliefs, family support, friend support, and health facilities, proportion (51,8%) of contributing to antenatal care compliance. We recommend a health district program to make services more accessible to pregnant women. Health education programs need to increase the knowledge of pregnant women and families to provide support in antenatal care compliance. Local governments shall improve antenatal care quality by mapping, planning, and evaluating this program.
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Affiliation(s)
- Hetty Ismainar
- Doctoral Program, Faculty of Public Health, Diponegoro University, Semarang, Indonesia
| | - Hertanto W Subagio
- Department of Nutrition, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Bagoes Widjanarko
- Doctoral Program, Faculty of Public Health, Diponegoro University, Semarang, Indonesia.,Department of Health Promotion, Faculty of Public Health, Diponegoro University, Semarang, Indonesia
| | - Cahyono Hadi
- Department Obstetrics and Gynecology, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
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Mattison CA, Lavis JN, Wilson MG, Hutton EK, Dion ML. A critical interpretive synthesis of the roles of midwives in health systems. Health Res Policy Syst 2020; 18:77. [PMID: 32641053 PMCID: PMC7346500 DOI: 10.1186/s12961-020-00590-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Midwives' roles in sexual and reproductive health and rights continues to evolve. Understanding the profession's role and how midwives can be integrated into health systems is essential in creating evidence-informed policies. Our objective was to develop a theoretical framework of how political system factors and health systems arrangements influence the roles of midwives within the health system. METHODS A critical interpretive synthesis was used to develop the theoretical framework. A range of electronic bibliographic databases (CINAHL, EMBASE, Global Health database, HealthSTAR, Health Systems Evidence, MEDLINE and Web of Science) was searched through to 14 May 2020 as were policy and health systems-related and midwifery organisation websites. A coding structure was created to guide the data extraction. RESULTS A total of 4533 unique documents were retrieved through electronic searches, of which 4132 were excluded using explicit criteria, leaving 401 potentially relevant records, in addition to the 29 records that were purposively sampled through grey literature. A total of 100 documents were included in the critical interpretive synthesis. The resulting theoretical framework identified the range of political and health system components that can work together to facilitate the integration of midwifery into health systems or act as barriers that restrict the roles of the profession. CONCLUSIONS Any changes to the roles of midwives in health systems need to take into account the political system where decisions about their integration will be made as well as the nature of the health system in which they are being integrated. The theoretical framework, which can be thought of as a heuristic, identifies the core contextual factors that governments can use to best leverage their position when working to improve sexual and reproductive health and rights.
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Affiliation(s)
- Cristina A Mattison
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, 1280 Main St. West, HSC-4H26, Hamilton, ON, L8S 4K1, Canada.
| | - John N Lavis
- McMaster Health Forum, 1280 Main St West, MML-417, Hamilton, ON, L8S 4L6, Canada
| | - Michael G Wilson
- McMaster Health Forum, 1280 Main St West, MML-417, Hamilton, ON, L8S 4L6, Canada
| | - Eileen K Hutton
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, 1280 Main St. West, HSC-4H26, Hamilton, ON, L8S 4K1, Canada
| | - Michelle L Dion
- Department of Political Science, McMaster University, 1280 Main St. West, KTH-533, Hamilton, ON, L8S 4M4, Canada
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Graduate Midwifery Education in Uganda Aiming to Improve Maternal and Newborn Health Outcomes. Ann Glob Health 2020; 86:52. [PMID: 32477888 PMCID: PMC7243829 DOI: 10.5334/aogh.2804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Maternal and newborn health outcomes in Uganda have remained poor. The major challenge affecting the implementation of maternal and newborn interventions includes a shortage of skilled midwives. In 2013, Lira University, a Ugandan Public University, in partnership with Seed Global Health, started the first Bachelor of Science in Midwifery (BScM) in Uganda with a vision to develop a Master of Science in Midwifery (MScM) in the future. Objective: Evaluate results of Lira University’s Bachelors in Midwifery program to help inform the development of a Masters in Midwifery program, which would expand midwifery competencies in surgical obstetric and newborn care. Methods: Lira University and Ministry of Health records provided data on curriculum content, student enrollment and internships. The internship reports of the graduate midwives were reviewed to collect data on their employment and scope of practice. Interviews were also conducted with the graduates to confirm the added skills they were able to apply and their outcomes. Findings: The critical competences incorporated into the Bachelor in Midwifery curriculum included competences to care for pre- and post-operative caesarian section patients or assist in a caesarean section, newborn care (e.g. resuscitation from birth asphyxia), anesthesia, and theatre techniques, among others. Overall, 356 students (40.2% male, 59.8% female) enrolled in the BScM program over the period 2013–2018. Annual data shows an increasing trend in enrollment. Of the 32 graduates in January 2019, 87.6% were employed in maternal and newborn healthcare facilities, and 12.4% were employed in midwifery private practice. Follow-up interviews revealed that the graduate midwives reported positive maternal and newborn outcomes and the ability to practice advanced obstetrics and newborn care skills they acquired from the training. Conclusion: There is growing interest in a graduate midwifery education program in Uganda for both male and female students. The retention of the graduate midwives in healthcare facilities gives a renewed hope for mothers and newborns, who benefit from their extra obstetrics and newborn care competences in settings where there are neither medical doctors nor obstetricians and gynecologists. Recommendations: Further, larger tracer studies of the graduate midwives to identify the kinds of obstetric surgeries and newborn care services they ably performed and their corresponding maternal and newborn health outcomes is recommended. Also recommended is advocacy for recognition of extra skills of graduate midwives by health authorities in Uganda and the region.
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