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Sarmiento I, Paredes-Solís S, De Jesús-García A, Maciel-Paulino N, Meneses-Rentería A, Amaya C, Cockcroft A, Andersson N. Traditional Midwifery Contribution to Safe Birth in Cultural Safety: Narrative Evaluation of an Intervention in Guerrero, Mexico. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:377-389. [PMID: 36189713 PMCID: PMC11143758 DOI: 10.1177/0272684x221120481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A 2017 randomised controlled trial in Guerrero State, Mexico, showed supporting Indigenous traditional midwives on their own terms improved traditional childbirths without inferior maternal health outcomes. This narrative evaluation complements the trial to document participant experience of safer birth in cultural safety, transformative dynamics and implementation issues of the intervention. Stories came from 26 traditional midwives, 28 apprentices, 12 intercultural brokers and 20 Indigenous women who experienced the intervention. Their accounts indicate the intervention revitalised traditional midwifery and consolidated local skills through traditional midwife apprentices and intercultural brokers to support safe birth. According to the stories, communities reintroduced traditional perinatal care and reported positive health impacts for mothers, children, and other adults, which contributed to early collaboration with official health services. Challenges included remuneration and disinterest of younger apprentices and brokers. The intervention seems to have improved interaction between traditional and Western services, setting the stage for further intercultural dialogue.
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Affiliation(s)
- Iván Sarmiento
- CIET-PRAM, Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Grupo de Estudios en Sistemas Tradicionales de Salud, Universidad del Rosario, Bogotá, Colombia
| | - Sergio Paredes-Solís
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, México
| | - Abraham De Jesús-García
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, México
| | - Nadia Maciel-Paulino
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, México
| | - Alba Meneses-Rentería
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, México
| | - Carolina Amaya
- Grupo de Estudios en Sistemas Tradicionales de Salud, Universidad del Rosario, Bogotá, Colombia
| | - Anne Cockcroft
- CIET-PRAM, Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Neil Andersson
- CIET-PRAM, Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, México
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Venzor Strader A, Sotz M, Gilbert HN, Miller AC, Lee AC, Rohloff P. A biosocial analysis of perinatal and late neonatal mortality among Indigenous Maya Kaqchikel communities in Tecpán, Guatemala: a mixed-methods study. BMJ Glob Health 2024; 9:e013940. [PMID: 38631704 PMCID: PMC11029291 DOI: 10.1136/bmjgh-2023-013940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/27/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Neonatal mortality is a global public health challenge. Guatemala has the fifth highest neonatal mortality rate in Latin America, and Indigenous communities are particularly impacted. This study aims to understand factors driving neonatal mortality rates among Maya Kaqchikel communities. METHODS We used sequential explanatory mixed methods. The quantitative phase was a secondary analysis of 2014-2016 data from the Global Maternal and Newborn Health Registry from Chimaltenango, Guatemala. Multivariate logistic regression models identified factors associated with perinatal and late neonatal mortality. A number of 33 in-depth interviews were conducted with mothers, traditional Maya midwives and local healthcare professionals to explain quantitative findings. RESULTS Of 33 759 observations, 351 were lost to follow-up. There were 32 559 live births, 670 stillbirths (20/1000 births), 1265 (38/1000 births) perinatal deaths and 409 (12/1000 live births) late neonatal deaths. Factors identified to have statistically significant associations with a higher risk of perinatal or late neonatal mortality include lack of maternal education, maternal height <140 cm, maternal age under 20 or above 35, attending less than four antenatal visits, delivering without a skilled attendant, delivering at a health facility, preterm birth, congenital anomalies and presence of other obstetrical complications. Qualitative participants linked severe mental and emotional distress and inadequate maternal nutrition to heightened neonatal vulnerability. They also highlighted that mistrust in the healthcare system-fueled by language barriers and healthcare workers' use of coercive authority-delayed hospital presentations. They provided examples of cooperative relationships between traditional midwives and healthcare staff that resulted in positive outcomes. CONCLUSION Structural social forces influence neonatal vulnerability in rural Guatemala. When coupled with healthcare system shortcomings, these forces increase mistrust and mortality. Collaborative relationships among healthcare staff, traditional midwives and families may disrupt this cycle.
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Affiliation(s)
- Anahí Venzor Strader
- Department of Global Health and Social Medicine "Blavatnik Institute", Harvard Medical School, Boston, Massachusetts, USA
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Center for Indigenous Health Research, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
| | - Magda Sotz
- Center for Indigenous Health Research, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
| | - Hannah N Gilbert
- Department of Global Health and Social Medicine "Blavatnik Institute", Harvard Medical School, Boston, Massachusetts, USA
| | - Ann C Miller
- Department of Global Health and Social Medicine "Blavatnik Institute", Harvard Medical School, Boston, Massachusetts, USA
| | - Anne Cc Lee
- Department of Pediatrics, Global Advancement of Infants and Mothers, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Rohloff
- Center for Indigenous Health Research, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Abdolalipour S, Mousavi S, Hadian T, Meedya S, Mohammad‐Alizadeh‐Charandabi S, Mohammadi E, Mirghafourvand M. Adolescent pregnant women's perception of health practices: A qualitative study. Nurs Open 2023; 10:6186-6196. [PMID: 37209034 PMCID: PMC10416080 DOI: 10.1002/nop2.1852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 01/14/2023] [Accepted: 05/07/2023] [Indexed: 05/21/2023] Open
Abstract
AIM To explore adolescent pregnant women's perception of health practices. DESIGN A qualitative study. METHOD Fifteen pregnant women in Tehran (capital of Iran) were selected based on purposive sampling to participate in semi-structured, in-depth interviews. The content of interviews was recorded and transcribed and then analysed using conventional content analysis. RESULTS The first theme extracted was health practice with main categories of balanced rest/activity pattern, observance of an appropriate diet, sensitivity to personal health, observance of an appropriate pattern of social interactions, religious and spiritual orientations, recreational and leisure time activities, and stress management; second theme was perceived benefits with main categories of a sense of physical health improvement, a sense of mental health improvement, positive attitudes towards the effect of nutrition on pregnancy and childbirth health; and third theme was effective factors with main categories of facilitators of health practices and inhibitors of health practices. CONCLUSIONS Most pregnant adolescents' perception of health practices is at a satisfactory level; however, some inhibitors of health practice were explored in this study. These should be improved by adopting appropriate approaches in health policies. No Patient or Public Contribution.
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Affiliation(s)
- Somyieh Abdolalipour
- Department of Midwifery, Faculty of Nursing and MidwiferyTabriz University of Medical SciencesTabrizIran
| | - Sanaz Mousavi
- Women Reproductive Health Research CenterTabriz University of Medical SciencesTabrizIran
| | - Tahereh Hadian
- Departement of MidwiferyIslamic Azad University, Tehran Medical BranchTehranIran
| | - Shahla Meedya
- South Asia Infant Feeding Research Network (SAIFRN), School of Nursing, Faculty of Science, Medicine and HealthUniversity of WollongongWollongongNew South WalesAustralia
| | | | - Eesa Mohammadi
- Department of Nursing, School of MedicineTarbiat Modares UniversityTehranIran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Faculty of Nursing and MidwiferyTabriz University of Medical sciencesTabrizIran
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Ruderman RS, Dahl EC, Williams BR, Feinglass JM, Kominiarek MA, Grobman WA, Yee LM. Obstetric Provider Perspectives on Postpartum Patient Navigation for Low-Income Patients. HEALTH EDUCATION & BEHAVIOR 2023; 50:260-267. [PMID: 34636273 PMCID: PMC9086643 DOI: 10.1177/10901981211043117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patient navigation programs have shown promise for improving health but are not widely used in obstetric care. Our objective was to understand obstetric provider perspectives on how to implement patient navigation to optimize care during the postpartum period for low-income patients. METHOD Focus groups were conducted with obstetric physicians, nurses, and social workers who care for low-income pregnant and postpartum patients in an academic medical center. Semistructured interview guides were developed to elicit conversations about the potential value of patient navigators, recommendations for navigator training, and how navigators could be most effective in improving postpartum care. Analysis of themes was based on the constant comparative method. RESULTS Twenty-six obstetric providers (six focus groups) discussed elements for a successful obstetric navigation program. Successful implementation themes included selecting navigators with appropriate interpersonal attributes, arranging navigator training, and identifying the most valuable services navigators could render. Desirable navigator attributes included persistence in patient advocacy, consistency, relatability, and a supportive manner. Training recommendations included learning the health care system, identifying where to obtain health system and community resources, and learning how be effective health educators. Suggested services were broad, ranging from traditional care coordination to specific educational and resource-driven tasks. CONCLUSIONS Obstetric providers perceive patient navigation to be a potentially beneficial resource to support low-income patients and offered recommendations for navigation implementation. These included suggestions for patient-centered navigators, with specific training and services focused on promoting care continuity and coordination.
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Affiliation(s)
- Rachel S. Ruderman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Emma C. Dahl
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Brittney R. Williams
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joe M. Feinglass
- Division of General Internal Medicine and Geriatrics, Department of Medicine, and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michelle A. Kominiarek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William A. Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lynn M. Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Mulongo SM, Kaura D, Mash B. Self-reported continuity and coordination of antenatal care and its association with obstetric near miss in Uasin Gishu county, Kenya. Afr J Prim Health Care Fam Med 2023; 15:e1-e8. [PMID: 36744454 PMCID: PMC9900303 DOI: 10.4102/phcfm.v15i1.3452] [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: 01/26/2022] [Revised: 05/23/2022] [Accepted: 06/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Continuity and coordination of care are core principles of high-quality primary health care. Optimising continuity and coordination improves maternal satisfaction. However, their association with morbidity and mortality outcomes is unclear. The obstetric near-miss approach can be used to investigate whether continuity and coordination influences the occurrence of a severe maternal outcome. AIM To compare self-reported continuity and coordination of care between obstetric near-miss survivors and those without near miss during pregnancy, delivery and postpartum. SETTING Uasin Gishu county, Rift Valley region, Kenya. METHODS A cross-sectional survey targeting 340 postnatal mothers. Continuity of care index (COCI) and modified continuity of care index (MCCI) were used to estimate longitudinal continuity. The Likert scale was administered to measure perceived continuity and coordination of care. Mann-Whitney U test and binomial logistic regression were used for hypothesis testing. RESULTS COCI and MCCI were lower among near-miss survivors (COCI = 0.80, p = 0.0026), (MCCI = 0.62, p = 0.034). Near-miss survivors scored lower on items assessing coordination between a higher-level provider and usual antenatal clinic (mean = 3.6, p = 0.006) and general coordination of care during pregnancy (mean = 3.9, p = 0.019). Presence of a non-life-threatening morbidity in pregnancy was associated with occurrence of near miss (aOR = 4.34, p = 0.001). CONCLUSION Near-miss survivors scored lower on longitudinal continuity and coordination of care across levels. Further research should focus on strengthening coordination, determining the optimal level of longitudinal continuity and improving systems for early identification and management of morbidities in pregnancy.Contribution: The results of this study show that while longitudinal and relational COC is important during the antenatal period, the presence of a non-life-threatening condition in pregnancy remains the most important predictor of the occurrence of a near miss.
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Affiliation(s)
- Samuel M. Mulongo
- Department of Nursing, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Doreen Kaura
- Department of Nursing, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Bob Mash
- Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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OjiNjideka Hemphill N, Crooks N, Zhang W, Fitter F, Erbe K, Rutherford JN, Liese KL, Pearson P, Stewart K, Kessee N, Reed L, Tussing-Humphreys L, Koenig MD. Obstetric experiences of young black mothers: An intersectional perspective. Soc Sci Med 2023; 317:115604. [PMID: 36549014 PMCID: PMC9854070 DOI: 10.1016/j.socscimed.2022.115604] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/28/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND In Chicago, maternal morbidity and mortality is six times more likely among Black birthing people than white, despite policy initiatives to promote maternal health equity. Disparities in maternal morbidity and mortality reflect experiences of structural inequities - including limited quality obstetric care, implicit bias, and racism resulting patient mistrust in the health care system, inadequate social support, and financial insecurity. Although there is published literature on Black women's experiences with obstetric care, including experiences with individual and structural racism, little is known about the intersection of age and race and experiences with health care. The purpose of this study was to explore the maternal health and pregnancy experiences of young Black women utilizing an intersectional theoretical lens. METHODS In this study, we conducted two focus groups in a sample of 11 young Black pregnant people. We conducted a thematic analysis to identify codes, themes, and subthemes of the data. RESULTS We developed two overarching themes: obstetric racism and obstetric resistance. To elucidate how obstetric racism framed our participants' healthcare experiences, we identified sub-themes: intersectional identities as young Black women, medical mistrust, and pregnancy trauma. The second major theme describes ways in which participants protected themselves against obstetric racism to engender positive health experiences. These methods of resistance included identifying advocates and relying on trusted providers. CONCLUSIONS The current standard of obstetric care in the US is suboptimal due to individual and structural racism. This study provides unique data on the experiences with health care for young, Black pregnant individuals and delivers valuable insight into how individual and structural racism impacts obstetric care for young Black women.
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Affiliation(s)
- Nefertiti OjiNjideka Hemphill
- Department of Kinesiology and Nutrition, University of Illinois Chicago 1747 W Roosevelt Road, Chicago, IL, 60608, USA.
| | - Natasha Crooks
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
| | - Wenqiong Zhang
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
| | - Fareeha Fitter
- College of Liberal Arts and Sciences, University of Illinois Chicago 601 S. Morgan St., 4th Floor UH, Chicago, IL, 60607, USA.
| | - Katherine Erbe
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
| | - Julienne N Rutherford
- Biobehavioral Health Science Division at the University of Arizona, PO Box 210203, Tucson, AZ, 85721, USA.
| | - Kylea L Liese
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
| | - Pamela Pearson
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
| | - Karie Stewart
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
| | - Nicollette Kessee
- Department of Kinesiology and Nutrition, University of Illinois Chicago 1747 W Roosevelt Road, Chicago, IL, 60608, USA.
| | | | - Lisa Tussing-Humphreys
- Department of Kinesiology and Nutrition, University of Illinois Chicago 1747 W Roosevelt Road, Chicago, IL, 60608, USA.
| | - Mary Dawn Koenig
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
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Sethi R, Hill K, Stalls S, Moffson S, de Tejada SS, Gomez L, Marroquin MA. An exploratory study of client and provider experience and perceptions of facility-based childbirth care in Quiché, Guatemala. BMC Health Serv Res 2022; 22:591. [PMID: 35505322 PMCID: PMC9066966 DOI: 10.1186/s12913-022-07686-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Respectful maternity care (RMC) is fundamental to women's and families' experience of care and their decision about where to give birth. Studies from multiple countries describe the mistreatment of women during facility-based childbirth, though only a small number of studies from Guatemala have been published. Less information is available on women's negative and positive experiences of childbirth care and health workers' perceptions and experiences of providing maternity care. METHODS As part of a program implemented in the Western Highlands of Guatemala to improve quality of reproductive maternal newborn and child health care, a mixed methods assessment was conducted in three hospitals and surrounding areas to understand women's and health workers' experience and perceptions of maternity care. The quantitative component included a survey of 31 maternity health workers and 140 women who had recently given birth in these hospitals. The qualitative component included in-depth interviews (IDIs) and focus group discussions (FGDs) with women and maternity health workers and managers. RESULTS Women reported a mix of positive and negative experiences of childbirth care related to interpersonal and health system factors. 81% of surveyed women reported that health workers had treated them with respect while 21.4% of women reported verbal abuse. Fifty-five percent and 12% of women, respectively, reported not having access to a private toilet and bath or shower. During IDIs and FGDs, many women described higher rates of verbal abuse directed at women who do not speak Spanish. A regression analysis of survey results indicated that speaking Ixil or K'iche at home was associated with a higher likelihood of women being treated negatively during childbirth in a facility. Health worker survey results corroborated negative aspects of care described by women and also reported mistreatment of health workers by clients and families (70.9%) and colleagues (48.2%). CONCLUSIONS This study adds to the literature on women's experience of institutional childbirth and factors that influence this experience by triangulating experience and perceptions of both women and health workers. This assessment highlights opportunities to address mistreatment of both women and health workers and to build on positive care attributes to strengthen RMC for all women.
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Affiliation(s)
| | | | | | - Susan Moffson
- Momentum Country and Global Leadership, Washington, USA.
| | | | - Leonel Gomez
- Reproductive Health Independent Researcher/Consultant, Guatemala City, Guatemala
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Schaaf M, Boydell V, Topp SM, Iyer A, Sen G, Askew I. A summative content analysis of how programmes to improve the right to sexual and reproductive health address power. BMJ Glob Health 2022; 7:bmjgh-2022-008438. [PMID: 35443940 PMCID: PMC9021801 DOI: 10.1136/bmjgh-2022-008438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/27/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Power shapes all aspects of global health. The concept of power is not only useful in understanding the current situation, but it is also regularly mobilised in programmatic efforts that seek to change power relations. This paper uses summative content analysis to describe how sexual and reproductive health (SRH) programmes in low-income and middle-income countries explicitly and implicitly aim to alter relations of power. METHODS Content analysis is a qualitative approach to analysing textual data; in our analysis, peer-reviewed articles that describe programmes aiming to alter power relations to improve SRH constituted the data. We searched three databases, ultimately including 108 articles. We extracted the articles into a spreadsheet that included basic details about the paper and the programme, including what level of the social ecological model programme activities addressed. RESULTS The programmes reviewed reflect a diversity of priorities and approaches to addressing power, though most papers were largely based in a biomedical framework. Most programmes intervened at multiple levels simultaneously; some of these were 'structural' programmes that explicitly aimed to shift power relations, others addressed multiple levels using a more typical programme theory that sought to change individual behaviours and proximate drivers. This prevailing focus on proximate behaviours is somewhat mismatched with the broader literature on the power-related drivers of SRH health inequities, which explores the role of embedded norms and structures. CONCLUSION This paper adds value by summarising what the academic public health community has chosen to test and research in terms of power relations and SRH, and by raising questions about how this corresponds to the significant task of effecting change in power relations to improve the right to SRH.
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Affiliation(s)
- Marta Schaaf
- Independent Consultant, Brooklyn, New York, USA
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Victoria Boydell
- School of Health and Social Care, University of Essex Faculty of Science and Health, Colchester, UK
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - 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
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10
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Respectful Maternity Care Framework and Evidence-Based Clinical Practice Guideline. J Obstet Gynecol Neonatal Nurs 2022; 51:e3-e54. [PMID: 35101344 DOI: 10.1016/j.jogn.2022.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Austad K, Juarez M, Shryer H, Hibberd PL, Drainoni ML, Rohloff P, Chary A. Improving the experience of facility-based delivery for vulnerable women through obstetric care navigation: a qualitative evaluation. BMC Pregnancy Childbirth 2021; 21:425. [PMID: 34116648 PMCID: PMC8193958 DOI: 10.1186/s12884-021-03842-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 04/30/2021] [Indexed: 11/14/2022] Open
Abstract
Background Global disparities in maternal mortality could be reduced by universal facility delivery. Yet, deficiencies in the quality of care prevent some mothers from seeking facility-based obstetric care. Obstetric care navigators (OCNs) are a new form of lay health workers that combine elements of continuous labor support and care navigation to promote obstetric referrals. Here we report qualitative results from the pilot OCN project implemented in Indigenous villages in the Guatemalan central highlands. Methods We conducted semi-structured interviews with 17 mothers who received OCN accompaniment and 13 staff—namely physicians, nurses, and social workers—of the main public hospital in the pilot’s catchment area (Chimaltenango). Interviews queried OCN’s impact on patient and hospital staff experience and understanding of intended OCN roles. Audiorecorded interviews were transcribed, coded, and underwent content analysis. Results Maternal fear of surgical intervention, disrespectful and abusive treatment, and linguistic barriers were principal deterrents of care seeking. Physicians and nurses reported cultural barriers, opposition from family, and inadequate hospital resources as challenges to providing care to Indigenous mothers. Patient and hospital staff identified four valuable services offered by OCNs: emotional support, patient advocacy, facilitation of patient-provider communication, and care coordination. While patients and most physicians felt that OCNs had an overwhelmingly positive impact, nurses felt their effort would be better directed toward traditional nursing tasks. Conclusions Many barriers to maternity care exist for Indigenous mothers in Guatemala. OCNs can improve mothers’ experiences in public hospitals and reduce limitations faced by providers. However, broader buy-in from hospital staff—especially nurses—appears critical to program success. Future research should focus on measuring the impact of obstetric care navigation on key clinical outcomes (cesarean delivery) and mothers’ future care seeking behavior. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03842-1.
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Affiliation(s)
- Kirsten Austad
- Wuqu' Kawoq
- Maya Health Alliance, 2da Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango, Guatemala. .,Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, 850 Harrison Avenue, Dowling 5, Boston, MA, 02118, USA.
| | - Michel Juarez
- Wuqu' Kawoq
- Maya Health Alliance, 2da Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango, Guatemala
| | - Hannah Shryer
- Wuqu' Kawoq
- Maya Health Alliance, 2da Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango, Guatemala
| | - Patricia L Hibberd
- Department of Global Health, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
| | - Mari-Lynn Drainoni
- Section of Infectious Disease, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA, 02118, USA.,Department of Health Law Policy & Management, Boston University School of Public Health, Boston, USA.,Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Boston, USA
| | - Peter Rohloff
- Wuqu' Kawoq
- Maya Health Alliance, 2da Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango, Guatemala.,Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Anita Chary
- Wuqu' Kawoq
- Maya Health Alliance, 2da Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango, Guatemala.,Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
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Access to healthcare system of indigenous communities with musculoskeletal disorders and rheumatic disease in Chaco, Argentina: a qualitative study. Clin Rheumatol 2020; 40:2407-2417. [PMID: 33231776 PMCID: PMC7685194 DOI: 10.1007/s10067-020-05513-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/30/2020] [Accepted: 11/15/2020] [Indexed: 11/19/2022]
Abstract
Introduction/objectives The objective of this study is to describe the local healthcare system from the perspective of the health professionals, community health workers, and local representatives of the qom community living in the province of Chaco, Argentina. Methods A qualitative study, with an ethnographic approach, was carried out using two techniques: non-participant observations and semi-structured interviews. A guide for the interviews was designed and developed by a multidisciplinary group of GLADERPO researchers. The main aspects included were the following: reference into the local healthcare system and accessibility to the system. Andersen’s base conceptual model of health service utilization was applied for the analysis and for structuring the results. Results A total of 21 people were interviewed, twelve women and nine men with an age ranging between 25 and 60 years old. The main findings were different barriers (communication and cultural) between the community and the healthcare system; “navigation” within the health system carried out by the qom community; and migration and bureaucratization of the health system. Conclusions These findings should be incorporated into educational strategies to improve access to healthcare system and adherence to medical treatment, establishing an interaction between the different levels of the local care system and providing community health workers with an appropriate training with the support of the community representatives.Key Points • The different barriers between the community and the healthcare system were described. • The “navigation” within the health system carried out by the qom community and the migration were relevant points. • The bureaucratization of the health system and the need to design and implement educational strategies in the future were highlighted. |
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Infanti JJ, Zbikowski A, Wijewardene K, Swahnberg K. Feasibility of Participatory Theater Workshops to Increase Staff Awareness of and Readiness to Respond to Abuse in Health Care: A Qualitative Study of a Pilot Intervention Using Forum Play among Sri Lankan Health Care Providers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207698. [PMID: 33096886 PMCID: PMC7589055 DOI: 10.3390/ijerph17207698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 11/16/2022]
Abstract
Women globally experience mistreatment by health providers during childbirth. Researchers have identified strategies to counteract this type of abuse in health care, but few have been evaluated. We used a theater technique, Forum Play, in a brief training intervention to increase awareness of abuse in health care and promote taking action to reduce or prevent it. The intervention was implemented in four workshops with 50 participating physicians and nurses from three hospitals in Colombo, Sri Lanka. This article reports the views of 23 workshop participants who also took part in four focus group discussions on the acceptability and feasibility of the method. The participants reported that the intervention method stimulated dialogue and critical reflection and increased their awareness of the everyday nature of abuses experienced by patients. Participants appreciated the participatory format of Forum Play, which allowed them to re-enact scenarios they had experienced and rehearse realistic actions to improve patient care in these situations. Structural factors were reported as limitations to the effectiveness of the intervention, including under-developed systems for protecting patient rights and reporting health provider abuses. Nonetheless, the study indicates the acceptability and feasibility of a theater-based training intervention for reducing the mistreatment of patients by health care providers in Sri Lanka.
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Affiliation(s)
- Jennifer J. Infanti
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, N-7491 Trondheim, Norway
- Correspondence: ; Tel.: +47-94721964
| | - Anke Zbikowski
- Women’s Clinic, Ryhov County Hospital, SE-55185 Jönköping, Sweden;
| | - Kumudu Wijewardene
- Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda 10250, Sri Lanka;
| | - Katarina Swahnberg
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, SE-391 82 Kalmar, Sweden;
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Altman MR, McLemore MR, Oseguera T, Lyndon A, Franck LS. Listening to Women: Recommendations from Women of Color to Improve Experiences in Pregnancy and Birth Care. J Midwifery Womens Health 2020; 65:466-473. [PMID: 32558179 DOI: 10.1111/jmwh.13102] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/10/2020] [Accepted: 02/13/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Women of color are at increased risk for poor birth outcomes, often driven by upstream social determinants and socially structured systems. Given the increasing rate of maternal mortality in the United States, particularly for women of color, there is a pressing need to find solutions to improving care quality and access for racially marginalized communities. This study aims to describe and thematically analyze the recommendations to improve pregnancy and birth care made by women of color with lived experience of perinatal health care. METHODS Twenty-two women of color living in the San Francisco Bay Area and receiving support services from a community-based nonprofit organization participated in semistructured interviews about their experiences receiving health care during pregnancy and birth. Interviews were audio-recorded and transcribed, and transcripts were analyzed using thematic analysis to highlight recommendations for improving perinatal care experiences. RESULTS Participants shared experiences and provided recommendations for improving care at the individual health care provider level, including spending quality time, relationship building and making meaningful connections, individualized person-centered care, and partnership in decision making. At the health systems level, recommendations included continuity of care, racial concordance with providers, supportive health care system structures to meet the needs of women of color, and implicit bias trainings and education to reduce judgment, stereotyping, and discrimination. DISCUSSION Participants in this study shared practical ways that health care providers and systems can improve pregnancy and birth care experiences for women of color. In addition to the actions needed to address the recommendations, health care providers and systems need to listen more closely to women of color as experts on their experiences in order to create effective change. Community-centered research, driven by and for women of color, is essential to improve health disparities during pregnancy and birth.
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Affiliation(s)
- Molly R Altman
- University of Washington School of Nursing, Seattle, Washington.,Preterm Birth Initiative, University of California San Francisco, San Francisco, California
| | - Monica R McLemore
- Preterm Birth Initiative, University of California San Francisco, San Francisco, California.,University of California, San Francisco School of Nursing, San Francisco, California
| | - Talita Oseguera
- University of California, San Francisco School of Nursing, San Francisco, California
| | - Audrey Lyndon
- New York University Rory Meyers College of Nursing, New York, New York
| | - Linda S Franck
- Preterm Birth Initiative, University of California San Francisco, San Francisco, California.,University of California, San Francisco School of Nursing, San Francisco, California
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Sacks E, Peca E. Confronting the culture of care: a call to end disrespect, discrimination, and detainment of women and newborns in health facilities everywhere. BMC Pregnancy Childbirth 2020; 20:249. [PMID: 32345241 PMCID: PMC7189577 DOI: 10.1186/s12884-020-02894-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 03/24/2020] [Indexed: 11/10/2022] Open
Abstract
Quality and respect are increasingly recognized as critical aspects of the provision of health care, and poor quality may be an essential driver of low health care utilization, especially for maternal and neonatal care. Beyond differential access to care, unequal levels of quality exacerbate inequity, and those who need services most, including displaced, migrant, and conflict-affected populations, may be receiving poorer quality care, or may be deterred from seeking care at all.Examples from around the world show that mothers and their children are often judged and mistreated for presenting to facilities without clean or "modern" clothing, without soap or clean sheets to use in the hospital, or without gifts like sweets or candies for providers. Underfunded facilities may rely on income from those seeking care, but denying and shaming the poor further discriminates against vulnerable women and newborns, by placing additional financial burden on those already marginalized.The culture of care needs to shift to create welcoming environments for all care-seekers, regardless of socio-economic status. No one should fear mistreatment, denial of services, or detainment due to lack of gifts or payments. There is an urgent need to ensure that health care centers are safe, friendly, respectful, and hospitable spaces for women, their newborns, and their families.
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Affiliation(s)
- Emma Sacks
- Johns Hopkins School of Public Health, 615 North Wolfe St, E8011, Baltimore, MD 21205 USA
| | - Emily Peca
- University Research Co., LLC, 5404 Wisconsin Ave, Suite, Chevy Chase, MD 800 USA
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Bante A, Teji K, Seyoum B, Mersha A. Respectful maternity care and associated factors among women who delivered at Harar hospitals, eastern Ethiopia: a cross-sectional study. BMC Pregnancy Childbirth 2020; 20:86. [PMID: 32041564 PMCID: PMC7011506 DOI: 10.1186/s12884-020-2757-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 01/21/2020] [Indexed: 12/25/2022] Open
Abstract
Background In Ethiopia, approximately three-fourths of mothers do not deliver in health facilities. Disrespect and abuse during childbirth fallouts in underutilization of institutional delivery that upshots maternal morbidity and mortality. Thus, the ambition of this study was to assess respectful maternity care and associated factors in Harar hospitals, Eastern Ethiopia. Methods A facility-based cross-sectional study was conducted from April 01 to July 01, 2017. A total of 425 women, delivered at Harar town hospitals, were nominated using a systematic random sampling technique. A pretested and organized questionnaire was used to collect the data. After checking for completeness, the data were entered into EpiData version 3.1 and exported to SPSS version 22.0 for cleaning and analyses. Both bivariate and multivariable logistic regression was computed to identify factors associated with respectful maternity care. Statistical significance was declared at a P-value of < 0.05. Results Data were collected on 425 women. Overall, only 38.4% (95% CI: 33.7, 42.0%) of women received respectful maternity care. Delivering at private hospitals [AOR: 2.3, 95% CI: 1.25, 4.07], having ANC follow-up [AOR: 1.8, 95% CI: 1.10, 3.20], planned pregnancy [AOR: 3.0, 95% CI: 1.24, 7.34], labor attended by male provider [AOR: 1.8, 95% CI: 1.14, 2.77] and normal maternal outcome [AOR: 2.3, 95% CI: 1.13, 4.83] were significantly associated with respectful maternity care. Conclusions Only four out of ten women received respectful care during labor and delivery. Providing women-friendly, abusive free, timely and discriminative free care are the bases to improve the uptake of institutional delivery. Execution of respectful care advancement must be the business of all healthcare providers. Furthermore, to come up with a substantial reduction in maternal mortality, great emphasis should be given to make the service woman-centered.
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Affiliation(s)
- Agegnehu Bante
- Department of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
| | - Kedir Teji
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Berhanu Seyoum
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abera Mersha
- Department of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Dev A, Kivland C, Faustin M, Turnier O, Bell T, Leger MD. Perceptions of isolation during facility births in Haiti - a qualitative study. Reprod Health 2019; 16:185. [PMID: 31881973 PMCID: PMC6935234 DOI: 10.1186/s12978-019-0843-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 12/03/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Haiti's maternal mortality, stillbirth, and neonatal mortality rates are the highest in Latin America and the Caribbean. Despite inherent risks, the majority of women still deliver at home without supervision from a skilled birth attendant. The purpose of this study was to elucidate factors driving this decision. METHODS We conducted six focus group discussions with women living in urban (N = 14) or rural (N = 17) areas and asked them questions pertaining to their reasons for delivering at a facility or at home, perceptions of staff at the health facility, experiences with or knowledge of facility or home deliveries, and prior pregnancy experiences (if relevant). We also included currently pregnant women to learn about their plans for delivery, if any. RESULTS All of the women interviewed acknowledged similar perceived benefits of a facility birth, which were a reduced risk of complications during pregnancy and access to emergency care. However, many women also reported unfavorable birthing experiences at facilities. We identified four key thematic concerns that underpinned women's negative assessments of a facility birth: being left alone, feeling ignored, being subject to physical immobility, and lack of compassionate touch/care. Taken together, these concerns articulated an overarching sense of what we term "isolation," which encompasses feelings of being isolated in the hospital during delivery. CONCLUSION Although Haitian women recognized that a facility was a safer place for birthing than the home, an overarching stigma of patient neglect and isolation in facilities was a major determining factor in choosing to deliver at home. The Haitian maternal mortality rate is high and will not be lowered if women continue to feel that they will not receive comfort and compassionate touch/care at a facility compared to their experience of delivering with traditional birth attendants at home. Based on these results, we recommend that all secondary and tertiary facilities offering labor and delivery services develop patient support programs, where women are better supported from admission through the labor and delivery process, including but not limited to improvements in communication, privacy, companionship (if deemed safe), respectful care, attention to pain during vaginal exams, and choice of birth position.
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Affiliation(s)
- Alka Dev
- Geisel School of Medicine at Dartmouth College, Hanover, United States.
- Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, 330W Borwell, Lebanon, NH, 03756, United States.
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Austad K, Juarez M, Shryer H, Moratoya C, Rohloff P. Obstetric care navigation: results of a quality improvement project to provide accompaniment to women for facility-based maternity care in rural Guatemala. BMJ Qual Saf 2019; 29:169-178. [PMID: 31678958 PMCID: PMC7045784 DOI: 10.1136/bmjqs-2019-009524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 10/03/2019] [Accepted: 10/20/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Many maternal and perinatal deaths in low-resource settings are preventable. Inadequate access to timely, quality care in maternity facilities drives poor outcomes, especially where women deliver at home with traditional birth attendants (TBA). Yet few solutions exist to support TBA-initiated referrals or address reasons patients frequently refuse facility care, such as disrespectful and abusive treatment. We hypothesised that deploying accompaniers-obstetric care navigators (OCN)-trained to provide integrated patient support would facilitate referrals from TBAs to public hospitals. METHODS This project built on an existing collaboration with 41 TBAs who serve indigenous Maya villages in Guatemala's Western Highlands, which provided baseline data for comparison. When TBAs detected pregnancy complications, families were offered OCN referral support. Implementation was guided by bimonthly meetings of the interdisciplinary quality improvement team where the OCN role was iteratively tailored. The primary process outcomes were referral volume, proportion of births receiving facility referral, and referral success rate, which were analysed using statistical process control methods. RESULTS Over the 12-month pilot, TBAs attended 847 births. The median referral volume rose from 14 to 27.5, meeting criteria for special cause variation, without a decline in success rate. The proportion of births receiving facility-level care increased from 24±6% to 62±20% after OCN implementation. Hypertensive disorders of pregnancy and prolonged labour were the most common referral indications. The OCN role evolved to include a number of tasks, such as expediting emergency transportation and providing doula-like labour support. CONCLUSIONS OCN accompaniment increased the proportion of births under TBA care that received facility-level obstetric care. Results from this of obstetric care navigation suggest it is a feasible, patient-centred intervention to improve maternity care.
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Affiliation(s)
- Kirsten Austad
- Wuqu' Kawoq - Maya Health Alliance, Tecpán, Guatemala .,Family Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Division of Women's Health, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Michel Juarez
- Wuqu' Kawoq - Maya Health Alliance, Tecpán, Guatemala
| | - Hannah Shryer
- Wuqu' Kawoq - Maya Health Alliance, Tecpán, Guatemala
| | | | - Peter Rohloff
- Wuqu' Kawoq - Maya Health Alliance, Tecpán, Guatemala.,Division of Global Health Equity and Social Change, Brigham & Women's Hospital and Children's Hospital, Boston, Massachusetts, USA
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Orpin J, Puthussery S, Burden B. Healthcare providers' perspectives of disrespect and abuse in maternity care facilities in Nigeria: a qualitative study. Int J Public Health 2019; 64:1291-1299. [PMID: 31673736 PMCID: PMC6867981 DOI: 10.1007/s00038-019-01306-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 06/22/2019] [Accepted: 10/04/2019] [Indexed: 11/25/2022] Open
Abstract
Objectives To explore healthcare providers’ perspectives of disrespect and abuse in maternity care and the impact on women’s health and well-being.
Methods Qualitative interpretive approach using in-depth semi-structured interviews with sixteen healthcare providers in two public health facilities in Nigeria. Interviews were audio-recorded, transcribed, and analysed thematically. Results Healthcare providers’ accounts revealed awareness of what respectful maternity care encompassed in accordance with the existing guidelines. They considered disrespectful and abusive practices perpetrated or witnessed as violation of human rights, while highlighting women’s expectations of care as the basis for subjectivity of experiences. They perceived some practices as well-intended to ensure safety of mother and baby. Views reflected underlying gender-related notions and societal perceptions of women being considered weaker than men. There was recognition about adverse effects of disrespect and abuse including its impact on women, babies, and providers’ job satisfaction. Conclusions Healthcare providers need training on how to incorporate elements of respectful maternity care into practice including skills for rapport building and counselling. Women and family members should be educated about right to respectful care empowering them to report disrespectful practices.
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Affiliation(s)
- Joy Orpin
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire LU2 8LE UK
| | - Shuby Puthussery
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire LU2 8LE UK
| | - Barbara Burden
- School of Health Care Practice, University of Bedfordshire, Luton, Bedfordshire UK
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Ezran C, Bonds MH, Miller AC, Cordier LF, Haruna J, Mwanawabenea D, Randriamanambintsoa M, Razanadrakato HTR, Ouenzar MA, Razafinjato BR, Murray M, Garchitorena A. Assessing trends in the content of maternal and child care following a health system strengthening initiative in rural Madagascar: A longitudinal cohort study. PLoS Med 2019; 16:e1002869. [PMID: 31430286 PMCID: PMC6701767 DOI: 10.1371/journal.pmed.1002869] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/19/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In order to reach the health-related Sustainable Development Goals (SDGs) by 2030, gains attained in access to primary healthcare must be matched by gains in the quality of services delivered. Despite the broad consensus around the need to address quality, studies on the impact of health system strengthening (HSS) have focused predominantly on measures of healthcare access. Here, we examine changes in the content of maternal and child care as a proxy for healthcare quality, to better evaluate the effectiveness of an HSS intervention in a rural district of Madagascar. The intervention aimed at improving system readiness at all levels of care (community health, primary health centers, district hospital) through facility renovations, staffing, equipment, and training, while removing logistical and financial barriers to medical care (e.g., ambulance network and user-fee exemptions). METHODS AND FINDINGS We carried out a district-representative open longitudinal cohort study, with surveys administered to 1,522 households in the Ifanadiana district of Madagascar at the start of the HSS intervention in 2014, and again to 1,514 households in 2016. We examined changes in healthcare seeking behavior and outputs for sick-child care among children <5 years old, as well as for antenatal care and perinatal care among women aged 15-49. We used a difference-in-differences (DiD) analysis to compare trends between the intervention group (i.e., people living inside the HSS catchment area) and the non-intervention comparison group (i.e., the rest of the district). In addition, we used health facility-based surveys, monitoring service availability and readiness, to assess changes in the operational capacities of facilities supported by the intervention. The cohort study included 657 and 411 children (mean age = 2 years) reported to be ill in the 2014 and 2016 surveys, respectively (27.8% and 23.8% in the intervention group for each survey), as well as 552 and 524 women (mean age = 28 years) reported to have a live birth within the previous two years in the 2014 and 2016 surveys, respectively (31.5% and 29.6% in the intervention group for each survey). Over the two-year study period, the proportion of people who reported seeking care at health facilities experienced a relative change of +51.2% (from 41.4% in 2014 to 62.5% in 2016) and -7.1% (from 30.0% to 27.9%) in the intervention and non-intervention groups, respectively, for sick-child care (DiD p-value = 0.01); +11.4% (from 78.3% to 87.2%), and +10.3% (from 67.3% to 74.2%) for antenatal care (p-value = 0.75); and +66.2% (from 23.1% to 38.3%) and +28.9% (from 13.9% to 17.9%) for perinatal care (p-value = 0.13). Most indicators of care content, including rates of medication prescription and diagnostic test administration, appeared to increase more in the intervention compared to in the non-intervention group for the three areas of care we assessed. The reported prescription rate for oral rehydration therapy among children with diarrhea changed by +68.5% (from 29.6% to 49.9%) and -23.2% (from 17.8% to 13.7%) in the intervention and non-intervention groups, respectively (p-value = 0.05). However, trends observed in the care content varied widely by indicator and did not always match the large apparent increases observed in care seeking behavior, particularly for antenatal care, reflecting important gaps in the provision of essential health services for individuals who sought care. The main limitation of this study is that the intervention catchment was not randomly allocated, and some demographic indicators were better for this group at baseline than for the rest of the district, which could have impacted the trends observed. CONCLUSION Using a district-representative longitudinal cohort to assess the content of care delivered to the population, we found a substantial increase over the two-year study period in the prescription rate for ill children and in all World Health Organization (WHO)-recommended perinatal care outputs assessed in the intervention group, with more modest changes observed in the non-intervention group. Despite improvements associated with the HSS intervention, this study highlights the need for further quality improvement in certain areas of the district's healthcare system. We show how content of care, measured through standard population-based surveys, can be used as a component of HSS impact evaluations, enabling healthcare leaders to track progress as well as identify and address specific gaps in the provision of services that extend beyond care access.
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Affiliation(s)
- Camille Ezran
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail: (CE); (AG)
| | - Matthew H. Bonds
- PIVOT, Ranomafana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Blavatnik Institute, Boston, Massachusetts, United States of America
| | - Ann C. Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Blavatnik Institute, Boston, Massachusetts, United States of America
| | | | | | | | - Marius Randriamanambintsoa
- Direction de la Démographie et des Statistiques Sociales, Institut National de la Statistique, Antananarivo, Madagascar
| | - Hery-Tiana R. Razanadrakato
- Direction de la Démographie et des Statistiques Sociales, Institut National de la Statistique, Antananarivo, Madagascar
| | | | | | - Megan Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Blavatnik Institute, Boston, Massachusetts, United States of America
| | - Andres Garchitorena
- PIVOT, Ranomafana, Madagascar
- MIVEGEC, Univ Montpellier, CNRS, IRD, Montpellier, France
- * E-mail: (CE); (AG)
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Strohbach A, Hu F, Martinez NG, Yee LM. Evaluating the use of text message communication in a postpartum patient navigation program for publicly insured women. PATIENT EDUCATION AND COUNSELING 2019; 102:753-759. [PMID: 30448040 PMCID: PMC6440841 DOI: 10.1016/j.pec.2018.10.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/25/2018] [Accepted: 10/30/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To compare communication between navigators and women according to follow-up status in a postpartum patient navigation program ("Navigating New Motherhood" [NNM]). METHODS This is a mixed methods secondary analysis of text message and email transcripts from NNM. Transcripts were analyzed by number of messages sent, received, and unanswered. Message themes were qualitatively analyzed using constant comparative technique. Bivariable and multivariable tests were conducted. RESULTS Most women (98.2%) communicated with navigators via text message. Women who completed postpartum follow-up sent and received more texts than women who did not (7.8 vs. 3.7, p < 0.001 and 11.5 vs. 8.0, p < 0.05, respectively); exchange of ≥6 messages was associated with greater odds of follow-up (adjusted odds ratio 2.89, 95% CI1.13-7.41). Lack of patient response was also associated with lack of follow-up (p < 0.001). Four categories of message themes were identified: Rapport-building, Postpartum Care Coordination, Maternal Health, and Motherhood. Message threads with more Rapport-building or Maternal Health messages were associated with more frequent patient follow-up (p < 0.01 and p < 0.05, respectively), as was average number of emoticons per message thread (2.1 vs. 1.2, p = 0.01). CONCLUSION More frequent and multidimensional communication was associated with follow-up in a postpartum patient navigation program. PRACTICE IMPLICATIONS Text messaging can serve as a favorable communication platform within patient navigation.
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Affiliation(s)
- Angelina Strohbach
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Fengling Hu
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Amherst College, Amherst, MA, USA
| | - Noelle G Martinez
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Cnop K, Martinez B, Austad KE. Resistant dermatomyositis in a rural indigenous Maya woman. BMJ Case Rep 2019; 12:e223886. [PMID: 30796072 PMCID: PMC6388881 DOI: 10.1136/bcr-2017-223886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2019] [Indexed: 11/03/2022] Open
Abstract
A 28-year-old indigenous Guatemalan woman presented with 7 months of progressive weakness and numerous dermatological findings. She initially sought care within the free government-run health system and was treated with oral steroids for presumed dermatomyositis. Her symptoms progressed, including severe dysphagia, hypophonia and weakness preventing sitting. She was lost to follow-up in the public system due to financial and cultural barriers. A non-governmental organisation tailored to the needs of Maya patients provided home intravenous pulse dose methylprednisolone in the absence of first-line biologicals. With longitudinal home-based care, she achieved symptom free recovery. The rising burden of chronic non-communicable diseases highlights shortcomings in health systems evident in this case, including lack of provider capacity, limited infrastructure to test for and treat rare diseases and poor continuity of care. We provide potential solutions to help care delivery in low-resource settings adapt to the demans of chronic disease control with particular attention to social determinants of health.
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Affiliation(s)
- Katia Cnop
- Wuqu' Kawoq, Maya Health Alliance, Santiago, Guatemala
- Burrell College of Osteopathic Medicine, Las Cruces, New Mexico, USA
| | - Boris Martinez
- Wuqu' Kawoq, Maya Health Alliance, Santiago, Guatemala
- Internal Medicine, Saint Peter's University Hospital, Rutgers University, New Brunswick, New Jersey, USA
| | - Kirsten E Austad
- Wuqu' Kawoq, Maya Health Alliance, Santiago, Guatemala
- Internal Medicine Division of Women's Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
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23
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Abstract
Respectful maternity care is the new approach under National Health Mission providing services towards improved satisfaction of pregnant women while in the health facility. Maathru Samman Pants is a new transformational initiative respecting both the psychological and physiological concerns of the pregnant woman and her family during labor. Maathru Samman Pant is a pant with vulval opening which is appropriate in size to perform procedures like per vaginal examination, episiotomy, forceps, ventouse application, bladder catheterization, and delivery of baby and placenta with flap on the front and the back for privacy in various positions. This short communication outlines the background, features, benefits, and future directions of Maathru Samman Pants. I emphasize the need for dignified obstetric care, ensuring that all women receive high-quality, equitable, and respectful maternity care in all health facilities. To the present published literature, Maathru Samman Pants is the first of its kind in India for pregnant woman in normal labor. Innovation is vital to address patient needs in present tumultuous environment. Respectful maternity care standards need to be the designed in continuum with patient's perspectives. Therefore, I call on health system across various states to introduce Maathru Samman Pants, like Andhra Pradesh, thereby ensuring the respect of women's basic human right of dignity which is beyond the prevention of mortality and morbidity. The implications of this innovation (Maathru Samman Pants) should not be limited to India only; rather, it should be contemplated by the other health facilities worldwide.
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Affiliation(s)
- B Venkatashiva Reddy
- Department of Community Medicine, NRI Academy of Medical Sciences, Guntur, Andhra Pradesh, India
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24
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Flood D, Chary A, Austad K, Coj M, Lopez W, Rohloff P. Patient Navigation and Access to Cancer Care in Guatemala. J Glob Oncol 2018; 4:1-3. [PMID: 30241260 PMCID: PMC6223473 DOI: 10.1200/jgo.18.00027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- David Flood
- All authors: Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
| | - Anita Chary
- All authors: Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
| | - Kirsten Austad
- All authors: Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
| | - Merida Coj
- All authors: Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
| | - Waleska Lopez
- All authors: Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
| | - Peter Rohloff
- All authors: Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
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25
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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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26
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Martinez B, Ixen EC, Hall-Clifford R, Juarez M, Miller AC, Francis A, Valderrama CE, Stroux L, Clifford GD, Rohloff P. mHealth intervention to improve the continuum of maternal and perinatal care in rural Guatemala: a pragmatic, randomized controlled feasibility trial. Reprod Health 2018; 15:120. [PMID: 29973229 PMCID: PMC6033207 DOI: 10.1186/s12978-018-0554-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/13/2018] [Indexed: 11/22/2022] Open
Abstract
Background/objective Guatemala’s indigenous Maya population has one of the highest perinatal and maternal mortality rates in Latin America. In this population most births are delivered at home by traditional birth attendants (TBAs), who have limited support and linkages to public hospitals. The goal of this study was to characterize the detection of maternal and perinatal complications and rates of facility-level referral by TBAs, and to evaluate the impact of a mHealth decision support system on these rates. Methods A pragmatic one-year feasibility trial of an mHealth decisions support system was conducted in rural Maya communities in collaboration with TBAs. TBAs were individually randomized in an unblinded fashion to either early-access or later-access to the mHealth system. TBAs in the early-access arm used the mHealth system throughout the study. TBAs in the later-access arm provided usual care until crossing over uni-directionally to the mHealth system at the study midpoint. The primary study outcome was the monthly rate of referral to facility-level care, adjusted for birth volume. Results Forty-four TBAs were randomized, 23 to the early-access arm and 21 to the later-access arm. Outcomes were analyzed for 799 pregnancies (early-access 425, later-access 374). Monthly referral rates to facility-level care were significantly higher among the early-access arm (median 33 referrals per 100 births, IQR 22–58) compared to the later-access arm (median 20 per 100, IQR 0–30) (p = 0.03). At the study midpoint, the later-access arm began using the mHealth platform and its referral rates increased (median 34 referrals per 100 births, IQR 5–50) with no significant difference from the early-access arm (p = 0.58). Rates of complications were similar in both arms, except for hypertensive disorders of pregnancy, which were significantly higher among TBAs in the early-access arm (RR 3.3, 95% CI 1.10–9.86). Conclusions Referral rates were higher when TBAs had access to the mHealth platform. The introduction of mHealth supportive technologies for TBAs is feasible and can improve detection of complications and timely referral to facility-care within challenging healthcare delivery contexts. Trial registration Clinicaltrials.gov NCT02348840.
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Affiliation(s)
- Boris Martinez
- Wuqu' Kawoq
- Maya Health Alliance, 2a. Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala.,Department of Medicine, Saint Peter's University Hospital, New Brunswick, NJ, USA
| | - Enma Coyote Ixen
- Wuqu' Kawoq
- Maya Health Alliance, 2a. Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala
| | - Rachel Hall-Clifford
- Departments of Sociology and Anthropology and Public Health, Agnes Scott College, Decatur, GA, USA
| | - Michel Juarez
- Wuqu' Kawoq
- Maya Health Alliance, 2a. Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala
| | - Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Aaron Francis
- Department of Biomedical Informatics, Emory University, Atlanta, GA, USA
| | | | - Lisa Stroux
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University, Atlanta, GA, USA.,Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Peter Rohloff
- Wuqu' Kawoq
- Maya Health Alliance, 2a. Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala. .,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
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