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MacDonald T, Charles MC, Dorcely O, Darling EK, Greene S, Moll S, Logie C, Mbuagbaw L. Tande nou gwonde! (Hear us roar!)- Youth perspectives of maternal near-misses: Protocol for a photovoice study of young childbearing people's perspectives of maternal near-misses in northwest Haiti. PLoS One 2024; 19:e0303168. [PMID: 38758960 PMCID: PMC11101082 DOI: 10.1371/journal.pone.0303168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 04/21/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION Globally, a shift is occurring to recognize the importance of young peoples' health and well-being, their unique health challenges, and the potential they hold as key drivers of change in their communities. In Haiti, one of the four leading causes of death for those 20-24 years old is pregnancy, childbirth, and the weeks after birth or at the end of a pregnancy. Important gaps remain in existing knowledge about youth perspectives of maternal health and well-being within their communities. Youth with lived experiences of maternal near-misses are well-positioned to contribute to the understanding of maternal health in their communities and their potential role in bringing about change. OBJECTIVES To explore and understand youth perspectives of maternal near-miss experiences that occurred in a local healthcare facility or at home in rural Haiti. METHODS We will conduct a qualitative, community-based participatory research study regarding maternal near-miss experiences to understand current challenges and identify solutions to improve community maternal health, specifically focused on youth maternal health. We will use Photovoice to seek an understanding of the lived experiences of youth maternal near-miss survivors. Participants will be from La Pointe, a Haitian community served by their local healthcare facility. We will undertake purposeful sampling to recruit approximately 20 female youth, aged 15-24 years. Data will be generated through photos, individual interviews and small group discussions (grouped by setting of near-miss experience). Data generation and analysis are expected to occur over a three-month period. ETHICS AND DISSEMINATION Ethics approval will be sought from Centre Médical Béraca in La Pointe, Haiti, and from the Hamilton Integrated Research Ethics Board in Hamilton ON, Canada. We will involve community stakeholders, especially youth, in developing dissemination and knowledge mobilisation strategies. Our findings will be disseminated as an open access publication, be presented publicly, at conferences, and defended as part of a doctoral thesis.
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Affiliation(s)
- Tonya MacDonald
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- McMaster Midwifery Research Centre, McMaster University, Hamilton, ON, Canada
| | | | | | - Elizabeth K. Darling
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- McMaster Midwifery Research Centre, McMaster University, Hamilton, ON, Canada
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Saara Greene
- Faculty of Social Sciences, School of Social Work, McMaster University, Hamilton, ON, Canada
| | - Sandra Moll
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Carmen Logie
- Canada Research Chair in Global Health Equity and Social Justice with Marginalized Populations, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
- United Nations University Institute for Water, Environment & Health, Richmond Hill, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Centre, St. Joseph’s Healthcare, Hamilton, ON, Canada
- Centre for the Development of Best Practices in Health, Yaoundé Central Hospital, Yaoundé, Cameroon
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Akhter-Khan SC, van Es W, Prina M, Lawrence V, Piri I, Rokach A, Heu LC, Mayston R. Experiences of loneliness in lower- and middle-income countries: A systematic review of qualitative studies. Soc Sci Med 2024; 340:116438. [PMID: 38016310 DOI: 10.1016/j.socscimed.2023.116438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/03/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023]
Abstract
Loneliness is understood as a subjective experience resulting from unmet social relationship expectations. As most loneliness research has been conducted in higher-income-countries, there is limited understanding of loneliness in relation to diverse cultural, economic, and socio-political factors. To address this gap, the present review systematically synthesises existing qualitative studies on the experience of loneliness and social relationship expectations in lower- and middle-income countries (LMICs). Between June and July 2022, six online databases (Embase, Ovid Medline, APA PsycINFO, Global Health, Web of Science, Google Scholar) were searched for peer-reviewed studies from LMICs on loneliness using qualitative methods. There were no restrictions on publication date, language, or study setting. Studies that solely focused on social isolation or were conducted with children (<16 years) were excluded. Risk of bias was assessed with the Critical Appraisal Skills Programme. After deduplication, a total of 7866 records were identified and screened for inclusion, resulting in 24 studies published between 2002 and 2022. The included studies represent data from 728 participants in 15 countries across West Africa (Ghana, Nigeria, Niger, Mali), East Africa (Uganda, Kenya), North Africa (Egypt), West Asia (Iran), South Asia (India, Pakistan, Sri Lanka) and Southeast Asia (Myanmar, Cambodia, Indonesia, Philippines). Data were analysed combining inductive and deductive coding, summarised using narrative synthesis, and examined by geographical region. Common features of loneliness included rejection, overthinking, and pain. Loneliness was related to depression across regions. Whereas loneliness tended to be distinguished from social isolation in studies from Africa, it tended to be related with being alone in studies from Asia. Poverty and stigma were common barriers to fulfilling social relationship expectations. This review illustrates how loneliness and expectations are contextually embedded, with some expectations possibly being specific to a certain culture or life stage, having implications for assessment of and interventions for loneliness worldwide.
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Affiliation(s)
- Samia C Akhter-Khan
- Department of Global Health & Social Medicine, King's College London, London, United Kingdom.
| | - Willemijn van Es
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands
| | - Matthew Prina
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Vanessa Lawrence
- Department of Health Service & Population Research, King's College London, London, United Kingdom
| | - Ilayda Piri
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands
| | - Ami Rokach
- Department of Psychology, York University, Toronto, Canada
| | - Luzia C Heu
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands
| | - Rosie Mayston
- Department of Global Health & Social Medicine, King's College London, London, United Kingdom
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Jean-Baptiste M, Millien C, Pognon PR, Casella Jean-Baptiste M. Reframing the Three Delays framework: factors influencing referrals to facilities by matrones in rural Haiti. BMJ Glob Health 2023; 8:e011957. [PMID: 37967901 PMCID: PMC10693684 DOI: 10.1136/bmjgh-2023-011957] [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: 02/06/2023] [Accepted: 10/01/2023] [Indexed: 11/17/2023] Open
Abstract
In Haiti, there has been limited research on the experiences of traditional birth attendants/matrones when they decide to refer and accompany pregnant women to the facility for giving birth. Understanding this contextualised experience could help to strengthen programming aimed at improving maternal, neonatal, and child health (MNCH) outcomes in rural Haiti. This paper describes the qualitative findings from seven focus group discussions (FGDs) with matrones regarding their experience of referring pregnant women to facilities in Haiti's Central Plateau. Each FGD was conducted in Haitian Kreyol and audio recorded. Recordings were transcribed, translated to English, and thematically analysed. A conceptual model visualising factors influencing matrone decision-making was then developed using an adapted version of the Three Delays framework. Findings from this study show that matrones face a complex, multilayered web of intertwining factors related to attitudes and beliefs around their role, resource availability, and perceptions around quality of care and treatment. Each factor corresponds to a delay in the Three Delays framework. The factors can occur at the same time or each can occur individually at different times, and influence the decision to refer. The complexity of factors identified reflects the need to reassess the Three Delays framework so that it accounts for the intertwining, cyclical complexities faced by those trying to access the facility amidst the backdrop of both time and the community/social contexts. Results further reflect the need for strengthened health systems that better facilitate matrone facility-based referrals, improving outcomes for all parties involved and bridging the gap between homes/ communities and facilities. This calls for better integration of the matrones into the formal health system to systematically strengthen the continuum of MNCH health services provided from home to facility.
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Affiliation(s)
- Milenka Jean-Baptiste
- Department of Health Behavior, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Christophe Millien
- Medical Direction, Hopital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Pierre Ricard Pognon
- Strategic Health Information System (SHIS), Partners In Health - Sierra Leone, Freetown, Sierra Leone
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Determinants of Antenatal Care Access and Utilization in Haiti. WOMEN 2023. [DOI: 10.3390/women3010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Several pregnancy-related complications resulting in maternal mortality in low-income countries may be due to inaccessible or under-utilized antenatal healthcare services. This study aims to assess the sociodemographic characteristics of Haitian women and how these may affect their access to and use of antenatal care services (ANC) during pregnancy. Multi-logistic regression was used to analyze sociodemographic factors associated with ANC access and use among a cross-section of Haitian women (N = 4890) from the Demographic and Health Survey Haiti (2016–2017). Approximately 18.2% of the women had no education, 40.2% had secondary education, and 4.0% had higher education. About 45.6% of women with no education, 95% with higher education, and 76% of urban dwellers made four or more ANC visits. Only 3% of those who used public sector ANC had a higher education, and over 64.2% of those who used private sector ANC lived in urban areas. Rich women (OR = 2.49, 95% CI = 2.02–3.08) vs. poor women and mature mothers (OR = 1.97, 95% CI = 1.42–2.73) vs. teenage mothers both had higher odds of using ANC services four or more times. Women with higher education (OR = 0.19, 95% CI = 0.12–0.30) and those who were rich (OR = 0.67, 95% CI = 0.5–0.89) had lower odds of using public sector ANC vs. private sector ANC. Wealth and education are protective of ANC access and use by Haitian women. As over half the population has home births, public health education interventions targeting traditional birth attendants are recommended. Interventions training traditional birth attendants to provide better ANC during pregnancy and at the time of birth and to access skilled help during emergency deliveries is recommended.
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Dev A, Liu M, Kivland C. Insecure Birth: A Qualitative Study of Everyday Violence During Pregnancy in Port au Prince, Haiti. Matern Child Health J 2022; 26:1187-1193. [PMID: 35386032 DOI: 10.1007/s10995-022-03431-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION While the city offers economic opportunities for women in many countries, their safety and security remain vulnerable to urban violence, especially in poor areas. In Haiti, poor urban women may be subjected to multiple forms of physical, sexual, and structural violence leading to adverse birth outcomes. We explored some of the complexities of how pregnancy is experienced under the reality and threat of urban violence in Haiti. METHODS We examined data from focus group discussions with fourteen women who lived in severely disenfranchised neighborhoods in Port au Prince and who were pregnant or had recently delivered at the time of the study. RESULTS We report on three recurring themes that emerged from the discussion: (a) ways in which the threat or experience of violence affected women's ability to access maternal healthcare, (b) ways in which women altered their behavior to accommodate everyday violence, and (c) the extent to which violence was embedded in women's consensual and non-consensual sexual encounters with perpetrators. We found that Haitian women considered violence, labeled ensekirite (insecurity), to be an everyday threat in their lives and that they strategized ways to access maternal health care and other services while navigating ensekirite. DISCUSSION Pregnancy adds another layer of vulnerability that may necessitate further negotiations with the threat and presence of violence. The pervasiveness and impact of urban violence in women's daily lives needs to be better evaluated in maternal and newborn health research and programs.
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Affiliation(s)
- Alka Dev
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Minda Liu
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| | - Chelsey Kivland
- Department of Anthropology, Dartmouth College, Silsby Hall 3 Tuck Drive, Hanover, NH, 03755, USA
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Dev A, Casseus M, Baptiste WJ, LeWinter E, Joseph P, Wright P. Neonatal mortality in a public referral hospital in southern Haiti: a retrospective cohort study. BMC Pediatr 2022; 22:81. [PMID: 35130857 PMCID: PMC8819947 DOI: 10.1186/s12887-022-03141-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Haiti has the highest rate of neonatal mortality in the Latin America and Caribbean region. While the rate of facility births in Haiti has doubled over the past two decades, there have been no comparable reductions in maternal or neonatal mortality. Little data is available on the clinical characteristics of complications and morbidities among newborns requiring hospitalization after birth and their contribution to neonatal mortality. There is a need to better understand the status of newborn clinical care capacity in Haiti to prioritize training and resources. Methods We performed a retrospective observational cohort study of neonates admitted to a large public referral hospital in southern Haiti in the first 2 years of operation of a new neonatal unit that we established. All neonate cases hospitalized in the unit in these 2 years were reviewed and analyzed to identify their clinical characteristics and outcomes. Multivariable logistic regression was used to identify independent risk factors of hospital mortality. We present the outcomes for 1399 neonates admitted to the unit during August 2017 and August 2019. Results The leading cause of death was prematurity, followed by hypoxia and infection. Inborn neonates had better rates of hospital survival than those born elsewhere; they were also more likely to be born via cesarean section and to be admitted immediately following birth. There were no differences between the proportion of premature or low-birth-weight babies born at the hospital or elsewhere. Mortality in the second year of the unit’s operation was 12%, almost half that of the first year (21%). Multivariable regression analysis showed that mortality was consistently higher among premature and very low birthweight babies. Conclusions With modest investments, we were able to halve the mortality on a neonatal unit in Haiti. Resources are needed to address prematurity as an important outcome since hospital mortality was significant in this group. To this end, investment in uninterrupted supplies of oxygen and antibiotics, as well as ensuring adequate newborn resuscitation, infection control, laboratory testing, and timely morbidity and mortality reviews would go a long way toward lowering hospital mortality in Haiti.
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Affiliation(s)
- Alka Dev
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA. .,Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | - Michelucia Casseus
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Hopital Immaculae Conception, Les Cayes, Haiti
| | - Wilhermine Jean Baptiste
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Hopital Immaculae Conception, Les Cayes, Haiti
| | - Emma LeWinter
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Peter Wright
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Raymondville M, Rodriguez CA, Richterman A, Jerome G, Katz A, Gilbert H, Anderson G, Joseph JP, Franke MF, Ivers LC. Barriers and facilitators influencing facility-based childbirth in rural Haiti: a mixed method study with a convergent design. BMJ Glob Health 2021; 5:bmjgh-2020-002526. [PMID: 32830129 PMCID: PMC7445336 DOI: 10.1136/bmjgh-2020-002526] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/03/2020] [Accepted: 07/05/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction Haiti has the highest maternal mortality rate in the Western Hemisphere. Facility-based childbirth is promoted as the standard of care for reducing maternal and neonatal mortality. We conducted a convergent, mixed methods study to assess barriers and facilitators to facility-based childbirth at Hôpital Universitaire de Mirebalais (HUM) in Mirebalais, Haiti. Methods We conducted secondary analyses of a prospective cohort of pregnant women seeking antenatal care at HUM and quantitatively assessed predictors of not having a facility-based childbirth at HUM. We prospectively enrolled 30 pregnant women and interviewed them about their experiences delivering at home or at HUM. Results Of 1105 pregnant women seeking antenatal care at the hospital between May and December 2017, 773 (70%) returned to the hospital for facility-based childbirth. In multivariable analyses, living farther from the hospital (adjusted OR (AOR)=0.73; 95% CI 0.56 to 0.96), poverty (AOR=0.93; 95% CI 0.88 to 0.99) and household hunger (AOR=0.45; 95% CI 0.26 to 0.79) were associated with not having a facility-based childbirth. Primigravid women were more likely to have a facility-based childbirth (AOR=1.34, 95% CI 1.02 to 1.76). Qualitative data provided insight into the value women place on traditional birth attendants (‘matrons’) during home-based childbirths. While women perceived facility-based childbirths as better equipped to handle birth complications, barriers such as distance, costs of transportation and supplies, discomfort of facility birthing practices and mistreatment by medical staff resulted in negative perceptions of facility-based childbirths. Conclusion Pregnant women in rural Haiti must overcome substantial structural barriers and forfeit valued support from traditional birth attendants when they pursue facility-based childbirths. If traditional birth attendants could be involved in care alongside midwives at facilities, women may be more inclined to deliver there. While complex structural barriers remain, the inclusion of matrons at facilities may increase uptake of facility-based childbirths, and ultimately improve maternal and neonatal outcomes.
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Affiliation(s)
- Maxi Raymondville
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA .,Zanmi Lasante, Partners In Health, Port-au-Prince, Haiti
| | - Carly A Rodriguez
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Aaron Richterman
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA.,Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gregory Jerome
- Zanmi Lasante, Partners In Health, Port-au-Prince, Haiti
| | - Arlene Katz
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Hannah Gilbert
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | | | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Louise C Ivers
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
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