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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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Kihn-Alarcón AJ, Alvarado-Muñoz JF, Orozco-Fuentes LI, Calgua-Guerra E, Fuentes-de Falla V, Velarde A. Years of Potential Life Lost Because of Breast and Cervical Cancers in Guatemala. JCO Glob Oncol 2020; 6:761-765. [PMID: 32484750 PMCID: PMC7328121 DOI: 10.1200/jgo.19.00398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Worldwide cervical and breast cancers are among the most commonly diagnosed cancers and are leading cause of cancer deaths among females in low- and middle-income countries. In Guatemala, breast and cervical cancers are the main cause of cancer-related deaths among women. Therefore, the aim of this study was to determine the years of potential life lost (YPLL) as an indicator of premature deaths as a result of breast and cervical cancers. METHODS Data on the number of deaths as a result of breast and cervical cancers (International Classification of Diseases [10th revision] codes C50 and C53) between 2012 and 2016 and age composition by quinquennials were retrieved from the Health Information System of the Guatemalan Health Ministry. On the basis of each individual’s age at death, YPLL was estimated for females between 20 and 70 years of age. RESULTS A total of 1,476 deaths related to breast and cervical cancers was reported over the study period. The trend in breast cancer mortality rate and YPLL did not change from 2012 to 2016. The cervical cancer mortality rate has decreased to 10 deaths per 1 million habitants (P = .046). There has been a reduction in YPLL because of cervical cancer, from 50.18 YPLL in 2012 to 29.19 YPLL by 2016, mainly in women between 30 and 34 years of age, in whom YPLL decreased from 600 to 112.50 (P = .046). CONCLUSION Cervical cancer screening has significantly reduced the mortality rate of this malignancy, and screening of breast cancer must include creating awareness of the disease and providing access to women at risk.
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Affiliation(s)
- Alba J Kihn-Alarcón
- Research Department, Liga Nacional Contra el Cáncer & Instituto de Cancerología, Guatemala City, Guatemala
| | | | - Loida I Orozco-Fuentes
- Cancer Registry, Liga Nacional Contra el Cáncer & Instituto de Cancerología, Guatemala City, Guatemala
| | - Erwin Calgua-Guerra
- Research Department, Liga Nacional Contra el Cáncer & Instituto de Cancerología, Guatemala City, Guatemala.,Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Vicky Fuentes-de Falla
- Research Department, Liga Nacional Contra el Cáncer & Instituto de Cancerología, Guatemala City, Guatemala
| | - Angel Velarde
- Research Department, Liga Nacional Contra el Cáncer & Instituto de Cancerología, Guatemala City, Guatemala.,Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Flood D, Wilcox K, Ferro AA, Mendoza Montano C, Barnoya J, Garcia P, Lou-Meda R, Rohloff P, Chary A. Challenges in the provision of kidney care at the largest public nephrology center in Guatemala: a qualitative study with health professionals. BMC Nephrol 2020; 21:71. [PMID: 32111173 PMCID: PMC7049202 DOI: 10.1186/s12882-020-01732-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/19/2020] [Indexed: 01/29/2023] Open
Abstract
Background Chronic kidney disease (CKD) is increasing worldwide, and the majority of the CKD burden is in low- and middle-income countries (LMICs). However, there is wide variability in global access to kidney care therapies such as dialysis and kidney transplantation. The challenges health professionals experience while providing kidney care in LMICs have not been well described. The goal of this study is to elicit health professionals’ perceptions of providing kidney care in a resource-constrained environment, strategies for dealing with resource limitations, and suggestions for improving kidney care in Guatemala. Methods Semi-structured interviews were performed with 21 health professionals recruited through convenience sampling at the largest public nephrology center in Guatemala. Health professionals included administrators, physicians, nurses, technicians, nutritionists, psychologists, laboratory personnel, and social workers. Interviews were recorded and transcribed in Spanish. Qualitative data from interviews were analyzed in NVivo using an inductive approach, allowing dominant themes to emerge from interview transcriptions. Results Health professionals most frequently described challenges in providing high-quality care due to resource limitations. Reducing the frequency of hemodialysis, encouraging patients to opt for peritoneal dialysis rather than hemodialysis, and allocating resources based on clinical acuity were common strategies for reconciling high demand and limited resources. Providers experienced significant emotional challenges related to high patient volume and difficult decisions on resource allocation, leading to burnout and moral distress. To improve care, respondents suggested increased budgets for equipment and personnel, investments in preventative services, and decentralization of services. Conclusions Health professionals at the largest public nephrology center in Guatemala described multiple strategies to meet the rising demand for renal replacement therapy. Due to systems-level limitations, health professionals faced difficult choices on the stewardship of resources that are linked to sentiments of burnout and moral distress. This study offers important lessons in Guatemala and other countries seeking to build capacity to scale-up kidney care.
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Affiliation(s)
- David Flood
- National Clinicians Scholars Program, Division of Hospital Medicine, University of Michigan, Ann Arbor, MI, USA.,Wuqu' Kawoq
- Maya Health Alliance, Tecpán, Guatemala
| | - Katharine Wilcox
- Wuqu' Kawoq
- Maya Health Alliance, Tecpán, Guatemala.,Weill Cornell School of Medicine, New York, USA
| | | | - Carlos Mendoza Montano
- Institute of Nutrition of Central America and Panama (Instituto de Nutrición de Centroamérica y Panamá, INCAP), Guatemala City, Guatemala
| | - Joaquin Barnoya
- Unit for Cardiovascular Surgery (Unidad de Cirugía Cardiovascular de Guatemala, UNICAR), Guatemala City, Guatemala.,Institute of Research and Higher Studies in Health Sciences (El Instituto de Investigación y Estudios Superiores en Ciencias de la Salud, IECIS), Rafael Landívar University, Guatemala City, Guatemala
| | - Pablo Garcia
- Division of Nephrology, Stanford University, Palo Alto, USA
| | - Randall Lou-Meda
- Foundation for Children with Renal Disease (Fundación para el Niño Enfermo Renal, FUNDANIER), Guatemala City, Guatemala
| | - Peter Rohloff
- Wuqu' Kawoq
- Maya Health Alliance, Tecpán, Guatemala.,Department of Medicine, Department of Global Health Equity, Brigham and Women's Hospital, Boston, USA
| | - Anita Chary
- Wuqu' Kawoq
- Maya Health Alliance, Tecpán, Guatemala. .,Department of Emergency Medicine, Massachusetts General Hospital, Boston, USA.
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