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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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Anderson R, Zaman SB, Jimmy AN, Read JM, Limmer M. Strengthening quality in sexual, reproductive, maternal, and newborn health systems in low- and middle-income countries through midwives and facility mentoring: an integrative review. BMC Pregnancy Childbirth 2023; 23:712. [PMID: 37798690 PMCID: PMC10552246 DOI: 10.1186/s12884-023-06027-0] [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: 06/30/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND There is an urgent global call for health systems to strengthen access to quality sexual, reproductive, maternal, newborn and adolescent health, particularly for the most vulnerable. Professional midwives with enabling environments are identified as an important solution. However, a multitude of barriers prevent midwives from fully realizing their potential. Effective interventions to address known barriers and enable midwives and quality sexual, reproductive, maternal, newborn and adolescent health are less well known. This review intends to evaluate the literature on (1) introducing midwives in low- and middle-income countries, and (2) on mentoring as a facilitator to enable midwives and those in midwifery roles to improve sexual, reproductive, maternal, newborn and adolescent health service quality within health systems. METHODS An integrative systematic literature review was conducted, guided by the Population, Intervention, Comparison, Outcome framework. Articles were reviewed for quality and relevance using the Gough weight-of-evidence framework and themes were identified. A master table categorized articles by Gough score, methodology, country of focus, topic areas, themes, classification of midwives, and mentorship model. The World Health Organization health systems building block framework was applied for data extraction and analysis. RESULTS Fifty-three articles were included: 13 were rated as high, 36 as medium, and four as low according to the Gough criteria. Studies that focused on midwives primarily highlighted human resources, governance, and service delivery while those focused on mentoring were more likely to highlight quality services, lifesaving commodities, and health information systems. Midwives whose pre-service education met global standards were found to have more efficacy. The most effective mentoring packages were comprehensive, integrated into existing systems, and involved managers. CONCLUSIONS Effectively changing sexual, reproductive, maternal, newborn and adolescent health systems is complex. Globally standard midwives and a comprehensive mentoring package show effectiveness in improving service quality and utilization. TRIAL REGISTRATION The protocol is registered in PROSPERO (CRD42022367657).
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Affiliation(s)
- Rondi Anderson
- The Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
| | - Sojib Bin Zaman
- Department of Health Sciences, James Madison University, Harrisonburg, Virginia, USA
| | - Abdun Naqib Jimmy
- Environmental Science Department, Jahangirnagar University, Dhaka, Bangladesh
| | - Jonathan M Read
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Mark Limmer
- The Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Mwansisya T, Mbekenga C, Isangula K, Mwasha L, Mbelwa S, Lyimo M, Kisaka L, Mathias V, Pallangyo E, Edwards G, Mantel M, Konteh S, Rutachunzibwa T, Mrema S, Kidanto H, Temmerman M. The impact of training on self-reported performance in reproductive, maternal, and newborn health service delivery among healthcare workers in Tanzania: a baseline- and endline-survey. Reprod Health 2022; 19:143. [PMID: 35725562 PMCID: PMC9210613 DOI: 10.1186/s12978-022-01452-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 06/01/2022] [Indexed: 11/21/2022] Open
Abstract
Background Delivery of quality reproductive health services has been documented to depend on the availability of healthcare workers who are adequately supported with appropriate training. However, unmet training needs among healthcare workers in reproductive, maternal, and newborn health (RMNH) in low-income countries remain disproportionately high. This study investigated the effectiveness of training with onsite clinical mentorship towards self-reported performance in RMNH among healthcare workers in Mwanza Region, Tanzania. Methods The study used a quasi-experimental design with pre-and post-intervention evaluation strategy. The baseline was compared with two endline groups: those with intervention (training and onsite mentorship) and those without. The differences among the three groups in the sociodemographic characteristics were analyzed by using chi-square test for categorical variables, independent-sample t-test for continuous variables and Mann–Whitney U test for ordinal or skewed continuous data. The independent sample t-test was used to determine the effect of the intervention by comparing the computed self-reported performance on RMNH services between the intervention and control groups. The paired-samples t-test was used to measure the differences between before and after intervention groups. Significance was set at a 95% confidence interval with p ≤ 0.05. Results The study included a sample of 216 participants with before and after intervention groups comprising of 95 (44.0%) and 121 (56.0%) in the control group. The comparison between before and after intervention groups revealed a statistically significant difference (p ≤ 0.05) in all the dimensions of the self-reported performance scores. However, the comparison between intervention groups and controls indicated a statistical significant difference on intra-operative care (t = 3.10, df = 216, p = 0.002), leadership skills (t = 1.85, df = 216, p = 0.050),
Comprehensive emergency obstetric and newborn care (CEMONC) (t = 34.35, df = 216, p ≤ 0.001), and overall self-reported performance in RMNH (t = 3.15, df = 216, p = 0.002). Conclusions This study revealed that the training and onsite clinical mentorship to have significant positive changes in self-reported performance in a wide range of RMNH services especially on intra-operative care, leadership skills and CEMONC. However, further studies with rigorous designs are warranted to evaluate the long-term effect of such training programs on RMNH outcomes. Reproductive maternal and newborn health (RMNH) in low- and middle-income countries continue to face critical challenges. Training healthcare workers especially using a combined approach (training followed by immediate clinical mentorship) in RMNH have been documented as an essential strategy to reduce maternal and neonatal mortality in low-and middle-income countries closer to those in high-income countries. This study investigated the effectiveness of a Continuous Professional Development (CPD) trainings on performance among healthcare workers in Mwanza Region. The study included a sample of 216 participants with before and after intervention groups comprising of 95 participants and control group comprising of 121 participants. The findings revealed that in comparison between before and after intervention groups all dimensions of the self-reported TNA questionnaire had a statistically significant difference. However, the comparison between intervention and controls groups indicated a statistical significant difference on leadership skills, intra-operative care,
Comprehensive emergency obstetric and newborn care (CEMONC) and overall RMNH self-reported performance. In conclusion, the findings demonstrated that healthcare workers’ self-identified and prioritized training needs that are supported with clinical mentorship results in significant positive changes in performance across a wide range of RMNH tasks. Therefore, conducting TNA that is followed by training and mentorship according to the identified needs among healthcare workers plays a significant role in improving performance on RMNH services among healthcare workers.
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Affiliation(s)
- Tumbwene Mwansisya
- School of Nursing and Midwifery, The Aga Khan University, Dar es Salaam, Tanzania.
| | - Columba Mbekenga
- School of Nursing and Midwifery, The Aga Khan University, Dar es Salaam, Tanzania
| | - Kahabi Isangula
- School of Nursing and Midwifery, The Aga Khan University, Dar es Salaam, Tanzania
| | - Loveluck Mwasha
- School of Nursing and Midwifery, The Aga Khan University, Dar es Salaam, Tanzania
| | - Stewart Mbelwa
- School of Nursing and Midwifery, The Aga Khan University, Dar es Salaam, Tanzania
| | - Mary Lyimo
- School of Nursing and Midwifery, The Aga Khan University, Dar es Salaam, Tanzania
| | - Lucy Kisaka
- School of Nursing and Midwifery, The Aga Khan University, Dar es Salaam, Tanzania
| | - Victor Mathias
- School of Nursing and Midwifery, The Aga Khan University, Dar es Salaam, Tanzania
| | - Eunice Pallangyo
- School of Nursing and Midwifery, The Aga Khan University, Dar es Salaam, Tanzania
| | - Grace Edwards
- School of Nursing and Midwifery, The Aga Khan University, Kampala, Uganda
| | - Michaela Mantel
- Centre of Excellence in Women and Child Health, The Aga Khan University, Nairobi, Kenya
| | | | | | | | - Hussein Kidanto
- Department of Obstetrics and Gynecology, Aga Khan University, Dar es Salaam, Tanzania
| | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, The Aga Khan University, Nairobi, Kenya
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Kassie A, Wale A, Girma D, Amsalu H, Yechale M. The role of traditional birth attendants and problem of integration with health facilities in remote rural community of West Omo Zone 2021: exploratory qualitative study. BMC Pregnancy Childbirth 2022; 22:425. [PMID: 35596165 PMCID: PMC9123652 DOI: 10.1186/s12884-022-04753-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mothers in rural Ethiopian communities prefer giving birth at home. In developing countries, traditional birth attendants play an important role in reducing the maternal mortality rate. In Ethiopia, however, their role during pregnancy, childbirth, the postnatal period, and their integration with health professionals is not clearly defined. This study aimed to explore the role of traditional birth attendants in feto-maternal care during pregnancy, childbirth, and the postnatal period, and integration with health professionals in the West Omo Zone, southern Ethiopia. METHODS A qualitative descriptive design was used with triangulation of methods and data sources. We conducted in-depth interviews with traditional birth attendants, key informant interviews with health care professionals and community or religious leaders, and two focus group discussions with multiparous pregnant women. Each interview and focus group discussion was tape-recorded and the data obtained were transcribed and translated into English for analysis. The analysis was done based on thematic analysis framework. RESULTS Traditional birth attendants stated that they used herbal remedies to treat nausea and vomiting, decrease pain during labor, and increase pregnant women's desire to push. The absence of incentives for their work, shortage of logistics, and lack of training was mentioned as challenges to the continuity of their roles. All study participants explained the importance of training traditional birth attendants on maternal and child health in rural communities. However, health care professionals reported that few traditional birth attendants advised mothers about traditional practices such as milk tooth extraction and uvulectomy. CONCLUSION AND RECOMMENDATION Traditional birth attendants continued their roles despite the existing challenges. There was no integration between TBA and the formal health care system. The need for training traditional birth attendants has been emphasized by all study participants and its impact on reducing feto-maternal death was recognized by health care professionals. Therefore, the federal ministry of health should works better for the development of TBAs to scale up their skills across all regions in the country.
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Affiliation(s)
- Aychew Kassie
- Deparetment of Nursing, College of Medicine and Health Science, South Nation, Nationality and People Region, Mizan Tepi University, Mizan, Ethiopia
| | - Alemnew Wale
- Deparetment of Midwifery, College of Medicine and Health Science, South Nation, Nationality and People Region, Mizan Tepi University, Mizan, Ethiopia.
| | - Desalegn Girma
- Deparetment of Midwifery, College of Medicine and Health Science, South Nation, Nationality and People Region, Mizan Tepi University, Mizan, Ethiopia
| | - Hailemariam Amsalu
- Deparetment of Biomedical, College of Medicine and Health Science, South Nation, Nationality and People Region, Mizan Tepi University, Mizan, Ethiopia
| | - Mastewal Yechale
- Deparetment of Midwifery, College of Medicine and Health Science, South Nation, Nationality and People Region, Mizan Tepi University, Mizan, Ethiopia
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Stabnick A, Yeboah M, Arthur-Komeh J, Ankobea F, Moyer CA, Lawrence ER. "Once you get one maternal death, it's like the whole world is dropping on you": experiences of managing maternal mortality amongst obstetric care providers in Ghana. BMC Pregnancy Childbirth 2022; 22:206. [PMID: 35287601 PMCID: PMC8919901 DOI: 10.1186/s12884-022-04535-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/11/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Maternal mortality has a significant global impact, especially in low-resource settings. Little prior research has been conducted on the potential effects of poor maternal outcomes on the personal and professional well-being of healthcare providers. This study explores the in-depth experiences and perspectives of obstetric providers in Ghana who work in a setting with frequent maternal mortalities. METHODS This is a qualitative study of semi-structured interviews conducted at the Komfo Anokye Teaching Hospital in Ghana. Participants were obstetric healthcare providers, defined as midwives, house officers currently rotating on the obstetrics/gynecology service, and obstetrician/gynecologists at any training or practice level (residents, fellows, and specialists). Interviews were audio-recorded, transcribed verbatim, and uploaded into NVivo for qualitative analysis. Using the Attride-Stirling qualitative model, an incremental and iterative process was used to code interviews with keyword phrases and develop a framework of organizing and global themes. RESULTS Interviews were conducted with 27 participants-15 midwives and 12 physicians (three obstetrician/gynecologist residents, six obstetrician/gynecologist specialists, and three house officers), with sample size determined by data saturation. Obstetric providers' experiences in a setting with frequent maternal mortalities were dependent on their level of preparedness to manage maternal mortalities and the workplace environment. Providers' level of preparedness was dependent on both the training they had received on the medical management of obstetric emergencies, as well as a lack of training on the mental health aspects of coping with maternal mortality. The impact of the workplace environment was dependent on systems failures and limited resources, blame from colleagues and supervisors, and a lack of support in the workplace. In turn, obstetric providers' experiences managing frequent maternal mortalities impacted their clinical care performance and mental health. CONCLUSIONS Maternal deaths have profound personal and professional impacts on the healthcare providers who manage them. A large need exists for additional institutional training and support for obstetric providers who manage maternal mortality, especially in low-resource settings like Ghana.
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Affiliation(s)
- Anna Stabnick
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109 USA
| | - Michael Yeboah
- Directorate of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Okomfo Anokye Road, Kumasi, Ghana
| | - Johnny Arthur-Komeh
- Directorate of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Okomfo Anokye Road, Kumasi, Ghana
| | - Frank Ankobea
- Department of Obstetrics and Gynecology, KNUST-SMD, Kumasi, Ghana
| | - Cheryl A. Moyer
- Global REACH, Department of Obstetrics & Gynecology, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI 48109 USA
| | - Emma R. Lawrence
- Global REACH, Department of Obstetrics & Gynecology, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI 48109 USA
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Budu E, Chattu VK, Ahinkorah BO, Seidu AA, Mohammed A, Tetteh JK, Arthur-Holmes F, Adu C, Yaya S. Early age at first childbirth and skilled birth attendance during delivery among young women in sub-Saharan Africa. BMC Pregnancy Childbirth 2021; 21:834. [PMID: 34906105 PMCID: PMC8670119 DOI: 10.1186/s12884-021-04280-9] [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: 12/02/2020] [Accepted: 11/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background Despite the numerous policy interventions targeted at preventing early age at first childbirth globally, the prevalence of adolescent childbirth remains high. Meanwhile, skilled birth attendance is considered essential in preventing childbirth-related complications and deaths among adolescent mothers. Therefore, we estimated the prevalence of early age at first childbirth and skilled birth attendance among young women in sub-Saharan Africa and investigated the association between them. Methods Demographic and Health Survey data of 29 sub-Saharan African countries was utilized. Skilled birth attendance and age at first birth were the outcome and the key explanatory variables in this study respectively. Overall, a total of 52,875 young women aged 20-24 years were included in our study. A multilevel binary logistic regression analysis was performed and the results presented as crude and adjusted odds ratios at 95% confidence interval. Results Approximately 73% of young women had their first birth when they were less than 20 years with Chad having the highest proportion (85.7%) and Rwanda recording the lowest (43.3%). The average proportion of those who had skilled assistance during delivery in the 29 sub-Saharan African countries was 75.3% and this ranged from 38.4% in Chad to 93.7% in Rwanda. Young women who had their first birth at the age of 20-24 were more likely to have skilled birth attendance during delivery (aOR = 2.4, CI = 2.24-2.53) than those who had their first birth before 20 years. Conclusion Early age at first childbirth has been found to be associated with low skilled assistance during delivery. These findings re-emphasize the need for sub-Saharan African countries to implement programs that will sensitize and encourage the patronage of skilled birth attendance among young women in order to reduce complications and maternal mortalities. The lower likelihood of skilled birth attendance among young women who had their first birth when they were adolescents could mean that this cohort of young women face some barriers in accessing maternal healthcare services.
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Affiliation(s)
- Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Vijay Kumar Chattu
- Department of Public Health, Saveetha Medical College and Hospitals, SIMATS, Saveetha University, Chennai, TN, 600077, India.,Department of Community Medicine, Faculty of Medicine, Datta Meghe Institute of Medical Sciences (Deemed University), Wardha, MS, 442107, India
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Abdul-Aziz Seidu
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia. .,Centre For Gender and Advocacy, Takoradi Technical University, P.O.Box 256, Takoradi, Ghana.
| | - Aliu Mohammed
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Justice Kanor Tetteh
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Francis Arthur-Holmes
- Department of Sociology and Social Policy, Lingnan University, 8 Castle Peak Road, Tuen Mun, Hong Kong
| | - Collins Adu
- Department of Health Promotion, Education and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada.,The George Institute for Global Health, Imperial College London, London, UK
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Negero MG, Sibbritt D, Dawson A. How can human resources for health interventions contribute to sexual, reproductive, maternal, and newborn healthcare quality across the continuum in low- and lower-middle-income countries? A systematic review. HUMAN RESOURCES FOR HEALTH 2021; 19:54. [PMID: 33882968 PMCID: PMC8061056 DOI: 10.1186/s12960-021-00601-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Well-trained, competent, and motivated human resources for health (HRH) are crucial to delivering quality service provision across the sexual, reproductive, maternal, and newborn health (SRMNH) care continuum to achieve the 2030 Sustainable Development Goals (SDGs) maternal and neonatal health targets. This review aimed to identify HRH interventions to support lay and/or skilled personnel to improve SRMNH care quality along the continuum in low- and lower-middle-income countries (LLMICs). METHODS A structured search of CINAHL, Cochrane Library/trials, EMBASE, PubMed, SCOPUS, Web of Science, and HRH Global Resource Centre databases was undertaken, guided by the PRISMA framework. The inclusion criteria sought to identify papers with a focus on 1. HRH management, leadership, partnership, finance, education, and/or policy interventions; 2. HRH interventions' impact on two or more quality SRMNH care packages across the continuum from preconception to pregnancy, intrapartum and postnatal care; 3. Skilled and/or lay personnel; and 4. Reported primary research in English from LLMICs. A deductive qualitative content analysis was employed using the World Health Organization-HRH action framework. RESULTS Out of identified 2157 studies, 24 intervention studies were included in the review. Studies where ≥ 4 HRH interventions had been combined to target various healthcare system components, were more effective than those implementing ≤ 3 HRH interventions. In primary care, HRH interventions involving skilled and lay personnel were more productive than those involving either skilled or lay personnel alone. Results-based financing (RBF) and its policy improved the quality of targeted maternity services but had no impact on client satisfaction. Local budgeting, administration, and policy to deliver financial incentives to health workers and improve operational activities were more efficacious than donor-driven initiatives. Community-based recruitment, training, deployment, empowerment, supportive supervision, access to m-Health technology, and modest financial and non-financial incentives for community health workers (CHWs) improved the quality of care continuum. Skills-based, regular, short, focused, onsite, and clinical simulation, and/or mobile phone-assisted in-service training of skilled personnel were more productive than knowledge-based, irregular, and donor-funded training. Facility-based maternal and perinatal death reviews, coupled with training and certification of skilled personnel, positively affected SRMNH care quality across the continuum. Preconception care, an essential component of the SRMNH care continuum, lacks studies and services in LLMICs. CONCLUSIONS We recommend maternal and perinatal death audits in all health facilities; respectful, woman-centered care as a critical criterion of RBF initiatives; local administration of health worker allowances and incentives; and integration of CHWs into the healthcare system. There is an urgent need to include preconception care in the SRMNH care continuum and studies in LLMICs.
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Affiliation(s)
- Melese Girmaye Negero
- School of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
| | - David Sibbritt
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Angela Dawson
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Aryanty RI, Romadlona N, Besral B, Panggabean EDP, Utomo B, Makalew R, Magnani RJ. Contraceptive use and maternal mortality in Indonesia: a community-level ecological analysis. Reprod Health 2021; 18:42. [PMID: 33596945 PMCID: PMC7887778 DOI: 10.1186/s12978-020-01022-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 10/21/2020] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Prior studies have shown that contraceptive use reduces maternal mortality independently of other maternal health services. The present study took advantage of geographically detailed Indonesian data to study the interplay between contraceptive use and other risk and protective factors for maternal mortality at the community level, a level of analysis where the protective effects of family planning can be best understood. METHODS Data from the 2015 Intercensal Population Survey (SUPAS) and the 2014 Village Potential Survey (PODES) were used to construct a series of census block-level variables measuring key risk and protective factors for maternal mortality. The relationships between these factors and maternal mortality, measured via natural log-transformation of past five-year maternal mortality ratios in each of the 40,748 census blocks were assessed via log-linear regressions. RESULTS Higher community maternal mortality ratios were associated with lower community contraceptive prevalence, higher percentage of parity four-plus births, higher proportion of poor households, lower population density of hospitals, higher density of traditional birth attendants (TBA), and residence outside of Java-Bali. For every percentage point increase in CPR, community maternal mortality ratios were lower by 7.0 points (95% CI = 0.9, 14.3). Community-level household wealth was the strongest predictor of maternal mortality. CONCLUSIONS Community contraceptive prevalence made a significant contribution to reducing maternal mortality net of other risk and protective factors during 2010-2015. Increased health system responsiveness to the needs of pregnant women and reductions in socioeconomic and geographic disparities in maternal health services will be needed for Indonesia to reach the 2030 SDG maternal mortality goal.
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Affiliation(s)
| | - NohanArum Romadlona
- Department of Population and Biostatistics, Faculty of Public Health, University of Indonesia, Jakarta, Indonesia
| | - Besral Besral
- Department of Population and Biostatistics, Faculty of Public Health, University of Indonesia, Jakarta, Indonesia
| | - Elvi Debora P Panggabean
- Department of Population and Biostatistics, Faculty of Public Health, University of Indonesia, Jakarta, Indonesia
| | - Budi Utomo
- Department of Population and Biostatistics, Faculty of Public Health, University of Indonesia, Jakarta, Indonesia
| | | | - Robert J Magnani
- Faculty of Public Health, University of Indonesia, Jakarta, Indonesia
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Vargas B, Louzado-Feliciano P, Santos N, Fuller S, Jimsheleishvili S, Quiñones Á, Martin HH. An exploration of patient-provider dynamics and childbirth experiences in rural and urban Peru: a qualitative study. BMC Pregnancy Childbirth 2021; 21:135. [PMID: 33588780 PMCID: PMC7885576 DOI: 10.1186/s12884-021-03586-y] [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: 07/23/2020] [Accepted: 01/22/2021] [Indexed: 11/11/2022] Open
Abstract
Background Between 2006 and 2013, Peru implemented national programs which drastically decreased rates of maternal and neonatal mortality. However, since 2013, maternal and neonatal mortality in Peru have increased. Additionally, discrimination, abuse, and violence against women persists globally and impacts birthing experiences and mental health. This qualitative study sought to better understand the attitudes and beliefs regarding childbirth among women and providers in Southern Peru. This study also explores how these beliefs influence utilization of skilled care, patient-provider dynamics, and childbirth experiences and identifies factors that impact providers’ provision of care. Methods Thirty semi-structured interviews were conducted with 15 participants from rural Colca Canyon and 15 participants from urban Arequipa between April and May 2018. In each region, 10 women who had experienced recent births and five providers were interviewed. Provider participants predominantly identified as female and were mostly midwives. All interviews were conducted, transcribed, and coded in Spanish. A framework analysis was followed, and data were charted into two separate thematic frameworks using contextual and evaluative categories of conceptualization of childbirth. Results All recent births discussed were facility-based births. Four domains emerged: women’s current birth experiences, provision of childbirth care, beliefs about childbirth among women and providers, and future health-seeking behavior. Findings suggest that women’s feelings of helplessness and frustration were exacerbated by their unmet desire for respectful maternity care and patient advocacy or companionship. Providers attributed strain to perceived patient characteristics and insufficient support, including resources and staff. Conclusions Our findings suggest current childbirth experiences placed strain on the patient-provider dynamic and influenced women’s attitudes and beliefs about future experiences. Currently, the technical quality of safe childbirth is the main driver of skilled birth attendance and facility-based births for women regardless of negative experiences. However, lack of respectful maternity care has been shown to have major long-term implications for women and subsequently, their children. This is one of the first studies to describe the nuances of patient-provider relationships and women’s childbirth experiences in rural and urban Peru. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03586-y.
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Affiliation(s)
- Brianna Vargas
- University of California San Francisco, Institute for Global Health Sciences, San Francisco, CA, USA.
| | - Paola Louzado-Feliciano
- University of California San Francisco, Institute for Global Health Sciences, San Francisco, CA, USA.,Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Nicole Santos
- University of California San Francisco, Institute for Global Health Sciences, San Francisco, CA, USA
| | - Shannon Fuller
- University of California San Francisco, Institute for Global Health Sciences, San Francisco, CA, USA
| | | | - Ángela Quiñones
- Professional School of Human Medicine, Catholic University of Santa Maria, Arequipa, Peru
| | - Holly H Martin
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
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Saran A, White H, Albright K, Adona J. Mega-map of systematic reviews and evidence and gap maps on the interventions to improve child well-being in low- and middle-income countries. CAMPBELL SYSTEMATIC REVIEWS 2020; 16:e1116. [PMID: 37018457 PMCID: PMC8356294 DOI: 10.1002/cl2.1116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Despite a considerable reduction in child mortality, nearly six million children under the age of five die each year. Millions more are poorly nourished and in many parts of the world, the quality of education remains poor. Children are at risk from multiple violations of their rights, including child labour, early marriage, and sexual exploitation. Research plays a crucial role in helping to close the remaining gaps in child well-being, yet the global evidence base for interventions to meet these challenges is mostly weak, scattered and often unusable by policymakers and practitioners. This mega-map encourages the generation and use of rigorous evidence on effective ways to improve child well-being for policy and programming. OBJECTIVES The aim of this mega-map is to identify, map and provide an overview of the existing evidence synthesis on the interventions aimed at improving child well-being in low- and middle-income countries (LMICs). METHODS Campbell evidence and gap maps (EGMs) are based on a review of existing mapping standards (Saran & White, 2018) which drew in particular of the approach developed by 3ie (Snilstveit, Vojtkova, Bhavsar, & Gaarder, 2013). As defined in the Campbell EGM guidance paper; "Mega-map is a map of evidence synthesis, that is, systematic reviews, and does not include primary studies" (Campbell Collaboration, 2020). The mega-map on child well-being includes studies with participants aged 0-18 years, conducted in LMICs, and published from year 2000 onwards. The search followed strict inclusion criteria for interventions and outcomes in the domains of health, education, social work and welfare, social protection, environmental health, water supply and sanitation (WASH) and governance. Critical appraisal of included systematic reviews was conducted using "A Measurement Tool to Assess Systematic Reviews"-AMSTAR-2 rating scale (Shea, et al., 2017). RESULTS We identified 333 systematic reviews and 23 EGMs. The number of studies being published has increased year-on-year since 2000. However, the distribution of studies across World Bank regions, intervention and outcome categories are uneven. Most systematic reviews examine interventions pertaining to traditional areas of health and education. Systematic reviews in these traditional areas are also the most funded. There is limited evidence in social work and social protection. About 69% (231) of the reviews are assessed to be of low and medium quality. There are evidence gaps with respect to key vulnerable populations, including children with disabilities and those who belong to minority groups. CONCLUSION Although an increasing number of systematic reviews addressing child well-being topics are being published, some clear gaps in the evidence remain in terms of quality of reviews and some interventions and outcome areas. The clear gap is the small number of reviews focusing explicitly on either equity or programmes for disadvantaged groups and those who are discriminated against.
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Affiliation(s)
| | | | | | - Jill Adona
- Philippines Institute of Development StudiesManilaPhilippines
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Sarmiento I, Paredes-Solís S, Morris M, Pimentel J, Cockcroft A, Andersson N. Factors influencing maternal health in indigenous communities with presence of traditional midwifery in the Americas: protocol for a scoping review. BMJ Open 2020; 10:e037922. [PMID: 33109651 PMCID: PMC7592283 DOI: 10.1136/bmjopen-2020-037922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/20/2020] [Accepted: 07/17/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Indigenous mothers often receive culturally unsafe services that do not fully respond to their needs. The objective of this scoping review is to collate and assess evidence that identifies factors, including the role and influence of traditional midwives, that affect maternal health in indigenous communities in the Americas. The results will map Western perspectives reflected in published and unpublished literature to indicate the complex network of factors that influence maternal outcomes. These maps will allow for comparison with local stakeholder knowledge and discussion to identify what needs to change to promote culturally safe care. METHODS AND ANALYSIS A librarian will search studies with iterative and documented adjustments in CINAHL, Scopus, Latin American and Caribbean Health Sciences Literature (LILACS), MEDLINE, Embase and Google Scholar without any time restrictions, and use Google search engine for grey literature. Included studies will be empirical (quantitative, qualitative or mixed); address maternal health issues among indigenous communities in the Americas; and report on the role or influence of traditional midwives. Two researchers will independently screen and blindly select the included studies. The quality assessment of included manuscripts will rely on the Mixed Methods Appraisal Tool (MMAT). Two independent researchers will extract data on factors promoting or reducing maternal health in indigenous communities, including the role or influence of traditional midwives. Fuzzy cognitive mapping will summarise the findings as a list of relationships between identified factors and outcomes with weights indicating strength of the relationship and the evidence supporting this. ETHICS AND DISSEMINATION This review is part of a proposal approved by the ethics committees at McGill University and the Centro de Investigación de Enfermedades Tropicales in Guerrero. Participating indigenous communities in Guerrero State approved the study in 2015. The results of the scoping review will contribute to the field of cultural safety and intercultural dialogue for the promotion of maternal health in indigenous communities.
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Affiliation(s)
- Iván Sarmiento
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Québec, Canada
- Grupo de Estudios en Sistemas Tradicionales de Salud (GESTS), Universidad del Rosario, Bogotá, Cundinamarca, Colombia
| | - Sergio Paredes-Solís
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, México
| | - Martin Morris
- Schulich Library of Physical Sciences, Life Sciences and Engineering, McGill University, Montreal, Québec, Canada
| | - Juan Pimentel
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Québec, Canada
- Grupo de Estudios en Sistemas Tradicionales de Salud (GESTS), Universidad del Rosario, Bogotá, Cundinamarca, Colombia
| | - Anne Cockcroft
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Québec, Canada
| | - Neil Andersson
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Québec, Canada
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, México
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Garces A, McClure EM, Espinoza L, Saleem S, Figueroa L, Bucher S, Goldenberg RL. Traditional birth attendants and birth outcomes in low-middle income countries: A review. Semin Perinatol 2019; 43:247-251. [PMID: 30981470 PMCID: PMC6591059 DOI: 10.1053/j.semperi.2019.03.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Traditional birth attendants (TBAs) provided delivery care throughout the world prior to the development of organized systems of medical care. In 2016, an estimated 22% of pregnant women delivered with a TBA, mostly in rural or remote areas that lacked formal health services. Still active in many regions of LMICs, they provide care, including support and advice, to women during pregnancy and childbirth. Even though they generally have no formal training and are not recognized as medical practitioners, TBAs enjoy a high societal standing and many families seek them as health care providers. They are generally older women who have acquired their skills acting as apprentices of other TBAs or are self-taught. WHO and other international organizations have focused maternal mortality reduction efforts on the availability of skilled birth attendance, which excludes TBAs as providers of care. However, as countries move towards SBA, policy makers need to make the best use of TBAs while simultaneously planning for their replacement with skilled attendants. They often serve as a bridge between the community and the formal health system; once women are inside an institution, TBAs could potentially act as doulas, providing company and making women feel more comfortable in an unknown environment. In this paper, we will review who TBAs are, how many births they attend worldwide worldwide, where they provide delivery care, and finally, their relationships with the formal health care system and the communities they serve.
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Affiliation(s)
- Ana Garces
- Instituto de Nutrición de Centro América y Panamá, Guatemala City, Guatemala.
| | | | - Leopoldo Espinoza
- Instituto de Nutrición de Centro América y Panamá, Guatemala City, Guatemala
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Kararchi, Pakistan
| | - Lester Figueroa
- Instituto de Nutrición de Centro América y Panamá, Guatemala City, Guatemala
| | - Sherri Bucher
- School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
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Strengthening the community support group to improve maternal and neonatal health seeking behaviors: A cluster-randomized controlled trial in Satkhira District, Bangladesh. PLoS One 2019; 14:e0212847. [PMID: 30817784 PMCID: PMC6394907 DOI: 10.1371/journal.pone.0212847] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 02/08/2019] [Indexed: 11/20/2022] Open
Abstract
Background Although achieved development goals on maternal and child health, in the era of Sustainable Development Goals (SDGs), Bangladesh still needs to promote skilled attendance at birth as well as a continuum of care for mothers and babies. How to implement effective interventions by strengthening the community health system also remains as a crucial policy issue. The objective of the proposed study is to evaluate the impact of a community-based intervention as part of a bilateral development aid project on utilization of maternal and neonatal care provided by skilled providers and qualified facilities. Methods A cluster randomized trial was conducted in Kalaroa Upazila of Satkhira District. Community Clinics (CCs) in the study setting were randomly allocated to either intervention or control. We recruited all eligible women covered by CC catchment areas who gave a birth during the past 12 months of data collection at the baseline and end-line surveys. In the intervention areas, three Community Support Groups (CSGs) were developed in each of the CC areas. The members of CSG were trained to identify pregnant women, educate community people on pregnancy related danger signs, and encourage them for utilization of skilled services in the community and health facilities. The primary outcomes were the utilization of services for antenatal care, delivery, postnatal care and sick newborns. Difference-in-Difference (DID) analysis was performed to identify the changes by the intervention with adjustment of cluster effects by generalized mixed effects regression models. Result The major indicators of the utilization of maternal and neonatal care among pregnant women with different wealth status showed significant improvement after the intervention. The impacts of the intervention were in particular significant among the women of 2nd and 3rd quintiles of household wealth status. The use of CCs increased after the intervention and private hospitals / clinics served as the major health providers. The study also identified increased practices of cesarean section. Conclusion The success of the intervention suggests a potential of the government efforts to strengthen the community support system for promotion of safe motherhood. The intervention helps to identify and remove existing and emerging barriers that lie between women and healthcare providers for safe motherhood and continuum of care. Trial registration UMIN Clinical Trial Registry UMIN000031789.
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Anono EL, Ochola S, Wawire S, Ogada I, Ndedda C, Kung'u JK. Community perceptions towards the new role of traditional birth attendants as birth companions and nutrition advocates in Kakamega County, Kenya. MATERNAL AND CHILD NUTRITION 2019; 14 Suppl 1. [PMID: 29493900 DOI: 10.1111/mcn.12578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 12/19/2022]
Abstract
Delivery with skilled birth attendants is important for reducing maternal mortality in developing countries. However, traditional birth attendants (TBAs) are abundant in such settings, managing deliveries without the skills and resources necessary to prevent mortality in this situations. Interventions that have been proposed to mitigate the situation include redefining the role of TBAs to nutrition advocates and birth companions for pregnant women to health facilities. We thus explored community perceptions on these new roles of TBAs, as birth companions and nutrition advocates, and their influence on health facility deliveries in Kakamega County, Kenya. Qualitative data was collected through key informant interviews with health workers and focus group discussions with lactating mothers, pregnant women, husbands, community leaders, community health volunteers, and TBA. Content analysis was conducted; data was organized into subthemes and conclusions made from each subtheme using Atlas.ti software. TBAs adopted their birth companion role as the majority offered companionship to mothers delivering at health facilities. Mothers were happy with this role as TBAs continued providing companionship even after delivery. The community members were happy with the new role of TBAs and reported increased deliveries at the health facilities. In contrast, TBAs did not adopt the nutrition advocacy role sufficiently. We found that redefining the role of the TBAs into birth companions to support facility-based delivery is thus feasible and acceptable. Nutrition advocacy by the TBAs should be strengthened to maximize on the opportunity provided by the close association between TBAs and mothers and the community.
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Affiliation(s)
- Esther L Anono
- Department of Foods Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
| | - Sophie Ochola
- Department of Foods Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
| | | | - Irene Ogada
- Department of Foods Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
| | - Crispin Ndedda
- Kenya Country Office-Nutrition International, Nairobi, Kenya
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Haruna U, Kansanga MM, Galaa S. Examining the unresolved conundrum of Traditional Birth Attendants' involvement in maternal and child health care delivery in Ghana. Health Care Women Int 2018; 40:1336-1354. [PMID: 30481128 DOI: 10.1080/07399332.2018.1540006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Traditional Birth Attendants (TBAs) have been a critical human resource in maternal health care delivery in Ghana. However, following the World Health Organization's directive for countries to discontinue using TBAs, the government of Ghana has since emphasized the use of skilled birth attendants. This policy shift created tensions between TBAs and Community Health Nurses. We examine this conundrum in this paper. We find that despite the ban, TBAs still attend a significant number of births - a situation which has produced intense contestations and continuous jostling for "functioning space" and clients between TBAs and nurses. We recommend a consensus-based partnership approach that promotes cultural competence and is sensitive to contextual cultural practices that underpin pregnancy and childbirth.
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Affiliation(s)
- Umar Haruna
- Department of Social Political and Historical Studies, University for Development Studies, Wa, Ghana
| | | | - Sylvester Galaa
- Department of Social Political and Historical Studies, University for Development Studies, Wa, Ghana
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Andina-Diaz E, Ovalle-Perandones MA, Ramos-Vidal I, Camacho-Morell F, Siles-Gonzalez J, Marques-Sanchez P. Social Network Analysis Applied to a Historical Ethnographic Study Surrounding Home Birth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E837. [PMID: 29695089 PMCID: PMC5981876 DOI: 10.3390/ijerph15050837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/04/2018] [Accepted: 04/04/2018] [Indexed: 11/17/2022]
Abstract
Safety during birth has improved since hospital delivery became standard practice, but the process has also become increasingly medicalised. Hence, recent years have witnessed a growing interest in home births due to the advantages it offers to mothers and their newborn infants. The aims of the present study were to confirm the transition from a home birth model of care to a scenario in which deliveries began to occur almost exclusively in a hospital setting; to define the social networks surrounding home births; and to determine whether geography exerted any influence on the social networks surrounding home births. Adopting a qualitative approach, we recruited 19 women who had given birth at home in the mid 20th century in a rural area in Spain. We employed a social network analysis method. Our results revealed three essential aspects that remain relevant today: the importance of health professionals in home delivery care, the importance of the mother’s primary network, and the influence of the geographical location of the actors involved in childbirth. All of these factors must be taken into consideration when developing strategies for maternal health.
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Affiliation(s)
- Elena Andina-Diaz
- Health Research Group, Welfare and Social and Health Sustainability (SALBIS), Faculty of Health Science, University of León, Vegazana Campus, s/n, 24071 León, Spain.
| | - Mª Antonia Ovalle-Perandones
- Library and Information Science Department, Faculty of Humanities, Communication and Documentation, Carlos III University, 28903 Getafe, Madrid, Spain.
| | - Ignacio Ramos-Vidal
- Social Psychology Department, University of Seville, 41004 Seville, Spain.
- School of Social and Human Sciences, Pontifical Bolivarian University, Medellín, Colombia.
| | - Francisca Camacho-Morell
- Delivery Room, La Ribera University Hospital, 46600 Alcira, Valencia, Spain.
- Faculty of Nursing and Podiatry University of Valencia, 46010 Valencia, Spain.
| | - Jose Siles-Gonzalez
- Faculty of Health Sciences, University of Alicante, 03690 San Vicente del Raspeig, Alicante, Spain.
| | - Pilar Marques-Sanchez
- Health Research Group, Welfare and Social and Health Sustainability (SALBIS), Faculty of Health Science, University of León, Ponferrada Campus, s/n, 24401 Ponferrada, León, Spain.
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Chi PC, Urdal H. The evolving role of traditional birth attendants in maternal health in post-conflict Africa: A qualitative study of Burundi and northern Uganda. SAGE Open Med 2018; 6:2050312117753631. [PMID: 29375881 PMCID: PMC5777562 DOI: 10.1177/2050312117753631] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 12/20/2017] [Indexed: 11/17/2022] Open
Abstract
Objectives: Many conflict-affected countries are faced with an acute shortage of health care providers, including skilled birth attendants. As such, during conflicts traditional birth attendants have become the first point of call for many pregnant women, assisting them during pregnancy, labour and birth, and in the postpartum period. This study seeks to explore how the role of traditional birth attendants in maternal health, especially childbirth, has evolved in two post-conflict settings in sub-Saharan Africa (Burundi and northern Uganda) spanning the period of active warfare to the post-conflict era. Methods: A total of 63 individual semi-structured in-depth interviews and 8 focus group discussions were held with women of reproductive age, local health care providers and staff of non-governmental organisations working in the domain of maternal health who experienced the conflict, across urban, semi-urban and rural settings in Burundi and northern Uganda. Discussions focused on the role played by traditional birth attendants in maternal health, especially childbirth during the conflict and how the role has evolved in the post-conflict era. Transcripts from the interviews and focus group discussions were analysed by thematic analysis (framework approach). Results: Traditional birth attendants played a major role in childbirth-related activities in both Burundi and northern Uganda during the conflict, with some receiving training and delivery kits from the local health systems and non-governmental organisations to undertake deliveries. Following the end of the conflict, traditional birth attendants have been prohibited by the government from undertaking deliveries in both Burundi and northern Uganda. In Burundi, the traditional birth attendants have been integrated within the primary health care system, especially in rural areas, and re-assigned the role of ‘birth companions’. In this capacity they undertake maternal health promotion activities within their communities. In northern Uganda, on the other hand, traditional birth attendants have not been integrated within the local health system and still appear to undertake clandestine deliveries in some rural areas. Conclusion: The prominent role of traditional birth attendants in childbirth during the conflicts in Burundi and northern Uganda has been dwindling in the post-conflict era. Traditional birth attendants can still play an important role in facilitating facility and skilled attended births if appropriately integrated with the local health system.
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Affiliation(s)
- Primus Che Chi
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Peace Research Institute Oslo, Oslo, Norway
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Miller T, Smith H. Establishing partnership with traditional birth attendants for improved maternal and newborn health: a review of factors influencing implementation. BMC Pregnancy Childbirth 2017; 17:365. [PMID: 29052533 PMCID: PMC5649078 DOI: 10.1186/s12884-017-1534-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 08/04/2017] [Indexed: 11/10/2022] Open
Abstract
Background Recent World Health Organization recommendations recognize the important role Traditional Birth Attendants (TBAs) can play in supporting the health of women and newborns. This paper provides an analysis of key factors that affect the implementation of interventions to develop partnerships with TBAs to promote improved access to skilled care at birth. Methods We conducted a secondary analysis of 20 papers identified through two systematic reviews that examined the effectiveness of interventions to find new roles for TBAs on maternal and newborn health outcomes, as well as papers identified through a systematic mapping of the maternal health literature. The Supporting the Use of Research Evidence framework (SURE) guided the thematic analysis to explore the perceptions of various stakeholders and implementation barriers and facilitators, as well as other contextual issues. Results This analysis identified countries that have implemented interventions to support the transition from birth with a TBA to birth with a skilled birth attendant. Drawing on the experiences of these countries, the analysis highlights factors that are important to consider when designing and implementing such interventions. Barriers to implementation included resistance to change in more traditional communities, negative attitudes between TBAs and skilled attendants and TBAs concerns about the financial implications of assuming new roles. Facilitating factors included stakeholder involvement in devising and implementing interventions, knowledge sharing between TBAs and skilled birth attendants, and formalised roles and responsibilities and remuneration for TBAs. Conclusions The implementation barriers identified in this analysis could, if not addressed, prevent or discourage TBAs from carrying out newly defined roles supporting women in pregnancy and childbirth and linking them to the formal health system. This paper also identifies the factors that seem critical to success, which new programmes could consider adopting from the outset. In most cases a multi-faceted approach is needed to prepare TBAs and others for new roles, including the training of TBAs to strengthen their knowledge and skills to enable them to be able to assume new roles, alongside the sensitization of healthcare providers, communities, women and their families. Further research is required to map the transition process and stakeholder experiences in more detailed ways and to provide longer-term monitoring of existing interventions.
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Affiliation(s)
- Tina Miller
- Department of Social Sciences, Oxford Brookes University, Oxford, OX3 0BP, UK.
| | - Helen Smith
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
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Cheptum JJ, Gitonga MM, Mutua EM, Mukui SJ, Ndambuki JM, Koima WJ. Perception about traditional birth attendants by men and women of reproductive age in rural Migori County, Kenya. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2017. [DOI: 10.1016/j.ijans.2017.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Reeve M, Onyo P, Nyagero J, Morgan A, Nduba J, Kermode M. Knowledge, attitudes and practices of traditional birth attendants in pastoralist communities of Laikipia and Samburu counties, Kenya: a cross-sectional survey. Pan Afr Med J 2016; 25:13. [PMID: 28439337 PMCID: PMC5390066 DOI: 10.11604/pamj.supp.2016.25.2.9983] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 07/27/2016] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Current efforts to reduce maternal and newborn mortality focus on promoting institutional deliveries with skilled birth attendants (SBAs), and discouraging deliveries at home attended by traditional birth attendants (TBAs). In rural Kenya, semi-nomadic pastoralist communities are underserved by the formal health system, experience high maternal and neonatal mortality, and rely primarily on TBAs for delivery care, despite Government proscription of TBA-assisted births. This study examined the knowledge, attitude and practices of TBAs serving these communities to assess the potential for collaboration between TBAs and SBAs. METHODS A cross-sectional, interviewer-administered survey was conducted among 171 TBAs from Maasai and Samburu pastoralist communities in Laikipia and Samburu counties, Kenya, as part of a larger mixed-methods study in partnership with a local service provider. RESULTS BAs were relatively elderly (mean age 59.6 years), and attended an average of 5-6 deliveries per year. A minority (22.2%) had received formal training. They provided antenatal, intra-partum and post-partum care. Most TBA care was non-interventionist, but not necessarily consistent with best practice. Most had encountered birth complications, but knowledge regarding management of complications was sub-optimal. Most had previously referred at least one woman to a health facility (80.1%), were key participants in decision making to refer women (96.5%), and had been present at an institutional delivery (54.4%). CONCLUSION TBAs continue to be key providers of maternal and neonatal healthcare in regions where the formal health system has poor coverage or acceptability. Strengthening existing TBA/SBA collaborations could improve both community links to the formal health system, and the quality of care provided to pastoralist women, while remaining consistent with current Government policy.
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Affiliation(s)
- Matthew Reeve
- Nossal Institute for Global Health, University of Melbourne, Carlton 3010, VIC, Australia
| | | | | | - Alison Morgan
- Nossal Institute for Global Health, University of Melbourne, Carlton 3010, VIC, Australia
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Village midwives and their changing roles in Brunei Darussalam: A qualitative study. Women Birth 2016; 29:e73-e81. [PMID: 27105748 DOI: 10.1016/j.wombi.2016.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 03/07/2016] [Accepted: 04/04/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND There are lay midwives worldwide, interchangeably and universally called traditional birth attendants or traditional midwives by organisations such as the World Health Organization and the International Confederation of Midwives. AIM This study aimed to explore the history of lay midwives (village midwives) in Brunei, describe the evolution from their previous to current roles and determine if they are still needed by women today. METHODS This qualitative, descriptive study included in-depth, semi-structured interviews with eight women who had received care from village midwives. Data analysis was based on the principles underpinning thematic analysis and used a constant comparative method. FINDINGS Village midwives have been popular in Brunei since the 1900s, with their major role being to assist women with childbirth. However, since the 1960s, their roles and practices have changed to focus on pre-conception, antenatal, postnatal and women's general healthcare. Traditional practices were influenced by religion, culture and the social context of and within Brunei. DISCUSSION The major changes in village midwives' roles and practices resulted from the enforcement of the Brunei Midwives' Act in 1956. Village midwives' traditional practices became juxtaposed with modern complementary alternative medicine practices, and they began charging a fee for their services. CONCLUSION Brunei village midwives are trusted by women, and their practices may still be widely accepted in Brunei. Further research is necessary to confirm their existence, determine the detailed scope and appropriateness of their practices and verify the feasibility of them working together with healthcare professionals.
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Clinical trials registries are underused in the pregnancy and childbirth literature: a systematic review of the top 20 journals. BMC Res Notes 2016; 9:475. [PMID: 27769265 PMCID: PMC5073738 DOI: 10.1186/s13104-016-2280-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 10/12/2016] [Indexed: 12/24/2022] Open
Abstract
Background Systematic reviews and meta-analyses that do not include unpublished data in their analyses may be prone to publication bias, which in some cases has been shown to have deleterious consequences on determining the efficacy of interventions. Methods We retrieved systematic reviews and meta-analyses published in the past 8 years (January 1, 2007–December 31, 2015) from the top 20 journals in the Pregnancy and Childbirth literature, as rated by Google Scholar’s h5-index. A meta-epidemiologic analysis was performed to determine the frequency with which authors searched clinical trials registries for unpublished data. Results A PubMed search retrieved 372 citations, 297 of which were deemed to be either a systematic review or a meta-analysis and were included for analysis. Twelve (4 %) of these searched at least one WHO-approved clinical trials registry or clinicaltrials.gov. Conclusion Systematic reviews and meta-analyses published in pregnancy and childbirth journals do not routinely report searches of clinical trials registries. Including these registries in systematic reviews may be a promising avenue to limit publication bias if registry searches locate unpublished trial data that could be used in the systematic review.
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Implementing a culturally appropriate birthing policy: Ethnographic analysis of the experiences of skilled birth attendants in Peru. J Public Health Policy 2016; 37:353-368. [PMID: 27193501 DOI: 10.1057/jphp.2016.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Policies about skilled birth attendants (SBA) need to account for cultural acceptability of care rendered by SBAs. Few studies have assessed these policies from the perspective of SBAs. I identify challenges and analyze the experiences of SBAs implementing a culturally appropriate birth care policy in Peru. I collected data during 15 months of ethnographic research: conducting semi-structured interviews and informal conversations with 5 SBAs in 2 villages and with health officials. I compared interview results with my observations of consultations and of labor and delivery. Weak institutional support, lack of training, negative perceptions of the policy inhibited implementation, as did detrimental effects on future personal and professional opportunities. SBAs in Peru face many challenges when trying to establish intercultural birth care. My recommendations include provision of focused training, promoting a more diverse workforce, and increasing community engagement.Journal of Public Health Policy advance online publication, 19 May 2016; doi:10.1057/jphp.2016.19.
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Measuring the impact of a quality improvement collaboration to decrease maternal mortality in a Ghanaian regional hospital. Int J Gynaecol Obstet 2016; 134:181-5. [DOI: 10.1016/j.ijgo.2015.11.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/24/2015] [Accepted: 04/01/2016] [Indexed: 11/17/2022]
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Byrne A, Caulfield T, Onyo P, Nyagero J, Morgan A, Nduba J, Kermode M. Community and provider perceptions of traditional and skilled birth attendants providing maternal health care for pastoralist communities in Kenya: a qualitative study. BMC Pregnancy Childbirth 2016; 16:43. [PMID: 26931132 PMCID: PMC4774132 DOI: 10.1186/s12884-016-0828-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 02/12/2016] [Indexed: 11/10/2022] Open
Abstract
Background Kenya has a high burden of maternal and newborn mortality. Consequently, the Government of Kenya introduced health system reforms to promote the availability of skilled birth attendants (SBAs) and proscribed deliveries by traditional birth attendants (TBAs). Despite these changes, only 10 % of women from pastoralist communities are delivered by an SBA in a health facility, and the majority are delivered by TBAs at home. The aim of this study is to better understand the practices and perceptions of TBAs and SBAs serving the remotely located, semi-nomadic, pastoralist communities of Laikipia and Samburu counties in Kenya, to inform the development of an SBA/TBA collaborative care model. Methods This descriptive qualitative study was undertaken in 2013–14. We conducted four focus group discussions (FGDs) with TBAs, three with community health workers, ten with community women, and three with community men. In-depth interviews were conducted with seven SBAs and eight key informants. Topic areas covered were: practices and perceptions of SBAs and TBAs; rewards and challenges; managing obstetric complications; and options for SBA/TBA collaboration. All data were translated, transcribed and thematically analysed. Results TBAs are valued and accessible members of their communities who adhere to traditional practices and provide practical and emotional support to women during pregnancy, delivery and post-partum. Some TBA practices are potentially harmful to women e.g., restricting food intake during pregnancy, and participants recognised that TBAs are unable to manage obstetric complications. SBAs are acknowledged as having valuable technical skills and resources that contribute to safe and clean deliveries, especially in the event of complications, but there is also a perception that SBAs mistreat women. Both TBAs and SBAs identified a range of challenges related to their work, and instances of mutual respect and informal collaborations between SBAs and TBAs were described. Conclusions These findings clearly indicate that an SBA/TBA collaborative model of care consistent with Kenyan Government policy is a viable proposition. The transition from traditional birth to skilled birth attendance among the pastoralist communities of Laikipia and Samburu is going to be a gradual one, and an interim collaborative model is likely to increase the proportion of SBA assisted deliveries, improve obstetric outcomes, and facilitate the transition.
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Affiliation(s)
- Abbey Byrne
- Nossal Institute for Global Health, University of Melbourne, 161 Barry St, Carlton, VIC, 3010, Australia
| | - Tanya Caulfield
- Nossal Institute for Global Health, University of Melbourne, 161 Barry St, Carlton, VIC, 3010, Australia
| | - Pamela Onyo
- Amref Health Africa, PO Box 27691-00506, Nairobi, Kenya
| | | | - Alison Morgan
- Nossal Institute for Global Health, University of Melbourne, 161 Barry St, Carlton, VIC, 3010, Australia
| | - John Nduba
- Amref Health Africa, PO Box 27691-00506, Nairobi, Kenya
| | - Michelle Kermode
- Nossal Institute for Global Health, University of Melbourne, 161 Barry St, Carlton, VIC, 3010, Australia.
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Rishworth A, Dixon J, Luginaah I, Mkandawire P, Tampah Prince C. “I was on the way to the hospital but delivered in the bush”: Maternal health in Ghana's Upper West Region in the context of a traditional birth attendants' ban. Soc Sci Med 2016; 148:8-17. [DOI: 10.1016/j.socscimed.2015.11.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 11/04/2015] [Accepted: 11/11/2015] [Indexed: 11/16/2022]
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Taleb F, Perkins J, Ali NA, Capello C, Ali M, Santarelli C, Hoque DME. Transforming maternal and newborn health social norms and practices to increase utilization of health services in rural Bangladesh: a qualitative review. BMC Pregnancy Childbirth 2015; 15:75. [PMID: 25886165 PMCID: PMC4391089 DOI: 10.1186/s12884-015-0501-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 03/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since 2008, Participatory Action for Rural Development Innovation (PARI) Development Trust, with the support of Enfants du Monde, has been implementing a maternal and newborn health (MNH) program based on the World Health Organization's (WHO) framework for Working with Individuals, Families and Communities (IFC) to improve MNH in Netrokona district, Bangladesh. This program aims to empower women and families and increase utilization of quality health services, thereby helping women realize their rights related to maternal health. Birth preparedness and complication readiness and working with traditional birth attendants (TBAs) to exercise a new role in MNH and have formed key interventions of this program. The purpose of this study was to explore how the program has contributed to changing social norms and practices surrounding MNH at midpoint. METHODS This study relied primarily on qualitative data collection. Two focus group discussions (FGDs) were conducted with women who were pregnant or had recently given birth and one FGD with each of the following groups: husbands, family members, TBAs, and health workers. In-depth interviews were conducted with women who were pregnant or had recently given birth, family members of these women, health care providers, TBAs and community health workers in selected intervention areas. RESULTS Since implementation of interventions informants report an increase in planning for birth and complications and a shift in preference toward skilled care at birth. However, women still prefer to receive services at home. TBAs report encouraging women to access skilled care for both routine and emergency services. While community members' understanding of rights related to maternal health remains limited, they report increased women's participation in household decision- making processes, an important indicator of the realization of rights. CONCLUSION Results suggest that community-level interventions aiming to affect change in social norms and practices surrounding MNH can influence knowledge and practices even after a short period of time. Further evaluations will be required to quantify the degree to which these changes are having an impact on health services utilization.
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Affiliation(s)
- Fahmida Taleb
- Center for Child and Adolescent Health, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | | | - Nabeel Ashraf Ali
- Center for Child and Adolescent Health, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | | | - Muzahid Ali
- Enfants Du Monde South Asia Field Office, Dhaka, Bangladesh.
| | | | - Dewan Md Emdadul Hoque
- Center for Child and Adolescent Health, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
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Can community health officer-midwives effectively integrate skilled birth attendance in the community-based health planning and services program in rural Ghana? Reprod Health 2014; 11:90. [PMID: 25518900 PMCID: PMC4326211 DOI: 10.1186/1742-4755-11-90] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 12/11/2014] [Indexed: 11/10/2022] Open
Abstract
Background The burden of maternal mortality in sub-Saharan Africa is very high. In Ghana maternal mortality ratio was 380 deaths per 100,000 live births in 2013. Skilled birth attendance has been shown to reduce maternal mortality and morbidity, yet in 2010 only 68 percent of mothers in Ghana gave birth with the assistance of skilled birth attendants. In 2005, the Ghana Health Service piloted a strategy that involved using the integrated Community-based Health Planning and Services (CHPS) program and training Community Health Officers (CHOs) as midwives to address the gap in skilled attendance in rural Upper East Region (UER). The study assesses the feasibility of and extent to which the skilled delivery program has been implemented as an integrated component of the existing CHPS, and documents the benefits and challenges of the integrated program. Methods We employed an intrinsic case study design with a qualitative methodology. We conducted 41 in-depth interviews with health professionals and community stakeholders. We used a purposive sampling technique to identify and interview our respondents. Results The CHO-midwives provide integrated services that include skilled delivery in CHPS zones. The midwives collaborate with District Assemblies, Non-Governmental Organizations (NGOs) and communities to offer skilled delivery services in rural communities. They refer pregnant women with complications to district hospitals and health centers for care, and there has been observed improvement in the referral system. Stakeholders reported community members’ access to skilled attendants at birth, health education, antenatal attendance and postnatal care in rural communities. The CHO-midwives are provided with financial and non-financial incentives to motivate them for optimal work performance. The primary challenges that remain include inadequate numbers of CHO-midwives, insufficient transportation, and infrastructure weaknesses. Conclusions Our study demonstrates that CHOs can successfully be trained as midwives and deployed to provide skilled delivery services at the doorsteps of rural households. The integration of the skilled delivery program with the CHPS program appears to be an effective model for improving access to skilled birth attendance in rural communities of the UER of Ghana.
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Islam N, Islam MT, Yoshimura Y. Practices and determinants of delivery by skilled birth attendants in Bangladesh. Reprod Health 2014; 11:86. [PMID: 25495451 PMCID: PMC4292816 DOI: 10.1186/1742-4755-11-86] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 11/29/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction Utilization of Skilled Birth Attendants (SBAs) at birth is low (20%) in Bangladesh. Birth attendance by SBAs is considered as the “single most important factor in preventing maternal deaths”. This paper examined the practices and determinants of delivery by SBAs in rural Bangladesh. Methods The data come from the post-intervention survey of a cluster-randomized community controlled trial conducted to evaluate the impact of limited post-natal care (PNC) services on healthcare seeking behavior of women with a recent live birth in rural Bangladesh (n = 702). Multivariable logistic regression model was used to identify the potential determinants of delivery by SBAs. Results The respondents were aged between 16 and 45, with the mean age of 24.41 (± 5.03) years. Approximately one-third (30.06%) of the women had their last delivery by SBAs. Maternal occupation, parity, complications during pregnancy and antenatal checkup (ANC) by SBAs were the significant determinants of delivery by SBAs. Women who took antenatal care by SBAs were 2.62 times as likely (95% CI: 1.66, 4.14; p < 0.001) to have their delivery conducted by SBAs compared to those who did not, after adjusting for other covariates. Conclusion Our findings suggest that ANC by SBAs and complications during pregnancies are significant determinants of delivery by SBAs. Measure should be in place to promote antenatal checkup by SBAs to increase utilization of SBAs at birth in line with achieving the Millennium Development Goal-5. Future research should focus in exploring the unmet need for, and potential barriers in, the utilization of delivery by SBAs. Electronic supplementary material The online version of this article (doi:10.1186/1742-4755-11-86) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nazrul Islam
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Room# 417, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada.
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Lassi ZS, Das JK, Salam RA, Bhutta ZA. Evidence from community level inputs to improve quality of care for maternal and newborn health: interventions and findings. Reprod Health 2014; 11 Suppl 2:S2. [PMID: 25209692 PMCID: PMC4160921 DOI: 10.1186/1742-4755-11-s2-s2] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Annually around 40 million mothers give birth at home without any trained health worker. Consequently, most of the maternal and neonatal mortalities occur at the community level due to lack of good quality care during labour and birth. Interventions delivered at the community level have not only been advocated to improve access and coverage of essential interventions but also to reduce the existing disparities and reaching the hard to reach. In this paper, we have reviewed the effectiveness of care delivered through community level inputs for improving maternal and newborn health outcomes. We considered all available systematic reviews published before May 2013 on the pre-defined community level interventions and report findings from 43 systematic reviews. Findings suggest that home visitation significantly improved antenatal care, tetanus immunization coverage, referral and early initiation of breast feeding with reductions in antenatal hospital admission, cesarean-section rates birth, maternal morbidity, neonatal mortality and perinatal mortality. Task shifting to midwives and community health workers has shown to significantly improve immunization uptake and breast feeding initiation with reductions in antenatal hospitalization, episiotomy, instrumental delivery and hospital stay. Training of traditional birth attendants as a part of community based intervention package has significant impact on referrals, early breast feeding, maternal morbidity, neonatal mortality, and perinatal mortality. Formation of community based support groups decreased maternal morbidity, neonatal mortality, perinatal mortality with improved referrals and early breast feeding rates. At community level, home visitation, community mobilization and training of community health workers and traditional birth attendants have the maximum potential to improve a range of maternal and newborn health outcomes. There is lack of data to establish effectiveness of outreach services, mass media campaigns and community education as standalone interventions. Future efforts should be concerted on increasing the availability and training of the community based skilled health workers especially in resource limited settings where the highest burden exists with limited resources to mobilize.
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Affiliation(s)
- Zohra S Lassi
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Jai K Das
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Rehana A Salam
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
- Program for Global Pediatric Research, Hospital For Sick Children, Toronto
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Fullerton JT, Thompson JB, Johnson P. Competency-based education: The essential basis of pre-service education for the professional midwifery workforce. Midwifery 2013; 29:1129-36. [DOI: 10.1016/j.midw.2013.07.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 06/29/2013] [Accepted: 07/01/2013] [Indexed: 11/29/2022]
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