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Andrén A, Lindgren H, Akselsson A, Rådestad I, Erlandsson K. One size does not fit all: Perspectives from Swedish midwives on fetal movement counselling. Women Birth 2024; 37:101621. [PMID: 38688145 DOI: 10.1016/j.wombi.2024.101621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 04/22/2024] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
PROBLEM Migration continues to play a role in determining health outcomes related to pregnancy and childbirth in Sweden. BACKGROUND Migrant women have, compared to Swedish-born women, increased risks of adverse birth outcomes. Previous research suggests that migrant women seek care for decreased fetal movements less than Swedish-born women. Given these documented risks, understanding midwives' perspectives in this context is crucial to address maternal health inequities. AIM To explore midwives' experiences conveying information about fetal movement to migrant women in antenatal healthcare settings. METHODS Semi-structured, individual interviews with midwives (n=15) experienced in providing information about fetal movements to migrant women. The interviews were analysed using reflexive thematic analysis. FINDINGS The midwives' efforts to compensate for the deficiencies within the antenatal healthcare organisation and to ensure that all women received access to information and care regarding fetal movements are described in four themes: (a) building a trusting relationship; (b) empowering women through guidance and support; (c) overcoming communication challenges; and d) navigating safety measures. DISCUSSION Our findings suggest that the standard antenatal care programme does not support midwives to provide holistic and individualised care that aligns with midwifery care philosophy. CONCLUSION To reduce health inequities for migrant women, this study highlights the need for more flexible guidelines within the standard antenatal care programme. These guidelines should prioritise the individual woman's needs over institutional protocols, acknowledge the midwife-woman relationship as the core of midwifery practice and support midwives to build a partnership with women through continuity of care.
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Affiliation(s)
- Anna Andrén
- Department of Health Promoting Science, Sophiahemmet University, Valhallavägen 91, Stockholm SE-114 28, Sweden.
| | - Helena Lindgren
- Department of Health Promoting Science, Sophiahemmet University, Valhallavägen 91, Stockholm SE-114 28, Sweden; Department of Women's and Children's Health, Karolinska Institute, Tomtebodavägen 18A, Solna SE-171 77, Sweden
| | - Anna Akselsson
- Department of Health Promoting Science, Sophiahemmet University, Valhallavägen 91, Stockholm SE-114 28, Sweden
| | - Ingela Rådestad
- Department of Health Promoting Science, Sophiahemmet University, Valhallavägen 91, Stockholm SE-114 28, Sweden
| | - Kerstin Erlandsson
- School of Health and Welfare, Dalarna University, Högskolegatan 2, Falun SE-791 88, Sweden
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Bürger I, Erlandsson K, Borneskog C. Perceived associations between the menstrual cycle and Attention Deficit Hyperactivity Disorder (ADHD): A qualitative interview study exploring lived experiences. Sex Reprod Healthc 2024; 40:100975. [PMID: 38678676 DOI: 10.1016/j.srhc.2024.100975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 04/20/2024] [Accepted: 04/23/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND The research gap regarding Attention Deficit Hyperactivity Disorder (ADHD) in people who were assigned female at birth has led to a lack of knowledge and adequate approaches in clinical practice, as well as diagnosis processes. Recent studies report potential associations between reproductive hormones and ADHD, but existing research remains scarce. AIM This study aims to explore the experiences of people who perceive an association between their menstrual cycle and their ADHD symptoms. METHODOLOGY Design and Method. A qualitative research design with an inductive approach was used. Ten participants were interviewed, using semi-structured, in-depth interviews. The data was transcribed, coded, and analyzed using reflexive thematic analysis according to Braun and Clarke. RESULTS Findings show participant's perceived associations between their ADHD and their menstrual cycle: participants reported experiencing ADHD symptom mor severe during the mid-luteal phase of the menstrual cycle. Other results showed uncertainty around ADHD medication in relation to the cycle and varied experiences with health care encounters as well as heightened challenged around menstrual health management. CONCLUSIONS This study provides insights to how perceived associations between ADHD and the menstrual cycle might be experienced. This report highlights the need for further research and theory about the potential associations between ADHD and reproductive hormones. The researchers strongly suggested that forthcoming ADHD studies consider times of key hormonal changes, such as puberty and menarche, menopause, hormonal birth control, pregnancy, hormone treatment, and more.
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Affiliation(s)
- Isabel Bürger
- Dalarna University, School of Health and Welfare, Sweden
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Ferede AJ, Gezie LD, Geda B, Erlandsson K, Wettergren L. Perceptions of caring behaviors: Experiences of nurses in Ethiopia. Nurs Health Sci 2024; 26:e13096. [PMID: 38369316 DOI: 10.1111/nhs.13096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 01/02/2024] [Accepted: 01/25/2024] [Indexed: 02/20/2024]
Abstract
Caring is a universal phenomenon that influences nurse-patient interactions and feelings, forming the foundation of the nursing profession. How nurses perceive and experience caring in low-income settings is not well understood. Therefore, the purpose of this study was to explore Ethiopian nurses' perceptions and experiences of caring using a qualitative descriptive design. Individual semi-structured interviews were conducted with 13 nurses aged 28-57. Interviews were analyzed inductively using reflexive thematic analysis guided by the recommendations of Braun and Clarke. The analysis resulted in three themes: caring is the heartbeat of patient care, constraints to the provision of care, and ways to overcome constraints. The results revealed that nurses were committed to fulfilling their professional obligations and meeting patients' needs despite experiencing multiple constraints. The findings provide a comprehensive perspective in understanding nurses' experiences of caring. Their narratives demonstrate that they face constraints in their clinical practice, which limit the quality of care, including rotation and lack of resources. Cooperation between health policymakers and nurse authorities is essential for shifting the clinical environment from the prevailing traditional task-oriented approach to patient-centered care.
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Affiliation(s)
- Abebaw Jember Ferede
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lemma Derseh Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Biftu Geda
- Department of Nursing, College of Health Science, Shashamene Campus, Madda Walabu University, Shashamene, Ethiopia
| | - Kerstin Erlandsson
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Lena Wettergren
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Blomgren J, Wells MB, Erlandsson K, Amongin D, Kabiri L, Lindgren H. Putting co-creation into practice: lessons learned from developing a midwife-led quality improvement intervention. Glob Health Action 2023; 16:2275866. [PMID: 37930253 PMCID: PMC10629418 DOI: 10.1080/16549716.2023.2275866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Integrating evidence-based midwifery practices improves healthcare quality for women and newborns, but an evidence-to-practice gap exists. Co-created quality improvement initiatives led by midwives could bridge this gap, prevent resource waste and ensure intervention relevance. However, how to co-create a midwife-led quality improvement intervention has not been scientifically explored. OBJECTIVE The objective of this study is to describe the co-creation process and explore the needs and determinants of a midwife-led quality improvement targeting evidence-based midwifery practices. METHODS A qualitative deductive approach using the Consolidated Framework for Advancing Implementation Science was employed. An analysis matrix based on the framework was developed, and the data were coded according to categories. Data were gathered from interviews, focus group discussions, observations and workshops. New mothers and birth companions (n = 19) were included through convenience sampling. Midwives (n = 26), professional association representatives, educators, policymakers, managers, and doctors (n = 7) were purposely sampled. RESULTS The co-creation process of the midwife-led Quality Improvement intervention took place in four stages. Firstly, core elements of the intervention were established, featuring a group of midwife champions leading a quality improvement initiative using a train-the-trainers approach. Secondly, the intervention needs, context and determinants were explored, which showed knowledge and skills gaps, a lack of shared goals among staff, and limited resources. However, there was clear relevance, compatibility, and mission alignment for a midwife-led quality improvement at all levels. Thirdly, during co-creation workshops with new mothers and companions, the consensus was to prioritise improved intrapartum support, while workshops with midwives identified enhancing the use of birth positions and perineal protection as key focus areas for the forthcoming Quality Improvement intervention. Lastly, the findings guided intervention strategies, including peer-assisted learning, using existing structures, developing educational material, and building stakeholder relationships. CONCLUSIONS This study provides a practical example of a co-creation process for a midwife-led quality improvement intervention, which can be relevant in different maternity care settings.
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Affiliation(s)
- Johanna Blomgren
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Michael B. Wells
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Erlandsson
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Institution of Health and Welfare, Dalarna University, Falun, Sweden
| | - Dinah Amongin
- Department of Health Policy Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Lydia Kabiri
- Department of Nursing and Midwifery, School of Health Sciences, College of Health Sciences Makerere University, Kampala, Uganda
| | - Helena Lindgren
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Department of Health Promotion, Sophiahemmet University, Stockholm, Sweden
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Pappu NI, Holmedahl J, Gudjonsdottir S, Erlandsson K, Byrskog U. Quality midwifery care during the COVID-19 pandemic in Bangladesh: A focus group study with midwives, nurses, and midwifery educators. Eur J Midwifery 2023; 7:41. [PMID: 38106465 PMCID: PMC10722304 DOI: 10.18332/ejm/174234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/26/2023] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
INTRODUCTION Bangladesh has made remarkable strides in the development of the midwifery profession. However, the COVID-19 pandemic has had profound effects on healthcare systems worldwide, including those related to reproductive, perinatal, and maternal health. Given the recent advancements in the midwifery field in Bangladesh, it is crucial to examine the pandemic's impact on existing barriers and the capacity of midwifery professionals to deliver high-quality care. The aim of this study is to describe the possibility of midwives being able to provide quality midwifery care in Bangladesh during the COVID-19 pandemic. METHODS To gather insights, data were collected from July to October 2020 via four qualitative focus group discussions online; 23 actively practicing midwives, nurses specializing in midwifery care, and midwifery educators, participated. The data analysis employed reflexive thematic analysis. RESULTS The COVID-19 crisis posed significant threats to women's safety and health, with lockdowns exacerbating gender inequalities in society. Midwives faced added challenges due to their relatively low professional status and increased workloads. Insufficient policy implementation further compromised midwives' safety. Fear of contracting the virus and working during their free time also raised concerns about the quality of care provided. Nevertheless, the pandemic provided opportunities for midwives to demonstrate their ability to deliver independent midwifery care in Bangladesh. CONCLUSIONS The pandemic underscored the importance of creating respectful and dignified working conditions for midwives. It revealed that professional midwives can work independently when provided with the necessary space and a supportive work environment. This opens the door for the implementation of a midwifery-led care model. Further research is recommended to investigate the medical safety and efficacy of independent midwifery care in the context of Bangladesh.
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Affiliation(s)
- Noor I. Pappu
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Jonna Holmedahl
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | | | | | - Ulrika Byrskog
- School of Health and Welfare, Dalarna University, Falun, Sweden
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Asaye MM, Gelaye KA, Matebe YH, Lindgren H, Erlandsson K. Experience and perceptions of healthcare providers on clinical management and care of near-miss infants: a qualitative content analysis. BMC Health Serv Res 2023; 23:1403. [PMID: 38093259 PMCID: PMC10720054 DOI: 10.1186/s12913-023-10097-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 09/30/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Neonatal Near Miss (NNM) refers to neonates with severe complications who almost died but survived immediately after birth. In Ethiopia, the prevalence of NNM has been assessed using a validated Neonatal Near-Miss Assessment Scale. However, understanding the experiences and perceptions of healthcare providers in the clinical management and care of NNM infants remains unexplored. The aim was to investigate the determinants contributing to the survival of neonatal near-miss babies and to identify any barriers encountered, as reported by the experiences of healthcare providers in public hospitals of Amhara Regional State, northwest Ethiopia. METHODS Semi structured interviews were used to collect data from 25 midwives, nurses, and pediatricians with at least six months of prior experience in one of the labor wards or neonatal intensive care units at one of the four public health hospitals in the Amhara Regional state of northwest Ethiopia included in a large intervention study assessing a NNM scale. Purposeful sampling was used, selecting participants based on their experiences related to the aim of this study. The participants had a varying level of education and years of experience to care for NNM infants. The average age of the healthcare providers was 31 years, with 7 years of work experience. The transcripts of the interviews with the healthcare providers were analyzed using qualitative content analysis. RESULTS The experience and perceptions of healthcare providers was described in the main category "A sense of hopelessness when caring for the baby" capturing a broader emotional and professional aspect, while the subcategories "Unclear responsibilities discharging one's mission", "Provision of kangaroo mother care" and "Quick action required at birth" are more specific and practical. Healthcare providers perceived a sense of hopelessness when caring for the NNM infant, particularly providing Kangaroo Mother Care (KMC) and quick actions when required at birth to save the life of the infant. CONCLUSION Unclear responsibilities and a sense of hopelessness could have acted as barriers, hindering the ability of healthcare providers to fulfill their mission of taking swift actions and providing KMC to NNM infants, thus impacting their ability to save the lives of these infants. Healthcare providers' and parents' attitudes must be changed towards hope rather than hopelessness when caring for NNM infants.
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Affiliation(s)
- Mengstu Melkamu Asaye
- Department of Women and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yohannes Hailu Matebe
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden
- Sofiahemmet University, Stockholm, Sweden
| | - Kerstin Erlandsson
- Department of Women's and Children's Health, Solna, Sweden.
- School of Health and Welfare, Karolinska Institute, Dalarna University, Falun, Sweden.
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Sattar SMRU, Akeredolu O, Bogren M, Erlandsson K, Borneskog C. Facilitators influencing midwives to leadership positions in policy, education and practice: A systematic integrative literature review. Sex Reprod Healthc 2023; 38:100917. [PMID: 37769484 DOI: 10.1016/j.srhc.2023.100917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/29/2023] [Accepted: 09/11/2023] [Indexed: 10/03/2023]
Abstract
The development of midwives as leaders is a crucial step towards achieving equality in sexual, reproductive, maternal, and neonatal health, Universal Health Coverage (UHC) and Sustainable Development Goals (SDG). However, many midwives work only to implement policies made by others rather than being drivers of policy changes. Little is known and researched about why midwives are not involved in decision and policymaking related to sexual, reproductive, maternal, and neonatal health. Hence, with a focus on midwifery leadership within the global community and the limited opportunities for women to hold leadership positions, this research explores the facilitators influencing midwives' opportunities to become leaders in policy development, education and practice. Inspired by Whittemore and Knafl, this integrative literature review was conducted after twenty-two relevant articles were identified through a search of the following databases: PubMed, CINAHL, and Scopus. Inductive content analysis was applied to analyze data. The result indicates that for midwives to become influential leaders, they must be active in strategic planning at the highest level. This inevitably effects how far midwives can act as agents for change, even if they possess the knowledge and skills for a leadership position. Policies and regulations influence how midwives' status in society is acknowledged and recognized. A clearly articulated educational pathway will enable their professional growth and expertise, making them knowledgeable and skillful as leaders. Enabling midwives to step into leadership positions at government level requires reforms which include midwives in decision-making. Excluding midwives from decision-making processes is detrimental to the goal of achieving universal health coverage. The first step is to provide midwives with a protected title, enabling them to work autonomously in an enabling environment with normal pregnancy and birth to achieve the SDG 2030 goals.
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Affiliation(s)
| | | | - Malin Bogren
- Institute of Health and Care Sciences, SE-405 30 Gotheburg, Sweden
| | - Kerstin Erlandsson
- Dalarna University, School of Health and Welfare, SE-791 88 Falun, Sweden
| | - Catrin Borneskog
- Dalarna University, School of Health and Welfare, SE-791 88 Falun, Sweden.
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Jha P, Jha VK, Sharma B, Jha A, Erlandsson K, Bogren M. Cultural adaptation and psychometric evaluation of Childbirth Experience Questionnaire 2 in Karnataka state, India. PLoS One 2023; 18:e0291591. [PMID: 38015907 PMCID: PMC10684018 DOI: 10.1371/journal.pone.0291591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/25/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Women's birthing experience is a sensitive indicator of the quality of childbirth care and can impact the physical and mental health of both women and their neonates. Negligible evidence exists on Indian women's birth experiences and-to the best of authors' knowledge-no questionnaire has been tested in India for measuring women's birthing experiences. This study aimed to test the construct validity and reliability of the Kannada-translated Revised Childbirth Experience Questionnaire. METHODOLOGY A cross-sectional survey was carried out among postnatal women (n = 251, up to six months postpartum, with a live healthy neonate) who had given birth at a public or private health facility using the Kannada-translated CEQ2 in two districts of Karnataka. Data were collected at participants' homes after seeking written informed consent. Model fit was determined by Confirmatory Factor Analyses. RESULTS The 4-factor model of the CEQ2 showed good fit after deletion of one item (item 8, subcategory "participation") with CMIN = 1.33; SRMR = 0.04; GFI = 0.92, CFI = 0.98, TLI = 0.99, RMSEA = 0.037 and p value 0.002). The Cronbach alpha values were acceptable for the four subscales (0.92, 0.93, 0.97, 0.91) as well as for the overall 21-item scale (0.84). CONCLUSIONS The Kannada-translated CEQ2 is a reliable tool to measure the childbirth experiences among Kannada-speaking women and can serve as a reliable ongoing evaluation of women's birth experiences.
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Affiliation(s)
- Paridhi Jha
- Foundation for Research in Health Systems, Bangalore, Karnataka, India
| | | | - Bharati Sharma
- Indian Institute of Public Health Gandhinagar, Gandhinagar, Gujarat, India
| | - Ajeya Jha
- Department of Management Studies, Sikkim Manipal Institute of Technology, Rangpo, Sikkim, India
| | | | - Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Andrén A, Akselsson A, Rådestad I, Ali SB, Lindgren H, Osman HM, Erlandsson K. Miscommunication influences how women act when fetal movements decrease an interview study with Swedish Somali migrant women. Midwifery 2023; 126:103796. [PMID: 37672854 DOI: 10.1016/j.midw.2023.103796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To explore how Swedish Somali migrant women perceive fetal movements, process information about fetal movements, and take actions if decreased fetal activity occurs. DESIGN A qualitative study based on individual semi-structured interviews. The interviews were analysed using content analysis. SETTING The study was conducted in Sweden. PARTICIPANTS Swedish Somali migrant women (n=15) pregnant in their third trimester or recently given birth. FINDINGS The analysis led to the main category: tailored information about fetal movements enhances the possibility to seek care if the movements decrease. The results are described in the generic categories: explanatory models determine action; and understand and interpret information. KEY CONCLUSIONS Miscommunication on fetal movements can be a hurdle for Swedish Somali migrant women that may have impact on stillbirth prevention and the quality of care. Improved communication and information tailored to individual needs is essential to achieve equality for women and their newborns. IMPLICATIONS FOR PRACTICE The midwife can be used as a hub for reassuring that adequate information about fetal movements reaches each individual woman in antenatal care. Individualised information on fetal movements based on the women's own understanding is suggested to increase the possibility that the pregnant woman will seek care if the movements decrease. Somali women's verbal communication can be used to spread accurate information in the Somali community on the importance of seeking care if fetal movements decrease.
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Affiliation(s)
| | | | | | - Salma Burhan Ali
- Region Uppsala, Enköping Hospital, Department of Gynecology, Sweden
| | - Helena Lindgren
- Sophiahemmet University, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Sweden
| | - Hodan Mohamoud Osman
- College of Health Science and Medicine, Faculty of Nursing and Midwifery, Hargeisa University, Somaliland
| | - Kerstin Erlandsson
- Department of Women's and Children's Health, Karolinska Institutet, Sweden; School of Health and Welfare, Dalarna University, Sweden
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Ali Egal J, Essa A, Osman F, Klingberg-Allvin M, Erlandsson K. Facility-based maternal deaths: Their prevalence, causes and underlying circumstances. A mixed method study from the national referral hospital of Somaliland. Sex Reprod Healthc 2023; 37:100862. [PMID: 37269618 DOI: 10.1016/j.srhc.2023.100862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 05/01/2023] [Accepted: 05/24/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Somaliland has one of the highest rates of maternal deaths in the world. An estimated 732 women die for every 100,000 live births. This study aims to identify the prevalence of facility-based maternal deaths, the causes and their underlying circumstances by interviewing relatives and health care providers at the main referral hospital. METHOD A hospital-based mixed method study. The prospective cross-sectional design of the WHO Maternal Near Miss tool was combined with narrative interviews with 28 relatives and 28 health care providers in direct contact with maternal deaths. The quantitative data was analysed with descriptive statistics using SPSS and the qualitative part of the study was analysed with content analysis using NVivo. RESULTS From the 6658 women included 28 women died. The highest direct cause of maternal death was severe obstetric haemorrhage (46.4%), followed by hypertensive disorders (25%) and severe sepsis (10.7%). An indirect obstetric cause of death was medical complications (17.9%). Twenty-five per cent of these cases were admitted to ICU and 89% had referred themselves to the hospital for treatment. The qualitative data identifies two categories of missed opportunities that could have prevented these maternal mortalities: poor risk awareness in the community and inadequate interprofessional collaboration at the hospital. CONCLUSION The referral system needs to be strengthened utilizing Traditional Birth Attendants as community resource supporting the community facilities. The communication skills and interprofessional collaboration of the health care providers at the hospital needs to be addressed and a national maternal death surveillance system needs to be commenced.
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Affiliation(s)
- Jama Ali Egal
- School of Health and Welfare, Dalarna University, Sweden.
| | - Amina Essa
- Department of Midwifery, University of Hargeisa, Somaliland.
| | - Fatumo Osman
- School of Health and Welfare, Dalarna University, Sweden.
| | - Marie Klingberg-Allvin
- School of Health and Welfare, Dalarna University, Sweden; Department of Women and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Borneskog C, Engström G, Islam N, Byrskog U, Pedersen C, Stromsöe A, Erlandsson K. Midwife Educators' perceptions of the efficacy of the Objective Structured clinical assessment of life-saving interventions - a qualitative interview study in Bangladesh. Sex Reprod Healthc 2023; 37:100861. [PMID: 37267736 DOI: 10.1016/j.srhc.2023.100861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/26/2023] [Accepted: 05/23/2023] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Objective Structured Clinical Assessment (OSCA) is a way of evaluating students or clinicians in how they are carrying out their duties. The aim of this study was to examine how midwifery educators in Bangladesh perceived using OSCA as an assessment device in midwifery education for student performance in life-saving midwifery interventions. METHOD Individual interviews were conducted with 47 academic midwives and clinical midwives using purposive sampling at 38 education institutions in Bangladesh. Content analysis inspired by Elo and Kyngas was used to analyze the data. RESULTS The ability of students to perform effectively in the OSCA-evaluated simulation of life-saving skills was related to the educators' understanding of the concept of midwifery. The overarching main category of this study showed that for midwifery educators to be able to effectually teach professional, evidence-based midwifery, they need to be able to synthesize the delivery of practical and theoretical skills with pedagogical skills and knowledge. To implement the OSCA tool more effectively, midwifery educators need to understand the underpinning principles of midwifery values and philosophy including leadership, ownership, responsibility, and personal engagement. CONCLUSION There is potential to improve the efficacy of using OSCA to deliver the teaching of life-saving skills. Team sessions with midwives and physicians aiming to practice teamwork and role divisions in life-saving interventions are recommended.
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Affiliation(s)
- Catrin Borneskog
- School of Health and Welfare, Dalarna University, Falun, Sweden.
| | | | - Noor Islam
- School of Health and Welfare, Dalarna University, Falun, Sweden.
| | - Ulrika Byrskog
- School of Health and Welfare, Dalarna University, Faun, Sweden.
| | | | - Anneli Stromsöe
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden; Department of Prehospital Care, Region of Dalarna, Falun, Sweden.
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Kiragu JM, Osika Friberg I, Erlandsson K, Wells MB, Wagoro MCA, Blomgren J, Lindgren H. Costs and intermediate outcomes for the implementation of evidence-based practices of midwifery under a MIDWIZE framework in an urban health facility in Nairobi, Kenya. Sex Reprod Healthc 2023; 37:100893. [PMID: 37586305 DOI: 10.1016/j.srhc.2023.100893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/05/2023] [Accepted: 07/20/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Three evidence-based midwife-led care practices: dynamic birth positions (DBP), immediate skin-to-skin contact (SSC) with zero separation between mother and newborn, and delayed cord clamping (DCC), were implemented in four sub-Saharan African countries after an internet-based capacity building program for midwifery leadership in quality improvement (QI). Knowledge on costs of this QI initiative can inform resource mobilization for scale up and sustainability. METHODS We estimated the costs and intermediate outcomes from the implementation of the three evidence-based practices under the midwife-led care (MIDWIZE) framework in a single facility in Kenya through a pre- and post-test implementation design. Daily observations for the level of practice on DBP, SSC and DCC was done at baseline for 1 week and continued during the 11 weeks of the training intervention. Three cost scenarios from the health facility perspective included: scenario 1; staff participation time costs ($515 USD), scenario 2; staff participation time costs plus hired trainer time costs, training material and logistical costs ($1318 USD) and scenario 3; staff participation time costs plus total program costs for the head trainer as the QI leader from the capacity building midwifery program ($8548 USD). RESULTS At baseline, the level of DBP and SSC practices per the guidelines was at 0 % while that of DCC was at 80 %. After 11 weeks, we observed an adoption of DBP practice of 36 % (N = 111 births), SSC practice of 79 % (N = 241 births), and no change in DCC practice. Major cost driver(s) were midwives' participation time costs (56 %) for scenario 1 (collaborative), trainers' material and logistic costs (55 %) in scenario 2(collaborative) and capacity building program costs for the trainer (QI lead) (94 %) in scenario 3 (programmatic). Costs per intermediate outcome were $2.3 USD per birth and $0.5 USD per birth adopting DBP and SSC respectively in Scenario 1; $6.0 USD per birth adopting DBP and $1.4 USD per birth adopting SSC in Scenario 2; $38.5 USD per birth adopting DBP and $8.8 USD per birth adopting SSC in scenario 3. The average hourly wage of the facility midwife was $4.7 USD. CONCLUSION Improving adoption of DBP and SSC practices can be done at reasonable facility costs under a collaborative MIDWIZE QI approach. In a programmatic approach, higher facility costs would be needed. This can inform resource mobilization for future QI in similar resource-constrained settings.
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Affiliation(s)
- John Macharia Kiragu
- Department of Public and Global Health, University of Nairobi, Kenya; Department of Nursing Sciences, University of Nairobi, Kenya.
| | | | - Kerstin Erlandsson
- Women's and Children's Health, Karolinska Institutet, Solna, Sweden; Institution for Health and Welfare, Dalarna University, Falun, Sweden.
| | - M B Wells
- Women's and Children's Health, Karolinska Institutet, Solna, Sweden.
| | | | - Johanna Blomgren
- Women's and Children's Health, Karolinska Institutet, Solna, Sweden.
| | - Helena Lindgren
- Women's and Children's Health, Karolinska Institutet, Solna, Sweden; Sophiahemmet University, Sweden.
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Blomgren J, Gabrielsson S, Erlandsson K, Wagoro MCA, Namutebi M, Chimala E, Lindgren H. Maternal health leaders' perceptions of barriers to midwife-led care in Ethiopia, Kenya, Malawi, Somalia, and Uganda. Midwifery 2023; 124:103734. [PMID: 37269678 DOI: 10.1016/j.midw.2023.103734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 04/05/2023] [Accepted: 05/19/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To identify and examine barriers to midwife-led care in Eastern Africa and how these barriers can be reduced DESIGN: A qualitative inductive study with online focus group discussions and semi-structured interviews using content analysis SETTING: The study examines midwife-led care in Ethiopia, Malawi, Kenya, Somalia, and Uganda -five African countries with an unmet need for midwives and a need to improve maternal and neonatal health outcomes. PARTICIPANTS Twenty-five participants with a health care profession background and current position as a maternal and child health leader from one of the five study countries. FINDINGS The findings demonstrate barriers to midwife-led care connected to organisational structures, traditional hierarchies, gender disparities, and inadequate leadership. Societal and gendered norms, organisational traditions, and differences in power and authority between professions are some factors explaining why the barriers persist. A focus on intra- and multisectoral collaborations, the inclusion of midwife leaders, and providing midwives with role models to leverage their empowerment are examples of how to reduce the barriers. KEY CONCLUSIONS This study provides new knowledge on midwife-led care from the perspectives of health leaders in five African countries. Transforming outdated structures to ensure midwives are empowered to deliver midwife-led care at all healthcare system levels is crucial to moving forward. IMPLICATIONS FOR PRACTISE This knowledge is important as enhancing the midwife-led care provision is associated with substantially improved maternal and neonatal health outcomes, higher satisfaction of care, and enhanced utilisation of health system resources. Nevertheless, the model of care is not adequately integrated into the five countries' health systems. Future studies are warranted to further explore how reducing barriers to midwife-led care can be adapted at a broader level.
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Affiliation(s)
- Johanna Blomgren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | | | - Kerstin Erlandsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Institution of Health and Welfare, Dalarna University, Falun, Sweden
| | | | - Mariam Namutebi
- Department of Nursing, Makerere University College of Health Sciences, Kampala, Uganda
| | - Eveles Chimala
- School of Maternal, Neonatal and Reproductive Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Sophiahemmet University, Stockholm, Sweden
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Ferede AJ, Wettergren L, Erlandsson K, Gezie LD, Lindgren H, Geda B. Patients' perceptions of caring behaviors at referral hospitals in Ethiopia: A cross-sectional survey. Int J Nurs Sci 2023; 10:391-397. [PMID: 37545766 PMCID: PMC10401340 DOI: 10.1016/j.ijnss.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 08/08/2023] Open
Abstract
Objective The purpose of this study was to determine patients' perceptions of nurse caring behaviors and to identify factors associated with these perceptions. Methods A cross-sectional study was conducted at three referral hospitals in Ethiopia. A consecutive sample of male and female patients (n = 652, response rate 98.8%) was interviewed using the Amharic version of the Caring Behaviors Inventory-16 (CBI-16, including four subscales: Assurance, Knowledge and skill, Respectful, and Connectedness) and the Patient Satisfaction Instrument (PSI). Socio-demographic and clinical factors associated with perceptions of caring behaviors were identified using multiple linear regression analysis. Results Patients' perceptions of nurse caring behaviors were high (total Mean = 4.86, SD = 0.72). Behaviors related to the Assurance subscale were rated the highest. The multiple linear regression analysis result showed several socio-demographic and clinical factors statistically significantly associated with patients' perceptions of caring behaviors (total mean scores). Patients who were 40-49 years (B = -0.19, P = 0.012) and single (B = -0.13, P = 0.03) scored lower on total CBI-16 scores. Whereas, patients who had a higher educational level (B = 0.35, P = 0.001), cared for at surgery units (B = 0.11, P = 0.027), and reported having spent more time with a nurse in the past 8-h shift (B = 0.16, P < 0.001) were more likely to have higher perceptions of the care they received. The CBI-16 was positively correlated with satisfaction with received care, as measured with the Patient Satisfaction Instrument (r = 0.62, P < 0.001). Conclusion Hospitalized patients in Ethiopia have overall high perceptions of nurse caring behaviors, especially with regard to physical-based caring, while their expectations of emotional-focused care are lower. We identified patients who were in need of care, patients aged 40-49 years and single. The time spent with nurses plays a pivotal role in patients' perceptions of nurse caring behaviors.
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Affiliation(s)
- Abebaw Jember Ferede
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Postal address: 196, Gondar, Ethiopia
| | - Lena Wettergren
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Kerstin Erlandsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- School of Education, Health and Welfare, Dalarna University, Falun, Sweden
| | - Lemma Derseh Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Helena Lindgren
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Biftu Geda
- Department of Nursing, College of Health Science, Shashamene Campus, Madda Walabu University, Shashamene, Ethiopia
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Mekonnen HS, Lindgren H, Geda B, Azale T, Erlandsson K. Being an Elderly Person Living in Metropolitan Cities of Northwestern Ethiopia: A Descriptive Phenomenological Study. Clin Interv Aging 2023; 18:205-218. [PMID: 36814539 PMCID: PMC9939788 DOI: 10.2147/cia.s389305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
Background As people grow old, they pass through various life courses. Thus, it is important to realize aging in the context of each of these stages, as aging is not only physiological and psychological processes. To understand the lifeworld experiences of the phenomenon "being an elderly person" from the individual perspective was important, in this study, within day-to-day life in Metropolitan cities of northwestern Ethiopia. Objective The aim of this study was to describe the lifeworld of elderly persons living in Bahir Dar and Gondar Cities, Northwest Ethiopia. Methods A community based qualitative study conducted from October 29, 2021 to November 6, 2021. A purposive sampling technique and in-depth interviews were used for sampling and data collection, respectively. To explore the life experience /life-world/ of the elderly, a descriptive phenomenological study was conducted among 15 elderly persons. The audio records were transcribed and the field notes incorporated. Transcribed texts were translated into the English language, and a descriptive phenomenological analysis was done. Results In this study, the essence of the phenomenon, being an elderly person, means, in an ebb and flow motion, balancing a life change characterized by changing perspective, ambiguity to body functions, and preparing for being released. The elderly experienced physical, mental, and psychosocial changes. They had encountered positive and negative situations throughout their life span. They also expressed that their time was over and wished to prepare for God's Kingdom. Conclusion The use of phenomenology for this research provided an opportunity for a deeper understanding of the experiences of elderly persons. With knowledge from this study, nurses and other health professionals can understand and support the elderly from an individual point of view.
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Affiliation(s)
- Habtamu Sewunet Mekonnen
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia,Correspondence: Habtamu Sewunet Mekonnen, Email
| | - Helena Lindgren
- Department of Women’s and Children’s Health, Karolinska Institutet, Solna, Sweden
| | - Biftu Geda
- Department of Nursing, College of Health Science, Madda Walabu University, Shashemene Campus, Shashemene, Ethiopia
| | - Telake Azale
- Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kerstin Erlandsson
- Department of Women’s and Children’s Health, Karolinska Institutet, Solna, Sweden and School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Bogren M, Jha P, Sharma B, Erlandsson K. Contextual factors influencing the implementation of midwifery-led care units in India. Women Birth 2023; 36:e134-e141. [PMID: 35641395 DOI: 10.1016/j.wombi.2022.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The Government of India has committed to educate 90,000 midwives functioning in midwifery-led care units (MLCUs) to care for women during labour and birth. There is a need to consider local circumstances in India, as there is no 'one size fits all' prescription for MLCUs. AIM To explore contextual factors influencing the implementation of MLCUs across India. METHOD Data were collected through six focus group interviews with 16 nurses, midwives, public health experts and physicians, representing six national and international organisations supporting the Indian Government in its midwifery initiative. Transcribed interviews were analysed using content analysis. FINDINGS Four generic categories describe the contextual factors which influence the implementation of MLCUs in India: (i) Perceptions of the Nurse Practitioner in Midwifery and MLCUs and their acceptance, (ii) Reversing the medicalization of childbirth, (iii) Engagement with the community, and (iv) The need for legal frameworks and standards. CONCLUSION Based on the identified contextual factors in this study, we recommend that in India and other similar contexts the following should be in place when designing and implementing MLCUs: legal frameworks to enable midwives to provide full scope of practice in line with the midwifery philosophy and informed by global standards; pre- and in-service training to optimize interdisciplinary teamwork and the knowledge and skills required for the implementation of the midwifery philosophy; midwifery leadership acknowledged as key to the planning and implementation of midwifery-led care at the MLCUs; and a demand among women created through effective midwifery-led care and advocacy messages.
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Affiliation(s)
- Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe 1, 413 46 Gothenburg, Sweden.
| | - Paridhi Jha
- Foundation for Research in Health Systems, Bangalore, Karnataka, India
| | - Bharati Sharma
- Indian Institute of Public Health Gandhinagar, Gujarat, India
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Asaye MM, Gelaye KA, Matebe YH, Lindgren H, Erlandsson K. Effect of fetal malposition, primiparous, and premature rupture of membrane on Neonatal Near miss mediated by grade three meconium-stained amniotic fluids and duration of the active first stage of labor: Mediation analysis. PLoS One 2023; 18:e0285280. [PMID: 37146028 PMCID: PMC10162561 DOI: 10.1371/journal.pone.0285280] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 04/18/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND In many low-income countries, including Ethiopia, neonatal mortality remains a major concern. For every newborn that dies, many more neonates survived (near-miss neonates) the first 28 days after birth from life-threatening conditions. The generation of evidence on neonatal near-miss determinants could be a critical step in reducing neonatal mortality rates. However, studies causal pathway determinants are limited in Ethiopia. This study aimed to investigate the Neonatal Near-miss determinants in public health hospitals in Amhara Regional State, northwest Ethiopia. METHOD A cross-sectional study was conducted on 1277 mother-newborn pairs at six hospitals between July 2021 and January 2022. A validated interviewer-administered questionnaire and a review of medical records were used to collect data. Data were entered into Epi-Info version 7.1.2 and exported to STATA version 16 in California, America for analysis. The paths from exposure variables to Neonatal Near-Miss via mediators were examined using multiple logistic regression analysis. The adjusted odds ratio (AOR) and ß-coefficients were calculated and reported with a 95% confidence interval and a p-value of 0.05. RESULTS The proportion of neonatal near-misses was 28.6% (365/1277) (95% CI: 26-31%). Women who could not read and write (AOR = 1.67,95%CI:1.14-2.47), being primiparous (AOR = 2.48,95% CI:1.63-3.79), pregnancy-induced hypertension (AOR = 2.10,95% CI:1.49-2.95),being referred from other health facilities (AOR = 2.28,95% CI:1.88-3.29), premature rupture of membrane (AOR = 1.47,95% CI:1.09-1.98), and fetal malposition (AOR = 1.89,95% CI:1.14-3.16) were associated with Neonatal Near-miss. Grade III meconium stained amniotic fluid partially mediated the relationship between primiparous (ß = 0.517), fetal malposition (ß = 0.526), pregnant women referred from other health facilities (ß = 0.948) and Neonatal Near-Miss at P-value < 0.01. Duration of the active first stage of labour partially mediated the relationship between primiparous (ß = -0.345), fetal malposition (ß = -0.656), premature rupture of membranes (ß = -0.550) and Neonatal Near-Miss at P- value <0.01.It had also a significant indirect effect (ß = 0.581, P<0.001) on NNM with variables (primiparous, fetal malposition, and premature rupture of membranes). CONCLUSIONS The relationship between fetal malposition, primiparous, referred from other health facilities, premature rupture of membrane, and Neonatal Near miss were partially mediated by grade III meconium stained amniotic fluid and duration of the active first stage of labour. Early diagnosis of these potential danger signs and appropriate intervention could be of supreme importance in reducing NNM.
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Affiliation(s)
- Mengstu Melkamu Asaye
- Department of Women and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yohannes Hailu Matebe
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institute, Solna, Sweden
| | - Kerstin Erlandsson
- Department of Women's and Children's Health, Karolinska Institute, Solna, Sweden
- Institution for Health and Welfare, Dalarna University, Solna, Sweden
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Pappu NI, Öberg I, Byrskog U, Raha P, Moni R, Akhtar S, Barua P, Das SR, De S, Jyoti HJ, Rahman R, Sinha GR, Erlandsson K. The commitment to a midwifery centre care model in Bangladesh: An interview study with midwives, educators and students. PLoS One 2023; 18:e0271867. [PMID: 37036838 PMCID: PMC10085017 DOI: 10.1371/journal.pone.0271867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 03/24/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Midwifery-led care is a key factor in reducing maternal and new-born mortality globally. In Bangladesh, only a third of births are attended by professionals and almost 70% of births occur outside healthcare facilities. Midwifery is a relatively new profession in Bangladesh and a midwifery centre care model has only recently been introduced. This study aims to explore the willingness within the healthcare system to support a greater role for midwifery centres in maternity services. METHODS Data were collected through individual semi-structured interviews with 55 midwives, midwifery educators and final year midwifery students. Two of the midwifery educators were principals of nursing institutes involved in the government's midwifery leadership and considered as experts in the midwifery care system. The data was analysed using qualitative content analysis. The transcribed interviews comprised 150 pages. The study received ethical approval from the Directorate General of Nursing and Midwifery in Bangladesh. RESULTS One main category emerged from the study: "The foundations of a midwifery centre care model need to be strengthened for the sustainable implementation of midwifery centres in Bangladesh to continue". Five additional categories were identified: 1) The midwifery centre care model is inaccessible for communities, 2) Striving for acceptable standards of care within a midwifery centre care model is not a priority 3) Respectful, woman-centred care is weak, 4) Community engagement with the midwifery centre care model is insufficient, and 5) The midwifery centre care model is not integrated into the healthcare system. These categories were supported by the identification of 11 sub-categories. CONCLUSION The willingness to commit to a midwifery centre care model is not yet in place in Bangladesh. Advocacy, information, and education about the benefits of normal birth assisted by professional midwives is needed at all levels of Bangladeshi society.
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Affiliation(s)
| | - Ida Öberg
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Ulrika Byrskog
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Pronita Raha
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Ratna Moni
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Shaheen Akhtar
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Priti Barua
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Sujata Rani Das
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Shipra De
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | | | - Rezaur Rahman
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Gita Rani Sinha
- School of Health and Welfare, Dalarna University, Falun, Sweden
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Melkamu Asaye M, Gelaye KA, Matebe YH, Lindgren H, Erlandsson K. Valid and reliable neonatal near-miss assessment scale in Ethiopia: a psychometric validation. Glob Health Action 2022; 15:2029334. [PMID: 35107412 PMCID: PMC8812796 DOI: 10.1080/16549716.2022.2029334] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The concept of a neonatal near miss is used to explain neonates who nearly died but survived a life-threatening complication in the first 28 days of life. We have left many ill surviving (near-miss) neonates, due to a lack of valid and reliable assessment scale, particularly in Ethiopia. Aim We aim to psychometrically validate the neonatal near-miss assessment scale (NNMAS) for Ethiopia. Methods A total of 465 live birth neonates were included with the assumption of a participant-to-item ratio of 15:1. A new contextually validated NNMAS was used to collect data. The Kaiseri––Mayer––Olkin (KMO) measure of sampling adequacy with a cutoff value of ≥0.50 for each item was applied. For reliability and validity of NNMAS, exploratory factor analysis using principal component analysis with oblique varimax rotation was used. Internal consistency and reliability were assessed using Cronbach’s alpha. Convergent and discriminant validity was assessed using composite reliability (CR) and average variance extracted (AVE). Results The Kaiser––Mayer––Olkin (KMO = 0.74) measure of sampling adequacy and Bartlett’s Sphericity test for the appropriateness of the identity matrix (χ2 = 2903.9, df = 276, and P = 0.000) were suitable for exploratory factor analysis (EFA). The correlation matrix determinant of the study was 0.002. The principal component analysis (PCA) identified six factors and together explained 54.3% of the variation in the Neonatal Near miss. The Cronbach-alpha coefficient was 0.80 for the entire scale. The composite reliability values of the factors ranged from 0.87 to 0.95. The AVEs, CR, and factor loadings were above 0.5 for all factors indicating that convergent validity was met. The square roots of the AVEs were greater than factor correlation values. It was revealed that discriminated validity was also met. Conclusion The neonatal near-miss assessment scale was found to be valid and reliable in the present context. The scale can be used to identify near-miss neonates in Ethiopia.
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Affiliation(s)
- Mengstu Melkamu Asaye
- Department of Women and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yohannes Hailu Matebe
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institute, Solna, Sweden
| | - Kerstin Erlandsson
- Department of Women's and Children's Health, Karolinska Institute, Solna, Sweden.,Institution for Health and Welfare, Dalarna University, Falun, Sweden
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Egal JA, Essa A, Yusuf R, Osman F, Ereg D, Klingberg-Allvin M, Erlandsson K. A lack of reproductive agency in facility-based births makes home births a first choice regardless of potential risks and medical needs-a qualitative study among multiparous women in Somaliland. Glob Health Action 2022; 15:2054110. [PMID: 35389334 PMCID: PMC9004503 DOI: 10.1080/16549716.2022.2054110] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Around 20% of births in Somaliland take place at health facilities staffed by trained healthcare professionals; 80% take place at home assisted by Traditional Birth Attendants (TBAs) with no formal training. There has been no research into women’s choice of place of birth. Objective In this study, we explore multipara women’s needs and preferences when choosing the place of birth. Method An explorative qualitative study using individual in-depth interviews analysed inductively using content analysis. The interviews were conducted in Somaliland with 25 multiparous women who had experience of giving birth both at home and at a health facility within the past three years. Results The results provide a description of how, for women in Somaliland, a lack of reproductive agency in facility-based births makes home births a first choice regardless of potential risks and medical need. The women in this study desired intentionality in their role as mothers and sought some measure of control over the environment where they planned to give birth, depending on the circumstances of that particular birth. The results describe what quality care means for multipara women in Somaliland and how women choose birthplace based on previous experiences of care. The expectation of respectful care was a vital part for women when choosing a place of birth. Conclusion To meet women’s needs and preferences in Somaliland, further investments are needed to strengthen the midwifery profession and to define and test a context specific midwife-led continuity of care model to be scaled up. A dialogue to create new roles and responsibilities for the TBAs who attend most home births is further needed to link them to the formal healthcare system and assure timely healthcare seeking during pregnancy and birth.
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Affiliation(s)
- Jama Ali Egal
- Lead Department of Midwifery, College of Medicine & Health Sciences, University of Hargeisa, Hargeisa, Somaliland
| | - Amina Essa
- Lead Department of Midwifery, College of Medicine & Health Sciences, University of Hargeisa, Hargeisa, Somaliland
| | - Rahma Yusuf
- Lead Department of Midwifery, College of Medicine & Health Sciences, University of Hargeisa, Hargeisa, Somaliland
| | - Fatumo Osman
- Institution for Health and Welfare, Dalarna University, Falun, Sweden
| | - Derie Ereg
- College of Medicine and Health Sciences, University of Hargeisa, Hargeisa, Somaliland
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Lindgren H, Bogren M, Osika Friberg I, Berg M, Hök G, Erlandsson K. The midwife's role in achieving the Sustainable Development Goals: protect and invest together - the Swedish example. Glob Health Action 2022; 15:2051222. [PMID: 35522127 PMCID: PMC9090391 DOI: 10.1080/16549716.2022.2051222] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
'The midwife's role in achieving the Sustainable Development Goals: Protect and Invest Together' is a report providing the reader the opportunity for understanding and appreciating the history of midwifery in Sweden and the interlinked nature of the United Nation's SDGs supporting health and wellbeing of women and children. To realise the opportunity to have a country with well-educated midwives of high academic standard, and, at the same time, promoting gender equality and equity we need to protect and invest together in midwives. This paper provides the foundation for a revitalised discussion on midwives' role for women and child health in the 21st century. The full Swedish Midwifery report was published in October 2021.
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Affiliation(s)
- Helena Lindgren
- Department of Women’s and Children’s Health, Karolinska Institutet, Solna, Sweden,CONTACT Helena Lindgren Department of Women’s and Children’s Health, Karolinska Institutet, Solna, Sweden
| | - Malin Bogren
- Institute for Health and Care Science, Sahlgrenska Academy, Gothenburg, Sweden
| | - Ingrid Osika Friberg
- Department of Women’s and Children’s Health, Karolinska Institutet, Solna, Sweden,Swedish Agency for Gender Equality, Gothenburg, Sweden
| | - Marie Berg
- Institute for Health and Care Science, Sahlgrenska Academy, Gothenburg, Sweden
| | - Gabriella Hök
- Swedish Institute for Global Health Transformation, Stockholm, Sweden
| | - Kerstin Erlandsson
- Department of Women’s and Children’s Health, Karolinska Institutet, Solna, Sweden,Department of Health, Care and Wellbeing, Dalarna University, Falun, Sweden
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Egal JA, Kiruja J, Litorp H, Osman F, Erlandsson K, Klingberg‐Allvin M. Incidence and causes of severe maternal outcomes in Somaliland using the sub-Saharan Africa maternal near-miss criteria: A prospective cross-sectional study in a national referral hospital. Int J Gynaecol Obstet 2022; 159:856-864. [PMID: 35490394 PMCID: PMC9790269 DOI: 10.1002/ijgo.14236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/21/2022] [Accepted: 04/23/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To describe the incidence and causes of severe maternal outcomes and the unmet need for life-saving obstetric interventions among women admitted for delivery in a referral hospital in Somaliland. METHODS A prospective cross-sectional study was conducted from April 15, 2019 to March 31, 2020, with women admitted during pregnancy or childbirth or within 42 days after delivery. Data were collected using the World Health Organization (WHO) and sub-Saharan Africa (SSA) maternal near-miss (MNM) tools. Descriptive analysis was performed by computing frequencies, proportions, and ratios. RESULTS The MNM ratios were 56 (SSA criteria) and 13 (WHO criteria) per 1000 live births. The mortality index was highest among women with medical complications (63%), followed by obstetric hemorrhage (13%), pregnancy-related infection (10%), and hypertensive disorders (7.9%) according to the SSA MNM criteria. Most women giving birth received prophylactic oxytocin for postpartum hemorrhage prevention (97%), and most laparotomies (60%) for ruptured uterus were conducted after 3 h. CONCLUSION There is a need to improve the quality of maternal health services through implementation of evidence-based obstetric interventions and continuous in-service training for healthcare providers. Using the SSA MNM criteria could facilitate such preventive measures in this setting as well as similar low-resource contexts.
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Affiliation(s)
- Jama Ali Egal
- College of Medicine and Health ScienceUniversity of HargeisaHargeisaSomaliland,Institution of Health and WelfareDalarna UniversityDalarnaSweden
| | - Jonah Kiruja
- College of Medicine and Health ScienceUniversity of HargeisaHargeisaSomaliland,Institution of Health and WelfareDalarna UniversityDalarnaSweden
| | - Helena Litorp
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden,Department of Global Public HealthKarolinska InstitutetStockholmSweden
| | - Fatumo Osman
- Institution of Health and WelfareDalarna UniversityDalarnaSweden,Department of Public Health and Caring ScienceUppsala UniversityUppsalaSweden
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Erlandsson K, Jha P, Sharma B, Bogren M. Contextual factors influencing the implementation of a new midwife education programme in India: a qualitative study. BMC Med Educ 2022; 22:755. [PMID: 36333775 PMCID: PMC9636670 DOI: 10.1186/s12909-022-03814-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
The Indian Government has committed to educate 90,000 midwives in accordance with international norms. This goal is critical as midwives provide evidence-based, high-quality midwifery care. There is a need to explore the contextual factors influencing this new midwifery education programme. Hence, the aim of this study is to explore contextual factors influencing the implementation of the national midwifery education programme for midwifery educators and the future Nurse Practitioners in Midwifery (NPMs) in India. A qualitative research design was used, with data collected through focus group discussions (n = 8) with a total of 27 participants representing seven national and international organisations supporting the Indian Government in its midwifery initiative. Transcribed interviews were analysed using content analysis. This study on contextual factors influencing the implementation of the new midwifery education programme in India showed that organisational and administrative processes are complex and the development of midwifery educators and nurse practitioners in midwifery needs to be fast tracked. The education of educators and future midwives in India, and elsewhere in similar settings, could benefit from efforts to simplify the organisational and administration processes and, in parallel, mobilize innovative teaching and learning approaches to bridge theory and practice.
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Affiliation(s)
- Kerstin Erlandsson
- School of Health and Welfare, Dalarna University, Falun, Sweden.
- Department for Women's and Children's health, Karolinska Institutet, Solna, Sweden.
| | - Paridhi Jha
- Foundation for Research in Health Systems, Bangalore, Karnataka, India
| | - Bharati Sharma
- Foundation for Research in Health Systems, Bangalore, Karnataka, India
- Indian Institute of Public Health Gandhinagar, Gujarat, India
| | - Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Lindgren H, Erlandsson K. The MIDWIZE conceptual framework: a midwife-led care model that fits the Swedish health care system might after contextualization, fit others. BMC Res Notes 2022; 15:306. [PMID: 36138471 PMCID: PMC9503192 DOI: 10.1186/s13104-022-06198-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/07/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Familiarity with the unique tradition and experience of Swedish midwives during the more than 300 years in which midwife-led care has contributed to one of the lowest maternal and neonatal mortality and morbidity ratio in the world might encourage professionals in other countries to follow the Swedish example. The framework described below, reflecting the midwife's role in the Swedish health care system, might, after implementation, strengthen maternal and neonatal outcomes if contextualized to other settings. RESULTS Using a four-step procedure we identified our topic, made a literature review, identified the key components and their internal relationship, and finally developed the MIDWIZE conceptual framework. In this framework, the midwives in collaboration with obstetricians, provide evidence-based care with continuous quality improvements during the whole reproductive life cycle. Teamwork including specialists for referral and a responsive, relational, trust-based practice is the foundation for provision of midwife-led care for healthy women with a normal pregnancy. The well-educated midwife, of high academic standard, promoting gender equality and equity is the hub in the team and the primary care provider.
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Affiliation(s)
- Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden.
| | - Kerstin Erlandsson
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden.,Department of Health, Care and Wellbeing, Dalarna University, Falun, Sweden
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Salih MH, Mekonnen H, Derseh L, Lindgren H, Erlandsson K. Anticipated stigma and associated factors among chronic illness patients in Amhara Region Referral Hospitals, Ethiopia: A multicenter cross-sectional study. PLoS One 2022; 17:e0273734. [PMID: 36107943 PMCID: PMC9477324 DOI: 10.1371/journal.pone.0273734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background Anticipated stigma related to chronic illness patients undermines diagnosis, treatment, and successful health outcomes. The study aimed to assess the magnitude and factors associated with anticipated stigma among patients with chronic illness attending follow-up clinics in Amhara Region Referral Hospitals, Ethiopia. Methods A cross-sectional institution-based study was conducted in Amhara Region Referral Hospitals from 01 March to 15 April 2021. A simple random sampling technique was used to select the three Referral Hospitals in the region and study subjects. Data were collected using a pre-tested interview-based questionnaire. Data were entered and cleaned with Epi-Info version 6 and exported for analysis STATA version 14. Multiple linear regression was used to show the association between anticipated stigma and potential factors. Associations were measured using ß coefficients and were considered statistically significant if the p-value > 0.05. Results A total of 779 patients were included for analysis with a response rate of 97%. Their mean (Standard deviation) of anticipated stigma was estimated at 1.86 and 0.5, respectively. After running an assumption test for multiple linear regression; educational status, cigarette smoking, psychological distress, medication adherence, alcohol consumption, and social part of the quality of life were statically significantly associated with anticipated stigma. Conclusion and recommendation The result showed a high level of anticipated stigma reported among the participants. Emphasizing improving their social part of the quality of life, avoiding risky behaviors like alcohol consumption and cigarette smoking, access to health education for chronically ill patients, integrating mental health in all types of chronic disease, and developing strategies and protocols which will help to improve patient medication adherence to their prescribed medication will be crucial. This can provide a foundation for government andnon-governmental organizations, and researchers implementing evidence-based interventions and strategies on chronic care to address factors related to anticipated stigma.
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Affiliation(s)
- Mohammed Hassen Salih
- University of Gondar, College of Medicine and Health Sciences, School of Nursing, Gondar, Ethiopia
- * E-mail:
| | - Hussen Mekonnen
- Addis Ababa University, School of Nursing and Midwifery, College of Nursing and Midwifery, Addis Ababa, Ethiopia
| | - Lema Derseh
- University of Gondar, College of Medicine and Health Sciences, Institute of Public Health, Gondar, Ethiopia
| | - Helena Lindgren
- Department of Women’s and Children’s Health, Karolinska Institute, Solna, Sweden
| | - Kerstin Erlandsson
- Department of Women and Children’s Health, Karolinska Institute, Karolinska Institutet, Solna and School of Health and Welfare, Dalarna University, Falun, Sweden
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Mekonnen HS, Lindgren H, Geda B, Azale T, Erlandsson K. Satisfaction with life and associated factors among elderly people living in two cities in northwest Ethiopia: a community-based cross-sectional study. BMJ Open 2022; 12:e061931. [PMID: 36581991 PMCID: PMC9438199 DOI: 10.1136/bmjopen-2022-061931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE This study aimed to determine the level of life satisfaction and identify associated factors among elderly people living in two cities in northwest Ethiopia. DESIGN Community-based cross-sectional study. SETTING Two cities in northwest Ethiopia (Gondar and Bahir Dar). PARTICIPANTS 816 elderly people age 60 years and above living in Gondar and Bahir Dar, northwest Ethiopia. Systematic random sampling was used to select study participants. MAIN OUTCOME MEASURE Level of life satisfaction. Considering the mean and SD, three levels of satisfaction appeared to suffice as the basis for analysis and discussion: 23.5-34.4 dissatisfied, 34.5-56.5 averagely satisfied and 56.6-67.5 satisfied. Multivariable ordinal regression analysis was done to control the confounders. Since the outcome variable has an ordinal category, ordinal regression analysis is appropriate. A p≤0.05 and AOR (adjusted OR) with a 95% CI were considered to determine the statistically significant variables and strength of the association. RESULTS The mean age of the respondents was 68.2 years with an SD±7.2. The level of life satisfaction was: dissatisfied 17.2%, moderately satisfied 63.8% and well satisfied 19.0%. Overall, 45.8% (95% CI 42.2% to 49.2%) of the participants had a score equal to or above the mean. Regarding associated factors; retired current occupation (AOR=2.23, 95% CI 1.09 to 4.55), good self-rated health status (AOR=2.54, 95% CI 1.29 to 4.99), having no chronic disease (AOR=1.48, 95% CI 1.03 to 2.11), somewhat-good (AOR=2.15, 95% CI 1.12 to 4.13) and good (AOR=4.51, 95% CI 2.40 to 8.45) self-perception on ageing life, moderate functional impairment on daily living activities (AOR=5.43, 95% CI 1.81 to 16.24), high sense of coherence (AOR=3.80, 95% CI 2.04 to 7.08), house rent as a source of finance (AOR=2.60, 95% CI 1.49 to 4.52) and high perceived social support (AOR=2.13, 95% CI 1.44 to 3.16) had statistically significant association with the life satisfaction. CONCLUSION The life satisfaction level in our study group was lower than in some more highly developed countries. To improve the level of life satisfaction in Ethiopia, a holistic programme of nursing care for elderly people, particularly as concerns about their health and psychosocial conditions is crucial in both community and clinical settings.
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Affiliation(s)
- Habtamu Sewunet Mekonnen
- School of Nursing, Department of Medical Nursing, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden
| | - Biftu Geda
- College of Health Science, Department of Nursing, Madda Walabu University, Shashamene Campus, Robe, Ethiopia
| | - Telake Azale
- Institute of Public Health, Department of Health Education and Behavioral Sciences, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Kerstin Erlandsson
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden
- Dalarna University School of Education Health and Social Studies, Falun, Sweden
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Salih MH, Wettergren L, Lindgren H, Erlandsson K, Mekonen H, Derseh L. Translation and psychometric evaluation of chronic illness anticipated stigma scale (CIASS) among patients in Ethiopia. PLoS One 2022; 17:e0262744. [PMID: 35061829 PMCID: PMC8782391 DOI: 10.1371/journal.pone.0262744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 01/04/2022] [Indexed: 12/03/2022] Open
Abstract
Background Stigma is common among patients with chronic illnesses. It affects the delivery of healthcare for not addressing the psychological components and may interfere with the patient’s attendance to necessary health care services. Therefore, a valid and reliable instrument to measure anticipated stigma related to chronic illness is vital to inform possible interventions. This study aimed to translate the Chronic Illness Anticipated Stigma Scale (CIASS) into the Amharic language and evaluate its psychometric properties in Ethiopia. Methods The CIASS was translated into Amharic language using standard procedures. The Amharic version was completed by 173 patients (response rate 96%) with chronic illness from three referral hospitals in the Amhara region. Internal consistency was examined through Cronbach’s alpha. Construct validity was evaluated by confirmatory factor analysis and convergent validity by using a Pearson correlation of P-value less than or equal to 0.05. Results The internal consistency was estimated at Cronbach alpha of 0.92. By using a structural equation model, and modification indices a model fitness testing was run and shows a root mean squared error of approximation 0.049 (90% CI, 0.012–0.075). The structural validity results in 78.8% of confirmatory factor analysis showed from the extraction of the three-dimension (components). Validity tests for convergent by using Pearson correlation positively correlated with common mental distress and negatively correlated with quality of life–BREF, and the construct validity shows a good valid tool to CIASS. Conclusion The Amharic language version of the chronic illness anticipated stigma scale shows a satisfactory level of reliability and validity on different psychometric measures of assessment. The tool may be useful for future researchers and patients with chronic illness in the Amharic-speaking population. Moreover, it will be used to see the psychological burden related to chronic illness and for comparison among international population groups.
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Affiliation(s)
- Mohammed Hassen Salih
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Lena Wettergren
- Department of Public Health and Caring Sciences, Uppsala University and Department of Women’s and Children’s Health, Karolinska Institute, Solna, Sweden
| | - Helena Lindgren
- Department of Women’s and Children’s Health, Karolinska Institute, Solna, Sweden
| | - Kerstin Erlandsson
- School of Education, Health and Social Studies, Dalarna University and Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institute, Solna, Sweden
| | - Hussen Mekonen
- School of Nursing and Midwifery, College of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lemma Derseh
- College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Khatun M, Akter P, Yunus S, Alam K, Pedersen C, Byrskog U, Erlandsson K. Challenges to implement evidence-based midwifery care in Bangladesh. An interview study with medical doctors mentoring health care providers. Sex Reprod Healthc 2021; 31:100692. [PMID: 34990978 DOI: 10.1016/j.srhc.2021.100692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/05/2021] [Accepted: 12/17/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND In 2013 the first midwives in Bangladesh to be educated according to international standards completed their course and were awarded a diploma. Sixty percent of their training took place in clinical placement sites. In order to achieve appropriate mentor support while in clinical practice, a mentorship programme was initiated whereby local doctors were appointed by Save the Children. The aim of this study is to describe the mentors' purpose and the actions they took to improve midwifery care at clinical placement sites. Their appointment was intended to support local Health Care Providers (HCPs) at clinical placement sites meant for educating midwifery students in evidence-based midwifery care. METHODS An open-ended interview study with 14 mentors. The data was analysed using content analysis. RESULTS The main category, the theme that emerged from the analysis was "Creating commitment". "Creating commitment" describe how the mentors; the medical doctors employed by Save the Children, "Motivate", "Educate", "Mentor", "Advocate" and "Communicate" (subcategories) to creating commitment for quality midwifery care "In the organization of care" and "In clinical care practices" (categories). As intended, they enabled HCPs, midwifery students, and newly graduated midwives to provide quality midwifery care. CONCLUSIONS Using medical doctors' status and power to support the development of a newly emerging midwifery cadre in a country where midwifery is just emerging as a profession is because midwives integrated in the health system will improve the birthing process, improve life chances for newborns, and reduce morbidity and mortality in Bangladesh. It is recommended for implementation in other similar national contexts.
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Affiliation(s)
| | | | - Samiha Yunus
- Save the Children Bangladesh, House No-CWN(A)35, House No-43; Gulshan-2, Dhaka, Bangladesh
| | - Khairul Alam
- Save the Children Bangladesh, House No-CWN(A)35, House No-43; Gulshan-2, Dhaka, Bangladesh
| | - Christina Pedersen
- School of Education, Health and Social Studies, Dalarna University, 791 88 Falun, Sweden
| | - Ulrika Byrskog
- School of Education, Health and Social Studies, Dalarna University, 791 88 Falun, Sweden
| | - Kerstin Erlandsson
- School of Education, Health and Social Studies, Dalarna University, 791 88 Falun, Sweden. https://twitter.com/erlandsson_kerstin
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Mekonnen HS, Lindgren H, Geda B, Azale T, Erlandsson K. Translation, Cultural Adaptation, and Psychometric Properties of the Life Satisfaction Index for the Third Age-Short Form (LSITA-SF12) for Use among Ethiopian Elders. Nurs Rep 2021; 11:981-996. [PMID: 34968283 PMCID: PMC8715472 DOI: 10.3390/nursrep11040089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/22/2021] [Accepted: 12/02/2021] [Indexed: 01/07/2023] Open
Abstract
(1) Background: Self-reported measures play a crucial role in research, clinical practice, and health assessment. Instruments used to assess life satisfaction need validation to ensure that they measure what they are intended to detect true variations over time. An adapted instrument measuring life satisfaction for use among Ethiopian elders was lacking; therefore, this study aimed to culturally adapt and evaluate the psychometric properties of the Life Satisfaction Index for the Third Age—Short Form (LSITA-SF12) in Ethiopia. (2) Methods: Elderly people (n = 130) in Metropolitan cities of northwestern Ethiopia answered the LSITA-SF12 in the Amharic language. Selected reliability and validity tests were examined. (3) Result: The scale had an acceptable limit of content validity index, internal consistency, test-retest, inter-rater reliabilities, and concurrent and discriminant validities. (4) Conclusion: The Amharic language version of LSITA-SF12 appeared to be valid and reliable measures and can be recommended for use in research and clinical purposes among Amharic-speaking Ethiopian elders.
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Affiliation(s)
- Habtamu Sewunet Mekonnen
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar 196, Ethiopia
- Correspondence:
| | - Helena Lindgren
- Department of Women’s and Children’s Health, Karolinska Institutet, 171 77 Solna, Sweden; (H.L.); (K.E.)
| | - Biftu Geda
- Department of Nursing, College of Health Science, Shashamene Campus, Madda Walabu University, Robe 247, Ethiopia;
| | - Telake Azale
- Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar 196, Ethiopia;
| | - Kerstin Erlandsson
- Department of Women’s and Children’s Health, Karolinska Institutet, 171 77 Solna, Sweden; (H.L.); (K.E.)
- School of Education, Health and Social Studies, Dalarna University, 791 31 Falun, Sweden
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Erlandsson K, Lindgren H, Wettergren L, Mekuriaw A, Berta M, Melkamu M, Seyoum T, Hailemeskel S, Jember A, Hassen M, Gebrie M, Geda B, Gelaye K, Mekonnen SH, Mekonnen Abebe S, Christensson K. Half-time evaluation of a new 4-year Ph.D. program in nursing and midwifery at the University of Gondar, Ethiopia. Glob Health Action 2021; 14:1905304. [PMID: 34402771 PMCID: PMC8381928 DOI: 10.1080/16549716.2021.1905304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A new four-year Ph.D. programme in nursing and midwifery, the first of its kind in Ethiopia, was started in 2018/2019 at the University of Gondar when eight doctoral students in nursing and midwifery entered the program. We who have been involved see this as an appropriate time to evaluate what has been accomplished to date and to look toward future possibilities. Our aim in carrying out such an evaluation and presenting our findings is in part to determine if similar programs might be developed in other similar settings and in part to learn what modifications to the present program might be considered. The key elements of a questionnaire survey with closed and open response alternatives were based on the content, structure and learning outcomes of the home university Ph.D. programme as described in the curriculum. The questionnaire responses captured changes that would be needed to maintain a fully satisfactory programme that blends onsite instruction and online access to faculty resulting in a twenty-first century blended Ph.D. programme. Improved dialogue between the home university faculty and the external supervisors is needed. The programme can provide a career pathway that midwifery and nursing educators can follow in their own country rather than having to leave to study in another country. The findings provide insight into the feasibility of extending similar Ph.D. programmes to other parts of East Africa and with the SDG 5 in mind with an increased focus on women leadership. The justification for this initiative is to meet the need for more nursing and midwifery faculty who can provide quality midwifery and nursing education in East African countries. Retention of these professionals will help to deal with the shortage of healthcare personnel and will provide better care for the general population.
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Affiliation(s)
| | - Helena Lindgren
- Women's and Children's Health, Karolinska Institutet, Sweden
| | - Lena Wettergren
- Women's and Children's Health, Karolinska Institutet, Sweden
| | - Alemayehu Mekuriaw
- Institute of Public Health, College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Marta Berta
- School of Midwifery, College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Mengstu Melkamu
- School of Midwifery, College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Tewodros Seyoum
- School of Midwifery, College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Solomon Hailemeskel
- School of Midwifery, College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Abebaw Jember
- School of Nursing, College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Mohammed Hassen
- School of Nursing, College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Mignote Gebrie
- School of Nursing, College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Biftu Geda
- Department of Nursing, College of Health and Medical Science, Meda Welabu University, Ethiopia
| | - Kassahun Gelaye
- Institute of Public Health, College of Medicine and Health Science, University of Gondar, Ethiopia
| | | | - Salomon Mekonnen Abebe
- Health Sciences, Addis Ababa University by College of Health Science, Addis Ababa University, Ethiopia
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Ahmed CA, Khokhar AT, Erlandsson K, Bogren M. Defibulated immigrant women's sexual and reproductive health from the perspective of midwives and gynaecologists as primary care providers in Sweden - A phenomenographic study. Sex Reprod Healthc 2021; 29:100644. [PMID: 34265570 DOI: 10.1016/j.srhc.2021.100644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/19/2021] [Accepted: 06/28/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To capture care providers' perceptions of defibulated immigrant women's sexual and reproductive health, illuminated by their experiences as care providers for these women. METHODS Individual interview study with 13 care providers at Swedish healthcare facilities: six gynaecologists and seven midwives caring for defibulated immigrant women, analysed with a phenomenographic method. FINDINGS One of the care providers' perceptions of women who had been defibulated was that they had an altered genital function, meaning a wider introitus, improved vaginal intercourse, and more ease urinating and menstruating. The care providers also perceived that women who were defibulated had to balance their wellbeing, struggling between a positive self-image and handling their emotions. Existing in-between cultural values led to a fear of being excluded while at the same time having a desire to be included in the new culture. CONCLUSION Defibulation affects women's sexual and reproductive health and calls for a holistic perspective when providing services, individualized according to the woman's care needs. Support and counselling, should include information about defibulation already during the adolescent years to promote sexual and reproductive health and well-being.
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Affiliation(s)
- Caisha Arai Ahmed
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | | | - Kerstin Erlandsson
- Women's and Children's Health, Karolinska Institutet, Solna, Sweden; School of Education, Health and Social Studies, Dalarna University, Dalarna, Sweden.
| | - Malin Bogren
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
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Bogren M, Alesö A, Teklemariam M, Sjöblom H, Hammarbäck L, Erlandsson K. Facilitators of and barriers to providing high-quality midwifery education in South-East Asia-An integrative review. Women Birth 2021; 35:e199-e210. [PMID: 34217676 DOI: 10.1016/j.wombi.2021.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND With a diversity in midwifery education across the South-East Asia region, and with the knowledge about the lifesaving competency of the midwife profession, this study's aim is to describe facilitators of and barriers to providing high-quality midwifery education in South-East Asia. METHODS Inspired by Whittemore and Knafl, we conducted a systematic integrative literature review including the five key stages of problem identification, literature search, data evaluation, data analysis, and presentation of results. The literature searches were conducted in October 2020 in the databases CINAHL, PubMed, and Scopus. A deductive data analysis based on global standards was performed. RESULTS The search identified 1257 articles, 34 of which were included. Countries in South-East Asia did not fully comply with the ICM global standards. Midwifery education was not separated from that of nursing, and educators lacked formal qualifications in midwifery. Curriculum implementation in the clinical area was a key barrier to achieving learning outcomes. Higher academic education for midwifery educators and mentorship programs facilitated the pedagogic and assessment process, focusing on the abilities of critical thinking, reflection, and decision-making. CONCLUSIONS Countries in South-East Asia still have a long way to go before they can provide high-quality midwifery education. The identified facilitators can lead to a difference in students' academic achievement and confidence in their clinical work. Coordinated actions will enable the progress in achieving competent midwives matching national health priorities. The findings highlight a need for more research on midwifery education in both theory and practice across the region.
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Affiliation(s)
- Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe 1, 413 46 Gothenburg, Sweden.
| | - Anna Alesö
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe 1, 413 46 Gothenburg, Sweden
| | - Milena Teklemariam
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe 1, 413 46 Gothenburg, Sweden
| | - Helen Sjöblom
- Biomedical Library, Gothenburg University Library, University of Gothenburg, Gothenburg, Sweden
| | - Linda Hammarbäck
- Biomedical Library, Gothenburg University Library, University of Gothenburg, Gothenburg, Sweden
| | - Kerstin Erlandsson
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Department of Women's and Children's Health, Karolinska Institute, Solna, Sweden. https://www.twitter.com/erlandsson_kerstin
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Ayala A, Christensson K, Christensson E, Cavada G, Erlandsson K, Velandia M. Newborn infants who received skin-to-skin contact with fathers after Caesarean sections showed stable physiological patterns. Acta Paediatr 2021; 110:1461-1467. [PMID: 33403688 PMCID: PMC8246930 DOI: 10.1111/apa.15685] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 11/07/2020] [Accepted: 11/19/2020] [Indexed: 01/16/2023]
Abstract
Aim Separating infants and their parents after a Caesarean section is still the routine care worldwide. This study investigated three caregiving models on the wakefulness and physiological parameters of full‐term infants after an elective Caesarean section. Methods Newborn infants born in a Chilean public hospital in 2009‐12 were randomised to three groups: cot, fathers' arms or skin‐to‐skin contact with their father. They were assessed at 15‐minute intervals, from 45 to 120 minutes after the Caesarean section. Their physiological parameters were measured, and their wakefulness was assessed using the Neonatal Behavioural Assessment Scale. Results We studied 95 infant (53% girls) born at a mean gestational age of 38.9 ± 0.9 weeks. Heart rates were significantly higher in the skin‐to‐skin than cot or fathers' arms groups and showed greater stability over time. Wakefulness was initially higher in the skin‐to‐skin group, but there were no significant differences by the end of the observation. There were no differences between the groups in peripheral oxygen saturation. Skin‐to‐skin contact had no negative impact on the infants. Conclusion The skin‐to‐skin group showed some advantages over the cot and fathers' arms groups when it came to establishing stable physiological parameters and wakefulness. This approach should be supported during mother‐infant separation.
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Affiliation(s)
- Ana Ayala
- Department of Women's and Children's Health Division Reproductive HealthKarolinska Institutet Stockholm Sweden
- Ministry of Health Santiago de Chile Chile
| | - Kyllike Christensson
- Department of Women's and Children's Health Division Reproductive HealthKarolinska Institutet Stockholm Sweden
| | - Eva Christensson
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden
| | - Gabriel Cavada
- School of Public Health Faculty of Medicine University of Chile Santiago Chile
| | - Kerstin Erlandsson
- Department of Women's and Children's Health Division Reproductive HealthKarolinska Institutet Stockholm Sweden
- School of Education, Health and Social Science Dalarna University Falun Sweden
| | - Marianne Velandia
- School of Health, Care and Social Welfare Mälardalen University Västerås Sweden
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Bogren M, Banu A, Parvin S, Chowdhury M, Erlandsson K. Findings from a context specific accreditation assessment at 38 public midwifery education institutions in Bangladesh. Women Birth 2021; 34:e76-e83. [DOI: 10.1016/j.wombi.2020.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/30/2020] [Accepted: 06/25/2020] [Indexed: 01/05/2023]
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Melkamu Asaye M, Gelaye KA, Matebe YH, Lindgren H, Erlandsson K. Assessment of content validity for a Neonatal Near miss Scale in the context of Ethiopia. Glob Health Action 2021; 14:1983121. [PMID: 34694977 PMCID: PMC8547862 DOI: 10.1080/16549716.2021.1983121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The concept of neonatal near miss is used to identify neonates who nearly died but survived a life-threatening complication in the first 28 days of life. Neonatal mortality is the tip of the iceberg. Quality improvement through utilization of a validated scale and reduction in adverse neonatal outcome is a priority for achieving sustainable development goals. Objectives To develop and assess the content validity of neonatal near-miss scale in the public health hospitals in Amhara Regional State, northwest Ethiopia. Methods A literature review was performed prior to the development of the neonatal near-miss assessment scale. An expert panel committee was formed by health facility practitioners and by the members of the academia. Two rounds of meetings were conducted with the expert panel to reach consensus on the face and content validity. The content validity index, Kappa statistics, and the content validity ratio were computed to estimate the content validity scale of neonatal near miss. Results In this study, four domains (pragmatic, clinical, management, and lab-investigations) with 32 items were identified. The item-level content validity index ranged from 0.7 to 1. The overall scale content validity (S-CVI) (average) for the domains (pragmatic, clinical, management, and lab-investigations) were 0.98, 0.95, 0.96, and 0.96, respectively. The overall S-CVI (universal) was 0.78 to 1, whereas the overall S-CVI (average) of neonatal near miss assessment scale was found to be 0.96. The content validity ratio and Kappa statistics values ranged from 0.6 to 1 and 0.9 to 1 for the respective domains. Conclusion The identified four domains and the respective items were valid enough (content-wise) to be used as identification criteria for neonatal near-miss cases. The scale will contribute to neonatal near-miss identification and also improve the quality of neonatal management care.
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Affiliation(s)
- Mengstu Melkamu Asaye
- Department of Women and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yohannes Hailu Matebe
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Helena Lindgren
- Department of Women's and Children's Health, KarolinskaInstitute, Solna, Sweden
| | - Kerstin Erlandsson
- Department of Women's and Children's Health, KarolinskaInstitute and Institution for Health and Welfare, Dalarna University, Solna, Sweden
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Bogren M, Banu A, Parvin S, Chowdhury M, Erlandsson K. Implementation of a context-specific accreditation assessment tool for affirming quality midwifery education in Bangladesh: a qualitative research study. Glob Health Action 2020; 13:1761642. [PMID: 32429821 PMCID: PMC7301700 DOI: 10.1080/16549716.2020.1761642] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/07/2020] [Indexed: 11/03/2022] Open
Abstract
Background: Only recently did midwifery become a profession in Bangladesh. As such, sufficient quality education, both theory and practice, remains a challenge. In 2018, a context-specific accreditation assessment tool for affirming quality midwifery education was therefore developed and implemented.Objectives: To describe both the positive and negative aspects of the implementation of an accreditation process at midwifery education institutions in Bangladesh and to sketch out areas for possible improvement.Method: Forty focus group discussions were conducted with 276 policymakers, regulatory authorities and educators involved in midwifery education and services in Bangladesh. The Consolidated Framework for Implementation Research (CFIR) was used in a directed content analysis approach.Results: The accreditation assessment tool was developed using a participatory and consensus-building approach, building on existing policies, which resulted in the national ownership of its implementation. Staff from clinical sites were not included in the accreditation process; unless this changes, this will make it difficult for Bangladesh to achieve the set accreditation standards. The accreditation process has improved communication between the midwifery teaching institutions, policymakers and regulatory authorities. Educators started to visit the clinical sites more frequently. The planning process was complex and time-consuming, and emphasis was put on the importance of developing a plan of action for measuring improvements.Conclusion: In the move from the initial assessment of an accreditation process to its implementation, it is essential to make public the results found at all educational institutions. This encourages acceptance, while soliciting feedback and suggestions for future action. Only then can an accreditation process have an impact on the provision of high-quality midwifery education and services. This paper aims to encourage and guide other countries in their development, planning and implementation of a national accreditation process for midwifery education.
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Affiliation(s)
- Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Afroza Banu
- Directorate General of Nursing and Midwifery, Sher-E-Bangla Nagar Nursing College, Dhaka, Bangladesh
| | - Shahanaj Parvin
- Directorate General of Nursing and Midwifery, Sher-E-Bangla Nagar Nursing College, Dhaka, Bangladesh
| | - Merry Chowdhury
- Chattogram Nursing College, Chattogram Nursing College, Chattogram, Bangladesh
| | - Kerstin Erlandsson
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Carminati M, D'Adda I, Morahan AJ, Erlandsson K, Nagy K, Czeller M, Tolgyesi B, Nyitrai Z, Savi A, van Mullekom P, Hutton BF, Fiorini C. Clinical SiPM-Based MRI-Compatible SPECT: Preliminary Characterization. IEEE Trans Radiat Plasma Med Sci 2020. [DOI: 10.1109/trpms.2019.2951355] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Kalid M, Osman F, Sulaiman M, Dykes F, Erlandsson K. Infant and young child nutritional status and their caregivers' feeding knowledge and hygiene practices in internally displaced person camps, Somalia. BMC Nutr 2020; 5:59. [PMID: 32153972 PMCID: PMC7050725 DOI: 10.1186/s40795-019-0325-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 11/13/2019] [Indexed: 11/21/2022] Open
Abstract
Background In an attempt to design an educational programme targeting caregivers of children aged 6 to 59 months in internally displaced persons camps in Somalia, the objective of this study was twofold. First, to explore the nutritional situation of all children aged 6–59 months enrolled in a nutrition programme provided by Save the Children in 2017 in internally displaced persons camps. Second, to identify gaps in the caregivers’ hygiene and feeding practices. Methods In a study of 1655 households, 1655 caregivers for 2370 children aged 6 to 59 months enrolled in a nutrition programme provided by Save the Children answered an adapted questionnaire on hygiene and feeding practices. At the same time, based on standard criteria in the questionnaire, naturalistic observations of caregivers’ hygiene practices were conducted. Every child in the study was measured with anthropometric Mid-Upper-Arm Circumference measurements for the classification of Moderate Acute Malnutrition, Severe Acute Malnutrition and Global Acute Malnutrition. Descriptive statistics were used for analysis. Results 1) There was Severe (12.1%) and Global Acute (19.9%) Malnutrition among children included in the nutrition programme, more frequently in the 6–24 month age group compared to the 25–59 month age group (p < 0.01). 2). The practices in the households were below what could generally be considered hygienic. 3) There was poor caregivers’ knowledge of breastfeeding benefits and complementary foods. Conclusion Child malnutrition might derive from gaps in the caregiver’s knowledge, attitudes, and practices regarding hygiene and infant feeding. An awareness of these gaps can be helpful in designing future educational programmes that target caregivers, particularly in at-risk population groups.
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Affiliation(s)
- Mohamed Kalid
- 1Save the Children International, Somalia and Dalarna University, School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Fatumo Osman
- 2School of Education, Health and Social Studies, Dalarna University, Högskolegatan 2, 791 31 Falun, Sweden
| | - Munshi Sulaiman
- Research Evaluation, Monitoring, Learning and Monitoring (REALM) Save the Children International, Somalia Country Office, Nairobi, Kenya
| | - Fiona Dykes
- 4Fiona Dykes, Maternal and Infant Nutrition and Nurture Unit (MAINN), School of Community Health and Midwifery, University of Central Lancashire, Preston, Lancashire PR1 2HE UK
| | - Kerstin Erlandsson
- 2School of Education, Health and Social Studies, Dalarna University, Högskolegatan 2, 791 31 Falun, Sweden
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Bogren M, Erlandsson K, Johansson A, Kalid M, Abdi Igal A, Mohamed J, Said F, Pedersen C, Byrskog U, Osman F. Health workforce perspectives of barriers inhibiting the provision of quality care in Nepal and Somalia - A qualitative study. Sex Reprod Healthc 2019; 23:100481. [PMID: 31783321 DOI: 10.1016/j.srhc.2019.100481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE In this paper settings from Nepal and Somalia are used to focus on the perspectives of healthcare providers within two fragile health systems. The objective of this study was to describe barriers inhibiting quality healthcare in Nepal and Somalia from a health workforce perspective. METHODS Data were collected through 19 semi-structured interviews with healthcare providers working in healthcare facilities. Ten interviews were conducted in Nepal and nine in Somalia. RESULTS Various structural barriers inhibiting the availability, accessibility, and acceptability of the quality care were similar in both countries. Barriers inhibiting the availability of quality care were linked to healthcare providers being overburdened with multiple concurrent jobs. Barriers inhibiting the accessibility to quality healthcare included long distances and the uncertain availability of transportation, and barriers to acceptability of quality healthcare was inhibited by a lack of respect from healthcare providers, characterised by neglect, verbal abuse, and lack of competence. CONCLUSIONS Inequality, poverty, traditional and cultural practices plus the heavy burden placed on healthcare providers are described as the underlying causes of the poor provision of quality care and the consequential shortcomings that emerge from it. In order to improve this situation adequate planning and policies that support the deployment and retention of the healthcare providers and its equitable distribution is required. Another important aspect is provision of training to equip healthcare providers with the ability to provide respectful quality care in order for the population to enjoy good standard of healthcare services.
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Affiliation(s)
- Malin Bogren
- Institute of Health Care and Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Kerstin Erlandsson
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
| | | | | | | | | | - Fatumo Said
- Ministry of Health, Garowe, Puntland, Somalia
| | - Christina Pedersen
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
| | - Ulrika Byrskog
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
| | - Fatumo Osman
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
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Carminati M, Valtorta S, Belloli S, Moresco RM, Savi A, Iadanza A, Falini A, Politi LS, Cadioli M, Hutton BF, Fiorini C, Baratelli FM, Occhipinti M, Erlandsson K, Nagy K, Nyitrai Z, Czeller M, Kuhne A, Niendorf T. Validation and Performance Assessment of a Preclinical SiPM-Based SPECT/MRI Insert. IEEE Trans Radiat Plasma Med Sci 2019. [DOI: 10.1109/trpms.2019.2893377] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Egeh AA, Dugsieh O, Erlandsson K, Osman F. The views of Somali religious leaders on birth spacing - A qualitative study. Sex Reprod Healthc 2019; 20:27-31. [PMID: 31084814 DOI: 10.1016/j.srhc.2019.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 02/01/2019] [Accepted: 02/12/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Birth spacing is an important health intervention for women to attain good physical and mental health. In Somalia, religious leaders play a decisive role in approving or rejecting the use of family planning. OBJECTIVE The study aimed to investigate Somali Islamic religious leaders' views on birth spacing. METHOD Qualitative individual interviews were conducted with 17 Somali Islamic religious leaders aged 28-59 years and analysed through content analysis. RESULTS The main category that emerged from the analysis was that the concept "birth spacing should be used and nor family planning to be in accordance with the Islamic religion. Two perspectives of views of birth spacing were identified: accepted ways and unaccepted ways. The accepted ways include breastfeeding, use of contraceptives causing no harm to the women's health, and coitus interruptus. The preferred method should be determined by a joint agreement between the husband and wife, and that Muslim doctors should play a key role while the couples investigate their preferred method. Using contraceptives with the intention to limit the number of children was against Islamic values and practice. In addition, it was believed that using condoms promoted the temptation to engage in sex outside the marriage and was therefore prohibited. CONCLUSION According to the religious Islamic leaders, selected practice recommendations for contraceptive use is permitted in relation to birth spacing to promote the health of the mother and child. When providing professional contraceptive counselling to Muslim women, the word "birth spacing" is recommended to be used instead of "family planning".
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Affiliation(s)
- Abdi-Aziz Egeh
- School of Nursing and Midwifery, Amoud University, Borama, Somaliland, Somalia
| | - Osman Dugsieh
- School of Nursing and Midwifery, Amoud University, Borama, Somaliland, Somalia
| | - Kerstin Erlandsson
- School of Education, Health and Social Studies, Dalarna University Falun, Sweden
| | - Fatumo Osman
- School of Education, Health and Social Studies, Dalarna University Falun, Sweden.
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Mattebo M, Bogren M, Brunner N, Dolk A, Pedersen C, Erlandsson K. Perspectives on adolescent girls' health-seeking behaviour in relation to sexual and reproductive health in Nepal. Sex Reprod Healthc 2019; 20:7-12. [PMID: 31084822 DOI: 10.1016/j.srhc.2019.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 01/11/2019] [Accepted: 01/21/2019] [Indexed: 11/26/2022]
Abstract
AIM To explore health care providers' perspectives on adolescent girls' health-seeking behaviour in Nepal in relation to their sexual and reproductive health and rights. Twenty health-care providers were included in this interview study. Ethical approval was obtained from the Nepal Health Research Council. FINDINGS The main category 'Barriers affect adolescent girls' health-seeking behaviour in relation to their sexual and reproductive health' was divided into five categories: a conservative society with social stigma; lack of information, education and knowledge; lack of facilities and respectful care; insufficient confidentiality and privacy; and unmet needs of adolescent-friendly facilities. CONCLUSIONS Lack of knowledge among adolescent girls and unmet needs of adolescent-friendly facilities affect their access to sexual and reproductive health care in Nepal. Lack of knowledge could be seen as a barrier, and as a reason why adolescent girls do not seek sexual and reproductive health care.
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Affiliation(s)
- Magdalena Mattebo
- School of Health, Care and Social Welfare, Mälardalen University, Sweden.
| | - Malin Bogren
- Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Nadja Brunner
- School of Education, Health and Social Studies, Dalarna University, Sweden
| | - Alma Dolk
- School of Education, Health and Social Studies, Dalarna University, Sweden
| | - Christina Pedersen
- School of Education, Health and Social Studies, Dalarna University, Sweden
| | - Kerstin Erlandsson
- School of Education, Health and Social Studies, Dalarna University, Sweden
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Erlandsson K, Byrskog U, Osman F, Pedersen C, Hatakka M, Klingberg-Allvin M. Evaluating a model for the capacity building of midwifery eduators in Bangladesh through a blended, web-based master's programme. Glob Health Action 2019; 12:1652022. [PMID: 31411128 PMCID: PMC6713181 DOI: 10.1080/16549716.2019.1652022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/31/2019] [Indexed: 10/26/2022] Open
Abstract
Background: While setting international standards for midwifery education has attracted considerable global attention, the education and training of midwifery educators has been relatively neglected, particularly in low-resource settings where capacity building is crucial. Objective: The aim of this study was to describe the expectations of midwifery educators in Bangladesh who took part in a blended web-based master's programme in SRHR and the extent to which these were realized after 12 months of part-time study. Methods: Both quantitative and qualitative methods have been used to collect data. A structured baseline questionnaire was distributed to all participants at the start of the first course (n = 30) and a second endpoint questionnaire was distributed after they (n = 29) had completed the core courses one year later. At the start of the first course, five focus group discussions (FGD) were held with the midwifery educators. Descriptive statistics and content analysis were used for the analyses. Results: Midwifery educators who took part in the study identified expectations that can be grouped into three distinct areas. They hoped to become more familiar with technology, anticipated they would learn pedagogical and other skills that would enable them to better support their students' learning and thought they might acquire skills to empower their students as human beings. Participants reported they realized these ambitions, attributing the master's programme with helping them take responsibility for their own teaching and learning, showing them how to enhance their students' learning and how to foster reflective and critical thinking among them. Conclusions: Midwifery educators have taken part in a creative learning environment which has developed their engagement in teaching and learning. They have done this using a blended learning model which combines online learning with face-to-face contact. This model can be scaled up in low resource and remote settings.
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Affiliation(s)
- Kerstin Erlandsson
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Ulrika Byrskog
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Fatumo Osman
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Christina Pedersen
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Mathias Hatakka
- School of Technology and Business Studies, Dalarna University, Falun, Sweden
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Hatakka M, Osman F, Erlandsson K, Byrskog U, Egal J, Klingberg-Allvin M. "Change-makers in midwifery care": Exploring the differences between expectations and outcomes-A qualitative study of a midwifery net-based education programme in the Somali region. Midwifery 2018; 69:135-142. [PMID: 30503998 DOI: 10.1016/j.midw.2018.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/30/2018] [Accepted: 11/17/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study is to explore midwifery educators' expected outcomes in the net-based master's programme, the programmes' realised outcomes and the reported difference regarding the increased choices for the graduates and the effect on their agency. DESIGN In this case study, we focused on a net-based master's programme in sexual and reproductive health in Somalia. Somalia suffers from a shortage of skilled birth attendants and there is a need for building up the capacity of midwifery educators. SETTING AND PARTICIPANTS Data was collected in focus group discussions at the start of the programme and eight months after the students graduated. The data were analysed through the lens of the choice framework, which is based on the capability approach. FINDINGS Findings show that many of the graduates' expectations were met, while some were more difficult to fulfil. While the midwives' choices and resource portfolios had improved because of their role as educators, the social structure prevented them from acting on their agency, specifically in regards to making changes at the social level. Several of the positive developments can be attributed to the pedagogy and structure of the programme. CONCLUSION The flexibility of net-based education gave the midwifery educators a new educational opportunity that they previously did not have. Students gained increased power and influence on some levels. However, they still lack power in government organisations where, in addition to their role as educators, they could use their skills and knowledge to change policies at the social level.
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Affiliation(s)
- Mathias Hatakka
- School of Technology and Business Studies, Dalarna University, 791 88 Falun, Sweden
| | - Fatumo Osman
- School of Education, Health and Social Studies, Dalarna University, 791 88 Falun, Sweden
| | - Kerstin Erlandsson
- School of Education, Health and Social Studies, Dalarna University, 791 88 Falun, Sweden
| | - Ulrika Byrskog
- School of Education, Health and Social Studies, Dalarna University, 791 88 Falun, Sweden
| | - Jama Egal
- School of Health Science, Hargeisa University, Hargesia, Somaliland
| | - Marie Klingberg-Allvin
- School of Education, Health and Social Studies, Dalarna University, 791 88 Falun, Sweden.
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Dalmar AA, Hussein AS, Walhad SA, Ibrahim AO, Abdi AA, Ali MK, Ereg DI, Egal KA, Shirwa AM, Aden MH, Yusuf MW, Abdi YA, Freij L, Johansson A, Mohamud KB, Abdulkadir Y, Emmelin M, Eriksen J, Erlandsson K, Gustafsson LL, Ivarsson A, Klingberg-Allvin M, Kinsman J, Källestål C, Målqvist M, Osman F, Persson LÅ, Sahlén KG, Wall S. Rebuilding research capacity in fragile states: the case of a Somali-Swedish global health initiative. Glob Health Action 2018; 10:1348693. [PMID: 28799463 PMCID: PMC5645673 DOI: 10.1080/16549716.2017.1348693] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This paper presents an initiative to revive the previous Somali–Swedish Research Cooperation, which started in 1981 and was cut short by the civil war in Somalia. A programme focusing on research capacity building in the health sector is currently underway through the work of an alliance of three partner groups: six new Somali universities, five Swedish universities, and Somali diaspora professionals. Somali ownership is key to the sustainability of the programme, as is close collaboration with Somali health ministries. The programme aims to develop a model for working collaboratively across regions and cultural barriers within fragile states, with the goal of creating hope and energy. It is based on the conviction that health research has a key role in rebuilding national health services and trusted institutions.
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Affiliation(s)
| | | | - Said Ahmed Walhad
- b College of Health Sciences , Amoud University , Borama , Somaliland
| | | | - Abshir Ali Abdi
- c Faculty of Medicine , East Africa University , Bosasso , Somalia
| | | | | | - Khadra Ali Egal
- d Medical College , University of Hargeisa , Hargeisa , Somaliland
| | | | - Mohamed Hussain Aden
- f Medical College , Puntland University of Science and Technology , Galkayo , Somalia
| | | | | | - Lennart Freij
- g Somali-Swedish Researchers' Association , Stockholm , Sweden
| | | | | | | | - Maria Emmelin
- h Unit of Social Medicine and Global Health , Lund University , Lund , Sweden
| | - Jaran Eriksen
- i Division of Clinical Pharmacology , Karolinska Institutet , Stockholm , Sweden
| | | | - Lars L Gustafsson
- i Division of Clinical Pharmacology , Karolinska Institutet , Stockholm , Sweden
| | - Anneli Ivarsson
- k Unit of Epidemiology and Global Health , Umeå University , Umeå , Sweden
| | | | - John Kinsman
- k Unit of Epidemiology and Global Health , Umeå University , Umeå , Sweden
| | - Carina Källestål
- l Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | - Mats Målqvist
- l Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | | | - Lars-Åke Persson
- l Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | - Klas-Göran Sahlén
- k Unit of Epidemiology and Global Health , Umeå University , Umeå , Sweden
| | - Stig Wall
- k Unit of Epidemiology and Global Health , Umeå University , Umeå , Sweden
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Bogren M, Erlandsson K, Byrskog U. What prevents midwifery quality care in Bangladesh? A focus group enquiry with midwifery students. BMC Health Serv Res 2018; 18:639. [PMID: 30111324 PMCID: PMC6094463 DOI: 10.1186/s12913-018-3447-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 08/05/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND With professional midwives being introduced in Bangladesh in 2013, the aim of this study was to describe midwifery students perceptions on midwives' realities in Bangladesh, based on their own experiences. METHOD Data were collected through 14 focus group discussions that included a total of 67 third-year diploma midwifery students at public nursing institutes/colleges in different parts of Bangladesh. Data were analyzed deductively using an analytical framework identifying social, professional and economical barriers to the provision of quality care by midwifery personnel. RESULTS The social barriers preventing midwifery quality care falls outside the parameters of Bangladeshi cultural norms that have been shaped by beliefs associated with religion, society, and gender norms. This puts midwives in a vulnerable position due to cultural prejudice. Professional barriers include heavy workloads with a shortage of staff who were not utilized to their full capacity within the health system. The reason for this was a lack of recognition in the medical hierarchy, leaving midwives with low levels of autonomy. Economical barriers were reflected by lack of supplies and hospital beds, midwives earning only low and/or irregular salaries, a lack of opportunities for recreation, and personal insecurity related to lack of housing and transportation. CONCLUSION Without adequate support for midwives, to strengthen their self-confidence through education and through continuous professional and economic development, little can be achieved in terms of improving quality care of women during the period around early and late pregnancy including childbirth.The findings can be used for discussions aimed to mobilize a midwifery workforce across the continuum of care to deliver quality reproductive health care services. No matter how much adequate support is provided to midwives, to strengthen their self-confidence through education, continuous professional and economic development, addressing the social barriers is a prerequisite for provision of quality care.
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Affiliation(s)
- Malin Bogren
- School of Education, Health and Social Studies, Dalarna University, 791 88 Falun, Sweden
| | - Kerstin Erlandsson
- School of Education, Health and Social Studies, Dalarna University, 791 88 Falun, Sweden
| | - Ulrika Byrskog
- School of Education, Health and Social Studies, Dalarna University, 791 88 Falun, Sweden
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Byrskog U, Hussein IH, Yusuf FM, Egal JA, Erlandsson K. The situation for female survivors of non-partner sexual violence: A focused enquiry of Somali young women’s views, knowledge and opinions. Sexual & Reproductive Healthcare 2018; 16:39-44. [PMID: 29804773 DOI: 10.1016/j.srhc.2018.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/26/2018] [Accepted: 01/30/2018] [Indexed: 10/18/2022]
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Bogren M, Erlandsson K. Opportunities, challenges and strategies when building a midwifery profession. Findings from a qualitative study in Bangladesh and Nepal. Sexual & Reproductive Healthcare 2018; 16:45-49. [DOI: 10.1016/j.srhc.2018.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 02/09/2018] [Accepted: 02/11/2018] [Indexed: 11/15/2022]
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Abdillahi HA, Hassan KA, Kiruja J, Osman F, Egal JA, Klingberg-Allvin M, Erlandsson K. A mixed-methods study of maternal near miss and death after emergency cesarean delivery at a referral hospital in Somaliland. Int J Gynaecol Obstet 2017; 138:119-124. [PMID: 28391614 DOI: 10.1002/ijgo.12176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/04/2017] [Accepted: 04/06/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To explore maternal near miss and death after emergency cesarean delivery in Somaliland, including the impact of the prerequisite for family consent. METHODS A facility-based, mixed-methods study was conducted to assess all maternal near misses and deaths recorded at a referral hospital that provided services to women from all regions of Somaliland. The data sources comprised a quantitative prospective cross-sectional study using the WHO near-miss tool (performed from August 1 to December 31, 2015) and qualitative interviews with 17 healthcare providers working at the referral hospital who were in direct contact with the women in labor (performed from January 15 to March 15, 2015). RESULTS Of the 138 maternal near misses and deaths recorded, 50 (36%) were associated with emergency cesarean delivery. The most frequent maternal complication was severe pre-eclampsia (n=17; 34%), and the most frequent underlying causes were hypertensive disorders (n=31; 62%) and obstetric hemorrhage (n=15; 30%). Healthcare providers were often prevented from performing emergency cesarean delivery until the required consent had been received from the woman's extended family. CONCLUSION Maternity care in Somaliland must be improved, and the issue of legal authority for consent examined, to ensure both safe and timely provision of emergency cesarean delivery.
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Affiliation(s)
- Hamda A Abdillahi
- College of Health Science and Medicine, Faculty of Nursing and Midwifery, Hargeisa University, Hargeisa, Somaliland
| | - Khadra A Hassan
- College of Health Science and Medicine, Faculty of Nursing and Midwifery, Hargeisa University, Hargeisa, Somaliland
| | - Jonah Kiruja
- College of Health Science and Medicine, Faculty of Nursing and Midwifery, Hargeisa University, Hargeisa, Somaliland
| | - Fatumo Osman
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Jama A Egal
- College of Health Science and Medicine, Faculty of Nursing and Midwifery, Hargeisa University, Hargeisa, Somaliland
| | | | - Kerstin Erlandsson
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Osman HM, Egal JA, Kiruja J, Osman F, Byrskog U, Erlandsson K. Women's experiences of stillbirth in Somaliland: A phenomenological description. Sex Reprod Healthc 2017; 11:107-111. [PMID: 28159120 DOI: 10.1016/j.srhc.2016.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 12/30/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Low- and middle-income countries in Africa have the highest rates of stillbirths in the world today: as such, the stories of the grief of these women who have had a stillbirth in these settings need to be told and the silence on stillbirth needs to be broken. In an attempt to fill this gap, the aim of this study was to describe the experiences of Muslim Somali mothers who have lost their babies at birth. METHOD Qualitative interviews with ten Somali women one to six months after they experienced a stillbirth. Data were analyzed using Giorgi's method of phenomenological description. RESULTS In the analysis, four descriptive structures emerged: "a feeling of alienation"; "altered stability in life"; "immediate pain when the sight of the dead baby turns into a precious memory"; and "a wave of despair eases". Together, these supported the essence: "Balancing feelings of anxiety, fear and worries for one's own health and life by accepting Allah's will and putting one's trust in him". CONCLUSIONS This study makes an important contribution to our knowledge about how stillbirth is experienced by women in Somaliland. This information can be useful when health care providers communicate the experiences of stillbirth to women of Muslim faith who have experienced an intrauterine fatal death (IUFD) resulting in a stillbirth.
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Affiliation(s)
- Hodan Mohamoud Osman
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; College of Health Science and Medicine, Faculty of Nursing and Midwifery, Hargeisa University, Somaliland
| | - Jama Ali Egal
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; College of Health Science and Medicine, Faculty of Nursing and Midwifery, Hargeisa University, Somaliland
| | - Jonah Kiruja
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; College of Health Science and Medicine, Faculty of Nursing and Midwifery, Hargeisa University, Somaliland
| | - Fatumo Osman
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; College of Health Science and Medicine, Faculty of Nursing and Midwifery, Hargeisa University, Somaliland
| | - Ulrika Byrskog
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; College of Health Science and Medicine, Faculty of Nursing and Midwifery, Hargeisa University, Somaliland
| | - Kerstin Erlandsson
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; College of Health Science and Medicine, Faculty of Nursing and Midwifery, Hargeisa University, Somaliland.
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