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Reddy B, Thomas S, Karachiwala B, Sadhu R, Iyer A, Sen G, Mehrtash H, Tunçalp Ö. A scoping review of the impact of organisational factors on providers and related interventions in LMICs: Implications for respectful maternity care. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001134. [PMID: 36962616 PMCID: PMC10021694 DOI: 10.1371/journal.pgph.0001134] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/14/2022] [Indexed: 11/05/2022]
Abstract
We have limited understanding of the organisational issues at the health facility-level that impact providers and care as it relates to mistreatment in childbirth, especially in low- and middle-income countries (LMICs). By extension, it is not clear what types of facility-level organisational changes or changes in working environments in LMICs could support and enable respectful maternity care (RMC). While there has been relatively more attention to health system pressures related to shortages of staff and other resources as key barriers, other organisational challenges may be less explored in the context of RMC. This scoping review aims to consolidate evidence to address these gaps. We searched literature published in English between 2000-2021 within Scopus, PubMed, Google Scholar and ScienceDirect databases. Study selection was two-fold. Maternal health articles articulating an organisational issue at the facility- level and impact on providers and/or care in an LMIC setting were included. We also searched for literature on interventions but due to the limited number of related intervention studies in maternity care specifically, we expanded intervention study criteria to include all medical disciplines. Organisational issues captured from the non-intervention, maternal health studies, and solutions offered by intervention studies across disciplines were organised thematically and to establish linkages between problems and solutions. Of 5677 hits, 54 articles were included: 41 non-intervention maternal healthcare studies and 13 intervention studies across all medical disciplines. Key organisational challenges relate to high workload, unbalanced division of work, lack of professional autonomy, low pay, inadequate training, poor feedback and supervision, and workplace violence, and these were differentially influenced by resource shortages. Interventions that respond to these challenges focus on leadership, supportive supervision, peer support, mitigating workplace violence, and planning for shortages. While many of these issues were worsened by resource shortages, medical and professional hierarchies also strongly underpinned a number of organisational problems. Frontline providers, particularly midwives and nurses, suffer disproportionately and need greater attention. Transforming institutional leadership and approaches to supervision may be particularly useful to tackle existing power hierarchies that could in turn support a culture of respectful care.
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Affiliation(s)
- Bhavya Reddy
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Sophia Thomas
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Baneen Karachiwala
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Ravi Sadhu
- T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Aditi Iyer
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Gita Sen
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Hedieh Mehrtash
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Bayou NB, Grant L, Riley SC, Bradley EH. Structural quality of labor and delivery care in government hospitals of Ethiopia: a descriptive analysis. BMC Pregnancy Childbirth 2022; 22:523. [PMID: 35764981 PMCID: PMC9241271 DOI: 10.1186/s12884-022-04850-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 06/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Ethiopia has low skilled birth attendance rates coupled with low quality of care within health facilities contributing to one of the highest maternal mortality rates in Sub-Saharan Africa, at 412 deaths per 100,000 live births. There is lack of evidence on the readiness of health facilities to deliver quality labor and delivery (L&D) care. This paper describes the structural quality of routine L&D care in government hospitals of Ethiopia. Methods A facility-based cross-sectional study design, involving census of all government hospitals in Southern Nations Nationalities and People’s Region (SNNPR) (N = 20) was conducted in November 2016 through facility audit using a structured checklist. Data collectors verified the availability and functioning of the required items through observation and interview with the heads of labor and delivery case team. An overall mean score of structural quality was calculated considering domain scores such as general infrastructure, human resource and essential drugs, supplies, equipment and laboratory services. Summary statistics such as proportion, mean and standard deviation were computed to describe the degree of adherence of the hospitals to the standards related to structural quality of routine labor and delivery care. Results One third of hospitals had low readiness to provide quality routine L&D care, with only two approaching near fulfilment of all the standards. Hospitals had fulfilled 68.2% of the standards for the structural aspects of quality of L&D care. Of the facility audit criteria, the availability of essential equipment and supplies for infection prevention scored the highest (88.8%), followed by safety, comfort and woman friendliness of the environment (76.4%). Availability skilled health professionals and quality management practices scored 72.5% each, while availability of the required items of general infrastructure was 64.6%. The two critical domains with the lowest score were availability of essential drugs, supplies and equipment (52.2%); and laboratory services and safe blood supply (50%). Conclusion Substantial capacity gaps were observed in the hospitals challenging the provision of quality routine L&D care services, with only two thirds of required resources available. The largest gaps were in laboratory services and safe blood, and essential drugs, supplies and equipment. The results suggest the need to ensure that all public hospitals in SNNPR meet the required structure to enable the provision of quality routine L&D care with emphases on the identified gaps.
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Affiliation(s)
- Negalign B Bayou
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Liz Grant
- Center for Population Health Sciences, Global Health Academy, Usher Institute of Population Health Sciences and Informatics, Scotland, University of Edinburgh, Scotland, Edinburgh, United Kingdom
| | - Simon C Riley
- Centre for Reproductive Health, University of Edinburgh, Scotland, Edinburgh, United Kingdom
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Vestering A, de Kok BC, Browne JL, Adu-Bonsaffoh K. Navigating with logics: Care for women with hypertensive disorders of pregnancy in a tertiary hospital in Ghana. Soc Sci Med 2021; 289:114402. [PMID: 34600357 DOI: 10.1016/j.socscimed.2021.114402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 09/02/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
This paper explores how care for women with hypertensive disorders of pregnancy (HDP) is practiced in a tertiary hospital in Ghana. Partly in response to the persistently high maternal and neonatal mortality rates in Low- and Middle-income countries, efforts to improve quality of maternity care have increased. Quality improvement initiatives are shaped by the underlying conceptualisation of quality of care, often driven by global (WHO) standards and protocols. However, there are tensions between global standards of care and local clients' and providers' understandings of care practices and quality of care. Implementation of standards is further complicated by structural and organisational restrictions that influence providers' possibilities and priorities. Based on ethnographic fieldwork, we explore how clinical guidelines and professionals' and patients' perspectives converge and, more importantly, diverge. We illuminate local, situated care practices and show how professionals creatively deal with tensions that arise on the ground. In this middle-income setting, caring for women with HDP involves tinkering and navigating in contexts of uncertainty, scarcity, varying responsibilities and conflicting interests. We unravelled a complex web of, at times, contradictory logics, from which various forms of care arise and in which different notions of good care co-exist. While practitioners navigated through and with these varying logics of care, the logic of survival permeated all practices. This study provides important initial insights into how professionals might implement and innovatively adapt the latest quality of maternity care guidelines which seek to marry clinical standards and patients' needs, preferences and experiences.
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Affiliation(s)
| | | | - Joyce L Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Kwame Adu-Bonsaffoh
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands; Department of Obstetrics and Gynaecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
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Pessa Valente E, Barbone F, de Melo E Lima TR, de Mascena Diniz Maia PFC, Vezzini F, Tamburlini G. Quality of maternal and newborn hospital care in Brazil: a quality improvement cycle using the WHO assessment and quality tool. Int J Qual Health Care 2021; 33:6146808. [PMID: 33619561 DOI: 10.1093/intqhc/mzab028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 02/09/2021] [Accepted: 02/20/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Increasing efforts toward quality improvement (QI) are necessary in low- and middle-income countries (LMICs) to reduce maternal and perinatal mortality and morbidity and to promote respectful care. In Brazil, perinatal health indicators are below targets in several states despite universal access to perinatal services and very high rates of institutional births, indicating poor quality of care (QoC) as a key issue to be addressed. However, research efforts to develop and test QoC improvement interventions are scarce. OBJECTIVES We assessed the effects of a 1-year comprehensive QI cycle using a World Health Organization (WHO) assessment and quality tool on maternal and newborn care at hospital level and documented QIs obtained after a 1-year comprehensive QI cycle. METHODS Uncontrolled, unblinded, pre-post study carried out in six maternity hospitals in Pernambuco, Brazil, accounting for 29 128 live births in 2014. A standards-based and participatory approach based on a WHO quality assessment and improvement tool for maternal and neonatal care at hospital level was used. A national team of assessors supervised by international experts carried out baseline and final assessments. An action plan was developed and implemented to address key quality gaps emerging from the baseline assessment and from two supportive supervision visits. RESULTS At baseline, hospitals presented a variety of quality gaps, the majority common to all participating centers. Gaps in case management of normal and complicated deliveries and in respectful and holistic care were predominant, in both teaching/tertiary and secondary care hospitals. After one year, several improvements were observed, particularly in respectful care during labor and at delivery, in case management of normal labor and delivery and in neonatal care. CONCLUSIONS A systematic participatory approach based on a WHO tool produced important QIs in a relatively short time and should be considered for use for large-scale QI programs in Brazil and other LMICs. Its comprehensive, peer-to-peer and action-oriented nature and its capability to document QI over time and to build a QI culture represent important comparative advantages over other QI interventions.
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Affiliation(s)
- Emanuelle Pessa Valente
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Via dell'Istria 65/1, Trieste, Friuli Venezia Giulia Region 34137, Italy
| | - Fabio Barbone
- Scientific Direction, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Via dell'Istria 65/1, Trieste, Friuli Venezia Giulia Region 34137, Italy
| | - Tereza Rebecca de Melo E Lima
- Post graduation department, doctorate on integral medicine, Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Rua dos Coelhos, 300 - Boa Vista, Recife, Pernambuco 50070-902, Brazil.,Medicine course department, Faculdade Pernambucana de Saúde (FPS), av. Mal. Mascarenhas de Morais, 4861 - Imbiribeira, Recife - Pernambuco 51150-000, Pernambuco, Brazil
| | - Paula Ferdinanda Conceiçîo de Mascena Diniz Maia
- Medicine course department, Faculdade Pernambucana de Saúde (FPS), av. Mal. Mascarenhas de Morais, 4861 - Imbiribeira, Recife - Pernambuco 51150-000, Pernambuco, Brazil.,Pediatric department, Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235 - Cidade Universitària, Recife - Pernambuco 50670-901, Brazil
| | - Francesca Vezzini
- Post graduation department, doctorate on integral medicine, Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Rua dos Coelhos, 300 - Boa Vista, Recife, Pernambuco 50070-902, Brazil.,Dottorato di Ricerca in Scienze della Riproduzione e dello Sviluppo, Università degli Studi di Trieste, Piazzale Europa, Trieste 34127, Italy
| | - Giorgio Tamburlini
- Dottorato di Ricerca in Scienze della Riproduzione e dello Sviluppo, Università degli Studi di Trieste, Piazzale Europa, Trieste 34127, Italy.,Director, Centro per la Salute del Bambino, Via Nocolò de Rin, 19, Trieste, Friuli Venezia Giulia Region 34143, Italy
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Wanaka S, Hussen S, Alagaw A, Tolosie K, Boti N. Maternal Delays for Institutional Delivery and Associated Factors Among Postnatal Mothers at Public Health Facilities of Gamo Zone, Southern Ethiopia. Int J Womens Health 2020; 12:127-138. [PMID: 32184676 PMCID: PMC7061422 DOI: 10.2147/ijwh.s240608] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/20/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Maternal health delays like delay in deciding to seek care, reaching a health facility, and receiving appropriate care were identified as the main contributing factors for maternal mortality and morbidity in many developing countries including Ethiopia. However, little is known about the magnitude and factors predisposing for maternal health delays in Ethiopia especially in a rural part of the country. Therefore, the aim of this study is to assess the magnitude of maternal delays for institutional delivery and associated factors among mothers attending post-natal service at public health facilities of the Gamo zone, Southern Ethiopia. METHODS A cross-sectional study was conducted in rural districts of Gamo zone. Eleven public health centers in the two districts were selected randomly. The Systematic random sampling method was used to select study participants from each public health centers. A total of 394 postnatal mothers were selected every secondly and interviewed in a separate room. Face to face interview methods were used to collect the data. Binary and multivariable logistic regression analyses were conducted to identify the associated factors for the three delays. RESULTS The magnitude of first, second and third maternal delays were 46.80%, 44.00%, and 31.70%, respectively. Unemployed women [AOR: 2.20, 95% CI (1.15, 4.16)], birth preparedness [AOR: 2.70, 95% CI (1.29, 5.71)], husband's decisions making [AOR: 6.00, 95% CI (2.87, 12.42)] were found to be significantly associated with first delay. Distance to health facility [AOR: 7.00, 95% CI (3.58, 13.71)], and means of transportation [AOR: 3.30, 95% CI (1.13, 9.54)] were found to be significantly associated with the second delay. Availability of obstetric drugs [AOR: 8.40, 95% CI (3.76, 18.76)], and availability of skilled health provider [AOR: 10.40, 95% CI (4.24, 25.69)] were found to be significantly associated with the third delay for institutional delivery. CONCLUSION The magnitude of first, second and third maternal delays were high which indicates that most mothers were not receiving institutional delivery services at the recommended time. Maternal socio-economic, obstetric factors and health-care system factors affected the three delays in this study. Therefore, improving women empowerment and resource availability at health facilities is vital.
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Affiliation(s)
- Seifu Wanaka
- Gamo Zone Health Department, Arba Minch, Ethiopia
| | - Sultan Hussen
- Arba Minch University, College of Medicine & Health Sciences, Department of Public Health, Arba Minch, Ethiopia
| | - Amsalu Alagaw
- Arba Minch University, College of Medicine & Health Sciences, Department of Public Health, Arba Minch, Ethiopia
| | - Kabtamu Tolosie
- Arba Minch University, College of Natural Sciences, Department of Statistics, Arba Minch, Ethiopia
| | - Negussie Boti
- Arba Minch University, College of Medicine & Health Sciences, Department of Public Health, Arba Minch, Ethiopia
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Hrusa G, Spigt M, Dejene T, Shiferaw S. Quality of Family Planning Counseling in Ethiopia: Trends and determinants of information received by female modern contraceptive users, evidence from national survey data, (2014- 2018). PLoS One 2020; 15:e0228714. [PMID: 32040485 PMCID: PMC7010283 DOI: 10.1371/journal.pone.0228714] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/21/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Family planning counseling is critical for women to make informed reproductive and sexual health decisions. Despite Ethiopia's success in expanding access to family planning services, information on the quality of family planning counseling is limited. The objectives of this study were to assess whether the quality of counseling from the female client´s perspective has changed over time (2014 to 2018) and to investigate determinants associated with the quality of counseling to provide a more nuanced understanding of disparities in sexual and reproductive health outcomes in Ethiopia. METHODS Data were obtained from five rounds of the Ethiopian Performance Monitoring and Accountability 2020 female survey questionnaire. Quality of counseling was categorized into four levels based on the responses of the questions that compose the Method Information Index, a core Family Planning 2020 indicator that serves as a proxy for quality of counseling and reflects the extent to which women are informed about side effects and alternate methods. The proportion of female contraceptive users that received good counseling were examined over time by each region, demographic characteristics, and contraception method type and source. Ordinal logistic regression was applied to the last survey round (2018) to investigate determinants associated with counseling quality. RESULTS The proportion of female contraception users that reported receiving information on all three questions did not significantly change over the period 2014 to 2018. Overall quality of counseling on family planning was low, with only 30% of women reporting receiving sufficient information during counseling. The likelihood of good quality counseling was the least among those who had no formal schooling when compared to those who had higher educational attainment (OR = 0.70, 95% CI: 0.50, 0.97). Women from the wealthiest quintile were 1.72 times more likely (95% CI: 1.10, 2.69) to receive good quality counseling when compared to women in the lower wealth quintile. Women from rural areas were 1.51 times more likely to have received good counseling when compared to those in urban areas (95% CI: 1.04, 2.18). Amhara residents were less likely to receive good counseling when compared to the SNNPR (OR: 0.51, 95% CI: 0.32, 0.81). Women who acquired their method from the private sector had worse counseling (OR: 0.31, 95% CI: 0.23, 0.41) when compared to the public sector. Those using short-acting methods were more at risk of receiving lesser quality counseling when compared to users of long-acting methods (OR: 0.58, 95% CI: 0.46, 0.72). CONCLUSION The results of this analysis indicated that Ethiopia's overall progress in modern contraceptive use has not been accompanied by a corresponding increase in the quality of family planning counseling. Improving the quality of contraception counseling for women across all demographics, including wealth quintiles and education, is a crucial strategy to support positive reproductive health outcomes with a rights-based focus. Based on the findings of this study, it is essential to emphasize the need to do proper counseling for all methods including short-acting methods especially for those working the private sector and some of the regions which have lower prevalence of good counseling. Further community-based participatory and qualitative research should focus on understanding the root causes and barriers to the delivery of high-quality counseling in Ethiopia.
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Affiliation(s)
- Gili Hrusa
- Department of Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- * E-mail:
| | - Mark Spigt
- Department of Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Community Medicine, General Practice Research Unit, the Arctic University of Norway, Tromsø, Norway
| | - Tariku Dejene
- Center for Population Studies, College of Development Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Shiferaw
- Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Horwood C, Haskins L, Luthuli S, McKerrow N. Communication between mothers and health workers is important for quality of newborn care: a qualitative study in neonatal units in district hospitals in South Africa. BMC Pediatr 2019; 19:496. [PMID: 31842824 PMCID: PMC6913017 DOI: 10.1186/s12887-019-1874-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 12/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background There is a high global burden of neonatal mortality, with many newborn babies dying of preventable and treatable conditions, particularly in low and middle-income countries. Improving quality of newborn care could save the lives of many thousands of babies. Quality of care (QoC) is a complex and multifaceted construct that is difficult to measure, but patients’ experiences of care are an important component in any measurement of QoC. We report the findings of a qualitative study exploring observations and experiences of health workers (HWs) and mothers of babies in neonatal units in South Africa. Methods A qualitative case study approach was adopted to explore care of newborn babies admitted to neonatal units in district hospitals. Observation data were collected by a registered nurse during working hours over a continuous five-day period. Doctors and nurses working in the neonatal unit and mothers of babies admitted during the observation period were interviewed using a semi-structured interview guide. All interviews were audio recorded. Observation data were transcribed from hand written notes. Audiotapes of interviews were transcribed verbatim and, where necessary, translated into English. A thematic content analysis was used to analyse the data. Results Observations and interviews were conducted in seven participating hospitals between November 2015 and May 2016. Our findings highlight the importance of information sharing between HWs and mothers of babies, contrasting the positive communication reported by many mothers which led to them feeling empowered and participating actively in the care of their babies, with incidents of poor communication. Poor communication, rudeness and disrespectful behaviour of HWs was frequently described by mothers, and led to mothers feeling anxious, unwilling to ask questions and excluded from their baby’s care. In some cases poor communication and misunderstandings led to serious mismanagement of babies with HWs delaying or withholding care, or to mothers putting their babies at risk by not following instructions. Conclusion Good communication between mothers and HWs is critical for building mothers’ confidence, promoting bonding and participation of mothers in the care of their baby and may have long term benefits for the health and well-being of the mother and her baby.
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Affiliation(s)
- Christiane Horwood
- Centre for Rural Health, University of KwaZulu-Natal, George Campbell Building, Howard College Campus, Durban, South Africa
| | - Lyn Haskins
- Centre for Rural Health, University of KwaZulu-Natal, George Campbell Building, Howard College Campus, Durban, South Africa.
| | - Silondile Luthuli
- Centre for Rural Health, University of KwaZulu-Natal, George Campbell Building, Howard College Campus, Durban, South Africa
| | - Neil McKerrow
- KwaZulu-Natal Department of Health, Durban, South Africa.,Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
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Jolly Y, Aminu M, Mgawadere F, van den Broek N. "We are the ones who should make the decision" - knowledge and understanding of the rights-based approach to maternity care among women and healthcare providers. BMC Pregnancy Childbirth 2019; 19:42. [PMID: 30764788 PMCID: PMC6376786 DOI: 10.1186/s12884-019-2189-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 01/14/2019] [Indexed: 11/10/2022] Open
Abstract
Background Experiences and perceptions of poor quality of care is a powerful determinant of utilisation of maternity services. With many reports of disrespect and abuse in healthcare facilities in low-resource settings, women’s and healthcare providers’ understanding and perception of disrespect and abuse are important in eliminating disrespect and abuse, but these are rarely explored together. Methods This was a qualitative study assessing the continuum of maternity care (antenatal, intrapartum and postnatal care) at the Maternity Unit of Bwaila Hospital in Lilongwe, Malawi. Focus group discussions (FGDs) were conducted separately for mothers attending antenatal clinic and those attending postnatal clinic. For women who accessed intrapartum care services, in-depth interviews were used. Participants were recruited purposively. Key informant interviews were conducted with healthcare providers involved in the delivery of maternal and newborn health services. Topic guides were developed based on the seven domains of the Respectful Maternity Care (RMC) Charter. Data was transcribed verbatim, coded and analysed using the thematic framework approach. Results A total of 8 focus group discussions and 9 in-depth interviews involving 64 women and 9 key informant interviews with health care providers were conducted. Important themes that emerged included: the importance of a valued patient-provider relationship as determined by a good attitude and method of communication, the need for more education of women regarding the stages of pregnancy and labour, what happens at each stage and which complications could occur, the importance of a woman’s involvement in decision-making, the need to maintain confidentiality when required and the problem of insufficient human resources. Prompt and timely service was considered a priority. Neither women accessing maternity care nor trained healthcare providers providing this care were aware of the RMC Charter. Conclusions This study has highlighted the most essential aspects of respectful maternity care from the viewpoint of both women accessing maternity care and healthcare providers. Although RMC components are in place, healthcare providers were not aware of them. There is the need to promote the RMC Charter among both women who seek care and healthcare providers. Electronic supplementary material The online version of this article (10.1186/s12884-019-2189-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yasmin Jolly
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Mamuda Aminu
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Florence Mgawadere
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
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Client satisfaction with existing labor and delivery care and associated factors among mothers who gave birth in university of Gondar teaching hospital; Northwest Ethiopia: Institution based cross-sectional study. PLoS One 2019; 14:e0210693. [PMID: 30726297 PMCID: PMC6364872 DOI: 10.1371/journal.pone.0210693] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 12/17/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There are many reasons for mothers not receiving modern obstetric care, being dissatisfied by health care deliveries is one of the major factors. There are limited studies about maternal satisfaction with labor and delivery care services in Ethiopia and particularly in the study area. Therefore, the aim of this study was to better understand client satisfaction on existing labor and delivery care service and associated factors among mothers who gave birth in the University of Gondar Teaching Hospital, Ethiopia. METHODS This institution based cross-sectional study was conducted at the University of Gondar Referral Hospital. 593 mothers who gave birth between July and September 2016 were enrolled. Study participants were selected by systematic random sampling. A standardized, interviewer-administered questionnaire was used to collect data. Descriptive and summary statistics were performed. A linear regression model was fitted and variables having a P value of ≤0.05 in the multivariable model were considered statistically significant. RESULT Overall, 31.3% of mothers were satisfied by the existing labor and delivery care. Living in rural areas (-2.9%; 95% CI: -5.75,-0.12) and the presence of a co-morbidity (-3.2%; 95%CI:-5.70, -0.72) were the factor which have a negative influence on maternal satisfaction. On the other hand, travel time to reach to the hospital (hours) (0.79%; 95% CI: 0.07, 1.52), birth by episiotomy or assisted vaginal delivery (6.3%; 95%CI: 1.56, 11.04), and receiving cost-free maternal health services (6.66%; 95%CI: 3.31, 10.01) were the factors that had positive influence. CONCLUSION The level of satisfaction of laboring mothers with the labor and delivery care services was poor. Rural residency and chronic medical co-morbidity were negatively associated with level of satisfaction while travel time, mode of delivery, and payment free delivery service had a statistically significant positive influence on satisfaction.
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Horwood C, Haskins L, Phakathi S, McKerrow N. A health systems strengthening intervention to improve quality of care for sick and small newborn infants: results from an evaluation in district hospitals in KwaZulu-Natal, South Africa. BMC Pediatr 2019; 19:29. [PMID: 30678646 PMCID: PMC6345064 DOI: 10.1186/s12887-019-1396-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 01/08/2019] [Indexed: 11/17/2022] Open
Abstract
Background Many newborn infants die from preventable causes in South Africa, often these deaths occur in district hospitals. A multipronged intervention aiming to improve quality of newborn care in district hospitals was implemented comprising training in clinical care for sick and small newborns, skills development for health managers, on-site mentoring, and hospital accreditation. We present the results of the project evaluation. Methods We conducted three sequential cross-sectional surveys in 39 participating district hospitals at baseline, midpoint and endpoint of the three-year intervention period. Data were collected by a trained midwife using a series of checklists including: availability of trained staff, drugs and equipment; newborn care practices; perinatal mortality audits; neonatal unit staff skills; quality of record keeping. A scoring system was developed for three domains: resources; care practices; resuscitation equipment, and a composite score that included all variables measured. Health worker (HW) knowledge was assessed at midpoint and endpoint. Results The average score for resources increased from 13.5 at baseline to 22.6 at endpoint (maximum score 34), for care practices from 17.7 to 22.6 (maximum score 29), and for resuscitation equipment from 10.8 to 16.1 (maximum 25). Average composite score improved significantly from 42.0 at baseline to 55.7 at midpoint to 60.7 at endpoint (maximum score 88) (p = 0.0012). Among 39 participating hospitals, 38 achieved higher scores at endpoint compared to baseline. Knowledge was higher among HWs trained during the project at midpoint and endpoint. Gaps that remained included poor infrastructure, lack of resuscitation equipment in some areas, poor postnatal care and lack of a dedicated doctor. Conclusions This intervention achieved measurable improvements in many important elements contributing to newborn care. A scoring system was used to track progress, compare facilities’ performance, and identify areas for improvement. Various methods were used to generate the quality of care score, including skills assessment and record reviews. However, measuring quality of clinical care and outcomes was challenging, and we were unable to determine whether the intervention improved clinical care and lead directly to improved outcomes for babies. In developing a future score for quality of care, a stronger focus should be placed on assessing clinical care and outcomes.
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Affiliation(s)
- C Horwood
- Centre for Rural Health, George Campbell Building, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa
| | - L Haskins
- Centre for Rural Health, George Campbell Building, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa.
| | - S Phakathi
- Centre for Rural Health, George Campbell Building, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa
| | - N McKerrow
- KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa.,Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
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Arnold R, van Teijlingen E, Ryan K, Holloway I. Parallel worlds: An ethnography of care in an Afghan maternity hospital. Soc Sci Med 2018; 216:33-40. [DOI: 10.1016/j.socscimed.2018.09.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 01/22/2023]
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Housseine N, Punt MC, Browne JL, Meguid T, Klipstein-Grobusch K, Kwast BE, Franx A, Grobbee DE, Rijken MJ. Strategies for intrapartum foetal surveillance in low- and middle-income countries: A systematic review. PLoS One 2018; 13:e0206295. [PMID: 30365564 PMCID: PMC6203373 DOI: 10.1371/journal.pone.0206295] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 10/10/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The majority of the five million perinatal deaths worldwide take place in low-resource settings. In contrast to high-resource settings, almost 50% of stillbirths occur intrapartum. The aim of this study was to synthesise available evidence of strategies for foetal surveillance in low-resource settings and associated neonatal and maternal outcomes, including barriers to their implementation. METHODS AND FINDINGS The review was registered with Prospero (CRD42016038679). Five databases were searched up to May 1st, 2016 for studies related to intrapartum foetal monitoring strategies and neonatal outcomes in low-resource settings. Two authors extracted data and assessed the risk of bias for each study. The outcomes were narratively synthesised. Strengths, weaknesses, opportunities and threats analysis (SWOT) was conducted for each monitoring technique to analyse their implementation. There were 37 studies included: five intervention and 32 observational studies. Use of the partograph improved perinatal outcomes. Intermittent auscultation with Pinard was associated with lowest rates of caesarean sections (10-15%) but with comparable perinatal outcomes to hand-held Doppler and Cardiotocography (CTG). CTG was associated with the highest rates of caesarean sections (28-34%) without proven benefits for perinatal outcome. Several tests on admission (admission tests) and adjunctive tests including foetal stimulation tests improved the accuracy of foetal heart rate monitoring in predicting adverse perinatal outcomes. CONCLUSIONS From the available evidence, the partograph is associated with improved perinatal outcomes and is recommended for use with intermittent auscultation for intrapartum monitoring in low resource settings. CTG is associated with higher caesarean section rates without proven benefits for perinatal outcomes, and should not be recommended in low-resource settings. High-quality evidence considering implementation barriers and enablers is needed to determine the optimal foetal monitoring strategy in low-resource settings.
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Affiliation(s)
- Natasha Housseine
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - Marieke C. Punt
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joyce L. Browne
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Tarek Meguid
- Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania
- School of Health and Medical Science, State University of Zanzibar (SUZA), Zanzibar, Tanzania
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Barbara E. Kwast
- International Consultant Maternal Health and Safe Motherhood, Leusden, The Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Diederick E. Grobbee
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marcus J. Rijken
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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Montagu D, Sudhinaraset M, Diamond-Smith N, Campbell O, Gabrysch S, Freedman L, Kruk ME, Donnay F. Where women go to deliver: understanding the changing landscape of childbirth in Africa and Asia. Health Policy Plan 2018; 32:1146-1152. [PMID: 28541422 PMCID: PMC5886217 DOI: 10.1093/heapol/czx060] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2017] [Indexed: 11/13/2022] Open
Abstract
Growing evidence from a number of countries in Asia and Africa documents a large shift towards facility deliveries in the past decade. These increases have not led to the improvements in health outcomes that were predicted by health policy researchers in the past. In light of this unexpected evidence, we have assessed data from multiple sources, including nationally representative data from 43 countries in Asia and Africa, to understand the size and range of changing delivery location in Asia and Africa. We have reviewed the policies, programs and financing experiences in multiple countries to understand the drivers of changing practices, and the consequences for maternal and neonatal health and the health systems serving women and newborns. And finally, we have considered what implications changes in delivery location will have for maternal and neonatal care strategies as we move forward into the next stage of global action. As a result of our analysis we make four major policy recommendations. (1) An expansion of investment in mid-level facilities for delivery services and a shift away from low-volume rural delivery facilities. (2) Assured access for rural women through funding for transport infrastructure, travel vouchers, targeted subsidies for services and residence support before and after delivery. (3) Increased specialization of maternity facilities and dedicated maternity wards within larger institutions. And (4) a renewed focus on quality improvements at all levels of delivery facilities, in both private and public settings.
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Affiliation(s)
- Dominic Montagu
- Department of Epidemiology and Biostatistics, Global Health Sciences, University of California, San Francisco; San Francisco, CA, USA
| | - May Sudhinaraset
- Department of Epidemiology and Biostatistics, Global Health Sciences, University of California, San Francisco; San Francisco, CA, USA.,Community Health Sciences; University of California, Los Angeles; Los Angeles, CA, USA
| | - Nadia Diamond-Smith
- Department of Epidemiology and Biostatistics, Global Health Sciences, University of California, San Francisco; San Francisco, CA, USA
| | - Oona Campbell
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Lynn Freedman
- Population and Family Health, Columbia University, New York, NY, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard University, Cambridge, MA, USA
| | - France Donnay
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
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Izugbara CO, Wekesah F. What does quality maternity care mean in a context of medical pluralism? Perspectives of women in Nigeria. Health Policy Plan 2018; 33:1-8. [PMID: 29036530 PMCID: PMC5886285 DOI: 10.1093/heapol/czx131] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 11/20/2022] Open
Abstract
User priorities regarding quality care in contexts of medical pluralism are poorly documented. Drawing on group and individual interviews with women, we interrogate ideas of quality maternity care in the context of Nigeria's medical pluralism. We found complex utilization patterns for conventional, complementary and alternative maternity care services as well as ideas of quality maternity care that stress effective coordination and integration of different typologies of maternity health services; socially sensitive and truthful providers; and socioeconomic, physical and parochial forms of safety. Informal providers were the commonly reported source of maternal health services in the study. Maternal health services in the country were also generally viewed as poor quality, characterized by pervasive abuse, quackery and lack of commitment to the needs and sensitivities of women. Convenience, availability and affordability of maternal health services, as well as sociocultural factors were major influences on women's use of services. Results demonstrate the embeddedness of women's quality of care notions in the vast socioeconomic inequities that typify Nigeria's particular form of poorly regulated medical pluralism, raising need for strategies to strengthen the delivery, coordination and supervision of maternal health services in the country.
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Affiliation(s)
- Chimaraoke O Izugbara
- African Population and Health Research Center, 2nd Floor, APHRC Campus, P.O. Box 10787- 00100, Nairobi, Kenya
| | - Frederick Wekesah
- African Population and Health Research Center, 2nd Floor, APHRC Campus, P.O. Box 10787- 00100, Nairobi, Kenya
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Munabi‐Babigumira S, Glenton C, Lewin S, Fretheim A, Nabudere H. Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis. Cochrane Database Syst Rev 2017; 11:CD011558. [PMID: 29148566 PMCID: PMC5721625 DOI: 10.1002/14651858.cd011558.pub2] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND In many low- and middle-income countries women are encouraged to give birth in clinics and hospitals so that they can receive care from skilled birth attendants. A skilled birth attendant (SBA) is a health worker such as a midwife, doctor, or nurse who is trained to manage normal pregnancy and childbirth. (S)he is also trained to identify, manage, and refer any health problems that arise for mother and baby. The skills, attitudes and behaviour of SBAs, and the extent to which they work in an enabling working environment, impact on the quality of care provided. If any of these factors are missing, mothers and babies are likely to receive suboptimal care. OBJECTIVES To explore the views, experiences, and behaviours of skilled birth attendants and those who support them; to identify factors that influence the delivery of intrapartum and postnatal care in low- and middle-income countries; and to explore the extent to which these factors were reflected in intervention studies. SEARCH METHODS Our search strategies specified key and free text terms related to the perinatal period, and the health provider, and included methodological filters for qualitative evidence syntheses and for low- and middle-income countries. We searched MEDLINE, OvidSP (searched 21 November 2016), Embase, OvidSP (searched 28 November 2016), PsycINFO, OvidSP (searched 30 November 2016), POPLINE, K4Health (searched 30 November 2016), CINAHL, EBSCOhost (searched 30 November 2016), ProQuest Dissertations and Theses (searched 15 August 2013), Web of Science (searched 1 December 2016), World Health Organization Reproductive Health Library (searched 16 August 2013), and World Health Organization Global Health Library for WHO databases (searched 1 December 2016). SELECTION CRITERIA We included qualitative studies that focused on the views, experiences, and behaviours of SBAs and those who work with them as part of the team. We included studies from all levels of health care in low- and middle-income countries. DATA COLLECTION AND ANALYSIS One review author extracted data and assessed study quality, and another review author checked the data. We synthesised data using the best fit framework synthesis approach and assessed confidence in the evidence using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. We used a matrix approach to explore whether the factors identified by health workers in our synthesis as important for providing maternity care were reflected in the interventions evaluated in the studies in a related intervention review. MAIN RESULTS We included 31 studies that explored the views and experiences of different types of SBAs, including doctors, midwives, nurses, auxiliary nurses and their managers. The included studies took place in Africa, Asia, and Latin America.Our synthesis pointed to a number of factors affecting SBAs' provision of quality care. The following factors were based on evidence assessed as of moderate to high confidence. Skilled birth attendants reported that they were not always given sufficient training during their education or after they had begun clinical work. Also, inadequate staffing of facilities could increase the workloads of skilled birth attendants, make it difficult to provide supervision and result in mothers being offered poorer care. In addition, SBAs did not always believe that their salaries and benefits reflected their tasks and responsibilities and the personal risks they undertook. Together with poor living and working conditions, these issues were seen to increase stress and to negatively affect family life. Some SBAs also felt that managers lacked capacity and skills, and felt unsupported when their workplace concerns were not addressed.Possible causes of staff shortages in facilities included problems with hiring and assigning health workers to facilities where they were needed; lack of funding; poor management and bureaucratic systems; and low salaries. Skilled birth attendants and their managers suggested factors that could help recruit, keep, and motivate health workers, and improve the quality of care; these included good-quality housing, allowances for extra work, paid vacations, continuing education, appropriate assessments of their work, and rewards.Skilled birth attendants' ability to provide quality care was also limited by a lack of equipment, supplies, and drugs; blood and the infrastructure to manage blood transfusions; electricity and water supplies; and adequate space and amenities on maternity wards. These factors were seen to reduce SBAs' morale, increase their workload and infection risk, and make them less efficient in their work. A lack of transport sometimes made it difficult for SBAs to refer women on to higher levels of care. In addition, women's negative perceptions of the health system could make them reluctant to accept referral.We identified some other factors that also may have affected the quality of care, which were based on findings assessed as of low or very low confidence. Poor teamwork and lack of trust and collaboration between health workers appeared to negatively influence care. In contrast, good collaboration and teamwork appeared to increase skilled birth attendants' motivation, their decision-making abilities, and the quality of care. Skilled birth attendants' workloads and staff shortages influenced their interactions with mothers. In addition, poor communication undermined trust between skilled birth attendants and mothers. AUTHORS' CONCLUSIONS Many factors influence the care that SBAs are able to provide to mothers during childbirth. These include access to training and supervision; staff numbers and workloads; salaries and living conditions; and access to well-equipped, well-organised healthcare facilities with water, electricity, and transport. Other factors that may play a role include the existence of teamwork and of trust, collaboration, and communication between health workers and with mothers. Skilled birth attendants reported many problems tied to all of these factors.
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Affiliation(s)
| | - Claire Glenton
- Norwegian Institute of Public HealthPO Box 4404, NydalenOsloNorwayN‐0403
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 4404, NydalenOsloNorwayN‐0403
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
| | - Atle Fretheim
- Norwegian Institute of Public HealthPO Box 4404, NydalenOsloNorwayN‐0403
- University of OsloInstitute of Health and SocietyOsloNorway
| | - Harriet Nabudere
- Uganda National Health Research OrganisationPlot 2, Berkeley Lane, EntebbeEntebbeUganda
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Duysburgh E, Temmerman M, Yé M, Williams A, Massawe S, Williams J, Mpembeni R, Loukanova S, Haefeli WE, Blank A. Quality of antenatal and childbirth care in rural health facilities in Burkina Faso, Ghana and Tanzania: an intervention study. Trop Med Int Health 2015; 21:70-83. [PMID: 26503485 DOI: 10.1111/tmi.12627] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess the impact of an intervention consisting of a computer-assisted clinical decision support system and performance-based incentives, aiming at improving quality of antenatal and childbirth care. METHODS Intervention study in rural primary healthcare (PHC) facilities in Burkina Faso, Ghana and Tanzania. In each country, six intervention and six non-intervention PHC facilities, located in one intervention and one non-intervention rural districts, were selected. Quality was assessed in each facility by health facility surveys, direct observation of antenatal and childbirth care, exit interviews, and reviews of patient records and maternal and child health registers. Findings of pre- and post-intervention and of intervention and non-intervention health facility quality assessments were analysed and assessed for significant (P < 0.05) quality of care differences. RESULTS Post-intervention quality scores do not show a clear difference to pre-intervention scores and scores at non-intervention facilities. Only a few variables had a statistically significant better post-intervention quality score and when this is the case this is mostly observed in only one study-arm, being pre-/post-intervention or intervention/non-intervention. Post-intervention care shows similar deficiencies in quality of antenatal and childbirth care and in detection, prevention, and management of obstetric complications as at baseline and non-intervention study facilities. CONCLUSION Our intervention study did not show a significant improvement in quality of care during the study period. However, the use of new technology seems acceptable and feasible in rural PHC facilities in resource-constrained settings, creating the opportunity to use this technology to improve quality of care.
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Affiliation(s)
- Els Duysburgh
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Marleen Temmerman
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Maurice Yé
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | - Siriel Massawe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Rose Mpembeni
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Svetla Loukanova
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Antje Blank
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
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King R, Jackson R, Dietsch E, Hailemariam A. Barriers and facilitators to accessing skilled birth attendants in Afar region, Ethiopia. Midwifery 2015; 31:540-6. [PMID: 25745841 DOI: 10.1016/j.midw.2015.02.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/21/2015] [Accepted: 02/07/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE to explore barriers and facilitators that enable women to access skilled birth attendance in Afar Region, Ethiopia. DESIGN researchers used a Key Informant Research approach (KIR), whereby Health Extension Workers participated in an intensive training workshop and conducted interviews with Afar women in their communities. Data was also collected from health-care workers through questionnaires, interviews and focus groups. PARTICIPANTS fourteen health extension workers were key informants and interviewers; 33 women and eight other health-care workers with a range of experience in caring for Afar childbearing women provided data as individuals and in focus groups. FINDINGS participants identified friendly service, female skilled birth attendants (SBA) and the introduction of the ambulance service as facilitators to SBA. There are many barriers to accessing SBA, including women׳s low status and restricted opportunities for decision making, lack of confidence in health-care facilities, long distances, cost, domestic workload, and traditional practices which include a preference for birthing at home with a traditional birth attendant. KEY CONCLUSIONS many Afar men and women expressed a lack of confidence in the services provided at health-care facilities which impacts on skilled birth attendance utilisation. IMPLICATIONS FOR PRACTICE ambulance services that are free of charge to women are effective as a means to transfer women to a hospital for emergency care if required and expansion of ambulance services would be a powerful facilitator to increasing institutional birth. Skilled birth attendants working in institutions need to ensure their practice is culturally, physically and emotionally safe if more Afar women are to accept their midwifery care. Adequate equipping and staffing of institutions providing emergency obstetric and newborn care will assist in improving community perceptions of these services. Most importantly, mutual respect and collaboration between traditional birth attendants (Afar women׳s preferred caregiver), health extension workers and skilled birth attendants will help ensure timely consultation and referral and reduce delay for women if they require emergency maternity care.
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Affiliation(s)
- Rosemary King
- Federation University, PO Box 663, Ballarat, Vic. 3353, Australia.
| | - Ruth Jackson
- Alfred Deakin Research Institute, Deakin University, Geelong Waterfront Campus, Locked Bag 20000, Geelong, Vic. 3220, Australia.
| | - Elaine Dietsch
- Charles Sturt University, School of Nursing, Midwifery and Indigenous Health, The Grange Chancellery, Panorama Avenue, Bathurst, NSW 2795, Australia; Griffith University, School of Nursing and Midwifery, 170 Kessels Road, Nathan, Qld. 4111, Australia.
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Duysburgh E, Williams A, Williams J, Loukanova S, Temmerman M. Quality of antenatal and childbirth care in northern Ghana. BJOG 2014; 121 Suppl 4:117-26. [PMID: 25236645 DOI: 10.1111/1471-0528.12905] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2014] [Indexed: 12/01/2022]
Abstract
The QUALMAT research project aims to improve maternal and newborn health by improving the quality of antenatal and childbirth care provided in primary healthcare facilities. Within the frame of this project, a comprehensive quality assessment took place in selected health centres in northern Ghana. The results of this assessment showed that overall quality of routine antenatal and childbirth care was satisfactory, although some critical gaps were identified. Counselling and health education practices need to be improved; laboratory investigations are often not performed; examination and monitoring of mother and newborn during childbirth are inadequate; partographs are often not used and poorly completed; and equipment to provide assisted vaginal deliveries was absent.
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Affiliation(s)
- E Duysburgh
- International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium
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McMahon SA, George AS, Chebet JJ, Mosha IH, Mpembeni RNM, Winch PJ. Experiences of and responses to disrespectful maternity care and abuse during childbirth; a qualitative study with women and men in Morogoro Region, Tanzania. BMC Pregnancy Childbirth 2014; 14:268. [PMID: 25112432 PMCID: PMC4261577 DOI: 10.1186/1471-2393-14-268] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 08/05/2014] [Indexed: 12/05/2022] Open
Abstract
Background Interventions to reduce maternal mortality have focused on delivery in facilities, yet in many low-resource settings rates of facility-based birth have remained persistently low. In Tanzania, rates of facility delivery have remained static for more than 20 years. With an aim to advance research and inform policy changes, this paper builds on a growing body of work that explores dimensions of and responses to disrespectful maternity care and abuse during childbirth in facilities across Morogoro Region, Tanzania. Methods This research drew on in-depth interviews with 112 respondents including women who delivered in the preceding 14 months, their male partners, public opinion leaders and community health workers to understand experiences with and responses to abuse during childbirth. All interviews were recorded, transcribed, translated and coded using Atlas.ti. Analysis drew on the principles of Grounded Theory. Results When initially describing birth experiences, women portrayed encounters with providers in a neutral or satisfactory light. Upon probing, women recounted events or circumstances that are described as abusive in maternal health literature: feeling ignored or neglected; monetary demands or discriminatory treatment; verbal abuse; and in rare instances physical abuse. Findings were consistent across respondent groups and districts. As a response to abuse, women described acquiescence or non-confrontational strategies: resigning oneself to abuse, returning home, or bypassing certain facilities or providers. Male respondents described more assertive approaches: requesting better care, paying a bribe, lodging a complaint and in one case assaulting a provider. Conclusions Many Tanzanian women included in this study experienced unfavorable conditions when delivering in facilities. Providers, women and their families must be made aware of women’s rights to respectful care. Recommendations for further research include investigations of the prevalence and dimensions of disrespectful care and abuse, on mechanisms for women and their families to effectively report and redress such events and on interventions that could mitigate neglect or isolation among delivering women. Respectful care is a critical component to improve maternal health.
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Affiliation(s)
- Shannon A McMahon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
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Moreira MEL, Gama SGND, Pereira APE, Silva AAMD, Lansky S, Pinheiro RDS, Gonçalves ADC, Leal MDC. Práticas de atenção hospitalar ao recém-nascido saudável no Brasil. CAD SAUDE PUBLICA 2014; 30 Suppl 1:S1-12. [DOI: 10.1590/0102-311x00145213] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 03/28/2014] [Indexed: 11/22/2022] Open
Abstract
O objetivo do estudo foi avaliar o cuidado ao recém-nascido saudável a termo e identificar variações nesse cuidado no atendimento ao parto e na primeira hora de vida. Utilizou-se a base de dados da pesquisa Nascer no Brasil. Foram estimadas as razões de produtos cruzados OR brutas e ajustadas entre as características do hospital, maternas e de assistência ao parto com os desfechos: aspiração de vias aéreas e gástrica, uso do oxigênio inalatório, uso de incubadora, contato pele a pele, alojamento conjunto e oferta do seio materno na sala de parto e na primeira hora de vida. Foi observada grande variação das práticas usadas na assistência ao recém-nascido a termo na sala de parto. Práticas consideradas inadequadas como uso de oxigênio inalatório (9,5%), aspiração de vias aéreas (71,1%) e gástrica (39,7%) e uso de incubadora (8,8%) foram excessivamente usadas. A ida ao seio na sala de parto foi considerada baixa (16,1%), mesmo nos hospitais com título de Hospital Amigo da Criança (24%). Esses resultados sugerem baixos níveis de conhecimento e aderência às boas práticas clínicas.
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Affiliation(s)
| | | | | | | | - Sônia Lansky
- Secretaria Municipal de Saúde de Belo Horizonte, Brasil
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O'Donnell E, Utz B, Khonje D, van den Broek N. 'At the right time, in the right way, with the right resources': perceptions of the quality of care provided during childbirth in Malawi. BMC Pregnancy Childbirth 2014; 14:248. [PMID: 25069534 PMCID: PMC4133077 DOI: 10.1186/1471-2393-14-248] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 07/07/2014] [Indexed: 12/02/2022] Open
Abstract
Background Improving the quality of care women receive during childbirth is as important as ensuring increased availability of care and numbers of healthcare providers. To be able to improve quality of care, it is important to understand what quality means for mothers as well as providers of care. Methods 33 postnatal mothers and 10 healthcare providers from all 4 major hospitals in one district in Malawi were interviewed via 27 in-depth interviews and 2 focus group discussions. Data was transcribed and analysed using the thematic framework approach. Results Perceptions of quality of care differed substantially between care providers and postnatal mothers. For caregivers, characteristics of good quality care included availability of resources while for postnatal mothers positive relationships with their caregiver were important. Lack of autonomy and decision making power is a barrier to quality of care and it exists both at the level of the patient (mother) and at the level of her caregiver with healthcare providers unable to influence decisions made by more senior staff or management. Lack of autonomy was linked with the emerging themes of staff de-motivation, frustration, lack of empowerment to make change and resulting in a poor quality of care provided. Conclusions Creating a reciprocal understanding of what good quality care comprises and the barriers as well as promoters of this should be the starting point for improving the quality of maternity care. A renewed focus is needed on improving communication, strengthening patient rights and autonomy whilst simultaneously motivating and enabling healthcare workers to provide comprehensive and inclusive quality of care.
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Affiliation(s)
| | | | | | - Nynke van den Broek
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
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Faye A, Dumont A, Ndiaye P, Fournier P. Development of an instrument to evaluate intrapartum care quality in Senegal: evaluation quality care. Int J Qual Health Care 2014; 26:184-9. [PMID: 24585857 DOI: 10.1093/intqhc/mzu018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the reliability of direct observation for measuring intrapartum care and compare this method with clinical audits using objective criteria based on patients' medical charts. DESIGN Cross-sectional study, data collected by two independent evaluators. SETTING Hospital in Dakar, Senegal. PARTICIPANTS Thirty consecutive intrapartum care episodes provided by midwives and the corresponding medical charts. Outcome Measure The presence or absence of each of twelve criteria selected on the basis of national and international norms for monitoring of labour and delivery (six criteria) and the immediate postpartum period (six criteria). RESULTS For direct observation, the labour and delivery mean quality scores ranged from 5.34 to 5.77. In contrast, for the chart-based method, the scores ranged from 0.32 to 0.45. For postpartum care evaluated only with direct observation, the scores were also high (5.21-5.65). For direct observation, inter-evaluator agreement was high: kappa coefficients varied from 0.78 to 0.93 depending on the criterion (total score ICC = 0.74). For the chart-based method, inter-evaluator agreement was also high: 0.66 to 1 (total score ICC = 0.72). Comparison of the two methods showed strong differences by items and subscores. CONCLUSION Using direct observation, the quality of obstetric care was high for both the monitoring of labour and delivery and postpartum care. Both measurement instruments showed high reliability. The chart-based method underestimated the quality of care because of poor medical record documentation. Medical-record-based measurement may not be appropriate for the evaluation of the quality of obstetric care in Senegal and other low-income settings.
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Karkee R, Lee AH, Pokharel PK. Women's perception of quality of maternity services: a longitudinal survey in Nepal. BMC Pregnancy Childbirth 2014; 14:45. [PMID: 24456544 PMCID: PMC3902186 DOI: 10.1186/1471-2393-14-45] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 01/23/2014] [Indexed: 11/10/2022] Open
Abstract
Background In the context of maternity service, the mother’s assessment of quality is central because emotional, cultural and respectful supports are vital during labour and the delivery process. This study compared client-perceived quality of maternity services between birth centres, public and private hospitals in a central hills district of Nepal. Methods A cohort of 701 pregnant women of 5 months or more gestational age were recruited and interviewed, followed by another interview within 45 days of delivery. Perception of quality was measured by a 20-item scale with three sub-scales: health facility, health care delivery, and interpersonal aspects. Perceived quality scores were analysed by ANOVA with post-hoc comparisons and multiple linear regression. Results Within the health facility sub-scale, birth centre was rated lowest on items ‘adequacy of medical equipment’, ‘health staff suited to women’s health’ and ‘adequacy of health staff’, whereas public hospital was rated the lowest with respect to ‘adequacy of room’, ‘adequacy of water’, ‘environment clean’, ‘privacy’ and ‘adequacy of information’. Mean scores of total quality and sub-scales health facility and health care delivery for women attending private hospital were higher (p < 0.001) than those using birth centre or public hospital. Mean score of the sub-scale interpersonal aspects for public hospital users was lower (p < 0.001) than those delivered at private hospital and birth centre. However, perception on interpersonal aspects by women using public hospital improved significantly after delivery (p < 0.001). Conclusions Overall, perception of quality differed significantly by types of health facility used for delivery. They rated lowest the supplies and equipment in birth centres and the amenities and interpersonal aspects in the public hospital. Accordingly, attention to these aspects is needed to improve the quality.
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Affiliation(s)
- Rajendra Karkee
- School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal.
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Nesbitt RC, Lohela TJ, Manu A, Vesel L, Okyere E, Edmond K, Owusu-Agyei S, Kirkwood BR, Gabrysch S. Quality along the continuum: a health facility assessment of intrapartum and postnatal care in Ghana. PLoS One 2013; 8:e81089. [PMID: 24312265 PMCID: PMC3842335 DOI: 10.1371/journal.pone.0081089] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 10/09/2013] [Indexed: 11/18/2022] Open
Abstract
Objective To evaluate quality of routine and emergency intrapartum and postnatal care using a health facility assessment, and to estimate “effective coverage” of skilled attendance in Brong Ahafo, Ghana. Methods We conducted an assessment of all 86 health facilities in seven districts in Brong Ahafo. Using performance of key signal functions and the availability of relevant drugs, equipment and trained health professionals, we created composite quality categories in four dimensions: routine delivery care, emergency obstetric care (EmOC), emergency newborn care (EmNC) and non-medical quality. Linking the health facility assessment to surveillance data we estimated “effective coverage” of skilled attendance as the proportion of births in facilities of high quality. Findings Delivery care was offered in 64/86 facilities; only 3-13% fulfilled our requirements for the highest quality category in any dimension. Quality was lowest in the emergency care dimensions, with 63% and 58% of facilities categorized as “low” or “substandard” for EmOC and EmNC, respectively. This implies performing less than four EmOC or three EmNC signal functions, and/or employing less than two skilled health professionals, and/or that no health professionals were present during our visit. Routine delivery care was “low” or “substandard” in 39% of facilities, meaning 25/64 facilities performed less than six routine signal functions and/or had less than two skilled health professionals and/or less than one midwife. While 68% of births were in health facilities, only 18% were in facilities with “high” or “highest” quality in all dimensions. Conclusion Our comprehensive facility assessment showed that quality of routine and emergency intrapartum and postnatal care was generally low in the study region. While coverage with facility delivery was 68%, we estimated “effective coverage” of skilled attendance at 18%, thus revealing a large “quality gap.” Effective coverage could be a meaningful indicator of progress towards reducing maternal and newborn mortality.
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Affiliation(s)
- Robin C. Nesbitt
- Epidemiology and Biostatistics Unit, Institute of Public Health, Heidelberg University, Heidelberg, Germany
- * E-mail:
| | - Terhi J. Lohela
- Department of Anaesthesiology and Intensive Care Medicine, Jorvi Hospital, Helsinki University Hospital, Espoo, Finland
| | - Alexander Manu
- Kintampo Health Research Center, Ghana Health Service, Kintampo, Ghana
- Maternal & Child Health Intervention Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Linda Vesel
- Maternal & Child Health Intervention Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Eunice Okyere
- Kintampo Health Research Center, Ghana Health Service, Kintampo, Ghana
| | - Karen Edmond
- School of Paediatrics and Child Health, University of Western Australia, Subiaco, Australia
| | - Seth Owusu-Agyei
- Kintampo Health Research Center, Ghana Health Service, Kintampo, Ghana,
| | - Betty R. Kirkwood
- Maternal & Child Health Intervention Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sabine Gabrysch
- Epidemiology and Biostatistics Unit, Institute of Public Health, Heidelberg University, Heidelberg, Germany
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Kigenyi O, Tefera GB, Nabiwemba E, Orach CG. Quality of intrapartum care at Mulago national referral hospital, Uganda: clients' perspective. BMC Pregnancy Childbirth 2013; 13:162. [PMID: 23941203 PMCID: PMC3751160 DOI: 10.1186/1471-2393-13-162] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 08/10/2013] [Indexed: 11/24/2022] Open
Abstract
Background Quality of intrapartum care is an important intervention towards increasing clients’ utilization of skilled attendance at birth and accelerating improvements in newborn’s and maternal survival and wellbeing. Ensuring quality of care is one of the key challenges facing maternal and neonatal services in Uganda. The study assessed quality of intrapartum care services in the general labor ward of the Mulago national referral and teaching hospital in Uganda from clients’ perspective. Methods A cross sectional study was conducted using face to face interviews at discharge with 384 systematically selected clients, who delivered in general labor ward at Mulago hospital during May, 2012. Data analysis was done using STATA Version (10) software. Means and median general index scores for quality of intrapartum care services were calculated. Linear regression models were used to determine factors associated with quality of care. Results Overall, quality of intrapartum care mean index score was 49.4 (standard deviation (sd) 15.46, and the median (interquartile range (IQR)) was 49.1 (37.5–58.9). Median index scores (IQR) per selected quality of care indicators were; dignity and respect 75 (50–87.5); relief of pain and suffering 71.4 (42.8-85.7); information 42.1 (31.6-55.3); privacy and confidentiality 33.3 (1–66.7); and involvement in decision making 16.7 (1–33.3). On average, higher educational level (college/university) (β: 6.81, 95% CI: 0.85-15.46) and rural residence of clients (β: 5.67, 95% CI: 0.95-10.3) were statistically associated with higher quality scores. Conclusion This study has revealed that quality of intrapartum care services from clients’ perspective was low. Improvements should be focused on involving clients in decision making, provision of information about their conditions and care, and provision of privacy and confidentiality. There is also need to improve the number and availability of health care providers in the labor ward.
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Affiliation(s)
- Omar Kigenyi
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
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Knight HE, Self A, Kennedy SH. Why are women dying when they reach hospital on time? A systematic review of the 'third delay'. PLoS One 2013; 8:e63846. [PMID: 23704943 PMCID: PMC3660500 DOI: 10.1371/journal.pone.0063846] [Citation(s) in RCA: 159] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 04/04/2013] [Indexed: 11/13/2022] Open
Abstract
Background The ‘three delays model’ attempts to explain delays in women accessing emergency obstetric care as the result of: 1) decision-making, 2) accessing services and 3) receipt of appropriate care once a health facility is reached. The third delay, although under-researched, is likely to be a source of considerable inequity in access to emergency obstetric care in developing countries. The aim of this systematic review was to identify and categorise specific facility-level barriers to the provision of evidence-based maternal health care in developing countries. Methods and Findings Five electronic databases were systematically searched using a 4-way strategy that combined search terms related to: 1) maternal health care; 2) maternity units; 3) barriers, and 4) developing countries. Forty-three original research articles were eligible to be included in the review. Thirty-two barriers to the receipt of timely and appropriate obstetric care at the facility level were identified and categorised into six emerging themes (Drugs and equipment; Policy and guidelines; Human resources; Facility infrastructure; Patient-related and Referral-related). Two investigators independently recorded the frequency with which barriers relating to the third delay were reported in the literature. The most commonly cited barriers were inadequate training/skills mix (86%); drug procurement/logistics problems (65%); staff shortages (60%); lack of equipment (51%) and low staff motivation (44%). Conclusions This review highlights how a focus on patient-side delays in the decision to seek care can conceal the fact that many health facilities in the developing world are still chronically under-resourced and unable to cope effectively with serious obstetric complications. We stress the importance of addressing supply-side barriers alongside demand-side factors if further reductions in maternal mortality are to be achieved.
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Affiliation(s)
- Hannah E Knight
- Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Oxford, United Kingdom.
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Duysburgh E, Zhang WH, Ye M, Williams A, Massawe S, Sié A, Williams J, Mpembeni R, Loukanova S, Temmerman M. Quality of antenatal and childbirth care in selected rural health facilities in Burkina Faso, Ghana and Tanzania: similar finding. Trop Med Int Health 2013; 18:534-47. [PMID: 23398053 DOI: 10.1111/tmi.12076] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To measure pre-intervention quality of routine antenatal and childbirth care in rural districts of Burkina Faso, Ghana and Tanzania and to identify shortcomings. METHODS In each country, we selected two adjoining rural districts. Within each district, we randomly sampled 6 primary healthcare facilities. Quality of care was assessed through health facility surveys, direct observation of antenatal and childbirth care, exit interviews and review of patient records. RESULTS By and large, quality of antenatal and childbirth care in the six districts was satisfactory, but we did identify some critical gaps common to the study sites in all three countries. Counselling and health education practices are poor; laboratory investigations are often not performed; examination and monitoring of mother and newborn during childbirth are inadequate; partographs are not used. Equipment required to provide assisted vaginal deliveries (vacuum extractor or forceps) was absent in all surveyed facilities. CONCLUSION Quality of care in the three study sites can be improved with the available human resources and without major investments. This improvement could reduce maternal and neonatal mortality and morbidity.
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Affiliation(s)
- E Duysburgh
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium.
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Abstract
PURPOSE OF REVIEW This review discusses the unprecedented global commitment to improve maternal health and scientific advancements in the field achieved during the last year. RECENT FINDINGS Achievements at political, scientific, and programmatic levels targeted at improving maternal health, especially in low-resource settings, are described. Remaining challenges are discussed and the most promising areas of research and practice aimed at addressing these challenges are identified. SUMMARY For the first time in decades, it is evident that progress in reducing mortality on a global scale is possible. Results showing increases in coverage of key maternal health interventions and the establishment of a system for promoting accountability are key determinants of that progress.
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de Kok B, Hussein J, Jeffery P. Joining-up thinking: Loss in childbearing from inter-disciplinary perspectives. Soc Sci Med 2010; 71:1703-10. [DOI: 10.1016/j.socscimed.2010.08.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 08/11/2010] [Accepted: 08/13/2010] [Indexed: 11/26/2022]
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