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Nkurunziza A, Smye VL, Wathen CN, Jackson KT, Cechetto DF, Tryphonopoulos P, Gishoma D. Integrating trauma- and violence-informed care for adolescent mothers in Rwanda: a qualitative study with community health workers. BMC Health Serv Res 2024; 24:868. [PMID: 39080753 PMCID: PMC11289957 DOI: 10.1186/s12913-024-11352-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024] Open
Abstract
INTRODUCTION In Rwanda, maternal community health workers play a critical role to improving maternal, newborn and child health, but little is known about their specific experiences with adolescent mothers, who face unique challenges, including trauma, ongoing violence, stigma, ostracism, mental health issues, barriers within the healthcare system, and lack of access to the social determinants of health. This study explored the experiences of maternal community health workers when caring for adolescent mothers in Rwanda to inform the delivery of trauma- and violence-informed care in community maternal services. METHODS Interpretive Description methodology was used to understand the experiences of 12 community health workers purposively recruited for interviews due to their management roles. To gain additional insights about the context, seven key informants were also interviewed. FINDINGS Maternal community health workers provided personalized support to adolescent mothers through the provision of continuity of care, acting as a liaison, engaging relationally and tailoring home visits. They reported feeling passionate about their work, supporting each other, and receiving support from their leaders as facilitators in caring for adolescent mothers. Challenges in their work included handling disclosures of violence, dealing with adolescent mothers' financial constraints, difficulties accessing these young mothers, and transportation issues. Adolescent mothers' circumstances are generally difficult, leading to self-reports of vicarious trauma among this sample of workers. CONCLUSION Maternal community health workers play a key role in addressing the complex needs of adolescent mothers in Rwanda. However, they face individual and structural challenges highlighting the complexities of their work. To sustain and enhance their roles, it is imperative for government and other stakeholders to invest in resources, mentorship, and support. Additionally, training in equity-oriented approaches, particularly trauma- and violence-informed care, is essential to ensure safe and effective care for adolescent mothers and to mitigate vicarious trauma among maternal community health workers.
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Affiliation(s)
- Aimable Nkurunziza
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, ON, Canada.
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
- School of Nursing, Nipissing University, North Bay, Canada.
| | - Victoria L Smye
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, ON, Canada
| | - C Nadine Wathen
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Kimberley T Jackson
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, ON, Canada
| | - David F Cechetto
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Panagiota Tryphonopoulos
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Darius Gishoma
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Mental Health Division, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
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Alizadeh-Dibazari Z, Abbasalizadeh F, Mohammad-Alizadeh-Charandabi S, Jahanfar S, Mirghafourvand M. Childbirth preparation and its facilitating and inhibiting factors from the perspectives of pregnant and postpartum women in Tabriz-Iran: a qualitative study. Reprod Health 2024; 21:106. [PMID: 38997718 PMCID: PMC11241919 DOI: 10.1186/s12978-024-01844-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND The World Health Organization recognizes childbirth preparation as an essential component of antenatal care, as it plays a crucial role in reducing maternal mortality and improving women's childbirth experience. Countries worldwide have implemented various interventions to assist women in preparing for childbirth, based on their own resources. This study was conducted with the aim of exploring the perspectives of pregnant and postpartum women on childbirth preparation and the facilitating and inhibiting factors, in Tabriz, Iran. METHODS This qualitative study was conducted with 25 participants, selected purposively among pregnant women in weeks 37 to 40 of gestation and postpartum women within 10 days to 6 weeks after childbirth. Data collection was done through semi-structured, in-depth individual interviews using an interview guide. The data was analyzed using content analysis method with conventional approach. RESULTS The perspectives of pregnant and postpartum women regarding childbirth preparation revealed that factors such as maternal health during pregnancy, having an antenatal care plan, improving health literacy, and developing a birth plan were identified as crucial elements for effective childbirth preparation. Additionally, mental and emotional preparation, support, financial planning, participation in preparation classes, and awareness of childbirth methods were recognized as facilitators. On the other hand, insufficient mental and emotional preparedness, inadequate support, weak antenatal care, information deficiencies, insufficient physical activity, and a lack of a birth plan were identified as barriers. CONCLUSION The findings highlight the multifaceted nature of childbirth preparedness, necessitating the involvement of families, the healthcare system, and the entire community. Utilizing the study results in strategic planning for pre-pregnancy, during pregnancy, and inter-pregnancy care can enhance childbirth preparedness and contribute to achieving Iran's population rejuvenation policy goals.
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Affiliation(s)
- Zohreh Alizadeh-Dibazari
- Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Abbasalizadeh
- Women Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Shayesteh Jahanfar
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Shatilwe JT, Kuupiel D, Mashamba-Thompson TP. Evidence on access to healthcare information by women of reproductive age in low- and middle-income countries: Scoping review. PLoS One 2021; 16:e0251633. [PMID: 34086686 PMCID: PMC8177524 DOI: 10.1371/journal.pone.0251633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 04/30/2021] [Indexed: 12/02/2022] Open
Abstract
Background A majority of women of reproductive age in low- and middle-income countries (LMICs) are not able to access healthcare information due to different factors. This scoping review aimed to map the literature on access to healthcare information by women of reproductive age in LMICs. Methods The literature search was conducted through the following databases: Google Scholar, Science Direct, PubMed, EBSCOhost (Academic search complete, CINAHL with full text, MEDLINE with full text, MEDLINE, and PsycINFO), Emerald, Embase, published and peer-reviewed journals, organizational projects, reference lists, and grey literature. Results A total of 377 457 articles were identified from all the databases searched. Of these, four articles met inclusion criteria after full article screening and were included for data extraction. The themes that emerged from our study are as follows: accessibility, financial accessibility/affordability, connectivity, and challenges. This study demonstrated that there are minimal interventions that enable women of reproductive age to access healthcare information in terms of accessibility, financial accessibility, and connectivity. Conclusion The findings of the study revealed poor access and utilization of healthcare information by women of reproductive age. We, therefore, recommend primary studies in other LMICs to determine the accessibility, financial accessibility, connectivity, and challenges faced by women of reproductive age in LMICs.
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Affiliation(s)
- Joyce Twahafifwa Shatilwe
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- * E-mail:
| | - Desmond Kuupiel
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Tivani P. Mashamba-Thompson
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Orwa J, Gatimu SM, Mantel M, Luchters S, Mugerwa MA, Brownie S, Subi L, Mrema S, Nyaga L, Edwards G, Mwasha L, Isangula K, Selestine E, Jadavji S, Pell R, Mbekenga C, Temmerman M. Birth preparedness and complication readiness among women of reproductive age in Kenya and Tanzania: a community-based cross-sectional survey. BMC Pregnancy Childbirth 2020; 20:636. [PMID: 33076869 PMCID: PMC7574438 DOI: 10.1186/s12884-020-03329-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/09/2020] [Indexed: 12/28/2022] Open
Abstract
Background Delayed health-seeking continues to contribute to preventable maternal and neonatal deaths in low resource countries. Some of the strategies to avoid the delay include early preparation for the birth and detection of danger signs. We aimed to assess the level of practice and factors associated with birth preparedness and complication readiness (BPCR) in Kenya and Tanzania. Methods We conducted community-based multi-stage cross-sectional surveys in Kilifi and Kisii counties in Kenya and Mwanza region in Tanzania and included women who delivered two years preceding the survey (2016–2017). A woman who mentioned at least three out of five BPCR components was considered well-prepared. Bivariate and multivariable proportional odds model were used to determine the factors associated with the BPCR. The STROBE guidelines for cross-sectional studies informed the design and reporting of this study. Results Only 11.4% (59/519) and 7.6% (31/409) of women were well-prepared for birth and its complications in Kenya and Tanzania, respectively, while 39.7 and 30.6% were unprepared, respectively. Level of education (primary: adjusted odds ratio (aOR): 1.59, 95% CI: 1.14–2.20, secondary: aOR: 2.24, 95% CI: 1.39–3.59), delivery within health facility (aOR: 1.63, 95% CI: 1.15–2.29), good knowledge of danger signs during pregnancy (aOR: 1.28, 95% CI: 0.80–2.04), labour and childbirth (aOR: 1.57, 95% CI: 0.93–2.67), postpartum (aOR: 2.69, 95% CI: 1.24–5.79), and antenatal care were associated with BPCR (aOR: 1.42, 95% CI: 1.13–1.78). Conclusion Overall, most pregnant women were not prepared for birth and its complications in Kilifi, Kisii and Mwanza region. Improving level of education, creating awareness on danger signs during preconception, pregnancy, childbirth, and postpartum period, and encouraging antenatal care and skilled birth care among women and their male partners/families are recommended strategies to promote BPCR practices and contribute to improved pregnancy outcomes in women and newborns.
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Affiliation(s)
- James Orwa
- Centre of Excellence Women and Child Health/MERL, Aga Khan University, P. O. Box 30270-00010, Nairobi, Kenya. .,Department of Population Health, Aga Khan University, Nairobi, Kenya.
| | | | - Michaela Mantel
- Centre of Excellence Women and Child Health/MERL, Aga Khan University, P. O. Box 30270-00010, Nairobi, Kenya.,Department of Population Health, Aga Khan University, Nairobi, Kenya.,Department of Obstetrics and Gynaecology, Aga Khan University, Nairobi, Kenya
| | - Stanley Luchters
- Department of Population Health, Aga Khan University, Nairobi, Kenya.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | | | - Sharon Brownie
- Centre for Health & Social Practice, Waikato Institute of Technology (Wintec), Hamilton, New Zealand.,School of Medicine, Griffith University, Brisbane, QLD, Australia.,Green Templeton College, Oxford University, Oxford, UK
| | - Leonard Subi
- Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Secilia Mrema
- Regional Reproductive and Child Health Office, Region, Mwanza, Tanzania
| | - Lucy Nyaga
- Centre of Excellence Women and Child Health/MERL, Aga Khan University, P. O. Box 30270-00010, Nairobi, Kenya
| | - Grace Edwards
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
| | - Loveluck Mwasha
- School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania
| | - Kahabi Isangula
- School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania
| | | | | | | | - Columba Mbekenga
- School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania
| | - Marleen Temmerman
- Centre of Excellence Women and Child Health/MERL, Aga Khan University, P. O. Box 30270-00010, Nairobi, Kenya.,Department of Obstetrics and Gynaecology, Aga Khan University, Nairobi, Kenya.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Klobodu C, Milliron BJ, Agyabeng K, Akweongo P, Adomah-Afari A. Maternal birth preparedness and complication readiness in the Greater Accra region of Ghana: a cross-sectional study of two urban health facilities. BMC Pregnancy Childbirth 2020; 20:566. [PMID: 32977757 PMCID: PMC7519482 DOI: 10.1186/s12884-020-03263-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background High maternal mortality ratios remain a critical public health concern in Ghana. Birth preparedness and complication readiness (BP/CR), which is a component of focused antenatal care, is a safe motherhood strategy intended to promote skilled birth attendance by helping women and their families plan for pregnancy and childbirth, thereby reducing maternal mortality. The objective of this study was to determine the level of BP/CR and to assess factors associated with maternal BP/CR in the Greater Accra Region of Ghana. Method A cross sectional descriptive quantitative study was carried out among 300 postnatal women attending the Adabraka Polyclinic and the Greater Accra Regional Hospital both within Accra, the capital city of Ghana. Data were collected with a structured questionnaire which assessed socio-demographic, health facility/provider and social support factors and their associations with BP/CR. Levels of BP/CR were assessed using validated tools. Data from 300 women were analyzed using STATA version 15.0. Logistic regression analysis was conducted to establish associations between BP/CR and socio-demographic, health facility/provider and social support factors. Results Approximately 234 (78%) of the women were birth prepared. Strong predictors of BP/CR included having ≥4 antenatal clinic visits (aOR 2.63; 95% CI 1.03–6.73), being employed (aOR 4.07; 95% CI 1.49–11.11) and belonging to maternal health promoting clubs or groups during the antenatal period (aOR 3.00; 95% CI 1.07–8.40) . Conclusion BP/CR is generally high among the study population. Predictors of BP/CR are multifactorial and found to cut across all aspects assessed in the study. Therefore, the creation of a BP/CR tool is recommended to routinely monitor trends in maternal birth preparedness in antenatal clinics. This may help to sustain and improve current levels and indicators of BP/CR.
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Affiliation(s)
- Cynthia Klobodu
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana - Legon, P.O. Box LG 13, University of Ghana, Legon, Ghana
| | - Brandy-Joe Milliron
- Department of Nutrition Sciences, Centre for Family Intervention Science, College of Nursing and Health Professions, Drexel University, 1601 Cherry Street. Suite 383, Philadelphia, PA, 19102, USA.
| | - Kofi Agyabeng
- Ministry of Education, National Inspectorate Board, Private Mail Bag 18, Ministries Post Office, Ameda Street, Yooyi Ln, Accra, Ghana
| | - Patricia Akweongo
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana - Legon, P.O. Box LG 13, University of Ghana, Legon, Ghana
| | - Augustine Adomah-Afari
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana - Legon, P.O. Box LG 13, University of Ghana, Legon, Ghana
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Haider S, Ali RF, Ahmed M, Humayon AA, Sajjad M, Ahmad J. Barriers to implementation of emergency obstetric and neonatal care in rural Pakistan. PLoS One 2019; 14:e0224161. [PMID: 31689316 PMCID: PMC6830770 DOI: 10.1371/journal.pone.0224161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 10/06/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Recognizing the need for improving maternal and newborn care, the Punjab public health department (Pakistan) launched emergency obstetric neonatal care (EmONC) services under WHO guideline. Unfortunately, the program implementation is facing some serious problems. The purpose of this study was to identify barriers to implementation of EmONC in district Bahawalnagar (Pakistan). METHODS This study used sequential exploratory design. Specifically, a qualitative study was conducted to identify barriers to EmONC. Subsequently, the relative importance of these barriers was determined in a quantitative study. Participants were health service providers involved in 24-hours basic EmONC services in the basic health units of district Bahawalnagar (Pakistan). Qualitative data were gathered by interviewing the participants using key informant guide. Quantitative data were collected in a rank order survey of the same participants. The methodological quality was assessed using mixed methods appraisal tool (MMAT) version 2011. RESULTS The results indicate that lack of teamwork, conflict management, communication, and improper power distribution are important interpersonal barriers. The significant organizational-level barriers include job insecurity, lack of organizational culture, human resource deployment issues, and lack of role clarity. Lack of target management, lack of resource availability, house job requirement, and dual practice issues were identified as major system-level barriers. CONCLUSION Barriers to EmONC implementation must be addressed for improving maternal and neonatal care in district Bahawalnagar.
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Affiliation(s)
- Sajid Haider
- Department of Management Sciences, COMSATS University Islamabad, Vehari, Pakistan
| | - Rana Farhan Ali
- Health and Nutrition Supervisor, Chishtian, District Health Office, Bahawalnagar, Pakistan
| | - Munir Ahmed
- Department of Management Sciences, COMSATS University Islamabad, Vehari, Pakistan
- * E-mail:
| | - Asad Afzal Humayon
- Department of Management Sciences, COMSATS University Islamabad, Vehari, Pakistan
| | - Muhammad Sajjad
- Department of Management Sciences, COMSATS University Islamabad, Vehari, Pakistan
| | - Jamil Ahmad
- Department of Management Sciences, COMSATS University Islamabad, Vehari, Pakistan
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