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Kuru Alici N, Ogüncer A. Knowledge, Beliefs, and Cultural Practices of Sexual and Reproductive Health Among Afghan Refugee Women in Türkiye. J Transcult Nurs 2024; 35:30-40. [PMID: 37933749 DOI: 10.1177/10436596231209042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
INTRODUCTION Limited research on experiences of women, who constitute a double vulnerable group in both women and refugee status, regarding sexual and reproductive health. The purpose of this study is to examine the knowledge, beliefs, and cultural practices of Afghan women living in Türkiye regarding sexual and reproductive health. METHOD This descriptive phenomenological study was conducted with 18 Afghan refugee women. In-depth, semi-structured interviews were conducted to collect data. RESULTS Four themes emerged from interviews: cultural practices and beliefs related to pregnancy and postpartum, use of contraceptive methods, gender-based violence, and access to health services. CONCLUSIONS Afghan women have different cultural practices regarding prenatal, pregnancy, and postpartum and lack of knowledge about sexual and reproductive health. Considering individual differences in sexual and reproductive health, providing sensitive, supportive, and informative services is recommended.
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Affiliation(s)
| | - Ali Ogüncer
- Refugee Support Association, Eskisehir, Türkiye
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Rent S, Bakari A, Plange-Rhule G, Bockarie Y, Kukora S, Moyer CA. Provider perspectives on Asram in Ghana. J Biosoc Sci 2021; 54:1-13. [PMID: 33866977 DOI: 10.1017/s0021932021000158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Neonatal mortality is one of the leading causes of under-five mortality globally, with the majority of these deaths occurring in low- and middle-income countries. In Ghana, there is a belief in an array of newborn conditions, called Asram, that are thought to have a spiritual, rather than physical, cause. These conditions are predominantly managed by traditional healers as they are considered unable to be treated by allopathic medical providers. Through a series of semi-structured qualitative interviews of medical providers in Kumasi, Ghana, conducted in July-August 2018, this study sought to elucidate perspectives of allopathic medical providers about Asram, including the perceived implications of traditional newborn care patterns on newborn health and higher-level neonatal care. Twenty health care providers participated and represented a tertiary care hospital and a district hospital. Medical providers were universally aware of Asram but varied on the latitude they gave this belief system within the arena of newborn care. Some providers rationalized the existence of Asram in the backdrop of high neonatal mortality rates and long-standing belief systems. Others highlighted their frustration with Asram, citing delays in care and complications due to traditional medical treatments. Providers utilized varying approaches to bridge culture gaps with families in their care and emphasized the importance of open communication with the shared goal of improved newborn health and survival. This study describes the importance of providers being aware of socio-cultural constructs within which pregnant women operate and suggests a focus on the shared goal of timely and effective newborn care in Ghana.
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Affiliation(s)
- Sharla Rent
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Ashura Bakari
- Suntreso Government Hospital, Ghana Health Service, Kumasi, Ghana
| | | | | | - Stephanie Kukora
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Cheryl A Moyer
- Departments of Learning Health Sciences and Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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Abstract
Introduction Although culture is an integral part of health, there is scarcity of evidence on the influence of culture on caregiving experiences of parents of preterm infants. The aim of this study was to explore the influence of sociocultural practices on caring for preterm infants in the Ghanaian community. Method Narrative inquiry was utilized to explore the influence of sociocultural practices on the care of preterm infants from 21 mothers, 9 fathers, and 12 household members. Data were collected through face-to-face semistructured interviews and observations at participants’ homes. Results Analysis of data resulted in three threads/themes—respect for the elderly, use of herbal medicines, and communal living. Discussion Community and extended family members have great influence on the care of preterm infants. Traditional herbal medicines are considered effective in treating traditional illnesses among preterm infants. Understanding the influence of culture on the care of vulnerable preterm infants in the community is essential in developing interventions for infant survival.
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Affiliation(s)
| | - Deborah Sundin
- Edith Cowan University, Joondalup, Western Australia, Australia
| | - Sara Bayes
- Edith Cowan University, Joondalup, Western Australia, Australia
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Bakari A, Bell AJ, Oppong S, Woodford J, Kaselitz E, Moyer CA. ' Asram is really killing us here': attribution for pregnancy losses and newborn mortality in the Ashanti Region of Ghana. J Biosoc Sci 2021; 53:497-507. [PMID: 32578530 DOI: 10.1017/S0021932020000322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
While overall neonatal mortality rates are improving in Ghana, the Ashanti Region has the highest mortality rate in the country. The clinical causes of newborn deaths are well known, yet local beliefs about illness aetiology, cause of death and care-seeking are less well understood. This exploratory qualitative study sought to understand how community members perceive and respond to neonatal illness. Researchers worked with public health nurses, community health nurses and opinion leaders in the Ashanti Region of Ghana to identify women who had lost a baby, either during pregnancy or after delivery. In-depth interviews and focus group discussions were conducted about knowledge, attitudes and beliefs regarding neonatal mortality. The transcripts were coded and analysed using NVivo 10.0. A total of 100 participants were interviewed: 24% reported a previous stillbirth; 37% reported a previous miscarriage; and 45% reported losing a baby who was born alive. Nine per cent experienced more than one type of loss. The local illness of asram - an illness with supernatural causes - was cited as a leading cause of death of newborns. Every participant reported hearing of, knowing someone, or having a child who had become ill with asram. While women gave varying information on symptoms, method of contraction and treatment, all participants agreed that asram was common and often fatal. Four overarching themes emerged: 1) asram is not a hospital sickness; 2) there is both a fear of traditional healers as a source of asram, as well as a reliance upon them to cure asram; 3) there are rural/urban differences in perceptions of asram; and 4) asram may serve as a mechanism of social control for pregnant women and new mothers. Local beliefs and practices must be better understood and incorporated into health education campaigns if neonatal mortality is to be reduced in Ghana.
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Hedstrom A, Perez K, Umoren R, Batra M, Engmann C. Recent progress in global newborn health: thinking beyond acute to strategic care? J Perinatol 2019; 39:1031-1041. [PMID: 31182774 DOI: 10.1038/s41372-019-0384-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/04/2019] [Accepted: 03/29/2019] [Indexed: 12/12/2022]
Abstract
Advancements in neonatal care globally highlight ongoing disparities in neonatal outcomes between low-income countries (LICs) and high-income countries (HICs). Drivers of this gap are primarily prematurity, infection, and intrapartum-related events. Significant success is being achieved; however, for neonatal outcomes in LIC to approximate those of HICs within a generation, acceleration of the current trajectory of progress is needed. This requires a renewed focus on newborn-specific and newborn-sensitive strategies. Newborn-specific strategies are those directly affecting the well-being of the neonate. Newborn-sensitive strategies address the broader macro-environmental drivers that affect underlying neonatal outcomes such as decreased poverty, improved sanitation, and increased maternal empowerment and health. To create such an enabling macro-environment requires significant political will, financing, advocacy, and policy generation. This manuscript highlights recent advances in newborn research, programming, policy, and funding, and highlights key opportunities to bend the curve on advancing neonatal health globally.
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Affiliation(s)
- Anna Hedstrom
- Department of Pediatrics, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Krystle Perez
- Department of Pediatrics, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Rachel Umoren
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Maneesh Batra
- Department of Pediatrics, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Cyril Engmann
- Department of Pediatrics, University of Washington, Seattle, WA, USA. .,Department of Global Health, University of Washington, Seattle, WA, USA. .,Maternal, Newborn, Child Health and Nutrition, PATH, Seattle, WA, USA.
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Geerlings E, Kaselitz E, Aborigo RA, Williams J, Youngblood J, Avrakotos A, Chatio S, Moyer C. 'I am still confused as to what caused the problem': Perceptions of mothers on communication regarding newborn illness and death in Northern Ghana. Glob Public Health 2019; 14:1784-1792. [PMID: 31322063 DOI: 10.1080/17441692.2019.1642930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Neonatal morbidity and mortality remain a significant challenge in Ghana. Given the relationship between care-seeking and understanding of illness, this study aimed to explore mothers' perceptions of the cause of illness and/or death in Northern Ghana. All neonatal deaths and near-misses (babies who survived a life-threatening complication) in 2015 and 2016 were identified through a community - and facility-based surveillance system. Mothers of the deceased or ill infants participated in open narrative qualitative interviews. Narratives that included discussion of whether the mother understood what caused the baby's illness or death were analysed. Interviews with 155 mothers included discussion of their perception of the cause of newborn illness or death. Of the 155 interviews, 108 interviews involved mothers whose babies died, and 47 interviews involved mothers whose newborns survived a life-threatening illness, a neonatal 'near-miss'. Very few expressed a clear understanding of the cause of death or illness. Those mothers who did not understand were either not told or did not understand the cause of illness or death. Newborn health outcomes may be improved by increased maternal awareness and understanding of neonatal illnesses. Future interventions need to address communication issues that impair mothers' understanding, facilitate recognition of danger signs, and prompt timely care-seeking.
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Affiliation(s)
- Emily Geerlings
- University of Michigan Medical School , Ann Arbor , MI , USA
| | - Elizabeth Kaselitz
- Department of Global REACH, University of Michigan Medical School , Ann Arbor , MI , USA
| | | | | | | | - Avery Avrakotos
- School of Public Health, University of Michigan , Ann Arbor , MI , USA
| | | | - Cheryl Moyer
- Department of Learning Health Sciences, University of Michigan Medical School , Ann Arbor , MI , USA.,Department of Obstetrics & Gynecology, University of Michigan Medical School , Ann Arbor , MI , USA
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Amare Y, Paul S, Sibley LM. Illness recognition and appropriate care seeking for newborn complications in rural Oromia and Amhara regional states of Ethiopia. BMC Pediatr 2018; 18:265. [PMID: 30081872 PMCID: PMC6090701 DOI: 10.1186/s12887-018-1196-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 06/27/2018] [Indexed: 11/25/2022] Open
Abstract
Background Ethiopia has made significant progress in reducing child mortality but newborn mortality has stagnated at around 29 deaths per 1000 births. The Maternal Health in Ethiopia Partnership (MaNHEP) was a 3.5-year implementation project aimed at developing a community-oriented model of maternal and newborn health in rural Ethiopia and to position it for scale up. In 2014, we conducted a case study of the project focusing on recognition of and timely biomedical care seeking for maternal and newborn complications. In this paper, we detail the main findings from one component of the case study – the narrative interviews on newborn complications. Methods The study area, comprised of six districts in which MaNHEP had been implemented, was located in the two most populous federal regions of Ethiopia, Oromia and Amhara. The final purposive sample consisted of 16 cases in which the newborn survived to 28 days of life, and 13 cases in which the newborn died within 28 days of life, for a total sample size of 29 cases. Narrative interview were conducted with the main caregiver and several witnesses to the event. Analysis of the data included thematic content analysis and the determination of care seeking pathways and levels and timeliness of biomedical care seeking. Results Mothers and other witnesses do recognize certain symptoms of newborn illness which they often mentioned in clusters. The majority considered the symptoms to be serious and in some case hopeless. Perceived causes were mostly natural. Forty-one percent of care seekers sought timely biomedical care in the neonatal period. Surprisingly, perceived severity did not necessarily trigger care seeking. Facilitators of biomedical care seeking included accessibility of health facilities and counseling by health workers, whereas barriers included perceived vulnerability of newborns, post-partum restrictions on movements, hopelessness, wait-and-see atttitudes, poor communication and physical inaccessibility of health facilities. Conclusions Symptom recognition and care seeking patterns indicate the need to strengthen focused locally relevant health messages which target mothers, fathers and other community members, to further enhance access to health care and to improve referral and quality of care.
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Affiliation(s)
- Y Amare
- Consultancy for Social Development, P.O. Box - 70196, Addis Ababa, Ethiopia.
| | - S Paul
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, 30322, Atlanta, Georgia
| | - L M Sibley
- Nell Hodgson Woodruff School of Nursing and Rollins School of Public Health, Emory University, 1520 Clifton Road NE, 30322, Atlanta, Georgia
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Turner C, Pol S, Suon K, Neou L, Day NPJ, Parker M, Kingori P. Beliefs and practices during pregnancy, post-partum and in the first days of an infant's life in rural Cambodia. BMC Pregnancy Childbirth 2017; 17:116. [PMID: 28403813 PMCID: PMC5389162 DOI: 10.1186/s12884-017-1305-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 04/07/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of this study was to record the beliefs, practices during pregnancy, post-partum and in the first few days of an infant's life, held by a cross section of the community in rural Cambodia to determine beneficial community interventions to improve early neonatal health. METHODS Qualitative study design with data generated from semi structured interviews (SSI) and focus group discussions (FGD). Data were analysed by thematic content analysis, with an a priori coding structure developed using available relevant literature. Further reading of the transcripts permitted additional coding to be performed in vivo. This study was conducted in two locations, firstly the Angkor Hospital for Children and secondarily in five villages in Sotnikum, Siem Reap Province, Cambodia. RESULTS A total of 20 participants underwent a SSIs (15 in hospital and five in the community) and six (three in hospital and three in the community; a total of 58 participants) FGDs were conducted. Harmful practices that occurred in the past (for example: discarding colostrum and putting mud on the umbilical stump) were not described as being practiced. Village elders did not enforce traditional views. Parents could describe signs of illness and felt responsible to seek care for their child even if other family members disagreed, however participants were unaware of the signs or danger of neonatal jaundice. Cost of transportation was the major barrier to healthcare that was identified. CONCLUSIONS In the population examined, traditional practices in late pregnancy and the post-partum period were no longer commonly performed. However, jaundice, a potentially serious neonatal condition, was not recognised. Community neonatal interventions should be tailored to the populations existing practice and knowledge.
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Affiliation(s)
- Claudia Turner
- Cambodia Oxford Medical Research Unit, Siem Reap, Cambodia
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Angkor Hospital for Children, PO Box 50, Siem Reap, Cambodia
| | - Sreymom Pol
- Cambodia Oxford Medical Research Unit, Siem Reap, Cambodia
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kamsan Suon
- Cambodia Oxford Medical Research Unit, Siem Reap, Cambodia
| | - Leakhena Neou
- Angkor Hospital for Children, PO Box 50, Siem Reap, Cambodia
| | - Nicholas P. J. Day
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Michael Parker
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Patricia Kingori
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Engmann CM, Hodgson A, Aborigo R, Adongo PL, Moyer CA. Addressing the continuum of maternal and newborn care in Ghana: implications for policy and practice. Health Policy Plan 2016; 31:1355-1363. [PMID: 27354099 DOI: 10.1093/heapol/czw072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2016] [Indexed: 11/15/2022] Open
Abstract
Although the past decade has brought global reductions in maternal, infant and child mortality, many low-resource settings have failed to make significant gains relative to their high-income counterparts. In Ghana, nearly 50% of under-five mortality in 2014 could be attributed to deaths during the first 28 days after birth. This article analyses the data across a mixed-methods study of the factors impacting maternal and neonatal care in northern Ghana. The stillbirth and neonatal death study (SANDS) was conducted in 2010 and included both quantitative (N = 20 497) and qualitative data collection (N = 253) to explore the issues associated with the continuum of reproductive health care. Findings were compared against an adaptation of the WHO/UNICEF framework for integrated maternal and newborn care and used to generate concrete recommendations for clinicians, policymakers and programmers across the continuum of care, from pregnancy through delivery and postnatal care. SANDS elucidated epidemiological trends: 40% of neonatal deaths occurred on the first day after birth, and the leading causes of early neonatal mortality were birth asphyxia/injury, infection and complications of prematurity. Qualitative data reflect findings along two axes-community to facility-based care, and pre-pregnancy through the postnatal period. Resulting recommendations include the need to improving clinicians' understanding of and sensitization to local traditional practices, the need for policies to better address quality of care and coordination of training efforts, and the need for comprehensive, integrated programmes that ensure continuity of care from pre-pregnancy through the post-partum period. SANDS illustrates complex medical-social-cultural knowledge, attitudes and practices that span the reproductive period in rural northern Ghana. Data illustrate that not only are the first few days of life critical in infant survival but also there are significant social and cultural barriers to ensuring that mothers and their newborns are cared for in a timely, evidence-based manner.
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Affiliation(s)
- Cyril M Engmann
- Departments of Pediatrics and Global Health, Schools of Medicine and Public Health, University of Washington, WA, USA .,Maternal, Newborn, Child Health and Nutrition, PATH, Seattle, WA, USA
| | - Abraham Hodgson
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Raymond Aborigo
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Philip L Adongo
- Department of Social and Behavioral Sciences School of Public Health, University of Ghana, Legon, Ghana
| | - Cheryl A Moyer
- Department of Learning Health Sciences and Obstetrics & Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
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Moyer CA, Aborigo RA, Kaselitz EB, Gupta ML, Oduro A, Williams J. PREventing Maternal And Neonatal Deaths (PREMAND): a study protocol for examining social and cultural factors contributing to infant and maternal deaths and near-misses in rural northern Ghana. Reprod Health 2016; 13:20. [PMID: 26957319 PMCID: PMC4784316 DOI: 10.1186/s12978-016-0142-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 02/25/2016] [Indexed: 11/30/2022] Open
Abstract
Plain English Summary The Preventing Maternal And Neonatal Deaths (PREMAND) project works to understand the social and cultural factors that may contribute to the deaths and near-misses (people who almost die but end up surviving) of mothers and babies in four districts in Northern Ghana. Examples of these factors include such thing as treating a sick baby at home with traditional medicine instead of going to a hospital or health center, or pregnant women needing permission from several people before they can go to a hospital to deliver. These social and cultural factors will be placed on a map to understand where patterns and clusters of deaths and near-misses are present in these four communities. The final phase of the project will include support and small grants for community members and local leaders to use these maps and this information to create their own solutions that address the specific needs of each community. Abstract Background While Ghana is a leader in some health indicators among West African nations, it still struggles with high maternal and neonatal morbidity and mortality rates, especially in the northern areas. The clinical causes of mortality and morbidity are relatively well understood in Ghana, but little is known about the impact of social and cultural factors on maternal and neonatal outcomes. Less still is understood about how such factors may vary by geographic location, and how such variability may inform locally-tailored solutions. Methods/Design Preventing Maternal And Neonatal Deaths (PREMAND) is a three-year, three-phase project that takes place in four districts in the Upper East, Upper West, and Northern Regions of Ghana. PREMAND will prospectively identify all maternal and neonatal deaths and ‘near-misses’, or those mothers and babies who survive a life threatening complication, in the project districts. Each event will be followed by either a social autopsy (in the case of deaths) or a sociocultural audit (in the case of near-misses). Geospatial technology will be used to visualize the variability in outcomes as well as the social, cultural, and clinical predictors of those outcomes. Data from PREMAND will be used to generate maps for local leaders, community members and Government of Ghana to identify priority areas for intervention. PREMAND is an effort of the Navrongo Health Research Centre and the University of Michigan Medical School. Discussion PREMAND uses an innovative, multifaceted approach to better understand and address neonatal and maternal morbidity and mortality in northern Ghana. It will provide unprecedented access to information on the social and cultural factors that contribute to deaths and near-misses in the project regions, and will allow such causal factors to be situated geographically. PREMAND will create the opportunity for local, regional, and national stakeholders to see how these events cluster, and place them relative to traditional healer compounds, health facilities, and other important geographic markers. Finally, PREMAND will enable local communities to generate their own solutions to maternal and neonatal morbidity and mortality, an effort that has great potential for long-term impact. Electronic supplementary material The online version of this article (doi:10.1186/s12978-016-0142-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cheryl A Moyer
- University of Michigan Medical School, 1111 Catherine St, Ann Arbor, MI, 48109, USA.
| | | | - Elizabeth B Kaselitz
- University of Michigan Medical School, 1111 Catherine St, Ann Arbor, MI, 48109, USA.
| | - Mira L Gupta
- University of Michigan Medical School, 1111 Catherine St, Ann Arbor, MI, 48109, USA.
| | - Abraham Oduro
- Navrongo Health Research Centre, PO Box 114, Navrongo, UE/R, Ghana.
| | - John Williams
- Navrongo Health Research Centre, PO Box 114, Navrongo, UE/R, Ghana.
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Iganus R, Hill Z, Manzi F, Bee M, Amare Y, Shamba D, Odebiyi A, Adejuyigbe E, Omotara B, Skordis-Worrall J. Roles and responsibilities in newborn care in four African sites. Trop Med Int Health 2015; 20:1258-64. [PMID: 26031746 PMCID: PMC5008199 DOI: 10.1111/tmi.12550] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objectives To explore roles and responsibilities in newborn care in the intra‐ and postpartum period in Nigeria, Tanzania and Ethiopia. Methods Qualitative data were collected using in‐depth interviews with mothers, grandmothers, fathers, health workers and birth attendants and were analysed through content and framework analyses. Results We found that birth attendants were the main decision‐makers and care takers in the intrapartum period. Birth attendants varied across sites and included female relatives (Ethiopia and Nigeria), traditional birth attendants (Tanzania and Nigeria), spiritual birth attendants (Nigeria) and health workers (Tanzania and Nigeria). In the early newborn period, when the mother is deemed to be resting, female family members assumed this role. The mothers themselves only took full responsibility for newborn care after a few days or weeks. The early newborn period was protracted for first‐time mothers, who were perceived as needing training on caring for the baby. Clear gender roles were described, with newborn care being considered a woman's domain. Fathers had little physical contact with the newborn, but played an important role in financing newborn care, and were considered the ultimate decision‐maker in the family. Conclusion Interventions should move beyond a focus on the mother–child dyad, to include other carers who perform and decide on newborn care practices. Given this power dynamic, interventions that involve men have the potential to result in behaviour change.
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Affiliation(s)
- R Iganus
- Department of Community Medicine, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Z Hill
- Institute of Global Health, University College London, London, UK
| | - F Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - M Bee
- Institute of Global Health, University College London, London, UK
| | - Y Amare
- Consultancy for Social Development, Addis Ababa, Ethiopia
| | - D Shamba
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - A Odebiyi
- Post-Graduate School, Lead City University, Ibadan, Nigeria
| | - E Adejuyigbe
- Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-ife, Nigeria
| | - B Omotara
- Department of Community Medicine, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
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Gupta ML, Aborigo RA, Adongo PB, Rominski S, Hodgson A, Engmann CM, Moyer CA. Grandmothers as gatekeepers? The role of grandmothers in influencing health-seeking for mothers and newborns in rural northern Ghana. Glob Public Health 2015; 10:1078-91. [PMID: 25635475 DOI: 10.1080/17441692.2014.1002413] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Previous research suggests that care-seeking in rural northern Ghana is often governed by a woman's husband or compound head. This study was designed to explore the role grandmothers (typically a woman's mother-in-law) play in influencing maternal and newborn healthcare decisions. In-depth interviews were conducted with 35 mothers of newborns, 8 traditional birth attendants and local healers, 16 community leaders and 13 healthcare practitioners. An additional 18 focus groups were conducted with stakeholders such as household heads, compound leaders and grandmothers. In this region, grandmothers play many roles. They may act as primary support providers to pregnant mothers, care for newborns following delivery, preserve cultural traditions and serve as repositories of knowledge on local medicine. Grandmothers may also serve as gatekeepers for health-seeking behaviour, especially with regard to their daughters and daughters-in-law. This research also sheds light on the potential gap between health education campaigns that target mothers as autonomous decision-makers, and the reality of a more collectivist community structure in which mothers rarely make such decisions without the support of other community members.
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Affiliation(s)
- Mira L Gupta
- a Global REACH , University of Michigan Medical School , Ann Arbor , MI , USA
| | - Raymond Akawire Aborigo
- b Navrongo Health Research Centre , Navrongo UE/R , Ghana.,c Department of Public Health , Monash University School of Medical and Health Sciences , Selangor Darul Ehasan , Malaysia
| | - Philip Baba Adongo
- d Department of Social and Behavioral Science , University of Ghana School of Public Health , Legon , Ghana
| | - Sarah Rominski
- a Global REACH , University of Michigan Medical School , Ann Arbor , MI , USA
| | | | - Cyril M Engmann
- e Department of Maternal and Child Health , University of North Carolina School of Public Health , Chapel Hill , NC , USA
| | - Cheryl A Moyer
- a Global REACH , University of Michigan Medical School , Ann Arbor , MI , USA.,f Department of Medical Education , University of Michigan Medical School , Ann Arbor , MI , USA
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Sialubanje C, Massar K, Hamer DH, Ruiter RAC. Personal and environmental predictors of the intention to use maternal healthcare services in Kalomo, Zambia. Health Educ Res 2014; 29:1028-1040. [PMID: 25274723 DOI: 10.1093/her/cyu057] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Low maternal healthcare service utilization contributes to poor maternal and new born health outcomes in rural Zambia. The purpose of this study was to identify important factors influencing women's intention to use these services in Kalomo, Zambia. An interviewer-administered questionnaire was used to collect data from 1007 women of reproductive age (15-45 years) from 13 rural health centres with the lowest service utilization rates in the district. Questions included measures of (past) healthcare seeking behaviour, psychosocial variables (attitude, perceived social norms, perceived behavioural control), logistical barriers (e.g., distance to the clinic) and sociodemographic variables (e.g., age, income and education level). Overall, our findings showed that most respondents had high intention to use healthcare services. Intention was positively associated with attitude, personal norms, behavioural control, education and income levels. Conversely, intention was negatively related to perceived social norms, age and distance. Multivariate regression analysis showed that, together, these variables accounted for 41.8% of the variance in intention, with perceived behavioural control being the strongest predictor of intention, followed by geographical distance and perceived social norms. These findings suggest that public health programmes mitigating these important factors are likely to motivate pregnant women to use maternal healthcare services.
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Affiliation(s)
- Cephas Sialubanje
- Monze District Medical Office, Ministry of Health, P.O. Box 660144, Monze, Zambia, Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands, Zambia Centre for Applied Health Research and Development, P.O. Box 30910, Lusaka, Zambia, Centre for Global Health and Development Boston University, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USA and Department of Global Health, Boston University School of Public Health, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USA Monze District Medical Office, Ministry of Health, P.O. Box 660144, Monze, Zambia, Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands, Zambia Centre for Applied Health Research and Development, P.O. Box 30910, Lusaka, Zambia, Centre for Global Health and Development Boston University, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USA and Department of Global Health, Boston University School of Public Health, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Karlijn Massar
- Monze District Medical Office, Ministry of Health, P.O. Box 660144, Monze, Zambia, Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands, Zambia Centre for Applied Health Research and Development, P.O. Box 30910, Lusaka, Zambia, Centre for Global Health and Development Boston University, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USA and Department of Global Health, Boston University School of Public Health, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Davidson H Hamer
- Monze District Medical Office, Ministry of Health, P.O. Box 660144, Monze, Zambia, Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands, Zambia Centre for Applied Health Research and Development, P.O. Box 30910, Lusaka, Zambia, Centre for Global Health and Development Boston University, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USA and Department of Global Health, Boston University School of Public Health, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USA Monze District Medical Office, Ministry of Health, P.O. Box 660144, Monze, Zambia, Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands, Zambia Centre for Applied Health Research and Development, P.O. Box 30910, Lusaka, Zambia, Centre for Global Health and Development Boston University, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USA and Department of Global Health, Boston University School of Public Health, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USA Monze District Medical Office, Ministry of Health, P.O. Box 660144, Monze, Zambia, Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands, Zambia Centre for Applied Health Research and Development, P.O. Box 30910, Lusaka, Zambia, Centre for Global Health and Development Boston University, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USA and Department of Global Health, Boston University School of Public Health, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Robert A C Ruiter
- Monze District Medical Office, Ministry of Health, P.O. Box 660144, Monze, Zambia, Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands, Zambia Centre for Applied Health Research and Development, P.O. Box 30910, Lusaka, Zambia, Centre for Global Health and Development Boston University, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USA and Department of Global Health, Boston University School of Public Health, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USA
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Kanmiki EW, Bawah AA, Agorinya I, Achana FS, Awoonor-williams JK, Oduro AR, Phillips JF, Akazili J. Socio-economic and demographic determinants of under-five mortality in rural northern Ghana. BMC Int Health Hum Rights 2014; 14:24. [PMID: 25145383 PMCID: PMC4144693 DOI: 10.1186/1472-698x-14-24] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/13/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND In spite of global decline in under-five mortality, the goal of achieving MDG 4 still remains largely unattained in low and middle income countries as the year 2015 closes-in. To accelerate the pace of mortality decline, proven interventions with high impact need to be implemented to help achieve the goal of drastically reducing childhood mortality. This paper explores the association between socio-economic and demographic factors and under-five mortality in an impoverished region in rural northern Ghana. METHODS We used survey data on 3975 women aged 15-49 who have ever given birth. First, chi-square test was used to test the association of social, economic and demographic characteristics of mothers with the experience of under-five death. Subsequently, we ran a logistic regression model to estimate the relative association of factors that influence childhood mortality after excluding variables that were not significant at the bivariate level. RESULTS Factors that significantly predict under-five mortality included mothers' educational level, presence of co-wives, age and marital status. Mothers who have achieved primary or junior high school education were 45% less likely to experience under-five death than mothers with no formal education at all (OR = 0.55, p < 0.001). Monogamous women were 22% less likely to experience under-five deaths than mothers in polygamous marriages (OR = 0.78, p = 0.01). Similarly, mothers who were between the ages of 35 and 49 were about eleven times more likely to experience under-five deaths than those below the age of 20 years (OR = 11.44, p < 0.001). Also, women who were married had a 27% less likelihood (OR = 0.73, p = 0.01) of experiencing an under-five death than those who were single, divorced or widowed. CONCLUSION Taken independently, maternal education, age, marital status and presence of co-wives are associated with childhood mortality. The relationship of these indicators with women's autonomy, health seeking behavior, and other factors that affect child survival merit further investigation so that interventions could be designed to foster reductions in child mortality by considering the needs and welfare of women including the need for female education, autonomy and socioeconomic well-being.
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Affiliation(s)
- Edmund Wedam Kanmiki
- Navrongo Health Research Centre, Ghana Health Service, Upper East Region, Box 114, Navrongo, Ghana
| | - Ayaga A Bawah
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, Columbia, USA
| | - Isaiah Agorinya
- Navrongo Health Research Centre, Ghana Health Service, Upper East Region, Box 114, Navrongo, Ghana
| | - Fabian S Achana
- Navrongo Health Research Centre, Ghana Health Service, Upper East Region, Box 114, Navrongo, Ghana
| | | | - Abraham R Oduro
- Navrongo Health Research Centre, Ghana Health Service, Upper East Region, Box 114, Navrongo, Ghana
| | - James F Phillips
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, Columbia, USA
| | - James Akazili
- Navrongo Health Research Centre, Ghana Health Service, Upper East Region, Box 114, Navrongo, Ghana
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Qazi SA, Wall S, Brandes N, Engmann C, Darmstadt GL, Bahl R. An innovative multipartner research program to address detection, assessment and treatment of neonatal infections in low-resource settings. Pediatr Infect Dis J 2013; 32 Suppl 1:S3-6. [PMID: 23945573 PMCID: PMC3814851 DOI: 10.1097/inf.0b013e31829ff5e5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In pursuit of innovative approaches for the management of severe infections in young infants, which is a major cause of mortality, a multipartner research program was conceptualized to provide right care in the right place. The primary objective was to generate evidence and identify a simple, safe and effective treatment regimen for young infants with severe infections that can be provided closer to home by trained health workers where referral is not possible. RESEARCH Published and nonpublished data on community-based approaches for the management of neonatal sepsis were critically reviewed by an independent expert panel convened in 2007 by the World Health Organization in collaboration with the United States Agency for International Development and Save the Children/Saving Newborn Lives. These stakeholders agreed to 1) undertake research to improve the specificity of a diagnostic algorithm and revise World Health Organization/United Nations International Children's Emergency Fund Integrated Management of Childhood Illness guidelines to identify sick young infants for referral, 2) develop research studies with common research designs (1 site in each Bangladesh and Pakistan and a multicentre site in Democratic Republic of Congo, Kenya and Nigeria) and oversight mechanisms to evaluate antibiotic regimens (when referral is not accepted by the family) that are safe and efficacious, appropriate to the severity of infection, and deployable on a large scale and 3) utilize existing program delivery structures incorporating community health workers, skilled health workers to deliver simple antibiotic treatment when referral is not possible. CONCLUSIONS This research program facilitated innovative research in different geographical, cultural and administrative milieus to generate recommendations for policy.
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Affiliation(s)
- Shamim Ahmad Qazi
- Department of Maternal Newborn Child and Adolescent Health, World Health Organization, Geneva, Switzerland.
| | - Steve Wall
- From the Department of Maternal Newborn Child and Adolescent Health, World Health Organization, Geneva, Switzerland; Saving Newborn Lives, Save the Children, Federation, Inc., Hartford, Connecticut; United States Agency for International Development, Washington, DC; University of North Carolina, Chapel Hill, North Carolina; and Bill and Melinda Gates Foundation, Seattle, Washington
| | - Neal Brandes
- From the Department of Maternal Newborn Child and Adolescent Health, World Health Organization, Geneva, Switzerland; Saving Newborn Lives, Save the Children, Federation, Inc., Hartford, Connecticut; United States Agency for International Development, Washington, DC; University of North Carolina, Chapel Hill, North Carolina; and Bill and Melinda Gates Foundation, Seattle, Washington
| | - Cyril Engmann
- From the Department of Maternal Newborn Child and Adolescent Health, World Health Organization, Geneva, Switzerland; Saving Newborn Lives, Save the Children, Federation, Inc., Hartford, Connecticut; United States Agency for International Development, Washington, DC; University of North Carolina, Chapel Hill, North Carolina; and Bill and Melinda Gates Foundation, Seattle, Washington
| | - Gary L. Darmstadt
- From the Department of Maternal Newborn Child and Adolescent Health, World Health Organization, Geneva, Switzerland; Saving Newborn Lives, Save the Children, Federation, Inc., Hartford, Connecticut; United States Agency for International Development, Washington, DC; University of North Carolina, Chapel Hill, North Carolina; and Bill and Melinda Gates Foundation, Seattle, Washington
| | - Rajiv Bahl
- From the Department of Maternal Newborn Child and Adolescent Health, World Health Organization, Geneva, Switzerland; Saving Newborn Lives, Save the Children, Federation, Inc., Hartford, Connecticut; United States Agency for International Development, Washington, DC; University of North Carolina, Chapel Hill, North Carolina; and Bill and Melinda Gates Foundation, Seattle, Washington
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