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Tawfiq E, Azimi MD, Feroz A, Hadad AS, Soroush MS, Jafari M, Yaftali MS, Saeedzai SA. Predicting maternal healthcare seeking behaviour in Afghanistan: exploring sociodemographic factors and women's knowledge of severity of illness. BMC Pregnancy Childbirth 2023; 23:561. [PMID: 37533023 PMCID: PMC10398983 DOI: 10.1186/s12884-023-05750-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 05/31/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Little is known whether women's knowledge of perceived severity of illness and sociodemographic characteristics of women influence healthcare seeking behavior for maternal health services in Afghanistan. The aim of this study was to address this knowledge gap. METHODS Data were used from the Afghanistan Health Survey 2018. Women's knowledge in terms of danger signs or symptoms during pregnancy was assessed. The signs or symptoms were bleeding, swelling of the body, headache, fever, or any other danger sign or symptom (e.g., high blood pressure). A categorical variable of knowledge score was created. The outcome variables were defined as ≥ 4 ANC vs. 0-3 ANC; ≥ 4 PNC vs. 0-3 PNC visits; institutional vs. non-institutional deliveries. A multivariable generalized linear model (GLM) was used. RESULTS Data were used from 9,190 ever-married women, aged 13-49 years, who gave birth in the past two years. It was found that 56%, 22% and 2% of women sought healthcare for institutional delivery, ≥ 4 ANC, ≥ 4 PNC visits, respectively, and that women's knowledge is a strong predictor of healthcare seeking [odds ratio (OR)1.77(1.54-2.05), 2.28(1.99-2.61), and 2.78 (2.34-3.32) on knowledge of 1, 2, and 3-5 signs or symptoms, respectively, in women with ≥ 4 ANC visits when compared with women who knew none of the signs or symptoms. In women with ≥ 4 PNC visits, it was 1.80(1.12-2.90), 2.22(1.42-3.48), and 3.33(2.00-5.54), respectively. In women with institutional deliveries, it was 1.49(1.32-1.68), 2.02(1.78-2.28), and 2.34(1.95-2.79), respectively. Other strong predictors were women's education level, multiparity, residential areas (urban vs. rural), socioeconomic status, access to mass media (radio, TV, the internet), access of women to health workers for birth, and decision-making for women where to deliver. However, age of women was not a strong predictor. CONCLUSION Our findings suggest that pregnant women's healthcare seeking behaviour is influenced by women's knowledge of danger signs and symptoms during pregnancy, women's education, socioeconomic status, access to media, husband's, in-laws' and relatives' decisions, residential area, multiparity, and access to health workers. The findings have implications for promoting safe motherhood and childbirth practices through improving women's knowledge, education, and social status.
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Affiliation(s)
- Essa Tawfiq
- The Kirby Institute, UNSW Sydney, Sydney, Australia.
| | | | - Aeraj Feroz
- Formerly the Ministry of Public Health, Kabul, Afghanistan
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Amu H, Aboagye RG, Dowou RK, Kongnyuy EJ, Adoma PO, Memiah P, Tarkang EE, Bain LE. Towards achievement of Sustainable Development Goal 3: multilevel analyses of demographic and health survey data on health insurance coverage and maternal healthcare utilisation in sub-Saharan Africa. Int Health 2023; 15:134-149. [PMID: 35439814 PMCID: PMC9977256 DOI: 10.1093/inthealth/ihac017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 12/28/2021] [Accepted: 03/19/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Improving maternal health and achieving universal health coverage (UHC) are important expectations in the global Sustainable Development Goals (SDGs) agenda. While health insurance has been shown as effective in the utilisation of maternal healthcare, there is a paucity of literature on this relationship in sub-Saharan Africa (SSA). We examined the relationship between health insurance coverage and maternal healthcare utilisation using demographic and health survey data. METHODS This was a cross-sectional study of 195 651 women aged 15-49 y from 28 countries in SSA. We adopted bivariable and multivariable analyses comprising χ2 test and multilevel binary logistic regression in analysing the data. RESULTS The prevalence of maternal healthcare utilisation was 58, 70.6 and 40.7% for antenatal care (ANC), skilled birth attendance (SBA) and postnatal care (PNC), respectively. The prevalence of health insurance coverage was 6.4%. Women covered by health insurance were more likely to utilise ANC (adjusted OR [aOR]=1.48, 95% CI 1.41 to 1.54), SBA (aOR=1.37, 95% CI 1.30 to 1.45) and PNC (aOR=1.42, 95% CI 1.37 to 1.48). CONCLUSION Health insurance coverage was an important predictor of maternal healthcare utilisation in our study. To accelerate progress towards the achievement of SDG 3 targets related to the reduction of maternal mortality and achievement of UHC, countries should adopt interventions to increase maternal insurance coverage, which may lead to higher maternal healthcare access and utilisation during pregnancy.
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Affiliation(s)
- Hubert Amu
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Richard Gyan Aboagye
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Robert Kokou Dowou
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | | | - Prince Owusu Adoma
- Department of Health Administration and Education, Faculty of Science Education, University of Education, Winneba, Ghana
| | - Peter Memiah
- Division of Epidemiology and Prevention: Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Elvis Enowbeyang Tarkang
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Luchuo Engelbert Bain
- Lincoln International Institute for Rural Health (LIIRH), College of Social Science, University of Lincoln, Lincoln, UK
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Health system-related barriers to prenatal care management in low- and middle-income countries: a systematic review of the qualitative literature. Prim Health Care Res Dev 2023; 24:e15. [PMID: 36843095 PMCID: PMC9972358 DOI: 10.1017/s1463423622000706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
BACKGROUND Appropriate prenatal care (PNC) is essential for improving maternal and infant health; nevertheless, millions of women in low- and middle-income countries (LMICs) do not receive it properly. The objective of this review is to identify and summarize the qualitative studies that report on health system-related barriers in PNC management in LMICs. METHODS This systematic review was conducted in 2022. A range of electronic databases including PubMed, Web of Knowledge, CINHAL, SCOPUS, Embase, and Science Direct were searched for qualitative studies conducted in LMICs. The reference lists of eligible studies also were hand searched. The studies that reported health system-related barrier of PNC management from the perspectives of PNC stakeholders were considered for inclusion. Study quality assessment was performed applying the Critical Appraisal Skills Programme (CASP) checklist, and thematic analyses performed. RESULTS Of the 32 included studies, 25 (78%) were published either in or after 2013. The total population sample included 1677 participants including 629 pregnant women, 122 mothers, 240 healthcare providers, 54 key informed, 164 women of childbearing age, 380 community members, and 88 participants from other groups (such as male partners and relatives). Of 32 studies meeting inclusion criteria, four major themes emerged: (1) healthcare provider-related issues; (2) service delivery issues; (3) inaccessible PNC; and (4) poor PNC infrastructure. CONCLUSION This systematic review provided essential findings regarding PNC barriers in LMICs to help inform the development of effective PNC strategies and public policy programs.
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Rahimi BA, Mohamadi E, Maku M, Hemat MD, Farooqi K, Mahboobi BA, Mudaser GM, Taylor WR. Challenges in antenatal care utilization in Kandahar, Afghanistan: A cross-sectional analytical study. PLoS One 2022; 17:e0277075. [PMID: 36409670 PMCID: PMC9678260 DOI: 10.1371/journal.pone.0277075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/20/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Quality antenatal care (ANC) is one of the four pillars of safe motherhood initiatives and improves the survival and health of mother and neonate. The main objective of this study was to assess the barriers in the utilization of ANC services in Kandahar, Afghanistan. METHODS This was a cross-sectional analytical study conducted over one year from December 2018-November 2019. Data were analyzed by descriptive statistics, Chi squared, and binary logistic regression. RESULTS A total of 1524 women were recruited in this study with mean age of 30.3 years. Of these women, 848 (55.6%) were rural dwellers, 1450/1510 (96.0%) were illiterate, 438/608 (72.0%) belonged to low-income families, 1112/1508 (73.7%) lived in joint families, 1420/1484 (95.7%) lived in a house of >10 inhabitants, while 388/1494 (26.0%) had attended had at least one ANC visit during their last pregnancy. On univariate analysis, the main barriers in the utilization of ANC services were living in rural areas, being illiterate, having lower socio-economic status, remoteness of the health facility from home, bad behavior of clinic personnel, and unplanned pregnancy. Only lower socio-economic status and bad behavior of clinic personnel were independent explanatory variables in the regression model. CONCLUSIONS Utilization of ANC services is inadequate in Kandahar province. Improving clinic staff professional behavior and status of women by expanding educational opportunities, and enhancing community awareness of the value of ANC are recommended.
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Affiliation(s)
- Bilal Ahmad Rahimi
- Faculty of Medicine, Department of Pediatrics, Kandahar University, Kandahar, Afghanistan
- Head of Research Unit, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
- * E-mail:
| | - Enayatullah Mohamadi
- Faculty of Medicine, Department of Public Health, Kandahar University, Kandahar, Afghanistan
| | - Muhibullah Maku
- Faculty of Medicine, Department of Public Health, Kandahar University, Kandahar, Afghanistan
| | - Mohammad Dawood Hemat
- Faculty of Medicine, Department of Public Health, Kandahar University, Kandahar, Afghanistan
| | - Khushhal Farooqi
- Faculty of Medicine, Department of Dermatology, Kandahar University, Kandahar, Afghanistan
| | - Bashir Ahmad Mahboobi
- Faculty of Medicine, Department of Pediatrics, Kandahar University, Kandahar, Afghanistan
| | | | - Walter R. Taylor
- Senior Clinical Research Fellow, Mahidol Oxford Tropical Medicine Clinical Research unit (MORU), Mahidol University, Bangkok, Thailand
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Horodnic AV, Williams CC, Drugă RI. The Companion Pandemic to COVID-19: The Use of Informal Practices to Access Public Healthcare Services in the European Union. Int J Public Health 2022; 67:1604405. [DOI: 10.3389/ijph.2022.1604405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/06/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: The objective of this paper is to evaluate the use of informal payments and personal connections to gain preferential access to public health services during the COVID-19 pandemic and to propose effective policy measures for tackling this phenomenon.Methods: Using data from 25,744 patients in the European Union, six different scenarios are analyzed in relation to making informal payments and/or relying on personal connections to access public healthcare services. To evaluate the propensity to engage in informal practices in healthcare, probit regressions with sample selection and predicted probabilities are used. Robustness checks are also performed to test the reliability of the findings.Results: For each scenario, a statistically significant association is revealed between the propensity to make informal payments and/or rely on personal connections and the asymmetry between the formal rules and the patients’ personal norms and trust in public authorities.Conclusion: To tackle informal practices in healthcare, policy measures are required to reduce the asymmetry between the formal rules and personal norms by raising trust in public authorities.
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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: 0] [Impact Index Per Article: 0] [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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Alibhai KM, Ziegler BR, Meddings L, Batung E, Luginaah I. Factors impacting antenatal care utilization: a systematic review of 37 fragile and conflict-affected situations. Confl Health 2022; 16:33. [PMID: 35690840 PMCID: PMC9188725 DOI: 10.1186/s13031-022-00459-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 05/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is estimated that over 930 million people live in fragile and conflict-affected situations (FCAS) worldwide. These regions, characterized by violence, civil unrest, and war, are often governed by corrupt administrations who are unwilling to provide their citizens with basic human rights. Individuals living in FCAS face health inequities; however, women are disproportionally affected and face additional barriers to accessing sexual and reproductive services, including antenatal care (ANC). This systematic review aims to identify the factors that impact ANC usage in the 37 countries or regions classified as FCAS in 2020 by The World Bank. METHODS Using the PRISMA guidelines, a systematic search of five databases (SCOPUS, Web of Science, PubMed, EMBASE, and CINAHL) was conducted. Results were limited to human studies, written in English, and published between January 2002 and January 2022. Studies that identified factors affecting utilization of ANC or maternal health services were included for review and critically appraised using the National Institute of Health's Quality Assessment Tools. Findings were summarized using a narrative synthesis approach. RESULTS The database search yielded 26,527 studies. After title, abstract and full-text review, and exclusion of duplicate articles, 121 studies remained. Twenty-eight of the 37 FCAS were represented in the included studies. The studies highlighted that women in FCAS' are still not meeting the World Health Organization's 2002 recommendation of four ANC visits during pregnancy, a recommendation which has since been increased to eight visits. The most cited factors impacting ANC were socioeconomic status, education, and poor quality of ANC. Despite all studies being conducted in conflict-affected regions, only nine studies explicitly identified conflict as a direct barrier to accessing ANC. CONCLUSION This review demonstrated that there is a paucity in the literature examining the direct and indirect impacts of conflict on ANC utilization. Specifically, research should be conducted in the nine FCAS that are not currently represented in the literature. To mitigate the barriers that prevent utilization of maternal health services identified in this review, policy makers, women utilizing ANC, and global organizations should attempt to collaborate to enact policy change at the local level.
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Affiliation(s)
| | - Bianca R Ziegler
- DeGroote School of Medicine, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada
| | - Louise Meddings
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Evans Batung
- Department of Geography, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
- Environment Health and Hazards Lab, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Isaac Luginaah
- Department of Geography, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
- Environment Health and Hazards Lab, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
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Khalil M, Carasso KB, Kabakian-Khasholian T. Exposing Obstetric Violence in the Eastern Mediterranean Region: A Review of Women's Narratives of Disrespect and Abuse in Childbirth. Front Glob Womens Health 2022; 3:850796. [PMID: 35547827 PMCID: PMC9082810 DOI: 10.3389/fgwh.2022.850796] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/07/2022] [Indexed: 11/27/2022] Open
Abstract
Background Obstetric violence (OV) threatens the provision of dignified, rights-based, high-quality, and respectful maternal care (RMC). The dearth of evidence on OV in the Eastern Mediterranean Region poses a knowledge gap requiring research to improve rights-based and respectful health practice and policy. While efforts to improve the quality of maternal health have long-existed, women's experiences of childbirth and perceptions of dignity and respect are not adequately or systematically recorded, especially in the said region. Aim This study centered on the experiences of women's mistreatment in childbirth to provide an overview of OV and offer recommendations to improve RMC. Methods A scoping review was conducted, and a total of 38 articles met the inclusion criteria and were analyzed using Bowser and Hill's framework of the seven typologies of Disrespect and Abuse (D&A) in childbirth. D&A in childbirth (or violations to RMC) is a manifestation of OV and served as a proxy to analyze its prevalence in the EMR. Findings and Discussion This study indicated that across the EMR, women experienced every type of D&A in childbirth. This happens regardless of health systems' strength or country's income, with 6 out of 7 types of D&A found in almost two-thirds of included countries. In the EMR, the most common types of D&A in childbirth are physical abuse (especially overused routine interventions) and non-dignified care (embedded in patriarchal socio-cultural norms). The intersections of these abuses enable the objectification of women's bodies and overuse of unconsented routine interventions in a hierarchical and patriarchal system that regards the power and autonomy of doctors above birthing women. If unchecked, the implications include acceptance, continuation, and underreporting of D&A in childbirth, as well as passivity toward human-rights violations, which all further cause the continuing the cycle of OV. Conclusion In order to eliminate OV, a paradigm shift is required involving infrastructure changes, education, empowerment, advocacy, a women-centered and gender-sensitive approach to health system strengthening, and policy development. Recommendations are given at individual, community, health systems, and policy levels to ensure that every woman achieves her right to health and birth in a dignified, respectful, and empowered manner.
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Affiliation(s)
- Merette Khalil
- Your Egyptian Doula, Cairo, Egypt
- International Course for Health and Development, Health Unit, KIT Royal Tropical Institute, Amsterdam, Netherlands
- *Correspondence: Merette Khalil
| | - Kashi Barbara Carasso
- International Course for Health and Development, Health Unit, KIT Royal Tropical Institute, Amsterdam, Netherlands
| | - Tamar Kabakian-Khasholian
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Delmaifanis D, Siregar K, Prabawa A. mHealth Conceptual Model for Providing Quality Antenatal Care in Health Centers during the Coronavirus Disease 2019 Pandemic. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: In Indonesia, the maternal mortality rate is still high and far from the Sustainable Development Goals target of 305 compared to 70 per 100,000 live births.
AIM: This study aims to design the mHealth concept to improve the quality of antenatal care (ANC) with features that support service workers during the coronavirus disease 2019 (COVID-19) pandemic.
METHODS: The method used was literature study and conceptual design of the mHealth model with Rapid Application Development approach.
RESULTS: The result showed that several factors influence the quality of ANC and the potential for improvement with mHealth. There are nine features of pregnancy services designed to improve the quality of ANC, such as standard operating procedure compliance, maternal health records, clinical decision aids, referral links, teleconsultation, health promotion improvement, alerts, and reminders, real-time reports, and distribution maps for pregnant women. The depicted context diagram consists of four external entities such as pregnant women, midwives, maternal and child health coordinators at Health centers and Health offices in Indonesia as well as the flow of data or information to and from mHealth, and the interface design understands users’ role and is executed accordingly.
CONCLUSION: The problems of pregnant women during the COVID-19 pandemic or the new normal were partially resolved with mHealth innovations, teleconsultation features, and improving health promotion. Therefore, all the mHealth features this helps in improving the quality of ANC.
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Currie S, Natiq L, Anwari Z, Tappis H. Assessing respectful maternity care in a fragile, conflict-affected context: Observations from a 2016 national assessment in Afghanistan. Health Care Women Int 2021; 45:169-189. [PMID: 34126037 DOI: 10.1080/07399332.2021.1932890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 05/17/2021] [Indexed: 12/17/2022]
Abstract
Evidence on experiences and perceptions of care in pregnancy and childbirth in conflict-affected settings is limited. We interviewed 561 maternity care providers and observed 413 antenatal care consultations, 671 births, and 393 postnatal care consultations at public health facilities across Afghanistan. We found that healthcare providers work under stressed conditions with insufficient support, and most women receive mixed quality care. Understanding socio-cultural and contextual factors underpinning acceptance of mistreatment in childbirth, related to conflict, insecurity, gender and power dynamics, is critical for improving the quality of maternity care in Afghanistan and similar fragile and conflict affected settings.
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Affiliation(s)
- Sheena Currie
- Jhpiego, Technical Leadership Office, Baltimore, Maryland, USA
| | - Laila Natiq
- Jhpiego, Technical Leadership Office, Baltimore, Maryland, USA
- Independent Researcher, Alexandria, Virginia, USA
| | | | - Hannah Tappis
- Jhpiego, Technical Leadership Office, Baltimore, Maryland, USA
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Alyahya MS, Khader YS, Al-Sheyab NA, Shattnawi KK, Altal OF, Batieha A. Modifiable Factors and Delays Associated with Neonatal Deaths and Stillbirths in Jordan: Findings from Facility-Based Neonatal Death and Stillbirth Audits. Am J Perinatol 2021; 40:731-740. [PMID: 34058760 DOI: 10.1055/s-0041-1730434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study employed the "three-delay" model to investigate the types of critical delays and modifiable factors that contribute to the neonatal deaths and stillbirths in Jordan. STUDY DESIGN A triangulation research method was followed in this study to present the findings of death review committees (DRCs), which were formally established in five major hospitals across Jordan. The DRCs used a specific death summary form to facilitate identifying the type of delay, if any, and to plan specific actions to prevent future similar deaths. A death case review form with key details was also filled immediately after each death. Moreover, data were collected from patient notes and medical records, and further information about a specific cause of death or the contributing factors, if needed, were collected. RESULTS During the study period (August 1, 2019-February 1, 2020), 10,726 births, 156 neonatal deaths, and 108 stillbirths were registered. A delay in recognizing the need for care and in the decision to seek care (delay 1) was believed to be responsible for 118 (44.6%) deaths. Most common factors included were poor awareness of when to seek care, not recognizing the problem or the danger signs, no or late antenatal care, and financial constraints and concern about the cost of care. Delay 2 (delay in seeking care or reaching care) was responsible for nine (3.4%) cases. Delay 3 (delay in receiving care) was responsible for 81 (30.7%) deaths. The most common modifiable factors were the poor or lack of training that followed by heavy workload, insufficient staff members, and no antenatal documentation. Effective actions were initiated across all the five hospitals in response to the delays to reduce preventable deaths. CONCLUSION The formation of the facility-based DRCs was vital in identifying critical delays and modifiable factors, as well as developing initiatives and actions to address modifiable factors. KEY POINTS · Death review committees play key roles in identifying critical delays and modifiable factors.. · The "three-delay" model was successful in identifying preventable neonatal deaths and stillbirths.. · Death review committees are central in developing actions to reduce preventable deaths..
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Affiliation(s)
- Mohammad S Alyahya
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yousef S Khader
- Medical Education and Biostatistics, Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Nihaya A Al-Sheyab
- Allied Medical Sciences Department, Faculty of Applied Medical Sciences, Department of Maternal and Child Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Khulood K Shattnawi
- Department of Maternal and Child Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar F Altal
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Anwar Batieha
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Adatara P, Amooba PA, Afaya A, Salia SM, Avane MA, Kuug A, Maalman RSE, Atakro CA, Attachie IT, Atachie C. Challenges experienced by midwives working in rural communities in the Upper East Region of Ghana: a qualitative study. BMC Pregnancy Childbirth 2021; 21:287. [PMID: 33836689 PMCID: PMC8033657 DOI: 10.1186/s12884-021-03762-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background In 2017, a total of 295,000 women lost their lives due to pregnancy and childbirth across the globe, with sub-Saharan Africa and South Asia accounting for approximately 86 % of all maternal deaths. The maternal mortality ratio in Ghana is exceptionally high, with approximately 308 deaths/100,000 live births in 2017. Most of these maternal deaths occur in rural areas than in urban areas. Thus, we aimed to explore and gain insights into midwives’ experiences of working and providing women-centred care in rural northern Ghana. Methods A qualitative descriptive exploratory design was used to explore the challenges midwives face in delivering women-centred midwifery care in low-resource, rural areas. A total of 30 midwives practicing in the Upper East Region of Ghana were purposefully selected. Data were collected using individual semistructured interviews and analysed through qualitative content analysis. Results Five main themes emerged from the data analysis. These themes included were: inadequate infrastructure (lack of bed and physical space), shortage of midwifery staff, logistical challenges, lack of motivation, and limited in-service training opportunities. Conclusions Midwives experience myriad challenges in providing sufficient women-centred care in rural Ghana. To overcome these challenges, measures such as providing adequate beds and physical space, making more equipment available, and increasing midwifery staff strength to reduce individual workload, coupled with motivation from facility managers, are needed.
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Affiliation(s)
- Peter Adatara
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Volta Region, Ho, Ghana
| | - Philemon Adoliwine Amooba
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Agani Afaya
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Volta Region, Ho, Ghana. .,College of Nursing, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea.
| | - Solomon Mohammed Salia
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Volta Region, Ho, Ghana
| | - Mabel Apaanye Avane
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Volta Region, Ho, Ghana
| | - Anthony Kuug
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Volta Region, Ho, Ghana
| | - Raymond Saa-Eru Maalman
- Department of Basic Medical Sciences, School of Medicine, University of Health and Allied Sciences, Volta Region, Ho, Ghana
| | | | - Irene Torshie Attachie
- Department of Midwifery, School of Nursing and Midwifery, University of Health and Allied Sciences, Volta Region, Ho, Ghana
| | - Constancia Atachie
- Department of Midwifery, School of Nursing and Midwifery, University of Health and Allied Sciences, Volta Region, Ho, Ghana
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Jordan K, Lewis TP, Roberts B. Quality in crisis: a systematic review of the quality of health systems in humanitarian settings. Confl Health 2021; 15:7. [PMID: 33531065 PMCID: PMC7851932 DOI: 10.1186/s13031-021-00342-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 01/22/2021] [Indexed: 12/03/2022] Open
Abstract
Background There is a growing concern that the quality of health systems in humanitarian crises and the care they provide has received little attention. To help better understand current practice and research on health system quality, this paper aimed to examine the evidence on the quality of health systems in humanitarian settings. Methods This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The context of interest was populations affected by humanitarian crisis in low- and middle- income countries (LMICs). We included studies where the intervention of interest, health services for populations affected by crisis, was provided by the formal health system. Our outcome of interest was the quality of the health system. We included primary research studies, from a combination of information sources, published in English between January 2000 and January 2019 using quantitative and qualitative methods. We used the High Quality Health Systems Framework to analyze the included studies by quality domain and sub-domain. Results We identified 2285 articles through our search, of which 163 were eligible for full-text review, and 55 articles were eligible for inclusion in our systematic review. Poor diagnosis, inadequate patient referrals, and inappropriate treatment of illness were commonly cited barriers to quality care. There was a strong focus placed on the foundations of a health system with emphasis on the workforce and tools, but a limited focus on the health impacts of health systems. The review also suggests some barriers to high quality health systems that are specific to humanitarian settings such as language barriers for refugees in their host country, discontinued care for migrant populations with chronic conditions, and fears around provider safety. Conclusion The review highlights a large gap in the measurement of quality both at the point of care and at the health system level. There is a need for further work particularly on health system measurement strategies, accountability mechanisms, and patient-centered approaches in humanitarian settings. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-021-00342-z.
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Affiliation(s)
- Keely Jordan
- Department of Health Policy, New York University School of Global Public Health, 665 Broadway, New York, NY, 10012, USA.
| | - Todd P Lewis
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Bayard Roberts
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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14
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Landrian A, Phillips BS, Singhal S, Mishra S, Kajal F, Sudhinaraset M. Do you need to pay for quality care? Associations between bribes and out-of-pocket expenditures on quality of care during childbirth in India. Health Policy Plan 2020; 35:600-608. [PMID: 32163567 DOI: 10.1093/heapol/czaa008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2020] [Indexed: 11/14/2022] Open
Abstract
While it is mandated that reproductive and child health services be provided for free at public facilities in India, qualitative evidence suggests it is common for facilities to request bribes and other informal payments for medicines, medical tests or equipment. This article examines the prevalence of bribe requests, total out-of-pocket expenditures (OOPEs) and associations between bribe requests and total OOPEs on the experience of quality of care and maternal complications during childbirth. Women who delivered in public facilities in Uttar Pradesh, India were administered a survey on sociodemographic characteristics, bribe requests, total OOPEs, types of health checks received and experience of maternal complications. Data were analysed using descriptive, bivariate and multivariate statistics. Among the 2018 women who completed the survey, 43% were asked to pay a bribe and 73% incurred OOPEs. Bribe requests were associated with lower odds of receiving all health checks upon arrival to the facility (aOR = 0.49; 95% CI: 0.24-0.98) and during labour and delivery (aOR = 0.44; 95% CI: 0.25-0.76), lower odds of receiving most or all health checks after delivery (aOR = 0.44; 95% CI: 0.31-0.62) and higher odds of experiencing maternal complications (aOR = 1.45; 95% CI: 1.13-1.87). Although it is mandated that maternity care be provided for free in public facilities in India, these findings suggest that OOPEs are high, and bribes/tips contribute significantly. Interventions centred on improving person-centred care (particularly guidelines around bribes), health system conditions and women's expectations of care are needed.
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Affiliation(s)
- Amanda Landrian
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Drive South, Los Angeles, CA 90095, USA
| | - Beth S Phillips
- Institute for Global Health Sciences, School of Medicine, University of California, Mission Hall, Box 1224, 550 16th Street, San Francisco, CA 94158, USA
| | - Shreya Singhal
- Community Empowerment Lab, Lucknow, Uttar Pradesh, India
| | - Shambhavi Mishra
- Department of Statistics, University of Lucknow, Lucknow, Uttar Pradesh, India
| | - Fnu Kajal
- Institute for Global Health Sciences, School of Medicine, University of California, Mission Hall, Box 1224, 550 16th Street, San Francisco, CA 94158, USA
| | - May Sudhinaraset
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Drive South, Los Angeles, CA 90095, USA
- Institute for Global Health Sciences, School of Medicine, University of California, Mission Hall, Box 1224, 550 16th Street, San Francisco, CA 94158, USA
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15
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Siam ZA, Leone T. Service utilization patterns for childbirth and neonatal mortality in the occupied Palestinian territory during conflict. Eur J Public Health 2020; 30:856-860. [PMID: 32206813 DOI: 10.1093/eurpub/ckaa043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The global incidence of man-made crises has increased in the last decade. Evidence on deviations in service uptake during conflict is needed to better understand the link between conflict and adverse neonatal outcomes. We assessed the association between conflict intensity in the occupied Palestinian territory (oPt) at time of birth and (i) utilization patterns for childbirth across different providers; and (ii) neonatal mortality. METHODS We combined data on conflict intensity with four demographic and health surveys (2004, 2006, 2010 and 2014) that included nationally representative samples of women of childbearing age. Our exposure variable was casualties per 100 000 population in defined sub-regions of the oPt. Our outcome specifications were a binary variable for neonatal deaths and a categorical variable for childbirth location. We used multivariate logistic and multinomial regressions to assess the associations. RESULTS High conflict intensity was associated with fewer childbirths in the private sector (RR=0.97, P=0.04), and non-governmental organizations (RR=0.95, P=0.03) compared to public facilities. Conflict intensity was not associated with higher neonatal mortality beyond 2004. CONCLUSIONS Policy implications include better preparedness in the public sector for childbirth during conflict and exploring reasons for the slow decline in neonatal mortality in the territory beyond conflict at time of birth.
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Affiliation(s)
- Zeina Ali Siam
- Graduate School of Arts and Sciences, Harvard University, Cambridge, MA, USA
| | - Tiziana Leone
- Department of International Development, London School of Economics and Political Science, London, UK
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Shahbazi Sighaldeh S, Nazari A, Maasoumi R, Kazemnejad A, Mazari Z. Prevalence, related factors and maternal outcomes of primary postpartum haemorrhage in governmental hospitals in Kabul-Afghanistan. BMC Pregnancy Childbirth 2020; 20:428. [PMID: 32723320 PMCID: PMC7390104 DOI: 10.1186/s12884-020-03123-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine the prevalence, related factors and maternal outcomes of primary PPH in governmental hospitals in Kabul Afghanistan. METHODS An observational study was designed to determine the prevalence, related factors and maternal outcomes of primary PPH in governmental hospitals in Kabul-Afghanistan. The population of this study consisted of all women who gave birth to a child between August and October 2018. The structured checklist was used to collect the data from patients who were suffering from primary PPH. RESULTS Among the 8652 women who were observed, 215 (2.5%) of them suffered from primary PPH and 2 (0.9%) of them died under caesarean section. The most common related factors of primary PPH were uterine atonia (65.6%), previous PPH (34.9%), prolonged labor (27%), genital tract trauma (26.5%), and induction of labor (20.5%). The most common maternal outcomes of primary PPH were respiratory failure (7%), hysterectomy (6%), and hypovolaemic shock (5.1%). CONCLUSIONS According to our findings, the major cause of postpartum bleeding was uterine atonia. Therefore, postpartum care of women is essential, especially for those with previous PPH and prolonged labor that require more attention.
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Affiliation(s)
- Shirin Shahbazi Sighaldeh
- Reproductive health department, School of Nursing and Midwifery, Tehran University of Medical Sciences, P.O. Box 6459, Tehran, Iran
| | - Adela Nazari
- Midwifery department, School of Nursing and Midwifery, Kabul Medical University, Kabul, Afghanistan.
| | - Raziyeh Maasoumi
- Reproductive health department, School of Nursing and Midwifery, Tehran University of Medical Sciences, P.O. Box 6459, Tehran, Iran
| | - Anoshirvan Kazemnejad
- Department of biostatistics, Tarbiat Modares University, P.O. Box 8288, TMU, Tehran, Iran
| | - Ziba Mazari
- Midwifery department, School of Nursing and Midwifery, Kabul Medical University, Kabul, Afghanistan
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17
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Male participation in antenatal care and its influence on their pregnant partners' reproductive health care utilization: insight from the 2015 Afghanistan Demographic and Health Survey. J Biosoc Sci 2020; 53:436-458. [PMID: 32536350 DOI: 10.1017/s0021932020000292] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Afghanistan has made remarkable progress in reducing maternal mortality over the past few decades, and male participation in their pregnant partner's reproductive health care is crucial for further improvement. This study aimed to examine whether male attendance at antenatal care (ANC) with their pregnant partners might be beneficially associated with the degree of utilization of reproductive health care by the pregnant partners. Data for 2660 couples (women aged 16-49 years) were taken from the 2015 Afghanistan Demographic and Health Survey (AfDHS). Bivariate and multivariate logistic regression models were employed to explore the association between male attendance at ANC with their pregnant partners and reproductive health care utilization outcomes, including adequate utilization (four or more visits) of ANC services, ANC visits during the first trimester (up to 12 weeks) of pregnancy, rate of blood and urine testing during pregnancy, rate of institutional delivery and utilization of postnatal check-up services. The results indicated that the rate of male attendance at ANC with their pregnant partners was 69.4%. After controlling for covariates, pregnant partners who were accompanied to ANC by their male partners were more likely to adequately utilize ANC services (AOR=1.42; 95% CI: 1.18-1.71), commence ANC visits even during the first trimester (AOR=1.21; 95% CI: 1.03-1.42), give birth at a health facility (AOR=1.23; 95% CI: 1.03-1.47) and present themselves for postnatal check-ups (AOR=1.24; 95% CI: 1.04-1.47) than those who were not accompanied by them. The study demonstrated that participation of male partners in ANC was positively associated with their pregnant partners' utilization of reproductive health care services in Afghanistan. The findings suggest that, to improve maternal and child health outcomes in the country, it would be worthwhile implementing interventions to encourage male partners to become more engaged in the ANC of their pregnant partners.
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18
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Thommesen T, Kismul H, Kaplan I, Safi K, Van den Bergh G. "The midwife helped me ... otherwise I could have died": women's experience of professional midwifery services in rural Afghanistan - a qualitative study in the provinces Kunar and Laghman. BMC Pregnancy Childbirth 2020; 20:140. [PMID: 32138695 PMCID: PMC7059669 DOI: 10.1186/s12884-020-2818-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 02/18/2020] [Indexed: 11/11/2022] Open
Abstract
Background Afghanistan has one of the world’s highest maternal mortality ratios, with more than 60% of women having no access to a skilled birth attendant in some areas. The main challenges for childbearing Afghan women are access to skilled birth attendance, emergency obstetric care and reliable contraception. The NGO-based project Advancing Maternal and Newborn Health in Afghanistan has supported education of midwives since 2002, in accordance with the national plan for midwifery education. The aim of this study is to explore women’s experiences of professional midwifery care in four villages in Afghanistan covered by the project, so as to reveal challenges and improve services in rural and conflict-affected areas of the country. Methods An exploratory case-study approach was adopted. Fourteen in-depth interviews and four focus-group discussions were conducted. A total of 39 women participated – 25 who had given birth during the last six months, 11 mothers-in-law and three community midwives in the provinces of Kunar and Laghman. Data generated by the interviews and observations was analysed using thematic content analysis. Findings Many of the women greatly valued the trained midwives’ life-saving experience, skills and care, and the latter were important reasons for choosing to give birth in a clinic. Women further appreciated midwives’ promotion of immediate skin-to-skin contact and breastfeeding. However, some women experienced rudeness, discrimination and negligence on the part of the midwives. Moreover, relatives’ disapproval, shame and problems with transport and security were important obstacles to women giving birth in the clinics. Conclusions Local recruitment and professional education of midwives as promoted by Afghan authorities and applied in the project seem successful in promoting utilisation and satisfaction with maternal and neonatal health services in rural Afghanistan. Nevertheless, the quality of the services is still lacking, with some women complaining of disrespectful care. There seems to be a need to focus more on communication issues during the education of midwives. An increased focus on in-service training and factors promoting quality care and respectful communication is necessary and should be prioritised.
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Affiliation(s)
- Trude Thommesen
- Centre for International Health, Department for Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
| | - Hallgeir Kismul
- Centre for International Health, Department for Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - Ian Kaplan
- Norwegian Afghanistan Committee, Kabul, Afghanistan
| | - Khadija Safi
- Norwegian Afghanistan Committee, Kabul, Afghanistan
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Christou A, Alam A, Sadat Hofiani SM, Rasooly MH, Mubasher A, Rashidi MK, Dibley MJ, Raynes-Greenow C. Understanding pathways leading to stillbirth: The role of care-seeking and care received during pregnancy and childbirth in Kabul province, Afghanistan. Women Birth 2020; 33:544-555. [PMID: 32094034 DOI: 10.1016/j.wombi.2020.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/20/2020] [Accepted: 02/12/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND The underlying pathways leading to stillbirth in low- and middle-income countries are not well understood. Context-specific understanding of how and why stillbirths occur is needed to prioritise interventions and identify barriers to their effective implementation and uptake. AIM To explore the contribution of contextual, individual, household-level and health system factors to stillbirth in Afghanistan. METHODS Using a qualitative approach, we conducted semi-structured in-depth interviews with women and men that experienced stillbirth, female elders, community health workers, healthcare providers, and government officials in Kabul province, Afghanistan between October-November 2017. We used thematic analysis to identify contributing factors and developed a conceptual map describing possible pathways to stillbirth. FINDINGS We found that low utilisation and access to healthcare was a key contributing factor, as were unmanaged conditions in pregnancy that increased women's risk of complications and stillbirth. Sociocultural factors related to the treatment of women and perceptions about medical interventions deprived women of interventions that could potentially prevent stillbirth. The quality of care from public and private providers during pregnancy and childbirth was a recurring concern exacerbated by health system constraints that led to unnecessary delays; while environmental factors linked to the ongoing conflict were also perceived to contribute to stillbirth. These pathways were underscored by social, cultural, economic factors and individual perceptions that contributed to the three-delays. DISCUSSION Efforts are needed at the community-level to facilitate care-seeking and raise awareness of stillbirth risk factors and the facility-level to strengthen antenatal and childbirth care quality, ensure culturally appropriate and respectful care, and reduce treatment delays.
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Affiliation(s)
- Aliki Christou
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Ashraful Alam
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Mohammad Hafiz Rasooly
- Afghanistan National Public Health Institute, Ministry of Public Health, Kabul, Afghanistan
| | | | | | - Michael J Dibley
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Camille Raynes-Greenow
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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20
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Villains or victims? An ethnography of Afghan maternity staff and the challenge of high quality respectful care. BMC Pregnancy Childbirth 2019; 19:307. [PMID: 31443691 PMCID: PMC6708168 DOI: 10.1186/s12884-019-2420-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 07/19/2019] [Indexed: 11/25/2022] Open
Abstract
Background Healthcare providers are the vital link between evidence-based policies and women receiving high quality maternity care. Explanations for suboptimal care often include poor working conditions for staff and a lack of essential supplies. Other explanations suggest that doctors, midwives and care assistants might lack essential skills or be unaware of the rights of the women for whom they care. This ethnography examined the everyday lives of maternal healthcare providers working in a tertiary maternity hospital in Kabul, Afghanistan between 2010 and 2012. The aim was to understand their notions of care, varying levels of commitment, and the obstacles and dilemmas that affected standards. Methods The culture of care was explored through six weeks of observation, 41 background interviews, 23 semi-structured interviews with doctors, midwives and care assistants. Focus groups were held with two diverse groups of women in community settings to understand their experiences and desires regarding care in maternity hospitals. Data were analysed thematically. Results Women related many instances of neglect, verbal abuse and demands for bribes from staff. Doctors and midwives concurred that they did not provide care as they had been taught and blamed the workload, lack of a shift system, insufficient supplies and inadequate support from management. Closer inspection revealed a complex reality where care was impeded by low levels of supplies and medicines but theft reduced them further; where staff were unfairly blamed by management but others flouted rules with impunity; and where motivated staff tried hard to work well but, when overwhelmed with the workload, admitted that they lost patience and shouted at women in childbirth. In addition there were extreme examples of both abusive and vulnerable staff. Conclusions Providing respectful quality maternity care for women in Afghanistan requires multifaceted initiatives because the factors leading to suboptimal care or mistreatment are complex and interrelated. Standards need enforcing and abusive practices confronting to provide a supportive, facilitating environment for both staff and childbearing women. Polarized perspectives such as ‘villain’ or ‘victim’ are unhelpful as they exclude the complex realities of human behaviour and consequently limit the scope of problem solving.
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Azimi MW, Yamamoto E, Saw YM, Kariya T, Arab AS, Sadaat SI, Farzad F, Hamajima N. Factors associated with antenatal care visits in Afghanistan: secondary analysis of Afghanistan Demographic and Health Survey 2015. NAGOYA JOURNAL OF MEDICAL SCIENCE 2019; 81:121-131. [PMID: 30962661 PMCID: PMC6433637 DOI: 10.18999/nagjms.81.1.121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Afghanistan is one of the countries with the poorest maternal mortality ratio in the world. Inadequate utilization of antenatal care (ANC) services increases the risk of maternal mortality. This study aimed to identify the factors associated with ANC visits in Afghanistan. The dataset of the Afghanistan Demographic and Health Survey (AfDHS) 2015 were used for taking the socio-demographic factors, cultural factors, and the number of ANC visits. The subjects of this study were 18,790 women who had at least one live birth in the last five years, and 10,554 women (56.2%) had availed of at least one ANC visit. Most women were 20-29 years old (53.3%), poor (41.7%), had 2–4 children (43.9%), lived in rural areas (76.1%), and had no education (85.0%) or no job (86.7%). Most women answered that husbands made a decision about their healthcare and that getting permission from their husbands was a major challenge. Multivariate analysis showed that age, ethnicity, area of residence, parity, women’s education, husband’s education, literacy, having a job, wealth, the decision maker for healthcare, and difficulty in getting permission from the husband were significantly correlated with availing of the ANC visits. This study showed that not only the socio-demographic factors but also the cultural factors were associated with ANC visits. The Afghanistan government should improve the education programs at schools and healthcare facilities, for both men and women. To augment women’s propensity to take a decision, the programs for women’s empowerment need to be supported and extended across the country.
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Affiliation(s)
- Mohammad Walid Azimi
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Monitoring Department, Ministry of Public Health, Kabul, Afghanistan
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yu Mon Saw
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Nagoya University Asian Satellite Campus Institute, Nagoya, Japan
| | - Tetsuyoshi Kariya
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Nagoya University Asian Satellite Campus Institute, Nagoya, Japan
| | - Ahmad Shekib Arab
- Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Tokyo, Japan
| | - Said Iftekhar Sadaat
- Research and Evaluation Department, Ministry of Public Health, Kabul, Afghanistan
| | - Fraidoon Farzad
- Chief of Staff Office, Ministry of Public Health, Kabul, Afghanistan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Downe S, Finlayson K, Tunçalp Ö, Gülmezoglu AM. Provision and uptake of routine antenatal services: a qualitative evidence synthesis. Cochrane Database Syst Rev 2019; 6:CD012392. [PMID: 31194903 PMCID: PMC6564082 DOI: 10.1002/14651858.cd012392.pub2] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Antenatal care (ANC) is a core component of maternity care. However, both quality of care provision and rates of attendance vary widely between and within countries. Qualitative research can assess factors underlying variation, including acceptability, feasibility, and the values and beliefs that frame provision and uptake of ANC programmes.This synthesis links to the Cochrane Reviews of the effectiveness of different antenatal models of care. It was designed to inform the World Health Organization guidelines for a positive pregnancy experience and to provide insights for the design and implementation of improved antenatal care in the future. OBJECTIVES To identify, appraise, and synthesise qualitative studies exploring:· Women's views and experiences of attending ANC; and factors influencing the uptake of ANC arising from women's accounts;· Healthcare providers' views and experiences of providing ANC; and factors influencing the provision of ANC arising from the accounts of healthcare providers. SEARCH METHODS To find primary studies we searched MEDLINE, Ovid; Embase, Ovid; CINAHL, EbscoHost; PsycINFO, EbscoHost; AMED, EbscoHost; LILACS, VHL; and African Journals Online (AJOL) from January 2000 to February 2019. We handsearched reference lists of included papers and checked the contents pages of 50 relevant journals through Zetoc alerts received during the searching phase. SELECTION CRITERIA We included studies that used qualitative methodology and that met our quality threshold; that explored the views and experiences of routine ANC among healthy, pregnant and postnatal women or among healthcare providers offering this care, including doctors, midwives, nurses, lay health workers and traditional birth attendants; and that took place in any setting where ANC was provided.We excluded studies of ANC programmes designed for women with specific complications. We also excluded studies of programmes that focused solely on antenatal education. DATA COLLECTION AND ANALYSIS Two authors undertook data extraction, logged study characteristics, and assessed study quality. We used meta-ethnographic and Framework techniques to code and categorise study data. We developed findings from the data and presented these in a 'Summary of Qualitative Findings' (SoQF) table. We assessed confidence in each finding using GRADE-CERQual. We used these findings to generate higher-level explanatory thematic domains. We then developed two lines of argument syntheses, one from service user data, and one from healthcare provider data. In addition, we mapped the findings to relevant Cochrane effectiveness reviews to assess how far review authors had taken account of behavioural and organisational factors in the design and implementation of the interventions they tested. We also translated the findings into logic models to explain full, partial and no uptake of ANC, using the theory of planned behaviour. MAIN RESULTS We include 85 studies in our synthesis. Forty-six studies explored the views and experiences of healthy pregnant or postnatal women, 17 studies explored the views and experiences of healthcare providers and 22 studies incorporated the views of both women and healthcare providers. The studies took place in 41 countries, including eight high-income countries, 18 middle-income countries and 15 low-income countries, in rural, urban and semi-urban locations. We developed 52 findings in total and organised these into three thematic domains: socio-cultural context (11 findings, five moderate- or high-confidence); service design and provision (24 findings, 15 moderate- or high-confidence); and what matters to women and staff (17 findings, 11 moderate- or high-confidence) The third domain was sub-divided into two conceptual areas; personalised supportive care, and information and safety. We also developed two lines of argument, using high- or moderate-confidence findings:For women, initial or continued use of ANC depends on a perception that doing so will be a positive experience. This is a result of the provision of good-quality local services that are not dependent on the payment of informal fees and that include continuity of care that is authentically personalised, kind, caring, supportive, culturally sensitive, flexible, and respectful of women's need for privacy, and that allow staff to take the time needed to provide relevant support, information and clinical safety for the woman and the baby, as and when they need it. Women's perceptions of the value of ANC depend on their general beliefs about pregnancy as a healthy or a risky state, and on their reaction to being pregnant, as well as on local socio-cultural norms relating to the advantages or otherwise of antenatal care for healthy pregnancies, and for those with complications. Whether they continue to use ANC or not depends on their experience of ANC design and provision when they access it for the first time.The capacity of healthcare providers to deliver the kind of high-quality, relationship-based, locally accessible ANC that is likely to facilitate access by women depends on the provision of sufficient resources and staffing as well as the time to provide flexible personalised, private appointments that are not overloaded with organisational tasks. Such provision also depends on organisational norms and values that overtly value kind, caring staff who make effective, culturally-appropriate links with local communities, who respect women's belief that pregnancy is usually a normal life event, but who can recognise and respond to complications when they arise. Healthcare providers also require sufficient training and education to do their job well, as well as an adequate salary, so that they do not need to demand extra informal funds from women and families, to supplement their income, or to fund essential supplies. AUTHORS' CONCLUSIONS This review has identified key barriers and facilitators to the uptake (or not) of ANC services by pregnant women, and in the provision (or not) of good-quality ANC by healthcare providers. It complements existing effectiveness reviews of models of ANC provision and adds essential insights into why a particular type of ANC provided in specific local contexts may or may not be acceptable, accessible, or valued by some pregnant women and their families/communities. Those providing and funding services should consider the three thematic domains identified by the review as a basis for service development and improvement. Such developments should include pregnant and postnatal women, community members and other relevant stakeholders.
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Affiliation(s)
- Soo Downe
- University of Central LancashireResearch in Childbirth and Health (ReaCH) unitPrestonUKPR1 2HE
| | - Kenneth Finlayson
- University of Central LancashireResearch in Childbirth and Health (ReaCH) unitPrestonUKPR1 2HE
| | - Özge Tunçalp
- World Health OrganizationUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research20 Avenue AppiaGenevaSwitzerland1211
| | - Ahmet Metin Gülmezoglu
- World Health OrganizationUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research20 Avenue AppiaGenevaSwitzerland1211
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Mumtaz S, Bahk J, Khang YH. Current status and determinants of maternal healthcare utilization in Afghanistan: Analysis from Afghanistan Demographic and Health Survey 2015. PLoS One 2019; 14:e0217827. [PMID: 31185028 PMCID: PMC6559709 DOI: 10.1371/journal.pone.0217827] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 05/21/2019] [Indexed: 12/02/2022] Open
Abstract
Background Advancing maternal health is central to global health policy-making; therefore, considerable efforts have been made to improve maternal health. Still, in many developing countries, particularly in Sub-Saharan Africa and South Asia, including Afghanistan, the maternal mortality ratio (MMR) remains high. The objective of this study was to examine the determinants and current status of the utilization of maternal healthcare in Afghanistan. Methods This study used the most recent data from the Afghanistan Demographic and Health Survey 2015. The unit of analysis for this study was women who had a live birth in the five years preceding the survey. The outcome variables were four or more antenatal care (ANC) visits, delivery assistance by a skilled birth attendant (SBA), and delivery by cesarean section (CS). The explanatory variables were basic sociodemographic characteristics of the mothers. We examined the sociodemographic characteristics of women utilizing ANC, SBA, and CS using descriptive statistics and estimated usage of ANC, SBA and CS after adjusting for maternal age and parity groups via direct standardization. Multivariable logistic regression models were employed to investigate the determinants of maternal healthcare variables. Results Overall, 17.8% of women attended four or more ANC visits, 53.6% utilized an SBA, and 3.4% of women gave birth through CS. Women’s education, wealth status, urbanity, autonomy, and availability of their own transport were found to be the major determinants of service utilization. Conclusions This study underscores low utilization of maternal healthcare services with wide disparities in Afghanistan and highlighted the need for an adequate health strategy and policy implementation to improve maternal healthcare uptake.
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Affiliation(s)
- Sarwat Mumtaz
- Department of Health Policy and Management, College of Medicine, Seoul National University, Seoul, South Korea
- Department of Health Policy and Management, School of Public Health, University of Hail, Hail, Kingdom of Saudi Arabia
| | - Jinwook Bahk
- Department of Public Health, Keimyung University, Daegu, South Korea
| | - Young-Ho Khang
- Department of Health Policy and Management, College of Medicine, Seoul National University, Seoul, South Korea
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea
- * E-mail:
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Aparicio M, Centeno C, Arantzamendi M. The significance of gratitude for palliative care professionals: a mixed method protocol. BMC Palliat Care 2019; 18:28. [PMID: 30898130 PMCID: PMC6427884 DOI: 10.1186/s12904-019-0412-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 03/01/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In palliative care (PC) patients and relatives (P/R) often show their gratitude to the healthcare professionals (HP) who care for them. HP appreciate these displays of gratitude, although the impact of the same has not been examined in detail. Publications analysed tell personal experiences in which HP say that displays of gratitude create sensations of well-being, pride and increased motivation to carry on caring. No systematic examination in PC was found. These aspects related to gratitude may be important in the field of PC, where there is constant exposure to suffering and the preoccupation which arises from wanting to help HP to go on with their work, but it needs closer study and systemisation. The purpose of this study is to understand the significance and the role of the gratitude received from P/R for palliative care health professionals (PCHP). METHODS A suitable mixed method will be used. The first phase will be quantitative and will consist of a survey, piloted by experts, whose goal is to explore the current situation in Spain as regards displays of gratitude received by HP at PC services. It will be sent by e-mail. The results from this part will be incorporated into the second part which will be qualitative and whose goal is to understand the significance of the experience of receiving displays of gratitude from the perspective of PCHP, using a phenomenological approach. Interviews will be undertaken amongst PCHP. The interview guide will be designed after taking the survey results into account. The project has been granted ethical approval. DISCUSSION These results are set to provide a key contribution within the context of the growing preoccupation on how to care for HP, how to ensure retention and keep them from resigning, as well as preventing burnout, emotional fatigue and boosting their resilience. In order to do this, it is both interesting and ground breaking, to analyse the repercussion of spontaneous gratitude shown by P/R towards PCHP, to see if this is a useful resource to reduce these problems and to encourage the greater presence of dignity and humanisation, for both those receiving care and for those providing it. This gratitude may be one of these strategies.
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Affiliation(s)
- Maria Aparicio
- Universidad de Navarra, ICS, ATLANTES, Campus Universitario, 31080, Pamplona, Spain
- Palliative Care Clinical Nurse Specialist at St Christopher’s Hospice, London, UK
| | - Carlos Centeno
- Universidad de Navarra, ICS, ATLANTES, Campus Universitario, 31080, Pamplona, Spain
- Clínica Universidad de Navarra, Servicio de cuidados paliativos, Av. Pio XII, 31008 Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - María Arantzamendi
- Universidad de Navarra, ICS, ATLANTES, Campus Universitario, 31080, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
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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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Wesson J, Hamunime N, Viadro C, Carlough M, Katjiuanjo P, McQuide P, Kalimugogo P. Provider and client perspectives on maternity care in Namibia: results from two cross-sectional studies. BMC Pregnancy Childbirth 2018; 18:363. [PMID: 30185161 PMCID: PMC6126026 DOI: 10.1186/s12884-018-1999-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 08/28/2018] [Indexed: 12/30/2022] Open
Abstract
Background Disrespectful and abusive maternity care is a complex phenomenon. In Namibia, HIV and high maternal mortality ratios make it vital to understand factors affecting maternity care quality. We report on two studies commissioned by Namibia’s Ministry of Health and Social Services. A health worker study examined cultural and structural factors that influence maternity care workers’ attitudes and practices, and a maternal and neonatal mortality study explored community perceptions about maternity care. Methods The health worker study involved medical officers, matrons, and registered or enrolled nurses working in Namibia’s 35 district and referral hospitals. The study included a survey (N = 281) and 19 focus group discussions. The community study conducted 12 focus groups in five southern regions with recently delivered mothers and relatives. Results Most participants in the health worker study were experienced maternity care nurses. One-third (31%) of survey respondents reported witnessing or knowing of client mistreatment at their hospital, about half (49%) agreed that “sometimes you have to yell at a woman in labor,” and a third (30%) agreed that pinching or slapping a laboring woman can make her push harder. Nurses were much more likely to agree with these statements than medical officers. Health workers’ commitment to babies’ welfare and stressful workloads were the two primary reasons cited to justify “harsh” behaviors. Respondents who were dissatisfied with their workload were twice as likely to approve of pinching or slapping. Half of the nurses surveyed (versus 14% of medical officers) reported providing care above or beneath their scope of work. The community focus group study identified 14 negative practices affecting clients’ maternity care experiences, including both systemic and health-worker-related practices. Conclusions Namibia’s public sector hospital maternity units confront health workers and clients with structural and cultural impediments to quality care. Negative interactions between health workers and laboring women were reported as common, despite high health worker commitment to babies’ welfare. Key recommendations include multicomponent interventions that address heavy workloads and other structural factors, educate communities and the media about maternity care and health workers’ roles, incorporate client-centered care into preservice education, and ensure ongoing health worker mentoring and supervision. Electronic supplementary material The online version of this article (10.1186/s12884-018-1999-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer Wesson
- IntraHealth International, 6340 Quadrangle Drive, Suite 200, Chapel Hill, NC, USA.
| | - Ndapewa Hamunime
- Ministry of Health and Social Services, Windhoek, Private Bag 13198, Namibia
| | | | - Martha Carlough
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Puumue Katjiuanjo
- Ministry of Health and Social Services, Windhoek, Private Bag 13198, Namibia
| | - Pamela McQuide
- IntraHealth International, 351 Dr. Sam Nujoma Dr., Klein Windhoek, Windhoek, Namibia
| | - Pearl Kalimugogo
- IntraHealth International, 351 Dr. Sam Nujoma Dr., Klein Windhoek, Windhoek, Namibia
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Naziri M, Higgins-Steele A, Anwari Z, Yousufi K, Fossand K, Amin SS, Hipgrave DB, Varkey S. Scaling up newborn care in Afghanistan: opportunities and challenges for the health sector. Health Policy Plan 2018; 33:271-282. [PMID: 29190374 DOI: 10.1093/heapol/czx136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2017] [Indexed: 11/13/2022] Open
Abstract
Newborn health in Afghanistan is receiving increased attention, but reduction in newborn deaths there has not kept pace with declines in maternal and child mortality. Using the continuum of care and health systems building block frameworks, this article identifies, organizes and provides a synthesis of the available evidence on and gaps in coverage of care and health systems, programmes, policies and practices related to newborn health in Afghanistan. Newborn mortality in Afghanistan is related to the nation's weak health system, itself associated with decades of conflict, low and uneven coverage of essential interventions, demand-side and cultural specificities, and compromised quality. A majority of deliveries still take place at home. Birth asphyxia, low birth weight, perinatal infections and poor post-natal care are responsible for many preventable newborn deaths. Though the situation has improved, there remain many opportunities to accelerate progress. Analyses conducted using the Lives Saved Tools suggest that an additional 10 405 newborn lives could be saved in Afghanistan in 5 years (2015-20), through reasonable increases in coverage of these high-impact interventions. A long-term vision and strong leadership are essential for the Ministry of Public Health to play an effective stewardship role in formulating related policy and strategy, setting standards and monitoring maternal and newborn services. Promotion of equitable access to health services, including health workforce planning, development and management, and the coordination of much-needed donor support are also imperative.
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Affiliation(s)
- Malalai Naziri
- UNICEF Afghanistan, Health Section, UNOCA Jalalabad Road, Kabul, Afghanistan
| | | | - Zelaikha Anwari
- Ministry of Public Health, Reproductive, Maternal, Newborn, Child, and Adolescent Directorate, Kabul, Afghanistan and
| | - Khaksar Yousufi
- UNICEF Afghanistan, Health Section, UNOCA Jalalabad Road, Kabul, Afghanistan
| | | | | | - David B Hipgrave
- UNICEF Afghanistan, Health Section, UNOCA Jalalabad Road, Kabul, Afghanistan
| | - Sherin Varkey
- UNICEF Afghanistan, Health Section, UNOCA Jalalabad Road, Kabul, Afghanistan
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Yevoo LL, Agyepong IA, Gerrits T, van Dijk H. Mothers' reproductive and medical history misinformation practices as strategies against healthcare providers' domination and humiliation in maternal care decision-making interactions: an ethnographic study in Southern Ghana. BMC Pregnancy Childbirth 2018; 18:274. [PMID: 29970029 PMCID: PMC6029400 DOI: 10.1186/s12884-018-1916-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 06/24/2018] [Indexed: 11/10/2022] Open
Abstract
Background Pregnant women can misinform or withhold their reproductive and medical information from providers when they interact with them during care decision-making interactions, although, the information clients reveal or withhold while seeking care plays a critical role in the quality of care provided. This study explored ‘how’ and ‘why’ pregnant women in Ghana control their past obstetric and reproductive information as they interact with providers at their first antenatal visit, and how this influences providers’ decision-making at the time and in subsequent care encounters. Methods This research was a case-study of two public hospitals in southern Ghana, using participant observation, conversations, interviews and focus group discussions with antenatal, delivery, and post-natal clients and providers over a 22-month period. The Ghana Health Service Ethical Review Committee gave ethical approval for the study (Ethical approval number: GHS-ERC: 03/01/12). Data analysis was conducted according to grounded theory. Results Many of the women in this study selectively controlled the reproductive, obstetric and social history information they shared with their provider at their first visit. They believed that telling a complete history might cause providers to verbally abuse them and they would be regarded in a negative light. Examples of the information controlled included concealing the actual number of children or self-induced abortions. The women adopted this behaviour as a resistance strategy to mitigate providers’ disrespectful treatment through verbal abuses and questioning women’s practices that contradicted providers’ biomedical ideologies. Secondly, they utilised this strategy to evade public humiliation because of inadequate privacy in the hospitals. The withheld information affected quality of care decision-making and care provision processes and outcomes, since misinformed providers were unaware of particular women’s risk profile. Conclusion Many mothers in this study withhold or misinform providers about their obstetric, reproductive and social information as a way to avoid receiving disrespectful maternal care and protect their privacy. Improving provider client relationship skills, empowering clients and providing adequate infrastructure to ensure privacy and confidentiality in hospitals, are critical to the provision of respectful maternal care. Electronic supplementary material The online version of this article (10.1186/s12884-018-1916-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Linda L Yevoo
- Sociology of Development and Change Group, Wageningen University, P. O. Box 8130, Hollandsweg 1, 6700 EW, Wageningen, Netherlands. .,Dodowa Health Research Centre, Research & Development Division, Ghana Health Service, P. O. Box DD 1, Dodowa-Accra, Ghana.
| | - Irene A Agyepong
- Dodowa Health Research Centre, Research & Development Division, Ghana Health Service, P. O. Box DD 1, Dodowa-Accra, Ghana
| | - Trudie Gerrits
- Graduate School of Social Sciences, Kloveiersburgwal 48 1012 CX Amsterdam, University of Amsterdam, Amsterdam, Netherlands
| | - Han van Dijk
- Sociology of Development and Change Group, Wageningen University, P. O. Box 8130, Hollandsweg 1, 6700 EW, Wageningen, Netherlands
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Dynes MM, Twentyman E, Kelly L, Maro G, Msuya AA, Dominico S, Chaote P, Rusibamayila R, Serbanescu F. Patient and provider determinants for receipt of three dimensions of respectful maternity care in Kigoma Region, Tanzania-April-July, 2016. Reprod Health 2018; 15:41. [PMID: 29506559 PMCID: PMC5838967 DOI: 10.1186/s12978-018-0486-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lack of respectful maternity care (RMC) is increasingly recognized as a human rights issue and a key deterrent to women seeking facility-based deliveries. Ensuring facility-based RMC is essential for improving maternal and neonatal health, especially in sub-Saharan African countries where mortality and non-skilled delivery care remain high. Few studies have attempted to quantitatively identify patient and delivery factors associated with RMC, and none has modeled the influence of provider characteristics on RMC. This study aims to help fill these gaps through collection and analysis of interviews linked between clients and providers, allowing for description of both patient and provider characteristics and their association with receipt of RMC. METHODS We conducted cross-sectional surveys across 61 facilities in Kigoma Region, Tanzania, from April to July 2016. Measures of RMC were developed using 21-items in a Principal Components Analysis (PCA). We conducted multilevel, mixed effects generalized linear regression analyses on matched data from 249 providers and 935 post-delivery clients. The outcomes of interest included three dimensions of RMC-Friendliness/Comfort/Attention; Information/Consent; and Non-abuse/Kindness-developed from the first three components of PCA. Significance level was set at p < 0.05. RESULTS Significant client-level determinants for perceived Friendliness/Comfort/Attention RMC included age (30-39 versus 15-19 years: Coefficient [Coef] 0.63; 40-49 versus 15-19 years: Coef 0.79) and self-reported complications (reported complications versus did not: Coef - 0.41). Significant provider-level determinants included perception of fair pay (Perceives fair pay versus unfair pay: Coef 0.46), cadre (Nurses/midwives versus Clinicians: Coef - 0.46), and number of deliveries in the last month (11-20 versus < 11 deliveries: Coef - 0.35). Significant client-level determinants for Information/Consent RMC included labor companionship (Companion versus none: Coef 0.37) and religiosity (Attends services at least weekly versus less often: Coef - 0.31). Significant provider-level determinants included perception of fair pay (Perceives fair pay versus unfair: Coef 0.37), weekly work hours (Coef 0.01), and age (30-39 versus 20-29 years: Coef - 0.34; 40-49 versus 20-29 years: Coef - 0.58). Significant provider-level determinants for Non-abuse/Kindness RMC included the predictors of age (age 50+ versus 20-29 years: Coef 0.34) and access to electronic mentoring (Access to two mentoring types versus none: Coef 0.37). CONCLUSIONS These findings illustrate the value of including both client and provider information in the analysis of RMC. Strategies that address provider-level determinants of RMC (such as equitable pay, work environment, access to mentoring platforms) may improve RMC and subsequently address uptake of facility delivery.
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Affiliation(s)
- M. M. Dynes
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - E. Twentyman
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - L. Kelly
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - G. Maro
- Bloomberg Philanthropies Tanzania, Kigoma, Tanzania
| | | | | | - P. Chaote
- Kigoma Region Ministry of Health, Kigoma, Tanzania
| | - R. Rusibamayila
- Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Tanzania
| | - F. Serbanescu
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
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Gopalan SS, Das A, Howard N. Maternal and neonatal service usage and determinants in fragile and conflict-affected situations: a systematic review of Asia and the Middle-East. BMC Womens Health 2017; 17:20. [PMID: 28298198 PMCID: PMC5353776 DOI: 10.1186/s12905-017-0379-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 03/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fragile and conflict-affected situations (FCS) in Asia and the Middle-East contribute significantly to global maternal and neonatal deaths. This systematic review explored maternal and neonatal health (MNH) services usage and determinants in FCS in Asia and the Middle-East to inform policy on health service provision in these challenging settings. METHODS This systematic review was conducted using a standardised protocol. Pubmed, Embase, Web of Science, and selected development agency websites were searched for studies meeting inclusion criteria. Studies were assessed for methodological quality using an adapted evaluation tool. Qualitative and quantitative data were synthesized and pooled odds ratios generated for meta-analysis of service-usage determinants. RESULTS Of 18 eligible peer-reviewed studies, eight were from Nepal, four from Afghanistan, and two each from Iraq, Yemen, and the Palestinian Territories. Fragile situations provide limited evidence on emergency obstetric care, postnatal care, and newborn services. Usage of MNH services was low in all FCS, irrespective of economic growth level. Demand-side determinants of service-usage were transportation, female education, autonomy, health awareness, and ability-to-pay. Supply-side determinants included service availability and quality, existence of community health-workers, costs, and informal payments in health facilities. Evidence is particularly sparse on MNH in acute crises, and remains limited in fragile situations generally. CONCLUSIONS Findings emphasize that poor MNH status in FCS is a leading contributor to the burden of maternal and neonatal ill-health in Asia and the Middle-East. Essential services for skilled birth attendance and emergency obstetric, newborn, and postnatal care require improvement in FCS. FCS require additional resources and policy attention to address the barriers to appropriate MNH care. Authors discuss the 'targeted policy approach for vulnerable groups' as a means of addressing MNH service usage inequities.
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Affiliation(s)
- Saji S. Gopalan
- London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | | | - Natasha Howard
- London School of Hygiene and Tropical Medicine (LSHTM), London, UK
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Dickson KS, Darteh EKM, Kumi-Kyereme A. Providers of antenatal care services in Ghana: evidence from Ghana demographic and health surveys 1988-2014. BMC Health Serv Res 2017; 17:203. [PMID: 28288647 PMCID: PMC5348873 DOI: 10.1186/s12913-017-2145-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 03/08/2017] [Indexed: 11/10/2022] Open
Abstract
Background Antenatal care is one of the three most essential care - antenatal, delivery and post-natal, given to women during pregnancy and has the potential to contribute towards the achievement of the Sustainable Development Goal (SDG) target 3.1- reducing the global maternal mortality ratio to less than 70 per 100,000 and target 3.8 – achieve universal health coverage. The main objective is to examine the contribution of the various providers of antenatal care services in Ghana from 1988 to 2014. Methods The study uses data from all the six rounds of the Ghana Demographic and Health Survey (GDHS). Binary logistic regression models were applied to examine the association between background characteristics of respondents and providers of antenatal care services. Results The results show that majority of antenatal care services were provided by nurses over the period under review. The proportion of women who received antenatal care services from nurses improved over the period from 55% in 1988 to 89.5% in 2014. Moreover, there was a decline in antenatal care services provided by traditional birth attendants and women who did not receive antenatal care services from any service provider over the years under review. It was observed that women from rural areas were more likely to utilise antenatal care services provided by traditional birth attendants, whilst those from urban areas were more likely to utilise antenatal care from doctors and nurses. Conclusion To further improve access to and utilisation of antenatal care services provided by nurses and doctors it is recommended that the Ghana Health Service and the Ministry of Health should put in place systems aimed at improving on the quality of care given such as regular training workshops for health personnel and assessment of patient’s satisfaction with services provided. Also, they should encourage women in rural areas especially those from the savannah zone to utilise antenatal care services from skilled providers through social and behaviour change communication campaigns.
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Affiliation(s)
| | | | - Akwasi Kumi-Kyereme
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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Return Migrants' Experience of Access to Care in Corrupt Healthcare Systems: The Bosnian Example. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13090924. [PMID: 27657096 PMCID: PMC5036757 DOI: 10.3390/ijerph13090924] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 09/08/2016] [Accepted: 09/13/2016] [Indexed: 11/18/2022]
Abstract
Equal and universal access to healthcare services is a core priority for a just health system. A key societal determinant seen to create inequality in access to healthcare is corruption in the healthcare system. How return migrants’ access to healthcare is affected by corruption is largely unstudied, even though return migrants may be particularly vulnerable to problems related to corruption due to their period of absence from their country of origin. This article investigates how corruption in the healthcare sector affects access to healthcare for refugees who repatriated to Bosnia, a country with a high level of corruption, from Denmark, a country with a low level of corruption. The study is based on 18 semi-structured interviews with 33 refugees who returned after long-term residence in Denmark. We found that the returned refugees faced greater problems with corruption than was the case for those who had not left the country, as doctors considered them to be better endowed financially and therefore demanded larger bribes from them than they did from those who had remained in Bosnia. Moreover, during their stay abroad the returnees had lost the connections that could have helped them sidestep the corruption. Returned refugees are thus particularly vulnerable to the effects of corruption.
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Filby A, McConville F, Portela A. What Prevents Quality Midwifery Care? A Systematic Mapping of Barriers in Low and Middle Income Countries from the Provider Perspective. PLoS One 2016; 11:e0153391. [PMID: 27135248 PMCID: PMC4852911 DOI: 10.1371/journal.pone.0153391] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 03/29/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Quality of care is essential for further progress in reducing maternal and newborn deaths. The integration of educated, trained, regulated and licensed midwives into the health system is associated with improved quality of care and sustained decreases in maternal and newborn mortality. To date, research on barriers to quality of care for women and newborns has not given due attention to the care provider's perspective. This paper addresses this gap by presenting the findings of a systematic mapping of the literature of the social, economic and professional barriers preventing midwifery personnel in low and middle income countries (LMICs) from providing quality of care. METHODS AND FINDINGS A systematic search of five electronic databases for literature published between January 1990 and August 2013. Eligible items included published and unpublished items in all languages. Items were screened against inclusion and exclusion criteria, yielding 82 items from 34 countries. 44% discussed countries or regions in Africa, 38% in Asia, and 5% in the Americas. Nearly half the articles were published since 2011. Data was extracted and presented in a narrative synthesis and tables. Items were organized into three categories; social; economic and professional barriers, based on an analytical framework. Barriers connected to the socially and culturally constructed context of childbirth, although least reported, appear instrumental in preventing quality midwifery care. CONCLUSIONS Significant social and cultural, economic and professional barriers can prevent the provision of quality midwifery care in LMICs. An analytical framework is proposed to show how the overlaps between the barriers reinforce each other, and that they arise from gender inequality. Links are made between burn out and moral distress, caused by the barriers, and poor quality care. Ongoing mechanisms to improve quality care will need to address the barriers from the midwifery provider perspective, as well as the underlying gender inequality.
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Affiliation(s)
- Alex Filby
- National Health Service of England and Wales, The Whittington Hospital, London, United Kingdom
| | - Fran McConville
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
- * E-mail:
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
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Afulani PA, Moyer C. Explaining Disparities in Use of Skilled Birth Attendants in Developing Countries: A Conceptual Framework. PLoS One 2016; 11:e0154110. [PMID: 27105309 PMCID: PMC4841546 DOI: 10.1371/journal.pone.0154110] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/08/2016] [Indexed: 11/18/2022] Open
Abstract
Despite World Health Organization recommendations that all women deliver with a skilled birth attendant (SBA), research continues to demonstrate large disparities in use of SBAs by socioeconomic status (SES). Yet few quantitative studies empirically examine the factors underlying these disparities, due in part to the fact that current models do not provide clear pathways-with measurable mediators-for how distal factors like SES may affect maternal health-seeking behaviors like delivering with SBAs. We propose the Disparities in Skilled Birth Attendance (DiSBA) framework for examining the determinants of use of SBAs. We posit that three proximal factors directly affect use of SBAs: perceived need, perceived accessibility of maternal health services, and perceived quality of care. Distal factors like SES affect use of SBAs indirectly through these proximal factors, and the effects can be measured. We test the assumptions of the DiSBA framework using data from the Ghana Maternal Health Survey. The analytic techniques we use include logistic regression with mediation analysis to examine the intervening effects. We find that our proxies for perceived access, perceived need, and perceived quality of care account for approximately 23% of the difference between women with no education and those with primary school education, and about 55% of the difference between women in the lowest wealth quintile and those in the middle wealth quintiles. This study suggests that proximal factors are worthy of increased attention in terms of measurement, data collection, analysis, programmatic efforts, and policy interventions, as these factors are potentially more amenable to change than the distal factors. The effects of proximal factors are also likely context specific, thus sufficient understanding in different contexts is essential to developing appropriate interventions.
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Affiliation(s)
- Patience A. Afulani
- Department of Obstetrics, Gynecology, & Reproductive Sciences, School of medicine, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Cheryl Moyer
- Departments of Learning Health Sciences and Obstetrics & Gynecology and Global REACH, University of Michigan, Ann Arbor, Michigan, United States of America
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Nisar YB, Aurangzeb B, Dibley MJ, Alam A. Qualitative exploration of facilitating factors and barriers to use of antenatal care services by pregnant women in urban and rural settings in Pakistan. BMC Pregnancy Childbirth 2016; 16:42. [PMID: 26931205 PMCID: PMC4772650 DOI: 10.1186/s12884-016-0829-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 02/16/2016] [Indexed: 11/23/2022] Open
Abstract
Background World Health Organisation recommends that pregnant women with no complications should visit a healthcare provider at least four times to receive sufficient antenatal care services. In Pakistan only 37 % of women reported to have had four or more antenatal care visits during their last pregnancy. This study aimed to explore facilitators and barriers to use of antenatal care services in rural and urban communities of two selected districts in Pakistan. Methods Qualitative explorative study using in-depth interviews with currently pregnant women, lady health workers and doctors providing antenatal care services, and focus group discussion with women who had a child aged 5 years or younger, was conducted in a rural community in the district Swabi and in a tertiary care hospital in urban Islamabad in Pakistan. The audio-recorded interviews and discussions were transcribed verbatim in Urdu (the language spoken by the respondents). A list of topical codes for all topics related to the research questions was developed. Subsequently the text pertaining to each topical code was discussed and summarised in a document that presented the findings for each topic using quotes and tables. Results We conducted in-depth interviews with six lady health workers, four doctors, and ten currently pregnant women, and facilitated ten focus group discussions with women who had a child aged 5 years or younger. Currently pregnant women, and women who had a child aged 5 years or younger, were not aware of the recommended minimum number of antenatal care visits to be made during pregnancy. Facilitating factors to visit a particular health care facility were: availability of qualified healthcare providers (private facility); trust in healthcare providers; recommendation from a family member, friend or lady health worker (in rural areas); availability of good quality services including medical equipment and laboratory facilities; low cost (public facility); and easy access to the health facility (private facility). Common barriers to visiting a health facility for antenatal care services were: financial limitations; perceived absence of any major health problems during pregnancy; difficulties in reaching the health facility; restriction from husband or mother-in-law; busy performing household chores; no previous experience of antenatal care visits; and perceived unavailability of healthcare providers and/or services. Conclusions The current study identified several policy-relevant facilitating factors and barriers to visiting a health facility for antenatal care services as reported by urban and rural women, and healthcare providers. There is a need to formulate and implement intervention packages based on these findings to increase the coverage of the recommended four antenatal care visits in Pakistan. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-0829-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yasir Bin Nisar
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia. .,United Nations Office for Project Services (UNOPS), UN Compound, Diplomatic Enclave, Islamabad, Pakistan.
| | - Brekhna Aurangzeb
- Children's Hospital, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Michael J Dibley
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Ashraful Alam
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
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Attitudes and behaviours of maternal health care providers in interactions with clients: a systematic review. Global Health 2015; 11:36. [PMID: 26276053 PMCID: PMC4537564 DOI: 10.1186/s12992-015-0117-9] [Citation(s) in RCA: 204] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 06/30/2015] [Indexed: 11/10/2022] Open
Abstract
Background High maternal mortality and morbidity persist, in large part due to inadequate access to timely and quality health care. Attitudes and behaviours of maternal health care providers (MHCPs) influence health care seeking and quality of care. Methods Five electronic databases were searched for studies from January 1990 to December 2014. Included studies report on types or impacts of MHCP attitudes and behaviours towards their clients, or the factors influencing these attitudes and behaviours. Attitudes and behaviours mentioned in relation to HIV infection, and studies of health providers outside the formal health system, such as traditional birth attendants, were excluded. Findings Of 967 titles and 412 abstracts screened, 125 full-text papers were reviewed and 81 included. Around two-thirds used qualitative methods and over half studied public-sector facilities. Most studies were in Africa (n = 55), followed by Asia and the Pacific (n = 17). Fifty-eight studies covered only negative attitudes or behaviours, with a minority describing positive provider behaviours, such as being caring, respectful, sympathetic and helpful. Negative attitudes and behaviours commonly entailed verbal abuse (n = 45), rudeness such as ignoring or ridiculing patients (n = 35), or neglect (n = 32). Studies also documented physical abuse towards women, absenteeism or unavailability of providers, corruption, lack of regard for privacy, poor communication, unwillingness to accommodate traditional practices, and authoritarian or frightening attitudes. These behaviours were influenced by provider workload, patients’ attitudes and behaviours, provider beliefs and prejudices, and feelings of superiority among MHCPs. Overall, negative attitudes and behaviours undermined health care seeking and affected patient well-being. Conclusions The review documented a broad range of negative MHCP attitudes and behaviours affecting patient well-being, satisfaction with care and care seeking. Reported negative patient interactions far outweigh positive ones. The nature of the factors which influence health worker attitudes and behaviours suggests that strengthening health systems, and workforce development, including in communication and counselling skills, are important. Greater attention is required to the attitudes and behaviours of MHCPs within efforts to improve maternal health, for the sake of both women and health care providers. Electronic supplementary material The online version of this article (doi:10.1186/s12992-015-0117-9) contains supplementary material, which is available to authorized users.
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Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, Aguiar C, Saraiva Coneglian F, Diniz ALA, Tunçalp Ö, Javadi D, Oladapo OT, Khosla R, Hindin MJ, Gülmezoglu AM. The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review. PLoS Med 2015; 12:e1001847; discussion e1001847. [PMID: 26126110 PMCID: PMC4488322 DOI: 10.1371/journal.pmed.1001847] [Citation(s) in RCA: 746] [Impact Index Per Article: 82.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 05/22/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Despite growing recognition of neglectful, abusive, and disrespectful treatment of women during childbirth in health facilities, there is no consensus at a global level on how these occurrences are defined and measured. This mixed-methods systematic review aims to synthesize qualitative and quantitative evidence on the mistreatment of women during childbirth in health facilities to inform the development of an evidence-based typology of the phenomenon. METHODS AND FINDINGS We searched PubMed, CINAHL, and Embase databases and grey literature using a predetermined search strategy to identify qualitative, quantitative, and mixed-methods studies on the mistreatment of women during childbirth across all geographical and income-level settings. We used a thematic synthesis approach to synthesize the qualitative evidence and assessed the confidence in the qualitative review findings using the CERQual approach. In total, 65 studies were included from 34 countries. Qualitative findings were organized under seven domains: (1) physical abuse, (2) sexual abuse, (3) verbal abuse, (4) stigma and discrimination, (5) failure to meet professional standards of care, (6) poor rapport between women and providers, and (7) health system conditions and constraints. Due to high heterogeneity of the quantitative data, we were unable to conduct a meta-analysis; instead, we present descriptions of study characteristics, outcome measures, and results. Additional themes identified in the quantitative studies are integrated into the typology. CONCLUSIONS This systematic review presents a comprehensive, evidence-based typology of the mistreatment of women during childbirth in health facilities, and demonstrates that mistreatment can occur at the level of interaction between the woman and provider, as well as through systemic failures at the health facility and health system levels. We propose this typology be adopted to describe the phenomenon and be used to develop measurement tools and inform future research, programs, and interventions.
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Affiliation(s)
- Meghan A. Bohren
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Joshua P. Vogel
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Erin C. Hunter
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Olha Lutsiv
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Suprita K. Makh
- Population Services International, Washington, D. C., United States of America
| | - João Paulo Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Carolina Aguiar
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Fernando Saraiva Coneglian
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Alex Luíz Araújo Diniz
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Özge Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Dena Javadi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Olufemi T. Oladapo
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Rajat Khosla
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Michelle J. Hindin
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - A. Metin Gülmezoglu
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
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Ahmadi Q, Danesh H, Makharashvili V, Mishkin K, Mupfukura L, Teed H, Huff-Rousselle M. SWOT analysis of program design and implementation: a case study on the reduction of maternal mortality in Afghanistan. Int J Health Plann Manage 2015; 31:247-59. [PMID: 25950757 DOI: 10.1002/hpm.2288] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This case study analyzes the design and implementation of the Basic Package of Health Services (BPHS) in Afghanistan by synthesizing the literature with a focus on maternal health services. The authors are a group of graduate students in the Brandeis University International Health Policy and Management Program and Sustainable International Development Program who used the experience in Afghanistan to analyze an example of successfully implementing policy; two of the authors are Afghan physicians with direct experience in implementing the BPHS. Data is drawn from a literature review, and a unique aspect of the case study is the application of the business-oriented SWOT analysis to the design and implementation of the program that successfully targeted lowering maternal mortality in Afghanistan. It provides a useful example of how SWOT analysis can be used to consider the reasons for, or likelihood of, successful or unsuccessful design and implementation of a policy or program. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Qudratullah Ahmadi
- Ministry of Higher Education, University Medical School, Kandahar, Afghanistan
| | - Homayoon Danesh
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, USA
| | - Vasil Makharashvili
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, USA
| | - Kathryn Mishkin
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, USA
| | - Lovemore Mupfukura
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, USA
| | - Hillary Teed
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, USA
| | - Maggie Huff-Rousselle
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, USA.,Massachusetts College of Pharmacy, Boston, MA, USA
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Howard N, Woodward A, Patel D, Shafi A, Oddy L, ter Veen A, Atta N, Sondorp E, Roberts B. Perspectives on reproductive healthcare delivered through a basic package of health services in Afghanistan: a qualitative study. BMC Health Serv Res 2014; 14:359. [PMID: 25167872 PMCID: PMC4169831 DOI: 10.1186/1472-6963-14-359] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 08/19/2014] [Indexed: 12/04/2022] Open
Abstract
Background Contracting-out non-state providers to deliver a minimum package of essential health services is an increasingly common health service delivery mechanism in conflict-affected settings, where government capacity and resources are particularly constrained. Afghanistan, the longest-running example of Basic Package of Health Services (BPHS) contracting in a conflict-affected setting, enables study of how implementation of a national intervention influences access to prioritised health services. This study explores stakeholder perspectives of sexual and reproductive health (SRH) services delivered through the BPHS in Afghanistan, using Bamyan Province as a case study. Methods Twenty-six in-depth interviews were conducted with health-system practitioners (e.g. policy/regulatory, middle management, frontline providers) and four focus groups with service-users. Inductive thematic coding used the WHO Health System Framework categories (i.e. service delivery, workforce, medicines, information, financing, stewardship), while allowing for emergent themes. Results Improvements were noted by respondents in all health-system components discussed, with significant improvements identified in service coverage and workforce, particularly improved gender balance, numbers, training, and standardisation. Despite improvements, remaining weaknesses included service access and usage - especially in remote areas, staff retention, workload, and community accountability. Conclusions By including perspectives on SRH service provision and BPHS contracting across health-system components and levels, this study contributes to broader debates on the effects of contracting on perceptions and experiences among practitioners and service-users in conflict-affected countries.
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Affiliation(s)
- Natasha Howard
- London School of Hygiene and Tropical Medicine, London, UK.
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