An integrative review of home care recommendations for women after caesarean section

AIM

To describe home-based care and practices recommended for mothers after caesarean section (CS), existing in the literature.

DESIGN

Systematic review.

METHODS

This integrative literature review was conducted by using Google Scholar, PubMed and Hinari databases from its inception to June 2021. The search included research articles, protocols and guidelines that describe home care practice after CS and assessed for their quality. Synthesis of recommendations from the included literature was classified based on the type of study design, and the review was guided by methodology registered in Prospero (ID CRD42021276905).

RESULTS

A total of 681 literatures were found, and 12 met the criteria. Recommended home care components were divided into four major categories; wound care practice (wound cleaning, drying and bandage change); nutrition (high-protein diet, vitamin C, fibre and balanced diet); exercise (pelvic floor muscle, walking and breathing exercise) and hygiene (bathing and wearing clean clothes). There was limited literature addressing the components of perineal care and home environment. Varying recommendations were found regarding wound cleaning and dressing in the studies done in low- and high-income countries.

Electronic medical record systems data use in decision-making and associated factors among health managers at public primary health facilities, Dodoma region: a cross-sectional analytical study

Background

Tanzania has shown some improvements in the adoption of electronic medical record (EMR) systems in public health facilities; however, the rate of utilization of data generated from EMRs among health managers is not well documented. This study aims to assess the use of electronic medical record systems data in decision-making among health managers at public primary health facilities in Dodoma Region, Central Tanzania.

Methods

A facility-based quantitative cross-sectional analytical study was conducted among 308 randomly selected health managers. A self-administered questionnaire supplemented with documentary review was used. Descriptive summary statistics and bivariable and multivariable logistic regression analyses (crude and adjusted odds ratios) were used. A P-value of <0.05 was used to declare statistically significant associations.

Results

Overall, more than a third (40.6%) of the health managers, that is 174 of the 308 included in the study, reported using data generated by EMR systems in decision-making. One-third (33.4%) of the health managers were adequately using data generated by EMR systems, of which 39.3% used data to support continuous quality improvement initiatives. Among the facilities visited, only nine (30%) had good documented EMR systems data use. Access to computers [adjusted odds ratio (AOR) = 4.72, 95% confidence interval (CI): 1.65, 13.48, p-value (p) = 0.004] and discussions on EMRs during meetings (AOR = 2.77, 95% CI: 1.01, 7.58, p = 0.047) were independent predictors of EMR system data use. Those who reported having EMR systems in all working areas were seven times more likely to use EMR system data (AOR = 7.23, 95% CI: 3.15, 16.59, p = 0.001). The respondents with good perceived EMR system information quality were more likely to use EMR system data (AOR = 2.84, 95% CI: 1.50, 5.39, p = 0.001) than those with poor perception. Furthermore, health managers who had excellent knowledge of computers and data use had higher odds of using EMR system data (AOR = 1.84, 95% CI: 3.38, 10.13, p = 0.001) compared with their counterparts.

Conclusions

The findings of this study indicate that utilization of EMR system data in decision-making among health managers was optimal. It was found that training in itself is insufficient to improve use of EMR, which points to more organizational aspects of work routine as a challenge. Hence, a comprehensive approach that addresses these factors is essential for maximizing EMR system data use in decision-making.

Protocol for designing and testing the effectiveness of a post caesarean section home care guide in preventing surgical site infection in Central Tanzania

BACKGROUND

The advantages of caesarean section (CS) in managing obstetric emergencies are abundant, but it is associated with several complications including surgical site infection (SSI). SSI significantly contributes to maternal morbidity and mortality rates. Mothers often do not receive adequate information about their at-home post-delivery care. Also, guidelines on post-CS care worldwide typically do not include home care recommendations. Because of the increased rate of CS and space constraints in the hospitals, mothers are often discharged home within 48 hours after CS. Therefore, it is anticipated that using an evidence-based home care guide would provide instruction to the mothers and is likely to prevent postpartum complications and promote the well-being of both the mother and the newborn.

AIM

To design and test the effectiveness of a post-CS home care guide in preventing SSI in central Tanzania.

METHODOLOGY

This is a sequential exploratory mixed-method interventional study conducted in two regional referral hospitals in central Tanzania. A qualitative study will be conducted to explore the experiences of nurse midwives, mothers who had caesarean deliveries and their caretakers regarding the care of mothers and newborns at home. The findings will inform the development of a post-CS home care guide. Following a series of validations of the guide, research assistants will employ the guidelines to instruct post-CS mothers about home care as part of the intervention. Thirty participants will purposively be recruited for the qualitative study and a random sample of 248 nurse-midwives and 414 post-CS mothers to assess the effectiveness of the guide in improving knowledge of home care and preventing SSI. SPSS version 25 will be used to analyse quantitative data and content analysis, and ATLAS.ti will guide in analysing the qualitative data.

CONCLUSION

The post-CS home care guide will provide instructions to post-CS mothers and their caretakers about the care of the mothers after CS to enhance their recovery.

Sociocultural practices and beliefs during pregnancy, childbirth, and postpartum among indigenous pastoralist women of reproductive age in Manyara, Tanzania: a descriptive qualitative study

BACKGROUND

Despite interventions improving maternal and newborn morbidity and mortality, progress has been sluggish, especially in hard-to-reach indigenous communities. Sociocultural beliefs in these communities more often influence the adoption of particular behaviors throughout pregnancy, childbirth, and postpartum. Therefore, this study identified sociocultural beliefs and practices during pregnancy, childbirth, and postpartum among indigenous pastoralist women of reproductive age in the Manyara region, Tanzania.

METHODS

The study was a descriptive qualitative design. We used purposive sampling to select twelve participants among community members who were indigenous women of Manyara who had ever experienced pregnancy. In-depth interviews were audio-recorded and transcribed verbatim, and organized manually. We used manual coding and inductive-deductive thematic analysis.

RESULTS

The study's findings showed that sociocultural beliefs and practices are widespread, covering antenatal through childbirth to the postnatal period. Both harmful and harmless practices were identified. For example, the use of herbal preparations to augment labor was reported. Previously, most women preferred home delivery; however, the practice is changing because of increased knowledge of home delivery complications and the accessibility of the facilities. Nevertheless, women still practice hazardous behaviors like applying strange things in the birth canal after delivery, increasing the risk of puerperal infection.

CONCLUSIONS

Sociocultural practices are predominant and widely applied throughout the peripartum period. These beliefs encourage adopting specific behaviors, most harmful to both mother and fetus. These sociocultural practices tend to affect the utilization of some essential maternal and child health practices. Eliminating unsafe peripartum practices will increase the use of medical services and ultimately improve outcomes for both mothers and their newborns. Public health interventions must recognize the cultural context informing these cultural practices in marginalized indigenous communities. Healthcare providers should routinely take the history of commonly traditional practices during the peripartum period to guide them in providing quality care to women by correcting all harmful practices.

The Pattern and Level of Knowledge on Obstetric and Newborn Danger Signs and Birth Preparedness among Pregnant Women in Dodoma Municipal: a Cross Sectional Study

Background:

Unacceptable high maternal mortality rates remain a major challenge in many low-income countries. Early detection and management of antenatal risk factors and good preparation for birth and emergencies are critical for improved maternal and infant outcomes. The aim of this study was to understand the pattern and level of knowledge on obstetric and newborn danger signs, Individual Birth Preparedness and Complication Readiness (IBPACR) among pregnant women in Dodoma Municipal.

Methods:

A quantitative cross sectional study was carried out between February and June 2018. A random selection of participants was employed to achieve a sample size of 450 pregnant women. A standard semi-structure questionnaire was used to collect data and descriptive analysis was carried out by using SPSS software to see the pattern and level of knowledge on obstetric danger signs and individual birth preparedness.

Results:

The mean age of participants was 25.6 years ranging from 16 to 48 years and majority 326 (72.4%) had 2 to 4 pregnancies. Only 203(45.1%) of the pregnant women were able to tell 8 and above danger signs with at least 1 from each of the 4 phases, with the most known obstetric danger signs being vagina bleeding during pregnancy 287(63.8), labour and delivery 234(52.0%), after delivery 278 (61.8) . 164 (36.4%) of the participants reported fever and difficult in feeding 182 (40.4%) as danger signs in newborn. Furthermore, only 75(16.7%) of the participants reported to be prepared for birth and complications. The most known component of birth preparedness was preparing important supply which are needed during birth 283 (62.9%).

Conclusion:

Results of this study showed a low level of knowledge on obstetric and newborn danger signs as well as poor individual birth preparedness and complication readiness. Important predictors of knowledge level and birth preparedness were found to be age, education level, gestation age at first visit and husband involvement in Antenatal visit and care.