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Dumbaugh M, Belem M, Kousse S, Ouoba P, Sankoudouma A, Tchibozo AM, Fearon P, Hollowell J, Hill Z. 'Children awaken by playing ': a qualitative exploration of caregivers' norms, beliefs and practices related to young children's learning and early childhood development in rural Burkina Faso. BMJ Open 2023; 13:e075675. [PMID: 37899153 PMCID: PMC10619012 DOI: 10.1136/bmjopen-2023-075675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/04/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION Evidence suggests that responsive caregiving and early learning activities positively impact developmental outcomes, with positive effects throughout the life course. Early childhood development interventions should align with local values, beliefs and resources but there has been little research of caregiver beliefs and perspectives on development and learning, especially in sub-Saharan Africa. This qualitative study explored norms, beliefs, practices and aspirations around child development of caregivers of young children in rural Burkina Faso. METHODS We conducted 32 in-depth interviews with mothers and fathers of young children and 24 focus group discussions with mothers, fathers and grandmothers, which included trying behaviours and reporting on experiences. The research informed the development of Scaling Up Nurturing Care, a Radio Intervention to Stimulate Early Childhood Development (SUNRISE), an early child development radio intervention. RESULTS Caregivers described a process of 'awakening', through which children become aware of themselves and the world around them.Perceptions of the timing of awakening varied, but the ability to learn was thought to increase as children became older and more awake. Consequently, talking and playing with babies and younger children were perceived to have little developmental impact. Caregivers said children's interactions with them, alongside God-given intelligence, was believed to impact later behaviour and development. Caregivers felt their role in helping their children achieve later in life was to pay for education, save money, provide advice and be good role models. Interaction and learning activities were not specifically mentioned. Caregivers who trialled interaction and learning activities reported positive experiences for themselves and their child, but interactions were often caregiver led and directive and play was often physical. Key barriers to carrying out the behaviours were poverty and a lack of time. CONCLUSIONS Exploring early childhood beliefs and practices can reveal important sociocultural beliefs which, if incorporated into programme planning and implementation, could help achieve more impactful, acceptable and equitable programmes. TRIAL REGISTRATION NUMBER NCT05335395.
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Affiliation(s)
- Mari Dumbaugh
- Institute for Global Health, University College London, London, UK
- Insight Impact Consulting, Chicago, Illinois, USA
| | - Mireille Belem
- Research, Develpment Media International, Ouagadougou, Burkina Faso
| | - Sylvain Kousse
- Research, Develpment Media International, Ouagadougou, Burkina Faso
| | - Patricia Ouoba
- Research, Develpment Media International, Ouagadougou, Burkina Faso
| | - Adama Sankoudouma
- Innovations for Poverty Action Francophone West Africa, Ouagadougou, Burkina Faso
| | | | - Pasco Fearon
- Department of Psychology, University of Cambridge, Cambridge, UK
- Centre for Family Research, Department of Psychology, University College London, London, UK
| | | | - Z Hill
- Institute for Global Health, University College London Research Department of Epidemiology and Public Health, London, UK
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Procureur F, Estifanos AS, Keraga DW, Kiflie Alemayehu AK, Hailemariam NW, Schellenberg J, Magge H, Hill Z. "Quality teaches you how to use water. It doesn't provide a water pump": a qualitative study of context and mechanisms of action in an Ethiopian quality improvement program. BMC Health Serv Res 2023; 23:381. [PMID: 37076845 PMCID: PMC10116784 DOI: 10.1186/s12913-023-09341-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/25/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Quality improvement collaboratives are a common approach to bridging the quality-of-care gap, but little is known about implementation in low-income settings. Implementers rarely consider mechanisms of change or the role of context, which may explain collaboratives' varied impacts. METHODS To understand mechanisms and contextual influences we conducted 55 in-depth interviews with staff from four health centres and two hospitals involved in quality improvement collaboratives in Ethiopia. We also generated control charts for selected indicators to explore any impacts of the collaboratives. RESULTS The cross facility learning sessions increased the prominence and focus on quality, allowed learning from experts and peers and were motivational through public recognition of success or a desire to emulate peers. Within facilities, new structures and processes were created. These were fragile and sometimes alienating to those outside the improvement team. The trusted and respected mentors were important for support, motivation and accountability. Where mentor visits were infrequent or mentors less skilled, team function was impacted. These mechanisms were more prominent, and quality improvement more functional, in facilities with strong leadership and pre-existing good teamwork; as staff had shared goals, an active approach to problems and were more willing and able to be flexible to implement change ideas. Quality improvement structures and processes were more likely to be internally driven and knowledge transferred to other staff in these facilities, which reduced the impact of staff turnover and increased buy-in. In facilities which lacked essential inputs, staff struggled to see how the collaborative could meaningfully improve quality and were less likely to have functioning quality improvement. The unexpected civil unrest in one region strongly disrupted the health system and the collaborative. These contextual issues were fluid, with multiple interactions and linkages. CONCLUSIONS The study confirms the need to carefully consider context in the implementation of quality improvement collaboratives. Facilities that implement quality improvement successfully may be those that already have characteristics that foster quality. Quality improvement may be alienating to those outside of the improvement team and implementers should not assume the organic spread or transfer of quality improvement knowledge.
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Affiliation(s)
- F Procureur
- Institute for Global Health, University College London, Guilford St, London, WC1N 1EH, UK
| | - A S Estifanos
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - D W Keraga
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - J Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - H Magge
- Institute for Healthcare Improvement, Addis Ababa, Ethiopia
- Brigham and Women's Hospital, Division of Global Health Equity, 75 Francis Street, Boston, MA, 02115, USA
| | - Z Hill
- Institute for Global Health, University College London, Guilford St, London, WC1N 1EH, UK.
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Iganus R, Hill Z, Manzi F, Bee M, Amare Y, Shamba D, Odebiyi A, Adejuyigbe E, Omotara B, Skordis-Worrall J. Roles and responsibilities in newborn care in four African sites. Trop Med Int Health 2015; 20:1258-64. [PMID: 26031746 PMCID: PMC5008199 DOI: 10.1111/tmi.12550] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objectives To explore roles and responsibilities in newborn care in the intra‐ and postpartum period in Nigeria, Tanzania and Ethiopia. Methods Qualitative data were collected using in‐depth interviews with mothers, grandmothers, fathers, health workers and birth attendants and were analysed through content and framework analyses. Results We found that birth attendants were the main decision‐makers and care takers in the intrapartum period. Birth attendants varied across sites and included female relatives (Ethiopia and Nigeria), traditional birth attendants (Tanzania and Nigeria), spiritual birth attendants (Nigeria) and health workers (Tanzania and Nigeria). In the early newborn period, when the mother is deemed to be resting, female family members assumed this role. The mothers themselves only took full responsibility for newborn care after a few days or weeks. The early newborn period was protracted for first‐time mothers, who were perceived as needing training on caring for the baby. Clear gender roles were described, with newborn care being considered a woman's domain. Fathers had little physical contact with the newborn, but played an important role in financing newborn care, and were considered the ultimate decision‐maker in the family. Conclusion Interventions should move beyond a focus on the mother–child dyad, to include other carers who perform and decide on newborn care practices. Given this power dynamic, interventions that involve men have the potential to result in behaviour change.
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Affiliation(s)
- R Iganus
- Department of Community Medicine, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Z Hill
- Institute of Global Health, University College London, London, UK
| | - F Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - M Bee
- Institute of Global Health, University College London, London, UK
| | - Y Amare
- Consultancy for Social Development, Addis Ababa, Ethiopia
| | - D Shamba
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - A Odebiyi
- Post-Graduate School, Lead City University, Ibadan, Nigeria
| | - E Adejuyigbe
- Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-ife, Nigeria
| | - B Omotara
- Department of Community Medicine, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
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Dzakpasu S, Soremekun S, Manu A, ten Asbroek G, Tawiah C, Hurt L, Fenty J, Owusu-Agyei S, Hill Z, Campbell O, Kirkwood B. O206 GHANA'S POLICY OF FREE NATIONAL HEALTH INSURANCE FOR PREGNANT WOMEN: IMPACT ON HEALTH FACILITY DELIVERY AND INSURANCE COVERAGE IN THE BRONG AHAFO REGION. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)60636-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
AIMS To explore the role of a traditional illness of the newborn, asram, in care-seeking in rural Ghana. METHODS Data are from formative research into newborn care which included collecting qualitative data from 14 villages in Brong Ahafo region of Ghana through 25 birth narratives, 30 in-depth interviews and two focus groups with recently delivered/pregnant women, 20 in-depth interviews and six focus groups with birth attendants/grandmothers, 12 in-depth interviews and two focus groups with husbands, and six in-depth interviews with asram healers. RESULTS The study confirmed that asram is characterised by symptoms which include green/black veins, a big head and the newborn growing lean. However, a complex classification of 14 types of asram covering a wide array of symptoms was identified. Asram was perceived as a common illness which cannot be treated at health facilities and to which many danger signs in the newborn are attributed, and thus it affects care-seeking. Asram treatment includes frequent cold herbal baths and air-drying; however, oral treatments and preventive bathing are also used. Any modification of asram treatment was reported to require the sanction of a healer. CONCLUSION Understanding traditional illnesses as a potential barrier to newborn care-seeking is essential for designing care-seeking interventions. An asram diagnosis can prevent sick newborns being taken to health facilities and traditional treatment exposes them to the risk of hypothermia.
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Affiliation(s)
- E Okyere
- Kintampo Health Research Centre, Kintampo, Ghana
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McCoy D, Storeng K, Filippi V, Ronsmans C, Osrin D, Borchert M, Campbell O, Wolfe R, Prost A, Hill Z, Costello A, Azad K, Mwansambo C, Manandhar D. Erratum to “Maternal, neonatal and child health interventions and services: moving from knowledge of what works to systems that deliver” [International Health 2 (2010) 87-98]. Int Health 2010. [DOI: 10.1016/j.inhe.2010.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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McCoy D, Storeng K, Filippi V, Ronsmans C, Osrin D, Borchert M, Campbell OM, Wolfe R, Prost A, Hill Z, Costello A, Azad K, Mwansambo C, Manandhar DS. Erratum to "Maternal, neonatal and child health interventions and services: moving from knowledge of what works to systems that deliver" [International Health 2 (2010) 87-98]. Int Health 2010; 2:228. [PMID: 24037704 DOI: 10.1016/j.inhe.2010.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The Publisher regrets that an error occurred in the name of the 6th listed co-author for this paper. B. Matthias was listed in the original paper instead of M. Borchert; the correct listing can be seen above.
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Affiliation(s)
- D McCoy
- Centre for International Health and Development, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom
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Abstract
To explore why women in Ghana initiate breast-feeding early or late, who gives advice about initiation and what foods or fluids are given to babies when breast-feeding initiation is late. Qualitative data were collected through 52 semistructured interviews with recent mothers, 8 focus group discussions with women of child-bearing age and 13 semistructured interviews with health workers, policy makers and implementers. The major reasons for delaying initiation of breast-feeding were the perception of a lack of breast milk, performing postbirth activities such as bathing, perception that the mother and the baby need rest after birth and the baby not crying for milk. Facilitating factors for early initiation included delivery in a health facility, where the staff encouraged early breast-feeding, and the belief in some ethnic groups that putting the baby to the breast encourages the milk. Policy makers tended to focus on exclusive breast-feeding rather than early initiation. Most activities for the promotion of early initiation of breast-feeding were focused on health facilities with very few community activities. It is important to raise awareness about early initiation of breast-feeding in communities and in the policy arena. Interventions should focus on addressing barriers to early initiation and should include a community component.
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Affiliation(s)
- C Tawiah-Agyemang
- Kintampo Health Research Center, Ghana Health Service, Kintampo, Ghana
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Hill Z, Manu A, Tawiah-Agyemang C, Gyan T, Turner K, Weobong B, Ten Asbroek AHA, Kirkwood BR. How did formative research inform the development of a home-based neonatal care intervention in rural Ghana? J Perinatol 2008; 28 Suppl 2:S38-45. [PMID: 19057567 DOI: 10.1038/jp.2008.172] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Formative research is often used to inform intervention design, but the design process is rarely reported. This study describes how an integrated home visit intervention for newborns in Ghana was designed. As a first step in the design process, the known intervention parameters were listed, information required to refine the intervention was then identified and a formative research strategy designed. The strategy included synthesizing available data, collecting data on newborn care practices in homes and facilities, on barriers and facilitators to adopting desired behaviors and on practical issues such as whom to include in the intervention. The data were used to develop an intervention plan through workshops with national and international stakeholders and experts. The intervention plan was operationalized by district level committees. This included developing work plans, a creative brief for the materials and completing a community volunteer inventory. The intervention was then piloted and the intervention materials were finalized. The design process took over a year and was iterative. Throughout the process, literature was reviewed to identify the best practice. The intervention focuses on birth preparedness, using treated bednets in pregnancy, early and exclusive breastfeeding, thermal care, special care for small babies and prompt care seeking for newborns with danger signs. The need for a problem-solving approach was identified to help ensure behavior change. A subset of behaviors were already being performed adequately, or were the focus of other interventions, but were important to reinforce in the visits. These include attending antenatal care and care seeking for danger signs in pregnancy. On the basis of the intervention content, the timing of newborn deaths and the acceptability of visits, two antenatal and three visits in the first week of life (days 1, 3 and 7) were planned. Several household members were identified to include in the visits as they were involved in newborn care or they made financial decisions. Birth attendants and health workers were often the locus of control for immediate newborn care, and sensitization activities were designed to improve their practices and to help ensure that families received consistent messages. An existing cadre of community volunteers was identified to deliver the intervention-these volunteers were already trusted and accepted by the community, already visited pregnant women at home and had the time and commitment to deliver the intervention. A supervision and remuneration system was developed through discussions with the volunteers and at the planning workshops. The need for community entry activities was identified to garner community support for the intervention, to encourage self-identification of pregnant and delivered women and to motivate the volunteer through community recognition. Formative research is an essential step in helping to ensure the development of an effective, appropriate and sustainable intervention.
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Affiliation(s)
- Z Hill
- Nutrition and Public Health Intervention Unit, Department of Epidemiology and Population health, London School of Hygiene and Tropical Medicine, London, UK.
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Miller C, Hill Z, Ren L, Hutchinson J. Beyond shock absorbers: Elephant feet as multi-functional dynamic structures. Comp Biochem Physiol A Mol Integr Physiol 2008. [DOI: 10.1016/j.cbpa.2008.04.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
OBJECTIVES To explore how subjects in a placebo-controlled vitamin A supplementation trial among Ghanaian women aged 15-45 years perceive the trial and whether they know that not all trial capsules are the same, and to identify factors associated with this knowledge. METHODS 60 semistructured interviews and 12 focus groups were conducted to explore subjects' perceptions of the trial. Steps were taken to address areas of low comprehension, including retraining fieldworkers. 1971 trial subjects were randomly selected for a survey measuring their knowledge that not all trial capsules are the same. The subjects' fieldworkers were also interviewed about their characteristics and trial knowledge. Factors associated with knowledge were explored using multi-level modeling. RESULTS Although subjects knew they were taking part in research, most thought they were receiving an active and beneficial medication. Variables associated with knowledge were education and district of residence. Radio broadcasts benefited those with some schooling. Fieldworkers' characteristics were not associated with subjects' knowledge. CONCLUSIONS Research and debate on new or improved consent procedures are urgently required, particularly for subjects with little education.
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Affiliation(s)
- Z Hill
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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Hrncirová L, Klabusay L, Vitulová V, Svobodová V, Lokaj J, Hill Z. [Genetic and immunologic aspects of synovitis after viral infection]. Vnitr Lek 1985; 31:838-43. [PMID: 3876644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Hrncírová L, Klabusay L, Lokaj J, Hill Z, Vitulová V. [Reactive arthritis after viral infection and HLA]. Vnitr Lek 1984; 30:1015-1019. [PMID: 6334933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Vitulová V, Vachtenheim J, Hill Z, Valnícková Z, Klabusay L, Krácmar C. [HLA in Reiter's syndrome. Incidence of HLA B27 and a family study]. Fysiatr Revmatol Vestn 1982; 60:11-6. [PMID: 6978278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Kuthan F, Streda A, Parma R, Krepelková M, Hill Z, Valnícková Z. [Diagnostic significance of the occurrence of tissue antigen HLA-B27 in various rheumatic diseases]. Vnitr Lek 1979; 25:578-3. [PMID: 313621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Hill Z. [The 70th birthday of Head Physician Jiri Hynie]. Cesk Oftalmol 1975; 31:78-9. [PMID: 1089485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Hill Z, Makesová D, Krejcová O. The factors Gm(1), Gm(2), Gm(4), Gm(5) and Inv(1) in the sera of patients with allergic diseases. Acta Allergol 1968; 23:124-9. [PMID: 5755557 DOI: 10.1111/j.1398-9995.1968.tb03711.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Hill Z, Krejcová O. [Serum factors Gm and Inv in the population of Brno]. Vnitr Lek 1968; 14:174-6. [PMID: 4170209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Kubíková Kourilová A, Hill Z. [A simplified compatibility test for extracorporeal circulation and for extensive transfusions]. Rozhl Chir 1965; 44:831-4. [PMID: 5858022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Hill Z. 1The District Blood Transfusion Centre, Třebíě, Czechoslovakia. Vox Sang 1962. [DOI: 10.1111/j.1423-0410.1962.tb03228.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hill Z. On the Problem of Species Specificity of Antiglobulin Sera. Vox Sang 1962. [DOI: 10.1159/000464749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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