scholarly journals We Won’t Go There: Barriers to Accessing Maternal and Newborn Care in District Thatta, Pakistan

Healthcare ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1314
Author(s):  
Muhammad Asim ◽  
Sarah Saleem ◽  
Zarak Husain Ahmed ◽  
Imran Naeem ◽  
Farina Abrejo ◽  
...  
Keyword(s):  
Health Workers ◽  
Newborn Care ◽  
Newborn Health ◽  
Structured Interview ◽  
Maternal And Newborn Health ◽  
Structural Level ◽  
Care Seeking ◽  
Structural Barriers ◽  
Maternal And Newborn Care ◽  
Maternal And Newborn

Accessibility and utilization of healthcare plays a significant role in preventing complications during pregnancy, labor, and the early postnatal period. However, multiple barriers can prevent women from accessing services. The aim of this study was to explore the multifaceted barriers that inhibit women from seeking maternal and newborn health care in Thatta, Sindh, Pakistan. This study employed an interpretive research design using a purposive sampling approach. Pre-tested, semi-structured interview guides were used for data collection. The data were collected through eight focus group discussions with men and women, and six in-depth interviews with lady health workers and analyzed through thematic analysis. The study identified individual, sociocultural, and structural-level barriers that inhibit women from seeking maternal and newborn care. Individual barriers included mistrust towards public health facilities and inadequate symptom recognition. The three identified sociocultural barriers were aversion to biomedical interventions, gendered imbalances in decision making, and women’s restricted mobility. The structural barriers included ineffective referral systems and prohibitively expensive transportation services. Increasing the coverage of healthcare service without addressing the multifaceted barriers that influence service utilization will not reduce the burden of maternal and neonatal mortality. As this study reveals, care seeking is influenced by a diverse array of barriers that are individual, sociocultural, and structural in nature. A combination of capacity development, health awareness, and structural interventions can address many if not all of these barriers.

scholarly journals Barriers to accessing maternal and newborn care: a qualitative study in district Thatta, Pakistan

2020 ◽  
Author(s):  
Muhammad Asim ◽  
Sarah Saleem ◽  
Zarak Hussain Ahmad ◽  
Imran Naeem ◽  
Farina Abrejo ◽  
...  
Keyword(s):  
Health Care ◽  
Health Workers ◽  
Newborn Care ◽  
Structured Interview ◽  
Maternal And Newborn Health ◽  
Structural Level ◽  
Care Seeking ◽  
Structural Barriers ◽  
Maternal And Newborn Care ◽  
Maternal And Newborn

Abstract Background: Accessibility and utilization of health care play a significant role in preventing complications during pregnancy, labor, and the early postnatal period. However, multiple barriers can prevent women from accessing pregnancy and neonatal care. The aim of this study was to explore the multifaceted barriers that inhibit women to seek maternal and newborn health care in Thatta, Sindh, Pakistan.Methods: This study employed an interpretive research design using purposive sampling approach. Pre-tested semi-structured interview guides were used for data collection. The data were collected through eight focus group discussions with men and women, and six in-depth interviews with lady health workers and analyzed through thematic analysis. Findings: The study identified individual, socio-cultural, and structural level barriers that inhibit women from seeking maternal and newborn care. Individual barriers included: mistrust towards public health facilities, and inadequate symptom recognition. The two identified socio-cultural barriers were: aversion to biomedical interventions, and gendered imbalances in decision making. The structural barriers included: prohibitively expensive transportation services, and ineffective referral systems. Conclusion and Suggestions: Increasing the coverage of healthcare service without addressing the multifaceted barriers that influence service utilization will not reduce the burden of maternal and neonatal mortality. As this study reveals, care seeking is influenced by a diverse array of barriers that are individual, sociocultural, and structural in nature. A combination of capacity development, health awareness, and structural interventions can address many if not all of these barriers.

scholarly journals Community-based maternal and newborn care: A concept analysis

Curationis ◽  
2018 ◽  
Vol 41 (1) ◽  
Author(s):  
Yonas R. Guta ◽  
Patrone R. Risenga ◽  
Mary M. Moleki ◽  
Merertu T. Alemu
Keyword(s):  
Low Income ◽  
Newborn Care ◽  
Newborn Health ◽  
Concept Analysis ◽  
Low Income Countries ◽  
Maternal And Newborn Health ◽  
Community Based ◽  
Care Services ◽  
Maternal And Newborn Care ◽  
Maternal And Newborn

Background: Community-based care can serve as a valuable programme in the provision of essential maternal and newborn care, specifically in communities in low-income countries. However, its application in maternal and newborn care is not clearly documented in relation to the rendering of services by skilled birth attendants.Objectives: The purpose of the analysis was to clarify the meaning of the concept ‘community-based maternal and newborn care and its relationship to maternal and newborn health’.Method: Walker and Avant’s and Rodgers and Knafl’s as well as Chin and Kramer’s approaches to concept analysis were followed to analyse community-based maternal and newborn care.Results: The attributes of community-based care in maternal and newborn health include (1) the provision of home- and/or community-level skilled care, (2) linkages of health services and (3) community participation and mobilisation. These attributes are influenced by antecedents as well as consequences.Conclusion: The provision of good maternal and newborn care to all clients is a crucial aspect in provision of maternal and newborn services. In order for low-income countries to promote maternal and newborn health, community-based care services are the best option to follow.

scholarly journals “That’s a woman’s problem”: a qualitative analysis to understand male involvement in maternal and newborn health in Jigawa state, northern Nigeria

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Vandana Sharma ◽  
Jessica Leight ◽  
Nadège Giroux ◽  
Fatima AbdulAziz ◽  
Martina Bjorkman Nyqvist
Keyword(s):  
Health Workers ◽  
Post Partum ◽  
Newborn Health ◽  
Male Involvement ◽  
Maternal And Newborn Health ◽  
Northern Nigeria ◽  
Care Seeking ◽  
Health Providers ◽  
Post Partum Period ◽  
Maternal And Newborn

Abstract Background Maternal and newborn mortality continue to be major challenges in Nigeria. While greater participation of men in maternal and newborn health has been associated with positive outcomes in many settings, male involvement remains low. The objective of this analysis was to investigate male involvement in maternal and newborn health in Jigawa state, northern Nigeria. Methods This qualitative study included 40 event narratives conducted with families who had experienced a maternal or newborn complication or death, in-depth interviews with 10 husbands and four community leaders, and four focus group discussions with community health workers. The interviews focused on understanding illness recognition and care seeking as well as the role of husbands at each stage on the continuum of maternal and newborn health. Data were transcribed, translated to English, and coded and analyzed using Dedoose software and a codebook developed a priori. Results This paper reports low levels of knowledge of obstetric and newborn complications among men and limited male involvement during pregnancy, childbirth and the post-partum period in Jigawa state. Men are key decision-makers around the location of the delivery and other decisions linked to maternal and newborn health, and they provide crucial resources including nutritious foods and transportation. However, they generally do not accompany their wives to antenatal visits, are rarely present for deliveries, and do not make decisions about complications arising during delivery and the immediate post-partum period. These gendered roles are deeply ingrained, and men are often ridiculed for stepping outside of them. Additional barriers for male involvement include minimal engagement with health programs and challenges at health facilities including a poor attitude of health providers towards men and accompanying family members. Conclusion These findings suggest that male involvement is limited by low knowledge and barriers related to social norms and within health systems. Interventions engaging men in maternal and newborn health must take into account these obstacles while protecting women’s autonomy and avoiding reinforcement of gender inequitable roles and behaviors.

Training health workers to provide person-centred maternal and newborn health care in Burkina Faso

2013 ◽  
Vol 3 (2) ◽  
pp. 154-159
Author(s):  
Janet Perkins ◽  
Aminata Bargo ◽  
Cecilia Capello ◽  
Carlo Santarelli
Keyword(s):  
Health Care ◽  
Burkina Faso ◽  
Health Care Providers ◽  
Health Workers ◽  
Healthcare Providers ◽  
Newborn Health ◽  
World Health ◽  
Maternal And Newborn Health ◽  
Care Providers ◽  
Maternal And Newborn

Assuring the provision of person-centred care is critical in maternal and newborn health (MNH). As a component of the national strategy to improve MNH, Burkina Faso Ministry of Health, supported by Enfants du Monde, La Fondation pour le Développement Communautaire/Burkina Faso and UNFPA, is implementing the World Health Organization’s (WHO) framework for Working with Individuals, Families and Communities (IFC) to improve MNH. As a first step in district implementation, participatory community assessments were conducted. These assessments consistently revealed that poor interactions with healthcare providers posed one important barrier preventing women from seeking MNH services. In order to address this barrier, healthcare providers were trained to improve their interpersonal skills and in counselling women. During 2011-12 a total of 175 personnel were trained over a 5-day course developed using a WHO manual. The course was met with enthusiasm as providers expressed their need and desire for such training. Immediate post-test results revealed an impressive increase in knowledge and anecdotal evidence suggests that training has influenced provider’s behaviours in their interactions with women. In addition, health care providers are taking concrete action to build the capabilities of women to experience pregnancy and birth safely by engaging directly with communities.  While early findings are promising, an evaluation will be necessary to measure how the training has influenced practices, whether this translates into a shift of perceptions at community level and ultimately its contribution toward promoting person-centred care in Burkina Faso.

Combined clinical audits and low-dose, high-frequency, in-service training of health care providers and community health workers to improve maternal and newborn health in Mali: protocol for a pragmatic cluster randomized trial (Preprint)

2021 ◽  
Author(s):  
David Zombre ◽  
Diego Bassani ◽  
Farhana Zareef ◽  
Moussa Doumbia ◽  
Sekou Doumbia ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Health Workers ◽  
Newborn Health ◽  
Maternal And Newborn Health ◽  
Classroom Setting ◽  
Care Providers ◽  
Mortality And Morbidity ◽  
Hands On ◽  
Service Training ◽  
Maternal And Newborn

BACKGROUND Despite most births in Mali occurring in health facilities, a substantial number of newborns still die during delivery and within the first 7 days of life, mainly due to existing training deficiencies and the challenges of maintaining intrapartum and postpartum care skills. OBJECTIVE This trial aims to assess the effectiveness, and cost-effectiveness, of an intervention combining clinical audits and low-dose high-frequency (LDHF) in-service training of health care providers and community health workers in reducing perinatal mortality. METHODS The study is a three-arm cluster RCT in the Koulikoro region, in Mali. The unit of randomization are each of 84 primary care facilities. Each trial arm will include 28 facilities. The facilities in the first intervention arm will receive support in implementing mortality and morbidity audits followed by one-day LDHF training biweekly, for 6 months. The health workers in second intervention arm (28 facilities), will receive a refresher course in Maternal, Newborn and Child Health (MNCH) for 10 days in a classroom setting, in addition to mortality and morbidity audits and LDHF hands-on training for 6 months. The control arm, also with 28 facilities, will consist solely of the standard MNCH refresher training delivered in a classroom setting. The main outcome are perinatal deaths in the intervention arms compared to the control arm. A final sample of approximately 600 deliveries per cluster is expected, for a total of 30,000 newborns over 14 months. Data sources include both routine health records and follow-up household surveys of all women who recently gave birth in study facility 7 days post-delivery. Data collection tools will capture perinatal deaths, complications and adverse events, as well as the status of the newborn during the perinatal period. A full economic evaluation will be conducted to determine the incremental cost-effectiveness of each of the case-based focused LDHF hands-on training strategies in comparison to MNCH refresher training in a classroom setting. RESULTS NA CONCLUSIONS The results will provide policy makers and practitioners crucial information on both the impact of different healthcare provider training modalities on maternal and newborn health outcomes, and how to successfully implement these strategies in resource-limited settings. CLINICALTRIAL Trial registration: ClinicalTrials.gov NCT03656237, registered on September 4, 2018.

scholarly journals Maternal and newborn health priority setting partnership in rural Uganda in association with the James Lind Alliance: a study protocol

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
James Ditai ◽  
Monicah Nakyazze ◽  
Deborah Andrinar Namutebi ◽  
Proscovia Auma ◽  
Martin Chebet ◽  
...  
Keyword(s):  
Health Workers ◽  
Newborn Health ◽  
Adverse Outcomes ◽  
Maternal And Newborn Health ◽  
Face To Face ◽  
The Public ◽  
James Lind Alliance ◽  
Research Questions ◽  
Eastern Uganda ◽  
Maternal And Newborn

Abstract Background Maternal and newborn deaths and ill health are relatively common in low income countries, but can adequately be addressed through locally, collaboratively designed, and responsive research. This has the potential to enable the affected women, their families and health workers themselves to explore ‘why maternal and newborn adverse outcomes continue to occur. The objectives of the study include; To work with seldom heard groups of mothers, their families, and health workers to identify unanswered research questions for maternal and newborn health in villages and health facilities in rural Uganda To establish locally responsive research questions for maternal and newborn health that could be prioritised together with the public in Uganda To support the case for locally responsive research in maternal and newborn health by the ministry of health, academic researchers and funding bodies in Uganda. Methods The present study will follow the James Lind Alliance (JLA) Priority Setting Partnership (PSP) methodology. The project was initiated by an academic research group and will be managed by a research team at the Sanyu Africa Research Institute on a day to day basis. A steering group with a separate lay mothers’ group and partners’ group (individuals or organisations with interest in maternal and newborn health) will be recruited. The PSP will be initiated by launch meetings, then a face-to-face initial survey for the collection of raw unanswered questions; followed by data collation. A face-to-face interim prioritisation survey will then be performed to choose questions before the three separate final prioritisation workshops. The PSP will involve many participants from an illiterate, non-internet population in rural eastern Uganda, but all with an interest in strategies to avert maternal and newborn deaths or morbidities in rural eastern Uganda. This includes local rural women, their families, health and social workers, and relevant local groups or organisations. We will generate a top 10 list of maternal and newborn health research priorities from a group with no prior experience in setting a research agenda in rural eastern Uganda. Discussion The current protocol elaborates the JLA methods for application with a new topic and in a new setting translating the JLA principles not just into the local language, but into a rural, vulnerable, illiterate, and non-internet population in Uganda. The face-to-face human interaction is powerful in eliciting what exactly matters to individuals in this particular context as opposed to online surveys. This will be the first time that mothers and lay public with current or previous experience of maternal or neonatal adverse outcomes will have the opportunity to identify and prioritise research questions that matter to them in Uganda. We will be able to compare how the public would prioritise maternal health research questions over newborn health in this setting.

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