"I don't know anything about their culture": the disconnect between allopathic and traditional maternity care providers in rural Northern Ghana

The provision of maternal and neonatal health care in rural northern Ghana is pluralistic, consisting of traditional and allopathic providers. Although women often use these providers interchangeably, important differences exist. This study explored the differences in approaches to maternal and neonatal care provision by these two different types of providers. This research was part of the Stillbirth and Neonatal Death Study (SANDS), conducted in northern Ghana in 2010. Trained field staff of the Navrongo Health Research Centre conducted in-depth interviews with 13 allopathic and 8 traditional providers. Interviews were audio-recorded, transcribed, and analyzed using in vivo coding and discussion amongst the research team. Three overarching themes resulted: 1) many allopathic providers were isolated from the culture of the communities in which they practiced, while traditional providers were much more aware of the local cultural beliefs and practices. 2) Allopathic and traditional healthcare providers have different frameworks for understanding health and disease, with allopathic providers relying heavily on their biomedical knowledge, and traditional providers drawing on their knowledge of natural remedies. 3) All providers agreed that education directed at pregnant women, providers (both allopathic and traditional), and the community at large is needed to improve maternal and neonatal outcomes. Our findings suggest that, among other things, programmatic efforts need to be placed on the cultural education of allopathic providers. (Afr J Reprod Health 2014; 18[2]: 36-45)

The JC Coetzee Memorial Lecture : Maternal Health in Primary Care: are we Providing Safe Maternity Units?

The Service Level Agreement of the Minister of Health provides; as one of its aims; to reduce the number of deaths of pregnant women and their babies. Over 60 of the births in South Africa; one third of all maternal deaths; and 62 of the perinatal deaths; occur at the prilevel of care. The numbers are far too high for a service which is supposed to cater to low-risk maternity cases. The Lives Saved Tool is a programme which can model the potential number of lives that can be saved depending on the pattern of disease; interventions used and coverage of these interventions. This tool has been used to select which interventions would be most effective in reducing maternal and perinatal mortality. If the effects of human immunodeficiency virus are excluded; the intervention that would save the most lives would be that of improving maternal and neonatal emergency care. A survey was conducted on the ability of healthcare facilities in 12 districts to provide essential emergency care services to pregnant women and their babies. It was found that the vast majority of the community healthcare facilities could not provide the seven lifesaving services needed for basic emergency obstetric care; and less than half of the district hospitals could provide the nine life-saving services required for comprehensive emergency obstetric care. Lack of knowledgeable and skilled staff; inadequate equipment and human resources; as well as poor emergency transport services at the sites are the main reasons for these unsafe maternity units. Realignment of the services might improve the ability of the districts to provide a safe maternity service

How Effective is the 2012 Maternal; Newborn and Child Health Week (MNCHW) in River State?

Nigeria is one of the countries noted to have made insufficient progress towards the attainment of the health-related MDGs. Experience has however shown that a few cost-effective interventions that can be delivered in resource poor settings; through family/community-level action and schedulable population-oriented services; are able to rapidly attain these goals. This was the basis of the Maternal; Newborn and Child Health Week (MNCHW) in Nigeria; designed to achieve rapid population coverage of chosen interventions; within the one week period of the programme. This study assessed the effectiveness of the week held in Rivers State; in June 2012. of the LGAs; while iron and folate tablets were given to just 2.86Materials and Methods: The data for the assessment was collected through on-the- spot observations; three semi-structured questionnaires; and the final summaries of the week; provided by the State Ministry of Health. The questionnaires were administered in nine health centers; in three randomly selected LGAs. The first questionnaire was used to assess the extent of the social mobilization carried out for the week; the second was an exit interview of clients of the health facilities; and used to assess the success of the social mobilization campaign; while the third questionnaire was used to assess the availability of the intervention commodities; and the quality of care given to the clients.Results: The social mobilization campaign for the week was poorly funded and did not have much effect; as only 28.57 of the clients of the health facilities were aware of the week. Most of the commodities for the week; except the NPI vaccines and vitamin A; were not available in the required quantities. Long Lasting Insecticide-treated Nets (LLINs) and Sulphadoxine-Pyrimethamine (SP) were not available in 65.22 of the LGAs; family planning commodities were not available in 30.43 of the LGAs; family planning commodities were not available in 30.43 of the LGAs; while iron and folate tablets were given to just 2.86 of the LGAs; while iron and folate tablets were given to just 2.86 of the targeted total. The coverage rate of the vaccines ranged from 1.29 recorded with the measles vaccine; to the 14.85; for the DPT vaccine. The coverage with vitamin A of 43.41; for the DPT vaccine. The coverage with vitamin A of 43.41 was the highest of all the interventions; while the 0.36 coverage for family planning commodities was the least.Conclusions: The MNCHW in Rivers State did not meet the stated objectives. Efforts should be made to leverage on the political will of the current government of the State for health programmes

Barriers to Utilisation of Maternal Health Services in a Semi-urban Community in Northern Nigeria: The Clients' Perspective

Low level of utilisation of maternal health services is a major factor responsible for high maternal mortality in northwestern region of Nigeria. This study was aimed at determining the barriers to utilisation of maternal health services from the perspective of mothers in northwestern Nigeria. Materials and Methods: A cross-sectional study of 150 mothers; selected through multistage technique; was conducted. Data were collected using a structured interviewer-administered questionnaire; and analysed using SPSS statistics 17.0. Results: Only 2.7 utilised preconception service; 98.7 antenatal care service (ANC); 24.0 delivery; 35.3 postnatal care and 14.0 utilised family planning service. Major reasons for non-utilisation of delivery service were not having a delivery complication in the past (57 (CI = 47.4-66.1)) and negative provider attitude (23.7(CI = 16.4-32.7)). For non-utilisation of postnatal care; the major reasons were also not having a postnatal complication in the past (60.8 (CI = 50.4-70.4)) and negative provider attitude (27.8 (CI = 19.4-38.0)). As for non-utilisation of family planning service; the major reason was desire to have more children (32.6 (CI = 24.7-41.4)). Reasons for non-use of preconception care and ANC were not computed because respondents to these questions were not enough; only 6 (4.0) were aware of preconception care in the first place and only 2 (1.3) were aware of preconception care in the first place and only 2 (1.3) were not using ANC. Conclusion: Despite living near a health facility; most of the mothers were not using maternal health services. It is recommended that while there is the need to raise awareness on the utilisation of maternal health services; bring it closer to the mothers and make it more affordable; there is a more pressing need to improve its quality; especially through the alleviation of negative attitude of health care providers

Potentials of Community Pharmacists to Improve Maternal; Newborn and Child Health

Background: With the high level of pregnancy; childbirth related and under-five deaths in Nigeria; achieving optimal maternal and child health has become the responsibility of all health personnel in a task sharing approach at all levels of care. Objectives: We assessed baseline status of community pharmacists' involvement in Maternal; Newbornand Child Health [MNCH]; described training intervention for community pharmacists on MNCH and assessed its impact on maternal and child health.Methods: Semi-experimental design; using multi-stage stratified sampling method was conducted in Abuja; Kwara; Abia and Edo States of Nigeria from June - September; 2011. Pre-tested questionnaires wereused to generate data on baseline activities of pharmacists. Two of the States were selected for trainingintervention while the remaining two served as control. A post-training MNCH activity level of the study and control settings was compared based on frequency of occurrence and Chi-Square analysis with the aidof Epi Info package.Results: Over 15 of community pharmacists reported seeing 5-10 women and 10-20 children daily. Agap in MNCH knowledge was observed. The training intervention improved MNCH knowledge in the study States (P 0.05); with post-training assessment showing a 40 average increase in the number of mothers and under-five caregivers counselled on key MNCH interventions.Conclusion: The baseline status of the community pharmacists' participation in MNCH revealed aconsiderable client load of pregnant and nursing mothers with under 5 years children in contact with the community pharmacists daily. Community pharmacists in MNCH interventions indicated a knowledge gap.The training intervention showed knowledge transfer and improved community pharmacists' position as promoters; facilitators and implementers of maternal; newborn and child health in Nigeria

Pattern and Outcome of Eclampsia Managed at a General Hospital in North-West Nigeria

Hypertensive disorders of pregnancy constitute major threats to maternal health during pregnancy; labour and the post-partum period. Eclampsia is a leading cause of maternal morbidity and mortality especially in low income and middle-income countries.Method: A retrospective review of the clinical records of women managed for eclampsia during a two-year period from December 2004 to November 2006 at the General hospital Aliero was undertaken.Results: Fifty-eight patients were managed for eclampsia during the 2-year period of study. Eclampsia occurred before and during labour in 47 patients while 11 patients had post-partum eclampsia.Conclusion: The reorientation of caregivers and the community in order to enhance awareness of eclampsia is recommended. The promotion of early presentation; routine antenatal care; and prompt referral to secondary center's as well as the provision of the resources for adequate management of eclampsia is advocated

Birth preparedness, complication readiness and fathers' participation in maternity care in a northern nigerian community

The role of men in maternity care in Africa is understudied, despite their economic dominance and decision making power. In a patriarchal society like northern Nigeria, pregnancy and childbirth are often regarded as exclusively women's affairs. Using data from interviewer administered questionnaires and in-depth interviews; we assessed birth preparedness, complication readiness and male participation in maternity care in Ungogo, a northern Nigerian community. Majority of pregnancies were unplanned (96%). Only 32.1% of men ever accompanied their spouses for maternity care. There was very little preparation for skilled assistance during delivery (6.2%), savings for emergencies (19.5%) or transportation during labour (24.2%). Young paternal age (adjusted odds ratio [AOR] =1.5, 95% confidence interval [CI]=1.2-2.6), formal education (AOR=1.9, 95%CI=1.1-3.4) and non-Hausa Fulani ethnicity (AOR=2.3, 95%CI=1.4-3.3) were independent predictors of male participation in maternity care. There is a need to increase involvement of men in their partner's maternity care through peer-led, culturally-sensitive community education and appropriate health system reforms (Afr J Reprod Health 2010; 14[1]:21-32)

Programmatic Correlates of Maternal Healthcare Seeking Behaviors in Ethiopia

Background: Considerable improvement in maternal healthcare use has been observed since the inception of the health extension program (HEP) in Ethiopia in 2003. Objective: This paper evaluates the influence of HEP outreach strategies on maternal healthcare use. Method: Cross-sectional survey of 2;916 women with children 0 to 11 months from Amhara; Oromiya; Southern Nations; Nationalities and People's; and Tigray regions; obtained between December 2008 and January 2009; were analyzed using regression models to assess the impacts of HEP strategies on maternal health outcomes. Result: The analyses found that communities (i.e.; kebeles) with relatively high prevalence of model families; higher rate of household visits by health extension workers; and higher rate of household visits by voluntary community health workers were associated with improved antenatal care use; tetanus toxoid vaccination coverage; and receiving postnatal care visits; but the strategies were not associated with deliveries attended by health professionals. Conclusion: Although the impacts of HEP strategies on maternal healthcare use were statistically significant; they were not optimum to reach the maternal mortality reduction targets of the government of Ethiopia. The HEP needs to review and strengthen its community based strategies in order to reach its goals

Care Seeking for Maternal Health: Challenges Remain for Poor Women

Background: In 2005 a Safe Motherhood Community-Based Survey was carried out on behalf of the Family Health Department to explore community values and practices surrounding pregnancy; childbirth and the postpartum period. Objective: To explore the knowledge; attitudes and beliefs which influence maternal care seeking behaviour and practices in pregnancy and childbirth. Methods: Qualitative data - focus group discussions and in depth interviews with women; men and adolescents- were gathered from communities distributed across Ethiopia's 11 regions. Data were analysed using Nudist software. Important findings: The location of childbirth involves retaining control of the process and outcome; and securing a safe delivery. The pregnant woman is influenced by her attendants; families only seek care for complications if local or herbal; remedies and prayer are defeated. Timely care seeking is reliant on the knowledge; understanding and financial means of the husband. Distance; cost and lack of support for the cultural practices around birth are impeding factors. Conclusions: Communities are aware of the dangers of giving birth at home. Women are constrained by the distance and cost in reaching and receiving care. Important traditions around birth are not recognised by health providers. Socio-cultural aspects must be addressed and incorporated into the care provided at the health facilities

Responding to the Maternal Health Care Challenge: the Ethiopian Health Extension Program

Background: Responding to challenges in achieving Millennium Development Goals (MDG); the Ethiopian government initiated the Health Extension Program in 2003 as part of the Health Sector Development Program (HSDP) to improve equitable access to preventive; promotive and select curative health interventions through paid community level health extension workers. Objective: To explore Ethiopia's progress toward achieving MDG 5 that focuses on improved maternal health through the Health Extension Program. Methods: This paper reviews available survey data and literature to determine the feasibility of reaching the targets specified for MDG 5 and for HSDP. Important findings: Achieving the set targets is a daunting task despite reaching the physical targets of two health extension workers per kebele. The 2015 MDG target for the Maternal Mortality Ratio (MMR) is 218 while the 2005 MMR estimate is 673. The HSDP target is 32skilled birth attendant use by 2010 but only about 12use was found in the four most populated regions of the country in 2009. Conclusions: Accelerating progress towards these targets is possible through the Health Extension Program at the worker level through improved promotion of family planning and specific maternal interventions; such as misoprostol for active management of third stage of labor; immediate postpartum visits; and improved coordination from community to referral level

Determinants of exclusive breastfeeding practices in Ethiopia

Background: Despite the demonstrated benefits of breast milk; the prevalence of breastfeeding; in-particular exclusive breastfeeding (EBF); in many developing countries including Ethiopia is lower than the international recommendation of EBF for the first six months of life Objective: To assess the practice of EBF and explore its determinants in Ethiopia and provide policy makers and NGOs with relevant information for future planning and interventions. Methods: Raw data collected from nine regions and two city administrations using stratified cluster sampling method by the Ethiopian Demographic Health Survey (EDHS) 2005 were used to study the practice and determinants of EBF countrywide. Analysis was based on children whose age was less than six months and alive at the time of interview that was extracted from the women's database. Results: The overall rates of exclusive and full breastfeeding were 49.0and 68.2respectively. Maternal education; marital status; wealth index and age of the child were closely associated with EBF practices; nonetheless; in the hierarchical analysis; being not married; middle/ richer/ richest wealth index; and child age 0-1and 2-3 month were retained as the predictors of EBF (P0.05). Conclusion: A range of maternal and child health attributes such as marital status; economical status and child age were found to influence the practice of EBF in Ethiopia. Actions to empower women and promotion of EBF campaignare recommended to achieve the fourth millennium development goal

Effectiveness of Community Health Workers (CHWS) in the Provision of Basic Preventive and Curative Maternal; Newborn and Child Health (MNCH) Interventions: A Systematic Review

Due to a shortage of health workers; many low income countries rely on community health workers (CHWs) for the provision of a wide range of primary health care services; both curative and preventive; including maternal newborn and child health (MNCH) interventions. Several systematic reviews have analysed the contribution of CHWs although none has specifically focused on their role in relation to MNCH. This review was designed to find evidence of the effectiveness of CHWs in providing basic preventive and curative MNCH interventions; and to identify the factors that are crucial to their performance. It was restricted to articles published from 1998-2008 in the eng language. It included studies with qualitative and quantitative designs. Six electronic databases were searched and data was extracted using a pretested data extraction form designed basing on the Centre for Reviews and Dissemination (CRD) guidelines (2008). A narrative synthesis approach was used. The quality of included studies was assessed using pretested validity assessment tools and the applicability of interventions was evaluated using the RE-AIM framework. After the filtering; 14 studies were critically appraised; and the majority (12/14) demonstrated that CHWs were effective at reducing neonatal/child mortality rates; promoting breastfeeding practices; increasing sulfadoxine-pyrimethamine (SP) coverage for intermittent preventive treatment of malaria in pregnancy (IPTp); they provided depot medroxy-progesterone acetate (DMPA) injections as safely as qualified staff; and treated malaria in children effectively; thereby reducing workload of health professionals at peripheral health facilities. Crucial factors to their performance included training; remuneration; inadequate medical supplies; and lack of career development structure. The review shows that CHWs can be effective at providing basic curative and preventive MNCH interventions. Developing country health systems can make use of this available resource to increase access of MNCH interventions

The Quality and use of Maternal Health Care in Oyam District; Uganda: a Baseline Survey for an Intervention

Despite the availability of technically sound approaches; maternal mortality and other reproductive health problems persist in Uganda and other developing countries. Utilisation of maternal health services remains very low; especially delivery attended by skilled birth attendants. In Oyam and other Ugandan districts smarting out of prolonged insurgency; reproductive health services are generally poorly utilised. Doctors with Africa-CUAMM; an Italian NGO; together with other partners and with funding from the EU; initiated a programme intended to improve the uptake and quality of repro- ductive health services in Oyam District. A baseline study was conducted in 2008 to document the initial pattern of use and quality of the existing maternal healthcare services in order to generate baseline data against which the performance of the programme will be evaluated. Its objectives were to establish the level of utilisation of maternal healthcare; the factors underlying mothers' health-seeking behaviour; the quality of maternal healthcare services; and to describe the outcome of pregnancies carried within the previous 5 years. The study had three major components: a household survey (1472 households); a survey of community resource persons (30 TBAs; and 9 senior women leaders); and a health facilities survey (1 hospital; 1 HC IV; and 5 HC IIIs). Government-owned facilities were the most prevalent and most utilised (by 84.7). The median age of the mothers at the last pregnancy was 24 years and by that age; most mothers had had 3 pregnancies. At the first onset of labour; most women consulted an untrained friend or relative; and TBAs due to proximity. Overall; 41of the deliveries in the district take place in health facilities; and 44at the TBAs but 3.2are not attended to. PNC services are not well utilised despite high levels of awareness of the presence and utility of the services (by 73). Most mothers utilize injectable hormonal contraceptives and natural methods. Resistance from spouses and perceived negative effects of FP methods are major hindrances to FP utilisation. Over 90of the pregnancies had a positive outcome for the mother and child. The study recommends focusing on quality improvement through implementation of the standard package of reproductive health services and support supervision

Maternal Perspectives of Prenatal Sonogram in a North-Eastern Population in Nigeria

Limited information exists on maternal perspectives of prenatal sonogram in north-eastern Nigeria. This study was aimed at documenting the views and expectations of pregnant women concerning prenatal sonogram as well as their level of awareness of its purpose; limitations and safety in a predominantly Moslem society. A survey was carried out on a convenience sample of 150 patients referred from ante-natal clinics for prenatal sonogram; by administering semi-structured questionnaires. The results show that 61.3of the women had prenatal sonogram; with little or no information about the purpose; capabilities and limitations of the procedure. 24.7had neither formal western nor Islamic educational background that may have influenced their perceptions. Most of the women (81.3) were sponsored by either government or their husbands; 72.7perceived sonogram to be affordable and 63.4viewed sonographic results as reliable. The perceived main reasons for having a prenatal sonogram were to determine the expected date of delivery and foetal well-being; and to obtain reassurance of maternal health. Sex determination and number of foetuses were the least considered reasons. The study indicates that providing pregnant women with adequate information and sensitising them to the purpose and limitations of sonograms is necessary to guarantee its rational utilisation. Improving patient care; enhancing the skill of sonographers and providing more facilities would improve the services and patients' perspectives of prenatal sonography

Maternal Depression and Anxiety among Children with Mental Health Problems

Objective: The investigation sought to examine depression and anxiety levels in mothers of children with mental health problems. Method: A case control design was employed and self-reports of depressive and anxiety symptoms were measured in a group of women whose children were receiving mental health care; as well as a community control group and a group of women receiving outpatient psychiatric care. Results: No significant differences were noted in depressive and anxiety symptoms between the mothers of children with mental health problems and the community controls; although both of these groups showed significantly lower levels of depression and anxiety than the psychiatric patient group. These findings were not influenced by demographic variables. Conclusions: The findings are contrary to those of high income countries where mothers of children with mental health problems show higher levels of depression and anxiety. This disparity may be due to the sampling and mental health service usage patterns in low-income countries where mothers who seek mental health care for their children probably constitute a specific group of people who have awareness of mental health problems and available services. As a result their own mental health is likely to be better

A Stepwise Regression Analysis on Under-Five Diarrhoael Morbidity Prevalence in Nekemte Town; Western Ethiopia: Maternal Care Giving And Hygiene Behavioral Determinants

Objective: Various studies have addressed the relationship between maternal care giving behaviours including hygiene behaviours and the occurrence of diarrhoea in children. However; very few studies have done in Ethiopia in general and none exist in Nekemte town; western Ethiopia. Therefore; the present study aimed to estimate the prevalence of under-five diarrhoea morbidity in relation to mothers/care takers behaviours including hygiene behavioural determinants. Methods: Community-based cross-sectional study was conducted in Nekemte town; western Ethiopia from October 15- November 26; 2007. 477 mothers/ care takers of index under-five children living in the households selected randomly from sub cities in the town formed the study population. Structured and pre-tested questionnaire was used to collect data. The data were entered into a computer; edited and analyzed using SPSS for windows version 12.01. Stepwise logistic regression model was used to calculate the Odds ratios and 95confidence interval for the different risk factors was considered. Results: From 477; 461 were participated in the study giving a response rate of 96.6The mean ages of the respondents and the index children were about 32.4 (+8.8 SD) years and 25.27(+15.16 SD) months respectively. Diarrhoea morbidity prevalence over a period of two weeks preceding the study was about 28.9. Although several maternal cares giving and hygiene-related risk factors showed significant association with diarrhoea morbidity on bivariate analysis; the use of cover material during drinking water transportation; faeces seen around the pit-hole and bottle feeding were the only significant variables on multivariate analysis. Conclusion: As diarrhoea morbidity was major problem among under-five children in Nekemte town; appropriate intervention programmes should be formulated focused on identified risk factors

The Role of Pregnancy Intention in HIV Prevention in South Africa: a Proposed Model for Policy and Practice

Mother-to-child transmission is a continuing source of new HIV infections in South Africa. The paper posits that insight into the socio-cultural; behavioural; environmental and economic factors that sustain the HIV epidemic is as important as understanding the biological causes of the disease when planning and implementing interventions to prevent and reduce perinatal transmission. Furthermore; understanding the pregnancy intentions of individuals in areas of endemic HIV/AIDS is vital for providing the best care for individuals who are HIV-positive. This paper suggests a model for types of support and interventions that are relative to the intention of HIV-positive women or couples to become pregnant. Included among these are interventions for prevention of unwanted pregnancy; prevention of transmission of HIV; protection of the infant; and protection of the mother

La durée de la phase d'expulsion lors de l'accouchement en présentation de sommet

Ce travail avait pour objectif d'apprecier l'impact de la phase d'expulsion sur l'etat maternel; foetal et neonatal.Il s'agit d'une etude prospective cas-temoins portant sur 140 parturientes ayant eu une duree d'expulsion normale 30 minutes comparees a un groupe de reference constitue par 310 parturientes qui ont eu une duree d'expulsion prolongee ? 30 minutes recensees a la maternite du CHU de Treichville sur une periode de 1 an.Il ressort de cette etude deux observations:1. La duree de la phase d'expulsion est beaucoup plus longue chez la primipare (moins de 30 minutes) que chez la multipare ou elle excede rarement 15 minutes.2. Le pronostic des accouchements avec une phase d'expulsion prolongee est moins bon que celui des accouchements avec une phase d'expulsion normale.*En effet; les accouchements avec une phase d'expulsion prolongee sont marques par un taux significativement plus eleve:-d'expulsion en OS-de bassin limite-de poids de naissance excessif-de pathologies funiculaires-de survenue d'une bosse serosanguine au cours du travail*Le pronostic maternel est domine par un taux significativement plus eleve d'episiotomie*Quant au pronostic foetal et neonatal; il est domine par un taux significativement plus important:-de bosse serosanguine-de score d'APGAR inferieur a 7-d'evacuation en Pediatrie des nouveau-nes.Afin d'ameliorer le pronostic; nous soulignons la necessite d'une prise en charge correcte conditionnee par un diagnostic precoce et une surveillance attentive