Midwives' perceptions of and attitudes towards prevention of mother-to-child-transmission of HIV

Background: Prevention of mother-to-child transmission (PMTCT) of HIV services has become an integral part of antenatal services. Prevention of mother-to-child transmission was introduced in all the regions of Ghana, but mother-to-child transmission (MTCT) continued to increase. Objectives: To explore and describe midwives' perceptions and attitudes towards PMTCT of HIV services. Method: Quantitative research approach and descriptive cross-sectional design were used. The population includes all midwives between the ages of 21 and 60 years who work in antenatal care (ANC) clinics in 11 district hospitals in the Central Region of Ghana where the study was conducted. Forty-eight midwives were interviewed using a census sample process. Data were analysed using the Statistical Package for the Social Sciences version 21. Correlation analysis was performed to find the relationships between the attitudes and the perceptions of the midwives on PMTCT of HIV services. Results: Seventy percent of midwives had positive perceptions of PMTCT of HIV services and 85% had positive attitudes towards the provision of PMTCT of HIV services. Midwives were screening all pregnant women who visited the ANCs and referring those who tested positive to other institutions where they can be monitored. Some of the concerns considered were views on retesting HIV-infected pregnant women throughout their pregnancy. There was a positive correlation between attitudes and perceptions of midwives on PMTCT of HIV services. Conclusion: Midwives had positive perceptions and positive attitudes towards the PMTCT of HIV services that they were providing to antenatal attendees. Also, as the attitudes of the midwives towards PMTCT of HIV services improved, their perceptions of PMTCT services also improved. Contribution: Decentralisation of PMTCT of HIV services to community-based health facilities is appropriate to enable sub-district health facilities to test for HIV and provide counselling services to pregnant women.

Support experiences of mothers with breastfeeding problems: A qualitative study

Understanding mothers with problems regarding support is important for planning care, directing interventions, and ensuring the continuity of breastfeeding. This is a qualitative analytic study. Data were collected by using questions about socio-demographic characteristics and semi-structured interview questions. The research sample consisted of 15 mothers who met the participation criteria and volunteered to participate. Most of the mothers stated that they want to be supported when they need it, they want positive support, they do not want to be compared with other mothers and they care about professional support. Social support given without ignoring the feelings and expectations of the woman during the breastfeeding process will positively affect the process. (Afr J Reprod Health 2022; 26[7]: 102-111).

Exploring experiences with sensitivity to cultural practices among birth attendants in Kenya: A phenomenological study

Background: Sensitivity to women's cultural needs and expectations by care providers is essential. Skilled birth services for women are as essential as traditional birth services. Therefore, collaborative skilled and cultural care optimises childbearing experiences. Aim: This study explored the experiences of birth attendants (BAs) with sensitivity to cultural practices (CPs) during pregnancy and birth among the Keiyo community in Kenya. Setting: The study was conducted in the purposively selected public health centres and dispensaries offering maternity services and the villages in Keiyo South Sub County in Kenya. Methods: A qualitative interpretive phenomenological study of BAs was conducted. Iterative and inductive interviews using a semistructured guide were conducted with 11 skilled BAs (SBAs) and eight traditional BAs (TBAs). Audio-recorded interviews were transcribed and analysed using ATLAS.ti software version 8.4.4 (1135), following Van Manen's five thematic analysis steps. Results: Three themes emerged: birth attendants' cultural encounters, response to cultural encounters and collaboration. Birth attendants' responses to different cultural encounters revealed their awareness of CPs. The response was experienced as a sensitivity to the need for a triad (woman, TBAs and SBAs) collaborative care, enabling collaborative, woman-centred and culturally safe care. Conclusion: Birth attendants are exposed to cultural encounters, and their responses determine their awareness of enabling sensitive care for optimal childbearing experiences. The study illuminated the need for further collaborative engagements between the BAs and the community to facilitate positive experiences by women through woman-centred, culturally safe care.

Lessons from COVID-19 pandemic: teaching midwifery at the national level in Sierra Leone in the pandemic and post pandemic

The contents of this article are drawn from personal experiences and National response by the Ministry of Health and Sanitation during the COVID-19 pandemic in the midst of teaching in a midwifery training school. Teaching Midwifery in COVID-19 Pandemic and Post Pandemic periods impacted on the way student midwives were taught. Contextual issues are highlighted during the COVID-19 Pandemic in the Midwifery Education profession. But more speciacally, the impact of Covid-19 on midwifery education basically around the way students were taught, classroom spacing rearrangement and institutionalizing national protocols and guidelines on prevention of COVID-19 spread among staff and students.

Access, perceived quality and uptake of antenatal services in urban communities of Osun state, Southwest Nigeria

Quality antenatal care (ANC) is one of the key interventions to improve intrapartum care uptakes and to reduce the menace of maternal deaths globally. Yet, ANC coverage has remained low in many developing countries like Nigeria. It becomes imperative to contextually understand factors associated with ANC uptake in Nigeria. The study assessed level of utilization, perceived quality, level of satisfaction and determinants of ANC utilization among women of reproductive age-group in Oshogbo, South-west Nigeria. Cross-sectional study design was employed and cluster sampling method was used to recruit 420 consenting respondents. Data were collected using pretested interviewer-administered, semi-structured questionnaire. Both descriptive and inferential statistics were done at p<0.05. The mean (±SD) age of the respondents was 30.84±6.0 years. Almost three-quarters (73.9%) of the respondents had at least 4 ANC visits. Main reasons for non-ANC usage were high cost of care, long waiting time at the clinic, long distance to the clinic and unsatisfactory service quality. Only 59.9% of respondents were satisfied with services received while 63.1% of them rated the service quality as excellent. Main determinants of ANC uptake were respondents' age (AOR=2.35;95%CI=1.34-5.89), level of education (AOR=0.56;95% CI= 0.42-0.71), socio-economic status (AOR=5.22; 95%CI=2.02-6.65) and monthly family income (AOR=0.89; 95%CI=0.02-0.90). Although the rate of ANC use was high in the study setting, the proportion of women who were satisfied with service quality was sub-optimal. There is need for implementation of multi-pronged intervention to make ANC services more available, accessible, affordable and acceptable to the Nigerian women

Accessibility of maternal health information and its influence on maternal health preferences in rural Tanzania: A case study of Chamwino District

Background: The access to quality maternal health information amongst pregnant women plays an important role in determining woman's health behaviour during pregnancy. Yet, access to maternal health information remains a major challenge in Tanzanian rural communities especially for pregnant women leading to low utilisation of skilled maternal health services. Objectives: The study aimed at examining the accessibility of maternal health information amongst pregnant women in rural Tanzania. Methods: A qualitative phenomenological study involving 25 pregnant women, 5 skilled healthcare providers (SHPs) and 5 traditional birth attendants (TBAs) was carried out in Chamwino District, Dodoma Region, Tanzania for a period of 6 months. Data were analysed thematically using the six-stage guide to thematic data analysis with NVivo Software. Results: The acute shortage of healthcare personnel and traditional beliefs influenced pregnant women's access to quality maternal health information. The majority of women used mothers-in-law and TBAs as their primary source of maternal health information rather than skilled healthcare providers. Conclusion: Despite the acute shortage, healthcare providers need to play a leading role in providing maternal health information amongst the rural populations. Furthermore, skilled health providers need to work in collaboration with the TBAs to increase access to maternal health information and build a well-informed healthy society.

Traditional birth attendants and reproductive health services in the context of covid-19: a scoping review

Background: In developing countries, the lack of accessible, affordable and acceptable orthodox care makes a significant proportion of the populace patronize the nearby available and cheap traditional birth attendants (TBAs) that share similar local custom and tradition. Although there are widely diverging shreds of evidence regarding their effectiveness as health care providers, they may have a limited role as a workforce during the ongoing COVID-19 pandemic where the more community-based distribution of commodities is increasingly considered due to movement restrictions. However, it is still doubtful if their integration into the formal health system may substantially contribute to basic health care delivery especially in the rural often hard to reach areas. Objectives: To explore the various roles of TBAs in reproductive health service delivery with implication for redefining their roles especially with the advent of the COVID-19 pandemic. Methodology: We searched and reviewed relevant literature on TBAs in PubMed, Africa Journals Online (AJOL) and Google scholar and relevant institutional websites for the role of TBAs pre and during the pandemic. The databases searched yielded 92 articles of potential significance to this review. After title/abstract review, 65 articles were moved to full document review. Nineteen articles explicitly and strictly focusing on TBAs concerning reproductive health were included in this review. Results: TBAs are providers of a wide range of reproductive health services and training to expand their roles and makes them safer is necessary for any consideration of their engagement; this implies the fight against COVID-19. TBAs should only be engaged if the gap in the resources for health must be filled by leveraging on their existing traditional roles and acceptance in the community. Conclusion: TBAs are widely utilised providers of care to their communities especially in the area of maternal care. With increasing emphasis on community-based services in healthcare delivery and the emergence of COVID-19, their roles must be reviewed and updated regularly to redefine their role in the health care delivery system especially because of the myriad personal and technical limitations associated with them. Any engagement with them should be with caution and as a stop-gap measur.

Knowledge and utilization of non-pneumatic anti-shock garment for the management of postpartum hemorrhage among midwives in government hospitals in Ogun State, Nigeria

Objective: To assess the knowledge and determine the level of utilization of Non-Pneumatic Anti-Shock Garment (NASG) for the management of PPH among Midwives.Method: The study employed a descriptive cross-sectional study design, using a validated self-administered questionnaire. A total of 198 randomly selected midwives across three health facilities in Ogun State participated in the study. A 10-point knowledge scale was used to assess the knowledge of midwives on NASG. Descriptive statistics were used to determine the level of utilization of NASG among midwives, while Chi-square statistics were used to determine the relationship between the dependent and independent variables of interest at p<0.05 level of significance.Results: Most (88.9%) of the respondents were female with a mean age of 40.2±5.6years. Most (48.5%) had a BNS degree. The majority (74.7%) of the respondents were aware of NASG. Close to a half (49.3%) of the respondents had fair knowledge scores, 34.5% had good knowledge scores, while 16.2% had poor knowledge scores. Only 22.7% of the respondents had ever used NASG in the management of PPH; 77.3% never used it before. Also, 67.2% of the respondents reported NASG was not available in their facilities. There was a significant influence of knowledge of NASG on the utilization among midwives (X2=37.151, P<0.05, df=2).Conclusion: This study demonstrated that midwives in healthcare facilities were aware, but did not have good knowledge of NASG. The utilization of the garment for the management of PPH was also very poor, probably due to suboptimal knowledge and non-availability of the garment

Socio-cultural beliefs and practices influencing institutional delivery service utilization in three communities of Ethiopia: a qualitative study

BACKGROUND: The influence of socio-cultural factors on institutional birth is not sufficiently documented in Ethiopia. Thus, this study explores socio-cultural beliefs and practices during childbirth and its influences on the utilization of institutional delivery services. METHODS: A qualitative study was conducted in three regions of Ethiopia through eight focus group discussions (with women) and thirty in-depth interviews with key informants which included health workers, community volunteers, and leaders. The data were analyzed thematically. RESULTS: The study identified six overarching socio-cultural factors influencing institutional birth in the study communities. The high preference for traditional birth attendants (TBAs) and home as it is intergenerational culture and suitable for privacy are among the factors. Correspondingly, culturally unacceptable birth practices at health facilities (such as birth position, physical assessment, delivery coach) and inconvenience of health facility setting to practice traditional birth rituals such as newborn welcoming ceremony made women avoid health facility birth. On the other hand, misperceptions and worries on medical interventions such as episiotomy, combined with mistreatment from health workers, and lack of parent engagement in delivery process discouraged women from seeking institutional birth. The provision of delivery service by male health workers was cited as a social taboo and against communities' belief system which prohibited women from giving birth at a health facility. CONCLUSIONS: Multiple socio-cultural factors and perceptions were generally affected utilization of institutional birth in study communities. Hence, culturally competent interventions through education, re-orientation, and adaptation of beneficial norms combined with women friendly care are essential to promote health facility birth

Caesarean section deliveries: Experiences of mothers of midwifery care at a public hospital in Nelson Mandela Bay

Background: The rate of caesarean section deliveries has increased globally and mothers are faced with challenges of postoperative recovery and caring thereof. Midwives have a duty to assist these mothers to self-care.Objective: The objective was to explore and describe experiences of post-caesarean section delivered mothers of midwifery care at a public hospital in Nelson Mandela Bay.Methods: A qualitative, descriptive and explorative research design was used in the study. Data were collected from 11 purposively criterion-selected mothers who had a caesarean section delivery. One-on-one semi-structured interviews were conducted in the post-natal wards. Research ethics, namely autonomy, beneficence, justice and informed consent, were adopted in the study. All participants were informed of their right to withdraw from the study at any stage without penalties. Interviews were analysed using Tesch's method of data analysis.Results: Three main themes were identified as experiences of: diverse pain, physical limitation and frustration and health care services as different.Conclusion: Experiences of mothers following a caesarean section delivery with midwifery services at a public hospital in Nelson Mandela Bay were explored and described as diverse. A need for adequate pain management as well as assistance and breastfeeding support to mothers following caesarean delivery was identified as crucial to promote a good mother-to-child relationship

Midwives' knowledge and use of partographs at Juba Teaching Hospital, South Sudan

Background:Evidence shows that good knowledge of partographs and proper application of this knowledge results in a remarkable reduction in prolonged and obstructed labour and reduces maternal mortality. Obstructed labour can be prevented by a simple and cost-effective health intervention tool, the partograph. A partograph is a graphical record of the progress of labour and salient conditions of the mother and foetus plotted against time in hours. This provides an opportunity for early identification of deviation from normal progress. Early detection of prolonged labour greatly contributes to prevention of obstructed labour and related complications.Objective:To assess midwives' knowledge and use of partographs in the maternity ward of Juba Teaching Hospital, South Sudan.Methods:A cross-sectional descriptive study was conducted to assess utilisation of partographs among healthcare providers in Juba Teaching Hospital. All providers working at the time of the study were included. An interviewer administered questionnaire prepared in English was used to assess socio-demographic and other related variables of respondents as well as knowledge and practice. Ethical procedures were followed at every step. Results:Only 20% of the 30 respondents were registered midwives, 67% knew the components -of a partograph, and 93% could differentiate between normal and abnormal labour with the use of a partograph. The factors affecting the use of partographs included; shortage of partographs in the ward, lack of protocols on partograph use, understanding semantics of the English language, absence of refresher training, late reporting of mothers to the ward, and a shortage of staff. Conclusions: Despite good knowledge of the partograph, about half of the providers do not use them. We recommend training and recruitment of more qualified midwives, a continuous supply of partographs to improve use of partographs continuous supportive supervision, mentoring of staff and motivation schemes

Primary health workers' knowledge and practices relating to neonatal jaundice in Ibadan, Nigeria

Background: Over half of births and newborn care occur in primary healthcare facilities in Nigeria, but information on activities of personnel working there is scarce. Aim: To assess the knowledge and practices relating to neonatal jaundice (NNJ) among community health workers (CHWs) and community birth attendants (CBAs) in Nigeria. Setting: We conducted a cross-sectional survey of all 227 CHWs and 193 registered CBAs in Ibadan, Nigeria.Methods: Knowledge and practices regarding NNJ were measured using a pretested questionnaire. Knowledge and practices were assessed on a 33-point scale and a 13-point scale, respectively. Scores ≤ 17 and ≤ 9 was regarded as poor knowledge and as wrong practice, respectively. Results: Many (64.5%) of the respondents could not correctly describe examination for NNJ (CHWs: 49.4%; CBAs: 50.6%). Of the 200 (47.6%) who treated NNJ 3 months prior to the study, 62.5% (CHWs: 66.9% and CBAs: 53.7%) treated NNJ with orthodox drugs. Drugs prescribed included: antibiotics (93.3%), antimalarials (5.3%), multivitamins (28.0%), paracetamol (6.2%) and phenobarbitone (7.1%). Significantly more CHWs than CBAs practiced exposure to sunlight (33.1% versus 16.4%) and administration of glucose water (28.6% versus 14.9%), while 58.0% of all respondents referred cases to secondary health facilities. Overall, 80.2% had poor knowledge (CHWs: 78.9%; CBAs: 81.9%) and 46.4% engaged in wrong practices (CHWs: 57.3%; CBAs: 33.7%). CHWs were more likely to indulge in wrong practices than CBAs (OR = 2.22, 95% CI = 1.03, 4.79). Conclusion: Primary Health Workers in Ibadan had poor knowledge and engaged in wrong practices about NNJ. The needs to organise regular training programmes were emphasised

Management of malaria in pregnancy by Traditional Birth Attendants in Ogun State, Nigeria

Background: Malaria in pregnancy is a major public health issue in sub-Saharan Africa. Most deliveries in this region are attended by the Traditional Birth Attendants (TBAs).Objective: To assess the knowledge and practice of prevention and treatment of malaria in pregnancy amongst TBAs in Ogun State, south-west Nigeria.Methods: This descriptive, cross-sectional study used systematic random sampling to select 200 registered TBAs within the state. Pre-tested, semi-structured interviewer-based questionnaires were used to obtain relevant data.Results: The mean age of respondents was 37.7 ± 2.2 years. Most of the respondents had secondary school education (82.0%) and were females (89.0%). The majority (68.0%) had good knowledge of malaria during pregnancy; 83.0% used blood test for the diagnosis of malaria while 62.2% of these used Malaria Rapid Diagnostic Test kits. A third of the respondents (33.0%) used Artemisinin-Combination Therapy for treatment while 13.0% used Chloroquine. The majority (85.5%) of the respondents did not practice directly observed therapy in intermittent preventive treatment for malaria using Sulphadoxine-Pyrimethamine (SP). The age of the respondents was significantly associated with their level of knowledge (p = 0.019).Conclusion: The TBAs had high level of knowledge and good practice of the management of malaria in pregnancy. However, some still treated malaria with Chloroquine and were not conversant with the use of SP for the prevention of malaria. It is recommended that capacity building sessions for the TBAs be instituted to improve the quality of care they provide

Experience de la premiere formation medicale continue en echographie destinee aux medecins generalistes et sages-femmes a l'UFR des sciences de la sante de Saint-Louis

Introduction. L'echographie est une modalite d'imagerie medicale non irradiante avec une innocuite parfaite. Ce travail rapporte la premiere experience de formation en echographie a l'UFR des sciences de la sante de Saint-Louis. L'objectif etait de renforcer les connaissances et savoir-faire en echographie de 11 medecins generalistes et 11 sages-femmes. Methode La formation s'est deroulee sur 13 semaines; avec un tronc commun portant sur les connaissances de base; et la pratique de l'echographie gyneco-obstetricale. A la fin du tronc commun; les sages-femmes debutaient les stages et les medecins poursuivaient la formation en echographie abdomino-pelvienne avant leurs stages. Des tests ont precede et cloture la partie theorique qui s'est deroulee sous forme d'exposes illustres d'images et cas pratiques. L'evaluation reposait sur le nombre d'objectifs atteint et l'assiduite. Resultats : 19 apprenants sur 22 ont valide la formation. Entre le pre-test et le Post-test; il y'avait chez les sages-femmes une progression de la moyenne de 66;6 et de 85;7 chez les medecins. L'assiduite etait satisfaisante. Le meilleur score d'objectif atteint chez une sage-femme etait de 100; et le score minimale chez elles etait de 85;5; avec une moyenne de 97;1 et un ecart type de 4;6. Chez les medecins le meilleur score etait de 95; le plus faible etait de 4;8 avec une moyenne de 72 et un ecart type de 3;1.Conclusion : Cette experience enclenche le processus de regionalisation de la formation medicale continue dans les universites senegalaises facilitant l'acces aux agents de sante a la formation medicale continue

The experiences of postnatal patients regarding postnatal care in Mopani District, Limpopo Province, South Africa

This paper describes the experiences of postnatal patients regarding postnatal care; with the intention of making recommendations to improve the quality of care during the postnatal period. The participants receive care from midwives for the first six hours after delivery and are discharged home. On discharge; the participants receive health advice from midwives on how to take care of themselves and newborn infants at home during the postnatal period. At home they receive care and advice from traditional birth attendants. Different pieces of advice confuse the participants because they interfere with decision-making skills. A qualitative; exploratory; descriptive and contextual research method was used in this study. A semi-structured interview guide was also used to conduct focus group interviews. Data were collected until saturation was reached during the second focus group interview. Participants revealed the following challenges: lack of openness and transparency between the midwives and the traditional birth attendants; exclusion of participants' relatives when giving health advice on discharge; conflicting postnatal care advice; lack of postnatal care supervision and follow up; postnatal patients under direct care of traditional birth attendants only; and feeling of insecurity by the participants. The participants suggested that there should be incorporation of indigenous postnatal care practices into the midwifery healthcare system in order to enhance teamwork between the midwives and the traditional birth attendants. Follow up should be conducted by the midwives to ensure safety; support; supervision and continuity of care to the participants during the postnatal period

Exploring the Feasibility of Engaging Traditional Birth Attendants in a Prevention of Mother to Child HIV Transmission Program in Lilongwe; Malawi

Objective:To investigate the willingness of Traditional Birth Attendants (TBAs) to provide single dose antiretroviral prophylaxis to infants born to mothers with HIV and the feasibility of providing the TBAs with antiretroviral medication. Design 2 focus groups with a total of 17 registered TBAs. Setting Lilongwe; Malawi Methods TBAs were recruited by local health workers and participated in focus groups assessing their attitudes towards participation in a PMTCT program. Results TBAs were willing to participate in this prevention of mother-to-child HIV transmission (PMTCT) program and helped identify barriers to their participation. Conclusions:Given appropriate support and training; TBAs' participation in PMTCT programs could be an additional way to deliver medication to mothers and neonates who might otherwise miss crucial doses of medication

Home Births and Postnatal Practices in Madagali; North-Eastern Nigeria

Background: Home births are common in resource poor countries and postnatal practices vary from one community to the other. Objective: To determine the proportion of home births; reasons for home delivery; and evaluate postnatal practices in Madagali; north-eastern Nigeria. Materials and Methods: This was a cross-sectional descriptive study of 400 women of reproductive age; who had put to birth in the past 1 year. The study was carried out over a period of 8 weeks from April to June 2010. The multistage method of sampling was used to select respondents. In the first stage; four of the five health districts were chosen randomly; namely; Gulak; Madagali; Sukur; and Duhu. The questionnaires were evenly distributed among the four health districts. In the second stage; from each district; two villages were chosen by simple random sample. In the third stage; two wards were selected in each village by simple random sampling. Result: Of the 400 respondents interviewed; 289 (72.2) were aged between 20 and 39 years; and most; 374 (93.5) were married. Only 14 (3.5) had tertiary education. Most respondents; 224 (56.0) were farmers and grandmultiparae; 187 (46.7). A total of 196 (49.0) women delivered at home; whereas 204 (51.0) delivered at the hospital. Of the 196 respondents who delivered at home; the bedroom 142 (72.4); was the preferred place of birth. The most common reason for home birth was short duration of labor in 71 (36.3) cases. Delivery was conducted by untrained persons in 50; (25.4); whereas 99 (50.8) and 31 (15.5) deliveries were supervised by Traditional Birth Attendants (TBAs) and Midwives/Nurses; respectively. Postpartum; the majority; 235 (58.7) respondents used sanitary pads to stanch lochia; whereas 140 (35) used rags. Conclusion: A significant number of births take place in the home and supervised by unskilled persons. Against the backdrop of poor education and low socio-economic status of respondents; perineal hygiene can be adjudged satisfactory. There is the need to increase on the number of hospital birth and also trained TBA who conduct most of home deliveries

Caring as a Core Concept in Educating Midwifery Learners: A qualitative Study

Caring is the core business of nursing and midwifery; involving a relationship in which the carer is committed to the needs of the one being cared for (Mason-Whitehead; Mcintosh; Bryan et Mason). Caring is the emotion which drives a midwife to care; the motive aimed at assisting someone to grow and self-actualise (Watson). The concern in midwifery is that irrespective of caring being central to the midwifery profession; caring taught in theoretical learning does not always translate into caring behaviour in practice. A qualitative exploratory study examined how midwifery educators impart the skill of caring during theoretical learning and clinical accompaniment; in order to respond to the general complaint made both locally and internationally that midwives are uncaring. The aim was to explore caring during theoretical learning and clinical accompaniment from the perspective of midwifery educators. Participants in the study were midwifery educators teaching midwifery in institutions of learning in Tshwane; South Africa. The naive sketch was used to gather data; wherein one central question was asked and the educators were invited to narrate and respond. Three themes emerged: the meaning of caring; how caring was conveyed during theoretical learning; and how it was conveyed during clinical accompaniment. Although the midwifery educators expressed how they conveyed caring to the learner midwives; it was not evident how caring competencies were assessed in order to ensure caring midwives at the end of training