Effect of traditional birth attendants-led health education intervention on utilization of skilled birth care in West Pokot County, Kenya

Background: Globally, between 2000 and 2017, maternal mortality ratio declined by 38%, with global lifetime risk of maternal death falling from 1 in 73 to 1 in 180, respectively. In West Pokot County, Kenya, over half of deliveries are managed by traditional birth attendants. The study investigated the effect of TBAs-led intervention on utilization of skilled birth care in this County. Methods: The study employed a prospective experimental design. In the intervention arm, TBAs were recruited and trained on SBC. They were assigned expectant mothers and followed until they delivered their babies. Chi-square test was used to determine the relationship between variables. Binary logistic regression was used to compare utilization of SBC between the intervention and control sites. Results: Majority of mothers (95%) in the intervention arm of the study went for TBAs’ services , and 79.5% of those in the control did the same. Most mothers in the intervention (81.4%) delivered in health care facility compared to 58.2% in the control (?2=21.256, p<0.001). There was a significant difference in the odds of mothers utilizing SBC between intervention and control groups. Those in the intervention group were almost 3 times more likely to utilize SBC than those in the control group (UOR; 95% CI: 3.137; 1.909-5.155). Conclusions: TBAs-led intervention increased utilization of SBC among mothers in the intervention compared to those in the control arm who utilized available ministry of health’s standard care.

Trends in the use of skilled birth attendants among women of reproductive age in a resource-limited setting

Background: Although there has been growing awareness on the need for professional assistance at delivery, and this has improved health-seeking behavior and the use of antenatal care (ANC) of pregnant women, presenting for ANC does not directly imply that a woman would use a skilled birth attendant (SBA) at delivery. This study analyzed the trend in the use of SBAs at delivery among Nigerian reproductive women from 2007 to 2017. Materials and Methods: The study used the United Nations Children’s Fund, Multiple Indicator Cluster Surveys data for the years 2007 (n = 1021), 2011 (n = 2927), and 2016/2017 (n = 4155). Multivariate logistic regression was used to determine the relationship between the use of SBAs and demographic characteristics of women aged 15–49 years in Nigeria. Results: There was a significant decline in the utilization of SBAs at delivery from 82.7% in 2007 to 71.8% in 2016/2017 (P < 0.001). There was a decline in the proportion of doctors and nurses/midwives as birth attendants from 28.3% and 54.4% in 2007 to 22.8% and 49.0% in 2016/2017, respectively (P < 0.001), whereas the use of traditional birth attendants increased from 5.2% to 8.0% during the periods (P = 0.003). Urban residence [adjusted odds ratio (AOR)=1.32, 95% confidence interval (CI)=1.18–1.47, P < 0.01], higher maternal age (AOR=1.49, 95% CI=1.30–1.70; P < 0.01), and education attainment (AOR=3.78, 95% CI=3.39–4.22; P < 0.001) were associated with higher odds of the utilization of SBAs. Conclusion: There is a need for intervention programs for women in rural areas and women with a low level of education and lower maternal age. This will further reduce the maternal mortality ratios of the country.

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

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.

The effect of a two-day training and refresher program on the basic emergency obstetric and newborn care knowledge and skills of health workers in Legazpi City, Albay

@#<p style="text-align: justify;"><strong>Objectives:</strong> The availability of emergency obstetric and newborn care (EmONC) services is one of the key strategies in improving maternal health and achieving Sustainable Development Goal 3. Health staff knowledge and competency on these interventions are crucial to ensure the effective handling and management of obstetric and newborn emergencies. Health workers, despite having undergone formal training, require regular refresher courses to keep up with new, evidence-based information on EmONC intervention; and to ensure compliance with national and local referral guidelines. A two-day workshop was implemented to assess the knowledge and skills of health workers in Legazpi, Albay, regarding obstetric emergency cases and referral guidelines.</p><p style="text-align: justify;"><strong>Methods:</strong> A pretest was conducted on the first day to assess the knowledge of the participants. A series of lectures were given before administering a posttest at the end of these lectures. An Objective Structured Clinical Examination (OSCE) was conducted on the second day, which aimed to assess the skills of the participants.</p><p style="text-align: justify;"><strong>Results:</strong> The pretest findings indicated that the participants are generally knowledgeable about areas such as handwashing and prenatal care. Results of the posttest show that participants had difficulty with the category of referrals. Moreover, comparing the pretest and posttest scores, there is strong evidence that there is a difference in the median values of the pretest scores as compared to the posttest scores. The results of the OSCE also indicate the need for further training on partograph use and adherence to an EINC protocol. More than half of the participants passed all five parts of the OSCE.</p><p style="text-align: justify;"><strong>Conclusion:</strong> The workshop contributed to an improvement in the knowledge of health care workers in obstetric emergency cases. Skills-wise, more frequent training may need to be conducted to improve other competencies such as partograph utilization and the practice of EINC interventions.</p><p style="text-align: justify;"><strong>Key Words:</strong> emergency obstetric care, training, skilled birth attendants, knowledge, skills</p>

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.

Determinants of Disparity between Antenatal Bookings and Institutional Deliveries in Port Harcourt, Southern Nigeria

Aim:To determine the reasons why women deliver outside institutions where they register for antenatal care. Study Design:Qualitative study.Place and Duration of Study:Antenatal clinic of the University of Port Harcourt Teaching Hospital in February 2018.Methodology:A qualitative study using in-depth interviews (IDIs) was conducted in Port Harcourt, Nigeria to collect information on various reasons why women do not deliver where they received antenatal care (ANC) or with skilled birth attendants (SBAs). This was done using structured interview guides. Specifically, we asked 30 pregnant women to elucidate the circumstances that lead women to deliver in places other thanwhere they had received antenatal care, and recommendations to enhance the number of women delivering with skilled birth attendants. All in-depth interviews were audio-taped, transcribed and content-analyzed.Results:Thirty IDIs were carried out. The women were all pregnant; aged 20 to 43 years old with mean age of 32.9 ± 5.5 years. The broad themes that emerged from their responses: Cost/financial reasons relating to inability to afford the cost of care in the hospitals, personal reasons such as fear of Caesarean section, and hospital-related reasons such as health workers’ strike action. Conclusion:Evidence from our study indicates that pregnant women’s non-use of skilled birth attendants during childbirth even when they received antenatal care in thehospital is mainly due to financial, personal and hospital-related reasons. These factors are modifiable and should be targeted to increase delivery with skilled attendants, a key strategy for the reduction of maternal and neonatal mortality and morbidity.

Calf circumference to detect low birth weight babies: a comparative study

Background: In developing countries 15 per cent of infants weigh less than 2,500 grams at birth .It is not possible to provide expensive weighing scales to the community members and families due to logistic (carrying a heavy scale) and operational (inability of Trained Birth Attenders to read) problems. Therefore it is essential to find out an alternative method for the estimation of birth weight. Almost 60 per cent of newborns in developing countries are not weighed. Which can lead to an underestimation of the incidence of low birth weight. That's why' we done' present study' to know the simple indicators to detect low birth weight babies. Aim of this study to compare calf circumference with other Low birth weight indicators as a reliable predictor of low birth weight babies.Methods: It is a cross-sectional study done during period 2018 January to 2018 October done at Niloufer Hospital Hyderabad. Statistical analysis is done using SPSS (version 17) statistical software. For comparison Pearson's Correlation coefficients used.Results: The best correlation was observed with both calf circumference (r=0.818) and head circumference (r=0.744) for identifying babies with birth weight <2 kg. For babies with birth weight <2.5 kg, calf circumference had the highest order of correlation (r = 0.986) followed closely by head circumference (r=0.886).Conclusion: In the absence of a weighing machine, simple measurements like calf circumference is the best indicator in identifying low birth weight babies (<2.5kg) at birth.

Investigation and analysis of menstrual disorders in 845 air crew / 中国实用妇科与产科杂志

OBJECTIVE: To study the influencing factors of menstrual disorder in flight attendants,and to do a good job in prevention and education.METHODS: Totally 845 qualified flight attendants of an airline company in 2018 were selected and questionnaires were conducted to list the possible influencing factors of menstrual disorder: mental factors,poor sleep,excessive fatigue,polar airlines,irregular diet,and menstrual flight.RESULTS: Among 845 respondents,312 crew members had menstrual disorders in the past year,accounting for 36.92%.Among them,dysfunctional uterine bleeding occurred most,accounting for 51.28%,followed by dysmenorrhea,premenstrual syndrome and amenorrhea.Univariate analysis showed that the incidence of sleep disorder,mental factors,excessive fatigue,irregular diet,menstrual flight and polar flight in the menstrual disorder group was significantly higher than that in the normal menstrual group(P<0.05).Logistic stepwise regression analysis showed that poor sleep,excessive fatigue,mental factors,irregular diet,menstrual flight(OR = 20.747,11.982,5.590,4.284,3.120,P<0.01),and polar airlines were removed from the equation(OR=0.741,P=0.389).CONCLUSION: The special working nature of flight attendants is more likely to lead to menstrual disorders.Sleep quality and excessive fatigue are the main factors of menstrual disorders.

Evaluation of competency and skills of skilled birth attendants in Madhya Pradesh, central India

The National Health Mission tracks the proportion of women delivered by skilled birth attendants (SBAs). We assessed SBAs competence in Madhya Pradesh, India, using structured evaluation tools. It is a cross-sectional study conducted from 2014 to 2015. We evaluated 335 trained SBAs using multistage stratified random sampling. Of total, 335 skilled births attendant selected 41.8% were auxiliary nurse midwife, 47.8% were staff nurse, and 10.4% were lady health visitors. Grouping all provider and knowledge test versions, SBAs were correct on 75.4% of the questions. By topic, results ranged from 77.9% correct for the management of normal pregnancy and childbirth to 70.2% correct for intranatal care. The skill evaluation score was 88.1% of infection prevention practices to 74.3% for postnatal care. The present study found significant variations in knowledge and skill competency scores of the SBAs. There is a critical need to improve the training quality of skill birth attendants.

The Relationships among Needs for Health Promotion Programs according to Emotional Labor and Heathy Lifestyle of Flight Attendants / 산업간호학회지

PURPOSE: The purpose of this study was to figure out emotional labor, healthy lifestyle, needs for health services of flight attendants and the relationships among needs for health services according to various characteristics of flight attendants. METHODS: The participants of this study were 140 flight attendants who work on major and low cost airlines. Data were collected through a questionnaire from 2017 .Jan.~2017. Feb. Data were subsequently analyzed using the SPSS 21 Program. RESULTS: The score of emotional labor was 3.76 surface acting was 3.75 and deep acting was 3.77. The average of healthy lifestyle was 2.41, and the highest was 3.13 of personal relationship and the lowest was 1.91 of eating habits. There is a positive correlation between emotional labor-deep acting and healthy lifestyle. Flight attendants demand health services for physical exercise, stress and emotional labor management, healthy eating habits, emergency treatment, prevention of fatigue, cancer screening, sexual harassment prevention, sex education and etc. CONCLUSION: These results show that flight attendants need to various interventions for improving healthy lifestyle and reducing emotional labor. It is necessary to develop customized health promotion program suited to their job and general characteristics.

O desafio do trabalho com adolescentes em conflito com a lei: intervenção em psicodinâmica do trabalho / The challenge of working with teenagers in conflict with the law: psychodynamic work intervention / Reto de trabajo con los adolescentes en conflicto con la ley: una intervención en psicodinámica del trabajo

Os Atendentes de Reintegração Socioeducativo (ATRS) trabalham no acompanhamento, guarda e segurança dos adolescentes que cumprem medidas socioeducativas por terem cometido atos infracionais previstos no Estatuto da Criança e do Adolescente (ECA). Trata-se de um trabalho, no âmbito das políticas públicas, que possui dimensão educativa e de sanção. Este artigo discute as estratégias coletivas de defesa desses trabalhadores, que lidam cotidianamente com adolescentes em conflito com a lei. Utilizou-se a metodologia proposta em Psicodinâmica do Trabalho. Concluiu-se que, por meio de uma forte união,esses trabalhadores protegem-se das patologias do trabalho, pois saem da posição de isolamento e se inserem em um espaço de relações intersubjetivas que sustentam o trabalho e afastam o medo e as angústias. O fortalecimento do coletivo ocorre pela mobilização da cooperação, em torno de uma disciplina quase carcerária direcionada aos adolescentes em privação de liberdade. Uma disciplina que dissimularia uma estratégia coletiva de defesa que nega o fato de que os adolescentes em conflito com a lei estão em situação de vulnerabilidade psíquica e social. Esta estratégia coletiva de defesa possui a função, nas condições atuais de trabalho, de proteger esses sujeitos do medo de tecerem uma relação de proximidade com os esses adolescentes, baseada na certeza de que em tal relação esses trabalhadores estariam em perigo e desprotegidos.

Socio-educational Reintegration Workers play a role in the custody, safety and monitoring of teenagers, complying with socio-educational measures for having infringed the law according to Brazil's Child and Teenager Statute. This study in terms of public policies has to do with education and sanction. Further, it discusses collective defense strategies from social reintegration workers, who deal on a daily basis with teenagers in conflict with the law. The methodology applied is based upon Work Psychodynamics. The study concludes that given their strong unity, social reintegration workers protect themselves from work-related pathologies given that they preserve themselves from isolation by inserting themselves in a space of intersubjective relations that support their work and keep them from fear and anxiety. Collective strength comes through cooperation built around the almost prison-like discipline shown towards teenagers deprived of their freedom. This discipline disguises a collective defense strategy that denies the fact that teenagers in conflict with the law are in a vulnerable psychosocial situation. This collective defense strategy serves under current work conditions to protect social reintegration workers from the fear of building a close relationship with teenagers given the certainty that this relationship will leave the first group at risk and unprotected.

Los asistentes de Reintegración socioeducativo (ATRS) trabajan en el seguimiento, la vigilancia y la seguridad de los adolescentes que están cumpliendo medidas socioeducativas por la comisión de actos ilegales previstas en Estatuto de la Infancia y la adolescencia (ECA). Es un trabajo en el contexto de la política pública, que tiene una dimensión educativa y sanción. Este artículo analiza las estrategias colectivas de defensa de los profesionales que tratan a diario con adolescentes en conflicto con la ley. Se utilizó la metodología propuesta para la psicodinámica del trabajo. Se concluyó que, por intermedio de una unión fuerte a los trabajadores a protegerse de las condiciones de trabajo, al salir de la posición de aislamiento y se insertan en un espacio interpersonal las relaciones que apoyan el trabajo y lejos del miedo y la angustia. El fortalecimiento del colectivo es la movilización de la cooperación en torno a una disciplina de la prisión casi dirigido a adolescentes de privación de libertad. Una disciplina que ocultaría una estrategia de defensa colectiva que niega el hecho de que los adolescentes en conflicto con la ley están en situación de vulnerabilidad psicológica y social. Esta estrategia colectiva de defensa tiene la función, las condiciones actuales de trabajo, para proteger a estos temas desde el miedo trenzó una estrecha relación con estos adolescentes, basado en la certeza de que a este respecto que estaban en peligro y sin protección.

Evaluation of flight attendants' ocular surface after different refractive corrections / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To evaluate flight attendants' ocular surface after different refractive corrections. ·METHODS:Forty-two flight attendants (84 eyes) were enrolled in the study. Those flight attendants, who were followed up from September 2014 to September 2016, all followed the doctor's orders. According to different refractive corrections, those flight attendants were divided into 4 groups: corneal refractive surgery group, soft contact lens group, rigid gas permeable contact lens ( RGP) group and control group without any refractive corrections. OSDI scores, tear meniscus heights, BUTs, fluorescein staining scores and Schirmer's tests were taken and analyzed. ·RESULTS: Compared with the control group, OSDI scores were worse, tear meniscus heights ( TMH ) were reduced, BUTs were shortened, fluorescein staining(FS) scores were worse, Schirmer's Tests ( SⅠt) were shorter in soft contact lens group and corneal refractive surgery group (P0. 05 ) . There was no significant difference in lid margin abnormalities among the four groups (F=3. 82, P=0. 45). ·CONCLUSION: RGP can improve flight attendants'ocular surface micro-environment.

Expanding Access to Maternal Health Services by the Use of Traditional Birth Attendants: Experiences of the Sunni Hospital Group, Maiduguri, Nigeria.

Aim: We intend to ascertain the experience of Sunni Hospital Maiduguri on the use of TBAs in enhancing Maternal Health Care Services. Study Design: It was a retrospective observational survey of a community health project. Place and Duration of Study: Maiduguri, Borno State Northeastern Nigeria between January 2001 and December 2007. Methodology: Post-intervention survey of a community health intervention that targeted Muslim underserved semi-urban women. Results: One thousand seven hundred and seventy eight (1,778) women were referred for life-saving interventions. More than 80% of the referrals were due to maternal and fetal complications identified by the TBAs in their respective communities. Six hundred and ninety one (691) deliveries were conducted using clean delivery kits. Their counseling and services consistently enhanced contraceptive uptake seen by generation of over 2,000 CYPs. Conclusion: TBAs play a significant role in expanding maternal and child health services in our communities. And TBAs are likely to continue to be key resource for improving maternal and child health. Therefore it is necessary to integrate these community workers in the health system.

Mulher, tempo e trabalho: o cotidiano de mulheres comissárias de voo / Mujer, tempo y trabajo: la vida cotidiana de mujeres azafatas / Woman, work and time: the daily life of women flight attendants

Este artigo aborda como mulheres mães, que atuam como comissárias de voo, percebem e organizam suas vidas cotidianas, abordando vivências e práticas em relação à organização temporal e espacial do trabalho na aviação. A relevância deste tema decorre das especificidades na organização temporal e espacial do trabalho, peculiaridades com relação à gestão da vida cotidiana e os possíveis atravessamentos da questão de gênero nesse universo laboral. Este estudo faz uma interlocução com a discussão sobre tempo e trabalho. Com inspiração no método cartográfico, foram entrevistadas seis mulheres mães comissárias de voo. Os discursos revelaram outras formas de gerenciar a casa e a maternidade, outros modelos de relação com filhos, amigos e familiares e uma concepção de trabalho que nos faz problematizar o que concebemos como penoso e gerador de sofrimento a partir dessas experiências que se dão em territórios existenciais pouco habitados.

Este artículo aborda como las mujeres madres, en calidad de azafatas, perciben y organizan su vida diaria, abordando experiencias y prácticas en relación con la organización espacial y temporal de trabajo en la aviación. La relevancia de este tema radica en la organización espacial y temporal específico de este trabajo, peculiaridades con respecto a la gestión de la vida cotidiana y las posibles influencias de la cuestión de género en el mundo laboral. Este estudio es un diálogo con la discusión de tiempo y trabajo. Inspirado por el método cartográfico, se entrevistaron seis mujeres asistentes de vuelo madres. Los discursos revelan otras maneras de administrar el hogar y la maternidad, otros tipos de relaciones con los hijos, los amigos y la familia y una concepción del trabajo que nos hace discutir lo que concebimos como doloroso y generador de sufrimiento en experiencias que se producen en territorios existenciales escasamente poblada.

This article discusses how women mothers who work as flight attendants perceive and organize their daily lives, discussing experiences and practices in relation to spatial and temporal organization of work in aviation. The relevance of this issue arises in the specific temporal and spatial organization of work, peculiarities regarding the management of everyday life and possible influences of gender issues in the working world. This study is a dialogue with the discussion of time and effort. Draws on the mapping method, six flight attendants women mothers were interviewed. The speeches revealed other ways of managing the home and motherhood, other types of relationships with children, friends and family and an understanding of work that makes us to question what we conceive as painful and suffering generator from these experiences that occur in existential territories sparsely populated.

Home delivery in Southern Lao PDR: Challenges to achieving MDG 4 and 5 targets

@#<p style="text-align: justify;">This study investigated rural Lao PDR village women's views and experiences of recent, or impeding, childbirth to better understand barriers to maternity service usage. Lao PDR has the highest maternal mortality rate (MMR) in the South-East Asian region with very low utilization rates for skilled birth assistance and health sector delivery services. The study site, Sekong, a southern Lao province, was lowest in the country on virtually all indicators of reproductive and maternal health, despite several recent maternal health service interventions. The study's aim was to gain a fuller understanding of barriers to maternity services usage to contribute towards maternity services enhancement, and district and national policy-making for progressing towards 2015 MDG 4 & 5 targets.</p> <p style="text-align: justify;">A descriptive cross-sectional study was used. First, face-to-face questionnaires were used to collect demographic and reproductive health and health care experience data from 166 village woman (120 with a child born in the previous year, and 46 who were currently pregnant). In-depth individual interviews then followed with 23 purposively selected woman, to probe personal experiences and perspectives on why women preferred home birthing.</p> <p style="text-align: justify;">The majority of the woman had given at home, assisted by untrained birth attendants (relatives or neighbours). While seventy percent had accessed some antenatal services, postpartum follow-up attendance was very low (17 percent). Limited finances, lack of access to transport and prior negative health service experiences were important factors influencing women's decision making. Giving birth at home was seen by many, not just as unavoidable, but, as the preferred option.</p> <p style="text-align: justify;">Recent top-down maternal health initiatives have had little impact in this region. Improving maternal and child-health strategies requires much greater community participation and use of participatory action methodologies, to increase women's engagement in policy and planning and subsequent usage of health service developments.</p>

The Factors Affecting Physical Fitness Level of Female Flight Attendants / 한국직업건강간호학회지

PURPOSE: This study is aimed at obtaining the information on the physical fitness level of female flight attendants at a local airline. METHODS: The subjects are 2,409 female flight attendants who have had medical examination and physical fitness tests at an airline medical center from January 2 to December 30, 2008. The independent variables include socio-demographic & behavioral characteristics, and medical examination results, whereas the dependent variable is their physical strength score representing their fitness level. RESULTS: Factors that affect the fitness strength score are age, flight hours per year, and fasting blood sugar level. It is found that physical fitness level is higher when the subjects are over 35, on board for over 850 hours per year and their fasting blood sugar level is over 100 mg/dL. CONCLUSION: It is concluded that for the improvement of flight attendants' health, more exercise to develop cardio-respiratory endurance and muscular strength is needed, and further study needs to be done to develop fitness enhancement programs considering flight attendants' job characteristics, working years, and flight hours per year, and programs for those returning to their workplace after a long-term leave, and new employees.

Skilled Care at Birth among Rural Women in Nepal: Practice and Challenges.

In Nepal, most births take place at home, and many, particularly in rural areas, are not attended by a skilled birth attendant. The main objectives of the study were to assess the use of skilled delivery care and barriers to access such care in a rural community and to assess health problems during delivery and seeking care. This cross-sectional study was carried out in two Village Development Committees in Nepal in 2006. In total, 150 women who had a live birth in the 24 months preceding the survey were interviewed using a structured questionnaire. The sample population included married women aged 15-49 years. Forty-six (31%) women delivered their babies at hospital, and 104 (69%) delivered at home. The cost of delivery at hospital was significantly (p<0.001) higher than that of a delivery at home. Results of univariate analysis showed that women from Brahmin-Chhetri ethnicity, women with higher education or who were more skilled, whose husbands had higher education and more skilled jobs, had first or second childbirth, and having adverse previous obstetric history were associated with institutional delivery while women with higher education and having an adverse history of pregnancy outcome predicted the uptake of skilled delivery care in Nepal. The main perceived problems to access skilled delivery care were: distance to hospital, lack of transportation, lack of awareness on delivery care, and cost. The main reasons for seeking intrapartum care were long labour, retained placenta, and excessive bleeding. Only a quarter of women sought care immediately after problems occurred. The main reasons seeking care late were: the woman or her family not perceiving that there was a serious problem, distance to health facility, and lack of transport. The use of skilled birth attendants at delivery among rural women in Nepal is very poor. Home delivery by unskilled birth attendants is still a common practice among them. Many associated factors relating to the use of skilled delivery care that were identified included age, education and occupation of women, and education and occupation of husbands. Therefore, the availability of skilled delivery care services at the community, initiation of a primary health centre with skilled staff for delivery, and increasing awareness among women to seek skilled delivery care are the best solution.

Where There Are (Few) Skilled Birth Attendants.

Recent efforts to reduce maternal mortality in developing countries have focused primarily on two longterm aims: training and deploying skilled birth attendants and upgrading emergency obstetric care facilities. Given the future population-level benefits, strengthening of health systems makes excellent strategic sense but it does not address the immediate safe-delivery needs of the estimated 45 million women who are likely to deliver at home, without a skilled birth attendant. There are currently 28 countries from four major regions in which fewer than half of all births are attended by skilled birth attendants. Sixty-nine percent of maternal deaths in these four regions can be attributed to these 28 countries, despite the fact that these countries only constitute 34% of the total population in these regions. Trends documenting the change in the proportion of births accompanied by a skilled attendant in these 28 countries over the last 15-20 years offer no indication that adequate change is imminent. To rapidly reduce maternal mortality in regions where births in the home without skilled birth attendants are common, governments and community- based organizations could implement a cost-effective, complementary strategy involving health workers who are likely to be present when births in the home take place. Training community-based birth attendants in primary and secondary prevention technologies (e.g. misoprostol, family planning, measurement of blood loss, and postpartum care) will increase the chance that women in the lowest economic quintiles will also benefit from global safe motherhood efforts.

Percepción de las actividades de educación para la salud en un grupo de personas que asisten a programas de promoción de la salud y prevención de la enfermedad cardiovascular: Bogotá, D. C., noviembre a diciembre de 2009 / Perception of health education activities in a group of people who attend health promotion and cardiovascular disease prevention programs: Bogotá, D. C., November to December 2009

El presente estudio surgió de la necesidad de la investigadora por plantear desde "otras perspectivas"; las de los individuos objetos de las acciones; de los programas de educación para el cuidado de la salud cardiovascular, cuales son en general la o las motivaciones hacia el inicio de cambios de hábitos que les permitan mantener y propiciar niveles óptimos para su salud cardiovascular, así como determinar si el proceso que se realiza para ello desde este tipo de actividades en el rol que corresponde al cuidado de enfermería, es acorde a las expectativas y necesidades de los individuos o comunidades objeto de ello y conocer cuánto la tradición, el contexto y los conocimientos influyen en la asunción y responsabilidad del comportamiento y control de las acciones encaminadas al cuidado de la salud. Con lo cual el objetivo planteado para este estudio fue: describir las percepciones de las actividades de educación para la salud como parte del cuidado de enfermería, en un grupo de personas asistentes a programas de promoción de la salud y prevención de la enfermedad cardiovascular, en la ciudad de Bogotá, D. C., de Noviembre a Diciembre de 2009. El desarrollo de la metodología que siguió esta investigación comprende un estudio cualitativo, descriptivo interpretativo de los datos ofrecidos en entrevista semi-estructurada, realizada con 14 participantes de una IPS de Bogotá; para analizar la información, se usó el método de Colaizzi, el cual permitió interpretar los hallazgos y obtener la agrupación de 16 categorías que describen la percepción del fenómeno en estudio.

This study was developed by the needs of the investigator to propose from "other perspectives", those generated by the individuals subject to the actions; and the education programs for the cardiovascular health care; what is the motivation or motivations to initiate changes in the habits that allow to maintain and produce optimum levels for the cardiovascular health care, as well as identify if the processes developed for this cardiovascular health care, from this type of activities in the role assigned to the nursery care, is aligned to the expectations and needs of the individuals or communities subject to this matter and to know if the tradition, context, and knowledge have an influence in the presumption and responsibility of the behavior and control of the actions related to the health care. Having said that, the objective proposed for this study was: to describe the perceptions of the health education activities as part of the nursery care, in a group of persons who assist to health care programs and prevention of cardiovascular decease in Bogota during November and December of 2009. The methodology followed by this investigation is composed by a qualitative, interpretative descriptive study from data offered by semi structured interview, developed with 14 individuals of an IPS in Bogotá; in order to analyze the information, the Colazzi method was used, this method allowed the interpretation of findings and to get the consolidation of 16 categories which describes the perception of the phenomenon under study.