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.

I(nter)dentificación racial: racialización de la salud materna a través del programa Oportunidades y clínicas gubernamentales en México / Racial i(nter)dentification: The racialization of maternal health through the Oportunidades program and in government clinics in México

RESUMEN Desde un abordaje etnográfico, este artículo examina el papel de la racialización en los procesos de salud-enfermedad-atención-cuidado, específicamente dentro del ámbito de la salud materna, a partir de las experiencias de los proveedores y administradores de salud, parteras y madres indígenas y las receptoras de transferencias monetarias condicionadas a través del programa Oportunidades. Al analizar las capacitaciones del Instituto Mexicano del Seguro Social (IMSS) a parteras indígenas y de los talleres del programa Oportunidades para personas indígenas, este artículo critica la utilización de la "interculturalidad" a través de formas que reafirman inadvertidamente la desigualdad. El concepto de i(nter)dentificación racial se ofrece como una manera para entender los procesos de racialización que refuerzan la discriminación sin hacer referencia explícita a la raza. La i(nter)dentificación racial es una herramienta para el análisis de variables múltiples que contribuyen al análisis interno inmediato que ocurre durante encuentros cotidianos con la diferencia, lo cual también estructura cómo los individuos interactúan durante los encuentros médicos. Este artículo muestra cómo las condiciones sociohistóricas y políticas desiguales y el acceso diferencial a los recursos económicos se convierten en determinantes de la salud.

ABSTRACT Using an ethnographic approach, this article examines the role of racialization in health-disease-care processes specifically within the realm of maternal health. It considers the experiences of health care administrators and providers, indigenous midwives and mothers, and recipients of conditional cash transfers through the Oportunidades program in Mexico. By detailing the delivery of trainings of the Mexican Social Security Institute (IMSS) [Instituto Mexicano del Seguro Social] for indigenous midwives and Oportunidades workshops to indigenous stipend recipients, the article critiques the deployment of "interculturality" in ways that inadvertently re-inscribe inequality. The concept of racial i(nter)dentification is offered as a way of understanding processes of racialization that reinforce discrimination without explicitly referencing race. Racial i(nter)dentification is a tool for analyzing the multiple variables contributing to the immediate mental calculus that occurs during quotidian encounters of difference, which in turn structures how individuals interact during medical encounters. The article demonstrates how unequal sociohistorical and political conditions and differential access to economic resources become determinants of health.

Training Traditional Birth Attendants on the Use of Misoprostol and a Blood Measurement Tool to Prevent Postpartum Haemorrhage: Lessons Learnt from Bangladesh.

A consensus emerged in the late 1990s among leaders in global maternal health that traditional birth attendants (TBAs) should no longer be trained in delivery skills and should instead be trained as promoters of facility-based care. Many TBAs continue to be trained in places where home deliveries are the norm and the potential impacts of this training are important to understand. The primary objective of this study was to gain a more nuanced understanding of the full impact of training TBAs to use misoprostol and a blood measurement tool (mat) for the prevention of postpartum haemorrhage (PPH) at home deliveries through the perspective of those involved in the project. This qualitative study, conducted between July 2009 and July 2010 in Bangladesh, was nested within larger operations research, testing the feasibility and acceptability of scaling up community-based provision of misoprostol and a blood measurement tool for prevention of PPH. A total of 87 in-depth interviews (IDIs) were conducted with TBAs, community health workers (CHWs), managers, and government-employed family welfare visitors (FWVs) at three time points during the study. Computer-assisted thematic data analysis was conducted using ATLAS.ti (version 5.2). Four primary themes emerged during the data analysis, which all highlight changes that occurred following the training. The first theme describes the perceived direct changes linked to the two new interventions. The following three themes describe the indirect changes that interviewees perceived: strengthened linkages between TBAs and the formal healthcare system; strengthened linkages between TBAs and the communities they serve; and improved quality of services/service utilization. The data indicate that training TBAs and CHW supervisors resulted in perceived broader and more nuanced changes than simply improvements in TBAs’ knowledge, attitudes, and practices. Acknowledgeing TBAs’ important role in the community and in home deliveries and integrating them into the formal healthcare system has the potential to result in changes similar to those seen in this study.

Neonatal Care Practices in Urban Villages.

Neonatal health is the key to child survival. Care practices during delivery and neonatal period contribute to risk of mortality and morbidity. The present study was conducted in two urban villages of east Delhi to study practices during delivery and neonatal period amongst mothers. A total of 100 neonate- mother pairs were studied. About two-third (64%) births took place at home, 48(75%) of the home deliveries were conducted by a traditional birth attendant. The traditional birth attendant did not wash her hands in 24 (37.5%) and did not wear gloves in 46(72%) of the deliveries conducted at home. Breast feeding was initiated within one hour in only 12% of the newborns. Early initiation of breast feeding was more likely in newborns with parents with higher education and higher income and those belonging to joint families. About one- third of newborns were bathed immediately after birth. Application to the cord was practiced by 86% of the mothers. The practice was not related to education of mother or income; it was more common in newborns whose fathers were more educated and those belonging to joint families. Thus unsafe traditional newborn practices are common in the area emphasizing the need for education in clean delivery practices and newborn care.