Factors influencing respectful perinatal care among healthcare professionals in low-and middle-resource countries: a systematic review.

BACKGROUND: This review aimed to provide healthcare professionals with a scientific summary of best available research evidence on factors influencing respectful perinatal care. The review question was 'What were the perceptions of midwives and doctors on factors that influence respectful perinatal care?' METHODS: A detailed search was done on electronic databases: EBSCOhost: Medline, OAlster, Scopus, SciELO, Science Direct, PubMed, Psych INFO, and SocINDEX. The databases were searched for available literature using a predetermined search strategy. Reference lists of included studies were analysed to identify studies missing from databases. The phenomenon of interest was factors influencing maternity care practices according to midwives and doctors. Pre-determined inclusion and exclusion criteria were used during selection of potential studies. In total, 13 studies were included in the data analysis and synthesis. Three themes were identified and a total of nine sub-themes. RESULTS: Studies conducted in various settings were included in the study. Various factors influencing respectful perinatal care were identified. During data synthesis three themes emerged namely healthcare institution, healthcare professional and women-related factors. Alongside the themes were sub-themes human resources, medical supplies, norms and practices, physical infrastructure, healthcare professional competencies and attributes, women's knowledge, and preferences. The three factors influence the provision of respectful perinatal care; addressing them might improve the provision of this care. CONCLUSION: Addressing factors that influence respectful perinatal care is vital towards the prevention of compromised patient care during the perinatal period as these factors have the potential to accelerate or hinder provision of respectful care.

Management of the third stage of labour by Basotho traditional birth attendants.

Background: Historically and to date, women still give birth at home with the support of elderly, experienced women who live within their communities. In Lesotho, traditional birth attendants (TBAs) are sometimes the only option for pregnant women living far from facilities. Women are vulnerable during the third stage of labour; therefore, correct management is crucial to limit undesirable outcomes. Postpartum haemorrhage and postpartum sepsis remain the leading direct causes of maternal mortality. Aim: This study aimed to explore and describe how Basotho TBAs manage the third stage of labour. Setting: The study was conducted in Lesotho, at Bolahla and Sejakhosi. These villages have the highest number of women giving birth at home. Methods: An explorative and descriptive design with a qualitative approach was used. Semistructured interview guide was utilised to conduct individual in-depth interviews about how the TBAs manage the third stage of labour and their support needs concerning this phase. The TBAs were purposively sampled. The data were analysed thematically. Results: Four themes emerged: challenges TBA experience in the management of the third stage of labour, management of the placenta by Basotho traditional birth attendants, support during the management of the placenta by Basotho traditional birth attendants, and management during emergencies. Conclusion: This study demonstrated that if TBAs are supported, they can contribute to the health of the mother and baby. Contribution: This study's findings can be valuable to healthcare professionals to understand better how TBAs in Lesotho manage the third stage of labour and the support they need.

Comorbidities of Child Malnutrition in Low- and Medium-Income Countries: A Systematic Review.

The study intended to review the best evidence on prevalence, diagnosis, and treatment outcomes of comorbidities associated with child malnutrition. The study design was a systematic review of quantitative studies. Critical appraisal tools were used to assess the methodological quality of the studies. Data were extracted according to the predetermined data extraction table. Data were further analyzed narratively according to the set study objectives and main concepts. Fifteen studies were eligible to include in the review. All 15 studies reported on the prevalence of 4 child malnutrition-associated comorbidities. Five (n = 5/15) studies reported on length of hospitalization/stay, 10 (n = 10) studies on recovery rate, and 9 (n = 9/15) studies on mortality rate as treatment outcomes of child malnutrition associated comorbidities. The most prevalent child malnutrition associated comorbidities were tuberculosis, pneumonia, gastroenteritis, and anemia. The treatment outcomes identified included the length of hospitalization/stay, recovery rate, and mortality rate. Screening of prevalent comorbidities in children admitted with malnutrition should be standard procedure in practice. More research needs to be done on the diagnosis of under-5 child malnutrition associated comorbidities.

The characteristics of compassionate care during childbirth according to midwives: a qualitative descriptive inquiry.

BACKGROUND: Although compassion is considered to be of prime importance in nursing and midwifery, there is no clear understanding of what compassionate care in childbirth entails, and how midwives perceive compassionate care is largely unknown. This study accordingly seeks to describe the characteristics, of compassionate care during childbirth as perceived by midwives. METHODS: A qualitative descriptive inquiry was undertaken with a voluntary online survey, where participants were recruited via snowball sampling on the social networking site, Facebook. The participants were midwives, and the unit of analysis was the received responses. Participants reported on instances of compassionate care during childbirth. The data was thematically analysed using Tesch's eight steps to identify common themes. RESULTS: Ninety-eight responses were analysed and three themes with eight sub-themes emerged as dominant characteristics. Themes and sub-themes were as follows: making meaningful connections with women (displaying good interpersonal skills, conduct based on dignity and respect, establishing trust); initiating individualised understanding of each woman (showing empathy, permitting maternal choice) and action through care and support (providing emotional support, assistance through instrumental care, continuous informational support). CONCLUSIONS: In seeking to determine what characterises compassionate care in childbirth, the findings reveal a process of making meaningful connections with women through recognising their needs, initiating individualised understanding of each woman's needs and desiring to ease it, which is subsequently manifested in action through emotional, instrumental and informational care and support. A better understanding of how midwives perceive compassionate care could potentially improve the quality of care midwives offer during childbirth.

Women's experiences of continuous support during childbirth: a meta-synthesis.

BACKGROUND: Despite the known benefits of continuous support during childbirth, the practice is still not routinely implemented in all maternity settings and women's views and experiences might not be considered. The purpose of the study was to integrate individual studies' findings related to women's experiences of continuous support during childbirth in order to expand the understanding of the phenomenon. The review question was: What were the views and experiences of women regarding continuous support during childbirth as reported in studies that adopted qualitative or mixed research methods (with a qualitative component) using semi-structured, in-depth or focus group interviews or case studies? METHODS: A detailed search was executed on electronic data bases: EBSCOhost: Medline, CINAHL, PsychINFO, SocINDEX, OAlster, Scopus, SciELO, Science Direct, PubMED and Google Scholar, using a predetermined search strategy. Reference lists of included studies were analysed to identify possible studies that were missing from electronic data bases. Pre-determined inclusion and exclusion criteria were applied during the selection of eligible sources. After critical appraisal, a total of 12 studies were included for data-extraction and meta-synthesis. RESULTS: Two themes were identified, namely the roles and attributes of the support persons and the type of support provided. Women's perceptions about continuous support during childbirth were influenced by the characteristics and attributes of the support person as well as the types of supportive care rendered. Women preferred someone with whom they were familiar and comfortable. CONCLUSION: Continuous support during childbirth was valued by most women. Their perceptions were influenced by the type of support person: a health professional or a lay support person. Health care institutions should include continuous support during childbirth in their policies and guidelines.

Challenges in implementing continuous support during childbirth in selected public hospitals in the North West Province of South Africa.

BACKGROUND: According to a Cochrane review, continuous support during childbirth increases the mother's chances of a vaginal birth without identified adverse effects. However, this evidence-based practice is not universally implemented. The objective of the study was to identify challenges encountered in implementing continuous support during childbirth in public hospitals in the North West Province of South Africa. METHOD: An explorative, descriptive and contextual qualitative approach was used. The data were collected during 2013 by conducting focus group interviews with 33 registered midwives who had worked in maternity units in three selected public hospitals in the North West Province for at least two years. RESULTS: Midwives identified challenges that negatively impacted the implementation of continuous support during childbirth at organisational and interpersonal levels. At the organisational level, challenges included human resources, policies and guidelines as well as the architectural outlay of the maternity units. The personal challenges related to communication and attitudes of nurses, patients and their families. CONCLUSIONS: Organisational and personal challenges had a negative impact on the provision of continuous care during childbirth.

Experiences and support needs of poverty-stricken people living with HIV in the Potchefstroom district in South Africa.

This study was undertaken to address the lack of support for poverty-stricken people living with HIV that was identified in the Potchefstroom district in the North-West Province in South Africa. A qualitative phenomenological design was used to explore the experience, identify the support needs, and formulate guidelines for effective support for poverty-stricken people living with HIV. A total of 25 in-depth interviews guided by two central questions resulted in the following themes: facilitative and impeding experiences of poverty-stricken people living with HIV, basic needs, psychosocial needs, cultural-spiritual needs, and self-actualization needs. The experience of poverty-stricken people living with HIV in the Potchefstroom district is closely related to their support needs. To address these needs holistically and to enhance the quality of life of poverty-stricken people living with HIV, the needs should first be addressed individually. Following that, the collective needs can be addressed by a support system.