Provision of inadequate information on postnatal care and services during antenatal visits in Busega, Northwest Tanzania: a simulated client study.

BACKGROUND: Most (94%) of global maternal deaths occur in low- and middle-income countries due to preventable causes. Maternal health care remains a key pillar in improving survival. Antenatal care (ANC) guidelines recommend that pregnant women should be provided with information about postnatal care in the third trimester. However, the utilization of postnatal care services is limited in developing countries including Tanzania. The aim of this study was to investigate the practice of health care workers in providing information on postnatal care to pregnant women during antenatal care visits. METHODS: A cross sectional study was conducted among health care workers from 27 health facilities that offer reproductive and child health services in Busega district Northwest Tanzania. A simulated client approach was utilized to observe quality of practice among health care workers with minimal reporting bias (i.e., the approach allows observing participants at their routine practices without pretending). Selected pregnant women who were trained to be simulated clients from the community within facility catchment area attended antenatal care sessions and observed 81 of 103 health care workers. Data analyses were carried out using STATA 13. RESULTS: Only 38.73% (95% CI; 28.18-49.49%) of health care workers were observed discussing subtopics related to postnatal care during the ANC visit. Few health care workers (19.35%), covered all eight subtopics recommended in the ANC guidelines. Postnatal danger signs (33.33%) and exclusive breast feeding (33.33%) were mostly discussed subtopics by health care workers. Being a doctor/nurse/clinical officer is associated by provision of postnatal education compared to medical attendant, aOR = 3.65 (95% CI; 1.21-12.14). CONCLUSION: The provision of postnatal education during ANC visits by health care workers in this district was limited. This situation could contribute to the low utilization of postnatal care services. Health care workers need to be reminded on the importance of delivering postnatal education to pregnant women attending ANC clinic visits. On job training can be used to empower health care workers of different cadres to deliver postnatal health education during ANC visits. These efforts could increase women's utilization of postnatal care and improve outcomes for mothers and newborns.

Experiences from leading parental education groups: Perceived difficulties and rewards as an indication of skill acquisition.

Developing skills in a professional setting is linked to practical experience. The relationship between experience and acquisition of skills can be seen as a transition from novice to expert. In a nursing setting, this has been studied using the Dreyfus model of skill acquisition. The aim was to investigate how experience influences midwives' and child healthcare nurses' views of difficulties and rewards in working with parental education groups. The study has a cross-sectional design with a mixed methods approach. A total of 437 midwives and child healthcare nurses answered a web-based survey. First, a qualitative analysis was carried out, and then patterns of experience were analysed. The results showed that less experience as a leader corresponds to a greater focus on one's own role and on personal benefits from working with parents, but not on the specific context of the group. With experience, leaders had a greater focus on the group itself and rewards of making it function well. Not being able to take the current group and the specific context into account when working as a leader reduces possibilities of achieving a well-functioning group and the goals of the parental education.

Maternidad adolescente en el seno de una familia extensa: el rol de la familia / Adolescent motherhood within an extended family: the role of the family

Objetivo: Identificar, desde la vivencia de la adolescente, el rol que cumple en el ejercicio de su maternidad la familia extensa con la cual reside. Metodología: Se asumió una metodología cualitativa, con un diseño de estudio de caso único. Se entrevistó a 5 mujeres que fueron madres entre los 18 y los 19 años, con un niño(a) de 2 a 3 años, que vivían en casa de sus padres, sin el padre del hijo(a), usuarias de un centro de salud familiar chileno. Se aplicó una entrevista biográfica, en visita domiciliaria una vez que tanto el adulto responsable como la entrevistada hubieran firmado el consentimiento y asentimiento informado. Se examinaron los datos mediante un análisis interpretativo, realizándose una triangulación de los mismos y un contrachequeo. Resultados: Se presentan aportes de la familia extensa vinculados al cuidado del hijo/a, entrega de conocimientos y delimitación del rol materno de la adolescente, así como los obstáculos asociados a la negociación de pautas de crianza, y los cambios en las funciones relativas a la optimización de los cuidados y la reorganización del sistema familiar ante la nueva situación. Conclusiones: Se concluye planteando cómo un momento de estrés en el ciclo vital familiar puede transformarse en una oportunidad de crecimiento para la familia y la adolescente, destacando que, a través del apoyo entregado por la familia extensa, se distribuyen las funciones y se reorganiza el sistema familiar favoreciendo el desarrollo del binomio madre adolescente-hijo. (AU)

Objective: Identify, from the adolescent’s experience, the role played by the extended family with which she resides in the exercise of her motherhood. Methodology: A qualitative methodology, design of a single case study was assumed. Five women who were mothers between 18 and 19 years of age, of a child between 2 and 3 years old were interviewed; who lived in their parents' house, without the father of the child, users of a Chilean family health center. A biographical interview was applied, in a home visit once both the responsible adult and the interviewee had signed the informed consent and assent. The data were analyzed through interpretive analysis, triangulation of data and a counter check. Results: Contributions from the extended family related to the care of the child, delivery of knowledge and delimitation of the adolescent's maternal role are presented; obstacles associated with negotiating parenting guidelines; changes in the functions related to the optimization of care and reorganization of the family system in the face of the changes that have occurred. Conclusions: It concludes by proposing how a moment of stress in the family life cycle can become an opportunity for growth for the family and the adolescent, highlighting how, through the support provided by the extended family, functions are distributed and the family system is reorganized favoring the development of the adolescent mother-son binomial. (AU)

Impact of a novel smartphone application on low-income, first-time mothers' breastfeeding rates: a randomized controlled trial.

BACKGROUND: Low-income women are less likely to exclusively breastfeed at postpartum day 2 compared with high-income women, but focus groups of low-income women have suggested that on-demand videos on breastfeeding and infant behavior would support exclusive breastfeeding beyond postpartum day 2. Smartphone applications provide on-demand video. OBJECTIVE: This study aimed to determine whether a novel smartphone application-Breastfeeding Friend-increases breastfeeding rates for low-income, first-time mothers. STUDY DESIGN: This double-blinded randomized trial recruited low-income, first-time mothers at 36 weeks' gestation. Consenting women received a complimentary Android smartphone and internet service before 1:1 randomization to Breastfeeding Friend or a control smartphone application. Breastfeeding Friend was created by a multidisciplinary team of perinatologists, neonatologists, lactation consultants, and a middle school teacher and was refined by end-user focus groups. Breastfeeding Friend contained on-demand education and videos on breastfeeding and newborn behavior, tailored to a fifth-grade reading level. The control smartphone application contained digital breastfeeding handouts. The primary outcome was exclusive breastfeeding at postpartum day 2; secondary outcomes were breastfeeding rates until 6 months postpartum and patient-reported best breastfeeding resource. Primary statistical analyses compared outcomes between study groups through intention-to-treat analysis; prespecified secondary analyses did so per protocol. A total of 170 women (85 per arm) were needed to determine whether Breastfeeding Friend increased exclusive breastfeeding at postpartum day 2 from 34% (known baseline) to 56%. RESULTS: A total of 253 women were approached; 170 women enrolled. Most participants were black, with more than half reporting annual household incomes of less than $25,000. Exclusive breastfeeding rates at postpartum day 2 were low and similar among Breastfeeding Friend and control smartphone application users (n=30 [36.6%] vs n=30 [35.7%]; relative risk, 1.02; 95% confidence interval, 0.068-1.53). Breastfeeding rates until 6 months postpartum were also similar between study groups: the rate of exclusive breastfeeding was 8.3% (n=5) and 10.4% (n=7) in the Breastfeeding Friend and control smartphone application groups, respectively (relative risk, 0.8; 95% confidence interval, 0.27-2.38). At 6 weeks postpartum, most Breastfeeding Friend smartphone application users (n=34 [52.3%]) rated their smartphone application as providing the best breastfeeding support. Excluding women who did not use their study smartphone application (Breastfeeding Friend, n=18 [21.4%]; control smartphone application, n=9 [10.6%]) did not affect outcomes. CONCLUSION: Neither of the smartphone applications improved breastfeeding rates among low-income, first-time mothers above the known baseline rates, despite user perception that Breastfeeding Friend was the best breastfeeding resource at 6 weeks postpartum. By demonstrating the feasibility of smartphone application-based interventions within a particularly high-needs population, our research supports efforts in obstetrics to examine whether mobile health improves peripartum health outcomes.

Valoración de las madres acerca de las recomendaciones para el cuidado del recién nacido al momento del alta hospitalaria / Maternal assessment of recommendations on the newborn infant care upon hospital discharge

Introducción. Es habitual que el pediatra ofrezca a los padres información sobre cuidados del neonato al momento del alta hospitalaria. Los objetivos del estudio son conocer la satisfacción respecto a dicha información, qué otras informaciones les hubiese gustado recibir y determinar qué factores pueden influir en esa demanda. Población y métodos. Estudio descriptivo que evalúa la opinión de las puérperas a los 5-15 días del parto, en cuanto a dicha información. Resultados. Se recogieron 176 encuestas. El 68,8% asistió a clases de preparación para el parto. El 61,4% refirió haber buscado consejos sobre cuidados del recién nacido, mayoritariamente en internet y libros. El 74,4% consideró suficiente la información recibida. Los aspectos de información más demandados fueron lactancia materna (33,3%), artificial (20,0%) y cuidados del cordón umbilical (11,1%). Las madres que demandaron más información acudieron con más frecuencia a clases de preparación para el parto (significativo) y buscaron información durante la gestación (no significativo). Asimismo, este grupo otorgó significativamente peores puntuaciones a la facilidad para plantear dudas y el grado de confianza en el pediatra. Conclusiones. La satisfacción de las madres respecto a la información ofrecida es buena; la mayoría no demanda más información. El aspecto sobre el que con más frecuencia demandan más información es la lactancia. La demanda de información es independiente de la edad materna, los estudios maternos, la situación laboral o la existencia de hijos previos. Asimismo, las dudas que les surgen a las madres no se ven satisfechas únicamente por la asistencia a clases de preparación para el parto.

Introduction.It is common for pediatricians to provide parents with information on how to look after their newborn baby at the time of discharge from the hospital. The objectives of this study are to determine the level of satisfaction regarding such information, to be aware of what additional information parents would have liked to receive, and to establish which factors may impact any additional information request. Population and Methods.Descriptive study evaluating the opinion of women at 5-15 days post- partum regarding such information. Results.A hundred and seventy-six surveys were collected. Of these, 68.8% respondents had attended childbirth classes. Sixty-one point four percent referred to have looked for advice on the newborn infant care, mostly on the Internet and in books. Seventy-four point four percent considered that the information provided sufficed. Most commonly, information was requested on breastfeeding (33.3%), bottle feeding (20.0%), and umbilical cord care (11.1%). Mothers who requested more information attended childbirth classes more frequently (significant) and searched for information during pregnancy (not significant). In addition, this group significantly assigned a lower score to the opportunity to ask questions and the level of trust on the pediatrician. Conclusions.Maternal satisfaction regarding the information provided is adequate; and most mothers do not request additional information. The topic on which they most frequently request additional information is breastfeeding. The decision to request information does not depend on maternal age, maternal education, employment condition, or having other children. Likewise, mothers have questions that are not satisfactorily answered during childbirth classes.

Valoración de las madres acerca de las recomendaciones para el cuidado del recién nacido al momento del alta hospitalaria / Maternal assessment of recommendations on the newborn infant care upon hospital discharge

Introducción. Es habitual que el pediatra ofrezca a los padres información sobre cuidados del neonato al momento del alta hospitalaria. Los objetivos del estudio son conocer la satisfacción respecto a dicha información, qué otras informaciones les hubiese gustado recibir y determinar qué factores pueden influir en esa demanda. Población y métodos. Estudio descriptivo que evalúa la opinión de las puérperas a los 5-15 días del parto, en cuanto a dicha información. Resultados. Se recogieron 176 encuestas. El 68,8% asistió a clases de preparación para el parto. El 61,4% refirió haber buscado consejos sobre cuidados del recién nacido, mayoritariamente en internet y libros. El 74,4% consideró suficiente la información recibida. Los aspectos de información más demandados fueron lactancia materna (33,3%), artificial (20,0%) y cuidados del cordón umbilical (11,1%). Las madres que demandaron más información acudieron con más frecuencia a clases de preparación para el parto (significativo) y buscaron información durante la gestación (no significativo). Asimismo, este grupo otorgó significativamente peores puntuaciones a la facilidad para plantear dudas y el grado de confianza en el pediatra. Conclusiones. La satisfacción de las madres respecto a la información ofrecida es buena; la mayoría no demanda más información. El aspecto sobre el que con más frecuencia demandan más información es la lactancia. La demanda de información es independiente de la edad materna, los estudios maternos, la situación laboral o la existencia de hijos previos. Asimismo, las dudas que les surgen a las madres no se ven satisfechas únicamente por la asistencia a clases de preparación para el parto.(AU)

Introduction.It is common for pediatricians to provide parents with information on how to look after their newborn baby at the time of discharge from the hospital. The objectives of this study are to determine the level of satisfaction regarding such information, to be aware of what additional information parents would have liked to receive, and to establish which factors may impact any additional information request. Population and Methods.Descriptive study evaluating the opinion of women at 5-15 days post- partum regarding such information. Results.A hundred and seventy-six surveys were collected. Of these, 68.8% respondents had attended childbirth classes. Sixty-one point four percent referred to have looked for advice on the newborn infant care, mostly on the Internet and in books. Seventy-four point four percent considered that the information provided sufficed. Most commonly, information was requested on breastfeeding (33.3%), bottle feeding (20.0%), and umbilical cord care (11.1%). Mothers who requested more information attended childbirth classes more frequently (significant) and searched for information during pregnancy (not significant). In addition, this group significantly assigned a lower score to the opportunity to ask questions and the level of trust on the pediatrician. Conclusions.Maternal satisfaction regarding the information provided is adequate; and most mothers do not request additional information. The topic on which they most frequently request additional information is breastfeeding. The decision to request information does not depend on maternal age, maternal education, employment condition, or having other children. Likewise, mothers have questions that are not satisfactorily answered during childbirth classes.(AU)

Valoración de las madres acerca de las recomendaciones para el cuidado del recién nacido al momento del alta hospitalaria / Maternal assessment of recommendations on the newborn infant care upon hospital discharge

Introducción. Es habitual que el pediatra ofrezca a los padres información sobre cuidados del neonato al momento del alta hospitalaria. Los objetivos del estudio son conocer la satisfacción respecto a dicha información, qué otras informaciones les hubiese gustado recibir y determinar qué factores pueden influir en esa demanda. Población y métodos. Estudio descriptivo que evalúa la opinión de las puérperas a los 5-15 días del parto, en cuanto a dicha información. Resultados. Se recogieron 176 encuestas. El 68,8% asistió a clases de preparación para el parto. El 61,4% refirió haber buscado consejos sobre cuidados del recién nacido, mayoritariamente en internet y libros. El 74,4% consideró suficiente la información recibida. Los aspectos de información más demandados fueron lactancia materna (33,3%), artificial (20,0%) y cuidados del cordón umbilical (11,1%). Las madres que demandaron más información acudieron con más frecuencia a clases de preparación para el parto (significativo) y buscaron información durante la gestación (no significativo). Asimismo, este grupo otorgó significativamente peores puntuaciones a la facilidad para plantear dudas y el grado de confianza en el pediatra. Conclusiones. La satisfacción de las madres respecto a la información ofrecida es buena; la mayoría no demanda más información. El aspecto sobre el que con más frecuencia demandan más información es la lactancia. La demanda de información es independiente de la edad materna, los estudios maternos, la situación laboral o la existencia de hijos previos. Asimismo, las dudas que les surgen a las madres no se ven satisfechas únicamente por la asistencia a clases de preparación para el parto.(AU)

Introduction.It is common for pediatricians to provide parents with information on how to look after their newborn baby at the time of discharge from the hospital. The objectives of this study are to determine the level of satisfaction regarding such information, to be aware of what additional information parents would have liked to receive, and to establish which factors may impact any additional information request. Population and Methods.Descriptive study evaluating the opinion of women at 5-15 days post- partum regarding such information. Results.A hundred and seventy-six surveys were collected. Of these, 68.8% respondents had attended childbirth classes. Sixty-one point four percent referred to have looked for advice on the newborn infant care, mostly on the Internet and in books. Seventy-four point four percent considered that the information provided sufficed. Most commonly, information was requested on breastfeeding (33.3%), bottle feeding (20.0%), and umbilical cord care (11.1%). Mothers who requested more information attended childbirth classes more frequently (significant) and searched for information during pregnancy (not significant). In addition, this group significantly assigned a lower score to the opportunity to ask questions and the level of trust on the pediatrician. Conclusions.Maternal satisfaction regarding the information provided is adequate; and most mothers do not request additional information. The topic on which they most frequently request additional information is breastfeeding. The decision to request information does not depend on maternal age, maternal education, employment condition, or having other children. Likewise, mothers have questions that are not satisfactorily answered during childbirth classes.(AU)

Enhancing fathers' educational experiences during the early postnatal period.

Since the 1970s, men have been encouraged to actively participate in the childbirth process, resulting in a shared experience for couples. Nevertheless, after the baby is born, many fathers find themselves displaced, unsure of how to embrace the transition to parenthood. The shift in cultural practice and evolving needs of families calls for the recognition of fathers as well as mothers in the provision of midwifery services. Innovative strategies must be considered to enhance postnatal education that is father-inclusive and responsive to the needs of families in the 21st century. This article introduces one strategy created from an action research study conducted to develop, implement, and evaluate strategies to improve postnatal education for parents.