Search results for: maternal health care

Authors: Mindy A. Brown, Emma E. Reardon, Jennifer Isenhour, Sheila E. Crowell, K. Lee Raby, Elisabeth Conradt

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The positive impact of maternal sensitivity on infant social and emotional development is well-known, as is the notion that stress may impair a mother’s ability to provide sensitive care for her infant. However, individual differences in susceptibility to parenting-related stress are less understood. This study explores how chronic prenatal stress moderates the effect of acute stressors on maternal sensitivity. Data were gathered from 110 mothers and their 7-month-old infants. Mothers were exposed to either an acute stress task or a control task, after which they engaged in the still-face paradigm, a face-to-face interaction where maternal sensitivity was measured. Chronic maternal stress was assessed using the UCLA Life Stress Interview during the third trimester of pregnancy. The results revealed that among mothers exposed to the stress condition, those with higher chronic stress levels in the previous six months displayed significantly lower sensitivity during the still-face paradigm compared to those with lower chronic stress. Notably, past stress levels had no effect on maternal sensitivity in the control condition. These findings suggest a moderating effect of chronic stress on maternal caregiving behavior, with higher prenatal stress diminishing a mother’s ability to cope with acute parenting-related stressors in the present. The mechanisms behind this may involve changes in stress reactivity pathways, such as the hypothalamic-pituitary-adrenal (HPA) axis or altered emotion regulation strategies developed in response to chronic stress. Understanding these pathways could guide targeted interventions for mothers who may be more vulnerable to stress, improving caregiving outcomes.

Keywords: acute stress, maternal stress, prenatal stress, still-face paradigm

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Authors: Maria Reichenber Arcilla

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Objective: To determine the risk factors for maternal and neonatal complications associated with operative vaginal deliveries. Methods: A retrospective chart review of 435 patients who underwent operative vaginal deliveries was done. Patient profiles – age, parity, AOG, duration of labor – and outcomes – birthweight, maternal and neonatal complications - were tabulated and multivariable analysis and logistic regression were performed using SPSS® Statistics Base. Results and Conclusion: There was no significant difference in the incidence of maternal and neonatal complications between those that underwent vacuum and forceps extraction. Among the variables analysed, parity and duration of labor reached statistical significance. The odds of maternal complications were 3 times higher among nulliparous patients. Neonatal complications were seen in those whose labor lasted more than 9 hours.

Keywords: operative vaginal deliveries, maternal, neonatal, morbidity

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Authors: Zaman Jawahar, Anne Rouve-Khiev, Elizabeth Hoban, Joanne Williams

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Ensuring access to timely obstetric care is essential to prevent maternal deaths. Geographical barriers pose significant challenges for women accessing quality reproductive and maternal health services in rural Cambodia. This policy brief affirms the need to address the issue of transportation and cost (direct and indirect) as critical barriers to accessing reproductive and maternal health (RMH) services in four provinces in Northeast Cambodia (Kratie, Ratanak Kiri, Mondul Kiri, Stung Treng). A systemic search of the literature identified 1,116 articles, and only ten articles from low-and-middle-income countries met the inclusion criteria. The ten articles reported on transportation and cost related to accessing RMH services. In addition, research findings from Partnering to Save Lives (PSL) studies in the four provinces were included in the analysis. Thematic data analysis using the information in the ten articles and PSL research findings was conducted, and the findings are presented in this paper. The key findings are the critical barriers to accessing RMH services in the four provinces because women experience: 1) difficulties finding affordable transportation; 2) lack of available and accessible transportation; 3) greater distance and traveling time to services; 4) poor geographical terrain and; 5) higher opportunity costs. Distance and poverty pose a double burden for the women accessing RMH services making a facility-based delivery less feasible compared to home delivery. Furthermore, indirect and hidden costs associated with institutional delivery may have an impact on women’s decision to seek RMH care. Existing health financing schemes in Cambodia such as the Health Equity Fund (HEF) and the Voucher Scheme contributed to the solution but have also shown some limitations. These schemes contribute to improving access to RMH services for the poorest group, but the barrier of transportation costs remains. In conclusion, initiatives that are proven to be effective in the Cambodian context should continue or be expanded in conjunction with the HEF, and special consideration should be given to communities living in geographically remote regions and difficult to access areas. The following strategies are recommended: 1) maintain and further strengthen transportation support in the HEF scheme; 2) expand community-based initiatives such as Community Managed Health Equity Funds and Village Saving Loans Associations; 3) establish maternity waiting homes; and 4) include antenatal and postnatal care in the provision of integrated outreach services. This policy brief can be used to inform key policymakers and provide evidence that can assist them to develop strategies to increase poor women’s access to RMH services in low-income settings, taking into consideration the geographic distance and other indirect costs associated with a facility-based delivery.

Keywords: access, barriers, northeast Cambodia, reproductive and maternal health service, transportation and cost

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Authors: Nabaweesi Josephine, Namwanje Regina Germina

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Antenatal care is referred to as the totality of care given to pregnant women from conception to delivery from a certified health care setting. A number of 8 contacts is recommended throughout pregnancy, according to WHO, 2016. Antenatal services are free in Uganda courtesy of the government of Uganda, though attendance is still very low, which has continued to cause maternal and infant mortality and morbidity from preventable causes. Early booking has an advantage for proper pregnancy information sharing and pregnancy monitoring. The purpose of this study was to determine pregnant women's knowledge, attitudes, and practices towards attendance of antenatal care at Mukono General Hospital. A sample of 60 pregnant women was used, and a descriptive quantitative design was employed. Data was collected using a structured questionnaire consisting of questions about socio-demographic factors, knowledge, attitude, and practice, and this was affected using the structured interview method. Pregnant women had good practice at 90.2%, a positive attitude of 94.6%, and slightly less knowledge of 66.7%. Only 12% were knowledgeable about the number of antenatal care visits recommended, 45% had knowledge about when to initiate first antenatal care visit, and 79% had a positive attitude towards the early booking. We recommend that pregnant women are given all the necessary information regarding antenatal care with special emphasis on the recommended number of visits and when to initiate their first visit and encourage early booking in order to achieve the 8 contacts WHO policy for antenatal care since when we increase knowledge, we increase antenatal care utilization according to Anderson's behavioral model.

Keywords: ANC- antenatal care, contacts, mortality, morbidity

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Authors: Sarah K. Basudan, Ragad I. Al Jazzar, Zeinah Sulaihim, Hanan M. Al-Kadri

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Background: Cesarean section has been increasing in recent years, with a wide range of etiologies contributing to this rise. This study aimed to assess the indications, outcomes, and complications in Riyadh, Saudi Arabia. Methods: A Retrospective Cohort study was conducted at King Abdulaziz medical city. The study includes two cohorts: G1 (2009) and G2 (2020) groups who met the inclusion criteria. The data was transferred to the SPSS (statistical package for social sciences) version 24 for analysis. The initial descriptive statistics were run for all variables, including numerical and categorical data. The numerical data were reported as median, and standard deviation and categorical data were reported as frequencies and percentages. Results: The data were collected from 399 women who were divided into two groups, G1(199) and G2(200). The mean age of all participants is 32+-6​; G1 and G2 had significant differences in age means with 30+-6 and 34+-5, respectively, with a p-value of <0.001, which indicates delayed fertility by four years. Moreover, a breech presentation was less likely to occur in G2 (OR 0.64, CI: 0.21-0.62. P<0.001). Nonetheless, maternal causes such as repeated C-sections and maternal medical conditions were more likely to happen in G2 (OR 1.5, CI: 1.04-2.38, p=0.03) and (OR 5.4, CI: 1.12-23.9, P=0.01), respectively. Furthermore, postpartum hemorrhage showed an increase of 12% in G2 (OR 5.4, CI: 2.2-13.4, p<0.001). G2 was more likely to be admitted to the neonatal intensive care unit (NICU) (OR 16, CI: 7.4-38.7) and to special care baby (SCB) (OR 7.2, CI: 3.9-13.1), both with a p-value<0.001 compared to regular nursery admission. Conclusion: There are multiple factors that are contributing to the increase in c section rate in a Saudi tertiary hospitals. The factors were suggested to be previous c-sections, abnormal fetal heart rate, malpresentation, and maternal or fetal medical conditions.

Keywords: cesarean sections, maternal indications, maternal complications, neonatal condition

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Authors: Lindy Van Vliet, Saloni Phadke, Anthea Nelson, Ann Gallant

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Holistic and patient-centred palliative care and support require an integrated system of care that includes health and social service providers working together to ensure that patients and families have access to the care they need. The objective of this study is to further explore and understand the benefits and challenges of mobilizing multidisciplinary care teams for health care professionals and social service providers. Drawing on an interpretivist, exploratory, qualitative design, our multidisciplinary research team (medicine, nursing and social work) conducted interviews with 15 health care and social service providers in the Ottawa region. Interview data was audio-recorded, transcribed, and analyzed using a reflexive thematic analysis approach. The data deepens our understandings of the facilitators and barriers posed by multidisciplinary care teams. Three main findings emerged: First, the data highlighted the benefits of multidisciplinary care teams for both patient outcomes and quality of life and provider mental health; second, the data showed that the lack of a system-wide integrated communication system reduces the quality of patient care and increases provider stress while working in multidisciplinary care teams; finally, the data demonstrated the existence of implicit hierarchies between disciplines, this coupled with different disciplinary perspectives of palliative care provision can lead to friction and challenges within care teams. These findings will have important implications for the future of palliative care as they will help to facilitate and build stronger person-centred/relationship-centred palliative care practices by naming the challenges faced by multidisciplinary palliative care teams and providing examples of best practices.

Keywords: public health palliative care, palliative care nursing, care networks, integrated health care, palliative care approach, public health, multidisciplinary work, care teams

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Authors: T. Pradhan, P. Rijal, M. C. Regmi

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Background: Eclampsia is a multisystem disorder that involves vital organs and failure of these may lead to deterioration of maternal condition and hypoxia and acidosis of fetus resulting in high maternal and perinatal mortality and morbidity. Thus, evaluation of the contributing factors for this condition and its complications leading to maternal deaths should be the priority. Formulating the plan and protocol to decrease these losses should be our goal. Aims and Objectives: To evaluate the risk factors associated with adverse maternal and fetal outcome in patients with eclampsia and to correlate the risk factors associated with maternal and fetal morbidity and mortality. Methods: All patients with eclampsia admitted in Department of Obstetrics and Gynecology, B. P. Koirala Institute of Health Sciences were enrolled after informed consent from February 2013 to February 2014. Questions as per per-forma were asked to patients, and attendants like Antenatal clinic visits, parity, number of episodes of seizures, duration from onset of seizure to magnesium sulfate and the patients were followed as per the hospital protocol, the mode of delivery, outcome of baby, post partum maternal condition like maternal Intensive Care Unit admission, neurological impairment and mortality were noted before discharge. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS 11). Mean and percentage were calculated for demographic variables. Pearson’s correlation test and chi-square test were applied to find the relation between the risk factors and the outcomes. P value less than 0.05 was considered significant. Results: There were 10,000 antenatal deliveries during the study period. Fifty-two patients with eclampsia were admitted. All of the patients were unbooked for our institute. Thirty-nine patients were antepartum eclampsia. Thirty-one patients required mechanical ventilator support. Twenty-four patients were delivered by emergency c-section and 21 babies were Low Birth Weight and there were 9 stillbirths. There was one maternal mortality and 45 patients were discharged with improvement but 3 patients had neurological impairment. Mortality was significantly related with number of seizure episodes and time interval between seizure onset and administration of magnesium sulphate. Conclusion: Early detection and management of hypertensive complicating pregnancy during antenatal clinic check up. Early hospitalization and management with magnesium sulphate for eclampsia can help to minimize the maternal and fetal adverse outcomes.

Keywords: eclampsia, maternal mortality, perinatal mortality, risk factors

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Authors: Adebusoye Michael, Okunola Olayinka, Owolabi Abdulateef, Jacob Anayo

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Introduction: Child undernutrition remains one of Africa’s most fundamental challenges for improved human development because the time and capacities of caregivers are limited; far too many children are unable to access effectively amenities they need for a healthy life. Methods and procedures: This cross-sectional, descriptive study evaluated the maternal care practices on nutritional status of pre-school children, 150 mothers were selected by systematic random sampling in Dass L.G.A., Bauchi-State, Nigeria. Information on relevant parameters were collected by questionaire, analysed by various indices of descriptive statistics using SPSS version 16.0.Spearman’s rank correlation was used to test for associations between the variables. Results: Thirty-five (23.3%) of the respondents were aged 21-25 years. Thirty-three (28.0%) had secondary education, while forty-nine (32.7%) were full housewives. Majority 79(52.7) earned NI,000- N10,000 monthly versus 10(6.7%) who earned N11,000- N20,000.113(75.3%) married while 7(4.7%) of respondents were separated. Sixty-one (40.7%) practiced exclusive breastfeeding within six months. Only seventy-one (47.3%) initiated breastfeeding between 7 and 13 months. Five (3.3%) of children were mildly underweight while nine (6.0%) were severely stunted. Conclusion: The outcome suggested that working time of mothers is a major determinant on their child nutritional status. However, there is a significant relationship on the working time of mothers, income level and educational level of mothers to the nutritional status of their children (P<0.05). Recommendation: Good policy programmes should aim at eradicating poverty, better child care practices that would reduce malnutrition among under-five children.

Keywords: maternal care, nutritional status, preschool children, Dass L.G.A.

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Authors: Asma Inge-Hanif, Ayyub Ansari Hanif

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The impact of conflicts, the subsequent refugee migration to America and their attempted use of societal resources implicate the lack of further humanitarian aid as a consequence of the abrupt decrease in services and policy changes stemming from new governmental mandates and Executive Orders. Statistical research data indicates a substantial decline in access to standardized health services by refugee women creating a significant alteration in the management of their maternal health care in America, previously shown to result in decreased mortality and morbidity. Studying nursing at Howard University in Washington, D.C., observed doctors were not always sensitive to the needs and modesty concerns of immigrant Muslim women - often unintentionally. Among health care professionals, the prevailing belief should be that every man, woman and child has the right to quality care in a dignified manner and the achievement of optimal health and well-being, regardless of race, creed, socio-economic level or status. In 1987 Muslimat Al Nisaa Health and Social Services Center was established to care for underserved and uninsured women and children. This Center, plus the subsequent shelter, provided direct access to those homeless, refugees, human trafficking and women victims of domestic violence was established and provides the data for this study. Understanding specific culture, social, economic and religious nuances respects their diversity and addressing their basic human needs that they achieve optimal success. The ultimate goal being to facilitate the rescue and housing of those whom escaped from a country/communities where girls are devalued, brought, sold and abused.

Keywords: women, refugee, domestic violence, health care

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Authors: Osvaldo Collazo, Cristiano Valerio Dos Santos

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Early maternal separation has been shown to bring about many negative effects on behavior in rats. In the present study, we evaluated the effects of early maternal separation on risky choice in rats. One group of male and female Wistar rats was exposed to an early maternal separation protocol while a control group was left undisturbed. Then both groups were exposed to a series of behavioral tests, including a test of risky choice, where one alternative offered a constant reward while the other offered a variable reward. There was a difference between groups when they chose between a variable and a constant reward delay, but no other difference was significant. These results suggest that early maternal separation may be related to a greater preference for shorter delays, which is characteristic of more impulsive choices.

Keywords: early maternal separation, impulsivity, risky choice, variability

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Authors: Yibeltal T. Bayou, Yohana S. Mashalla, Gloria Thupayagale-Tshweneagae

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Background: Maternal mortality has been shown to be lower in urban areas than in rural areas. However, disparities for the fast-growing population of urban poor who struggle as much their rural counterparts to access quality healthcare are masked by the urban averages. The aim of this paper is to report on the findings of antenatal adequacy among slum residents in Addis Ababa, Ethiopia. Methods and Materials: A quantitative and cross-sectional community-based study design was employed. A stratified two-stage cluster sampling technique was used to determine the sample and data was collected using structured questionnaire administered to 837 women aged 15-49 years. Binary logistic regression models were employed to identify predictors of adequacy of antenatal care. Results: The majority of slum residents did not have adequate antenatal care services i.e., only 50.7%, 19.3% and 10.2% of the slum resident women initiated early antenatal care, received adequate antenatal care service contents and had overall adequate antenatal care services. Pregnancy intention, educational status and place of ANC visits were important determinant factors for adequacy of ANC in the study area. Women with secondary and above educational status were 2.9 times more likely to have overall adequate care compared to those with no formal education. Similarly, women whose last pregnancy was intended and clients of private healthcare facilities were 1.8 and 2.8 times more likely to have overall adequate antenatal care compared to those whose last pregnancy was unintended and clients of public healthcare facilities respectively. Conclusion: In order to improve ANC adequacy in the study area, the policymaking, planning, and implementation processes should focus on the poor adequacy of ANC among the disadvantaged groups in particular and the slum residents in general.

Keywords: Addis Ababa, adequacy of antenatal care, slum residents, maternal mortality

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Authors: M. Van 'T Hof, R. V. Pasma, J. T. Bailly, H. W. Hoek, W. A. Ester

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Background: The transition into primary school can be challenging for children with an autism spectrum disorder (ASD). Due to the new demands that are made to children in this period, their limitations in social functioning and school achievements may manifest and appear faster. Detection of possible ASD signals mainly takes place by parents, teachers and during obligatory municipal maternal and child health centre visits. Physicians of municipal maternal and child health centres have limited education and instruments to detect ASD. Further education on detecting ASD is needed to optimally equip these doctors for this task. Most research aims to increase the early detection of ASD in children aged 0-3 years and shows positive results. However, there is a lack of research on educational interventions to detect ASD in children aged 4-6 years by municipal maternal and child health physicians. Aim: The aim of this study is to explore the effect of the online educational intervention: Detection of ASD in children aged 4-6 years for municipal maternal and child health physicians. This educational intervention is developed within The Reach-Aut Academic Centre for Autism; Transitions in education, and will be available throughout The Netherlands. Methods: Ninety-two participants will follow the educational intervention: Detection of ASD in children aged 4-6 years for municipal maternal and child health centre physicians. The educational intervention consists of three, one and a half hour sessions, which are offered through an online interactive classroom. The focus and content of the course has been developed in collaboration with three groups of stakeholders; autism scientists, clinical practitioners (municipal maternal and child health doctors and ASD experts) and parents of children with ASD. The primary outcome measure is knowledge about ASD: signals, early detection, communication with parents and referrals. The secondary outcome measures are the number of ASD related referrals, the attitude towards the mentally ill (CAMI), perceived competency about ASD knowledge and detection skills, and satisfaction about the educational intervention. Results and Conclusion: The study started in January 2016 and data collection will end mid 2017.

Keywords: ASD, child, detection, educational intervention, physicians

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Authors: Julie Mariam Abraham, G. J. Melendez-Torres

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Background. Maternal mortality is disproportionately higher in low- and middle- income countries (LMICs) compared to other parts of the world. At the current pace of progress, the Sustainable Development Goals for maternal mortality rate will not be achieved by 2030. A variety of factors influence the increased risk of maternal complications in LMICs. These are exacerbated by socio-economic and political factors, including poverty, illiteracy, and gender inequality. This paper aims to use realist synthesis to identify the contexts, mechanisms, and outcomes (CMOs) of maternal health interventions conducted in LMICs to inform evidence-based practice for future maternal health interventions. Methods. In May 2022, we searched four electronic databases for systematic reviews of maternal health interventions in LMICs published in the last five years. We used open and axial coding of CMOs to develop an explanatory framework for intervention effectiveness. Results. After eligibility screening and full-text analysis, 44 papers were included. The intervention strategies and measured outcomes varied within reviews. Healthcare system level contextual factors were the most frequently reported, and infrastructural capacity was the most reported context. The most prevalent mechanism was increased knowledge and awareness. Discussion. Health system infrastructure must be considered in interventions to ensure effective implementation and sustainability. Healthcare-seeking behaviours are embedded within social and cultural norms, environmental conditions, family influences, and provider attitudes. Therefore, effective engagement with communities and families is important to create new norms surrounding pregnancy and delivery. Future research should explore community mobilisation and involvement to enable tailored interventions with optimal contextual fit.

Keywords: maternal mortality, service delivery and organisation, realist synthesis, sustainable development goals, overview of reviews

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Authors: Sandrine Andriantsimietry, Hantanirina Ravaosendrasoa

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Madagascar, in 2018, set up the first best available technology, autoclave, to treat the health care waste in public hospitals according the best environmental practices in health care waste management. Incineration of health care waste, frequently through open burning is the most common practice of treatment and elimination of health care waste across the country. Autoclave is a best available technology for non-incineration of health care waste that permits recycling of treated waste and prevents harm in environment through the reduction of unintended persistent organic pollutants from the health sector. A Global Environment Fund project supported the introduction of the non-incineration treatment of health care waste to help countries in Africa to move towards Stockholm Convention objectives in the health sector. Two teaching hospitals in Antananarivo and one district hospital in Manjakandriana were equipped respectively with 1300L, 250L and 80L autoclaves. The capacity of these model hospitals was strengthened by the donation of equipment and materials and the training of the health workers in best environmental practices in health care waste management. Proper segregation of waste in the wards to collect the infectious waste that was treated in the autoclave was the main step guaranteeing a cost-efficient non-incineration of health care waste. Therefore, the start-up of the switch of incineration into non-incineration treatment was carried out progressively in each ward with close supervision of hygienist. Emissions avoided of unintended persistent organic pollutants during these four months of autoclaves use is 9.4 g Toxic Equivalent per year. Public hospitals in low income countries can be model in best environmental practices in health care waste management but efforts must be made internally for sustainment.

Keywords: autoclave, health care waste management, model hospitals, non-incineration

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Authors: Rachel Koshy, Nazrila Hairizan Bt. Nasir, Samsiah Bt. Awang, Kamaliah Bt. Mohamad Noh

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Malaysia collaborated as a ‘trailblazer’ country with PHCPI (Primary Health Care Performance Initiative) to populate the Primary Health Care (PHC) Vital Signs Profile (VSP) for the country. The PHC VSP provides an innovative snapshot of the primary health care system's performance. Four domains were assessed: system financing, system capacity, system performance, and system equity, and completed in 2019. There were two phases using a mixed method study design. The first phase involved a quantitative study, utilising existing secondary data from national and international sources. In the case of unavailability of data for any indicators, comparable alternative indicators were used. The second phase was a mixed quantitative-qualitative approach to measure the functional capacity based on governance and leadership, population health needs, inputs, population health management, and facility organisation and management. PHC spending constituted 35% of overall health spending in Malaysia, with a per capita PHC spending of $152. The capacity domain was strong in the three subdomains of governance and leadership, information system, and funds management. The two subdomains of drugs & supplies and facility organisation & management had low scores, but the lowest score was in empanelment of the population under the population health management. The PHC system performed with an access index of 98%, quality index of 84%, and service coverage of 62%. In the equity domain, there was little fluctuation in the coverage of reproductive, maternal, newborn, and child health services by mother’s level of education and under-five child mortality between urban and rural areas. The public sector was stronger in the capacity domain as compared to the private sector. This is due to the different financing, organisational structures, and service delivery mechanism. The VSP has identified areas for improvement in the effort to provide high-quality PHC for the population. The gaps in PHC can be addressed through the system approach and the positioning of public and private primary health care delivery systems.

Keywords: primary health care, health system, system domains, vital signs profile

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Authors: Aboli Gore, Aritra Das, Sunil Sonthalia, Tanmay Mahapatra, Sridhar Srikantiah, Hemant Shah

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AMANAT is an initiative, taken in collaboration with the Government of Bihar, aimed at improving the Quality of Maternal and Neonatal care services at Bihar’s public health facilities – those offering either the Basic Emergency Obstetric and Neonatal care (BEmONC) or Comprehensive Emergency Obstetric and Neonatal care (CEmONC) services. The effectiveness of this program is evaluated by conducting cross-sectional assessments at the concerned facilities prior to (baseline) and following completion (endline) of intervention. Direct Observation of Delivery (DOD) methodology is employed for carrying out the baseline and endline assessments – through which key obstetric and neonatal care practices among the Health Care Providers (especially the nurses) are assessed quantitatively by specially trained nursing professionals. Assessment of vitals prior to delivery improved during all three phases of BEmONC and all four phases of CEmONC training with statistically significant improvement noted in: i) pulse measurement in BEmONC phase 2 (9% to 68%), 3 (4% to 57%) & 4 (14% to 59%) and CEmONC phase 2 (7% to 72%) and 3 (0% to 64%); ii) blood pressure measurement in BEmONC phase 2 (27% to 84%), 3 (21% to 76%) & 4 (36% to 71%) and CEmONC phase 2 (23% to 76%) and 3 (2% to 70%); iii) fetal heart rate measurement in BEmONC phase 2 (10% to 72%), 3 (11% to 77%) & 4 (13% to 64%) and CEmONC phase 1 (24% to 38%), 2 (14% to 82%) and 3 (1% to 73%); and iv) abdominal examination in BEmONC phase 2 (14% to 59%), 3 (3% to 59%) & 4 (6% to 56%) and CEmONC phase 1 (0% to 24%), 2 (7% to 62%) & 3 (0% to 62%). Regarding infection control, wearing of apron, mask and cap by the delivery conductors improved significantly in all BEmONC phases. Similarly, the practice of handwashing improved in all BEmONC and CEmONC phases. Even on disaggregation, the handwashing showed significant improvement in all phases but CEmONC phase-4. Not only the positive practices related to handwashing improved but also negative practices such as turning off the tap with bare hands declined significantly in the aforementioned phases. Significant decline was also noted in negative maternal care practices such as application of fundal pressure for hastening the delivery process and administration of oxytocin prior to delivery. One of the notable achievement of AMANAT is an improvement in active management of the third stage of labor (AMTSL). The overall AMTSL (including administration of oxytocin or other uterotonics uterotonic in proper dose, route and time along with controlled cord traction and uterine massage) improved in all phases of BEmONC and CEmONC mentoring. Another key area of improvement, across phases, was in proper cutting/clamping of the umbilical cord. AMANAT mentoring also led to improvement in important immediate newborn care practices such as initiation of skin-to-skin care and timely initiation of breastfeeding. The next phase of the mentoring program seeks to institutionalize mentoring across the state that could potentially perpetuate improvement with minimal external intervention.

Keywords: capacity building, nurse-mentoring, quality of care, pregnancy, newborn care

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Authors: A. Kulprasutidilok

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In order to address the social factors of elderly health care, researcher and community members have turned to more inclusive and participatory approaches to research and interventions. One such approach, community-based participatory research (CBPR) in public health, has received increased attention as the academic and public health communities struggle to address the persistent problems of disparities in the use of health care and health outcomes for several over the past decade. As Thailand becomes an ageing society, health services and proper care systems specifically for the elderly group need to be prepared and well established. The purpose of this assignment was to study the health problems and was to explore the process of community participation in elderly health care. Participants in this study were member of elderly group of Paisanee Ramintra 65 community in Bangkok, Thailand. The results indicated two important components of community participation process in elderly health care: 1) a process to develop community participation in elderly health care, and 2) outcomes resulting from such process. The development of community participation consisted of four processes. As for the outcomes of the community participation development process, they consisted of elderly in the community got jointly and formulated a group, which strengthened the project because of collaborative supervision among themselves. Moreover, inactive health care services have changed to being energetic and focus on health promotion rather than medical achievement and elderly association of community can perform health care activities for chronically illness through the achievement of this development; consequently, they increasingly gained access to physical, cognitive, and social activity.

Keywords: community-based participatory research, elderly, heath care, Thailand.

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Authors: J. Niyitegeka, G. Nshimirimana, A. Silverstein, J. Odhiambo, Y. Lin, T. Nkurunziza, R. Riviello, S. Rulisa, P. Banguti, H. Magge, M. Macharia, J. P. Dushime, R. Habimana, B. Hedt-Gauthier

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In low-resource settings, women needing an emergency cesarean section experiences various delays in both reaching and receiving care that is often linked to poor neonatal outcomes. In this study, we quantified different measures of delays and assessed the association between these delays and neonatal outcomes at three rural district hospitals in Rwanda. This retrospective study included 441 neonates and their mothers who underwent emergency cesarean sections in 2015 at Butaro, Kirehe and Rwinkwavu District Hospitals. Four possible delays were measured: Time from start of labor to district hospital admission, travel time from a health center to the district hospital, time from admission to surgical incision, and time from the decision for the emergency cesarean section to surgical incision. Neonatal outcomes were categorized as unfavorable (APGAR < 7 or death) and favorable (APGAR ≥ 7). We assessed the relationship between each type of delay and neonatal outcomes using multivariate logistic regression. In our study, 38.7% (108 out of 279) of neonates’ mothers labored for 12 to 24 hours before hospital admission and 44.7% (159 of 356) of mothers were transferred from health centers that required 30 to 60 minutes of travel time to reach the district hospital. 48.1% (178 of 370) of caesarean sections started within five hours after admission and 85.2% (288 of 338) started more than thirty minutes after the decision for the emergency cesarean section was made. Neonatal outcomes were significantly worse among mothers with more than 90 minutes of travel time from the health center to the district hospital compared to health centers attached to the hospital (OR = 5.12, p = 0.02). Neonatal outcomes were also significantly different depending on decision to incision intervals; neonates with cesarean deliveries starting more than thirty minutes after decision had better outcomes than those started immediately (OR = 0.32, p = 0.04). Interventions that decrease barriers to access to maternal health care services can improve neonatal outcome after emergency cesarean section. Triaging could explain the inverse relationship between time from decision to incision and neonatal outcome; this must be studied more in the future.

Keywords: Africa, emergency obstetric care, rural health delivery, maternal and child health

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Authors: Ashleigh Medina

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Chronic conditions account for the majority of total health care spending both in the United States and globally. Encouraging self-management to improve chronic conditions, which in turn could decrease the strain placed on hospitals, requires resources to address the patient’s social concerns in addition to their medical concerns. Transitional care has been identified as a possible bridge between acutely managing conditions at the hospital to chronically managing conditions in a community setting. The aim of this integrative review was to examine the impact of transitional care on self-management outcomes of chronic conditions in un/underinsured populations. Both transitional care, by assisting with resources such as funding sources for healthcare and medications or identifying a healthcare provider for continued care, and self-management, by increasing responsibility for one’s care through goal setting and taking action, can impact health outcomes while providing health care cost-savings.

Keywords: chronic conditions, self-management, transitional care, uninsured

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Authors: Nur Atiqah Adam, Mor Jack Ng, Bernard Chern, Kok Hian Tan

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Introduction: Gestational diabetes (GDM) is a common pregnancy complication with short and long-term health consequences for both mother and fetus. Factors such as family history of diabetes mellitus, maternal obesity, maternal age, ethnicity and parity have been reported to influence the risk of GDM. In a multi-racial country like Singapore, it is worthwhile to study the GDM prevalences of different ethnicities. We aim to investigate the influence of ethnicity on the racial prevalences of GDM in Singapore. This is important as it may help us to improve guidelines on GDM healthcare services according to significant risk factors unique to Singapore. Materials and Methods: Obstetric cohort data of 926 singleton deliveries in KK Women’s and Children’s Hospital (KKH) from 2011 to 2013 was obtained. Only patients aged 18 and above and without complicated pregnancies or chronic illnesses were targeted. Factors such as ethnicity, maternal age, parity and maternal body mass index (BMI) at booking visit were studied. A multivariable logistic regression model, adjusted for confounders, was used to determine which of these factors are significantly associated with an increased risk of GDM. Results: The overall GDM prevalence rate based on WHO 1999 criteria & at risk screening (race alone not a risk factor) was 8.86%. GDM rates were higher among women above 35 years old (15.96%), obese (15.15%) and multiparous women (10.12%). Indians had a higher GDM rate (13.0 %) compared to the Chinese (9.57%) and Malays (5.20%). However, using multiple logistic regression model, variables that are significantly related to GDM rates were maternal age (p < 0.001) and maternal BMI at booking visit (p = 0.006). Conclusion: Maternal age (p < 0.001) and maternal booking BMI (p = 0.006) are the strongest risk factors for GDM. Ethnicity per se does not seem to have a significant influence on the prevalence of GDM in Singapore (p = 0.064). Hence we should tailor guidelines on GDM healthcare services according to maternal age and booking BMI rather than ethnicity.

Keywords: ethnicity, gestational diabetes, healthcare, pregnancy

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Authors: Ayşegül Bilge, Hacer Demirkol, Merve Uğuryol

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Therapeutic touch is one of the most important methods of complementary and alternative treatments. Therapeutic touch requires the sharing of universal energy. Therapeutic touch (TT) provides the interaction between the patient and the nurse. In addition, nurses can be aware of physical and mental symptoms of patients through therapeutic touch. Therapeutic touch (TT) is short-term provides the advantage for the nurse. For this reason, nurses have to be aware of the importance of therapeutic touch and they can use it from the primary care to tertiary care in nursing practices at in health field.

Keywords: health care services, complementary treatment, nursing, therapeutic touch

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Authors: Nuruddeen Abubakar Adamu

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Background: Global health nursing describes health-related work across borders and focuses more on the differences between the nurses’ role between countries and identified why nursing care in particular country differs from another. It also helps in analyzing the health issues and concerns that transcend national borders class, race, ethnicity and culture. The primary objective of this study is to introduce the concept of global health nursing. And the article also argues for the need for global health nursing. Methods This review assesses available evidence, both published and unpublished, on issues relating to the global health nursing and the nurse's role in global health. The review is qualitative based. Results: Globalization, modern technologies, travel, migration and changes in diseases trend globally has made the nursing role to become more diverse and less traditional. These issues change the nurse’s role in the healthcare industry to become enormous and very challenging. This article considers response to issues of emerging global health nursing concept, challenges, purposes, global health nursing activities in both developed and developing countries and the nurse's role globally in maternal-newborn health; preparedness for advocacy in global health within a framework of social justice, equity; and health system strengthening globally. Conclusion: Global health nursing goes beyond the intervention to care for a patient with a particular health problem but, however health is interconnected to political, economic and social context and therefore this explains the need of a multi-professional and multi-sectoral approach to achieve the goal of global health and the need for global health nursing. Global health equity can be promoted and if the profile of nursing and nurses will be raised and enable nurses to be aware of global health issues so as to enable them to work to their full maximum potential, to attain greater health outcome and wellness.

Keywords: global health nursing, double burden of diseases, globalization, health equity

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Authors: Maria Vargas Hernandez, Jose Rojas Suarez, Carmelo Dueñas Castell, Sandra Contreras, Camilo Bello, Diana Borre, Walter Anichiarico, Harold Vasquez, Eduard Perez, Jose Santacruz

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In the last two decades, there have been outbreaks of emerging infectious diseases, with an impact on both the general population and the obstetric population. These infections, which affect the general population, pose a high risk for adverse maternal and perinatal outcomes, taking into account that physiological and immunological changes that occur during pregnancy can increase their risk or severity. Among these, the pandemics of viral infections, Influenza A/H1N1 and SARS-CoV-2/COVID-19, stand out. In 2009, Influenza A/H1N1 infection (H1N1 2009pdm) affected approximately 3,110 obstetric patients, with data reported from 29 countries, including 1,625 (52.3%) cases that were hospitalized, 378 (23.3%) admissions to ICU and 130 (8%) deaths; and since the end of 2019, the Severe Acute Respiratory Syndrome - 2 (SARS-CoV-2) has been identified, causing the COVID-19 pandemic, with global mortality that is around 2-4% for the general population, and higher mortality in patients requiring admission to the intensive care unit. Its impact on the obstetric population is still unknown. Objectives: To evaluate the impact on maternal and perinatal outcomes of COVID-19 infection in reference to influenza A/H1N1 infection in the obstetric population. Methodology: Systematic review of the literature and meta-analysis. Results: Mortality from maternal infection with influenza A/H1N1 appears to be higher (8%) than mortality due to maternal infection with COVID-19 (3%). The rates of ICU admission, hospitalization, the requirement for invasive mechanical ventilation, and fetal death also appear to be higher in the maternal population with A/H1N1 infection, in reference to the maternal population with COVID-19 infection. Within perinatal outcomes, the admission to the neonatal ICU appears to be higher in the infants born to mothers with COVID-19 infection (28% vs. 15% for COVID-19 and A/H1N1, respectively). Conclusion: A/H1N1 infection in the obstetric population seems to be associated with a higher proportion of adverse outcomes in relation to COVID-19 infection. The actual impact of maternal influenza A/H1N1 infection on perinatal outcomes is unknown. More COVID-19 studies are needed to understand the impact of maternal infection on perinatal outcomes in this population.

Keywords: A/H1N1, COVID-19, maternal outcomes, perinatal outcomes

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Authors: Haatembo Mooya

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Cross-culturally, exclusive maternal care of infants is an exception, rather than a rule. In most traditional non-Western societies, child care is shared within the family while in most middle class Western societies parents tend to rely more on ‘hired hands’ for support. In both contexts however, a common caregiver is the sibling. Despite this, the phenomenon of sib-care has remained relatively understudied. Cultural and gender differences in sib-care and attachment were explored using a retrospective survey instrument comparing Zambian and Dutch college students. The total study sample (N = 394) comprised of 200 Zambian students from the University of Zambia and 194 Dutch students from Leiden University, the Netherlands. We tested four main hypotheses. Firstly, we hypothesized that the Zambian subjects performed more sib-care than Dutch subjects. Secondly we hypothesized that female participants performed more sib-care than males participants, both among the Zambian and Dutch subjects, especially when parents are not at home. Thirdly, we hypothesized that larger family size was associated with more sib-care. Finally, we hypothesized that securely attached participants performed more sib-care than their less securely attached peers. Results indicated that sib-care was prevalent in both Zambian and Dutch samples. Zambian subjects performed more sib-care than Dutch subjects, with females performing more sib-care than males, both when parents were at home (F(2, 244) = 62.09, p < .01) and when parents were not at home (F(2, 237) = 51.28, p < .01). We also found that family size and attachment related avoidance and anxiety were not significant predictors of sib-care. It is concluded that sib-care is understudied, not only in Africa but also in Western societies and that females perform more sib-care than males, especially when the parents are not at home. In addition, attachment related avoidance and anxiety appear to be more related to the quality than the quantity of sib-care provided.

Keywords: sibling, sib-care, attachment, Africa, Zambia, the Netherlands

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Authors: Minna K. Miller, Chantel. E. Canessa, Suzanna V. McRae, Susan Shumay, Alissa Collingridge

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Primary care provides the first point of contact and access to health care services. For the pediatric population, the goal is to help healthy children stay healthy and to help those that are sick get better. Primary care facilitates regular well baby/child visits; health promotion and disease prevention; investigation, diagnosis and management of acute and chronic illnesses; health education; both consultation and collaboration with, and referral to other health care professionals. There is a protective association between regular well-child visit care and preventable hospitalization. Further, low adherence to well-child care and poor continuity of care are independently associated with increased risk of hospitalization. With a declining number of family physicians caring for children, and only a portion of pediatricians providing primary care services, it is becoming increasingly difficult for children and their families to access primary care. Nurse practitioners are in a unique position to improve access to primary care and improve health outcomes for children. Limited literature is available on the nurse practitioner role in primary care pediatrics. The purpose of this paper is to describe the development, implementation and evaluation of a Nurse Practitioner-led pediatric primary care clinic in a tertiary care setting. Utilizing the participatory, evidence-based, patient-focused process for advanced practice nursing (PEPPA framework), this paper highlights the results of the initial needs assessment/gap analysis, the new service delivery model, populations served, and outcome measures.

Keywords: access, health outcomes, nurse practitioner, pediatric primary care, PEPPA framework

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Authors: Alya Al Ghufli, Kelaithim Al Tunaiji, Sara Al Ali, Khalid Samara

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It is well known that health care systems encompass a variety of key knowledge sources that need to be integrated and shared amongst all types of users to attain higher-levels of motivation and productivity. The development of Health Integrated Systems (HIS) is often seen as a crucial step in strengthening the integration of knowledge to help serve the information needs of health care users. As an emergent economy, the United Arab Emirates (UAE) is regarded as a new arrival in the area of health information systems. As a new nation, there may be several challenges in terms of organisational climate and the sufficient skills and knowledge activities for effective use of HIS. In this regard, the lack of coordination, attitudes and practice of health-related systems can eventually result in unnecessary data and generally poor use of the system. This paper includes results from a qualitative preliminary study carried out from a case study investigation in a single large primary health care organisation in the United Arab Emirates (UAE) comprising various health care users. The study explored health care user’s perceptions about health integration and the impact it has on their practice. The main sources of information were semi-structured interviews and non-obtrusive observations. The authors conclude by presenting various recommendations for the development of HIS and knowledge activities and areas for further study.

Keywords: health integrated systems, knowledge sharing, knowledge activities, health information systems

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Authors: Erhan Berk

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The purpose of this study is to examine the efficiency and productivity of the health care sector in Turkey based on four years of health care cross-sectional data. Efficiency measures are calculated by a nonparametric approach known as Data Envelopment Analysis (DEA). Productivity is measured by the Malmquist index. The research shows how DEA-based Malmquist productivity index can be operated to appraise the technology and productivity changes resulted in the Turkish hospitals which are located all across the country.

Keywords: data envelopment analysis, efficiency, health care, Malmquist Index

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Authors: Maria Luisa T. Uayan

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The global need for qualified nurses to take care of the clients with various health needs is an incessant occurrence that persistently cause migration of nurses from developing to developed countries. The pull-push theory of migration greatly affects health care delivery systems of sending countries which is the same way affects nursing management. The exodus of nurses prepared to provide the much needed leadership at the bedside leaves the country in clusters giving health care institutions limited time to develop the next front-line managers that will assure quality patient care. This paper focuses on the extent and consequences of the massive recurring migration phenomena that is felt ONLY IN THE PHILIPPINE health care arena. It deals with the causes, problems, and effects of the cyclical loss of competent Filipina nurses in terms of emigration. Also, it will highlights the difficulties confronted by nursing service departments and health care teams when more experienced nurses set out for the “greener pastures” and patients are placed under the care of novice nurses. Fundamentally, it will emphasize the impact of suffering the loss of competent nurse managers in the Philippine health care institutions and provide contemporary recommendations on how to responsd accordingly to this very timely issue.

Keywords: Migration, Nurse Manager, Philippines

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Authors: Areej Makeineldein Mustafa

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The study evaluates the management processes and healthcare provider compliance with the National Institute for Health and Care Excellence recommendations for constipation management. We aimed to evaluate the adherence to National Institute for Health and Care Excellence guidelines in the management of constipation during the period from February to June 2023. We collected data from a random sample ( 51 patients) over 4 months with inclusion criteria for patients above 60 who were just admitted to the care of the elderly department during this period. Patient age, sex, medical records for constipation, acute or chronic constipation, or opioid-induced constipation, and treatment options were used to identify constipation and the type of treatment given. Our findings indicate that there is a gap between practice and National Institute for Health and Care Excellence guideline steps; only 3 patient was given medications according to National Institute for Health and Care Excellence guidelines in order of combination or steps of escalation. Addressing these gaps could potentially lead to enhanced patient outcomes and an overall improvement in the quality of care provided to individuals suffering from constipation.

Keywords: constipation, elderly, management, patient

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Authors: Chinwe Okpoko, Vivian Atasie

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One of the leading causes of death amongst women of child-bearing age in southeast Nigeria is pregnancy. Women in the reproductive age group die at a higher rate than men of the same age bracket. Furthermore, most maternal deaths occur among poor women who live in rural communities, and who generally fall within the low socio-economic group in society. Failure of policy makers and the media to create the strategic awareness and communication that conform with the sensibilities of this group account, in part, for the persistence of this malaise. Family planning (FP) is an essential component of safe motherhood, which is designed to ensure that women receive high-quality care to achieve an optimum level of health of mother and infant. The aim is to control the number of children a woman can give birth to and prevent maternal and child mortality and morbidity. This is what sustainable development goal (SDG) health target of World Health Organization (WHO) also strives to achieve. FP programmes reduce exposure to the risks of child-bearing. Indeed, most maternal deaths in the developing world can be prevented by fully investing simultaneously in FP and maternal and new-born care. Given the intrinsic value of communication in health care delivery, it is vital to adopt the most efficacious means of awareness creation and communication amongst rural women in FP. In a country where over 50% of her population resides in rural areas with attendant low-level profile standard of living, the need to communicate health information like FP through indigenous channels becomes pertinent. Interpersonal communication amongst family, friends, religious groups and other associations, is an efficacious means of communicating social issues in rural Africa. Communication in informal settings identifies with the values and social context of the recipients. This study therefore sought to determine the place of interpersonal communication on the knowledge of rural women on FP and how it influences uptake of FP. Descriptive survey design was used in the study, with interviewer administered questionnaire constituting the instrument for data collection. The questionnaire was administered on 385 women from rural communities in southeast Nigeria. The results show that majority (58.5%) of the respondents agreed that interpersonal communication helps women understand how to plan their family size. Many rural women (82%) prefer the short term natural method to the more effective modern contraceptive methods (38.1%). Husbands’ approval of FP, as indicated in the Mean response of 2.56, is a major factor that accounts for the adoption of FP messages among rural women. Socio-demographic data also reveal that educational attainment and/or exposure influenced women’s acceptance or otherwise of FP messages. The study, therefore, recommends amongst others, the targeting of husbands in subsequent FP communication interventions, since they play major role on contraceptive usage.

Keywords: family planning, interpersonal communication, interpersonal interaction, traditional communication

Procedia PDF Downloads 135