The status of maternal and newborn care services in Sierra Leone 8 years after ceasefire

Background Despite greater emphasis on maternal and neonatal health through policy and programming in Nepal, maternal and neonatal health is still not impressive. Health care providers’ knowledge assessment on maternal and neonatal care has been well documented elsewhere, but it is very little understood in Nepal.Objective The primary objective of this study was to assess the critical knowledge of primary level nurse- midwives on maternal and newborn care in Kapilvastu District of Nepal.Method This was an Institution based cross-sectional study, conducted in Kapilvastu district, Nepal among sixty eight nurse-midwives. The participants were selected using simple random sampling technique. For collecting the data, health institutions were visited by enumerators for a month from 1st October to 1st November 2012. Data were entered into Microsoft Excel, cleaned and analyzed using SPSS version 17.0.Result More than 3/4th of the nurse-midwives had 10-20 years of experience. Majority of them (89.7%) had poor knowledge in taking action to prevent mother to child transmission for HIV positive women. More than half of them (54.4%) had some knowledge in performing the active management of third stage of labor whereas almost half (51.5%) had poor knowledge to actions needed on post-partum haemorrhage (PPH). Similarly, more than two third (69.1%) had poor knowledge in newborn care.Conclusion Majority of the nurse-midwives were found to have either poor or some level of knowledge in most of the components of maternal and newborn care services. So, greater emphasis should be given to upgrade the knowledge of nurse mid-wives.

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Community-based maternal and newborn care: A concept analysis

Curationis ◽

10.4102/curationis.v41i1.1922 ◽

2018 ◽

Vol 41 (1) ◽

Author(s):

Yonas R. Guta ◽

Patrone R. Risenga ◽

Mary M. Moleki ◽

Merertu T. Alemu

Keyword(s):

Low Income ◽

Newborn Care ◽

Newborn Health ◽

Concept Analysis ◽

Low Income Countries ◽

Maternal And Newborn Health ◽

Community Based ◽

Care Services ◽

Maternal And Newborn Care ◽

Maternal And Newborn

Background: Community-based care can serve as a valuable programme in the provision of essential maternal and newborn care, specifically in communities in low-income countries. However, its application in maternal and newborn care is not clearly documented in relation to the rendering of services by skilled birth attendants.Objectives: The purpose of the analysis was to clarify the meaning of the concept ‘community-based maternal and newborn care and its relationship to maternal and newborn health’.Method: Walker and Avant’s and Rodgers and Knafl’s as well as Chin and Kramer’s approaches to concept analysis were followed to analyse community-based maternal and newborn care.Results: The attributes of community-based care in maternal and newborn health include (1) the provision of home- and/or community-level skilled care, (2) linkages of health services and (3) community participation and mobilisation. These attributes are influenced by antecedents as well as consequences.Conclusion: The provision of good maternal and newborn care to all clients is a crucial aspect in provision of maternal and newborn services. In order for low-income countries to promote maternal and newborn health, community-based care services are the best option to follow.

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Maternal and newborn care practices in Sierra Leone: a mixed methods study of four underserved districts

Health Policy and Planning ◽

10.1093/heapol/czw104 ◽

2016 ◽

pp. czw104 ◽

Cited By ~ 2

Author(s):

Alyssa Sharkey ◽

Aisha Yansaneh ◽

Peter Soulaiman Bangura ◽

Augustin Kabano ◽

Eoghan Brady ◽

...

Keyword(s):

Mixed Methods ◽

Sierra Leone ◽

Newborn Care ◽

Mixed Methods Study ◽

Care Practices ◽

Maternal And Newborn Care ◽

Maternal And Newborn

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Voices from the frontline: findings from a thematic analysis of a rapid online global survey of maternal and newborn health professionals facing the COVID-19 pandemic

10.1101/2020.05.08.20093393 ◽

2020 ◽

Cited By ~ 2

Author(s):

Aline Semaan ◽

Constance Audet ◽

Elise Huysmans ◽

Bosede B Afolabi ◽

Bouchra Assarag ◽

...

Keyword(s):

Health Professionals ◽

Maternity Care ◽

Healthcare Providers ◽

Newborn Care ◽

Evidence Based ◽

List Type ◽

Care Services ◽

Care Processes ◽

Maternal And Newborn Care ◽

Maternal And Newborn

AbstractObjectiveTo prospectively document experiences of frontline maternal and newborn healthcare providers during the COVID-19 pandemic.DesignCross-sectional study via an online survey disseminated through professional networks and social media in 12 languages. We analysed responses using descriptive statistics and qualitative thematic analysis disaggregating by low- and middle-income countries (LMICs) and high-income countries (HICs).Setting81 countries, between March 24 and April 10, 2020.Participants714 maternal and newborn healthcare providers.Main outcome measuresPreparedness for and response to COVID-19, experiences of health workers providing care to women and newborns, and adaptations to 17 outpatient and inpatient care processes during the pandemic.ResultsOnly one third of respondents received training on COVID-19 from their health facility and nearly all searched for information themselves. Half of respondents in LMICs received updated guidelines for care provision compared with 82% in HICs. Overall, only 47% of participants in LMICs, and 69% in HICs felt mostly or completely knowledgeable in how to care for COVID-19 maternity patients. Facility-level responses to COVID-19 (signage, screening, testing, and isolation rooms) were more common in HICs than LMICs. Globally, 90% of respondents reported somewhat or substantially higher levels of stress. There was a widespread perception of reduced use of routine maternity care services, and of modification in care processes, some of which were not evidence-based.ConclusionsSubstantial knowledge gaps exist in guidance on management of maternity cases with or without COVID-19. Formal information sharing channels for providers must be established and mental health support provided. Surveys of maternity care providers can help track the situation, capture innovations, and support rapid development of effective responses.Key MessagesWhat is already knownIn addition to lack of healthcare worker protection, staffing shortages, heightened risk of nosocomial transmission and decreased healthcare use described in previous infectious disease outbreaks, maternal and newborn care during the COVID-19 pandemic has also been affected by large-scale lockdowns/curfews.The two studies assessing the indirect effects of COVID-19 on maternal and child health have used models to estimate mortality impacts.Experiences of frontline health professionals providing maternal and newborn care during the COVID-19 pandemic have not been empirically documented to date.What this study addsRespondents in high-income countries more commonly reported available/updated guidelines, access to COVID-19 testing, and dedicated isolation rooms for confirmed/suspected COVID-19 maternity patients.Levels of stress increased among health professionals globally, including due to changed working hours, difficulties in reaching health facilities, and staff shortages.Healthcare providers were worried about the impact of rapidly changing care practices on health outcomes: reduced access to antenatal care, fewer outpatient visits, shorter length-of-stay in facilities after birth, banning birth companions, separating newborns from COVID-19 positive mothers, and postponing routine immunisations.COVID-19 illustrates the susceptibility of maternity care services to emergencies, including by reversing hard-won gains in healthcare utilisation and use of evidence-based practices. These rapid findings can inform countries of the main issues emerging and help develop effective responses.

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Existing barriers to utilization of health services for maternal and newborn care in rural Western Kenya

BMC Health Services Research ◽

10.1186/s12913-021-06847-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

George Ayodo ◽

George O. Onyango ◽

Salome Wawire ◽

Nadia Diamond-Smith

Keyword(s):

Health Care ◽

Health Care Services ◽

Health Workers ◽

Newborn Care ◽

Health Facilities ◽

Western Kenya ◽

Care Services ◽

Maternal And Newborn Care ◽

Maternal And Newborn

Abstract Background Understanding the existing barriers to utilization of maternal and newborn health care services can inform improvement of care services in the rural settings in sub-Saharan Africa. However, how unintended pregnancy relates to the uptake of antenatal care (ANC) services and also how gaps in the role of the community health workers and health facilities affect maternal and newborn care and referral services are poorly understood. Methods This was a formative ethnographic study design to determine barriers to the utilization of health care services for maternal and newborns in rural Western Kenya. We interviewed 45 respondents through in-depth interviews in rural Bondo Sub- County, Western Kenya: Mothers and Fathers with children under 5 years), 2 Focus Group Discussions (FGDs) with Traditional Birth Attendants (TBA), and 2 FGDs with Skilled Birth Attendants (SBAs). The data were analyzed using Atlas-ti. Results We found that unintended pregnancy results into poor uptake of antenatal care (ANC) services due to limited knowledge and poor support system. The respondents appreciated the role of community health workers but poor government infrastructure exists. Also, perceived harshness of the health care providers, poor management of high-risk pregnancies, and unavailability of supplies and equipment at the health facilities are of concern. Conclusions The findings of this study highlight barriers to the utilization of maternal and newborn services that if addressed can improve the quality of care within and outside health facilities.

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Respectful maternal and newborn care: measurement in one EN-BIRTH study hospital in Nepal

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03516-4 ◽

2021 ◽

Vol 21 (S1) ◽

Author(s):

Rejina Gurung ◽

◽

Harriet Ruysen ◽

Avinash K. Sunny ◽

Louise T. Day ◽

...

Keyword(s):

Newborn Care ◽

Verbal Abuse ◽

Standards Of Care ◽

Skin Contact ◽

Mode Of Birth ◽

Survey Interviews ◽

Maternal And Newborn Care ◽

Poor Care ◽

Respectful Care ◽

Maternal And Newborn

Abstract Background Respectful maternal and newborn care (RMNC) is an important component of high-quality care but progress is impeded by critical measurement gaps for women and newborns. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study was an observational study with mixed methods assessing measurement validity for coverage and quality of maternal and newborn indicators. This paper reports results regarding the measurement of respectful care for women and newborns. Methods At one EN-BIRTH study site in Pokhara, Nepal, we included additional questions during exit-survey interviews with women about their experiences (July 2017–July 2018). The questionnaire was based on seven mistreatment typologies: Physical; Sexual; or Verbal abuse; Stigma/discrimination; Failure to meet professional standards of care; Poor rapport between women and providers; and Health care denied due to inability to pay. We calculated associations between these typologies and potential determinants of health – ethnicity, age, sex, mode of birth – as possible predictors for reporting poor care. Results Among 4296 women interviewed, none reported physical, sexual, or verbal abuse. 15.7% of women were dissatisfied with privacy, and 13.0% of women reported their birth experience did not meet their religious and cultural needs. In descriptive analysis, adjusted odds ratios and multivariate analysis showed primiparous women were less likely to report respectful care (β = 0.23, p-value < 0.0001). Women from Madeshi (a disadvantaged ethnic group) were more likely to report poor care (β = − 0.34; p-value 0.037) than women identifying as Chettri/Brahmin. Women who had caesarean section were less likely to report poor care during childbirth (β = − 0.42; p-value < 0.0001) than women with a vaginal birth. However, babies born by caesarean had a 98% decrease in the odds (aOR = 0.02, 95% CI, 0.01–0.05) of receiving skin-to-skin contact than those with vaginal births. Conclusions Measurement of respectful care at exit interview after hospital birth is challenging, and women generally reported 100% respectful care for themselves and their baby. Specific questions, with stratification by mode of birth, women’s age and ethnicity, are important to identify those mistreated during care and to prioritise action. More research is needed to develop evidence-based measures to track experience of care, including zero separation for the mother-newborn pair, and to improve monitoring.

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Implementation of a referral and expert advice call Center for Maternal and Newborn Care in the resource constrained health system context of the Greater Accra region of Ghana

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03534-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ebenezer Oduro-Mensah ◽

Irene Akua Agyepong ◽

Edith Frimpong ◽

Marjolein Zweekhorst ◽

Linda Amarkai Vanotoo

Keyword(s):

Decision Making ◽

Call Center ◽

Clinical Decision Making ◽

Newborn Care ◽

Clinical Decision ◽

Series Data ◽

Maternal And Newborn Care ◽

Greater Accra Region ◽

Maternal And Newborn ◽

Decision Making Support

Abstract Background Referral and clinical decision-making support are important for reducing delays in reaching and receiving appropriate and quality care. This paper presents analysis of the use of a pilot referral and decision making support call center for mothers and newborns in the Greater Accra region of Ghana, and challenges encountered in implementing such an intervention. Methods We analyzed longitudinal time series data from routine records of the call center over the first 33 months of its operation in Excel. Results During the first seventeen months of operation, the Information Communication Technology (ICT) platform was provided by the private telecommunication network MTN. The focus of the referral system was on maternal and newborn care. In this first phase, a total of 372 calls were handled by the center. 93% of the calls were requests for referral assistance (87% obstetric and 6% neonatal). The most frequent clinical reasons for maternal referral were prolonged labor (25%), hypertensive diseases in pregnancy (17%) and post-partum hemorrhage (7%). Birth asphyxia (58%) was the most common reason for neonatal referral. Inadequate bed space in referral facilities resulted in only 81% of referrals securing beds. The national ambulance service was able to handle only 61% of the requests for assistance with transportation because of its resource challenges. Resources could only be mobilized for the recurrent cost of running the center for 12 h (8.00 pm – 8.00 am) daily. During the second phase of the intervention we switched the use of the ICT platform to a free government platform operated by the National Security. In the next sixteen-month period when the focus was expanded to include all clinical cases, 390 calls were received with 51% being for medical emergency referrals and 30% for obstetrics and gynaecology emergencies. Request for bed space was honoured in 69% of cases. Conclusions The call center is a potentially useful and viable M-Health intervention to support referral and clinical decision making in the LMIC context of this study. However, health systems challenges such inadequacy of human resources, unavailability of referral beds, poor health infrastructure, lack of recurrent financing and emergency transportation need to be addressed for optimal functioning.

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Building a Maternal and Newborn Care Training Programme for Health-Care Professionals in Guinea-Bissau

Acta Médica Portuguesa ◽

10.20344/amp.8453 ◽

2017 ◽

Vol 30 (10) ◽

pp. 734 ◽

Cited By ~ 1

Author(s):

Ana Reynolds ◽

Ahmed Zaky ◽

Joana Moreira-Barros ◽

João Bernardes

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Newborn Care ◽

Training Programme ◽

Guinea Bissau ◽

Care Training ◽

Multiple Choice Questionnaire ◽

Training Programmes ◽

Maternal And Newborn Care ◽

Maternal And Newborn

Introduction: The Integrated Programme of Maternal and Child Health aims to reduce maternal and child mortality in Guinea-Bissau. The purpose of this article is to share our experience in building a training programme on maternal and newborn care for health-care professionals in Guinea-Bissau.Material and Methods: Regional directors of the four target areas chose a group of staff who provide prenatal and childbirth care to attend the course (12 to 15 trainees per region). In each region, 15 highly interactive and practical sessions were scheduled over eight weeks. The trainees’ summative and reactive assessment was obtained using a multiple choice questionnaire (final test) and an anonymous survey, respectively.Results: Attendees included 25 nurses, 17 midwives and 14 doctors. About two thirds had five years’ practice or less. Test median scores were higher among trainees with two to nine years of practice (54.4% to 60.9%), as compared to those with a year or less (47.8%) or 10 or more years (45.7%). Pedagogical variables were rated as ‘good’ or ‘very good’ by 91% to 95% of the attendees.Discussion: Use of an interactive and practical pedagogical methodology produced positive results and was crucial to tailoring the training to local needs. However, adapting the syllabus according to professional categories and experiences should be considered.Conclusion: Our results warrant further development and evaluation of training programmes on maternal and neonatal care in Guinea-Bissau.

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Ready to deliver maternal and newborn care? Health providers’ perceptions of their work context in rural Mozambique

Global Health Action ◽

10.1080/16549716.2018.1532631 ◽

2018 ◽

Vol 11 (1) ◽

pp. 1532631 ◽

Cited By ~ 1

Author(s):

Sibone Mocumbi ◽

Kevin McKee ◽

Khátia Munguambe ◽

Rogério Chiau ◽

Ulf Högberg ◽

...

Keyword(s):

Newborn Care ◽

Health Providers ◽

Work Context ◽

Care Health ◽

Maternal And Newborn Care ◽

Maternal And Newborn

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Free Newborn Care Services: A New Initiative in Nepal

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v16i3.1526 ◽

2018 ◽

Vol 16 (3) ◽

pp. 340-344

Author(s):

Gambhir Shrestha ◽

Prajwal Paudel ◽

Parashu Ram Shrestha ◽

Shambhu Prasad Jnawali ◽

Deepak Jha ◽

...

Keyword(s):

Human Resources ◽

Neonatal Mortality ◽

Newborn Care ◽

Public Hospitals ◽

Significant Progress ◽

The Public ◽

Care Services ◽

Common Causes ◽

The Status ◽

The Common

Background: Nepal has made a significant progress in reducing child mortality. However, the annual rate of reduction in neonatal mortality is not satisfactory. As safeguarded by constitution of Nepal and to address neonatal mortality due to poverty and inequity, government has introduced free newborn care (FNC) package. This study aims to assess the status of FNC services in all the public hospitals.Methods: Child Health Division organized 5 workshops region-wise with the theme of newborn care services in March/April 2018 to cover all the public hospitals in the country. A template was designed comprising of duration of FNC implementation, number of newborns admitted since implementation, morbidities pattern, and number of babies served. It was circulated and all hospitals were advised to fill it and present in the review. Later, the data were compiled and analyzed.Results: Only 58 presentations out of 93 participated hospitals were included in this study. The total admitted cases were 8564 newborns. The common causes of admission were neonatal sepsis (44.5%) followed by asphyxia (14.29%) and hyperbilirubinemia (11.4%). A total of 1573 neonates received services of FNC package C, 3722 package B, 3081 received package A. The main challenges faced in implementation reported were lack of infrastructure and human resources to provide services and the reimbursement is not enough.Conclusions: Free newborn care is a new initiative taken to reduce neonatal mortality. This package is very helpful to serve sick newborns. However, the package should be revised taking into consideration the appropriate reimbursement and extra staffs to provide this service.Keywords: Free newborn care; government efforts; health services.

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