scholarly journals Perceived disrespect and abuse among women delivering at a tertiary care center in Nepal

2021 ◽  
Author(s):  
Sabika Munikar ◽  
Mala Chalise ◽  
Ranjan Dhungana ◽  
Durga Laxmi Shrestha ◽  
Naresh Pratap KC ◽  
...  
Keyword(s):  
Maternity Care ◽  
Care Center ◽  
Tertiary Care ◽  
Respectful Maternity Care ◽  
Disrespect And Abuse ◽  
Monthly Income ◽  
Multinomial Regression ◽  
Cross Sectional ◽  
Free Care ◽  
Type Of Delivery

AbstractBackgroundOf the children born every year in Nepal, 57.4% are delivered in health facilities. Disrespect and abuse of women during maternity care are problems that can significantly impact women’s willingness to seek out life-saving maternity care. However, evidence suggests ongoing disrespectful maternity care worldwide. This study aims to identify perceived disrespect and abuse during labor and delivery among postnatal women delivering at Bheri Hospital, Nepal.MethodsA cross sectional study was conducted among 445 purposively selected women admitted in postnatal ward of Bheri Hospital, Nepal from February to March 2020. Ethical approval was obtained from Nepal Health Research Council. Informed written consent was obtained from each participant and a face-to-face interview was conducted for data collection. A semi-structured questionnaire consisting of demographic information and a pre-validated Respectful Maternity Care (RMC) tool was used. The information was then checked, coded, and entered in SPSS for descriptive and inferential analysis.ResultsIn this study, the participants perceived very high friendly care, abuse-free care and discrimination-free care but moderate timely care only. Timely care was found to be significantly associated with age, ethnicity, occupation, monthly income, gravida, type of delivery, and complications. On multinomial regression, monthly income and type of delivery were the only factors found to be significant. Those mothers who had spontaneous vaginal delivery were 2.07 times more likely to have neutral RMC, and those who earn less than twenty thousand Nepalese rupees per month were likely to perceive high timely RMC.ConclusionThis study concludes that disrespectful or abusive maternal care is not perceived among women delivering at Bheri Hospital in terms of friendly care, abuse-free care and non- discriminatory care. However, timely care is less reported. Appropriate interventions to provide timely care to delivering women must be instituted.

Disrespect and Abuse During Facility‐Based Childbirth in North Showa Zone, Ethiopia

2020 ◽  
Author(s):  
Yohannes Mehretie Adinew ◽  
Helen Hall ◽  
Amy Marshall ◽  
Janet Kelly
Keyword(s):  
Maternity Care ◽  
Positive Association ◽  
Cross Sectional Study ◽  
Public Health Facility ◽  
Respectful Maternity Care ◽  
P Value ◽  
Disrespect And Abuse ◽  
Structural Factors ◽  
Care Providers ◽  
Cross Sectional

Abstract Background: Respectful maternity care is a fundamental human right, and an important component of quality maternity care that every childbearing woman should receive. Disrespect and abuse during childbirth is not only a violation of a women’s rights, it is associated with a reduction in the number of women accessing professional maternity services and increases the risk of maternal mortality. This study investigated women’s experience of disrespect and abuse during facility-based childbirth in Ethiopia. Methods: A cross-sectional study was conducted with 435 randomly selected women who had given birth at public health facility within the previous twelve months in North showa zone of Ethiopia. A structured, researcher administered questionnaire was used with data collected using digital, tablet-based tools. Participants’ experiences were measured using the seven categories and verification criteria of disrespect and abuse identified by White Ribbon Alliance. Multivariable logistic regression was used to identify the association between experience of disrespect and abuse and interpersonal and structural factors at p-value < 0.05 and OR values with 95% confidence interval. Results: All participants reported at least one form of disrespect and abuse during childbirth. Types of disrespect and abuse experienced by participants were; physical abuse 435(100%), non-consented care 423(97.2%), non-confidential care 288 (66.2%), abandonment/ neglect (34.7%), non-dignified care 126(29%), discriminatory care 99(22.8%) and detention 24(5.5%). Hospital birth [AOR: 3.04, 95% CI: 1.75, 5.27], rural residence [AOR: 1.44, 95% CI: 0.76, 2.71], monthly household income less than 1,644 Birr (USD 57) [AOR: 2.26, 95% CI: 1.20, 4.26], being attended by female providers [AOR: 1.74, 95% CI: 1.06, 2.86] and midwifery nurses [AOR: 2.23, 95% CI: 1.13, 4.39] showed positive association with experience of disrespect and abuse. Conclusion: The level of disrespect and abuse is high and its drivers and enablers include both structural and interpersonal factors. Expanding the size and skill mix of professionals in the preferred facilities (hospitals), and sensitizing care providers and health managers regarding the magnitude and consequences of D&A are strategies that could possibly promote more dignified and respectful maternity care.

scholarly journals Exploring midwives’ understanding of respectful and non-abusive maternal care in Kumasi, Ghana: Qualitative Inquiry

2019 ◽  
Author(s):  
Dzomeku Veronica Millicent ◽  
Bonsu Adwoa Bemah ◽  
Nakua Kweku Emmanuel ◽  
Agbadi Pascal ◽  
Lori R. Jody ◽  
...  
Keyword(s):  
Maternity Care ◽  
Maternal Care ◽  
Study Data ◽  
Qualitative Inquiry ◽  
Respectful Maternity Care ◽  
Disrespect And Abuse ◽  
Cross Sectional ◽  
Middle Income ◽  
Healthcare Facilities ◽  
Evidenced Based

AbstractBackgroundVarious aspects of disrespect and abusive maternity care have received scholarly attention because of frequent reports of the phenomenon in most healthcare facilities globally, especially in low- and middle-income countries. However, the perspectives of skilled providers on respectful maternal care have not been extensively studied. Midwives’ knowledge of respectful maternity care is critical in designing any interventive measures to address the menace of disrespect and abuse in maternity care. Therefore, the present study sought to explore the views of midwives on respectful maternity care at a Teaching Hospital in Kumasi, Ghana.MethodsPhenomenological qualitative research design was employed in the study. Data were generated through individual in-depth interviews, which were audio-recorded and transcribed verbatim. Data saturation was reached with fifteen midwives. Open Code 4.03 was used to manage and analyse the data.FindingsThe midwives’ understanding of respectful maternity care was comprised of the following components: non-abusive care, consented care, confidential care, non-violation of childbearing women’s basic human rights, and non-discriminatory care. Probing questions to solicit midwives’ opinions on an evidenced-based component of respectful maternity care generated little information, suggesting that the midwives have a gap in knowledge regarding this component of respectful maternity care.ConclusionMidwives reported an understanding of most components of respectful maternity care, but their gap in knowledge on evidenced-based care requires policy attention and in-service training. To understand the extent to which this gap in knowledge can be generalized for midwives across Ghana to warrant a redesign of the national midwifery curriculum, the authors recommend a nationwide cross-sectional quantitative study.

scholarly journals Implementation of RMC at Tertiary Care Centre in South India

2021 ◽  
Author(s):  
Papa Dasari ◽  
Mahalakshmy Thulasingam
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Maternity Care ◽  
Tertiary Care ◽  
Respectful Maternity Care ◽  
Disrespect And Abuse ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Care Workers ◽  
Birth Companion

Title: Implementation of RMC at Tertiary Care Centre in South IndiaAbstract:Background: Disrespect and abuse experienced during childbirth has been reported by women to various sections of health care workers. The objective was to abolish Disrespect and Abuse and to bring about a policy change in labour room practices and to implement Respectful Maternity Care (RMC) in a high-volume tertiary care teaching hospital in South India.Methods: A Workshop and Continuous Medical Education Programme involving RMC experts were conducted in Phase I with defined objectives. These targeted health care workers were nurses, resident doctors, consultants, medical nursing students involved in giving care during pregnancy and labour. In Phase II the Govt. of India Policy on Birth Companion was presented in a meeting discussing on the National guidelines of “LaQshya”. Consent forms for birth companions were introduced and a dedicated public health nurse was trained to train the birth companions regarding their role in maternal support. The change of policy was officially intimated to the hospital administration. A qualitative assessment was done whether the Residents and Nurses practiced RMC as demonstrated in the Workshop. The operationalization of the birth companion policy was followed on daily observations, enquiries and onsite surprise visits over one year period.Results: The practice of RMC was followed only by few health care workers and certain cadre of women who laboured, received RMC and disrespect and abuse still prevailed. The bottle necks identified were low socioeconomic status of women, the in-charge consultants not insisting on presence of birth companions, the residents and nurses not promoting birth companion policy.Conclusions: : Implementation of Respectful Maternity Care needs change of attitudes of personnel who render care during child birth and it can only be successful unless it forms an integral part of Medical and Nursing curriculum.

Beyond Maternal Mortality: A Systematic Review of Evidences on Mistreatment and Disrespect During Childbirth in Health Facilities in India

2019 ◽  
pp. 152483801988171
Author(s):  
Suresh Jungari ◽  
Baby Sharma ◽  
Dhananjay Wagh
Keyword(s):  
Systematic Review ◽  
Low Socioeconomic Status ◽  
Maternity Care ◽  
Analytical Framework ◽  
Health Facilities ◽  
Current Evidence ◽  
Respectful Maternity Care ◽  
Disrespect And Abuse ◽  
Health Providers ◽  
Cross Sectional

The aim of this systematic review is to examine current evidence on the nature and extent of disrespect and abuse (D&A), mistreatment and practices of respectful maternity care of women during childbirth in India. Electronic databases were searched for published studies relevant to the topic. The search was conducted from May to September 2018. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to conduct the review. A results synthesis was done using the Bowser and Hill landscape analytical framework for D&A of women during childbirth. Eleven studies are included in this review of which six were cross-sectional, four were qualitative, and one used a mixed-method approach. The type of abuse most frequently reported was the lack of respect and dignity (nondignified care) experienced by the women, usually in the form of negative and unfriendly attitudes of the providers. The least frequent form of mistreatment was physical abuse and detention in the facilities. The frequency of reported D&A was high, ranging from 10% to 77.3%. These behaviors were influenced by lack of education and empowerment of the women, their low socioeconomic status, poor training of providers and supervision, and a lack of accountability. Overall, disrespectful and abusive behavior had adverse impact on the utilization of health facilities for childbirth. It created a psychological distance between women and health providers. To our knowledge, this is the first systematic literature review to be conducted on respectful maternity care in India.

Prehospital Intubations Are Associated with Elevated Endotracheal Tube Cuff Pressures: A Cross-Sectional Study Characterizing ETT Cuff Pressures at a Tertiary Care Emergency Department

2021 ◽  
pp. 1-4
Author(s):  
Ruo S. Chen ◽  
Laurel O’Connor ◽  
Matthew R. Rebesco ◽  
Kara L. LaBarge ◽  
Edgar J. Remotti ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Cuff Pressure ◽  
Care Center ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Endotracheal Tube Cuff ◽  
Cross Sectional ◽  
Tube Cuff ◽  
Respiratory Therapists ◽  
Significant Difference

Abstract Introduction: Emergency Medical Services (EMS) providers are trained to place endotracheal tubes (ETTs) in the prehospital setting when indicated. Endotracheal tube cuffs are traditionally inflated with 10cc of air to provide adequate seal against the tracheal lumen. There is literature suggesting that many ETTs are inflated well beyond the accepted safe pressures of 20-30cmH2O, leading to potential complications including ischemia, necrosis, scarring, and stenosis of the tracheal wall. Currently, EMS providers do not routinely check ETT cuff pressures. It was hypothesized that the average ETT cuff pressure of patients arriving at the study site who were intubated by EMS exceeds the safe pressure range of 20-30cmH2O. Objectives: While ETT cuff inflation is necessary to close the respiratory system, thus preventing air leaks and aspiration, there is evidence to suggest that over-inflated ETT cuffs can cause long-term complications. The purpose of this study is to characterize the cuff pressures of ETTs placed by EMS providers. Methods: This project was a single center, prospective observational study. Endotracheal tube cuff pressures were measured and recorded for adult patients intubated by EMS providers prior to arrival at a large, urban, tertiary care center over a nine-month period. All data were collected by respiratory therapists utilizing a cuff pressure measurement device which had a detectable range of 0-100cmH2O and was designed as a syringe. Results including basic patient demographics, cuff pressure, tube size, and EMS service were recorded. Results: In total, 45 measurements from six EMS services were included with ETT sizes ranging from 6.5-8.0mm. Mean patient age was 52.2 years (67.7% male). Mean cuff pressure was 81.8cmH2O with a range of 15 to 100 and a median of 100. The mode was 100cmH2O; 40 out of 45 (88.9%) cuff pressures were above 30cmH2O. Linear regression showed no correlation between age and ETT cuff pressure or between ETT size and cuff pressure. Two-tailed T tests did not show a significant difference in the mean cuff pressure between female versus male patients. Conclusion: An overwhelming majority of prehospital intubations are associated with elevated cuff pressures, and cuff pressure monitoring education is indicated to address this phenomenon.

A Comparison of Falls and Dizziness Handicap by Vestibular Diagnosis

2021 ◽  
pp. 1-10
Author(s):  
Ryan J. Huang ◽  
Sherri L. Smith ◽  
Libor Brezina ◽  
Kristal M. Riska
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Demographic Variables ◽  
Vestibular Migraine ◽  
Cross Sectional ◽  
Positional Vertigo ◽  
Increased Risk ◽  
Risk Of Falls ◽  
Paroxysmal Positional Vertigo

Purpose There is a paucity of data that directly compares the falls rate and dizziness handicap of different vestibular diagnoses. The purpose of this study is to compare the falls rate and dizziness handicap of common vestibular diagnoses encountered among a cohort of vestibular patients at a single institution. Method We conducted a retrospective cross-sectional study of patients evaluated for dizziness at a tertiary care center vestibular clinic between August 1, 2017, and March 19, 2019. Vestibular diagnosis, demographic variables, comorbidities, falls status, and Dizziness Handicap Inventory (DHI) were extracted from the medical record for analysis. Associations between vestibular diagnosis and falls history or DHI were evaluated using multivariate logistic and linear regression, respectively. Results A total of 283 patients met our inclusion criteria with the following diagnoses: benign paroxysmal positional vertigo (BPPV; n = 55), acoustic neuroma ( n = 30), Ménière's disease ( n = 28), multiple vestibular diagnoses ( n = 15), vestibular migraine ( n = 135), or vestibular neuritis ( n = 20). After adjusting for age, sex, race, medications, and comorbidities, the odds of falling was 2.47 times greater (95% CI [1.08, 6.06], p = .039) and the DHI score was 11.66 points higher (95% CI [4.99, 18.33], p < .001) in those with vestibular migraine compared to those with BPPV. Other diagnoses were comparable to BPPV with respect to odds of falling and dizziness handicap. Conclusions Patients with vestibular migraine may suffer an increased risk of falls and dizziness handicap compared to patients with BPPV. Our findings highlight the need for timely evaluation and treatment of all patients with vestibular disease.

Midwives' perceptions of disrespect and abuse of women during labour and childbirth in Lusaka, Zambia

2021 ◽  
Vol 15 (3) ◽  
pp. 1-12
Author(s):  
Namayipo Stella Wamukankamba Nankamba ◽  
Catherine Mubita Ngoma ◽  
Maureen Masumo Makoleka
Keyword(s):  
Logistic Regression ◽  
Maternity Care ◽  
Health Workers ◽  
Multivariate Logistic Regression Analysis ◽  
Study Data ◽  
Respectful Maternity Care ◽  
Disrespect And Abuse ◽  
Multivariate Logistic Regression ◽  
Abuse Of Women ◽  
And Training

Background/Aims Disrespect and abuse is a frequent occurrence in labour wards around the world. Disrespect and abuse during care by health workers can prevent pregnant women from seeking care during labour and childbirth, which can lead to increased maternal and neonatal mortality rates. This study aimed to explore midwives' perceptions of disrespect and abuse of women during labour and childbirth in Lusaka. Methods A concurrent convergent mixed-method approach was used for this study. Data were collected through a self-administered questionnaire given to 217 midwives actively practicing in maternal health services across Lusaka randomly sampled for the quantitative arm of the study. The data were analysed using bivariate and multivariate logistic regression, with P<0.05 used to indicate significance. For the qualitative component of the study, 13 purposively selected key informants were interviewed with an interview guide. Results Most of the respondents (88.5%) perceived disrespect and abuse of women during labour and childbirth as a negative phenomenon. However, almost half (40.1%) had provided care which was disrespectful and abusive during their practice and the majority (68.7%) had observed disrespect and abuse by other midwives. Bivariate and multivariate logistic regression analysis found an association between midwives' perception of disrespect and abuse and witnessing or participating in disrespectful and abusive behaviour during practice. In the qualitative arm of the study, midwives reported that disrespect and abuse occurred in labour wards across Lusaka, demonstrating an urgent need to prevent such practices. Midwives suggested actions such as increased sensitisation and training of midwives on respectful maternity care and improved staffing levels as ways to prevent this practice Conclusions Disrespect and abuse of women during labour and childbirth should be prevented. Increasing health education and training for both the public and midwives on respectful maternity care can help to achieve this goal. Midwives need to be motivated through good working environments, increased wages and increased time to rest while working, as the heavy workload was found to contribute to disrespect and abuse in labour wards.

scholarly journals Transport Factors Affecting the Outcome of Referred Neonates Admitted in A Tertiary Care Hospital

2018 ◽  
Vol 41 (3) ◽  
pp. 159-164 ◽  
Author(s):  
Madhabi Baidya ◽  
Mahfuza Shirin ◽  
Liton Chandra Saha
Keyword(s):  
Perinatal Asphyxia ◽  
Care Center ◽  
Tertiary Care ◽  
Preterm Neonates ◽  
P Value ◽  
Care Hospital ◽  
Cross Sectional ◽  
Neonatal Transport ◽  
Group I ◽  
Group Ii

Background: Adequate neonatal transport is a key component of care of the sick newborns who require referral to tertiary care center. Poor transportation is one of the iatrogenic factors associated with greater neonatal mortality. Neonatal transport is the greatest challenge faced today in our country. The purpose of this study was to find out characteristics of transport of referred neonates and to idention the factors that contribute to mortality.Methodology: This cross sectional study was conducted in Dhaka Shishu (Children) Hospital from June 2013 to November 2013. Both term and preterm neonates who were referred within first seven days of life were included and those with gross congenital abnormalities and left against medical advice were excluded from the study. After enrollment, data were collected using a structured questionnaire including birth details, interventions before transportation, reasons for referral, and details of transportation. Outcome & duration of hospital stay were also recorded. Neonates who were expired considered as group I and who were survived considered as group II. The study variables were analyzed for their association with immediate outcome by applying chi square test and t test. P value <0.05 was considered significant.Results: This study found that out of 332 neonates 181 were expired with 54.5% mortality rate. One eighty one neonates who were expired, considered as group I and one fifty one neonate were survived, considered as group II. The mortality was significantly high in male neonates [RR 0.80 (0.66-0.97)] and neonates those delivered at home [RR 1.34(1.10-1.64)] (p<0.05). Perinatal asphyxia, pre-term low birth weight, neonatal sepsis were the main causes of referral. It was found that transportation without any referral note [RR 1.40 (1.14- 1.71)], no advice regarding maintenance of airway[RR 1.50(1.17- 1.92)]and keeping warm [RR 1.51(1.17-1.950], resuscitation on admission [RR 1.63(1.23-2.17)] and transportation required > 3hours [RR 1.36(1.09-1.69)] were associated with significantly higher mortality among referred transported neonates(p<0.05).Conclusions: This study found that male neonates, home delivery, transportation without any referral note, no advice regarding maintenance of airway and keeping warm, resuscitation needed on admission and prolonged transportation time were significantly associated with mortality of referred transported neonates.Bangladesh J Child Health 2017; VOL 41 (3) :159-164

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