scholarly journals Context specific realities and experiences of nurses and midwives in basic emergency obstetric and newborn care services in two district hospitals in Rwanda: a qualitative study

BMC Nursing ◽  
2022 ◽  
Vol 21 (1) ◽  
Author(s):  
Aurore Nishimwe ◽  
Daphney Nozizwe Conco ◽  
Marc Nyssen ◽  
Latifat Ibisomi
Keyword(s):  
Healthcare Workers ◽  
Newborn Care ◽  
Obstetric Care ◽  
Middle Income ◽  
Research Results ◽  
Middle Income Countries ◽  
Care Services ◽  
District Hospitals ◽  
Nurses And Midwives

Abstract Background In low and middle-income countries, nurses and midwives are the frontline healthcare workers in obstetric care. Insights into experiences of these healthcare workers in managing obstetric emergencies are critical for improving the quality of care. This article presents such insights, from the nurses and midwives working in Rwandan district hospitals, who reflected on their experiences of managing the most common birth-related complications; postpartum hemorrhage (PPH) and newborn asphyxia. Rwanda has made remarkable progress in obstetric care. However, challenges remain in the provision of high-quality basic emergency obstetric and newborn care (BEmONC). This study is a qualitative part of a broader research project about implementation of an mLearning and mHealth decision support tool in BEmONC services in Rwanda. Methods In this exploratory qualitative aspect of the research, four focus group discussions (FGDs) with 26 nurses and midwives from two district hospitals in Rwanda were conducted. Each FGD was made up of two parts. The first part focused on the participants’ reflections on the research results (from the previous study), while the second part explored their experiences of delivering obstetric care services. The research results included: survey results reflecting their knowledge and skills of PPH management and of neonatal resuscitation (NR); and findings from a six-month record review of PPH management and NR outcomes, from the district hospitals under study. Data were analyzed using hybrid thematic analysis. Results The analysis revealed three main themes: (1) reflections to the baseline research results, (2) self-reflection on the current practices, and (3) contextual factors influencing the delivery of BEmONC services. Nurses and midwives felt that the presented findings were a true reflection of the reality and offered diverse explanations for the results. The participants’ narratives of lived experiences of providing BEmONC services are also presented. Conclusion The insights of nurses and midwives regarding the management of birth-related complications revealed multi-faceted factors that influence the quality of their obstetric care. Even though the study was focused on PPH management and NR, the resulting recommendations to improve quality of care could benefit the broader field of maternal and child health, particularly in low and middle-income countries.

scholarly journals Context Specific Realities and Experiences of Nurses and Midwives in Basic Emergency Obstetric and Newborn Care Services in Two District Hospitals in Rwanda

2021 ◽  
Author(s):  
Aurore Nishimwe ◽  
Daphney Nozizwe Conco ◽  
Marc Nyssen ◽  
Latifat Ibisomi
Keyword(s):  
Quality Of Care ◽  
Healthcare Workers ◽  
Newborn Care ◽  
Obstetric Care ◽  
Middle Income ◽  
Middle Income Countries ◽  
Care Services ◽  
District Hospitals ◽  
Nurses And Midwives

Abstract Background In low and middle-income countries, nurses and midwives are the frontline healthcare workers in obstetric care. Insights into the experiences of these healthcare workers in managing obstetric care emergencies are critical for improving quality of care. This article presents such insights, from the nurses and midwives working in Rwandan district hospitals, who reflected on their experiences of managing the most common birth-related complications; postpartum hemorrhage (PPH) and newborn asphyxia. This is a qualitative part of a broader research about implementation of an mLearning and mHealth decision support tool (Safe Delivery Application), in basic emergency obstetric and newborn care services in Rwanda. Methods In this exploratory qualitative aspect of the research, the first author facilitated four focus group discussions with 26 nurses and midwives from two district hospitals in Rwanda. Each focus group discussion was made up of two parts. The first part focused on the participants’ reflections on the research results, while the second part explored their experiences of delivering obstetric care services in their respective district hospitals. The research results included: survey results reflecting their knowledge and skills of PPH management and of neonatal resuscitation (NR); and findings from a six-month record review of PPH management and NR outcomes, from the district hospitals under study. Data were analyzed using hybrid thematic analysis. Results Nurses and midwives felt that the presented findings were a true reflection of the reality and offered diverse explanations for the results. The participants’ narratives of lived experiences of providing BEmONC services are presented under two broad themes: (1) self-reflections on their current practices and (2) contextual factors influencing the delivery of BEmONC services. Conclusion The insights of nurses and midwives regarding the management of birth related complications revealed multi-faceted factors that influence the quality of their obstetric care. Even though the study was focused on their management of PPH and NR, the resulting recommendations to improve quality of care could benefit the broader field of maternal and child health particularly in low and middle income countries.

scholarly journals Quality of Care for Maternal and Newborn Health in Health Facilities in Nepal

2019 ◽  
Vol 24 (S1) ◽  
pp. 31-38 ◽  
Author(s):  
Ashish KC ◽  
Dipendra Raman Singh ◽  
Madan Kumar Upadhyaya ◽  
Shyam Sundar Budhathoki ◽  
Abhishek Gurung ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health Facility ◽  
Newborn Care ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Health Facilities ◽  
Care Services ◽  
Quality Of Delivery ◽  
Maternal And Newborn

Abstract Introduction Nepal has pledged to substantially reduce maternal and newborn death by 2030. Improving quality of intrapartum health services will be vital to reduce these deaths. This paper examines quality of delivery and newborn services in health facilities of Nepal. Methods Data were sourced from the Nepal Health Facility Survey 2015, which covered a national representative sample of health facilities. The datasets were analysed to assess service readiness, availability and quality of delivery and newborn care in a sample of 992 health facilities. Results Of the 992 facilities in the sample, 623 provided delivery and newborn care services. Of the 623 facilities offering delivery and newborn care services, 13.3% offered comprehensive emergency obstetric care (CEmONC), 19.6% provided basic emergency obstetric care (BEmONC) and 53.9% provided basic delivery and newborn service. The availability of essential equipment for delivery and newborn care was more than 80% in health facilities. Except for the coverage of vitamin K injection, the coverage of immediate newborn care was more than 85% in all health facilities. The coverage of use of chlorhexidine ointment to all newborns was more than 70% in government hospitals and primary health care centers (PHCCs) and only 32.3% in private hospitals. Conclusions These findings show gaps in equipment and drugs, especially in PHCCs and private health facilities. Improving readiness and availability of equipment and drugs in PHCCs and private health facility will help improve the quality of care to further reduce maternal and newborn mortality in Nepal.

scholarly journals Technology-Based Newborn Health Learning Initiatives for Facility-Based Nurses and Midwives in Low- and Middle-Income Countries: A Scoping Review

2018 ◽  
Vol 8 (4) ◽  
pp. 252-268
Author(s):  
Nancy E. Bolan ◽  
Susan D. Newman ◽  
Lynne S. Nemeth
Keyword(s):  
Scoping Review ◽  
Simulation Training ◽  
Health Workers ◽  
Newborn Care ◽  
Newborn Health ◽  
Original Research ◽  
Middle Income ◽  
Middle Income Countries ◽  
Nurses And Midwives ◽  
Low And Middle Income

PURPOSEGiven high neonatal mortality in many low- and middle-income countries, addressing missed opportunities by enhancing the quality of newborn care provided by facility-based nurses and midwives is critical. This scoping review synthesizes and critiques the literature on technology-based newborn health learning initiatives. Kirkpatrick's model is used for training program evaluation.METHODSA literature review was conducted from multiple databases. Articles selected for analysis consisted of original research studies published in peer-reviewed journals from 2012 to 2017.RESULTSTwelve studies fell into two categories: (a) Simulation training in routine neonatal care and newborn resuscitation (n = 9) and (b) eLearning initiatives (n = 3). Most studies evaluated health provider's knowledge and skills before and/or after training (n = 9); fewer evaluated the effect on change in provider practice (n = 3) and/or patient health outcomes (n = 5) (Kirkpatrick levels 3–4). Few studies utilized robust study designs and validated measurement instruments.CONCLUSIONLearning approaches emphasizing simulation training and eLearning initiatives for facility-based health workers hold promise. However, existing simulation literature demonstrates that translation of knowledge gained during simulation into improved clinical outcomes in real births is variable. Additionally, the volume of peer-reviewed evidence demonstrating the potential benefit of eLearning strategies, especially in the neonatal period, is limited.

scholarly journals Analytical review of the demand and satisfaction of the population with inhome palliative care services for cancer patients provided by mobile teams in Almatу

2020 ◽  
Vol 56 (2) ◽  
pp. 4-8
Author(s):  
T. N. Ansatbaeva ◽  
D. R. Kaidarova ◽  
G. Zh. Kunirova ◽  
N. А. Izmagambetov
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Malignant Neoplasms ◽  
Middle Income ◽  
Middle Income Countries ◽  
Care Services ◽  
Palliative Care Services ◽  
Analytical Review

Relevance: Patients with advanced malignant neoplasms require constant monitoring and care. Mobile palliative care (PC) is one of the modern humanistic methods of supporting terminal cancer patients, as well as their relatives. The purpose of this study was to analyze the demand and satisfaction of the population with in-home PC services for cancer patients provided by mobile teams in Almaty. Results: According to WHO, the number of people who need PС services at the end of life is 20.4 million, of whom 94% are adults (69% are over 60 years, 25% are at the age of 15 to 59), and 6% are children. 34% of patients dying from cancer need PC services at the end of life. 80% of people in need of PC services live in lower-middle-income countries. At the end of 2018, the total number of palliative beds deployed in the Republic of Kazakhstan amounted to 415 (vs. 373 in 2017). Conclusion: Given the practical relevance and topicality, there is an urgent need to develop evidence-based recommendations for optimizing the provision of PC services, as well as improving the quality of life of cancer patients

scholarly journals The impact of COVID-19 on the care of people living with noncommunicable diseases in low- and middle-income countries: an online survey of physicians and pharmacists in nine countries

2021 ◽  
Vol 22 ◽  
Author(s):  
Chris Bullen ◽  
Jessica McCormack ◽  
Amanda Calder ◽  
Varsha Parag ◽  
Kannan Subramaniam ◽  
...  
Keyword(s):  
Public Health ◽  
Healthcare Workers ◽  
Online Survey ◽  
World Health ◽  
Noncommunicable Diseases ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Measures ◽  
The Impact ◽  
Low And Middle Income

Abstract Background: The global COVID-19 pandemic has disrupted healthcare worldwide. In low- and middle-income countries (LMICs), where people may have limited access to affordable quality care, the COVID-19 pandemic has the potential to have a particularly adverse impact on the health and healthcare of individuals with noncommunicable diseases (NCDs). A World Health Organization survey found that disruption of delivery of healthcare for NCDs was more significant in LMICs than in high-income countries. However, the study did not elicit insights into the day-to-day impacts of COVID-19 on healthcare by front-line healthcare workers (FLHCWs). Aim: To gain insights directly from FLHCWs working in countries with a high NCD burden, and thereby identify opportunities to improve the provision of healthcare during the current pandemic and in future healthcare emergencies. Methods: We recruited selected frontline healthcare workers (general practitioners, pharmacists, and other medical specialists) from nine countries to complete an online survey (n = 1347). Survey questions focused on the impact of COVID-19 pandemic on clinical practice and NCDs; barriers to clinical care during the pandemic; and innovative responses to the many challenges presented by the pandemic. Findings: The majority of FLHCWs responding to our survey reported that their care of patients had been impacted both adversely and positively by the public health measures imposed. Most FLHCs (95%) reported a deterioration in the mental health of their patients. Conclusions: Continuity of care for NCDs as part of pandemic preparedness is needed so that chronic conditions are not exacerbated by public health measures and the direct impacts of the pandemic.

scholarly journals Psychosocial influences on help-seeking behaviour for cancer in low-income and lower middle-income countries: a mixed-methods systematic review

2021 ◽  
Vol 6 (2) ◽  
pp. e004213
Author(s):  
Grace McCutchan ◽  
Bahr Weiss ◽  
Harriet Quinn-Scoggins ◽  
Anh Dao ◽  
Tom Downs ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mixed Methods ◽  
Cancer Treatment ◽  
Help Seeking ◽  
Middle Income ◽  
Cancer Symptoms ◽  
Middle Income Countries ◽  
Help Seeking Behaviour ◽  
Psychosocial Influences

IntroductionStarting cancer treatment early can improve outcomes. Psychosocial factors influencing patients’ medical help-seeking decisions may be particularly important in low and lower middle-income countries (LMIC) where cancer outcomes are poor. Comprehensive review evidence is needed to understand the psychosocial influences on medical help-seeking for cancer symptoms, attendance for diagnosis and starting cancer treatment.MethodsMixed-methods systematic review registered on PROSPERO (CRD42018099057). Peer-reviewed databases were searched until April 2020 for studies assessing patient-related barriers and facilitators to medical help-seeking for cancer symptoms, diagnosis and treatment in adults (18+ years) living in LMICs. Quality of included studies was assessed using the Critical Appraisal Skills Programme tool. Data were synthesised using meta-analytic techniques, meta-ethnography or narrative synthesis as appropriate.ResultsOf 3963 studies identified, 64 were included. In quantitative studies, use of traditional, complementary and alternative medicine (TCAM) was associated with 3.60 higher odds of prolonged medical help-seeking (95% CI 2.06 to 5.14). Qualitative studies suggested that use of TCAM was a key barrier to medical help-seeking in LMICs, and was influenced by causal beliefs, cultural norms and a preference to avoid biomedical treatment. Women face particular barriers, such as needing family permission for help-seeking, and higher stigma for cancer treatment. Additional psychosocial barriers included: shame and stigma associated with cancer such as fear of social rejection (eg, divorce/disownment); limited knowledge of cancer and associated symptoms; and financial and access barriers associated with travel and appointments.ConclusionDue to variable quality of studies, future evaluations would benefit from using validated measures and robust study designs. The use of TCAM and gender influences appear to be important barriers to help-seeking in LMIC. Cancer awareness campaigns developed with LMIC communities need to address cultural influences on medical help-seeking behaviour.

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