Women’s experiences of maternal and newborn health care services and support systems in Buikwe District, Uganda: A qualitative study

Background Uganda continues to have a high neonatal mortality rate, with 20 deaths per 1000 live births reported in 2018. A measure to reverse this trend is to fully implement the Uganda Clinical Guidelines on care for mothers and newborns during pregnancy, delivery and the postnatal period. This study aimed to describe women’s experiences of maternal and newborn health care services and support systems, focusing on antenatal care, delivery and the postnatal period. Methods We used triangulation of qualitative methods including participant observations, semi-structured interviews with key informants and focus group discussions with mothers. Audio-recorded data were transcribed word by word in the local language and translated into English. All collected data material were stored using two-level password protection or stored in a locked cabinet. Malterud’s Systematic text condensation was used for analysis, and NVivo software was used to structure the data. Findings Antenatal care was valued by mothers although not always accessible due to transport cost and distance. Mothers relied on professional health workers and traditional birth attendants for basic maternal services but expressed general discontentment with spousal support in maternal issues. Financial dependency, gender disparities, and lack of autonomy in decision making on maternal issues, prohibited women from receiving optimal help and support. Postnatal follow-ups were found unsatisfactory, with no scheduled follow-ups from professional health workers during the first six weeks. Conclusions Further focus on gender equity, involving women’s right to own decision making in maternity issues, higher recognition of male involvement in maternity care and improved postnatal follow-ups are suggestions to policy makers for improved maternal care and newborn health in Buikwe District, Uganda.

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NewsIMPROVING THE QUALITY OF MATERNAL AND NEWBORN HEALTH CARE SERVICES THROUGH ACCELERATED IMPLEMENTATION OF THE ESSENTIAL INTERVENTIONS BY THE HEALTH CARE PROFESSIONALS ASSOCIATIONSTRAINING OF MORE HMS BAB AND HBB CHAMPIONS AND MASTER TRAINERSTHIRD GLOBAL FORUM ON HUMAN RESOURCES FOR HEALTHTHIRD INTERNATIONAL CONFERENCE ON FAMILY PLANNING (ICFP)

International Journal of Childbirth ◽

10.1891/2156-5287.3.4.233 ◽

2013 ◽

Vol 3 (4) ◽

pp. 233-236

Keyword(s):

Health Care ◽

Human Resources ◽

Health Care Professionals ◽

Health Care Services ◽

Newborn Health ◽

Maternal And Newborn Health ◽

Care Services ◽

Essential Interventions ◽

Maternal And Newborn

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The status of maternal and newborn health care services in Zanzibar

BMC Pregnancy and Childbirth ◽

10.1186/s12884-016-0928-6 ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 9

Author(s):

Bakar Fakih ◽

Azzah A. S. Nofly ◽

Ali O. Ali ◽

Abdallah Mkopi ◽

Ali Hassan ◽

...

Keyword(s):

Health Care ◽

Health Care Services ◽

Newborn Health ◽

Maternal And Newborn Health ◽

Care Services ◽

The Status ◽

Maternal And Newborn

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Shared Decision-making in Maternal and Newborn Health in Burkina Faso

The International Journal of Person Centered Medicine ◽

10.5750/ijpcm.v5i2.526 ◽

2015 ◽

Vol 5 (2) ◽

pp. 68-73

Author(s):

Janet Perkins ◽

Cecilia Capello ◽

Aminata Bargo ◽

Carlo Santarelli

Keyword(s):

Health Care ◽

Decision Making ◽

Burkina Faso ◽

Health Sector ◽

Newborn Health ◽

Maternal And Newborn Health ◽

Birth Preparedness ◽

Care Providers ◽

Complication Readiness ◽

Maternal And Newborn

Community participation in decision-making within the health sector is an essential component in advancing efforts toward primary health care (PHC). Since 2006, Enfants du Monde, a Swiss non-governmental organization (NGO), in collaboration with the local NGO Fondation pour le Développement Communautaire/Burkina Faso (FDC/BF), has been supporting the Ministry of Health (MoH) to include communities in decision-making related to maternal and newborn health (MNH) services. Notably, participatory community assessments (PCA) are conducted to provide a platform for community members to discuss MNH needs and be involved in the decision-making within the health sector. During the PCAs, participants identify and prioritize needs and propose solutions to improve MNH, solutions which are then integrated in the annual district health action plan. Integrated interventions include: promotion of birth preparedness and complication readiness; training health care providers in counselling skills; building awareness of men on MNH issues and their capacity to support women; and strengthening community bodies to manage obstetrical and neonatal complications. The inclusion of these interventions has contributed to the advancement of PHC in three regions in Burkina Faso.

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Training health workers to provide person-centred maternal and newborn health care in Burkina Faso

The International Journal of Person Centered Medicine ◽

10.5750/ijpcm.v3i2.405 ◽

2013 ◽

Vol 3 (2) ◽

pp. 154-159

Author(s):

Janet Perkins ◽

Aminata Bargo ◽

Cecilia Capello ◽

Carlo Santarelli

Keyword(s):

Health Care ◽

Burkina Faso ◽

Health Care Providers ◽

Health Workers ◽

Healthcare Providers ◽

Newborn Health ◽

World Health ◽

Maternal And Newborn Health ◽

Care Providers ◽

Maternal And Newborn

Assuring the provision of person-centred care is critical in maternal and newborn health (MNH). As a component of the national strategy to improve MNH, Burkina Faso Ministry of Health, supported by Enfants du Monde, La Fondation pour le Développement Communautaire/Burkina Faso and UNFPA, is implementing the World Health Organization’s (WHO) framework for Working with Individuals, Families and Communities (IFC) to improve MNH. As a first step in district implementation, participatory community assessments were conducted. These assessments consistently revealed that poor interactions with healthcare providers posed one important barrier preventing women from seeking MNH services. In order to address this barrier, healthcare providers were trained to improve their interpersonal skills and in counselling women. During 2011-12 a total of 175 personnel were trained over a 5-day course developed using a WHO manual. The course was met with enthusiasm as providers expressed their need and desire for such training. Immediate post-test results revealed an impressive increase in knowledge and anecdotal evidence suggests that training has influenced provider’s behaviours in their interactions with women. In addition, health care providers are taking concrete action to build the capabilities of women to experience pregnancy and birth safely by engaging directly with communities. While early findings are promising, an evaluation will be necessary to measure how the training has influenced practices, whether this translates into a shift of perceptions at community level and ultimately its contribution toward promoting person-centred care in Burkina Faso.

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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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Determinants of postnatal care utilization in Ethiopia: a multilevel analysis

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03254-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Gizachew Tadele Tiruneh ◽

Alemayehu Worku ◽

Yemane Berhane ◽

Wuleta Betemariam ◽

Meaza Demissie

Keyword(s):

Health Care ◽

Health Services ◽

Postnatal Care ◽

Health Workers ◽

Newborn Health ◽

Maternal And Newborn Health ◽

Care Utilization ◽

Related Factors ◽

Obstetric Factors ◽

Maternal And Newborn

Abstract Background The expansion of primary health care services in Ethiopia made basic health services available and accessible. The Last Ten Kilometers (L10K) project has strengthened the primary health care system through implementing innovative strategies to engage local communities to improve maternal and newborn health care behavior and practices in Amhara, Oromia, Southern Nations, Nationalities and Peoples [SNNP], and Tigray regions over a decade. Despite the efforts of the government and its partners to improve the use of maternal health services, the coverage of postnatal care is persistently low in the country. This study examined the individual and community level determinants for the persistently low uptake of postnatal care in the project areas. Methods The study used a cross-sectional population-based survey that measured maternal and newborn health care practices among women who had live births in the last 12 months preceding the survey in Amhara, Oromia, SNNP, and Tigray regions. Multilevel random effects binary logistic regression analysis was used to assess the independent effects of community-and individual-level factors and moderating effects on the uptake of postnatal care. Results This study identified region of residence, obstetric factors, and health service-related factors to be significant determinants for use of postnatal care. Obstetric factors include knowledge of obstetric danger signs (AOR: 1.30; 95% CI: 1.05–1.60), cesarean section mode of delivery (AOR: 1.96; 95% CI: 1.28–3.00), and institutional delivery (AOR: 10.29; 95% CI: 7.57–13.98). While the health service-related factors include attended family conversation during pregnancy (AOR: 1.48; 95% CI: 1.04–2.12), birth notification (AOR: 2.66; 95% CI: 2.15–3.29), home visits by community health workers (AOR: 1.98; 95% CI: 1.58–2.50), and being recognized as a model family (AOR: 1.27; 95% CI: 1.03–1.57). Conclusion This study demonstrated that community-level interactions and promotive health services including antepartum home visits by community health workers, family conversation, birth notification, and model family, are important determinants to seek postnatal care. The findings also highlight the need for expansion of health facilities or design appropriate strategies to reach the disadvantaged communities. Program managers are recommended to strengthen community-based interventions to improve postnatal care utilization.

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Universal coverage of the first antenatal care visit but poor continuity of care across the maternal and newborn health continuum among Nepalese women: analysis of levels and correlates

Globalization and Health ◽

10.1186/s12992-021-00791-4 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Resham B Khatri ◽

Rajendra Karkee ◽

Jo Durham ◽

Yibeltal Assefa

Keyword(s):

Antenatal Care ◽

Maternity Care ◽

Institutional Delivery ◽

Health Workers ◽

Multinomial Logistic Regression ◽

Newborn Health ◽

Postnatal Period ◽

Outcome Variable ◽

Maternal And Newborn Health ◽

Maternal And Newborn

Abstract Background Routine maternity care visits (MCVs) such as antenatal care (ANC), institutional delivery, and postnatal care (PNC) visits are crucial to utilisation of maternal and newborn health (MNH) interventions during pregnancy-postnatal period. In Nepal, however, not all women complete these routine MCVs. Therefore, this study examined the levels and correlates of (dis)continuity of MCVs across the antenatal-postnatal period. Methods We conducted further analysis of the 2016 Nepal Demographic and Health Survey. A total of 1,978 women aged 15–49 years, who had live birth two years preceding the survey, were included in the analysis. The outcome variable was (dis)continuity of routine MCVs (at least four ANC visits, institutional delivery, and PNC visit) across the pathway of antennal through to postnatal period. Independent variables included several social determinants of health under structural, intermediary, and health system domains. Multinomial logistic regression was conducted to identify the correlates of routine MCVs. Relative risk ratios (RR) were reported with 95% confidence intervals at a significance level of p<0.05. Results Approximately 41% of women completed all routine MCVs with a high proportion of discontinuation around childbirth. Women of disadvantaged ethnicities, from low wealth status, who were illiterate had higher RR of discontinuation of MCVs (compared to completion of all MCVs). Similarly, women who speak Bhojpuri, from remote provinces (Karnali and Sudurpaschim), who had a high birth order (≥4), who were involved in the agricultural sector, and who had unwanted last birth had a higher RR of discontinuation of MCVs. Women discontinued routine MCVs if they had poor awareness of health mother-groups and perceived the problem of not having female providers. Conclusions Routine monitoring using composite coverage indicators is required to track the levels of (dis)continuity of routine MCVs at the maternity care continuum. Strategies such as raising awareness on the importance of maternity care, care provision from female health workers could potentially improve the completion of MCVs. In addition, policy and programmes for continuity of maternity care are needed to focus on women with socioeconomic and ethnic disadvantages and from remote provinces.

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