An Innovative Intervention to Improve Respectful Maternity Care in Three Districts in Ethiopia

Abstract BackgroundDisrespect and abuse (D&A) during childbirth are major violations of human rights and often deter women from accessing skilled delivery in health facilities. In Ethiopia, D&A has been documented to occur in up to 49.4% of mothers delivering in health facilities. This study describes the development, implementation and results of a novel intervention to improve respectful maternity care (RMC) and decrease D&A in three districts in Ethiopia.MethodsAs part of a national initiative to reduce maternal and perinatal mortality in Ethiopia, we developed a novel RMC training module with three core components: testimonial videos, didactic sessions on communication, and onsite coaching. As of February 2017, we implemented the RMC training in three districts within the regions of Oromia; Southern Nations, Nationalities, and People’s; and Tigray. Measures of births with privacy and a birth companion from a 27-month data from 17 health centers and three hospitals were analyzed using STATA version 13 for interrupted time series and a regression analysis was conducted to assess the significance of improvement. Facilitated discussions were conducted among health care providers to gauge the effectiveness of the videos. Facility level solutions applied to enhance RMC were documented. ResultsAn analysis of the effectiveness of integrating RMC using available programmatic data showed significant improvement following the RMC training, which was sustained beyond the project intervention (regression coefficients ranging from 0.18 to 0.77). Several local solutions were devised and implemented in the health facilities to improve the experience of care for mothers. Facilitated discussions with health care providers participating in the RMC training showed improved understanding of patients’ perspectives and the psychosocial needs of their clients. ConclusionThis study suggests that integrating the RMC training into the district-wide quality improvement (QI) collaborative is effective in improving RMC. Use of testimonial videos are especially helpful as they remind providers of the need to treat mothers with dignity and helps them reflect on potential root causes for this type of treatment and develop effective solutions.

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Assessment of Women’s Experience of Care during Childbirth for Quality Improvement at Level 5 Health Facilities in Bungoma County, Kenya

East African Journal of Health and Science ◽

10.37284/eajhs.5.1.521 ◽

2022 ◽

Vol 5 (1) ◽

pp. 1-18

Author(s):

Lucy Natecho Namusonge ◽

Maximilla N. Wanzala ◽

Edwin K. Wamukoya

Keyword(s):

Maternity Care ◽

Newborn Health ◽

Health Facilities ◽

Respectful Maternity Care ◽

Maternal And Newborn Health ◽

Disrespect And Abuse ◽

Live Births ◽

Experience Of Care ◽

Maternal And Newborn

High maternal and newborn mortality is a pressing problem in developing countries. Poor treatment during childbirth contributes directly and indirectly to this problem. Many women experience disrespectful and abusive treatment during childbirth worldwide which violates their rights. In Kenya, 20% of women report having experienced some form of disrespect and abuse (D&A). Bungoma County is among the 15 counties with the worst maternal and newborn health statistics in Kenya. The maternal mortality rate is 382 per 100,000 live births and newborn deaths 32 per 1,000 live births, while skilled birth attendance is 41.4%. This study was motivated by the poor maternal and newborn indicators, rising incidences of D&A, limited formal research on respectful maternity care. The study aimed at assessing women’s experience of care during childbirth at Level 5 health facilities in Bungoma County. The specific objectives were to determine the women’s experiences of care during childbirth, to determine factors contributing to disrespect and abuse during childbirth and to identify strategies for addressing issues affecting respectful maternity care for promoting quality of maternal and newborn care. A cross-sectional descriptive study design was used. It involved 360 mothers. Analysis of quantitative data was done using SPSS. Descriptive statistics were presented in graphs, tables, frequencies and percentages. Qualitative data was analysed thematically. The prevalence of D&A was 42.2%, younger age and lower education aggravated D&A. Autonomy, privacy and confidentiality, and absence of birth companionship were major aspects of D&A. Health workforce shortage, inadequate supervision, space and beds, poor provider-patient relationships were factors leading to D&A. It was concluded that there is a need for increased incorporation of Respectful Maternity Care (RMC) in routine care, deploy more staff, avail equipment and supplies, and enhance support supervision. The study information intends to assist stakeholders in prioritising policy actions for improving the quality of maternal and newborn health outcomes and indicators.

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An Innovative Intervention to Improve Respectful Maternity Care in Three Districts in Ethiopia

10.21203/rs.2.18578/v2 ◽

2020 ◽

Author(s):

Birkety Mengistu Jembere ◽

Haregeweyni Alemu ◽

Munir Kassa ◽

Meseret Zelalem ◽

Mehiret Abate ◽

...

Keyword(s):

Quality Improvement ◽

Maternity Care ◽

Interrupted Time Series ◽

Health Facilities ◽

Respectful Maternity Care ◽

Experience Of Care ◽

National Initiative ◽

Care Training ◽

Facility Level ◽

Birth Companion

Abstract Background: Mistreatment during childbirth are major violations of human rights and often deter women from accessing skilled delivery in health facilities. In Ethiopia, mistreatment has been documented to occur in up to 49.4% of mothers delivering in health facilities. This study describes the development, implementation and results of a novel intervention to improve respectful maternity care and decrease mistreatment in three districts in Ethiopia. Methods: As part of a national initiative to reduce maternal and perinatal mortality in Ethiopia, we developed a novel respectful maternity care training module with three core components: testimonial videos, didactic sessions on communication, and onsite coaching. As of February 2017, we implemented the respectful maternity care training in three districts within the regions of Oromia; Southern Nations, Nationalities, and People’s; and Tigray. Measures of births with privacy and a birth companion from a 27-month data from 17 health centers and three hospitals were analyzed using interrupted time series and a regression analysis was conducted to assess the significance of improvement. Facility level solutions applied to enhance privacy and birth companion were documented. Results: Analysis of the effectiveness of integrating respectful maternity care using available programmatic data showed significant improvement following the respectful maternity care training, which was sustained beyond the project intervention (regression coefficients ranging from 0.18 to 0.77). Several local solutions were devised and implemented in the health facilities to improve the experience of care for mothers. Conclusion: This study suggests that integrating the respectful maternity care training into the district-wide quality improvement collaborative is effective in improving respectful maternity care. Multi-pronged approach is especially helpful in enhancing respectful maternity care comprehensively. Use of testimonial videos helped providers to see their services from their clients’ perspective, the quality improvement training and coaching helped them reflect on potential root causes for this type of treatment and develop effective solutions.

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Women’s experiences with labor companionship in public facilities in Arab countries

European Journal of Public Health ◽

10.1093/eurpub/ckz186.190 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

T Kabakian-Khasholian ◽

H Bashour ◽

A El-Nemer ◽

N Nameh

Keyword(s):

Health Care ◽

Health Care System ◽

Health Care Providers ◽

Maternity Care ◽

Arab Countries ◽

Respectful Maternity Care ◽

Care Providers ◽

Public Facilities ◽

Women's Experiences ◽

Care System

Abstract Background Childbirth in the Arab region is characterized by over-medicalization and inequities in access to-and provision of care. Hospital practices do not provide choices for women and respond to the convenience of providers rather than women’s needs. Provision of maternity care is reflective of existing social inequities which is manifested through mistreatment and disrespect of women within the health care system. One such example lies in the restriction of birth companions in public facilities in Arab countries despite being practiced in private settings and the strong evidence supporting its implementation globally. Methods A phased mixed-methods implementation research study was undertaken in three public hospitals in Lebanon, Egypt and Syria with the aim of developing a tailored labor companionship model and evaluating its implementation. Data presented emanate from the qualitative component of the study. Semi-structured interviews were conducted with women giving birth (n = 59) and their labor companions (n = 57) in three facilities. Thematic analysis was used. Results Beyond the introduction of the model into the system, women reported improvements in dimensions of respectful maternity care. Changes made in shared labor rooms improved women’s privacy. The presence of labor companions improved communication between health care providers, women and their families. Women reported feeling “dignified” and “strong” in the presence of companions. There was a “feedback loop” from the facility to the community with word spreading about labor companionship “just like in private hospitals”. Conclusions The labor companionship model improved equitable access to dignified and respectful maternity care through better rapport between women and health care providers, preservation of women’s privacy and having access to birth companion of choice. The provision of evidence-based care has potential implications on women’s experiences with the health care system. Key messages This labor companionship model ensured positive experiences for women giving birth in public facilities in Arab countries. Women perceived the model as type of care that reduces differential treatment based on social status and enhances respectful maternity care.

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Development of a Study tool to Assess Gaps in Respectful Maternity Care in Health Facilities of India

10.21203/rs.3.rs-195127/v1 ◽

2021 ◽

Author(s):

Shalini Singh ◽

Aparajita Gogoi ◽

Leila Caleb-Varkey ◽

Mercy Manoranjini ◽

Tina Ravi ◽

...

Keyword(s):

Health Care ◽

Maternal Mortality ◽

Maternity Care ◽

Development Process ◽

Health Care Facilities ◽

Health Facilities ◽

Respectful Maternity Care ◽

Advisory Group ◽

Care Providers ◽

Technical Advisory Group

Abstract Background: Maternal mortality perdures to be a major challenge for India like in other developing countries. Though the efforts to increase the institutional deliveries have resulted in appreciable results, it has not translated to the corresponding decline in maternal mortality rates. Dearth in quality of care especially concerning respectful maternity care in health facilities is considered as a major reason for this phenomenon. This work describes the development process of the study tool to assess respectful maternity care in the health facilities of India. Methods: A collaborative approach was employed for the development of a comprehensive tool to be used to assess respectful maternity care in the Indian setting. The tool development process comprised of four steps: 1) literature review and meeting with Technical Advisory Group; 2) the National Stakeholders workshop and development of the initial tool; 3) feedback on the tool from twenty tertiary care public health facilities from various regions of India; 4) the final tool and its validity approval by Technical Advisory Group. Results: A comprehensive tool was made comprising of indicators for assessing deficits in respectful maternity care, and for assessing contextual data of the health care facility. The initial tool was tested at twenty facilities. The changes suggested and observed were adapted, and the final tool was prepared. The Technical Advisory Group approved the content validity of the tool.Conclusions: A comprehensive tool was made to assess various aspects of respectful maternity care provided in tertiary Indian institutional settings aiding in in a deeper understanding of the phenomenon. This tool is recommended, especially to health care providers of India, for assessing the status of maternity care in health facilities and bringing the required interventions in the health care facilities.

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Disrespect and abuse of women during the process of childbirth at health facilities in sub-Saharan Africa: a systematic review and meta-analysis

BMC International Health and Human Rights ◽

10.1186/s12914-020-00242-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Zemenu Yohannes Kassa ◽

Berhan Tsegaye ◽

Abebaw Abeje

Keyword(s):

Systematic Review ◽

Health Care ◽

Health Care Providers ◽

Meta Analysis ◽

Health Facilities ◽

Sub Saharan Africa ◽

Disrespect And Abuse ◽

Care Providers ◽

Sub Saharan ◽

Abuse Of Women

Abstract Background Disrespectful and abusive treatment of women by health care providers during the process of childbirth at health facility is an international problem. There is a lack of data on disrespect and abuse of women during the process of childbirth at health facilities in Sub-Saharan Africa. The purpose of this study was to determine the prevalence of disrespect and abuse of women during the process of childbirth at health facilities in sub-Saharan Africa. Methods The PRISMA guideline protocol was followed to write the systematic review and meta-analysis. Published studies were searched from Medline, PubMed, CINAHL, EMBASE, Maternal and infant care, science direct, and PsycINFO. Articles were accessed by three reviewers (ZY, BT and AA) using the following key terms, “attitude of health personnel” AND “delivery obstetrics*/nursing” OR “maternity care” AND “disrespect” OR “abuse” OR “professional misconduct” AND “parturition” AND “prevalence” AND “professional-patient relations” AND “Sub-Saharan Africa”. Additional articles were retrieved by cross referencing of reference. The heterogeneity of studies were weighed using Cochran’s Q test and I2 test statistics. Publication bias was assessed by Egger’s test. Results Thirty three studies met the inclusion and included in this systematic review and meta–analysis of disrespect and abuse of women during the process of childbirth at health facilities. The pooled prevalence of disrespect and abuse women during the process of childbirth at health facilities in Sub-Saharan Africa was 44.09% (95% CI: 29.94–58.24).Particularly physical abuse was 15.77% (95% CI: 13.38–18.15), non-confidential care was 16.87% (95% CI: 14.49–19.24), abandonment was 16.86% (95% CI: 13.88–19.84) and detention was 4.81% (95% CI: 3.96–5.67). Conclusion In this study disrespect and abuse of women during the process of childbirth at health facilities are high compared with other studies, particularly non-confidential care and abandonment his high compared with other studies. This study points out that the ministry of health, health care providers, maternal health experts shall due attention to women’s right during the process of childbirth at health facilities.

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An Innovative Intervention to Improve Respectful Maternity Care in Three Districts in Ethiopia

10.21203/rs.2.18578/v3 ◽

2020 ◽

Author(s):

Birkety Mengistu Jembere ◽

Haregeweyni Alemu ◽

Munir Kassa ◽

Meseret Zelalem ◽

Mehiret Abate ◽

...

Keyword(s):

Quality Improvement ◽

Maternity Care ◽

Interrupted Time Series ◽

Health Facilities ◽

Respectful Maternity Care ◽

Training Module ◽

Experience Of Care ◽

National Initiative ◽

Care Training ◽

Birth Companion

Abstract Background: Mistreatment of women during facility-based childbirth is a major violation of human rights and often deters women from accessing skilled delivery in health facilities. In Ethiopia, mistreatment has been documented to occur in up to 49.4% of mothers delivering in health facilities. This study describes the development, implementation and results of a novel intervention to improve respectful maternity care in Ethiopia. Methods: As part of a national initiative to reduce maternal and perinatal mortality in Ethiopia, we developed a novel respectful maternity care training module with three core components: testimonial videos, a skills-building session on communication, and onsite coaching. The respectful maternity care training was conducted in February 2017 in three districts within three regions of Ethiopia. Facility level solutions applied to enhance the experience of care for mothers as a result of the training module were documented. Safe Childbirth Checklist data measuring privacy maintained and birth companion offered during labor and delivery were collected over 27 months from 17 health centers and three hospitals in the three districts. Interrupted time series and a regression analysis were conducted to assess the significance of improvement. Results: Data analysis showed significant improvement in the percentage of births with two elements of respectful maternal care—privacy maintained and birth companionship offered—following the respectful maternity care training, which was sustained beyond the project intervention (regression coefficients ranging from 18% to 77% for births with privacy and with birth companion offered). About 23 local solutions were devised and implemented in the health facilities that improved the experience of care for mothers. Conclusion: This study suggests that integrating the respectful maternity care training into a district-wide quality improvement collaborative is effective in improving respectful maternity care. Use of a multi-pronged approach is especially helpful in enhancing respectful maternity care comprehensively. Testimonial videos helped providers to see their services from their clients’ perspective, while quality improvement training and coaching helped them reflect on potential root causes for this type of treatment and develop effective solutions.

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An innovative intervention to improve respectful maternity care in three Districts in Ethiopia

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03934-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Birkety Mengistu ◽

Haregeweyni Alemu ◽

Munir Kassa ◽

Meseret Zelalem ◽

Mehiret Abate ◽

...

Keyword(s):

Quality Improvement ◽

Maternity Care ◽

Regression Coefficient ◽

Interrupted Time Series ◽

The Other ◽

Respectful Maternity Care ◽

Experience Of Care ◽

National Initiative ◽

Care Training

Abstract Background Mistreatment of women during facility-based childbirth is a major violation of human rights and often deters women from attending skilled birth. In Ethiopia, mistreatment occurs in up to 49.4% of mothers giving birth in health facilities. This study describes the development, implementation and results of interventions to improve respectful maternity care. As part of a national initiative to reduce maternal and perinatal mortality in Ethiopia, we developed respectful maternity care training module with three core components: testimonial videos developed from key themes identified by staff as experiences of mothers, skills-building sessions on communication and onsite coaching. Respectful maternity care training was conducted in February 2017 in three districts within three regions. Methods Facility level solutions applied to enhance the experience of care were documented. Safe Childbirth Checklist data measuring privacy and birth companion offered during labor and childbirth were collected over 27 months from 17 health centers and three hospitals. Interrupted time series and regression analysis were conducted to assess significance of improvement using secondary routinely collected programmatic data. Results Significant improvement in the percentage of births with two elements of respectful maternal care—privacy and birth companionship offered— was noted in one district (with short and long-term regression coefficient of 18 and 27% respectively), while in the other two districts, results were mixed. The short-term regression coefficient in one of the districts was 26% which was not sustained in the long-term while in the other district the long-term coefficient was 77%. Testimonial videos helped providers to see their care from their clients’ perspectives, while quality improvement training and coaching helped them reflect on potential root causes for this type of treatment and develop effective solutions. This includes organizing tour to the birthing ward and allowing cultural celebrations. Conclusion This study demonstrated effective way of improving respectful maternity care. Use of a multipronged approach, where the respectful maternity care intervention was embedded in quality improvement approach helped in enhancing respectful maternity care in a comprehensive manner.

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Management of services in total quality management implemented and non-implemented health facilities

Asian Journal of Medical and Biological Research ◽

10.3329/ajmbr.v6i4.51235 ◽

2021 ◽

Vol 6 (4) ◽

pp. 689-696

Author(s):

Muhsina Begum ◽

Ashees Kumar Saha ◽

Sheuly Begum ◽

Nasima Akhter ◽

Pritikona Borua ◽

...

Keyword(s):

Health Care ◽

Quality Management ◽

Total Quality Management ◽

Health Care Providers ◽

Service Providers ◽

Health Facilities ◽

Working Environment ◽

Care Providers ◽

Total Quality ◽

Medical College

5S-CQI-TQM is a management technique that is aimed at bringing satisfaction of staff as well as the patients through improvement of working environment. A cross-sectional comparative study was carried out among 226 respondents who were selected purposively from the selected study place from 1st January to 31st December 2017. Among 226 respondents, 113 were taken from Dhaka Medical College and another 113 were taken from Mugdha Medical College. Among 113 respondents, 56 respondents were health care providers and 57 respondents were health care receivers. The purpose of this study to compare the management of services in Total Quality Management implemented (Dhaka Medical College and Hospital) and non-implemented (Mugdha Medical College and Hospital) health facilities. A Semi-structured interviewer administered questionnaire and an observational check list were developed to collect the data. Separate questionnaire was used for health care providers and health care receivers. The statistical analysis was conducted using SPSS (statistical package for social science) version 20 statistical software. Significant statistical differences were found between TQM implemented and TQM non-implemented hospital regarding workload (p=0.043), hospital authority always seriously consider staff’s suggestions for the improvement of quality of service (p<0.001), employees always respect to each other in the hospital (p<0.001) and 35 (62.5%) service providers expressed satisfactory opinion regarding management of the hospital. Asian J. Med. Biol. Res. December 2020, 6(4): 689-696

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Assessment of the Implementation of Tuberculosis and Diabetes Care in health systems: A Situational Analysis in Western Nigeria for consideration

10.21203/rs.2.12294/v1 ◽

2019 ◽

Author(s):

ASAGA MAC PETER ◽

JUDE OSAGIE Aighobahi.

Keyword(s):

Health Care ◽

Health Systems ◽

Health Care Providers ◽

Health Facilities ◽

Situational Analysis ◽

Care Providers ◽

Cross Sectional ◽

Attitudes And Practices ◽

Low Middle Income Countries ◽

Diabetes Patients

Abstract Background: Tuberculosis (TB) coexists with other non-communicable diseases (NCDs), including Diabetes Mellitus (DM). Smoking increases the risk of TB as well as DM. Health systems are poorly prepared in many low middle income countries (LMICs) and are currently facing the "triple burden of smoking, TB, and DM" that drives these countries into the vicious cycle of poverty. Methods: A cross-sectional study method was carried out to assess the proportion of TB care centers that included integration measures for diabetic care as well as those providing DM care that included integration measures for TB. A list of 49 health care centers in Lagos offering TB care and managing Diabetes patients were recruited. A focus Group Discussion(FGD) and Individual interviews were conducted to investigate health care providers ' knowledge, attitudes and practices and the barriers encountered in the process of integrating TB and DM care. Results: Out of the 49 health care centres recruited in this study, 6% of health care units are aware of a surveillance to screen for diabetes in tuberculosis patients, while 2% of health facilities confirmed awareness of a surveillance to screen for tuberculosis in diabetes patients. 91% of health centres either verified the lack of or no understanding of monitoring of both diseases. The percentage of health facilities that have existing guideline on TB and DM screening was evaluated, it was perceived that 8% of health facilities had implemented a guideline to screen for DM in TB patients, while 4% of these Care Centres have implemented a guideline for diabetes patients to be screened for TB. Conclusion TB/DM integrative screening, treatment and management could be better attained if both co-morbidities integration program is initiated in the healthcare centres and policies of western states and Nigeria as a whole.

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

10.21203/rs.3.rs-72775/v1 ◽

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.

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