Maternal and Child Health Services in Rural Settings of The Gambia: Contextual Determinants of Postnatal Care from Mothers’ Perspectives—A Community-Based Analytical Cross-Sectional Study

Background. Maternal and child health in The Gambia is a trending public health burden. The postnatal period is critical and vital to the lives and health of the maternal mothers and their newborns, and pieces of evidence deduced that a majority of maternal and newborn deaths occur during this period. Hence, this research aimed to assess the prevalence and determinants of postnatal care utilization across women in rural Gambia. Methods. A community-based cross-sectional design was conducted in January 2020, with 265 women of childbearing age were recruited from the selected households in rural communities across the Upper River Region (URR), Gambia, using multistage sampling technique. A structured-interview questionnaire was developed to elicit contextual sociodemographic characteristics regarding the use of postnatal care. Percentages, chi-square/Fisher’s exact test for variables with p value ≤0.15 were considered for inclusion into the logistic regression model. The significance level was set at p < 0.05 . The adjusted odds ratios (aOR) with 95% confidence interval (CI) were computed to declare significance. Results. The study revealed that 90% of women utilize postnatal care (PNC) services in the rural settings of URR, Gambia. Factors such as women’s occupation, location, number of pregnancies, attending in last pregnancy, current uptake of family planning, and complication(s) in last labor were found to be associated with PNC utilization. Women who attended antenatal care (ANC) services in their last pregnancy were 10.8 times (aOR = 10.795, 95% CI: 1.025–113.694), current users of FP were 10.7 times (aOR = 10.708, 95% CI: 1.379–83.152), women’s number of pregnancies increases by a factor of 4.6 times (aOR = 4.649, 95% CI: 1.518–14.243) more likely to utilize PNC while women’s number of children alive were less likely by 76.1% (aOR = 0.239, 95% CI: 0.071–0.810) as compared to those who were not utilizing PNC services. Conclusion. The findings showed that attending ANC services, current uptake of FP, women’s number of pregnancies, and number of children alive were associated with PNC. Strengthening women empowerment and designing responsive ANC programs especially for rural women to improve PNC services are required.

Reimagining the Contextualization of a Rural Teacher Educator Preparation Program During COVID

Within the rural context of our nation, education has largely been overlooked or ignored within the research. The predominant educational research focuses more upon larger urban areas with a distinct context. Training quality teacher educators within the context of a worldwide pandemic dismisses many established and traditional methods. In order to prepare our teacher candidates within this new context, our EPP revaluated its current practices. Innovation in teacher preparation is clearly at hand and is well within our reach if we use the pandemic as a springboard to reimagine a teaching force equipped to face any challenge and problem-solve to create the most effective learning environment for the students they teach. It is possible and doable and can sustain our public education system in ways that we thought impossible prior to the pandemic. It pushes us out of the rut we find ourselves within. The chapter address strategies to support preservice teachers in rural settings.

Exploring Vhavenda Indigenous Food Practices and Knowledge Contributions to Food (in)security

This chapter considers VhaVenda indigenous knowledge about foods, its production, and its consumption as a way of exploring indigenous-based solutions to food insecurity. External and internal factors contributing to food insecurity are discussed, beginning with an overview of the current state of food insecurity globally and then locally. Subsequently, the chapter discusses the impact of the COVID-19 pandemic on food security levels in both urban and rural settings within a single population. Specific attention is given to the rural setting of Thohoyandou Venda, drawing attention to its challenges and solution-possibilities with particular focus on subsistence farming and home gardening as aspects in VhaVenda culture. Finally, the authors provide a catalogue of indigenous food sources and agricultural practices thereby exploring local knowledge as a possible mechanism to combat food insecurity in the contemporary period.

TRADITION PATTERNS OF ANTENATAL CARE AND MATERNAL HEALTH IN MAMFE: UNDERSTANDING THE SOCIO-CULTURAL FACTOR OF MATERNAL MORTALITY IN RURAL CAMEROON

From the case study of Mamfe, this research has been tailored to highlight and examine the influence of traditional patterns of antenatal care on maternal morbidity and mortality in rural Cameroon. The country is one of the underachievers of the MDGs with strong socio-cultural attachment and a consequential high reliance on traditional patterns for antenatal care. Understanding the influence of this reliance gives a more complete view of the socio-cultural factor critical towards underlining the underlying determinants of maternal deaths. The rationales behind most traditional antenatal beliefs and practices, some of which have been highlighted in this work, scarcely correspond to the biomedical norms for useful maternal healthcare. They reportedly fulfill more superior and collective purposes that understandably prevail over maternal health. Non-respect for these traditional imperatives puts transgressors at odds with the community. Given their understandable vulnerability during pregnancy, expectant women are therefore predisposed to a higher risk of complications and death. The research was both cross-sectional and exploratory, constructed on a qualitative design. Non-probability purposive sampling was used to constitute a sample size of 140 participants. Research techniques employed included in-depth interviews, FGDs and direct observation. We discovered that expectant women widely attended conventional antenatal consultations but were rigorously constraint to respect and adhere to beliefs and practices for traditional maternal care. As such widespread facility-based deliveries in rural settings heralded as the ideal solution by many does not necessarily limit the influence of the socio-cultural factor on MMR. KEY WORDS: rural Cameroon, traditional patterns, influence, antenatal care, maternal mortality

Rural-urban disparities in the nutritional status of younger adolescents in Tanzania

Research on geographic differences in health focuses largely on children less than five years; little is known about adolescents—and even less regarding younger adolescents—a vulnerable group at a critical stage of the life course. Africa’s rapid population growth and urbanization rates, coupled with stagnant rates of undernutrition, further indicate the need for country-specific data on rural-urban health disparities to inform development policies. This study examined rural-urban disparities in body mass index-for-age-and-sex (BAZ) and height-for-age-and-sex z-scores (HAZ) among younger adolescents in Tanzania. Participants were randomly selected adolescents aged 10–14 years (N = 1,125) residing in Kilosa (rural) and Moshi (urban) districts of Tanzania. Individual and household-level data were collected using surveys and anthropometric data was collected on all adolescents. Age, sex, household living conditions, and assets were self-reported. BAZ and HAZ were calculated using the WHO reference guide. The prevalence of undernutrition was 10.9% among rural and 5.1% among urban adolescents (p<0.001). Similarly, stunting prevalence was greater in rural (64.5%) than urban (3.1%) adolescents (p<0.001). After adjusting for covariates, rural residence was significantly and inversely associated with BAZ (B = -0.29, 95% CI: -0.52, -0.70, p = 0.01), as well as with HAZ (B = -1.79, 95% CI: -2.03, -1.54, p<0.001). Self-identified males had lower BAZ (B = -0.23, 95% CI: -0.34, -0.11, p<0.001) and HAZ (B = -0.22, 95% CI: -0.35, -0.09, p = 0.001) than self-identified female adolescents. Rural-urban disparities in nutritional status were significant and gendered. Findings confirm place of residence as a key determinant of BAZ and HAZ among younger adolescents in Tanzania. Targeted gender-sensitive interventions are needed to limit growth faltering and improve health outcomes in rural settings.

Lead Exposure in Children: What Special Educators Need to Know

Journalists have reported large-scale lead poisoning affecting children in cities such as Flint, Michigan. Unfortunately, children’s exposure to lead is not isolated and occurs throughout the country in both urban and rural settings. The effects of lead exposure can cause children to develop disabilities, potentially requiring special education services to address their academic and behavioral difficulties. In this paper, we detail three areas where special education has a major role in addressing the lead crisis: special education identification; intervention; and advocacy, awareness, and prevention. For each area, we provide concrete suggestions for special educators to implement in order to ensure children exposed to lead receive the special education services they need.

Resilience of Water Supply in Practice: Experiences from the Frontline

Water Resilience in Practice is co-edited by two experienced water sector professionals and reviews resilience in water supply service delivery in the form of a series of case studies from different economic contexts – ranging from low-income and fragile states to upper-income countries. It documents real experiences and reflects on the initiatives different service providers apply to strengthen resilience in practice. It describes how service providers respond, adapt, innovate and learn on an ongoing basis, and how they endeavour to meet challenges and provide water supply to users equitably and sustainably. In recent years climate resilience in water supply has been a new emerging paradigm. In response it is helpful to document and record some up-to-date experiences, which can be consolidated in one place. However, it is also necessary to recognise the multiple pressures that water resources face, such as: population growth, increased water demands, existing climatic variability as well as climate change. These pressures are having a profound impact on water supply service delivery. In this context service providers and development professionals must take active measures to respond to these risks. This book is primarily addressed to organisations and practitioners involved in planning, designing, managing and financing water supply programmes in urban and rural settings. ISBN: 9781789061611 (paperback) ISBN: 9781789061628 (eBook) ISBN: 9781789061635 (ePub)

Perceptions of Community Health Workers (CHW) On Barriers And Enablers To Care For People With Psychosis In Rural Mozambique: Findings of a Focus Group Discussion Study Using The Capability, Opportunity, Motivation and Behavior Framework (COM-B Framework).

Background: Psychotic disorders contribute significantly to the global disease burden by causing disability, impaired quality of life, and higher mortality in affected people compared with the general population. In rural settings, where there is limited or no access to healthcare, individuals living with psychotic disorders often seek support from Community Health Workers (CHWs). However, little is known about what CHWs know about psychosis and how they manage such cases. This study aimed to explore the CHWs perception of psychosis and their experiences and beliefs about the factors that might enable or hinder care taking for patients with psychosis in rural settings in Mozambique. Methods: A qualitative study was conducted in rural districts of Maputo Province, a southern region of Mozambique, using six focus group discussions with participation of 79 CHWs. Thematic analysis was used informed by the Capabilities, Opportunities, Motivation and Behavior framework (COM-B).Results: Nine primary themes were identified. Overall, CHWs perceived psychosis as treatable medical conditions and held a positive attitude about being part of the care taking process of patients with psychosis in rural settings. Partnerships with key-stakeholders such as traditional healers, health care workers and families, were perceived by CHWs as enablers to improve access to care in rural areas. However, stigma, myths, and lack of competencies to treat people with psychosis were perceived by CHWs as barriers for appropriate care. Conclusion: CHWs, with adequate support, can play an important role in the care of patients with psychosis in rural settings, including identification of patients requiring care and referring them to appropriate healthcare professionals, and follow-up of medicated patients with psychosis within the rural remote setting. Training of CHWs should consider inclusion of basic mental health care competencies.

Under-Utilization of Maternal-Child Healthcare Services and Adverse Outcomes of Unwanted Pregnancies in Urban and Rural Areas of Indonesia

The study examines the association of unwanted pregnancy and the utilization of maternal-child health services, and the adverse health outcomes in urban and rural settings. The study employed data from the 2017 Indonesia Demographic Health Survey that included 13,806 live births; the mothers were not pregnant at the interview and were married participants. The multiple logistic regression analysis concerning residential areas was conducted separately to compare outcomes related to unwanted pregnancy. Non-standard antenatal care visits (adjusted odds ratio [AOR]=1.7; 95% confidence interval [CI]=1.2–2.4), prolonged labor (AOR=1.6; 95% CI=1.2–2.1), the absence of child’s birth documentation (AOR=1.3; 95% CI=1.0–1.6), and smaller baby size (AOR=1.2; 95% CI=1.0–1.4) are associated with unwanted pregnancy in urban areas. In rural settings, on the other hand, unwanted pregnancy is associated with non-standard antenatal care (AOR=1.6; 95% CI=1.2–2.2). Therefore, in Indonesia, urban areas lack maternal-child healthcare services utilization and higher adverse events due to unwanted pregnancy than rural areas. An adjustment approach is required in maternal-child health-related programs in both areas, particularly for women living in urban.