antenatal and postnatal care
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2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Kameela Miriam Alibhai ◽  
Malia S. Q. Murphy ◽  
Sandra Dunn ◽  
Erin Keely ◽  
Paloma O’Meara ◽  
...  

Abstract Background Breastmilk hand expression (BMHE) is recommended to promote lactation, relieve breast engorgement, and collect milk for future infant feedings. Resources to teach this skill are limited and infrequently developed in partnership with the obstetrical population. In collaboration with maternity care experts and individuals with recent breastfeeding experience, we designed a one-page toolkit that describes the process of BMHE and includes step-by-step instructions and images to illustrate the technique. This study aimed to evaluate the readability, clarity of content, layout, and informational value of this BMHE toolkit. Methods Individuals who intended to breastfeed, were currently breastfeeding, or had recently breastfed were electronically surveyed and completed a two-part survey that consisted of radio, multi-select, Likert scale, and open-ended questions. Part one captured sociodemographic factors, obstetrical history, and breastfeeding practices. Part two collected feedback on the BMHE toolkit. Participants were recruited electronically through social media and posters were circulated in antenatal and postnatal care settings in Ottawa, Canada between November 2020 and February 2021. Results Of the 123 participants, 117 (95.1%) had heard of hand expression prior to reviewing the toolkit and 99 (80.5%) had hand expressed before. Among the 48 participants who were no longer exclusively breastfeeding at the time of the survey, 22 (45.8%) had exclusively breastfed their infant for at least six months and 7 (14.6%) had discontinued exclusive breastfeeding within the first month. When asked about the BMHE toolkit, 118 (95.9%) participants said it was informative, 115 (93.5%) said it was easy to understand, and 114 (92.7%) said it was well laid-out. When asked about information seeking behaviours, participants indicated a preference for online resources (58.5%) and video resources (22.0%). Conclusions The BMHE toolkit was well received by participants and the feedback was favourable overall. The survey feedback will be used to create a revised version of the toolkit that has been validated by the obstetrical patient population. Future research should focus on identifying implementation strategies to optimize the use of the toolkit and increase its effectiveness as an educational resource to teach participants correctly BMHE.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bougangue Bassoumah ◽  
Andani Mohammed Adam ◽  
Martin Nyaaba Adokiya

Abstract Background The Community-based Health Planning and Services (CHPS) is a national health reform programme that provides healthcare at the doorsteps of rural community members, particularly, women and children. It seeks to reduce health inequalities and promote equity of health outcomes. The study explored implementation and utilization challenges of the CHPS programme in the Northern Region of Ghana. Methods This was an observational study that employed qualitative methods to interview key informants covering relevant stakeholders. The study was guided by the systems theory. In all, 30 in-depth interviews were conducted involving 8 community health officers, 8 community volunteers, and 14 women receiving postnatal care in four (4) CHPS zones in the Yendi Municipality. The data were thematically analysed using Atlas.ti.v.7 software and manual coding system. Results The participants reported poor clinical attendance including delays in seeking health care, low antenatal and postnatal care visits. The barriers of the CHPS utilization include lack of transportation, poor road network, cultural beliefs (e.g. taboos of certain foods), proof of women’s faithfulness to their husbands and absence of health workers. Other challenges were poor communication networks during emergencies, and inaccessibility of ambulance service. In seeking health care, insured members of the national health insurance scheme (NHIS) still pay for services that are covered by the NHIS. We found that the CHPS compounds lack the capacity to sterilize some of their equipment, lack of incentives for Community Health Officers and Community Health Volunteers and inadequate infrastructures such as potable water and electricity. The study also observed poor coordination of interventions, inadequate equipment and poor community engagement as setbacks to the progress of the CHPS policy. Conclusions Clinical attendance, timing and number of antenatal and postnatal care visits, remain major concerns for the CHPS programme in the study setting. The CHPS barriers include transportation, poor road network, cost of referrals, cultural beliefs, inadequate equipment, lack of incentives and poor community engagement. There is an urgent need to address these challenges to improve the utilization of CHPS compounds and to contribute to achieving the sustainable development goals.


Author(s):  
Na Geng ◽  
Xiaolan Xie

This paper is devoted to the management of advance admission requests for obstetric care. Pregnant women in China select one hospital and request admission for both antenatal and postnatal care after nine weeks of pregnancy. Schedulers must make the admission decision instantly based on the availability of the most critical resource, that is, hospital beds for postnatal care. The random delay between admission requests and postnatal care has created a distinct advance admission control problem. To address this issue, we propose a basic model that assumes a unit bed requirement for one day. Each admission generates a unit of revenue and each unit of overcapacity use incurs an overcapacity cost. With the objective of maximizing the expected net revenue, we establish an optimal policy for unlimited requests, that is, an expected arrival time quota (EATQ) policy that accepts a fixed quota of advance admission requests with the same expected date of confinement. We then propose an extended model for general capacity requirements. Using the Poisson approximation, we establish the optimality of the EATQ policy, which is shown to be solvable by a simple linear programming model. We compare the numerical results from the different policies and conduct a sensitivity analysis. The EATQ policy is demonstrated to be the best option in all test instances and notably outperforms the current admission rules used in hospitals, which usually accept admission requests according to some empirical monthly quota of the expected delivery month. The Poisson approximation is shown to be effective for determining the optimal EATQ policy for both stationary and nonstationary arrivals. Summary of Contribution: First, this paper investigates the advance admission control problem for obstetric care. Pregnant women in China choose one hospital and request admission for both antenatal and postnatal care after nine weeks of pregnancy but the most critical resource is hospitalization beds needed for postnatal care. The random delay between admission request and postnatal care makes the problem unique and challenging to solve. It belongs to the scope of computing and operations research. Second, this paper formulates a dynamic programming model, analyzes the structural properties of the optimal control policy, and finally proposes a mathematical programming model to determine the optimal quota. Numerical experiments show the validity of the proposed approach. It covers the research contents of theories on dynamic stochastic control, mathematic programming model, and experiments. Moreover, this paper is motivated by the practical problem (advance admission control) in obstetric units of Shanghai. Using these optimality properties, solution approaches, and numerical results, this paper provides guidance on how to manage advance obstetric admission requests.


2021 ◽  
Author(s):  
Bougangue Bassoumah ◽  
Mohammed Adam Andani ◽  
Martin Nyaaba Adokiya

Abstract Background The Community-based Health Planning and Services (CHPS) is a national health reform programme that provides healthcare at the doorsteps of rural community members, particularly, women and children. It seeks to reduce health inequalities and promote equity of health outcomes. The study explored challenges of the CHPS utilization following reports by the Ghana Statistical Service of poor clinic attendance and high maternal and child morbidities and mortalities in the Northern Region of Ghana. Methods This observational study employed qualitative methods to interview key informants covering relevant stakeholders. The study was guided by the systems theory. In all, 30 in-depth interviews were conducted involving 8 community health officers, 8 community volunteers, and 14 women receiving postnatal care in four (4) CHPS zones in the Yendi Municipality. The data were thematically analysed using Atlas.ti.v.7 software and manual coding system. 2 Results The study found poor clinical attendance in the form of delays in seeking health care, low antenatal and postnatal care visits, barriers affecting the utilization of the CHPS compounds to include lack of transportation and poor road network, cultural beliefs such as taboos of certain foods and proof for women's faithfulness to their husbands as challenges of health facility utilization. Besides, the absence of health workers at the CHPS compounds such as the CHOs, poor communication networks during emergencies when the ambulance service becomes inaccessible and lack of capacity by CHPS compound to sterilize some equipment. Furthermore, lack of incentives and adequate infrastructures like potable water and electricity, poor coordination of healthcare interventions and practices, lack of specialists and equipment as well as poor community engagement are major setbacks to the progress of the CHPS policy. Conclusions On clinical attendance, timing and number of antenatal and postnatal care visits, remain major concerns for the CHPS programme in the study setting. The barriers accounting for the low utilization of CHPS compounds are cost of referrals and cultural beliefs. There is an urgent need to address these challenges to improve the utilization of CHPS compounds and to contribute to achieving the sustainable development goals.


2021 ◽  
Author(s):  
Jacqueline Kumbiley ◽  
Anthony Amalba ◽  
Paul Armah Aryee ◽  
Simon Agongo Azure ◽  
VICTOR MOGRE

Abstract Background: Midwives and nurses are in an opportune position to provide nutrition care to pregnant women and lactating mothers during routine antenatal and postnatal care. However, midwives and nurses may not have adequate competencies and confidence to provide effective nutrition care. We evaluated the adequacy of nutrition education received in nursing and midwifery school; nutrition care competencies; self – efficacy and the nutrition care practice of midwives and nurses during routine antenatal and postnatal care in Ghana. We also evaluated determinants of nutrition care practice among these participants.Methods: This was a multi-site cross- sectional study conducted among midwives and nurses working at antenatal and postnatal contact points in Sunyani Municipality, Ghana. Data was collected using a self-administered questionnaire. Descriptive statistics of mean, standard deviation and frequencies were used to describe the data. Results: Almost 90% (n=267) of the participants received nutrition education during training. More than half of the participants were either unsatisfied or uncertain with: the amount of time allocated for nutrition education during training in school (77.5%); the integration of nutrition content into the curriculum (82.6%); and how nutrition course content was presented (77.4%). Almost 40% of the participants felt inadequately prepared from school to provide nutrition care during routine antenatal and postnatal care. The mean (±SD) knowledge of the participants was 57.46 (8.12) %. Participants attitude towards nutrition care was positive. Self-efficacy level ranged from moderate to low. Factors that had a positive association with nutrition care practice were age of respondents (B = 0.04; p = 0.002), nutrition-related knowledge (B = 0.05; p = 0.016), adequacy of nutrition education in school (0.14; p = 0.006), receipt of nutrition training after school (B = 0.38; p = 0.010) and nutrition care self-efficacy (B = 0.03; p = 0.048). Conclusion: Nutrition education received during nursing/midwifery training was unsatisfying and inadequate, resulting in participants inadequate knowledge in basic nutrition issues, feeling ill prepared, less confident and lacking the key skills to provide nutrition care. Although participants recognised nutrition care to be important and as their responsibility to provide it, they could not provide nutrition care as may be needed by mothers during routine antenatal and postnatal care.


2021 ◽  
Vol 8 ◽  
pp. 2333794X2110483
Author(s):  
Jacqueline Kumbiley ◽  
Anthony Amalba ◽  
Paul Armah Aryee ◽  
Simon Agongo Azure ◽  
Victor Mogre

Aim. Midwives and nurses are critical in nutrition care for pregnant women and lactating mothers. Ghanaian nurses and midwives’ perception of the adequacy and their satisfaction with nutrition education received during training in school, level of nutrition care competencies, and nutrition practice behavior is unknown. We evaluated the adequacy of nutrition education received in nursing and midwifery school; nutrition care competencies; self-efficacy and the nutrition care practice of midwives and nurses. We also evaluated determinants of nutrition care practice during routine antenatal and postnatal care. Methods. Cross-sectional study conducted among midwives and nurses working at antenatal and postnatal clinics in Ghana. Data was collected using a self-administered questionnaire. Data analysis was done using descriptive statistics, correlation, and linear regression. Findings. Almost 90% (n = 267) of the participants received nutrition education during training, 77.5% were unsatisfied with the amount of time allocated for nutrition education and 40% felt inadequately prepared from school to provide nutrition care. Self-efficacy ranged from moderate to low. Determinants of nutrition care practice were age of respondents ( B = 0.04; P = .002), nutrition-related knowledge ( B = 0.05; P = .016), adequacy of nutrition education ( B = 0.14; P = .006), nutrition training after school ( B = 0.38; P = .010) and nutrition care self-efficacy ( B = 0.03; P = .048). Conclusion. Notable knowledge gaps in basic nutrition, inadequate preparedness, and poor confidence to provide nutrition care was common. There is a need to improve the nutrition education experiences of midwives and nurses through curricula revision and refresher training courses.


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