Prevalence of vaginal candidiasis and associated factors in pregnant women with diabetes

Background/aims Vaginal candidiasis is commonly experienced by women with diabetes, but its prevalence is not well documented in Zimbabwe. This study aimed to assess the prevalence of vaginal candidiasis and factors associated with diabetic treatment adherence in pregnant women with diabetes. Methods This cross-sectional study was conducted on a consecutive sample of 157 participants from a central hospital in Harare, Zimbabwe. A structured questionnaire and physical examination of the perineum were used to collect data. All procedures were conducted in privacy. Diagnosis of vaginal candidiasis was made clinically. Data were analysed using the Chi-squared test, with P<0.05 being significant. Results The prevalence of vaginal candidiasis was 19.7%. There was a significant association between monthly family income (P=0.041), parity (P=0.029) and number of living children (P=0.049) and the presence of vaginal candidiasis. Women with poor adherence to diabetic therapy were 3.95 times more likely to have vaginal candidiasis (P=0.002). Conclusions Individualised health education on glycaemic control and good perineal hygiene remains key in the prevention of vaginal candidiasis among diabetic pregnant women.

Knowledge and effects of dysmenorrhoea among female adolescents in selected secondary schools in Lagos

Background Dysmenorrhoea is the leading cause of absenteeism from school among menstruating adolescents. It is a common health problem among women of reproductive age and it is known to have psychosocial effects on women and their interactions with others during such periods. This study assessed knowledge and effects of dysmenorrhoea among female adolescents in Lagos. Methods This non-experimental descriptive cross-sectional study involved 676 female adolescents attending secondary schools, who were selected using multistage sampling. A self-structured questionnaire (reliability r=0.79) was used for data collection. Data were analysed using the statistical package for social sciences software version 20. Descriptive and inferential statistics were presented in tables, charts and analysed using the Chi-squared test. Significance was set at P=0.05. Results The result showed that 62.8% of the respondents were 15–18 years old. The majority (64.8%) had poor knowledge of dysmenorrhoea, although 92.6% agreed that dysmenorrhoea affects their daily activities and 68.5% had good treatment-seeking methods. There was a significant association between knowledge of dysmenorrhoea and students' age (P<0.001), level of education (P=0.004) and department (P<0.001). There was also a significant association between treatment-seeking method and age (P<0.001), level of education (P=0.010) and department (P<0.001). Conclusions Dysmenorrhoea is a main cause of poor performance in daily activities among female adolescents in Lagos, although many have good treatment-seeking methods. Adopting good and effective treatment methods will go a long way in mitigating the effect of dysmenorrhoea.

Factors influencing women's knowledge at scheduled postnatal visits: a multi-centre study in Kakamega, Kenya

Background/aims Postnatal care is offered to mothers and their babies from birth and across the postnatal period. Visits are spread over the postnatal period, and a minimum of four visits is recommended. In many studies, postnatal visits in Africa have been reported to be low compared to antenatal visits. As a result of low postnatal visits, mothers are not able to utilise postnatal care services, resulting in delayed detection of and interventions for maternal and neonatal health problems, leading to high rates of maternal and neonatal morbidity and mortality. In Kenya, only 53% of mothers attend postnatal clinics; in Kakamega county, only 34% of mothers attend. This study aimed to establish factors influencing postnatal knowledge among mothers in selected hospitals in Kakamega, Kenya. Methods The study was a descriptive cross-sectional study involving 320 postnatal mothers recruited from four sub-counties. Systematic sampling was used to select eligible study participants. Data were collected using questionnaires that assessed the participants' knowledge of postnatal care in terms of what postnatal care is, recommended postnatal care, when to attend a clinic and the services offered at postnatal care clinics. The data were entered into a database and analysed using the Chi-squared test to assess how sociodemographic and socioeconomic characteristics were associated with knowledge of postnatal care. Results The majority of participants (73.1%) had poor or no knowledge of postnatal care and 89.7% had poor or no knowledge on when postnatal visits should be carried out. Most postnatal mothers (71.9%) received postnatal health information from health workers. Occupation (P<0.000), income (P<0.000), transport (P<0.000) and time taken to travel to hospital (P=0.034) were significantly associated with postnatal knowledge. Conclusions Knowledge on postnatal care is poor among postnatal mothers in Kakamega. The majority of participants obtained postnatal care information from health workers, and so it is recommended that Kakamega establishes other strategies for giving information on postnatal care, such as pamphlets to mothers.

Factors influencing labour and birthing positions in Malawi

Background/aims The World Health Organization encourages women in labour to ambulate and assume upright positions shown to be associated with favourable childbirth outcomes. However, the literature shows that most women in developed and developing countries, including Malawi, give birth in the supine position. There is a lack of research on factors that influence choice of birthing positions among women in Malawi. This study aimed to identify these factors. Methods A face-to-face descriptive survey was conducted on 373 low-risk postnatal women in Malawi. Bivariate and multivariate analyses were used to determine association between sociodemographic characteristics and choice of labour and birthing position, as well as to identify predictive factors. Results Walking during labour was significantly associated with age (P=0.018) and monthly family income (P=0.012). During birth, women who had received some degree of education were more likely to use the supine position than those who had not (93% vs 78%; P=0.011). However, women with a higher level of income were less likely to use the supine position than women with low income (82% vs 93%; P=0.005). Conclusions Age, income and education influence Malawian women's choices for labour and birthing position. There is a need for Malawian women to be informed about and encouraged to use different labour and birthing positions, regardless of their socioeconomic and demographic status, to promote positions that improve maternal and neonatal outcomes. Childbirth education sessions or classes during antenatal care should include information on different birthing positions.

An exploration of midwives' views of the latest World Health Organization labour care guide

Background/aims Effective labour monitoring is integral to intrapartum care. Yet, to date, tools to facilitate this have not reached their potential. This study aims to explore midwives' initial reactions to the latest World Health Organization labour care guide, which is a replacement to the existing partograph, to enable adaptations to be made and to inform implementation strategies. Methods This was a qualitative study that used interviews and focus groups to gather data from a convenience sample of midwife delegates from six sub-Saharan Africa countries who were attending a midwifery conference in Malawi. Data were analysed thematically. Results A total of 43 participants participated; six focus groups and 12 individual interviews were conducted. Participants expressed both positive and negative views of the guide. Three main themes were found. The theme ‘sticking to what is familiar’ demonstrated reluctance to change; ‘chart based on usual or optimum practice’ suggested that midwives wanted a chart that reflects the routine care provided as opposed to the evidence-based care they should provide; and ‘measures for effective implementation’ highlighted the importance of having carefully considered and robust strategies for implementing the guide. Conclusions This rapid evaluation provided a snapshot of midwives' initial reactions to the new labour care guide. Although the existing partograph has not reached its full potential, midwives showed a reluctance to change it for something new. Feedback from participants has been fed into the development phase of the guide, informing its presentation, contents and field testing.

Midwives' perceptions of disrespect and abuse of women during labour and childbirth in Lusaka, Zambia

Background/Aims Disrespect and abuse is a frequent occurrence in labour wards around the world. Disrespect and abuse during care by health workers can prevent pregnant women from seeking care during labour and childbirth, which can lead to increased maternal and neonatal mortality rates. This study aimed to explore midwives' perceptions of disrespect and abuse of women during labour and childbirth in Lusaka. Methods A concurrent convergent mixed-method approach was used for this study. Data were collected through a self-administered questionnaire given to 217 midwives actively practicing in maternal health services across Lusaka randomly sampled for the quantitative arm of the study. The data were analysed using bivariate and multivariate logistic regression, with P<0.05 used to indicate significance. For the qualitative component of the study, 13 purposively selected key informants were interviewed with an interview guide. Results Most of the respondents (88.5%) perceived disrespect and abuse of women during labour and childbirth as a negative phenomenon. However, almost half (40.1%) had provided care which was disrespectful and abusive during their practice and the majority (68.7%) had observed disrespect and abuse by other midwives. Bivariate and multivariate logistic regression analysis found an association between midwives' perception of disrespect and abuse and witnessing or participating in disrespectful and abusive behaviour during practice. In the qualitative arm of the study, midwives reported that disrespect and abuse occurred in labour wards across Lusaka, demonstrating an urgent need to prevent such practices. Midwives suggested actions such as increased sensitisation and training of midwives on respectful maternity care and improved staffing levels as ways to prevent this practice Conclusions Disrespect and abuse of women during labour and childbirth should be prevented. Increasing health education and training for both the public and midwives on respectful maternity care can help to achieve this goal. Midwives need to be motivated through good working environments, increased wages and increased time to rest while working, as the heavy workload was found to contribute to disrespect and abuse in labour wards.

Contributing factors to perinatal mortality among women who gave birth at the Jimma University Medical Centre, southwest Ethiopia

Background Perinatal mortality remains a challenge worldwide, particularly in developing countries. Although significant achievements have been made to reduce neonatal mortality worldwide, in the last two decades there was a total of 5.3 million neonatal deaths and stillbirths each year. This study aims to assess the magnitude of perinatal mortality and its contributing factors among births at the Jimma University Medical Centre in Ethiopia. Method A facility-based cross-sectional study was conducted between January and April 2017. Convenience sampling was used to select study participants and data were collected using interviewer-administered pretested structured questionnaires. Descriptive statistics were used to analyse the data, with the chi-square test used to assess the relationship between each factor and outcome. Statistical significance was set at P<0.05. Results The rate of perinatal death was 107 per 1000 births, of which 39.2%, 25.9% and 34.9% were fresh stillbirths, macerated stillbirths and early neonatal deaths respectively. The majority (77.8%) of stillbirths occurred before the study participant reached the hospital and 64.3% of stillbirths had low birth weight. Hyaline membrane disease (27.6%) and meconium aspiration syndrome (20.7%) were the two most common causes of early perinatal death. Obstetric complications contributed to 89.6% of perinatal deaths. Stillbirth was significantly associated with a lack of education (P=0.036). The rate of perinatal mortality was high among women with their first pregnancy (53.0%) and those who had no previous pregnancy-related problems (79.5%), and was significantly associated with mechanical causes and antepartum haemorrhage (P=0.015). Conclusions The findings indicated that the rate of perinatal mortality was high at the Himma University Medical Centre. Improving maternal education and health services in rural areas are important steps to prevent poor perinatal outcomes. Facilitating transport and improving referral procedures may help to prevent mechanical complications, which are the most common cause of perinatal death, particularly fresh stillbirths which, in the present study, often occurred before a participant arrived at the hospital.

Nurses' and midwives' views on male partner involvement in maternity care in Imo, Nigeria

Background/Aims In 2015, the World Health Organization recommended male partner involvement in maternal and child health as an effective strategy to combat maternal and child health in pregnancy. Healthcare practitioners' acceptance of male partners in maternal and child healthcare is likely to improve provider and patient satisfaction. The main objective of the study was to assess nurses' and midwives' perceptions of male partner involvement in maternity care, and their willingness and constraints to performing it in selected hospitals in Imo, Nigeria. Methods A mixed-method approach was used to gather data from nurses and midwives in the antenatal care, labour and postnatal care wards of selected hospitals. A semi-structured questionnaire and interview guide were used to collect data assessing the participants' perceptions of male partner involvement in maternity care and of the barriers to it. Quantitative data were analysed through bivariate analysis, using the Chi squared test, and key quotes were extracted from qualitative data to illustrate relevant points. Results The majority (57%) of the respondent had a good perception of the concept of male partner involvement. The ward that a participant worked in significantly affected their perception (P=0.01). Respondents were willing to accept male partners in maternity care through education and providing more male-friendly services. However, sociocultural, hospital policy and structural factors restricted acceptance of men in the wards. Conclusions Nurses and midwives in all wards should be educated on the importance of male partner involvement in maternity care. Nurses and midwives need to engage in community health education programmes that will modify cultural constraints to male partner involvement and facilities should modify their structure and policies to be more male-friendly.