Suchergebnisse

Aims: To assess the traditional birth attendants' (TBAs') knowledge of HIV and prevention of mother to child transmission (PMTCT) of HIV and their practice of PMTCT of HIV services delivery. It was also designed to train them on PMTCT of HIV and mobilization of the pregnant women in the community to access PMTCT of HIV services in a formal health facility. Study Design: The study was a cross-sectional descriptive study with an interventional component Place and Duration of Study: The 8 months study was conducted in Igbagu Community in Izzi Local Government Area of Ebonyi State Nigeria, in 2015. Methodology: A total population study of all TBAs in the study area identified using the snowball non-probabability sampling method was conducted. Baseline assessment of their knowledge and practice of PMTCT of HIV services delivery was done. They were subsequently trained on PMTCT of HIV and on mobilization and referral of pregnant women to access HIV counselling and testing (HCT) and other PMTCT of HIV services at a designated health facility in the community. At the end of the study, post training PMTCT of HIV knowledge assessment and determination of the number of pregnant women who complied with the TBAs' referral for PMTCT of HIV serices at the health facility were carried out. Results: Assessment of the TBAs' composite knowledge of modes of HIV transmission and preventive measures gave the mean score of 14.8% ± 11.5% and 68.8% ± 12.5% pre and post training respectively. The difference was statistically significant (Z = - 5.2; p < 0.001). Following the training, all the TBAs were referring their clients to health facility for PMTCT of HIV services compared to 10 (28.6%), before the study. Fifty two pregnant women complied with referral by the TBAs to the health facility for PMTCT of HIV services out of the 129 pregnant mothers who visited them during the study, giving a compliance rate of 40.3%.

Purpose – to understand the awareness and healthcare preferences of pregnant women in Calabar municipal for traditional birth homes and hospitals.Materials and methods. The research is a qualitative phenomenology research, based on interpretative phenomenology, involving focus group discussion that explored the views of the traditional birth attendants on the reason for their patients' preferences as well as indebt interviews that explored the pregnant women patronizing traditional birth homes preferences. Focus group discussion consisted of four major steps and included research design, data collection analysis and reporting of results.We used purposive sampling by taking from the list of registered midwives or traditional birth attendants (TBAs) of cross-river state Association, Calabar municipality chapter. The number of participants were 15 TBAs.Results. Results showed that there is diversity when considering the individual's values. The TBAs in their focused group discussion attempted to emphasize on the importance of patience. Though they all consider that without patience, one cannot be a TBA and it is the secret of their patients' attraction.Conclusions. There is no one «standalone» reason for the use of traditional birth attendant homes instead of the government hospital, but there is a mix of the reasons with some outstanding factors that influences Calabar pregnant women choice on the use of traditional birth homes instead of government hospitals.

Purpose – to understand the awareness and healthcare preferences of pregnant women in Calabar municipal for traditional birth homes and hospitals.Materials and methods. The research is a qualitative phenomenology research, based on interpretative phenomenology, involving focus group discussion that explored the views of the traditional birth attendants on the reason for their patients' preferences as well as indebt interviews that explored the pregnant women patronizing traditional birth homes preferences. Focus group discussion consisted of four major steps and included research design, data collection analysis and reporting of results.We used purposive sampling by taking from the list of registered midwives or traditional birth attendants (TBAs) of cross-river state Association, Calabar municipality chapter. The number of participants were 15 TBAs.Results. Results showed that there is diversity when considering the individual's values. The TBAs in their focused group discussion attempted to emphasize on the importance of patience. Though they all consider that without patience, one cannot be a TBA and it is the secret of their patients' attraction.Conclusions. There is no one «standalone» reason for the use of traditional birth attendant homes instead of the government hospital, but there is a mix of the reasons with some outstanding factors that influences Calabar pregnant women choice on the use of traditional birth homes instead of government hospitals.

The selection of birth attendants is one of the reproductive rights of a person in deciding where to give birth and who will assist the delivery. Safe delivery ensures that all birth attendants have the knowledge, skills and tools to provide safe and clean assistance, as well as providing postnatal care to mothers and babies, so that mothers and babies are healthy ensured. Maternal mortality is closely related to childbirth assistance and every minute a woman is rumored to die from complications related to pregnancy and childbirth. The purpose of this study are: Describe and analyze the factors that underlie maternal behavior in the selection of birth attendants; Describe and analyze the actors who play a role in maternal behavior in Deciding childbirth assistance. The perspective of this research is descriptive - qualitative. The results of this study are: First, the socio-cultural factors of the community in the tradition of giving birth with the same traditional birth attendant fostered a personal bond between maternal and shamans in birth planning assistance. Second, the quality of quack services to mothers is more dominant than the level of maternal education and economics in determining birth attendants. Third, maternal knowledge is predisposing factors that drive behaviors utilization of antenatal care services in health facilities; fourth, the choice of delivery assistance depends on the accessibility to health services items, namely the affordability of the location of the service, the type and quality of services available. ; Fifth, the level of education and maternal makeup Socioeconomic conditions rarely Involved in making decisions to Determine the helper delivery and submitted to parents / husband; Sixth, the calculation of social and economic costs as labor costs is a maternal consideration in Determining birth attendants and place of delivery; Seventh, maternal behavior in choosing birth attendants is determined by the intensity of interaction with various actors; eighth, Collaboration and commitment of all stakeholders, namely the Village Government, Health Center, non-commissioned officer and the police, Health Cadres, Shamans, Community Leaders and Maternal Ensure the success of public health services. maternal behavior in choosing birth attendants is determined by the intensity of interaction with various actors; eighth, Collaboration and commitment of all stakeholders, namely the Village Government, Health Center, non-commissioned officer and the police, Health Cadres, Shamans, Community Leaders and Maternal Ensure the success of public health services. maternal behavior in choosing birth attendants is determined by the intensity of interaction with various actors; eighth, Collaboration and commitment of all stakeholders, namely the Village Government, Health Center, non-commissioned officer and the police, Health Cadres, Shamans, Community Leaders and Maternal Ensure the success of public health services

INTRODUCTION: The aim of this study is to investigate how mothers, families, midwives, and traditional birth attendants in the Buginese-Bajo culture understanding breastfeeding and early initiation of breastfeeding (EIBF). Also to assess what support mothers receive from families, midwives, and traditional birth attendants during pregnancy, birth, and EIBF. METHODS: This qualitative study included 21 subjects (11 pregnant women, three midwives, and seven traditional birth attendants). Recorded interviews with the three groups of participants were transcribed verbatim and analyzed separately, using latent content analysis. The study started in December 2014 and ended in July 2015. RESULTS: Some mothers understood the meaning of EIBF, but engaged in it for different reasons. The midwives interpreted the principle of EIBF differently from a duration perspective. Traditional birth attendants explained it as a way to strengthen the relationship between mothers, and babies; they believed that prolonging breastfeeding until 2 years would change babies into caring children. According to them, this skin-to-skin contact has been practice for a century by traditional birth helpers. The philosophy of breastfeeding, according to the Buginese-Bajo, is creating "peru" relationships for mothers and babies each other for their whole lives. CONCLUSION: These findings show a connection between established science and cultural beliefs. The concept of peru is the central philosophy to be achieved in EIBF. Breast-feeding's psychological value is known and passed from generation to generation; this essential fact needs to be preserved as local capital for changing breastfeeding behavior. The government should pay more attention to this opportunity to increase awareness and promote breastfeeding behavior changes.

FrontMatter -- Acknowledgments -- Contents -- PART I Meeting the Challenge in the Developing World -- Executive Summary -- 1 Introduction -- PART II Addressing Maternal, Neonatal, and Fetal Mortality and Morbidity -- 2 Reducing Maternal Mortality and Morbidity -- 3 Reducing Neonatal Mortality and Morbidity -- 4 Reducing Fetal Mortality -- PART III Improving Health Care Systems -- 5 Improving Birth Outcomes Within Health Care Systems -- PART IV Additional Causes of Neonatal Mortality and Morbidity -- 6 The Problem of Low Birth Weight -- 7 Reducing Mortality and Morbidity from Birth Defects -- 8 Preventing Perinatal Transmission of HIV -- 9 Summing Up: The Way Forward -- APPENDIXES -- Appendix A Workshop Agenda -- Appendix B Defining Developing Countries -- Appendix C The Essential Competencies of a Skilled Birth Attendant -- Appendix D Committee Biographies -- Appendix E Dissenting Note -- Glossary -- Acronyms -- Index.

In Bangladesh, like other developing countries, most births occur at home or in the community, so logistic problems and taboos prevent the weighing of every newborn child. This study was performed to see whether other simpler measurements could be substituted for weight to identify neonates of low birth weight. A total of 1676 live births at the Chittagong Medical College Hospital constituted the study sample, and this showed a high correlation between mid-arm circumference and birth weight (r=0.792, p<0·000). A mid-arm circumference of <9·0 cm had the best sensitivity and specificity for identifying newborns with a birth weight of less than 2500 g. These neonates were followed up to record neonatal deaths. Neonatal mortality showed an inverse relation with mid-arm circumference. A mid-arm circumference of <9·0 cm and a birth weight of <2500 g were equally useful in predicting neonatal outcome. Mid-arm circumference is a simple, quick and reliable indicator for predicting low birth weight and neonatal outcome, and can be easily measured by medical practitioners and traditional birth attendants (TBAs) in the community of developing countries like Bangladesh.

All appendices are available from https://doi.org/10.17037/DATA.00000778. ; Objectives To assess the hand hygiene (HH) compliance before aseptic procedures among birth attendants in the10 highest-volume facilities in Zanzibar. We also examined the extent to which recontamination contributes to poor HH; recording exact recontamination occurrences is not possible using the existing World Health Organisation HH audit tool. Methods In this time-&-motion study, three trained coders used the WOMBATv2 software to record the hand actions of all birth attendants present in the study sites. The percentage compliance and 95% confidence intervals for individual HH behaviours and for behavioural sequences during labour and delivery were calculated.Results We observed 104 birth attendants and 781 HH opportunities before aseptic procedures. Compliance to hand rubbing/washing was 24.6% (CI:21.6-27.8). Only 9.6% (CI:7.6-11.9) also donned gloves and avoided glove recontamination. Half of the time when rubbing/washing or glove donning was performed, hands were recontaminated prior to the aseptic procedure. Conclusions In this study, HH compliance by birth attendants was poor before aseptic procedures. To our knowledge this is the first study in a LMIC to show the large contribution to poor HH compliance from hand and glove recontamination before the procedure. Recontamination is an important driver of infection risk from poor HH and should be understood for the purposes of improvement and therefore included in HH monitoring and interventions. © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. ; Medical Research Council–PHIND scheme, award number MR/N015975/1; The Soapbox Collaborative; CLEAN Study, funded by the United Kingdom Joint Global Health Trials (Wellcome, MRC, DFID, and DOH), award number MR/R019274/1; UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement which is also part of the EDCTP2 programme supported by the European Union. Grant Reference MR/K012126/1.

Abstract Background Maternal, perinatal and neonatal mortality rates remain high in rural areas of developing countries. Most deliveries take place at home and care-seeking behaviour is often delayed. We report on a combined quantitative and qualitative study of care seeking obstacles and practices relating to perinatal illness in rural Makwanpur district, Nepal, with particular emphasis on consultation strategies. Methods The analysis included a survey of 8798 women who reported a birth in the previous two years [of whom 3557 reported illness in their pregnancy], on 30 case studies of perinatal morbidity and mortality, and on 43 focus group discussions with mothers, other family members and health workers. Results Early pregnancy was often concealed, preparation for birth was minimal and trained attendance at birth was uncommon. Family members were favoured attendants, particularly mothers-in-law. The most common recalled maternal complications were prolonged labour, postpartum haemorrhage and retained placenta. Neonatal death, though less definable, was often associated with cessation of suckling and shortness of breath. Many home-based care practices for maternal and neonatal illness were described. Self-medication was common. There were delays in recognising and acting on danger signs, and in seeking care beyond the household, in which the cultural requirement for maternal seclusion, and the perceived expense of care, played a part. Of the 760 women who sought care at a government facility, 70% took more than 12 hours from the decision to seek help to actual consultation. Consultation was primarily with traditional healers, who were key actors in the ascription of causation. Use of the government primary health care system was limited: the most common source of allopathic care was the district hospital. Conclusions Major obstacles to seeking care were: a limited capacity to recognise danger signs; the need to watch and wait; and an overwhelming preference to treat illness within the community. Safer motherhood and newborn care programmes in rural communities, must address both community and health facility care to have an impact on morbidity and mortality. The roles of community actors such as mothers-in-law, husbands, local healers and pharmacies, and increased access to properly trained birth attendants need to be addressed if delays in reaching health facilities are to be shortened.

Women and men's preferences for delivery services in rural EthiopiaNancy BeamAims: This study aims to determine the combination of facility-based delivery care attributes preferred by women and men; if gender differences exist in attribute preferences; and key demographic factors associated with attribute preferences.Background: Despite programs to promote facility-based delivery, which has been shown to decrease maternal and neonatal mortality, 80% of women in rural Ethiopia deliver at home without a skilled birth attendant. A review of the Ethiopian literature on factors associated with delivery location revealed several weaknesses in research methods that need to be addressed. First, research participants were almost exclusively women, although male partners often make decisions about delivery location. Second, most quantitative study designs are similar in content to the Ethiopian Demographic Health Survey, limiting the generation of new knowledge. Third, cultural practices identified in qualitative studies as barriers to facility-based delivery have not been included in quantitative studies. This study addressed these weaknesses by using discrete choice experiment methodology to elicit preferences for delivery service attributes, including support persons in the delivery room, staff training and attitude, cost, distance and transportation availability.Methods: A cross-sectional, discrete choice experiment was conducted in 109 randomly selected households in rural Ethiopia in September-October 2015. Women, who were pregnant or who had a child < 2 years old, and their male partners were interviewed. After completing a demographic questionnaire, male and female respondents were asked separately to choose between facility-based scenarios that reflected various attributes for delivering their next baby. Data were analyzed using a multilevel mixed-effects logistic regression model. Results: Both women and men preferred health facilities where medications and supplies were available, a support person was allowed in the delivery room, cost was low, and doctors performed the delivery. Women also valued free ambulance service, while men favored nearby facilities with friendly providers. Men are disproportionately involved in making household decisions, including decisions about whether their wives seek health care. Yet, men are often unaware of their partners' prenatal care attendance.Implications: The Ethiopian government and health facilities could increase facility births in rural areas by responding to families' delivery service preferences.

Abstract
Background
This paper explores the changing experience of giving birth in Cambodia over a 53-year period. During this time, Cambodian people experienced armed conflict, extreme privation, foreign invasion, and civil unrest.

Methods
An historical perspective was used to explore the changing place and nature of birth assistance given to Cambodian women between 1950 and 2013. Twenty-four life histories of poor and non-poor Cambodians aged 40–74 were gathered and analysed using a grounded thematic approach.

Results
In the early lives of the respondents, almost all births occurred at home and were assisted by Traditional Birth Attendants. In modern times, towards the end of their lives, the respondents' grand-children and great grand-children are almost universally born in institutions in which skilled birth attendants are available. Respondents recognise that this is partly due to the availability of modern health care facilities but also describe the process by which attitudes to institutional and homebirth changed over time. Interviews can also chart the increasing awareness of the risks of homebirth, somewhat influenced by the success of health education messages transmitted by public health authorities.

Conclusions
The life histories provide insight into the factors driving the underlying cultural change: a modernising supply side; improving transport and communications infrastructure. In addition, a step-change occurred in the aftermath of the conflict with significant influence of extensive contact with the Vietnamese recognised.

Trial registration
None.