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1.
Xiaoning Liu Xiaoyan Zhou Duolao Wang 《International journal of gynaecology and obstetrics》2011,114(3):260-264
Objective
To explore maternal healthcare utilization in rural western China, and to analyze the socioeconomic and demographic determinants associated with use of maternal health services.Methods
Between July and August 2005, 14 112 women from 45 counties in 10 western provinces of China were enrolled in a cross-sectional study by a multi-stage probability sampling method. The women completed a structured questionnaire, and a 2-level logistic regression model was used to examine the data.Results
The proportion of women who had prenatal care was 95%. The average number of prenatal visits was 4.94. The proportion of women who had more than 4 prenatal visits was 52.9%, and 66.9% of these had their first prenatal visit within 12 weeks of gestation. The hospital delivery rate was 86.3%. The frequency of postnatal visits was 84.8%, and the average number of postnatal visits was 2.19. Han ethnicity, higher education, lower parity, higher wealth index, and lower altitude of county had a higher odds ratio for more than 4 prenatal visits, hospital delivery, and postnatal visits.Conclusion
Maternal healthcare utilization seems to be associated with socio-economic and regional factors. The Chinese government should focus on the supply, funding, and quality of maternity services in rural areas. 相似文献2.
Objective
To investigate the availability and quality of emergency obstetric care (EmOC) received by women in a rural Chinese province.Methods
The study was conducted in 7 rural counties and townships in Shanxi Province, China. Data sources included interviews with 7 hospital leaders, 5 maternal and child health workers, and 7 obstetricians; 118 records of complicated delivery were audited, 21 Maternal and Child Health Annual Reports analyzed, and observations conducted of facilities and advanced labor care.Results
The number of comprehensive EmOC facilities was adequate in all counties. Three counties had fewer basic EmOC facilities than recommended and only 4 counties reached the recommended level. Most of the existing township hospitals did not provide birthing services. All the county hospitals could perform cesarean deliveries with rates from 6.8%-40.8%. The management of complications was not evidence-based. For example, women with pre-eclampsia and eclampsia were given too little magnesium sulfate; women were not closely monitored for hemorrhage after birth and the partograph was used incorrectly with consequences for obstructed labor.Conclusion
Basic EmOC facilities are not adequate and township hospitals should be upgraded to provide birthing services. The quality of EmOC is poor and needs improvement. 相似文献3.
Kun Huang Fangbiao Tao Brian Faragher Joanna Raven Rachel Tolhurst Shenglan Tang Nynke van den Broek 《Midwifery》2013
Objective
to assess population-based caesarean section (CS) rates in rural China and explore determinants and reasons for choosing a CS.Design
cross-sectional study, quantitative and qualitative methods, statistical modelling.Setting
two rural counties in Anhui province, China.Participants
(a) household survey participants: 2326 women who gave birth in the two counties from January 2005 to December 2006; (b) qualitative study participants: health providers at township and village level and maternal health-care providers (N=58).Measurements and findings
the household survey were conducted among 2326 women, collecting data on socio-economic and health status and utilisation of maternal health services. Eleven Focus Group Discussions with health-care providers and users to explore perceptions surrounding CS.the CS rate in the two areas were 46.0% and 64.7%. There were complex and different interactions among social-economic and clinical determinants associated with differences in CS rates. The main determinants that emerged were maternal age, maternal education, yearly income, primiparity, uptake of antenatal care and recorded obstetric complications with complex and differing interactions for each county. Maternal fear of pain, worry about mothers' and infants' safety, not satisfied with doctors' competences and physicians' low confidence in vaginal delivery, and absence of a strong midwifery cadre together contributed to final determination of CS.Key conclusions
the CS rates were extremely high in the two counties in rural China. Maternal socio-economic, clinic characteristics and health providers' preference contributed together to the high rates of CS.Implications for practice
evidence-based knowledge and methods to reduce unnecessary CS should be communicated to medical professionals and women. Greater comprehensive attention needs to be paid to a complex pattern of medical, socio-cultural, political and economic contexts of maternity care. 相似文献4.
Amorim Francisco A Junqueira Vasconcellos de Oliveira SM Barbosa da Silva FM Bick D Gonzalez Riesco ML 《Midwifery》2011,(6):e254-e259
Objective
to identify the severity and prevalence of perineal pain during the post partum in-patient period and associated obstetric, maternal and newborn baby factors following birth.Design
cross-sectional study.Setting
a postnatal ward of a hospital in São Paulo, Brazil.Participants
303 postnatal women.Measurements
interviews and perineal assessment were conducted to evaluate the perineal outcomes (trauma and pain). Data on maternal characteristics and infant anthropometric variables were collected.Results
among all women, 80.5% had perineal trauma (60.7% had episiotomy) and 18.5% reported perineal pain. The mean pain intensity score was 4.8±1.9 on the visual analogue scale. Only maternal age (ORa=1.08) and performance of episiotomy (ORa=3.80) remained as independent predictors of perineal pain in the final logistic regression model.Key conclusions
perineal pain in the immediate postnatal period was highly associated with older maternal age and use of episiotomy, although the overall reporting of perineal pain was low.Implications for practice
perineal pain following vaginal birth is associated with interventions during labour as well as with maternal characteristics. Despite the negative impact on a woman's daily activities, perineal pain following birth is neglected by care givers and usually not reported by women who may consider it to be a normal outcome of giving birth. Care providers need to ensure all interventions during labour and birth are informed by evidence of benefit and that barriers to implementation of evidence are addressed. Further work is needed to obtain the views of women in Brazil on their health and well-being following birth. 相似文献5.
Background
Although antenatal care coverage in Tanzania is high, worrying gaps exist in terms of its quality and ability to prevent, diagnose or treat complications. Moreover, much less is known about the utilisation of postnatal care, by which we mean the care of mother and baby that begins one hour after the delivery until six weeks after childbirth. We describe the perspectives and experiences of women and health care providers on the use of antenatal and postnatal services.Methods
From March 2007 to January 2008, we conducted in-depth interviews with health care providers and village based informants in 8 villages of Lindi Rural and Tandahimba districts in southern Tanzania. Eight focus group discussions were also conducted with women who had babies younger than one year and pregnant women. The discussion guide included information about timing of antenatal and postnatal services, perceptions of the rationale and importance of antenatal and postnatal care, barriers to utilisation and suggestions for improvement.Results
Women were generally positive about both antenatal and postnatal care. Among common reasons mentioned for late initiation of antenatal care was to avoid having to make several visits to the clinic. Other concerns included fear of encountering wild animals on the way to the clinic as well as lack of money. Fear of caesarean section was reported as a factor hindering intrapartum care-seeking from hospitals. Despite the perceived benefits of postnatal care for children, there was a total lack of postnatal care for the mothers. Shortages of staff, equipment and supplies were common complaints in the community.Conclusion
Efforts to improve antenatal and postnatal care should focus on addressing geographical and economic access while striving to make services more culturally sensitive. Antenatal and postnatal care can offer important opportunities for linking the health system and the community by encouraging women to deliver with a skilled attendant. Addressing staff shortages through expanding training opportunities and incentives to health care providers and developing postnatal care guidelines are key steps to improve maternal and newborn health. 相似文献6.
Irena Anna Frei MSc PhD RN Programme Director Rosemary Mander MSc PhD RGN SCM MTD Emeritus Professor of Midwifery 《Midwifery》2011,27(5):716-722
Objective
to consider the relationship between first-time mothers and care providers in an organisational context.Design
an ethnographic approach was used to study the views and behaviours of providers and recipients of postnatal care. Fieldwork involved mainly conversations or qualitative interviews and observation.Setting
a postnatal unit in a tertiary referral hospital in Switzerland.Participants
10 child-bearing women and the care providers assigned to them.Analysis
analysis of the data was organised using the women’s expectations of care and the maternity unit’s mission statement. Thematic analysis centred around two main themes: the experience of ‘being on a postnatal journey’ and ‘caring relationships’.Findings
the findings presented fall within the framework of the second theme. A caring relationship was established through ‘weaving the net’. This relationship was then maintained through ‘keeping the thread’. The relationship was eventually ended through ‘finishing off’.Key conclusions
the quality of the caring relationship between a woman and a care provider influences satisfaction with received care. It determines the extent to which women feel in control of their situation at discharge. Organisational and professional factors influence this relationship, which in turn can influence a nurse's level of job satisfaction.Implications for practice
changes in the provision of postnatal care may involve organisational as well as clinical interventions to ensure continuous and consistent care. 相似文献7.
Ren Z 《Midwifery》2011,(6):e260-e266
Objectives
to analyse and evaluate the antenatal care services and its quality so as to improve the antenatal care, and make it more available and cost-effective.Design
retrospective survey. A multistage sampling technique was used to select townships and villages.Setting
the four rural counties of a project in Ningxia Hui Autonomous Region in northwest China, where more than one half of the population was Hui ethnicity, the average hospital delivery rate was 47% in 2005, and the maternal mortality ratio was estimated to be higher than 65 deaths per 100,000 live births in 2005.Participants
five hundred and fifty-four mothers of children under the age of five were interviewed at home using a structured questionnaire between August and September in 2006. No mothers refused to take part in the survey.Measurements and findings
the percentage using antenatal care, the number of antenatal visits and the timing of the first antenatal visit during the pregnancy of the youngest child were analysed. 78.2% of the mothers had received antenatal care services, but only 12.9% had at least five antenatal visits and 35.2% had their initial visit in the first trimester. Only 9.0% whose first antenatal visit took place during the first trimester had at least five antenatal visits. Ethnicity was an important factor determining antenatal care use. Hui mothers had significantly lower odds ratios of obtaining antenatal care in the first trimester (OR=0.32, P<0.001) or having at least five antenatal visits (OR=0.11, P<0.001) than Han mothers.Key conclusions
the quality of the antenatal care which the women received was low. It is necessary to rethink the current model of antenatal care, and to develop and standardise a new model of antenatal care. 相似文献8.
Joanna Morrison Machhindra Basnet Bharat Budhathoki Dhruba Adhikari Kirti Tumbahangphe Dharma Manandhar Anthony Costello Nora Groce 《Midwifery》2014
Objective
there is little evidence about disabled women?s access to maternal and newborn health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and care seeking. Our study explores disabled women?s experiences of maternal and newborn care in rural Nepal.Design
we used a qualitative methodology, using semi-structured interviews.Setting
rural Makwanpur District of central Nepal.Participants
we purposively sampled married women with different impairments who had delivered a baby in the past 10 years from different topographical areas of the district. We also interviewed maternal health workers. We compared our findings with a recent qualitative study of non-disabled women in the same district to explore the differences between disabled and non-disabled women.Findings
married disabled women considered pregnancy and childbirth to be normal and preferred to deliver at home. Issues of quality, cost and lack of family support were as pertinent for disabled women as they were for their non-disabled peers. Health workers felt unprepared to meet the maternal health needs of disabled women.Key conclusions and implications for practice
integration of disability into existing Skilled Birth Attendant training curricula may improve maternal health care for disabled women. There is a need to monitor progress of interventions that encourage institutional delivery through the use of disaggregated data, to check that disabled women are benefiting equally in efforts to improve access to maternal health care. 相似文献9.
Background
four hospitals comprising a health network in Melbourne, Australia, implemented a range of initiatives aimed at enhancing women's experiences of postnatal maternity care.Objective
to compare women's views and experiences of early postnatal care before and after implementation of maternity enhancement initiatives.Design
‘before and after’ study design incorporating two postal surveys of recent mothers (baseline and post-implementation).Setting
four hospitals in Melbourne, Australia. Analysis of postnatal outcomes was confined to three hospitals where the initiatives were fully operational.Participants
1256 women participated in the baseline survey in 1999 (before implementing the initiative) and 1050 women responded to the post-implementation survey in 2001.Findings
the response to the 1999 baseline survey was 65.3% (1256/1922) and to the 2001 post-implementation survey 57.4% (1050/1829). Comparative analysis revealed a statistically significant improvement in overall ratings of hospital postnatal care; the level of advice and support received in relation to discharge and going home; the sensitivity of caregivers; and the proportion of women receiving domiciliary care after discharge. There was little change in the time women spent in hospital after birth between the two survey time-points. Over 90% of women reported one or more health problems in the first 3 months postpartum. The proportion of women reporting physical or emotional health problems between the two surveys did not change.Key conclusion
mainstream maternity care can be restructured to improve women's experiences of early postnatal care.Implications for practice
maternity service providers should consider a multi-faceted approach to reorientating postnatal services and improving women's experiences of care. Approaches worthy of consideration include attempts to ensure consistency and continuity of care through staffing arrangements, guidelines and protocols; an emphasis on planning for postnatal care during pregnancy; the use of evidence to inform both consumer information and advice and in the practice of caring; and skill-enhancement opportunities for care providers in managing postnatal issues and in effective communication. 相似文献10.
Miyako Kimura Yoshihiko Yamazaki Mieko Mochizuki Tomoko Omiya 《BMC pregnancy and childbirth》2010,10(1):1-12
Background
In Tanzania, more than 90% of all pregnant women attend antenatal care at least once and approximately 62% four times or more, yet less than five in ten receive skilled delivery care at available health units. We conducted a qualitative study in Ngorongoro district, Northern Tanzania, in order to gain an understanding of the health systems and socio-cultural factors underlying this divergent pattern of high use of antenatal services and low use of skilled delivery care. Specifically, the study examined beliefs and behaviors related to antenatal, labor, delivery and postnatal care among the Maasai and Watemi ethnic groups. The perspectives of health care providers and traditional birth attendants on childbirth and the factors determining where women deliver were also investigated.Methods
Twelve key informant interviews and fifteen focus group discussions were held with Maasai and Watemi women, traditional birth attendants, health care providers, and community members. Principles of the grounded theory approach were used to elicit and assess the various perspectives of each group of participants interviewed.Results
The Maasai and Watemi women's preferences for a home birth and lack of planning for delivery are reinforced by the failure of health care providers to consistently communicate the importance of skilled delivery and immediate post-partum care for all women during routine antenatal visits. Husbands typically serve as gatekeepers of women's reproductive health in the two groups - including decisions about where they will deliver- yet they are rarely encouraged to attend antenatal sessions. While husbands are encouraged to participate in programs to prevent maternal-to-child transmission of HIV, messages about the importance of skilled delivery care for all women are not given emphasis.Conclusions
Increasing coverage of skilled delivery care and achieving the full implementation of Tanzania's Focused Antenatal Care Package in Ngorongoro depends upon improved training and monitoring of health care providers, and greater family participation in antenatal care visits. 相似文献11.
How can maternity services be developed to effectively address maternal obesity? A qualitative study
Nicola Heslehurst BSc MSc PhD Lecturer in Research Helen Moore BSc MSc PhD Lecturer Judith Rankin BSc PhD Reader in Maternal & Perinatal Epidemiology Louisa J. Ells BSc PhD Obesity Lead John R. Wilkinson MD Director Carolyn D. Summberbell BSc Dip Dietetics PhD Professor in Human Nutrition/Principal 《Midwifery》2011,27(5):e170
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Background
Understanding the strategies that health care providers employ in order to invite men to participate in maternal health care is very vital especially in today's dynamic cultural environment. Effective utilization of such strategies is dependent on uncovering the salient issues that facilitate male participation in maternal health care. This paper examines and describes the strategies that were used by different health care facilities to invite husbands to participate in maternal health care in rural and urban settings of southern Malawi.Methods
The data was collected through in-depth interviews from sixteen of the twenty health care providers from five different health facilities in rural and urban settings of Malawi. The health facilities comprised two health centres, one district hospital, one mission hospital, one private hospital and one central hospital. A semi-structured interview guide was used to collect data from health care providers with the aim of understanding strategies they used to invite men to participate in maternal health care.Results
Four main strategies were used to invite men to participate in maternal health care. The strategies were; health care provider initiative, partner notification, couple initiative and community mobilization. The health care provider initiative and partner notification were at health facility level, while the couple initiative was at family level and community mobilization was at village (community) level. The community mobilization had three sub-themes namely; male peer initiative, use of incentives and community sensitization. The sustainability of each strategy to significantly influence behaviour change for male participation in maternal health care is discussed.Conclusion
Strategies to invite men to participate in maternal health care were at health facility, family and community levels. The couple strategy was most appropriate but was mostly used by educated and city residents. The male peer strategy was effective and sustainable at community level. There is need for creation of awareness in men so that they sustain their participation in maternal health care activities of their female partners even in the absence of incentives, coercion or invitation. 相似文献15.
Cheryl A. Moyer Philip B. Adongo Raymond A. Aborigo Abraham Hodgson Cyril M. Engmann 《Midwifery》2014
Objective
to explore community and health-care provider attitudes towards maltreatment during delivery in rural northern Ghana, and compare findings against The White Ribbon Alliance's seven fundamental rights of childbearing women.Design
a cross-sectional qualitative study using in-depth interviews and focus groups.Setting
the Kassena-Nankana District of rural northern Ghana between July and October 2010.Participants
128 community members, including mothers with newborn infants, grandmothers, household heads, compound heads, traditional healers, traditional birth attendants, and community leaders, as well as 13 formally trained health-care providers.Measurements and findings
7 focus groups and 43 individual interviews were conducted with community members, and 13 individual interviews were conducted with health-care providers. All interviews were transcribed verbatim and entered into NVivo 9.0 for analysis. Despite the majority of respondents reporting positive experiences, unprompted, maltreatment was brought up in 6 of 7 community focus groups, 14 of 43 community interviews, and 8 of 13 interviews with health-care providers. Respondents reported physical abuse, verbal abuse, neglect, and discrimination. One additional category of maltreatment identified was denial of traditional practices.Key conclusions
maltreatment was spontaneously described by all types of interview respondents in this community, suggesting that the problem is not uncommon and may dissuade some women from seeking facility delivery.Implications for practice
provider outreach in rural northern Ghana is necessary to address and correct the problem, ensuring that all women who arrive at a facility receive timely, professional, non-judgmental, high-quality delivery care. 相似文献16.
Tewabech Wereta Wuleta Betemariam Ali Mehryar Karim Nebreed Fesseha Zemichael Selamawit Dagnew Abera Wanboru Antoinette Bhattacharya 《BMC pregnancy and childbirth》2018,18(1):364
Background
Maternal and newborn health care intervention coverage has increased in many low-income countries over the last decade, yet poor quality of care remains a challenge, limiting health gains. The World Health Organization envisions community engagement as a critical component of health care delivery systems to ensure quality services, responsive to community needs. Aligned with this, a Participatory Community Quality Improvement (PCQI) strategy was introduced in Ethiopia, in 14 of 91 rural woredas (districts) where the Last Ten Kilometers Project (L10 K) Platform activities were supporting national Basic Emergency Obstetric and Newborn Care (BEmONC) strengthening strategies. This paper examines the effects of the PCQI strategy in improving maternal and newborn care behaviors, and providers’ and households’ practices.Methods
PCQI engages communities in identifying barriers to access and quality of services, and developing, implementing and monitoring solutions. Thirty-four intervention kebeles (communities), which included the L10 K Platform, BEmONC, and PCQI, and 82 comparison kebeles, which included the L10 K Platform and BEmONC, were visited in December 2010–January 2011 and again 48 months later. Twelve women with children aged 0 to 11 months were interviewed in each kebele. Propensity score matching was used to estimate the program’s average treatment effects (ATEs) on women’s care seeking behavior, providers’ service provision behavior and households’ newborn care practices.Results
The ATEs of PCQI were statistically significant (p?<?0.05) for two care seeking behaviors — four or more antenatal care (ANC) visits and institutional deliveries at 14% (95% CI: 6, 21) and 11% (95% CI: 4, 17), respectively — and one service provision behavior — complete ANC at 17% (95% CI: 11, 24). We found no evidence of an effect on remaining outcomes relating to household newborn care practices, and postnatal care performed by the provider.Conclusions
National BEmONC strengthening and government initiatives to improve access and quality of maternal and newborn health services, together with L10 K Platform activities, appeared to work better for some care practices where communities were engaged in the PCQI strategy. Additional research with more robust measure of impact and cost-effectiveness analysis would be useful to establish effectiveness for a wider set of outcomes.17.
18.
Sharan M Ahmed S Ghebrehiwet M Rogo K 《International journal of gynaecology and obstetrics》2011,115(3):244-250
Objective
To examine the quality of the maternal health system in Eritrea to understand system deficiencies and its relevance to maternal mortality within the context of Millennium Development Goal (MDG) 5.Methods
A sample of 118 health facilities was surveyed. Data were collected on 5 dimensions of health system quality: availability; accessibility; management; infrastructure; and process indicators. Data on the causes of hospital admissions for obstetric patients and maternal deaths were extracted from medical records.Results
Eritrea has only 11 comprehensive emergency obstetric care (CEmOC) facilities, all of which are grossly understaffed. There is considerable pressure on the infrastructure and health providers at hospitals. Compliance with clinical care standards and availability of supplies were optimal. As a result, the case fatality rate of 0.65% was low. In total, 45.6% of obstetric admissions and 19.5% of maternal deaths were attributed to abortion complications.Conclusion
In Eritrea, critical gaps in the health system—especially those related to human resources—will impede progress toward MDG 5, and it will not be possible to reduce maternal mortality without addressing the high burden of abortion. 相似文献19.
Objective
timely initiation of antenatal care (i.e. within the first trimester) is associated with attendance of the full recommended regimen of antenatal visits. This study assessed social and behavioural factors that affect timely initiation of antenatal care in Kigali, Rwanda from the perspective of health facility professionals.Design
health facility professionals involved in antenatal care provision were interviewed on their perceptions about untimely initiation of antenatal care based on open-ended questions. These one-on-one interviews were tape recorded and transcribed for analysis.Setting
interviews were performed in June and July 2011 at Muhima Health Center in Kigali, Rwanda.Participants
17 health facility professionals with a wide range of skills and experience levels were selected from the 36 total staff members of Muhima Health Center based on their participation in and knowledge of antenatal care.Measurements and findings
inductive content analysis was used to group responses from these qualitative interviews with the goal of creating a conceptual map around barriers and solutions for untimely antenatal care. Qualitative responses were coded to identify the most common themes and sub-themes following a consensus methodology. The health-care professional interviews identified five themes as barriers to timely initiation of antenatal care: (1) lack of knowledge; (2) experience with previous births; (3) issues with male partners not willing/able to attend the clinic; (4) poverty or problems with health insurance; and (5) antenatal care culture. As potential solutions to these hurdles, the following themes were identified: (1) maternal/community education and sensitisation; (2) incentives to attend antenatal care visits; and (3) tracking the content and recommended number of antenatal visits.Key conclusions
qualitative results indicate that behavioural contextual interventions may help overcome antenatal care barriers. The Rwandan Government and health facilities should work together with target communities to improve antenatal care compliance, taking into account the solutions suggested by the health facility professional interviews.Implications for practice
study findings suggest that there are specific solutions to increase adherence with timely initiation of antenatal care in Rwanda, including education and sensitisation, modifying couples' HIV testing policies, addressing costs of antenatal care, and tracking the number of recommended antenatal visits. 相似文献20.