Background: Occupational stress is a global and complex phenomenon, and workers in developing countries can be affected by it (International Labour Organisation 2001). Staff within maternity settings have been identified as being at risk of suffering from stress, resulting in adverse health outcomes (Evenden and Sharpe, 2002). However, MWAs’ perceptions of stress have not been captured and are not reflected in the literature. Purpose: The aim of this study was to explore MWAs’ perceptions of occupational stress, possible cause(s), the impact and support available and the coping methods they adopted within maternity care settings (hospital) in Nigeria. Methodology: This study adopted a qualitative methodology. Husserl’s (1962) phenomenological approach was chosen as it enabled the researcher to collect rich, in-depth, descriptive accounts of the MWAs’ perceptions of the phenomenon under study through the use of semi-structured interviews. Findings: The major sources of stress for MWAs included work overload, long working hours, staff shortages, work exploitation and intensification and lack of support from senior staff. The stress levels MWAs experienced impacted on their health and well-being and resulted in related behavioural and physical reactions. Conclusion: This study confirmed that MWAs were exposed to similar stress factors experienced by other health workers and reported in the research literature. Additionally, it demonstrated the need for more qualitative studies to explore the perceptions of occupational stress among under-represented groups of healthcare workers. Importantly, this study created an opportunity to explore the experience of dedicated women facing challenging employment practices in hospital settings in Nigeria. Equally, it gave a voice to these unrecognised, almost invisible women, who were the MWAs that played a key role within the maternity services.

The Ministry of Health (MOH) and its partners are determined to prevent and manage preventable causes of morbidity and mortality in mothers, neonates and children. In the last decade, special emphasis has been given to increasing the number of health facilities that provide maternal and child health services (MNCH), huge production of skilled birth attendants (SBAs), and equipping the health facilities to improve the utilisation of quality services. This study investigated the community perspectives of health service utilisation and proposes a framework for improving the utilisation of the available SBA and postnatal care (PNC).The purpose of this study was to develop a framework for the utilisation of skilled care for delivery and postnatal care by women of childbearing age (15-45). The study used a Sequential explanatory Mixed Methods Approach to investigate the utilisation of SBA and PNC in a district in Ethiopia. The Delphi Technique helped to solicit input from maternal health care experts on the development of a Framework for utilisation of SBA and PNC. This study utilised the Anderson Health Utilisation Model. In the study, 79.8% and 248 (71.5%) of the women who delivered within 12 months prior to this study received ANC and skilled birth attendance respectively from SBA. Fifty five (15.8%) mothers and 131 (38%) babies received Postnatal care from SBA with in 45 days after delivery. The study further found that women who can read and write and were educated are more likely to utilise SBA and receive quality health care services. The study showed that certain factors such as disrespecting service users, abusing service users’ lack of trust on the SBA by service users, religion and superstition contribute negatively to the use of SBAs. None of the predisposing, enabling and need factors predicted the use of SBA for PNC by the mothers. Nevertheless, through the focus group discussions (FGDs) and individual interviews (IDI), it was revealed that there was a widespread knowledge and perception gaps in the community related to the importance of postnatal period and PNC. Religious sanctification also have imperative role in hampering PNC service use by the mothers. The Health care workers (HCWs) also lacked the keenness and orientation to provide the service. Babies born from families with monthly income equal to 500 or above USD were more likely to use PNC within 45 days. There was a widespread misconception in the community that Babies do not need PNC before 45 days of birth except for vaccination purpose. To examine their role in health service utilisation for SBA and PNC, researches can integrate social support and social network to the Andersen’s health- ervice utilisation model. A framework for utilisation of SBA and PNC is proposed. The researcher recommends developing an utilisation tool kit that specifies the detail operationalisation of the framework. / Health Studies / D. Litt. et Phil. (Health Studies)

Background: Occupational stress is a global and complex phenomenon, and workers in developing countries can be affected by it (International Labour Organisation 2001). Staff within maternity settings have been identified as being at risk of suffering from stress, resulting in adverse health outcomes (Evenden and Sharpe, 2002). However, MWAs’ perceptions of stress have not been captured and are not reflected in the literature. Purpose: The aim of this study was to explore MWAs’ perceptions of occupational stress, possible cause(s), the impact and support available and the coping methods they adopted within maternity care settings (hospital) in Nigeria. Methodology: This study adopted a qualitative methodology. Husserl’s (1962) phenomenological approach was chosen as it enabled the researcher to collect rich, in-depth, descriptive accounts of the MWAs’ perceptions of the phenomenon under study through the use of semi-structured interviews. Findings: The major sources of stress for MWAs included work overload, long working hours, staff shortages, work exploitation and intensification and lack of support from senior staff. The stress levels MWAs experienced impacted on their health and well-being and resulted in related behavioural and physical reactions. Conclusion: This study confirmed that MWAs were exposed to similar stress factors experienced by other health workers and reported in the research literature. Additionally, it demonstrated the need for more qualitative studies to explore the perceptions of occupational stress among under-represented groups of healthcare workers. Importantly, this study created an opportunity to explore the experience of dedicated women facing challenging employment practices in hospital settings in Nigeria. Equally, it gave a voice to these unrecognised, almost invisible women, who were the MWAs that played a key role within the maternity services.

Infant mortality (IM) incidence in health facility systems during or after infant delivery is substantially high in Nigeria. In this quantitative, cross-sectional study, the effects of skill birth attendants (SBAs), prenatal care, and providers of prenatal care on IM in health facility delivery centers were examined. The Mosley and Chen theoretical framework informed this study and was used to explain the relationship between SBAs, prenatal care, and providers of prenatal care and IM. One hundred and sixty infant deaths were examined among mothers who used an SBA versus those who did not, mothers who had prenatal care versus those without, and mothers who received prenatal care from a health facility versus traditional providers. The 2014 verbal and social autopsy secondary data set was analyzed using binary logistic regression technique. There was no significant difference in risk of IM between mothers who had SBA during infant delivery in health facility compared to those without SBA during delivery. Mothers who received prenatal care had a significant higher risk of infant death in a health facility compared to those that did not receive prenatal care. Mothers who received prenatal care from traditional providers did not have a statistically significant risk of IM compared to mothers who received prenatal care from a health facility. The findings could have positive social change implications by encouraging multilevel public health stakeholders to support and promote the use of health surveillance in understanding the barriers and challenges of health facility delivery practices, prenatal care, and use of SBA as it relates to IM to facilitate policy change in maternal and infant care practices in Nigeria.

The purpose of this study was to determine factors influencing skilled delivery service utilisation in order to develop strategies to improve utilisation of skilled birth attendance service in North West Ethiopia. The objectives were to explore and describe the perceptions and experiences of the community regarding skilled utilisation of the birth attendance service; explore reasons for non-utilisation of skilled birth attendance service; asses the health system experience of provision of skilled birth attendance service; and formulate strategies to improve utilisation of skilled birth attendance service. The study employed a qualitative, descriptive, and explorative research design to address the research questions formulated by the researcher. The study used focus group discussion guide to obtain information from pregnant women and women who gave birth recently. Furthermore, the study used an interview guide to gather information from health extension workers, midwives, health centre heads, district health office technical experts and heads. It also employed and inductive thematic analysis approach to analyse the qualitative data. The study further used the Atlas ti version 7 for the data analysis. The steps followed for the analysis were data immersion, coding, displaying, reduction, and interpretation. Overall, nine themes emerged from the analysis of the data. Consequently, the researcher used the findings of the study to develop strategies to improve the utilisation of skilled birth attendance service. / Health Studies / D. Litt. et Phil. (Health Studies)

Text in English, with Annexures in English and Amharic / Annexure 5 and Annexure 7 "Questionnaire for qualitative study" in English and Amharic / The Ministry of Health (MOH) and its partners are determined to prevent and manage preventable causes of morbidity and mortality in mothers, neonates and children. In the last decade, special emphasis has been given to increasing the number of health facilities that provide maternal and child health services (MNCH), huge production of skilled birth attendants (SBAs), and equipping the health facilities to improve the utilisation of quality services. This study investigated the community perspectives of health service utilisation and proposes a framework for improving the utilisation of the available SBA and postnatal care (PNC). PURPOSE The purpose of this study was to develop a framework for the utilisation of skilled care for delivery and postnatal care by women of childbearing age (15-45). METHODOLOGY The study used a Sequential explanatory Mixed Methods Approach to investigate the utilisation of SBA and PNC in a district in Ethiopia. The Delphi Technique helped to solicit input from maternal health care experts on the development of a Framework for utilisation of SBA and PNC. This study utilised the Anderson Health Utilisation Model. RESULTS In the study, 79.8% of the women who delivered within 12 months prior to this study received ANC from SBA. Baby care and PNC for the mother and baby received from SBA were at 248 (71.5%), 55 (15.8%), and 131 (38%) respectively. The study further found that women who can read and write and were educated are more likely to utilise SBA and receive quality health care services. The study showed that certain factors such as disrespecting service users, abusing service users’ lack of trust on the SBA by service users, religion and superstition contribute negatively to the use of SBAs. None of the predisposing, enabling and need factors predicted the use of SBA for PNC by the mothers. Nevertheless, through the focus group discussions (FGDs) and individual interviews (IDI), it was revealed that there was a widespread knowledge and perception gaps in the community related to the importance of postnatal period and PNC. Religious sanctification also have imperative role in hampering PNC service use by the mothers. The Health care workers (HCWs) also lacked the keenness and orientation to provide the service. Babies born from families with monthly income equal to 500 or above USD were more likely to use PNC within 45 days. There was a widespread misconception in the community that Babies do not need PNC before 45 days of birth except for vaccination purpose. CONCLUSION To examine their role in health service utilisation for SBA and PNC, researches can integrate social support and social network to the Andersen’s health-service utilisation model. A framework for utilisation of SBA and PNC is proposed. The researcher recommends developing an utilisation tool kit that specifies the detail operationalisation of the framework. / Health Studies / D. Litt. et Phil. (Health Studies)