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Association of Health Facility Delivery and Risk of Infant Mortality in NigeriaUkwu, Susan Adaku 01 January 2019 (has links)
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.
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Pre-hospital Barriers to Emergency Obstetric Care : Studies of Maternal Mortality and Near-miss in Bolivia and Guatemala / Barreras pre-hospitalarias para la atención obstétrica de emergencia : Estudios de mortalidad materna y morbilidad obstétrica severa en Bolivia y GuatemalaRööst, Mattias January 2010 (has links)
Maternal mortality is a global health concern but inequalities in utilization of maternal health care are not clearly understood. Severe morbidity (near-miss) is receiving increased attention due to methodological difficulties in maternal mortality studies. The present thesis seeks to increase understanding of factors that impede utilization of emergency obstetric care (EmOC) in Bolivia and Guatemala. Studies I and IV employed qualitative interviews to explore the role of traditional birth attendants (TBAs) and the care-seeking behaviour of women who arrived at hospital with a near-miss complication. Studies II–III documented maternal mortality and near-miss morbidity at the hospital level and investigated the influence of socio-demographic factors and antenatal care (ANC) on near-miss upon arrival. The studies identified unfamiliarity with EmOC among TBAs and a lack of collaboration with formal care providers. A perception of being dissociated from the health care system and a mistrust of health care providers was common among near-miss women from disadvantaged social backgrounds. In the Bolivian setting, 187 maternal deaths per 100,000 live births and 50 cases of near-miss per 1000 were recorded. Causes of near-miss differed from those of maternal deaths. Most women with near-miss arrived at hospital in critical condition: severe preeclampsia, complications after childbirth at home and abortions were mostly encountered among them. Lack of ANC, low education, and rural residence were interactively associated with near-miss. ANC reduced socio-demographic differentials for near-miss. Complementing maternal mortality reviews with data on near-miss morbidity increases the understanding of priority needs and quality of maternal health care. Additionally, focusing on near-miss upon arrival was found useful in exploring pre-hospital barriers to EmOC. The findings identified subgroups of women who seemed especially vulnerable to pre-hospital barriers. They also underscored the need for initiatives to reduce the effect of social marginalization and to acknowledge the influential role of formal and informal care providers on the utilization of EmOC. / La mortalidad materna es un tema de inquietud global, sin embargo la comprensión de las desigualdades en la utilización de los servicios de salud materna es limitada. La morbilidad obstétrica severa (near-miss) está recibiendo creciente atención, producto de problemas metodológicos en los estudios de mortalidad materna. El objetivo de la presente tesis es aumentar la comprensión de factores que impiden la utilización de la atención obstétrica de emergencia en Bolivia y Guatemala. Los estudios I y IV usaron metodologías cualitativas en un esfuerzo por explorar el rol de las parteras tradicionales y las estrategias de las mujeres que arriban a los hospitales con una morbilidad obstétrica severa. Los estudios II–III documentaron la mortalidad materna y la morbilidad obstétrica severa en el marco hospitalario e investigaron el impacto de los factores socio-demográficos y el control prenatal en la llegada a los establecimientos de salud con complicaciones severas. Los estudios identificaron la falta de familiaridad con atención obstétrica de emergencia entre las parteras tradicionales y la falta de cooperación con los profesionales de salud formales. La sensación de estar distanciadas del sistema de salud y la desconfianza hacia los profesionales de la salud eran aspectos comunes entre las mujeres de sectores marginales con experiencias de complicaciones severas. En el contexto boliviano, 187 muertes maternas por cada 100,000 nacidos vivos y 50 casos de morbilidad obstétrica severa por cada 1000 fueron registradas. Las causas de la morbilidad obstétrica severa y las muertes maternas se distinguieron. La major parte de las mujeres con morbilidad obstétrica severa llegaron al hospital en condiciones críticas: preeclampsia severa, complicaciones después de partos domiciliarios y abortos eran causas más frecuentes en esta categoría. Combinaciones del bajo nivel de educación con la falta de controles prenatales o la residencia en zonas rurales fueron asociadas con la morbilidad obstétrica severa. El control prenatal redujo diferencias socio-demográficas en lo concerniente a la morbilidad obstétrica severa. La complementación de estudios de mortalidad materna con datos sobre morbilidad obstétrica severa aumenta la comprensión de las prioridades y de la calidad en la atención de la salud materna. Además, centrándose en la morbilidad obstétrica severa a la llegada al establicimiento de salud, ha sido útil para investigar las barreras pre-hospitalarias en relación a la atención de emergencia obstétrica. Los resultados permiten identificar categorías específicas de mujeres que parecen ser especialmente vulnerables a las barreras pre-hospitalarias. Los resultados, también subrayan la necesidad de iniciativas que reduzcan los efectos de la marginalización social, y que reconozcan el importante rol que tanto el personal de salud formal como informal cumplen en la utilización de los servicios de atención obstétrica de emergencia.
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"A fragile job" : Haitian traditional midwives (matwons) and the navigation of clinical, spiritual and social riskWatson, Annaliese 10 January 2013 (has links)
Haiti's political and economy history has led to a maternity care system that lies out of reach, geographically and financially, of most Haitians, resulting in excessively high maternal and infant mortality. The most common birth practitioners are homebirth midwives (matwòns), who attend roughly three-fourths of all births in Haiti (UNICEF), often without the benefit of emergency obstetric services. In this ethnographic study, I examine how matwòns experience caring for mothers and babies in extraordinarily low-resource and high-risk settings. This qualitative research employed a critical approach and feminist research methodologies. In in-depth interviews I asked participants to describe the challenges they find in their work. Then, in an innovative style of group meeting called Open Space, matwòns reflected on those challenges collectively, with an aim to ameliorate their current situations. Data analysis utilized a modified grounded theory approach, which allowed the matwòns' own narratives to determine the categories of analysis. Emergent themes resulting from this analysis revealed four main challenges in the work of matwòns, as well as matwòns' own strategies to mitigate those challenges. The four broad challenges, which include physical risks, social/spiritual threats, a lack of livelihood, and an obligation to practice, are experienced either as episodic hazards or chronic stressors. Matwòns' personal mitigation strategies centered on two broad approaches, providing protection, and offering service. However, the Open Space meeting created an opportunity for matwòns to strategize collective mitigation efforts through professional organization. Based on these findings, I argue that a more nuanced understanding of matwòns' experiences reveals their adaptive skills, which, in part, resemble Davis Floyd's (2007) notion of a postmodern midwife, and offers opportunities for mutual accommodation (Jordan 1997[1978]). Recommendations include support and advocacy for the self-organization of Haitian matwòns, as well as their greater inclusion in efforts to improve maternal and infant health outcomes in post-earthquake Haiti. / Graduation date: 2013
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Cultural practices regarding antenatal care among Zulu women in a selected area in GautengNgubeni, Nozipho Beatrice 02 1900 (has links)
The registered midwives are engaged in continuous health education lessons In antenatal visits,
discouraging antenatal clients from using hannful traditional and cultural practices in an
attempt to preserve pregnancy to tenn. Despite the registered midwives' efforts, the clients
continue to use hannful cultural methods, which are life-threatening to both the mother and
the foetus In utero. The prenatal clients perceive the registered midwives as not being
sensitive to their culture.
The results of this study revealed that health education in antenatal clinics should be
collaborative: that is, the people who have influence over the clients' pregnancy, like me
mother-in-law, the traditional practitioners, cUents and their family members, should be
involved by the midwives during the preparation of pregnancy lessons and health education
lessons on how to preserve pregnancy to term according to· scientifically proven methods. / Health Studies / M.A. (Health Studies)
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Factors that influence pregnant women's choice of delivery site in Mukono district, UgandaKkonde, Anthony 03 1900 (has links)
The purpose of this study was to analyse and describe the factors that influence the choice of site of delivery by pregnant women in Mukono district. By employing quantitative, non experimental research methods, 431 women were interviewed by using structured questionnaires. These women had either delivered at; home, TBA, private or public clinic and 72% had been delivered by skilled attendants. Choice of delivery site was influenced by the attitudes of health workers which were rather poor in public sites, proximity of site, attendance of antenatal clinic at a site, availability of supplies and drugs, plus level of care including emergency obstetric care. / Health Studies / M. A. (Public Health)
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Shattered lives : understanding obstetric fistula in UgandaRuder, Bonnie J. 28 November 2012 (has links)
In Uganda, there are an estimated 200,000 women suffering from obstetric fistula, with
1,900 new cases expected annually. These figures, combined with a persistently high
maternal mortality rate, have led to an international discourse that claims the solution to
improving maternal health outcomes is facility-based delivery with a skilled birth
attendant. In accord with this discourse, the Ugandan government criminalized traditional
birth attendants in 2010. In this study, I examine the lived experience of traditional birth
attendants and women who have suffered from an obstetric fistula in eastern Uganda.
Using data collected from open-ended, semi-structured interviews, focus groups, and
participant-observation, I describe the biocultural determinants of obstetric fistula. Based
on findings, I argue that although emergency obstetric care is critical to prevent obstetric
fistula in cases of obstructed labor, the criminalization of the locally constructed system
of care, TBAs, serves as yet another layer of structural violence in the lives of rural, poor
women. Results demonstrate how political-economic and cultural determinants of
obstetric fistula are minimized in favor of a Western prescribed, bio-medical solution,
which is heavily resource dependent. This solution is promoted through a political
economy of hope fueled by the obstetric imaginary, or the enthusiastic belief in Western-style
biomedical obstetric care’s ability to deliver positive health outcomes for women
and infants regardless of local context and constraints. Recommendations include
increased obstetric fistula treatment facilities with improved communication from
medical staff, decriminalization of traditional birth attendants and renewed training
programs, and engaging local populations in maternal health discourse to ensure
culturally competent programs. / Graduation date: 2013
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Cultural practices regarding antenatal care among Zulu women in a selected area in GautengNgubeni, Nozipho Beatrice 02 1900 (has links)
The registered midwives are engaged in continuous health education lessons In antenatal visits,
discouraging antenatal clients from using hannful traditional and cultural practices in an
attempt to preserve pregnancy to tenn. Despite the registered midwives' efforts, the clients
continue to use hannful cultural methods, which are life-threatening to both the mother and
the foetus In utero. The prenatal clients perceive the registered midwives as not being
sensitive to their culture.
The results of this study revealed that health education in antenatal clinics should be
collaborative: that is, the people who have influence over the clients' pregnancy, like me
mother-in-law, the traditional practitioners, cUents and their family members, should be
involved by the midwives during the preparation of pregnancy lessons and health education
lessons on how to preserve pregnancy to term according to· scientifically proven methods. / Health Studies / M.A. (Health Studies)
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Factors that influence pregnant women's choice of delivery site in Mukono district, UgandaKkonde, Anthony 03 1900 (has links)
The purpose of this study was to analyse and describe the factors that influence the choice of site of delivery by pregnant women in Mukono district. By employing quantitative, non experimental research methods, 431 women were interviewed by using structured questionnaires. These women had either delivered at; home, TBA, private or public clinic and 72% had been delivered by skilled attendants. Choice of delivery site was influenced by the attitudes of health workers which were rather poor in public sites, proximity of site, attendance of antenatal clinic at a site, availability of supplies and drugs, plus level of care including emergency obstetric care. / Health Studies / M. A. (Public Health)
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