DOCSLIB.ORG

Experiences of a New Cadre of Midwives in Bangladesh: Findings from a Mixed Method Study Rashid U

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Experiences of a New Cadre of Midwives in Bangladesh: Findings from a Mixed Method Study Rashid U Zaman et al. Human Resources for Health (2020) 18:73 https://doi.org/10.1186/s12960-020-00505-8 RESEARCH Open Access Experiences of a new cadre of midwives in Bangladesh: findings from a mixed method study Rashid U. Zaman1* , Adiba Khaled2, Muhammod Abdus Sabur3, Shahidul Islam4, Shehlina Ahmed5, Joe Varghese6, Della Sherratt7 and Sophie Witter8 Abstract Background: Bangladesh did not have dedicated professional midwives in public sector health facilities until recently, when the country started a nation-wide programme to educate and deploy diploma midwives. The objective of the findings presented in this paper, which is part of a larger study, was to better understand the experience of the midwives of their education programme and first posting as a qualified midwife and to assess their midwifery knowledge and skills. Methods: We applied a mixed method approach, which included interviewing 329 midwives and conducting 6 focus group discussions with 43 midwives and midwifery students. Sampling weights were used to generate representative statistics for the entire cohort of the midwives deployed in the public sector health facilities. Results: Most of the midwives were satisfied with different dimensions of their education programme, with the exception of the level of exposure they had to the rural communities during their programme. Out of 329 midwives, 50% received tuition fee waivers, while 46% received funding for educational materials and 40% received free accommodation. The satisfaction with the various aspects of the current posting was high and nearly all midwives reported that a desire to work in the public sector in the long run. However, a significant proportion of the midwives expressed concerns with equipment, accommodation, transport and prospect of transfers. The scores on the knowledge test and self-reported skill levels were varied but reasonably high. Conclusion: While the midwives are highly motivated, satisfied with many aspects of their current jobs and have adequate knowledge and skills, there are some bottlenecks and concerns that, if unaddressed, may derail the success of this programme. To capture the career progress of these midwives, additional research, including a follow-up study with the same cohort of midwives, would be beneficial to this programme. Keywords: Bangladesh, Midwives, Health workforce, Health systems * Correspondence: [email protected] 1Health and Nutrition Portfolio, Oxford Policy Management, Level 3, Clarendon House, 52 Cornmarket Street, Oxford OX1 3HJ, United Kingdom Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Zaman et al. Human Resources for Health (2020) 18:73 Page 2 of 12 Background attendants (SBA), in addition to the questions of compe- There is significant global evidence that women and tency in fulfilling the definition of a SBA and the low up- their newborns receiving midwife-led care are less likely take of services by the community [14, 15] to develop complications and that scaling up profes- In 2010, at the 65th General Assembly of the United sional midwifery can avert maternal deaths, stillbirths Nations the Prime Minister of Bangladesh announced and neonatal deaths [1, 2]. Research also shows that producing and deploying dedicated midwives as an at- midwifery is associated with improved health outcomes tempt to have a permanent solution to the shortage of and efficient use of resources when it is provided by SBAs [4, 6]. Subsequently, the curriculum and the regu- midwives who are well-educated, trained, licensed, regu- latory frameworks for the diploma midwifery education lated and integrated into a health system with effective and mentorship programme were developed with sup- teamwork, referral mechanisms and sufficient resources port from the development partners [16, 17]. The cur- [3]. However, in 2014, only 4 out of 73 high-burden riculum has been designed to incorporate general countries (countries with 92% of global maternal and courses (Science and English), foundation courses (such neonatal mortality) had a midwifery workforce that was as anatomy and pharmacology) and professional courses adequate to meet the needs and there is a consensus that (from newborn complexities to maternity experience) more midwives are needed to improve maternal and [18]. In September 2018, 55 education and training insti- newborn survival [4, 5]. Bangladesh is one of those tutes (38 government and 17 private) had 1565 available countries which lacked dedicated midwives in its health placements (975 government and 590 private) to pro- workforce [6–8]. duce diploma midwives, while the government created Various initiatives have been taken in Bangladesh over 2996 midwifery service posts in 1733 primary healthcare the last four decades to increase the number of health- facilities across the country. In 2018, MoHFW recruited care workers with the competencies to assist women and 1143 licensed midwives and deployed them in 342 health newborn to make pregnancy and childbirth safer. Histor- facilities (Personal communications, MoHFW and ically, the nursing colleges have attempted to integrate United Nations Population Fund (UNFPA)). and provide supplementary midwifery education to The objective of this paper, which is part of a larger nurses to produce nurse-midwives to work in health fa- study, was to better understand the experience of the cilities [9]. Community maternal and child health ser- midwives in their education programme and their first vices are provided mainly by family welfare visitors posting and to assess their knowledge and skill. (FWVs), who are trained in the country’s public health administration and training institutions, named family Methods welfare visitors’ training institutes (FWVTIs), under dir- Overall design ection of the Family Planning Directorate (FPD). There were two components in this mixed method re- In the 1980s, the Ministry of Health and Family Wel- search: focus group discussions (FGDs) and a survey of fare (MoHFW) provided a short training to traditional midwives. The tools were developed based on the Inter- birth attendants (TBAs) to produce more than 50,000 national Confederation of Midwives (ICM) Global Es- trained traditional birth attendants (TTBAs) to assist sential Competencies for Midwifery Practice statements women in their communities and supplement the work [19]. The survey included a knowledge and skills test. of the FWVs, especially in hard to reach areas. The The knowledge test tools were adapted from previous programme did not achieve its intended results as stud- studies and were based on clinical scenarios of antenatal ies have shown that the TTBAs continued to adhere to care (ANC), delivery care, postnatal care (PNC), new- their traditional practices [10, 11]. Similar initiatives of born care and family planning services [20]. The skills training TBAs have failed in other countries as well and were self-assessed for various clinical procedures. the World Health Organization has cautioned against plans to simplify and delegate tasks [12, 13]. In 2003 Sampling responding to the global call to provide all pregnant A total of 1143 midwives, including 985 obtaining dip- women with a skilled birth attendant and recognising loma from public and 158 from private institutes, were that vast numbers of women still gave birth outside of a deployed in government health facilities in August 2018. health facility, the MoHFW embarked on a programme Based on this, the study required a participation of 288 to provided 6 months training to community health midwives in order to obtain results accurate to within ± workers and produced around 13,000 community skilled 5% at the 95% confidence level and a prevalence of 50%. birth attendants (CSBA). Despite large investment in this Simple random sampling was used without any cluster- programme, the impact could not be established and ing, due to the distribution of the midwives, and there- there were confusions with their dual role of providing fore, the design effect was 1. Anticipating a response community health services and as skilled birth rate of 85% and likely levels of attrition in future follow- Zaman et al. Human Resources for Health (2020) 18:73 Page 3 of 12 up surveys, we over-sampled and reached out to 331 sample. We used descriptive statistics and tested statistical midwives for the quantitative research component. The significance using a two-sample test of proportions at 95% sample was representative for the entire cohort of the confidence, where p value of < 0.05 was considered statis- midwives who have joined the public service in the first tically significant. To understand the costs associated with two batches. The sample size was large enough to detect the education programme, Bangladeshi Taka (BDT) was some statistically significant differences between the key used as the currency in the questionnaire and an exchange groups of research interest. These include the type of rate of 1 Great Britain Pound (GBP) equals 110 BDT was the education institutes (public versus private) and the used as the exchange rate during the analysis.
Load more

Recommended publications
  • WHO Safe Childbirth Checklist Implementation Guide Improving the Quality of Facility-Based Delivery for Mothers and Newborns
    BACKGROUND AND OVERVIEW WHO Safe Childbirth Checklist Implementation Guide Improving the quality of facility-based delivery for mothers and newborns WHO SAFE CHILDBIRTH CHECKLIST IMPLEMENTATION GUIDE 1 WHO Library Cataloguing-in-Publication Data WHO safe childbirth checklist implementation guide: improving the quality of facility-based delivery for mothers and newborns. 1.Parturition. 2.Birthing Centers. 3.Perinatal Care. 4.Maternal Health Services. 5.Infant, Newborn. 6.Quality of Health Care. 7.Checklist. I.World Health Organization. ISBN 978 92 4 154945 5 (NLM classification: WQ 300) © World Health Organization 2015 All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications—whether for sale or for non-commercial distribution—should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organiza- tion concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned.
    [Show full text]
  • The Role of a Midwife in Assisted Reproductive Units
    Clinical Obstetrics, Gynecology and Reproductive Medicine Research Article ISSN: 2059-4828 The role of a midwife in assisted reproductive units O Tsonis1, F Gkrozou2*, V Siafaka3 and M Paschopoulos1 1Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Greece 2Department of Obstetrics and Gynaecology, university Hospitals of Birmingham, UK 3Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Greece Abstract Problem: The role of midwifery in Assisted Reproductive Units remains unclear. Background: Midwives are valuable health workers in every field or phase of women’s health. Their true value has been consistently demonstrated and regards mainly their function in labour. Infertility is a quite new territory in which a great deal of innovating approaches has been made through the years. Aim: The aim of this study is to present the role of midwifery in Assisted Reproductive Units based on scientific data Methods: For this review 3 (three) major search engines were included MEDLINE, PubMed and EMBASE focusing on the role of midwives in the assisted reproductive units. Findings: It seems that midwives have three distinct roles, when it comes to emotional management of the infertile couple, being the representative of the infertile couple and also, performing assisted reproductive techniques in some cases. Their psychomedical support is profound and, in this review, we try to research their potential role in the assisted reproductive units. Discussion: In the literature, only few scientific articles have been conducted in search of the role of Midwifery in Infertility. Their importance is once again undeniable and further research needs to be conducted in order to increase their adequate participation into this medical field.
    [Show full text]
  • Out of Institution Birth Packet
    Out of Institution Birth Packet Revised 6/2021 511-1-3-05. Registration of Out of Institution Births 1. In any case where a birth occurs outside a hospital, or other recognized medical facility, without medical attendance and the birth certificate is filed by someone other than a health care provider, additional evidence in support of the facts of birth shall be completed and filed in the presence of the local Vital Records registrar in the county where the birth occurred. A birth certificate for a birth which occurs outside a recognized medical institution shall only be filed upon personal presentation of the following evidence by the individual(s) filing the certificate: (a) Proof of pregnancy: 1. Prenatal records; or 2. Statement from a physician or other licensed health care provider who is qualified to determine pregnancy; or 3. Prenatal blood analysis or positive pregnancy test results from a laboratory. (b) Proof of the mother’s residence on the date of the out of institution birth: 1. A valid driver’s license, or a state-issued identification card, which includes the mother’s current residence on the face of the license or card; or 2. A rent receipt which includes the mother’s name and address, and the name, address, and signature of the mother’s landlord. 3. A utility bill (e.g. electric bill, phone bill, or water bill) showing the address at child’s birth. (c) A copy of a bank statement showing the address at child’s birth. 2. An identifying document, with photograph, for the individual(s) personally presenting the evidence required to file the certificate.
    [Show full text]
  • Experiences of Transition to Motherhood Among Pregnant Women Following Assisted Reproductive Technology: a Systematic Review Protocol of Qualitative Evidence
    SYSTEMATIC REVIEW PROTOCOL Experiences of transition to motherhood among pregnant women following assisted reproductive technology: a systematic review protocol of qualitative evidence 1,2 1,2 1,2 1,2 1,2 Kunie Maehara Hiroko Iwata Mai Kosaka Kayoko Kimura Emi Mori 1Graduate School of Nursing, Chiba University, Chiba, Japan, 2The Chiba University Centre for Evidence Based Practice: a Joanna Briggs Institute Affiliated Group ABSTRACT Objective: This systematic review aims to identify and synthesize available qualitative evidence related to the experiences of transition to motherhood during pregnancy in women who conceived through assisted reproductive technology (ART). Introduction: Women who conceived through ART experience pregnancy-specific anxiety and paradoxical feelings, and face unique challenges in their identity transition to motherhood. It is important for healthcare professionals working with these women to understand the context and complexity of this special path to parenthood, including the emotional adaptation to pregnancy following ART. A qualitative systematic review can provide the best available evidence to inform development of nursing interventions to meet the needs of pregnant women after ART. Inclusion criteria: This review will consider any qualitative research data from empirical studies published from 1992–2019 in English or Japanese that described experiences of transition to motherhood during pregnancy in women who conceived with ART. Methods: This review will follow the JBI approach for qualitative systematic reviews. Databases that will be searched for published and unpublished studies include MEDLINE, CINAHL, PsycINFO, ProQuest Health & Medical Collection, Google Scholar and Open Access Theses and Dissertations (in English), and Ichushi-Web, CiNii and the Institutional Repositories Database (in Japanese).
    [Show full text]
  • The Factors Affecting Amniocentesis Decision by Pregnant Women in the Risk Group and the Influence of Consultant
    A L J O A T U N R I N R A E L P Original Article P L E R A Perinatal Journal 2019;27(1):6–13 I N N R A U T A L J O ©2019 Perinatal Medicine Foundation The factors affecting amniocentesis decision by pregnant women in the risk group and the influence of consultant Kanay Yararbafl1 İD , Ayflegül Kuflkucu2 İD 1Department of Medical Genetics, Faculty of Medicine, Ac›badem Mehmet Ali Ayd›nlar University, Istanbul, Turkey 2Department of Medical Genetics, Faculty of Medicine, Yeditepe University, Istanbul, Turkey Abstract Özet: Risk grubundaki gebelerin amniyosentez karar› almas›ndaki faktörler ve genetik dan›flman›n etkisi Objective: The most frequent goal for prenatal diagnosis is to Amaç: Do¤um öncesi tan›da günümüzde en s›k amaçlanan hedef detect pregnancies with Down syndrome. Since karyotyping, which Down sendromlu gebelikleri tespit etmektir. Tan›da alt›n standart is the golden standard for the diagnosis, has not been replaced with yöntem olan karyotiplemenin yerini henüz non-invaziv bir yön- a non-invasive method, pregnant women in the risk group should tem dolduramad›¤›ndan, CVS, amniyosentez gibi bir yöntem için choose the method such as CVS and amniocentesis. Therefore, risk alt›ndaki gebelerin seçimi gereklidir. Bu amaçla giriflimsel ol- screening tests are performed by non-invasive method, and preg- mayan yöntemlerle tarama testleri yap›lmakta, riskli gebelere ge- nant women under risk are provided genetic consultation and the netik dan›flma verilerek invaziv giriflim karar› aileye b›rak›lmakta- family is expected to make a decision for invasive procedure.
    [Show full text]
  • Iutzi, Masters Thesis 1 EVALUATION of A
    EVALUATION OF A TRADITIONAL BIRTH ATTENDANT AND COMMUNITY HEALTH LEADER TRAINING AND MENTORING PROGRAM: MATAGALPA, NICARAGUA Cassie J. Iutzi A thesis submitted in partial fulfillment of the requirements for the degree of Masters in Public Health University of Washington June 2013 Committee: Wendy Johnson Christopher Dodd Program Authorized to Offer Degree: Global Health Iutzi, Masters Thesis 1 Abstract Evidence strongly shows that the risk of childbirth is best mitigated through giving birth at or near a health institution with emergency obstetrical services and receiving regular prenatal visits. These interventions have been shown to improve maternal morbidity and mortality. Many under-resourced areas of the world continue to have difficulty connecting poor rural women to these services. In Matagalpa, Nicaragua a pioneering project, “Destrezas para Salvar Vidas,” was implemented in August 2011 to provide training and mentorship to the traditional birth attendants and community health leaders to connect pregnant women in rural communities with the formal health sector. This project was evaluated at the one-year point through tests of knowledge both before and after an initial one-week training, records of activities conducted by participants, and interviews with program participants and mentors. The aggregate test scores of participants’ knowledge during the initial week of training increased from an average score of 59.5% to 79.9% (differences 21.4%, p<0.001). Of the pregnant women in contact with program participants, 93% delivered at an institution, compared to 81% of all pregnant women in Matagalpa. Participants performed an average of 51 home visits each over the year. Reciprocal trust and communication increased between community participants and health sector workers.
    [Show full text]
  • Statement on Unassisted Birth Attended by a Doula
    Statement On Unassisted Birth Attended by a Doula _______________________________________________________ Definition Unassisted childbirth – the process of intentionally giving birth without the assistance of a medical or professional birth attendant – is a decision made by a very small percentage of parents. DONA International certified and member doulas provide physical, informational and emotional support. Any type of medical or clinical assistance is outside the scope of practice agreed upon by DONA International certified and member doulas. DONA International opines herein on the considerations a doula must make when accepting clients planning an unassisted birth. Introduction Unassisted childbirth (UC) refers to the process of intentionally giving birth without the assistance of a medical or professional birth attendant. UC is also sometimes referred to as free birth, DIY (do-it-yourself) birth, unhindered birth and couples birth. In response to the recent growth in interest over UC, several national medical societies, including the Society of Obstetricians and Gynaecologists of Canadai, the American College of Obstetricians and Gynecologistsii, and the Royal Australian and New Zealand College of Obstetricians and Gynaecologistsiii, have issued strongly worded public statements warning against the practice. Professional midwives' associations, including the Royal College of Midwivesiv and the American College of Nurse-Midwivesv also caution against UC. Those who promote UCvi claim the practice offers mothers-to-be a natural way of welcoming their child into the world, free from drugs, machinery and medical intervention. They also note that UC allows a woman to listen to her body's signals rather than coaching from an outsider. The women who are choosing UC may do so because they do not feel supported and respected in the obstetrical care facilities available in their areas, or they are unable to afford or obtain home midwifery or physician support, which is more in line with their philosophies.
    [Show full text]
  • Midwifery: a Career for Men in Nursing
    Midwifery: A career for men in nursing It may not be a common path men take, but how many male midwives are there? By Deanna Pilkenton, RN, CNM, MSN, and Mavis N. Schorn, RN, CNM, PHD(C) Every year, faculty at Vanderbilt University School of there are so few men in this profession. In fact, these Nursing reviews applications to the school’s nurse- conversations often lead to the unanimous sentiment midwifery program. The applicants’ diversity is always that men shouldn’t be in this specialty at all. Scanning of interest. A wide spectrum of age is common. A pleas- the web and reviewing blog discussions on this topic ant surprise has been the gradual improvement in the confirms that it’s a controversial idea, even among Eethnic and racial diversity of applicants. Nevertheless, midwives themselves. male applicants are still rare. It’s common knowledge that the profession of nurs- Many people wonder if there’s such thing as a male ing is female dominated, and the challenges and com- midwife. There are male midwives; there just aren’t plexities of this have been explored at length. many of them. When the subject of men in midwifery is Midwifery, however, may be one of the most exclusive- discussed, it usually conjures up perplexed looks. The ly and disproportionately female specialties in the field very idea of men in midwifery can create quite a stir, of nursing and it’s time to acknowledge the presence of and most laypeople don’t perceive it as strange that male midwives, the challenges they face, and the posi- www.meninnursingjournal.com February 2008 l Men in Nursing 29 tive attributes they bring to the pro- 1697, is credited with innovations fession.
    [Show full text]
  • Fetal Heart Rate Monitoring This Document Should Be Read in Conjunction with the Disclaimer
    King Edward Memorial Hospital Obstetrics & Gynaecology CLINICAL PRACTICE GUIDELINE Fetal heart rate monitoring This document should be read in conjunction with the Disclaimer This guideline must be read in conjunction with the Department of Health WA Mandatory Policy: MP 0076/18: Cardiotocography Monitoring Policy. The following Clinical Guideline complies with the Cardiotocography Monitoring Standard. Contents General requirements ........................................................................... 2 Indications for performing a cardiotocograph (CTG) ............................................... 2 Review, interpretation and signing of traces ........................................................... 4 Education and Fetal Surveillance Education Program (FSEP) practitioner levels ... 4 Storage ................................................................................................................... 4 Antenatal fetal heart rate (FHR) monitoring ........................................ 5 Key points ............................................................................................................... 5 Procedure ............................................................................................................... 5 Documentation ........................................................................................................ 5 Monitoring and additional information ..................................................................... 6 Escalation of care- antenatal ..................................................................................
    [Show full text]
  • Pregnancy Intention and Utilization of Maternal And
    Jurnal Kesehatan Reproduksi, 9(1), 2018: 27-36 DOI: 10.22435/kespro.v9i1.891.27-36 PREGNANCY INTENTION AND UTILIZATION OF MATERNAL AND CHILD HEALTH CARE SERVICES IN INDONESIA Ika Saptarini1,2,*, Diahhadi Setyonaluri1 1Faculty of Economic and Business, University of Indonesia 2National Institute of Health Research and Development, Ministry of Health, Indonesia Submitted 31 May 2018; reviewed 3 June 2018; approved 30 June 2018 Abstrak Latar belakang: Antenatal care, persalinan oleh tenaga kesehatan, postnatal care serta imunisasi lengkap membantu meningkatkan kesehatan ibu dan anak. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan antara perencanaan kehamilan dan pemanfaatan pelayanan kesehatan ibu dan anak. Metode: Penelitian ini menggunakan data dari Survei Kesehatan Demografi Indonesia 2012. Empat model regresi digunakan untuk mengidentifikasi hubungan antara perencanaan kehamilan dan pemanfaatan pelayanan kesehatan ibu dan anak. Hasil: Lebih dari seperlima (25,5%) responden menerima kelima jenis perawatan ibu dan anak. Lima belas persen wanita melaporkan bahwa kehamilan terakhir mereka tidak diinginkan. Perencanaan kehamilan berhubungan secara bermakna dengan penggunaan antenatal care yang memadai (OR: 0,53, 95% CI, 0,46-0,60), pemanfaatan antenatal care dan persalinan oleh tenaga kesehatan (OR: 0,62, 95% CI, 0,55-0,71), pemanfaatan antenatal care, persalinan oleh tenaga kesehatan dan postnatal care ( OR: 0,82, 95% CI, 0,72-0,93), namun tidak berhubungan secara signifikan dengan pemanfaatan antenatal care, persalinan oleh tenaga kesehatan, postnatal care hingga imunisasi lengkap (OR: 1,06, 95% CI, 0,91-1,22) setelah dikontrol menggunakan variabel sosiodemografi dan faktor obstetrik. Kesimpulan: Intervensi diperlukan untuk mengurangi kehamilan yang tidak diinginkan seperti meningkatkan akses ke layanan keluarga berencana.
    [Show full text]
  • Comprehensive Counseling for Reproductive Health—Participant’S Handbook © 2003 Engenderhealth
    From Comprehensive Counseling for Reproductive Health—Participant’s Handbook © 2003 EngenderHealth Appendix C Maternal Health Care Resource Materials Counseling duringMaternal Health Care 207 Phases of Counseling for PregnantWomen and Families 210 Postpartum Counseling Approaches for the Customer, Family, and Community 210 EngenderHealth Sexual and Reproductive Health Counseling—Participant's Handbook 205 AppendixC Counseling during Maternal Health Care Antenatal Counseling Approaches for the Customer, Family, and Community Some information and counseling is targeted to the pregnant woman individually for her per- sonal knowledge and behavioral change ("customerapproach"). Other information needs to be delivered to important decision-making family members, like the husband or mother-in-law, as well as to the pregnant woman, for effective implementation ("family approach"). In addition, such messagesare to be delivered to all strata of the communityto raise awareness and cooper- ation ("community approach"). Customer Approach: Information for the Pregnant Woman Diet during Pregnancy • From the daily normal diet list, eat an extra handful of food at every meal or eat one addi- tional meal every day. Additional food should include fruits and vegetables and foods rich in iron, such as beans, fish, meat, liver, kidney, eggs, and dark green, leafy vegetables. Drink plenty of clean (boiled) water. Rest and Activities • Rest after lunch and sleep at least six to eight hours at night. • Avoid long and tiresome journeys and avoid work that requires prolonged periods of stand- ing or sitting (i.e., more than four to five hours). • Make regular antenatal care visits to the health clinic. • Besides routine checkups, come to the health clinic at any time during the pregnancyor post- delivery periodif you feel unwell.
    [Show full text]
  • Introduction Aim Methodology Methodology TBA Interview
    Introduction Traditional Birth Attendants Traditional birth attendants (TBA) play a major role in and Their Role in the the delivery of healthcare services to women Delivery of Healthcare Their practice has continued to exist despite the availability of medical facilities such as clinics and Services to Women in hospitals Apam, Ghana It is important to understand the role that TBAs continue to play in the current healthcare environment. By: Elena Gore, MPH 2014 GE/NMF Scholar Medical University of South Carolina Mentor: Dr. Akye Essuman Aim Methodology To understand: Qualitative interviews with a convenience sample of 10 The scope of practice of TBAs TBAs in the Gomoa West District of Ghana TBAs’ current relationships with the local hospitals and Interviews ranged from 40 min to 1 hour 5 min clinics 4 (out of 7) qualitative interviews with trained midwives TBAs’ knowledge of the limits of their scope of practice of the Apam Hospital The healthcare community’s perceptions and attitudes Approx 10 min each towards TBAs 1 interview with Apam Hospital Medical Superintendent Approx 18 min Methodology Methodology TBA Interview Questions Midwife/physician interview Scope of practice How did you become a birth attendant? Who are your patients? questions What services do you offer? Perception of role of TBAs Relationship with hospital/clinics What do you think is the role of TBAs in the delivery of What relationship do you have with the hospital/clinic? healthcare services to women? Do you feel comfortable sending patients to
    [Show full text]