Search

Most maternal and newborn deaths in low-income countries, including Rwanda, are attributable to preventable causes. Timely access to Basic Emergency Obstetric and Newborn Care (BEmONC) guidelines to support clinical decisions could lead to better obstetric care thus reduction of maternal and newborn deaths. Besides, innovative methods such as the usage and reference to healthcare guidelines using mobile devices (mhealth) may support clinical decision making. However, there is little evidence about mhealth that focuses on the clinical decision support process. This proposal aims to investigate the effect of the Safe Delivery mhealth Application(SDA) on nurses' and midwives' clinical decision making, so as to inform mhealth interventions for work in specific contexts. The study adopts a quasi-experimental design. Convergent parallel mixed – methods will be used to collect, analyze and interpret data. A pre-intervention assessment of the BEmONC outcomes: Apgar score and PPH progressions, and related knowledge, skills, and perceptions of nurses and midwives will be conducted. The intervention will take place in two district hospitals in Rwanda and entails the implementation of the SDA for six months. Six months' post-intervention, the effect of the SDA on BEmONC outcomes and the nurses' and midwives' knowledge and skills will be evaluated. [ABSTRACT FROM AUTHOR]

Childlessness has major psychological and social implications for affected persons, especially in settings where fertility is highly valued. While a number of studies have documented how childlessness is perceived in these societies and the multitude of adverse consequences suffered by affected individuals, studies have not made a clear distinction between voluntary and involuntary childlessness in these settings. Using focus-group discussions from three Nigerian communities, this study explores societal perception and acceptance of childlessness in Nigeria, focusing on both voluntary and involuntary childlessness. Findings show that not having children, whether voluntarily or not, contributes to a kind of invisibility and poverty in Nigeria. Regardless of the reason, voluntary childlessness evoked strong negative feelings among discussants. The study also shows the broad definition given to voluntary childlessness in Nigeria as including individuals that are childless because they chose to stay with an infertile partner and also those who could not have biological children and chose not to adopt. Childlessness is not yet embraced in Nigeria, where pronatalist culture is still very strong. However, the study noted a more tolerant attitude to involuntary childlessness, suggesting possible changes in perceptions of the condition. Policy and programme implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

Background: Although there are significant numbers of people displaced by war in Africa, very little is known about long-term changes in the fertility of refugees. Refugees of the Mozambican civil war (1977-1992) settled in many neighbouring countries, including South Africa. A large number of Mozambican refugees settled within the Agincourt sub-district, underpinned by a Health and Socio-demographic Surveillance Site (AHDSS), established in 1992, and have remained there. The AHDSS data provide a unique opportunity to study changes in fertility over time and the role that the fertility of self-settled refugee populations plays in the overall fertility level of the host community, a highly relevant factor in many areas of sub-Saharan Africa. Objectives: To examine the change in fertility of former Mozambican self-settled refugees over a period of 16 years and to compare the overall fertility and fertility patterns of Mozambicans to host South Africans. Methods: Prospective data from the AHDSS on births from 1993 to 2009 were used to compare fertility trends and patterns and to examine socio-economic factors that may be associated with fertility change. Results: There has been a sharp decline in fertility in the Mozambican population and convergence in fertility patterns of Mozambican and local South African women. The convergence of fertility patterns coincides with a convergence in other socio-economic factors. Conclusion: The fertility of Mozambicans has decreased significantly and Mozambicans are adopting the childbearing patterns of South African women. The decline in Mozambican fertility has occurred alongside socio-economic gains. There remains, however, high unemployment and endemic poverty in the area and fertility is not likely to decrease further without increased delivery of family planning to adolescents and increased education and job opportunities for women. [ABSTRACT FROM AUTHOR]