Search

Purpose: Globally, the COVID-19 pandemic has brought attention to the impact of negative patient outcomes on healthcare providers. In Ghana, obstetric providers regularly face maternal and neonatal mortality, yet limited research has focused on provision of mental health support for these providers. This study sought to understand how obstetric providers viewed seeking mental health support after poor clinical outcomes, with a focus on the role of mental health stigma.Patients and Methods: Participants were 52 obstetric providers (20 obstetrician/gynecologists and 32 midwives) at two tertiary care hospitals in Ghana. Five focus groups, led by a trained facilitator and lasting approximately two hours, were conducted to explore provider experiences and perceptions of support following poor maternal and neonatal outcomes. Discussions were audiotaped and transcribed verbatim, then analyzed qualitatively using grounded theory methodology.Results: Most participants (84.3%, N=43) were finished with training, and 46.2% (N=24) had been in practice more than 10 years. Emerging themes included pervasive stigma associated with seeking mental health care after experiencing poor clinical outcomes, which was derived from two overlapping dimensions. First, societal-level stigma resulted from a cultural norm to keep emotions hidden, and the perception that psychiatry is equated with severe mental illness. Second, provider-level stigma resulted from the belief that healthcare workers should not have mental health problems, a perception that mental health care is acceptable for patients but not for providers, and a fear about lack of confidentiality. Despite many providers acknowledging negative mental health impacts following poor clinical outcomes, these additive layers of stigma limited their willingness to engage in formal mental health care.Conclusion: This study demonstrates that stigma creates significant barriers to acceptance of mental health support among obstetric providers. Interventions to support providers will need to respect provider concerns without reinforcing the stigma associated with seeking mental health care. [ABSTRACT FROM AUTHOR]

Background: While group antenatal care (ANC) has been delivered and studied in high-income countries for over a decade, it has only recently been introduced as an alternative to individual care in sub-Saharan Africa. Although the experimental design of the studies from high-resource countries have been scientifically rigorous, findings cannot be generalized to low-resource countries with low literacy rates and high rates of maternal and newborn morbidity and mortality. The Group Antenatal Care Delivery Project (GRAND) is a collaboration between the University of Michigan in the United States and the Dodowa Health Research Centre in Ghana. GRAND is a 5-year, cluster randomized controlled trial (RCT). Our intervention--group ANC--consists of grouping women by similar gestational ages of pregnancy into small groups at the first ANC visit. They then meet with the same group and the same midwife at the recommended intervals for care. Objective: This study aims to improve health literacy, increase birth preparedness and complication readiness, and optimize maternal and newborn outcomes among women attending ANC at seven rural health facilities in the Eastern Region of Ghana. Methods: Quantitative data will be collected at four time points using a secure web application for data collection and a database management tool. Data will be analyzed on an intention-to-treat basis to test the differences between the two arms: women randomized to group-based ANC and women randomized to routine individual ANC. We will conduct a process evaluation concurrently to identify and document patient, provider, and system barriers and facilitators to program implementation. Results: The study was funded in September 2018. Recruitment and enrollment of participants and data collection started in July 2019. In November 2021, we completed participant enrollment in the study (n=1761), and we completed data collection at the third trimester in May 2022 (n=1284). Data collection at the additional three time points is ongoing: 6 weeks postpartum, 6 months postpartum, and 1 year postpartum. Conclusions: This study is significant and timely because it is among the first RCTs to be conducted to examine the effects of group ANC among low-literacy and nonliterate participants. Our findings have the potential to impact how clinical care is delivered to low-literacy populations, both globally and domestically, to improve maternal and newborn outcomes. [ABSTRACT FROM AUTHOR]

While overall neonatal mortality rates are improving in Ghana, the Ashanti Region has the highest mortality rate in the country. The clinical causes of newborn deaths are well known, yet local beliefs about illness aetiology, cause of death and care-seeking are less well understood. This exploratory qualitative study sought to understand how community members perceive and respond to neonatal illness. Researchers worked with public health nurses, community health nurses and opinion leaders in the Ashanti Region of Ghana to identify women who had lost a baby, either during pregnancy or after delivery. In-depth interviews and focus group discussions were conducted about knowledge, attitudes and beliefs regarding neonatal mortality. The transcripts were coded and analysed using NVivo 10.0. A total of 100 participants were interviewed: 24% reported a previous stillbirth; 37% reported a previous miscarriage; and 45% reported losing a baby who was born alive. Nine per cent experienced more than one type of loss. The local illness of asram - an illness with supernatural causes - was cited as a leading cause of death of newborns. Every participant reported hearing of, knowing someone, or having a child who had become ill with asram. While women gave varying information on symptoms, method of contraction and treatment, all participants agreed that asram was common and often fatal. Four overarching themes emerged: 1) asram is not a hospital sickness; 2) there is both a fear of traditional healers as a source of asram, as well as a reliance upon them to cure asram; 3) there are rural/urban differences in perceptions of asram; and 4) asram may serve as a mechanism of social control for pregnant women and new mothers. Local beliefs and practices must be better understood and incorporated into health education campaigns if neonatal mortality is to be reduced in Ghana. [ABSTRACT FROM AUTHOR]

Introduction: A wide gap in knowledge exists about the factors associated with newborn care in rural Zambia. In this year of the nurse and midwife, the purpose of this article is to provide transcultural researchers with an example of how Bronfenbrenner's Ecological Systems Theory (EST) can be used to guide an exploration of the cultural practices, knowledge, and beliefs of newborn care and health-seeking behaviors in rural Zambia. Methodology: Based on the EST, maternal knowledge represents the microsystem while family and community members embody the mesosystem. Health care organization denotes the exosystem with culture representing the macrosystem and health policy the chronosystem. Results: Numerous implications for transcultural nursing practice emerged from this adaptation of the ecological systems approach. Findings reveal a maternal dualism faced by Zambian mothers as they navigate the complex interplay between cultural newborn care practices and evidence-based newborn care promoted by the health care system. Discussion: Based on our proposed operationalization of the EST for a transcultural nursing study, the EST can be applied globally, further validating the theory. [ABSTRACT FROM AUTHOR]

Objective: To explore pregnancy outcomes at a referral hospital in rural western Uganda.Methods: A retrospective study was undertaken using data for all deliveries at Virika Hospital, Fort Portal, Uganda, between July 1, 2009, and October 22, 2011. A detailed review of delivery logs was conducted. Categories were created for obstetric risk factors (e.g. grand multipara, history of hypertension), maternal delivery complications (e.g. eclampsia, hemorrhage), and neonatal complications (e.g. fetal distress, birth defects).Results: Overall, 4883 deliveries were included. Of the 517 neonates who did not survive, 430 (83.2%) had been stillborn. After controlling for parity, gestational age, obstetric risk factors, and neonatal complications, risk factors for stillbirth included maternal delivery complications (risk ratio [RR] 3.32, 95% confidence interval [CI] 2.34-4.71; P<0.001) and living 51-100km from the hospital (RR 3.37, 95% CI 2.41-4.74; P<0.001). Risk factors for neonatal death included neonatal complications (RR 5.79, 95% CI 2.49-13.46; P=0.001) and maternal delivery complications (RR 3.17, 95% CI 1.47-6.82; P=0.003).Conclusion: Qualified providers need to be deployed to rural areas of Uganda to facilitate the prompt identification and management of pregnancy, delivery, and neonatal complications. [ABSTRACT FROM AUTHOR]

Maternity waiting homes, usually located in rural, low-resource settings, may increase access to skilled care during delivery and ultimately improve maternal-newborn outcomes. Although there are studies exploring maternity waiting homes in rural settings, little is known about interest in and viability of maternity waiting home use in urban environments. The purpose of this study was to conduct a qualitative needs assessment about establishing a maternity waiting home as a health system strengthening intervention in urban Kumasi, Ghana. We conducted an exploratory qualitative needs assessment about the community beliefs, values, and interest in maternity waiting homes as a health system strengthening intervention to improve maternal-newborn outcomes. A semi-structured interview guide was based on several domains from the Tailored Implementation for Chronic Diseases checklist. Latent content analysis was used to analyze the data and elicit themes. Data were collected in late 2019 in urban Kumasi, Ghana near a large government hospital and in the community. Using purposive and snowball sampling, individual interviews (n = 14) were conducted with community stakeholders and key decision makers, and 8 focus group discussions were conducted with women of childbearing age (n = 38) and family members (n = 38). Three major overarching themes were identified: (1) Urban maternity waiting homes are perceived to provide a unique benefit; (2) Urban maternity waiting homes are anticipated to be successful, and; (3) barriers to establishing an urban maternity waiting home may prevent prompt action. There is community buy-in and engagement for building and using urban maternity waiting homes but they are not able to identify concrete sources of funding to pay for the physical construction of the home. There is overwhelming support for building and using maternity waiting homes as a health system strengthening intervention to improve maternal-newborn outcomes in urban Kumasi, Ghana. Participants perceive maternity waiting homes as providing unique benefits to improve maternal-newborn health and anticipate that maternity waiting homes would be a successful intervention. Participants identified financial barriers to establishing an urban maternity waiting home that might prevent timely implementation. Findings highlight interest in mobilizing resources to establish maternity waiting homes in an urban setting. To overcome potential barriers to roll-out, attention needs to be focused on securing funding to build an urban maternity waiting home in Kumasi. As health policy shifts towards women delivering in larger-volume facilities typically located in big cities, there is potential for maternity waiting homes to be implemented in urban settings throughout sub-Saharan Africa to maximize positive health outcomes. [ABSTRACT FROM AUTHOR]

Synopsis: Pregnant women in Ghana report skipping antenatal care and reconsidering facility delivery due to concerns about COVID‐19. [ABSTRACT FROM AUTHOR]

Many women blame themselves for the development of preeclampsia, and patients may benefit from an explicit discussion about the causes of preeclampsia with their healthcare provider. [ABSTRACT FROM AUTHOR]