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Background/Aims: Globally, there are three pathways to become a midwife: midwifery post nursing, direct entry midwifery and integrated nursing and midwifery. There is limited knowledge on the effectiveness of pre-service midwifery education. The aim of this study was to describe and compare midwifery students' confidence in intrapartum skills and associated factors such as type and level of education. Methods: A multi-country cross-sectional study was conducted, where midwifery students were approached in the final months of their education programme. Data were collected using a questionnaire, based on the basic skills by the International Confederation of Midwives. Intrapartum care comprised 40 skills. Results: In total, 1407 midwifery students from seven sub-Saharan countries responded. The 40 skills were grouped into six domains; three related to care during the first and second stage of labour and three related to care during the third stage of labour. Sex and age were significantly associated with confidence, with female students and those 26–35 years old having higher levels of confidence. Students enrolled in a direct entry programme were more confident than other students in all three domains of care related to the first and second stage of labour. Conclusions: Direct entry was found to result in higher confidence for midwifery students than post nursing programmes or integrated programmes. Further research is needed for evaluation of competence. [ABSTRACT FROM AUTHOR]

Background: Maternal mortality and morbidity rates remain high in sub-Saharan Africa, yet with appropriate management, these rates could be reduced significantly. Midwifery training to improve the management of women during intrapartum period is often lacking, calling for innovative training methods in midwifery clinical care. Aims: To develop and evaluate a game, aimed at the prevention and management of the main causes of maternal morbidity and mortality. Methods: In collaboration with the Lugina Africa Midwives Research Network (LAMRN), the authors developed an educational board game and field tested the final version in Kenya, Tanzania and Malawi with midwives (n=56) and student midwives (n=32). Findings: Qualitative and quantitative evaluation demonstrated that the game was well liked for its ease of use, acceptable appearance and relevance to practice. Conclusions: The board game, named 'Crisis', has potential to influence practice; however, further research is required to assess its ability to improve outcomes. [ABSTRACT FROM AUTHOR]

Background: The prevalence of blood-borne pathogens, including HIV and hepatitis B and C, remains high in sub-Saharan Africa. Nurses and midwives are therefore at high risk for occupational transmission. Aims: To examine the prevalence of sharps injuries and other work-related risks among nurses and midwives. Methods: Nurses and midwives (n=712) in sub-Saharan Africa completed an anonymous questionnaire. Generalised estimating questions were used to analyse the data. Findings: Nurses and midwives who made home visits, engaged in direct care, were called in to work 'off-hours', and performed needle-related tasks ≥15 times/day were more likely to have sharps injuries (all P<0.05). Among those injured, only 64.2% reported their injuries appropriately. Among those who reported, only 61.5% were tested for HIV or hepatitis B and C, and only 28.2% received HIV post-exposure prophylaxis. Conclusions: Future efforts should focus on optimising work schedules, reducing unnecessary needle-related tasks, introducing safety engineered needles and improving post-exposure prophylaxis. [ABSTRACT FROM AUTHOR]

Giving birth is considered a normal event in a woman's life and one embedded in all cultures. It is generally accepted, regardless of culture or country of residence, that almost all women have some degree of anxiety during pregnancy. Reasons for anxiety may change during the pregnancy, for example, during the first trimester this may be specifically related to the ongoing pregnancy and miscarriage. During the second trimester this might be replaced by thoughts on fetal abnormality, and finally in the third trimester, anxiety regarding labour and pain. For some women, anxiety surrounding the pregnancy and birth can spiral into what has become known as fear of birth. The reasons for fear of birth are multi-factorial, encompassing psychological, social, and spiritual dimensions. Therefore, it is conceivable that birth in different cultures and countries may result in different experiences for women. This short discussion paper observes fear of birth in women from England and Kenya, asking the question: Are the differences that different after all? [ABSTRACT FROM AUTHOR]

Background: The majority of Kenya's population lives in rural areas with limited access to higher education. A blended ‘eBSc Nursing’ programme was created to bridge the gap. Aims: To explore users' views on the effectiveness of the pilot blended e-learning BSc Nursing programme in Kenya. Methods: A mixed methods approach was used in data collection. All students in the pilot eBsc Nursing programme were sampled and focus group discussions were held with lecturers and mentors. Findings: The majority of the pilot cohort (84%) were satisfied with the quality of training and the inherent flexibility of the model. Offline e-learning sites were only accessible to 64% of learners. Limited ICT skills among lecturers were a concern to 46% of the respondents. Trainers were of the opinion that the in-service eLearners either performed at equal to or better than conventionally-trained BscN students. Conclusions: There was a positive user response to the eBscN upgrading programme. Learner support systems required more strengthening to deliver on desired objectives. [ABSTRACT FROM AUTHOR]

Background: Birth preparedness is a strategy that has been found to ensure readiness for birth and prevent obstetric delays. It is hindered, however, by lack of knowledge, cultural taboos and lack of finances. Methods: This was a descriptive cross-sectional study, which aimed to establish the knowledge and practice of birth preparedness among antenatal mothers attending public health facilities in Migori County, Kenya. The study used both quantitative and qualitative methods. Data were collected through interviewer-administered questionnaires and focus group discussions. A total of 389 women were interviewed in four randomly selected facilities. Data analysis was carried out and P-values reported. Content analysis was conducted for the qualitative data and reported in form of narration. Findings: The knowledge on birth preparedness was low (53%) and the respondents were unaware of its key concepts. Marital status (P=0.003), residence (P=<0.001), unemployment (P=0.001) and the partner's level of education (P=0.001) affected birth preparedness knowledge. Favourable birth preparedness practices were seen in 56% of participants. Marital status (P=0.05), residence (P=<0.001), partner's education, and health facility (P=<0.001) affected birth preparedness. Conclusions: More emphasis should be made on the key concepts of birth preparedness during health education. Effort should also be made to improve its practice. [ABSTRACT FROM AUTHOR]

Background: Obstetric fistula is caused by prolonged obstructed labour, and affects about 1% of women in Kenya. Although early treatment is recommended, women live with the condition for many years and endure physical, psychological and social suffering. Aims: To document the experiences of women with fistula illness. Methods: Using grounded theory methodology, narratives focusing on labour and childbirth were obtained from a purposive sample of 121 patients with obstetric fistula in 3 hospitals in Kenya. Narratives were analysed using a three-dimensional framework: Interaction, Continuity and Place. Findings: Six emergent themes predicting occurrence of fistula were identified. These were: people who assisted the labour process (interaction); time spent in labour; birth outcomes for baby (continuity); mode of delivery; referral of women in obstructed labour; and place of delivery. Conclusions: These findings have potential to inform the development of a midwifery early screening intervention for fistula care in Kenya. [ABSTRACT FROM AUTHOR]

Background: Previous research has demonstrated the likely benefits of partograph use in low-resourced settings. However, the challenges of completing a partograph are also reported. The objective of this study was to examine students' views and experiences of partograph use to gain understanding of the realities of using this tool in the labour ward. Methods: In a qualitative study, 51 student nurses, undertaking their maternity placement at a university in Nairobi, Kenya, participated in five focus group discussions. Data were audio recorded, transcribed verbatim and analysed thematically. Results: Four main themes emerged from the analyses: challenges to 'doing the right thing'; theory-practice disconnectedness; negative role models; and retrospective recording. Conclusions: The results provide insight into the challenges faced by students when practising in the labour ward environment. A more effective approach to partograph training and implementation should be adopted to support students. However, student midwife training is unlikely to be implemented into practice unless the qualified team supports their learning. Given that the partograph had little status in the labour ward, change may only happen when senior health professionals (midwives and obstetricians) lead by example. Further research is required to explore the views of obstetricians and qualified midwives on partograph use. Appropriate implementation strategies also warrant further investigation. [ABSTRACT FROM AUTHOR]

The HIV/AIDS epidemic is affecting the sub-Saharan Africa more severely than other parts of the world, with 60% of global AIDS cases occurring in Africa. This article explores predisposing factors for teenage pregnancy which have implications for the spread of HIV/AIDS and STIs among adolescents in Kenya. In a recent study in one district, four factors were found to be prominent in predisposing teenage pregnancy: having multiple partners, sex for money, seduction by teachers, and coercion by friends and relatives. In-depth interviews of a sub-group of the subjects revealed some issues that are of great concern in the context of the current efforts to combat the HIV/AIDS pandemic. Attention so far has been on creating awareness but risk behaviours in adolescents are common, with the attendant dangers of unintended pregnancy, HIV/AIDS and other STIs. This article seeks to highlight some of the factors that affect risky behaviours even in fully aware teenagers. It highlights a need for specific interventions beyond awareness creation. [ABSTRACT FROM AUTHOR]

The authors reflect on the programme The Lugina Africa Midwives Research Network named after the late Professor Helen Lugina. They said that the main objective of the programme is to promote the status of the midwives and to make suitable changes that will not only enhance clinical outcomes but also boost professional standing. The authors believe that the key element of the programme is the recognition of key research priorities that are vital to midwives.

The author reflects on the violence against women. He points out that sexual violence is a universal form of violence against women which is rampant worldwide but is seldom discussed in international security forums. He criticizes the countries that are short of appropriate prevention and response measures despite the eradication of all forms of violence against women and girls by the United Nations Security Council.