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Competing Interests: We declare no competing interests.

Background: Because of the profound shortage of nurse and midwifery researchers in many African countries, identification of clinical nursing and midwifery research is of highest priority for the region to improve health outcomes., Objectives: The aim of this study was to gain consensus from experts on the priorities of clinical nursing and midwifery research in southern and eastern African countries., Method: A Delphi survey was conducted among experts in the region. Criteria for "expert" included (a) a professional nurse, (b) a bachelor's degree or higher in nursing, (c) published research, (d) affiliated with a school of nursing with at least a master's level nursing program, and/or (e) identified by the African core collaborators as an expert in the region. A list of candidates was identified through searches of published and gray literature and then vetted by core collaborators in Kenya, Malawi, and South Africa. Core collaborators held leadership roles in a nursing school and a doctoral degree in nursing, had conducted and published nursing research, and resided in an included country., Results: Two rounds of the Delphi survey were required to reach consensus. In total, 40 participants completed both rounds, and at least one participant from each country completed both rounds; 73% and 85% response rates were achieved for each round, respectively. Critical clinical research priorities were infectious disease/infection control and midwifery/maternal health topics. These included subtopics such as HIV/AIDS, tuberculosis, maternal health and mortality, infant mortality, and obstetrical emergencies. Many other topics were ranked as important including patient outcomes, noncommunicable diseases, and rural health., Discussion: Areas identified as research priorities were consistent with gaps identified in current literature. As evidenced by previous research, there is a lack of clinical nursing and midwifery research in these areas as well as nurses and midwives trained to conduct research; these priorities will help direct resources to the most essential research needs.

In this first paper in a series of four papers on midwifery, we aimed to examine, comprehensively and systematically, the contribution midwifery can make to the quality of care of women and infants globally, and the role of midwives and others in providing midwifery care. Drawing on international definitions and current practice, we mapped the scope of midwifery. We then developed a framework for quality maternal and newborn care using a mixed-methods approach including synthesis of findings from systematic reviews of women's views and experiences, effective practices, and maternal and newborn care providers. The framework differentiates between what care is provided and how and by whom it is provided, and describes the care and services that childbearing women and newborn infants need in all settings. We identified more than 50 short-term, medium-term, and long-term outcomes that could be improved by care within the scope of midwifery; reduced maternal and neonatal mortality and morbidity, reduced stillbirth and preterm birth, decreased number of unnecessary interventions, and improved psychosocial and public health outcomes. Midwifery was associated with more efficient use of resources and improved outcomes when provided by midwives who were educated, trained, licensed, and regulated. Our findings support a system-level shift from maternal and newborn care focused on identification and treatment of pathology for the minority to skilled care for all. This change includes preventive and supportive care that works to strengthen women's capabilities in the context of respectful relationships, is tailored to their needs, focuses on promotion of normal reproductive processes, and in which first-line management of complications and accessible emergency treatment are provided when needed. Midwifery is pivotal to this approach, which requires effective interdisciplinary teamwork and integration across facility and community settings. Future planning for maternal and newborn care systems can benefit from using the quality framework in planning workforce development and resource allocation., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The nursing and midwifery workforce is key to improving the performance of the health system overall. Health workforce shortages are significantly influenced by the productive capacity of health professions education institutions. Long-standing underinvestment in preservice nursing and midwifery education severely limits the capacity of institutions to educate nurses and midwives in sufficient numbers, and with the necessary clinical skills, for current and anticipated population health needs. The Nursing Education Partnership Initiative (NEPI) was established in 2011 by the U.S. President's Emergency Plan for AIDS Relief in response to key capacity-building challenges facing preservice nursing and midwifery education in Sub-Saharan Africa. NEPI has formed partnerships with governments and key stakeholders in Ethiopia, Democratic Republic of Congo, Lesotho, Malawi, and Zambia and supports 19 nursing and midwifery education institutions and 1 nursing council. NEPI has been informed by activities that strengthen education systems, institutions, and organizations as well as faculty capacity building. Ministry of health-led advisory groups were established to provide strategic direction and oversight for the work, fostering intersectoral dialogue and ensuring country ownership and sustainability. Three illustrative examples of innovations at the system, institution, and workforce levels describe approaches for country ownership, for addressing the shortage of highly qualified faculty, and for remedying the inadequate teaching and learning infrastructure.

Aim: This paper is a report of a study to develop and evaluate a childbirth educational programme for Malawian women., Background: Providing parent education is integral to the midwife's role. Malawian midwives face a challenge in fulfilling this role, with no existing childbirth education programme to facilitate this process., Method: A mixed method approach was used for this three-phase study. In Phase 1, childbirth information needs of Malawian women were determined from literature and interviews with midwives. In Phase 2, a structured childbirth education programme was developed. In Phase 3, a quasi-experimental design using sequential sampling was conducted to evaluate the education programme. Participants were pregnant women who attended antenatal clinics in 2002, with 104 in the control group and 105 in the intervention group. Changes in childbirth knowledge were determined over a 6-week period., Findings: The childbirth education programme included information, teaching strategies and a schedule for implementation for content relevant to the antenatal, labour and birth and postnatal time periods. Results revealed no significant difference in knowledge in the control group between pretest and post-test scores. For the intervention group, however, an overall significant increase in knowledge across all time periods was demonstrated (P < 0.01)., Conclusion: A childbirth education programme, developed for the Malawian context, was associated with important increases in maternal knowledge about antenatal, labour and birth and postnatal topics. The findings have implications for midwives in other developing countries and offer an example of a midwifery-led initiative to provide formal childbirth education to these vulnerable women.

Purpose The purpose of this study was to examine women's evaluation of postpartum care services (postpartum clinical assessments, health education, and midwife kindness) received from midwives prior to discharge in rural health facilities, and to examine husband-and-wife-farmer dyads' reasons for their decisions to return or not return for 1-week postpartum care visits in rural central Malawi. Design Cross-sectional matched-pairs survey design. Methods Participants included a convenience sample of 70 husband-and-wife-farmer dyads living in rural communities who had a live birth in the past year at one of four health facilities in Ntcheu district, central Malawi. Data were collected using an interviewer-administered postpartum care questionnaire from the World Health Organization (WHO) Safe Motherhood Needs Assessment Questionnaires. Data analysis included univariate and multivariate statistics. Findings Women's evaluation of postpartum care assessments received from midwives in rural health facilities prior to discharge included partial assessments of blood pressure (44%), temperature (41%), abdominal examination (50%), vaginal examination/bleeding (46%), breast examination/soreness (34%), and baby examination (77%). Only 16% of the women received all six of these postpartum clinical assessments prior to discharge, while 11% received none. Women also reported that midwives did not: introduce themselves (50%); ask if patients had questions (44%); explain what they were doing (43%); or explain what to expect after delivery (50%). Despite this, 77% of women felt midwives paid close attention to them and 83% gave an overall positive evaluation (3.5-5 on a scale of 1-5). Numbers of postpartum clinical assessments ( p = .09) and overall evaluation ( p = .71) did not differ between the four health facilities. The top three reasons for husbands' and wives' decisions to return for 1-week postpartum care visits were: being advised to return for care, wanted the mother to be examined, and wanted the baby to be examined. Participants stated prior negative experiences, or not perceiving a need for care (feels fine), may potentially prevent them from returning for postpartum care visits in a health facility. Conclusions Most women reported they received only partial postpartum clinical assessments; thus, it is important for health facilities to address the adequacy of postpartum clinical assessments provided to women by midwives before discharge. Women returned for 1-week postpartum care visits because they were advised to return for care, and also to make sure their babies were examined. However, the principal reason why husbands permitted their wives to return for postpartum care was because they wanted their wives to be examined. Clinical Relevance Midwives need to advise all patients to return for postpartum care visits consistent with WHO or country guidelines, and continue to educate husbands and wives regarding the importance of postpartum care even when the wife feels fine. Refresher in-service trainings on postpartum care are recommended for midwives to encourage them to perform the recommended postpartum clinical assessments. [ABSTRACT FROM AUTHOR]