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Background Unacceptably high levels of childhood malnutrition have been registered in all regions of Uganda over the years. Buhweju district alone contributed 46% prevalence of childhood malnutrition to the 47.8% estimated national prevalence for the whole of western Uganda in 2014. This study assessed health provider and caregiver opinions on factors responsible for persistent malnutrition among under five children in Engaju and Nyakishana sub counties. Methods In this phenomenological qualitative study, we conducted two key informant interviews and six focus group discussions with Village Health Team members and care takers of under five children in Engaju and Nyakishana sub-counties respectively.to explore their opinions on the factors responsible for persistent malnutrition in Buhweju District in May 2018. Data were thematically analyzed manually and using Atals Ti 7.5. Results Historical and geographical challenges, poverty and economic occupation, parental alcoholism and domestic violence as well as inadequate childcare services were identified as factors responsible for persistent malnutrition among under five children in Engaju and Nyakishana sub counties. Conclusion Persistent malnutrition in under five children is mainly due to historical and geographical challenges and its associated factors that include poverty and economic occupation, parental alcoholism and domestic violence and inadequate childcare services. Thus literacy education for mothers and young adolescent boys and girls through engaging local leaders, local nongovernmental organizations and Companies operating in the district to contribute to social services provision would limit the domestic violence and increase sensitization on male responsibilities in the children care in Buhweju district.

Background The nutritional well-being of infants and young children is influenced by economic, environmental and maternal factors that range from food intake, health, sanitation and care. All regions of Uganda have registered unacceptably high levels of childhood malnutrition over the years, although with an uneven distribution across regions. This study assessed health provider and caregiver perspectives on factors responsible for persistent malnutrition among children aged 0-59 months in Engaju and Nyakishana sub counties in Buhweju district.Methods In this phenomenological qualitative study, we conducted six Focus group discussions with Village Health Team members and care takers of children aged 0-59 months in Engaju and Nyakishana sub-counties and two key informant interviews with two members of the district health team to explore their perceptives on the factors responsible for persistent malnutrition in Buhweju District in May 2018. Data were thematically analyzed manually and using Atals Ti 7.5Results Historical and geographical challenges, poverty and economic occupation, parental alcoholism and domestic violence as well as inadequate childcare services were identified as factors responsible for persistent malnutrition among children aged 0-59 months in Engaju and Nyakishana sub counties in Buhweju district Conclusion Persistent malnutrition in children aged 0-59 months in Buhweju district is mainly due to historical and geographical challenges and its associated factors that include poverty and economic occupation, parental alcoholism and domestic violence and inadequate childcare services . Addressing these factors from the grassroots up through, multisectoral collaboration between infrastructure, Agriculture, Education and health, engaging communities and effective policy changes and implementation has the potential to improve the nutrition status of children in Buhweju district

Background Nutritional well-being is fundamental to the attainment of the full social, economic, mental and physical potential of individuals, communities and populations. The nutritional well-being of infants and young children is positively and negatively affected by economic, environmental and maternal factors that range from food intake, health, sanitation and care. Several initiatives such as growth monitoring, vitamin A distribution, deworming programs have been undertaken to reduce the impact of nutritional deficiency and promotion of health of children under five years in Uganda. All regions of Uganda have registered unacceptably high levels of childhood malnutrition over the years, although with an uneven distribution across regions. Western Uganda has persistently registered the highest levels of malnutrition with Buhweju district having the highest levels above the national average. This study assessed health provider and caregiver perspectives on factors responsible for persistent malnutrition among children aged 0-59 months in Engaju and Nyakishana sub counties in Buhweju district.Methods Focus group discussions and key informant interviews with Village Health Team members and care takers of children aged 0-59 months in Engaju and Nyakishana sub-counties and healthcare providers in Buhweju district were conducted respectively to explore their perceptives on the factors responsible for persistent malnutrition in Buhweju District in May 2018.Results Inadequate childcare services, poverty and economic occupation, parental alcoholism and domestic violence as well as historic and geographic challenges were identified as factors responsible for persistent malnutrition among children aged 0-59 months in Engaju and Nyakishana sub counties in Buhweju district Conclusion Several factors are responsible for persistent malnutrition of children aged 0-59 months in Buhweju. Some can be readily addressed and should lead to improvement in the nutrition status of children in Buhweju district.

Nurse-midwives and obstetricians are the primary postpartum health-care providers for mothers and babies in Tanzania. It is imperative that mothers and babies receive adequate information and support in order to save lives. Feminist poststructuralism and discourse analysis were used to conduct and analyze 13 semi-structured interviews from nurse-midwives and obstetricians at three clinics in Dar es Salaam, Tanzania. Establishing friendly supportive relationships enabled nurse-midwives and obstetricians to work effectively with mothers postpartum. Participants explained the importance of including family members in postpartum care and about the strategies they used in a clinic environment that was not always supportive of including family. Effective relational maternity care focused on families during the postpartum period can facilitate the delivery of information and save lives.

Postpartum education can save lives of mothers and babies in developing countries, and the World Health Organization recommends all mothers receive three postpartum consultations. More information is needed to better understand how postpartum education is delivered and ultimately improves postpartum health outcomes. The purpose of this qualitative study was to examine how postpartum care was delivered in three postnatal hospital clinics in Dar es Salaam, Tanzania. Semistructured interviews with 10 nurse-midwives and three obstetricians were conducted. Feminist poststructuralism guided the research process. Postpartum education was seen to be an urgent matter; there was a lack of supportive resources and infrastructure in the hospital clinics, and nurse-midwives and obstetricians had to negotiate conflicting health and traditional discourses using various strategies. Nurse-midwives and obstetricians are well positioned to deliver life-saving postpartum education; however, improvements are required including increased number of nurse-midwives and obstetricians.

Background: Global health electives offer medical trainees the opportunity to broaden their clinical horizons. Canadian universities have been encouraged by regulatory bodies to offer institutional support to medical students going abroad; however, the extent to which such support is available to residents has not been extensively studied.Methods: We conducted a survey study of Canadian universities examining the institutional support available to post-graduate medical trainees before, during, and after global health electives.Results: Responses were received from 8 of 17 (47%) Canadian institutions. Results show that trainees are being sent to diverse locations around the world with more support than recommended by post-graduate regulatory bodies. However, we found that the content of the support infrastructure varies amongst universities and that certain components—pre-departure training, best practices, risk management, and post-return debriefing—could be more thoroughly addressed.Conclusion: Canadian universities are encouraged to continue to send their trainees on global health electives. To address the gaps in infrastructure reported in this study, the authors suggest the development of comprehensive standardized guidelines by post-graduate regulatory/advocacy bodies to better ensure patient and participant safety. We also encourage the centralization of infrastructure management to the universities’ global health departments to aid in resource management.

Background Tanzania has high maternal and neonatal mortality rates. Comprehensive guidelines for postpartum care have been developed by the government as a means to improve health outcomes during the perinatal period. Despite the creation of these guidelines and the government’s commitment to universal perinatal care for women and neonates, there is concern that the delivery of postpartum services may not be meeting the needs of mothers and neonates. Aim The purpose of this feminist poststructuralist study was to explore nurse-midwives’ and obstetricians’ experiences of providing postpartum care in Tanzania. Methods This qualitative study used feminist poststructuralism to explore the personal, social, and institutional discourses of postpartum care. We individually interviewed ten nurse-midwives and three obstetricians in Dar es Salaam, Tanzania. Feminist poststructuralist discourse analysis was used to analyze the transcribed interviews after their translation from Kiswahili to English. Findings Four main themes were identified. In this paper, we present the main theme of availability of resources, and its four corresponding subthemes; (1) space, (2) equipment, (3) staffing, and (4) government responsibility. Discussion The findings from our study illustrate the need for health workforce planning to be addressed in a comprehensive manner that accounts for context, required resources and systemic challenges. These findings are consistent with findings from other studies. Conclusion Understanding the resource challenges that nurse-midwives and obstetricians are facing in one low-and-middle-income-country will assist researchers, decision makers, and politicians as they address issues of mortality, morbidity, and disrespectful maternity care.

No abstract available.

AIMS AND OBJECTIVES To explore the nurse-midwives' and obstetricians' experiences delivering postpartum care assessments and how it was constructed through personal, social and institutional discourses. INTRODUCTION The Tanzanian Government has prioritised maternal and child health as an urgent healthcare issue. Nurse-midwives and obstetricians are the two main providers of care throughout the prenatal and postpartum periods. DESIGN A qualitative design guided by a feminist poststructuralist methodology. METHODS Ten nurse-midwives and three obstetricians from three Regional Hospitals in Dar es Salaam participated in individual semi-structured in-depth interviews. RESULTS Assessment emerged as a significant theme with three subthemes. Nurse-midwives shared their beliefs and values about assessments that focused on the safety of mothers and babies. They felt proud working with mothers and babies and shared their frustrations having to deal with inadequate working conditions. Guidelines and practices were part of the institutional discourse that impacted the day-to-day experiences of nurse-midwives and obstetricians. The nurse-midwives held the belief that it was vital to complete a comprehensive assessment to identify danger signs, keep mothers and babies safe and look for any abnormalities. They were concerned that mothers were being sent home too early. CONCLUSIONS Nurse-midwives' experiences in the provision of postpartum care portray that these health providers work heartedly to make sure that the mothers and their newborns receive the best care they can provide. The health system is challenged to address the needed supplies and equipment for reproductive health in particular postpartum care services. RELEVANCE TO CLINICAL PRACTICE Institutional health discourses significantly affect the practice of nurse-midwives and obstetricians to deliver timely and effective postpartum assessments. Immediate and ongoing postpartum assessments conducted by nurse-midwives and obstetricians can save lives. This study presents the first theme of the study: Caring assessments save lives.

Medical schools recognize that they have an important social mandate beyond their primary role to educate future physicians. The instantiation of social accountability (SA) within faculties of medicine requires intentional, effective partnering with diverse internal and external stakeholders. Despite early, promising academic work in the field of SA in medical education, there remains a lack of conceptual clarity about what SA could and should entail, and a lack of practical direction regarding how it could be implemented. The paper describes the development of an innovative SA framework that incorporates both pragmatic-evaluation and collaborative-enhancement components. The framework consists of five distinct phases, uses a deliberative engagement methodology, and is meaningfully informed by a set of four SA Lenses: Diversity, Inclusion and Cultural Responsiveness; Equity; Community / Stakeholder Engagement and Partnering; and Justice-Fairness and Sustainability. In addition to using the framework to evaluate and enhance the social accountability statuses of a variety of the medical school’s operational components, Dalhousie Faculty of Medicine leaders are committed to applying the framework’s SA Lenses to important decision-making processes, such as the revision of the medical school’s strategic directions and the allocation of limited resources to address important, emerging medical education issues and challenges.