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- Mbekenga, Columba K, 1972-
(författare)
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Striving to Promote Family Health after Childbirth : Studies in Low-Income Suburbs of Dar es Salaam, Tanzania
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Deeper understanding of family health and support after childbirth from the perspective of first-time parents and their informal support network is needed. Postpartum experiences and health concerns of first-time mothers and fathers and, discourses on sexuality and informal support after childbirth were explored in low-income, suburban areas in Ilala, Dar es Salaam, Tanzania. Individual qualitative interviews with first-time mothers (n=10) and fathers (n=10), and 14 focus group discussions with first-time parents (n=40) and informal support persons (n=42) provided the data, which were analyzed through qualitative content and discourse analysis. First-time parents’ areas of concern were newborn care and hygiene, infant feeding, handling crying infant, maternal nutrition and hygiene, uncertain body changes for the mother and, sexuality. The mothers were burdened with caring responsibilities and fathers felt neglected and excluded from the care of the mother and infant after childbirth, both by the families and the health care system. Sexuality after childbirth created tension between new parents due to the understanding that abstinence would protect child health during the breastfeeding period, which could be several years. Women’s adherence to sexual abstinence was more emphasized compared to men’s. Men’s engagement with other sex partners and the risk of contraction HIV was a threat to family health. First-time parents drew on support from both informal and formal sources. Informal support networks played a major role in providing information, materials, guidance and supervision while conveying stereotypic gender norms. Contradictions in the messages to parents within and between the support systems created uncertainties that might have negative implications for family health. Poor parents and those who did not adherence to the social norms were less likely to get informal support than others were. There is a need for information and practical guidance on basic aspects of care for the mother and infant, male involvement, and the importance of social support to first-time parents, as new parents face physical, social and relational challenges after childbirth. The link between the health care system and informal networks need to be strengthened to enable them to complement each other in promoting family health after child health.
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| 2. |
- Randive, Bharat, 1977-
(författare)
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Study of conditional cash transfer programme Janani Suraksha Yojana for promotion of institutional births : Studies from selected provinces of India
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: To accelerate the coverage of skilled birth attendance, in 2005, the Indian government initiated a conditional cash transfer (CCT) programme, Janani Suraksha Yojana (JSY) that provides cash to women upon delivering in health facilities. The attempt to increase the utilization of facilities through the JSY, given the health system’s fragile state, has raised concerns about the programme’s success at achieving its intended goal of reducing maternal mortality ratio (MMR).Aim: To understand the implementation of the CCT policy to promote institutional births in India, with a special focus on nine of India’s poorer states.Methods: Thesis uses both quantitative and qualitative methods. The changes in coverage and inequalities in institutional births in the nine states following the initiation of JSY were analysed by comparing levels before and during the programme using state and district level data. The association between the coverage of institutional births and MMR was assessed using regression analysis (I). The change in socioeconomic inequalities in institutional births was estimated using the concentration index and concentration curve, and contributions of different factors to inequalities was computed by decomposition analysis (II). The quality of referral services was studied by conducting a survey of health facilities (n=96) and post-partum women (n=1182) in three districts of Madhya Pradesh. Conditional logistic regression was used to study the association between maternal referrals and adverse birth outcomes, while spatial data for referrals were analysed using Geographical Information Systems (III). Semi-structured interviews were conducted with government and non-government stakeholders (n=11) to explore their perceptions of the JSY, and the data were analysed using a thematic framework approach (IV).Results: In five years, institutional births increased significantly from a pre-programme average of 20% to 49%. However, no significant association between district-level institutional birth proportions and MMR was found (I). The inequality in access to institutional delivery care, although reduced since the introduction of JSY, still persists. Differences in male literacy, availability of emergency obstetric care (EmOC) in public facilities and poverty explained 69% of the observed inequality. While MMR has decreased in all areas since the introduction of JSY, it has declined four times faster in the richest areas than in the poorest (II). Adjusted odds for adverse birth outcomes among those referred were twice than in those who were not referred (AOR 2.6, 95% CI 1.1-6.6). A spatial analysis of the inter-facility transfer time indicated that maternal deaths occurred despite good geographic access to EmOC facilities (III). While most health officials considered stimulus in the form of JSY money to be essential to promote institutional births, non-government stakeholders criticised JSY as an easy way of addressing basic developmental issues and emphasised the need for improvements to health services, instead. Supply-side constraints and poor care quality were cited as key challenges to programme success, also several implementation challenges were cited (IV).Conclusions: Although there was a sharp increase in coverage and a decline in institutional delivery care inequalities following the introduction of JSY, the availability of critical care is still poor. CCT programmes to increase service utilization need to be essentially supported by the provision of quality health care services, in order to achieve their intended impacts on health outcomes.
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| 3. |
- Kvist, Linda
(författare)
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Care and treatment of women with inflammatory symptoms of the breast during lactation
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Care and treatment of women with inflammatory symptoms of the breast during lactationInflammation of the breast during lactation causes considerable discomfort to mothers and carries a risk of early abandonment of breastfeeding. Little is known about the effects of care interventions, including acupuncture, used for these mothers or about mothers’ experiences of the complaint. Aim: to study care and treatment given at a midwife-led breastfeeding clinic to mothers with inflammatory symptoms of the breast during lactation, to gain knowledge of mothers’ experiences of being afflicted by breast inflammation and to investigate factors which may be associated with the development of breast abscess. Methods: method triangulation was used to study different aspects of the phenomenon of inflammatory symptoms of the breast during lactation; two randomised controlled trials I (n = 88) and II (n = 210), a descriptive study III (n = 210), an interview study with a Grounded Theory approach IV (n = 14), and a population-based register study V (n = 1,454,068 singleton deliveries). Results: mothers’ symptoms were more effectively relieved when acupuncture was used but acupuncture treatment did not shorten contact with health services. Nine percent (I) and 15 % (II) respectively, of mothers were prescribed antibiotics. Twelve percent experienced renewed symptoms requiring health care contact within 6 weeks (III). Seven mothers (0.1% of breastfeeding mothers) developed breast abscess, which was comparable to the figure in the population-based study (V). The presence of Group B streptococci in the breast milk was related to longer contact with health care (II). Mothers’ “will to breastfeed” may make it possible for them to withstand physical and emotional difficulties caused by the illness. Mothers considered access to clinical expertise to be an important factor in their care (IV). Primiparous mothers, those over the age of 30 years and those who give birth after 41 weeks gestation appear to be at a significantly increased risk for the development of breast abscess (V).Conclusions: mothers’ symptoms were more effectively dissipated when acupuncture treatment was used. However, acupuncture treatment did not shorten mothers’ contact with health care services. Interventions, including acupuncture treatment for relief of symptoms may help mothers to withstand their discomfort and await the body’s own anti-inflammatory response and therefore make it possible to substantially reduce the use of antibiotic therapy for this group. The results indicate a need for a better understanding of the influence on breastfeeding of hormones administered to birthing and breastfeeding women. The availability of immediate clinical expertise is an important factor for these mothers, which health care planners should be aware of. Information on potential breastfeeding problems should be improved.Key words: acupuncture, antibiotics, breast abscess, breastfeeding, care interventions, inflammatory symptoms, lactation mastitis
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| 4. |
- Skjutar, Åsa
(författare)
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Patients' needs regarding chronic pain rehabilitation and management
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis is to explore and describe patients’ needs related to chronic pain rehabilitation and management from the perspectives of health care professionals and patients with chronic pain. Study I explores indicators of need for referral to pain rehabilitation using a Delphi study with a multidisciplinary expert panel (n=23). The results show a multifaceted view of indicators, including aspects of physical and mental health, coping strategies, and work environment. Intuitive impressions of patients’ overall clinical presentations and patients’ ages are brought forward as indicators. Study II explores specific needs for occupational therapy using focus group discussions (n=6) with occupational therapists (n=25). Limitations of occupational performance is the theme found. Explicitly, 13 indicators for occupational therapy are found; these include aspects of patients’ behaviors, level of knowledge, level of occupational balance, mental health, and the physical or environmental strains that are present in the patients’ living contexts. In Study III, outcomes of an intervention, ‘Balance in Everyday Life’, are described and explored in terms of occupational performance and satisfaction using a single-case design (n=5). Results demonstrate that four out of five patients had improved their occupational performance (+0.1-2.3), two of which were of clinical significance. Also, five out of five patients had improved their occupational satisfaction (+0.1-5.3), and two were of clinical significance. Measures changed jointly and independently. Study IV describes needs related to pain management of participants with chronic pain; they were portrayed in stories of daily life using individual interviews (n=10). Results describe how participants need to protect themselves from themselves and need to balance their eager mind and their painful body’s need to rest. Participants also need to transform their self-image and to discover new behaviors, routines, and perspectives. The need for affirmation through communion and enjoyment of valued occupations is also highlighted as a prerequisite for successful pain management. Indicators that either pain rehabilitation or occupational therapy is needed involved dysfunctional behaviors of the patient with chronic pain, demographics (e.g., age), as well as tacit knowledge of health care professionals. The occupational needs of participants living with chronic pain could to some extent be met by the intervention received. Engaging in valued occupations and adopting an altered perspective of one’s priorities and occupational performance are highlighted as important for successful pain management.
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