| 1. |
- Kiruja, Jonah, et al.
(författare)
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Healthcare providers' experiences of comprehensive emergency obstetric care in Somaliland : An explorative study with focus on cesarean deliveries
- 2022
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier. - 1877-5756 .- 1877-5764. ; 34
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study aimed to explore the experiences of healthcare providers (HCPs) regarding the provision of emergency obstetric care (EmOC) with a focus on cesarean deliveries in a referral hospital and maternal and child health centers in SomalilandMethods: An exploratory qualitative approach using focus group discussions was employed at the main referral and teaching hospital and four maternal and child health centers in Hargeisa, Somaliland. Twenty-eight HCPs were divided into groups of 6-8 for discussions lasting 1 to 2 h. All HCPs included in the study had experiences with the provision of EmOC. Data were analyzed using thematic analysis.Results: Collective family decision making was identified by HCPs as a barrier to the provision of EmOC. This tradition of decision making at a group level was perceived as time-consuming and delayed HCPs from obtaining informed consent for EmOC. Low socioeconomic status and poor knowledge about maternal healthcare among users affected care seeking among women. Suboptimal EmOC at the hospital was reported to be due to miscommunication, inadequate interprofessional collaboration and lack of infrastructure.Conclusions: HCPs encountered difficulties with the provision of EmOC. A broad array of strategies targeting the community and healthcare system is needed, including training of HCPs on intracultural communication competence, interprofessional collaboration and use of alternative birth methods other than CS. Antenatal care can be used to prepare families for potential obstetric emergencies and as an opportunity to obtain written informed consent.
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| 2. |
- Kiruja, J., et al.
(författare)
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Maternal near-miss and death incidences – Frequencies, causes and the referral chain in Somaliland : A pilot study using the WHO near-miss approach
- 2017
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 12, s. 30-36
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Tidskriftsartikel (refereegranskat)abstract
- Background Somaliland is a self-declared country with a population of 3.5 million. Most of its population reside in rural areas. The objective of this pilot near-miss study was to monitor the frequency and causes of maternal near-miss and deaths and the referral chain for women to access Skilled Birth Attendants (SBA). Method: A facility-based study of all maternal near-miss and mortality cases over 5 months using the WHO near-miss tool in a main referral hospital. Reasons for bypassing the Antenatal Care facility (ANC) and late arrival to the referral hospital were investigated through verbal autopsy. Results: One hundred and thirty-eight (138) women with severe maternal complications were identified: 120 maternal near-miss, 18 maternal deaths. There were more near-miss cases on arrival (74.2%) compared with events that developed inside the hospital (25.8%). Likewise, there were more maternal deaths (77.8%) on arrival than was the case during hospitalization (22.2%). The most common mode of referral among maternal near-miss events was family referrals (66.7%). Of 18 maternal deaths, 15 were family referrals. Reasons for bypassing ANC were as follows: lack of confidence in the service provided; lack of financial resources; and lack of time to visit ANC. Reasons for late arrival to the referral hospital were as follows: lack of knowledge and transportation; and poor communication. Conclusion and clinical implication: To increase the utilization of ANC might indirectly lower the number of near-miss and death events. Collaboration between ANC staff and referral hospital staff and a more comprehensive near-miss project are proposed. © 2017 Elsevier B.V.
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| 3. |
- Ahmed, Caisha Arah, et al.
(författare)
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Defibulated immigrant women's sexual and reproductive health from the perspective of midwives and gynaecologists as primary care providers in Sweden-A phenomenographic study
- 2021
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Ingår i: Sexual & Reproductive Healthcare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 29, s. 100644-
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To capture care providers' perceptions of defibulated immigrant women's sexual and reproductive health, illuminated by their experiences as care providers for these women. Methods: Individual interview study with 13 care providers at Swedish healthcare facilities: six gynaecologists and seven midwives caring for defibulated immigrant women, analysed with a phenomenographic method. Findings: One of the care providers' perceptions of women who had been defibulated was that they had an altered genital function, meaning a wider introitus, improved vaginal intercourse, and more ease urinating and menstruating. The care providers also perceived that women who were defibulated had to balance their wellbeing, struggling between a positive self-image and handling their emotions. Existing in-between cultural values led to a fear of being excluded while at the same time having a desire to be included in the new culture. Conclusion: Defibulation affects women's sexual and reproductive health and calls for a holistic perspective when providing services, individualized according to the woman's care needs. Support and counselling, should include information about defibulation already during the adolescent years to promote sexual and reproductive health and well-being.
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| 4. |
- Almgren, Sara, 1979, et al.
(författare)
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GIS supported calculations of (137)Cs deposition in Sweden based on precipitation data.
- 2006
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Ingår i: The Science of the total environment. - : Elsevier BV. - 0048-9697 .- 1879-1026. ; 368:2-3, s. 804-13
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Tidskriftsartikel (refereegranskat)abstract
- It is of interest to know the spatial variation and the amount of (137)Cs e.g. in case of an accident with a radioactive discharge. In this study, the spatial distribution of the quarterly (137)Cs deposition over Sweden due to nuclear weapons fallout (NWF) during the period 1962-1966 was determined by relating the measured deposition density at a reference site to the amount of precipitation. Measured quarterly values of (137)Cs deposition density per unit precipitation at three reference sites and quarterly precipitation at 62 weather stations distributed over Sweden were used in the calculations. The reference sites were assumed to represent areas with different quarterly mean precipitation. The extent of these areas was determined from the distribution of the mean measured precipitation between 1961 and 1990 and varied according to seasonal variations in the mean precipitation pattern. Deposition maps were created by interpolation within a geographical information system (GIS). Both integrated (total) and cumulative (decay corrected) deposition densities were calculated. The lowest levels of NWF (137)Cs deposition density were noted in north-eastern and eastern parts of Sweden and the highest levels in the western parts of Sweden. Furthermore the deposition density of (137)Cs, resulting from the Chernobyl accident was determined for an area in western Sweden based on precipitation data. The highest levels of Chernobyl (137)Cs in western Sweden were found in the western parts of the area along the coast and the lowest in the east. The sum of the deposition densities from NWF and Chernobyl in western Sweden was then compared to the total activity measured in soil samples at 27 locations. Comparisons between the predicted values of this study show a good agreement with measured values and other studies.
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| 5. |
- Andrén, Anna, et al.
(författare)
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Miscommunication influences how women act when fetal movements decrease : An interview study with Swedish Somali migrant women
- 2023
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Ingår i: Midwifery. - 0266-6138 .- 1532-3099. ; 126
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To explore how Swedish Somali migrant women perceive fetal movements, process information about fetal movements, and take actions if decreased fetal activity occurs.DESIGN: A qualitative study based on individual semi-structured interviews. The interviews were analysed using content analysis.SETTING: The study was conducted in Sweden.PARTICIPANTS: Swedish Somali migrant women (n=15) pregnant in their third trimester or recently given birth.FINDINGS: The analysis led to the main category: tailored information about fetal movements enhances the possibility to seek care if the movements decrease. The results are described in the generic categories: explanatory models determine action; and understand and interpret information.KEY CONCLUSIONS: Miscommunication on fetal movements can be a hurdle for Swedish Somali migrant women that may have impact on stillbirth prevention and the quality of care. Improved communication and information tailored to individual needs is essential to achieve equality for women and their newborns.IMPLICATIONS FOR PRACTICE: The midwife can be used as a hub for reassuring that adequate information about fetal movements reaches each individual woman in antenatal care. Individualised information on fetal movements based on the women's own understanding is suggested to increase the possibility that the pregnant woman will seek care if the movements decrease. Somali women's verbal communication can be used to spread accurate information in the Somali community on the importance of seeking care if fetal movements decrease.
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| 6. |
- Andrén, Anna, et al.
(författare)
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One size does not fit all : Perspectives from Swedish midwives on fetal movement counselling
- 2024
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Ingår i: Women and Birth. - 1871-5192 .- 1878-1799. ; 37:4
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Tidskriftsartikel (refereegranskat)abstract
- PROBLEM: Migration continues to play a role in determining health outcomes related to pregnancy and childbirth in Sweden.BACKGROUND: Migrant women have, compared to Swedish-born women, increased risks of adverse birth outcomes. Previous research suggests that migrant women seek care for decreased fetal movements less than Swedish-born women. Given these documented risks, understanding midwives' perspectives in this context is crucial to address maternal health inequities.AIM: To explore midwives' experiences conveying information about fetal movement to migrant women in antenatal healthcare settings.METHODS: Semi-structured, individual interviews with midwives (n=15) experienced in providing information about fetal movements to migrant women. The interviews were analysed using reflexive thematic analysis.FINDINGS: The midwives' efforts to compensate for the deficiencies within the antenatal healthcare organisation and to ensure that all women received access to information and care regarding fetal movements are described in four themes: (a) building a trusting relationship; (b) empowering women through guidance and support; (c) overcoming communication challenges; and d) navigating safety measures.DISCUSSION: Our findings suggest that the standard antenatal care programme does not support midwives to provide holistic and individualised care that aligns with midwifery care philosophy.CONCLUSION: To reduce health inequities for migrant women, this study highlights the need for more flexible guidelines within the standard antenatal care programme. These guidelines should prioritise the individual woman's needs over institutional protocols, acknowledge the midwife-woman relationship as the core of midwifery practice and support midwives to build a partnership with women through continuity of care.
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| 7. |
- Asaye, Mengstu Melkamu, et al.
(författare)
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Effect of fetal malposition, primiparous, and premature rupture of membrane on Neonatal Near miss mediated by grade three meconium-stained amniotic fluids and duration of the active first stage of labor : Mediation analysis
- 2023
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Ingår i: PLOS ONE. - 1932-6203. ; 18:5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In many low-income countries, including Ethiopia, neonatal mortality remains a major concern. For every newborn that dies, many more neonates survived (near-miss neonates) the first 28 days after birth from life-threatening conditions. The generation of evidence on neonatal near-miss determinants could be a critical step in reducing neonatal mortality rates. However, studies causal pathway determinants are limited in Ethiopia. This study aimed to investigate the Neonatal Near-miss determinants in public health hospitals in Amhara Regional State, northwest Ethiopia.METHOD: A cross-sectional study was conducted on 1277 mother-newborn pairs at six hospitals between July 2021 and January 2022. A validated interviewer-administered questionnaire and a review of medical records were used to collect data. Data were entered into Epi-Info version 7.1.2 and exported to STATA version 16 in California, America for analysis. The paths from exposure variables to Neonatal Near-Miss via mediators were examined using multiple logistic regression analysis. The adjusted odds ratio (AOR) and ß-coefficients were calculated and reported with a 95% confidence interval and a p-value of 0.05.RESULTS: The proportion of neonatal near-misses was 28.6% (365/1277) (95% CI: 26-31%). Women who could not read and write (AOR = 1.67,95%CI:1.14-2.47), being primiparous (AOR = 2.48,95% CI:1.63-3.79), pregnancy-induced hypertension (AOR = 2.10,95% CI:1.49-2.95),being referred from other health facilities (AOR = 2.28,95% CI:1.88-3.29), premature rupture of membrane (AOR = 1.47,95% CI:1.09-1.98), and fetal malposition (AOR = 1.89,95% CI:1.14-3.16) were associated with Neonatal Near-miss. Grade III meconium stained amniotic fluid partially mediated the relationship between primiparous (ß = 0.517), fetal malposition (ß = 0.526), pregnant women referred from other health facilities (ß = 0.948) and Neonatal Near-Miss at P-value < 0.01. Duration of the active first stage of labour partially mediated the relationship between primiparous (ß = -0.345), fetal malposition (ß = -0.656), premature rupture of membranes (ß = -0.550) and Neonatal Near-Miss at P- value <0.01.It had also a significant indirect effect (ß = 0.581, P<0.001) on NNM with variables (primiparous, fetal malposition, and premature rupture of membranes).CONCLUSIONS: The relationship between fetal malposition, primiparous, referred from other health facilities, premature rupture of membrane, and Neonatal Near miss were partially mediated by grade III meconium stained amniotic fluid and duration of the active first stage of labour. Early diagnosis of these potential danger signs and appropriate intervention could be of supreme importance in reducing NNM.
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| 8. |
- Asaye, Mengstu Melkamu, et al.
(författare)
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Experience and perceptions of healthcare providers on clinical management and care of near-miss infants : a qualitative content analysis
- 2023
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Ingår i: BMC Health Services Research. - 1472-6963. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Neonatal Near Miss (NNM) refers to neonates with severe complications who almost died but survived immediately after birth. In Ethiopia, the prevalence of NNM has been assessed using a validated Neonatal Near-Miss Assessment Scale. However, understanding the experiences and perceptions of healthcare providers in the clinical management and care of NNM infants remains unexplored. The aim was to investigate the determinants contributing to the survival of neonatal near-miss babies and to identify any barriers encountered, as reported by the experiences of healthcare providers in public hospitals of Amhara Regional State, northwest Ethiopia.METHODS: Semi structured interviews were used to collect data from 25 midwives, nurses, and pediatricians with at least six months of prior experience in one of the labor wards or neonatal intensive care units at one of the four public health hospitals in the Amhara Regional state of northwest Ethiopia included in a large intervention study assessing a NNM scale. Purposeful sampling was used, selecting participants based on their experiences related to the aim of this study. The participants had a varying level of education and years of experience to care for NNM infants. The average age of the healthcare providers was 31 years, with 7 years of work experience. The transcripts of the interviews with the healthcare providers were analyzed using qualitative content analysis.RESULTS: The experience and perceptions of healthcare providers was described in the main category "A sense of hopelessness when caring for the baby" capturing a broader emotional and professional aspect, while the subcategories "Unclear responsibilities discharging one's mission", "Provision of kangaroo mother care" and "Quick action required at birth" are more specific and practical. Healthcare providers perceived a sense of hopelessness when caring for the NNM infant, particularly providing Kangaroo Mother Care (KMC) and quick actions when required at birth to save the life of the infant.CONCLUSION: Unclear responsibilities and a sense of hopelessness could have acted as barriers, hindering the ability of healthcare providers to fulfill their mission of taking swift actions and providing KMC to NNM infants, thus impacting their ability to save the lives of these infants. Healthcare providers' and parents' attitudes must be changed towards hope rather than hopelessness when caring for NNM infants.
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| 9. |
- Ayala, Ana, et al.
(författare)
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Fathers' care of the newborn infant after caesarean section in Chile : A qualitative study
- 2016
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 8, s. 75-81
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Tidskriftsartikel (refereegranskat)abstract
- Background: In Chilean hospitals the current model of care after caesarean section is to separate newborn infants from both parents. The care of newborn infants and the parents' experience immediately after caesarean section requires further exploration. Aim: To describe fathers' experiences and perceptions of being the primary caregiver to their newborn infant during the first 90 minutes after caesarean section in a public general maternity hospital setting in Santiago de Chile. Method: The questionnaire was one part of a larger research programme named: "Caregiving Models after Elective Caesarean Section Parents' perceptions and effects on infants' wellbeing". Four open ended questions were used to gather written text on the experiences and perceptions of 95 fathers who were the primary caregiver to their newborn infant. Ethical approval was obtained from the Ethics Committee, Scientific Assessment Metropolitan Health Service South East. Systematic text condensation according to Malterud's description was used for analysis of the written text. Findings: Two themes were identified: "understanding the first moment of life" and "shared responsibility for future family life" with each theme divided into six categories. Conclusion: This study concludes by arguing that in situations where the mother is unavailable or unable to provide basic care, the father should be supported to care for the newborn infant. Clinical implications: Parents should be made aware of the benefits of this caring model especially when mother and baby have been separated after birth.
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| 10. |
- Ayala, Ana, et al.
(författare)
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Mother’s Experiences and Perceptions of a Continuous Caring Model with Fathers after Caesarean Section : A Qualitative Study
- 2015
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Ingår i: The Open Women's Health Journal. - : Openventio Publishers. - 1874-2912. ; 1:3, s. 63-71
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Tidskriftsartikel (refereegranskat)abstract
- Background: In Chile, mothers and newborns are separated after caesarean sections. The caesarean section rate in Chile is approximately 40%. Once separated, newborns will miss out on the benefits of early contact unless a suitable model of early newborn contact after caesarean section is initiated.Aim: To describe mothers experiences and perceptions of a continuous parental model of newborn care after caesarean section during mother-infant separation.Methods: A questionnaire with 4 open ended questions to gather data on the experiences and perceptions of 95 mothers in the obstetric service of Sótero Del Rio Hospital in Chile between 2009 and 2012. Data were analyzed using qualitative content analysis.Results: One theme family friendly practice after caesarean section and four categories. Mothers described the benefits of this model of caring. The fathers presence was important to mother and baby. Mothers were reassured that the baby was not left alone with staff. It was important for the mothers to see that the father could love the baby as much as the mother. This model of care helped create ties between the father and newborn during the period of mother-infant separation and later with the mother.Conclusions: Family friendly practice after caesarean section was an important health care intervention for the whole family. This model could be stratified in the Chilean context in the case of complicated births and all caesarean sections.Clinical Implications: In the Chilean context, there is the potential to increase the number of parents who get to hold their baby immediately after birth and for as long as they like. When the mother and infant are separated after birth, parents can be informed about the benefits of this caring model. Further research using randomized control trials may support biological advantages.
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