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- August, Furaha, 1973-
(författare)
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Effect of Home Based Life Saving Skills education on knowledge of obstetric danger signs, birth preparedness, utilization of skilled care and male involvement : A Community-based intervention study in rural Tanzania
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Use of skilled care during antenatal visits and delivery is recommended to address the burden of maternal mortality. However there are few facility deliveries and insufficient knowledge of danger signs, especially in rural Tanzania. The aim of this thesis was to explore the perceptions and challenges that the community faces while preparing for childbirth and to evaluate an intervention of the Home Based Life Saving Skills education programme on knowledge of danger signs, facility delivery and male involvement when delivered by rural community health workers in Tanzania.In Paper I, Focus Group Discussions explored the perceptions and challenges that the community encounters while preparing for childbirth. Structured questionnaires assessed men’s knowledge of danger signs and birth preparedness and complication readiness in Paper II. The effect of the Home Based Life Saving Skills education programme in the community was assessed with a before-and-after evaluation in two districts; one intervention and one comparison. Paper III assessed the effect of the programme on knowledge of danger signs and birth preparedness and facility delivery among women, while Paper IV evaluated its effect on male involvement.The community perceived that all births must be prepared for and that obstetric complication demands hospital care; hence skilled care was favoured. Men’s knowledge of danger signs was limited; only 12% were prepared for childbirth and complications. Preparedness was associated with knowledge of obstetric complications (AOR=1.4 95% CI 1.8 – 2.6). The intervention showed women utilizing antenatal care (four visits) significantly more (43.4 vs 67.8%) with a net effect of 25.3% (95% CI: 16.9 – 33.2; p < .0001). The use of facility delivery improved in the intervention area (75.6 vs 90.2%; p = 0.0002), but with no significant net effect 11.5% (95% CI: -5.1 – 39.6; p = 0.123) when comparing the two districts. Male involvement improved (39.2% vs 80.9%) with a net intervention effect of 41.1% (CI: 28.5 – 53.8; p < .0001). Improvements were demonstrated in men’s knowledge level, in escorting partners for antenatal care and delivery, making birth preparations, and shared decision-making.The intervention, in educating this rural community, is effective in improving knowledge, birth preparedness, male involvement and use of skilled care.
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| 2. |
- Berner-Rodoreda, Astrid, et al.
(författare)
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Where is the 'global' in the European Union's Health Research and Innovation Agenda?
- 2019
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Ingår i: BMJ Global Health. - : BMJ. - 2059-7908. ; 4:5
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Tidskriftsartikel (refereegranskat)abstract
- Global Health has not featured as prominently in the European Union (EU) research agenda in recent years as it did in the first decade of the new millennium, and participation of low-income and middle-income countries (LMICs) in EU health research has declined substantially. The Horizon Europe Research and Innovation Framework adopted by the European Parliament in April 2019 for the period 2021-2027 will serve as an important funding instrument for health research, yet the proposed health research budget to be finalised towards the end of 2019 was reduced from 10% in the current framework, Horizon 2020, to 8% in Horizon Europe. Our analysis takes the evolvement of Horizon Europe from the initial framework of June 2018 to the framework agreed on in April 2019 into account. It shows that despite some improvements in terms of Global Health and reference to the Sustainable Development Goals, European industrial competitiveness continues to play a paramount role, with Global Health research needs and relevant health research for LMICs being only partially addressed. We argue that the globally interconnected nature of health and the transdisciplinary nature of health research need to be fully taken into account and acted on in the new European Research and Innovation Framework. A facilitated global research collaboration through Horizon Europe could ensure that Global Health innovations and solutions benefit all parts of the world including EU countries.
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| 3. |
- Mocumbi, Sibone
(författare)
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‘How good is good?’ : Studies of facility-based childbirth care in southern Mozambique, from the perspectives of women and health providers
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Despite the large shift toward facility-based childbirths occurred during the last 15 years in several low resource settings, including in Mozambique, the burden of maternal mortality and morbidity remain considerable. Obstetric fistula is one of the most devastating of all maternal morbidities which still prevalent and is entirely avoidable.The aim of this thesis was to evaluate and explore the provision of childbirth care, focusing on obstetric fistula as one of its complications, in a rural Mozambican setting of high facility delivery rate.The four studies constituting this thesis were implemented in Maputo and Gaza provinces, southern Mozambique, between April 2016 and March 2017. We included 4385 women having given birth up to 12 months the study identified from a cohort of women of reproductive age (12-49 years). We identified women with constant urine leakage, assess them clinically, confirm the diagnosis and estimate the incidence of obstetric fistula. In-depth interviews with selected women with and without fistula (n=28), were used to describe the women’s experiences of maternal care and pinpoint those experiences that are unique to women with fistula. During the same cross-sectional survey (n=4385) we also assessed the women’s experiences of care and satisfaction with care during childbirth. We complemented the women’s survey with a survey among 175 health workers of the study area to assess their perception of their work context.The incidence of fistulae was 1.1 per recently pregnant women (95% CI 0.14-2.16). Delays in receiving definite care at referral hospitals despite having reached the primary health facility in time, were reported by the women who had fistulae. Women without fistula, blamed the fistula condition on women’s physiological and behavioural characteristics. Most (92.5%) of the 4358 women interviewed reported to be satisfied with care during childbirth and would recommend a family member to deliver in the same facility. Women who gave birth in primary level facilities tended to be more satisfied than those gave birth in hospitals, and presence of a companion had a positive influence on the satisfaction, irrespective of age, education and socio-economic background. Health workers rated highly the items on all dimensions of context when asked to evaluate their work context using the Context Assessment for Community Health (COACH) tool, although still above the scale midpoint, the organizational resources dimension had the lowest score.This thesis demonstrates a high incidence of obstetric fistula despite a high coverage of facility-based childbirths in a rural context where services are generally perceived as adequate by childbearing women and health providers. To reduce maternal morbidity by fistula, major interventions are needed to improve the quality of childbirth care, including complication recognition and decision-making for referral, health facility preparedness as well as to improve the health providers’ work environment.
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| 4. |
- Pembe, Andrea Barnabas, 1966-
(författare)
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Quality Assessment and Monitoring of Maternal Referrals in Rural Tanzania
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- An efficient referral system is essential in providing access to emergency obstetric care at higher levels of care by supporting antenatal and delivery services in the primary level of care facilities (PLCF). The aim of this thesis was to assess community and health service factors affecting the quality of maternal referrals in rural Tanzania. Ten focus group discussions (FGDs) with health workers and community members were conducted to describe their perceptions on maternal referrals. Women (n=1118) were interviewed to determine awareness of obstetric danger signs and associated factors. Compliance with referral advice was analysed for 1538 women referred from PLCF. Counselling on danger signs and adherence to referral criteria was observed in 438 antenatal consultations. FGDs indicated that women had limited influence, especially on emergency referrals. The process of deciding to seek referral care considered the perception of seriousness and past experience of referral, access to transport, and the cost involved. Women had low awareness of danger signs of obstetric complications: higher years of schooling increased the likelihood of being aware of danger signs. Demographic risks accounted for 70% of referred women but less than half complied with the advice. Compliance was higher for historical obstetric risks, prenatal, natal, and postnatal complications groups. Few women were counselled on pregnancy danger signs and a significant number with ≥5 pregnancies and primigravidae <20 years were not informed of the risk factors. This thesis demonstrated a need for reviewing referral guidelines and an increase in supportive supervision for health workers counselling on obstetric danger signs to enhance acceptance of referrals advices. Women’s education should be given priority for increasing participation in decisions and becoming more aware of danger signs. Costs involved in maternal referrals can be relieved by improving family income, infrastructure, and alleviating the cost of referral through mobilising community transport and financial schemes.
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