North-central Nigerian women’s experiences of obstetric fistula risk factors and their perceived treatment services: An interpretive description

Background An obstetric fistula also known as vesico vaginal fistula (VVF), or recto-vaginal fistula (RVF) is an abnormal opening between the urogenital tract and intestinal tract caused by prolonged obstructed labour; when the head of the baby presses on the soft tissues in the pelvis leading to loss of blood flow to the women’s bladder, vagina, and rectum. This can cause necrosis of the soft tissues resulting in debilitating fistula formations. Aim This study aimed to uncover North-central Nigerian women’s experiences of obstetric fistula and their perceived treatment services. Design Qualitative, interpretive descriptive methodology underpinned by symbolic interactionism involving face-to-face semi-structured interviews was used to explore North-central Nigerian women’s experiences of obstetric fistula and their perceived treatment services. Sample A purposive sample of 15 women who had experienced obstetric fistula at a repair Centre in North-central Nigeria were eligible. Results Four themes emerged from North-central Nigerian women’s experiences of obstetric fistula and their perceived treatment services i) I was left alone in the room ii) Waiting for the one vehicle in the village iii) I never knew about labour until that very day iv) and We kept following the native doctors and sorcerers. Conclusion The findings from this study highlighted the depth of women’s experiences from the devastating complication of childbirth injury in North-central Nigeria. Analysis of insights from women’s voices directly affected by obstetric fistula demonstrated that in their views and experiences the themes identified were majorly responsible for their fistula status. Thus women need to raise their collective voices to resist oppressive harmful traditions and demand empowerment opportunities that will improve their social status. Government should improve primary healthcare facilities, train more midwives and subsidise maternal care for antenatal education and birth services spending for childbirth women may result in improved childbirth experiences for women in rural and urban communities. Tweetable Abstract Reproductive women call for increased accessibility to healthcare services and the provision of more midwives to mitigate obstetric fistula in North-central Nigerian communities

The psychosocial impact of rare diseases among children and adolescents attending mainstream schools in Western Australia

Living with a long-term medical condition is associated with heightened risk for mental health and psychosocial difficulties, but further research is required on this risk for children and adolescents with a rare disease in the educational setting. The aim of this study is to describe parents’ perceptions of the psychosocial impact of rare diseases on their school-aged children in Western Australia. A cross-sectional survey of 41 parents of school-aged children and adolescents diagnosed with a rare disease completed an online questionnaire. Questions related to their perceptions of health-related stigma, bullying, social competencies and mental health difficulties faced by their child. Results showed that stigmatisation was experienced by 75.6% of participants, and almost half (46.4%) reported their child was bullied. In this sample, parents reported high sensory (vision and hearing) abilities, but low to moderate self-care competence in relation to social activities and peer relations. Almost half of the respondents (43.9%) reported mental health difficulties among their children. Children and adolescents with a rare disease have unique psychological and social issues. These findings highlight the need for greater efforts to meet the diverse psychosocial, physical and emotional needs of children diagnosed with a rare disease who attend mainstream schools in Western Australia

Construct validity of the suboptimal health status questionnaire-25 in a Ghanaian population

Background The Suboptimal Health Status Questionnaire-25 (SHS-Q-25) developed to measure Suboptimal Health Status has been used worldwide, but its construct validity has only been tested in the Chinese population. Applying Structural Equation Modelling, we investigate aspects of the construct validity of the SHS-Q-25 to determine the interactions between SHS subscales in a Ghanaian population. Methods The study involved healthy Ghanaian participants (n = 263; aged 20–80 years; 63% female), who responded to the SHSQ-25. In an exploratory factor and parallel analysis, the study extracted a new domain structure and compared to the established five-domain structure of SHSQ-25. A confirmatory factor analysis (CFA) was conducted and the fit of the model further discussed. Invariance analysis was carried out to establish the consistency of the instrument across multi-groups. Results The extracted domains were reliable with Cronbach’s ɑ of 0.846, 0.820 and 0.864 respectively, for fatigue, immune-cardiovascular and cognitive. The CFA revealed that the model fit indices were excellent (RMSEA = 0.049 \u3c 0.08, CFI = 0.903 \u3e 0.9, GFI = 0.880 \u3c 0.9, TLI = 0.907 \u3e 0.9). The fit indices for the three-domain model were statistically superior to the five-domain model. There were, however, issues of insufficient discriminant validity as some average variance extracts were smaller than the corresponding maximum shared variance. The three-domain model was invariant for all constrained aspects of the structural model across age, which is an important risk factor for most chronic diseases. Conclusion The validity tests suggest that the SHS-Q25 can measure SHS in a Ghanaian population. It can be recommended as a screening tool to early detect chronic diseases especially in developing countries where access to facilities is diminished

Training attention control of very preterm infants: protocol for a feasibility study of the Attention Control Training (ACT)

Background Children born preterm may display cognitive, learning, and behaviour difficulties as they grow up. In particular, very premature birth (gestation age between 28 and less than 32 weeks) may put infants at increased risk of intellectual deficits and attention deficit disorder. Evidence suggests that the basis of these problems may lie in difficulties in the development of executive functions. One of the earliest executive functions to emerge around 1 year of age is the ability to control attention. An eye-tracking-based cognitive training programme to support this emerging ability, the Attention Control Training (ACT), has been developed and tested with typically developing infants. The aim of this study is to investigate the feasibility of using the ACT with healthy very preterm (VP) infants when they are 12 months of age (corrected age). The ACT has the potential to address the need for supporting emerging cognitive abilities of VP infants with an early intervention, which may capitalise on infants’ neural plasticity. Methods/design The feasibility study is designed to investigate whether it is possible to recruit and retain VP infants and their families in a randomised trial that compares attention and social attention of trained infants against those that are exposed to a control procedure. Feasibility issues include the referral/recruitment pathway, attendance, and engagement with testing and training sessions, completion of tasks, retention in the study, acceptability of outcome measures, quality of data collected (particularly, eye-tracking data). The results of the study will inform the development of a larger randomised trial. Discussion Several lines of evidence emphasise the need to support emerging cognitive and learning abilities of preterm infants using early interventions. However, early interventions with preterm infants, and particularly very preterm ones, face difficulties in recruiting and retaining participants. These problems are also augmented by the health vulnerability of this population. This feasibility study will provide the basis for informing the implementation of an early cognitive intervention for very preterm infants. Trial registration Registered Registration ID: NCT03896490. Retrospectively registered at Clinical Trials Protocol Registration and Results System (clinicaltrials.gov)

The bii4africa dataset of faunal and floral population intactness estimates across Africa’s major land uses

Sub-Saharan Africa is under-represented in global biodiversity datasets, particularly regarding the impact of land use on species’ population abundances. Drawing on recent advances in expert elicitation to ensure data consistency, 200 experts were convened using a modified-Delphi process to estimate ‘intactness scores’: the remaining proportion of an ‘intact’ reference population of a species group in a particular land use, on a scale from 0 (no remaining individuals) to 1 (same abundance as the reference) and, in rare cases, to 2 (populations that thrive in human-modified landscapes). The resulting bii4africa dataset contains intactness scores representing terrestrial vertebrates (tetrapods: ±5,400 amphibians, reptiles, birds, mammals) and vascular plants (±45,000 forbs, graminoids, trees, shrubs) in sub-Saharan Africa across the region’s major land uses (urban, cropland, rangeland, plantation, protected, etc.) and intensities (e.g., large-scale vs smallholder cropland). This dataset was co-produced as part of the Biodiversity Intactness Index for Africa Project. Additional uses include assessing ecosystem condition; rectifying geographic/ taxonomic biases in global biodiversity indicators and maps; and informing the Red List of Ecosystems

Exploring the sociocultural aspect of narrative inquiry: A dynamic nursing research methodology

Background: Human beings live storied lives and it is these stories that define the “self” in a community. Narrative inquiry, aqualitative research methodology seeks to understand social and cultural experiences of people and communities by studying stories from the perspective of individuals who are living the story and relating it to time, place and person. Narrative inquiry has two aspects: (1) the lived experiences (phenomenological aspect), and (2) the interactions of the stories with the story teller’s sociocultural environment (ethnographical aspect). However, only the lived experiences aspect of narrative inquiry is overemphasized in the literature. The aspect that deals with the interactions of stories to the story teller’s sociocultural environment has been overlooked. Aim: To explore the sociocultural feature of narrative inquiry and to demonstrate how this methodology was used to explore both lived experiences and cultural aspects of parents’ experiences of caring for preterm infants after discharge from four neonatal units in Ghana. Conclusions: Given the dynamic nature of narrative inquiry, this article proposes that its use should not be limited to the study of experiences only. For a qualitative study that requires the study of both experiences and the interaction of participants with their sociocultural environment, narrative inquiry serves the purpose

Parents’ experiences of caring for preterm infants after discharge with grandmothers as their main support

Aims and objectives To explore parents of preterm infants’ experiences of caring for their preterm infants with the grandmother as their primary support after discharge. Background Preterm delivery is the major cause of high neonatal mortality in sub‐Saharan Africa. There is poor neonatal health outcome in the Ghanaian community with some illnesses culturally classified as not‐for‐hospital. In the community, grandmothers or older women provide support for new parents and decide treatment options for sick infants. However, there is paucity of research on how parents of preterm infants experience this support in the Ghanaian community. Method Qualitative narrative inquiry methodology was used. Face‐to‐face interviews using semi‐structured interview guide were used to collect data from 21 mothers and nine fathers. Participant observation and field notes were used to complement interview data. Thematic content analysis of data within the three‐dimensional narrative space was employed. Analysis focussed on the relationship of time, place, person and cultural practices affecting the care of preterm infants in the community. Results Three themes emerged from the data, namely (i) Grandmother\u27s prescriptions, (ii) Fighting for the well‐being of the infant and (iii) Being in a confused state. Cultural practices mainly initiated by grandmothers resulted in adverse health problems for preterm infants and disruption in parents’ mental health. Conclusion As grandmothers perform their traditional role of supporting new parents to care for preterm infants after discharge, they give both positive and negative advice which can adversely affect the health of vulnerable preterm infants in the community. Relevance to clinical practice Grandmothers are the main support providers of parents of preterm infants after neonatal unit discharge. Nurses should identify and include grandmothers in predischarge education in order to equip them to render appropriate support to parents and preterm infants

Parents\u27 Experiences Of Caring For Preterm Infants After Discharge From Neonatal Intensive Care Unit: A Meta-synthesis Of The Literature

The difficulties of caring for preterm infants and associated psychological stress incurred by parents of preterm infants admitted to Neonatal Intensive Care Unit (NICU) have been well established. However, much less is known about parents\u27 experiences of caring for preterm infant at home after NICU discharge. This study synthesized qualitative studies on this phenomenon. Nine categories were obtained from 12 qualitative studies and grouped into three syntheses - (1) support improves confidence in care; (2) dealing with challenges of caring for preterm infant; (3) overprotective parenting. Parents\u27 experiences of caring for preterm infants post-NICU discharge is constructed as a process that requires support to improve caring confidence, a process that deals with the challenges of caring for preterm infants after discharge and complicated by overprotective parenting. Thus, NICU nurses must endeavour to provide appropriate support for parents in order to increase their caring confidence after discharge

Ghanaian fathers\u27 experiences of caring for preterm infants; a journey of exclusion

Aim To explore Ghanaian fathers\u27 experiences of caring for preterm infants in the neonatal unit and after discharge. Method Participants were part of a larger study to explore parents’ experiences of caring for preterm infants after discharge. Narrative inquiry methodology was used to interview nine fathers of preterm infants of gestational age 26–36 weeks at three stages-one week, one month and four months-after discharge from four level II and III neonatal units in Ghana. Data was analysed using thematic analysis guided by the three-dimensional narrative inquiry space. Ethical approval and consent from fathers were obtained before interviewing them at their residence. Result Three themes emerged from the data showing the chronological journey of fathers from the neonatal unit till four months after discharge–1. In the neonatal unit – “there\u27s no room for me; 2. Pre-discharge preparation – “I was not involved in discharge education” and 3. Home care/post discharge – “I\u27m scared of my preterm infant”. Fathers reported being continuously excluded from the care of their preterm infants. This exclusion resulted in increased stress and lack of confidence in caring for their preterm infants after discharge. Conclusion Fathers\u27 experiences of caring for preterm infants is a journey characterized by exclusion and lack of caring confidence after discharge. Recognising and addressing the needs of fathers of preterm infants in the neonatal unit is essential in building their caring confidence after discharge