Why Give Birth in Health Facility? Users' and Providers' Accounts of Poor Quality of Birth Care in Tanzania.

In Tanzania, half of all pregnant women access a health facility for delivery. The proportion receiving skilled care at birth is even lower. In order to reduce maternal mortality and morbidity, the government has set out to increase health facility deliveries by skilled care. The aim of this study was to describe the weaknesses in the provision of acceptable and adequate quality care through the accounts of women who have suffered obstetric fistula, nurse-midwives at both BEmOC and CEmOC health facilities and local community members. Semi-structured interviews involving 16 women affected by obstetric fistula and five nurse-midwives at maternity wards at both BEmOC and CEmOC health facilities, and Focus Group Discussions with husbands and community members were conducted between October 2008 and February 2010 at Comprehensive Community Based Rehabilitation in Tanzania and Temeke hospitals in Dar es Salaam, and Mpwapwa district in Dodoma region. Health care users and health providers experienced poor quality caring and working environments in the health facilities. Women in labour lacked support, experienced neglect, as well as physical and verbal abuse. Nurse-midwives lacked supportive supervision, supplies and also seemed to lack motivation. There was a consensus among women who have suffered serious birth injuries and nurse midwives staffing both BEmOC and CEmOC maternity wards that the quality of care offered to women in birth was inadequate. While the birth accounts of women pointed to failure of care, the nurses described a situation of disempowerment. The bad birth care experiences of women undermine the reputation of the health care system, lower community expectations of facility birth, and sustain high rates of home deliveries. The only way to increase the rate of skilled attendance at birth in the current Tanzanian context is to make facility birth a safer alternative than home birth. The findings from this study indicate that there is a long way to go

Ambient lighting atmospheres for influencing emotional expressiveness and cognitive performance

Item does not contain fulltextIn this paper a study is reported for investigating the effects of a lighting atmosphere on emotional expressiveness and cognitive processing. An experimental lighting atmosphere was created for hospital consultation rooms to better support the shared decision making process of patient and clinician. The lighting atmosphere consists of two phases: (1) indirect, dimmed-warm light (supporting emotional expressiveness) and (2) direct, cold-bright light (supporting cognitive processing). The ambient lighting atmosphere was compared with a standard office lighting atmosphere involving 54 male participants. Participants took part in the experiment in pairs. During the first phase, they watched two emotion inducing film fragments and then discussed these fragments with each other. Under warm-dimmed lighting conditions significantly more emotions were expressed with less negative valence. During the second phase, participants performed two cognitive tasks. No statistical significant effects of lighting condition on both attention and concentration tasks were found.AmI: 15th European Conference on Ambient Intelligence (Rome, Italy, November 13-15, 2019