Experiencing challenges when implementing Active Management of Third Stage of Labor (AMTSL): a qualitative study with midwives in Accra, Ghana

Background: Post-partum hemorrhage (PPH) is the major cause of maternal mortality in Ghana and worldwide. Active management of the third stage of labor (AMTSL) is a globally recommended three-step method that in clinical trials has been proven effective in prevention of PPH. The AMTSL guidelines were introduced in 2003, modified in 2006, and has been part of the national guidelines in Ghana since 2008. In 2012, the guidelines were modified a second time. Despite its positive effects on the incidence of PPH, the level of adherence to the guidelines seems to be low in the studied area. This appears to be a problem shared by several countries in the region. An in-depth understanding of midwives' experiences about AMTSL is important as it can provide a basis for further interventions in order to reach a higher grade of implementation. Methods: Twelve in-depth interviews were conducted with labor ward midwives who all had previous training in AMTSL. The interviews took place in 2011 at three hospitals in Accra Metropolis and data was analyzed using qualitative latent content analysis. Results: Our main finding was that the third step of AMTSL, uterine massage, was not implemented, even though the general attitude towards AMTSL was positive. Thus, despite regular training sessions, the midwives did not follow the Ghanaian national guidelines. Some contributing factors to difficulties in providing AMTSL to all women have been pointed out in this study, the most important being insufficiency in staff coverage. This led to a need for delegating certain steps of AMTSL to other health care staff, i.e. task shifting. The fact that the definition of AMTSL has changed several times since the introduction in 2003 might also be an aggravating factor. Conclusions: The results from this study highlight the need for continuous updates of national guidelines, extended educational interventions and recurrent controls of adherence to guidelines. AMTSL is an important tool in preventing PPH, however, it must be clarified how it should be used in countries with scarce resources. Also, considering the difficulties in implementing already existing guidelines, further modifications must be made with careful consideration

Acceptability and feasibility of introducing the WHO focused antenatal care package in Ghana

The main objective of this study, undertaken by Noguchi Memorial Institute for Medical Research in collaboration with the Ghana Health Service and FRONTIERS, with USAID funding, was to examine the extent to which adaptation of the WHO focused antenatal care (ANC) package influenced quality of care received by pregnant women and its acceptability to both providers and clients. The results indicate that national-level support for focused ANC is high. The package appears to have been well accepted by both clients and providers because of its comprehensiveness and the individualized care. The process of stimulating changes in focused ANC service delivery will need further consultation of key stakeholders (e.g., pre-service training institutions and professional bodies) to ensure its institutionalization. Community-level education is also required to create awareness about the timing of ANC visits, individual birth planning, advice on danger signs and self-care in pregnancy, complication preparedness, and the need to involve other family members in birth planning

Predictors of Work Engagement Among University Teachers: The Role of Personality and Perceived Organisational Support.

The present study was conducted with the aim of investigating whether perceived organisational support or HEXACO personality traits: honesty-humility, emotionality, extraversion, agreeableness, conscientiousness and openness; was a better predictor of work engagement among university teachers. A sample size of 157 university teachers was conveniently drawn both online and in person. The HEXACO-PI, Survey of Perceived Organisational Support (SPOS) and the Utrecht Work Engagement Scale (UWES) were used to measure personality, perceived organisational support and work engagement respectively. Multiple Regression Analysis was used to examine the data. The study revealed that Extraversion, Conscientiousness and Perceived Organisational Support were significant predictors of work engagement. The similarities in beta values suggest that both personality traits and perceived organisational support were crucial to work engagement. Limitations, as well as suggestions for future research, are discussed