Children’s perspectives of their psychosocial wellbeing in Tanzanian orphanages

The aim of this study was to explore factors affecting the wellbeing of institutionalized orphaned children in Dar es Salaam, Tanzania. A descriptive qualitative study was used to collect data from Tanzanian orphaned children receiving orphanage care. Purposive sampling was employed to select 10 orphanage centers from which 123 orphaned children were recruited. A semi-structured interview guide relevant to the study objectives was developed from the literature and was used to guide the focus group interviews. Data was analysed by way of thematic analysis. There were 76 male and 47 female orphans; orphans without one or both parents were 87 and 36 respectively. Seventy-eight orphans were in primary school and 45 orphans were in secondary education. Study findings revealed that the orphanages provided a higher degree of material support compared to psychosocial support services, such as emotional or counselling assistance. The orphanage schedule needs to include time for caregivers and children to talk about their feelings regarding the type services provided at their center, in particular educational services

“My hands are tied”: Nurses’ perception of organizational culture in Kenyan private hospitals

It is estimated that by 2030 the global shortage of nurses and midwives will be 7.6 million, with African countries among the most adversely affected. Within this context, it is important to understand the specific organizational factors that contribute to registered nurses (RNs)’ decisions to remain or leave their workplaces in East Africa. The aim of this study was to commence exploration of these factors by exploring nurses’ perceptions of organizational culture of selected private hospitals in Kenya. A small-scale exploratory qualitative approach was employed, with eight nurses undertaking semi-structured interviews. There were five female and three male nurses. All participants were RNs; two held a bachelor’s degree in nursing and the rest held diplomas in nursing. The thematic analysis revealed four major themes and nine sub-themes. The major themes included: restrictive work environment, top-down leadership, normalizing the abnormal in team dynamics and professionalism, and ethical concerns. These findings suggest an urgent need for Kenyan private hospital administrators to create a hospital work environment that provides more autonomy for nurses. There is a need for inclusive leadership styles that target hospital organizational structures and processes in order to address nursing workforce team dynamics. A merit-based salary and progressive reward systems are recommended to empower nurses to remain in the workforc

The Socio-Political Debate of Dying Today in the United Kingdom and New Zealand: ‘Letting Go’ of the Biomedical Model of Care in Order to Develop a Contemporary Ars Moriendi

Death is a reality of life. Despite this inevitability, death today remains unwelcome and has been sequestered into the enclaves of medical practice as a means of quelling the rising tide of fear it provokes. Medical practice currently maintains power over the dying individual, actualised through the selective collaboration between medicine and law as a means of subverting the individual who attempts to disrupt the contemporary accepted norms of dying. There is, however, a shift on the horizon as to whether we can make the notion of a true choice become a reality in New Zealand. This serves to offer a compelling movement towards individuals seeking control of their dying trajectory to actualise the notion of individual choice. With this shifting landscape there is an opportunity to be grasped to change how we manage our dying trajectory away from the biomedical patterns of behaviour when dying, in order to balance life decisions. To achieve this prospect, we need to engage with a framework upon which to pin the changes. This paper offers a re-framing and re-presenting approach, using illustrative examples that draw upon British and New Zealand literature, together with over 50 years of professional nursing, and the Ars Moriendi to reflect upon the self-centricity of the contemporary Western individual to access a ‘good death’ of choice

Moving backwards, moving forward: the experiences of older Filipino migrants adjusting to life in New Zealand

Purpose: To explore the experiences of older Filipino migrants adjusting to living perma- nently in New Zealand. Method: The qualitative descriptive approach taken in this study involved 17 individual face- to-face interviews of older Filipino migrants in New Zealand. Results: Three main themes emerged from the data. The first theme was “moving backwards and moving forward”, which described how these older Filipino migrants adjusted to chal- lenges they experienced with migration. The second theme was “engaging with health services” and presented challenges relating to the New Zealand healthcare system, including a lack of knowledge of the nature of health services, language barriers, and differences in cultural views. The third theme, “new-found home”, highlighted establishing a Filipino identity in New Zealand and adjusting to the challenges of relocation. Conclusion: Adjustment to life in New Zealand for these older Filipino migrants meant starting over again by building new values through learning the basics and then moving forward from there

Tanzanian Mothers’ Cultural Beliefs and Misinformation Regarding the Reasons for Their Cesarean Sections

Background: In Tanzania, cesarean section (CS) rates have been steadily increasing, yet little is known about mothers’ understanding of the medical rationale for their CSs. Aim: To identify mothers’ cultural understandings of the rationale for their CSs. Methods: Design: A qualitative descriptive design was employed. Setting: A government hospital in the western region in Tanzania. Participants: A total of 117 mothers were interviewed using convenience sampling post CS. Findings: Forty percent of the mothers were younger than 18 years, with more than 50% having had five or more live babies. Among multigravida women, 40.2% had had one or more previous CSs. The emergent themes were lack of dietary knowledge, use of local herbs, delays in coming to hospital, avoiding stressful labor pains and no ability to exercise, and no personal preferences of “push or go for an operation.” Conclusion: Pregnant women in Tanzania need improved health education to make informed choices about childbirth and be involved all processes of antepartum care decision making to achieve optimal birth outcome

Setting the stage: reviewing current knowledge on the health of New Zealand immigrants—an integrative review

The growth of migrant communities continues to rise globally, creating unique and complex health challenges. Literature on immigrant health in New Zealand (NZ) remains scant. This integrative literature review was conducted drawing on peer-reviewed research articles on immigrant health in NZ published between 2012 and 2018. The objectives were to: (i) provide a critical overview of immigrant health in NZ; (ii) identify general trends in health research conducted in NZ on immigrants; (iii) compare, contrast, and evaluate the quality of the information; (iv) develop a summary of research results and; (v) identify priorities and recommendations for future research. A search yielded more than 130 articles with 28 articles constituting the foundation of the review. This review is timely following the rapid increase in the scale, speed, and spread of immigration and its potential for changing NZ’s national health patterns and priorities. This integrative review led to the four primary conclusions. Firstly, migration in NZ is a gendered phenomenon, as there has been more women and girls arriving as migrants in NZ and being at risk of poor health in comparison with their male counterparts. Secondly, studies on infectious diseases take precedence over other health problems. Thirdly, research methodologies used to collect data may not be relevant to the cultural and traditional customs of the migrant populations. Furthermore, a number of research findings implemented have failed to meet the needs of NZ migrants. Lastly, policy initiatives are inclined more towards supporting health practitioners and lack a migrant centred approach

Sociodemographic factors associated with mothers’ experiences of psychosocial care and communication by midwives during childbirth in Nairobi, Kenya

Purpose: To clarify sociodemographic and socioeconomic factors associated with mothers’ experiences of psychosocial care and communication by midwives during childbirth in Nairobi, Kenya. Design: A descriptive cross-sectional study conducted in a government national referral hospital. Respondents were 109 systematically sampled mothers who delivered in the study hospital. Mothers’ experiences of intrapartum care were assessed using three subscales from the Experience of Psychosocial Care and Communication during Childbirth Questionnaire (effective communication; emotional support; and respect, care and dignity). Simple and multivariable logistic regression analyses were used to assess associations between sociodemographic factors, socioeconomic factors and mothers’ experiences of intrapartum care. Findings: The majority of respondents were aged 20–24 years (45.9%), married (71.6%), had primary school education (48.6%) and were self-employed (45%). The majority reported positive experiences of communication, respect, dignity and emotional support from their midwives. Being an older mother was significantly associated with a positive experience of intrapartum care (adjusted odds ratio [AOR] 7.32; 95% Confidence Interval (CI): 1.17–45.9). The odds of having a positive intrapartum care experience was significantly lower among women with parity of four or more (AOR 0.09; 95% CI: 0.01–0.56) and tertiary education (AOR 0.11; 95% CI: 0.01–0.91). Conclusion: Attention to the use of respectful language and adherence to clear communication must be an integral part of quality improvement for midwifery care in Kenya

My husband will love me more if I give birth to more children: Rural women’s perceptions and beliefs on family planning services utilization in a low resource setting

Introduction: Responsibility for family planning in low resource settings is almost solely delegated to women, with very low male involvement. This study investigated rural Tanzanian women’s perceptions and cultural beliefs of the barriers to family planning services utilization. Methods: This study used a qualitative descriptive approach drawing on four group discussions with 20 purposively selected married women with two or more children. The study followed COREQ guidelines for reporting qualitative studies. Data were collected from participants at four health facilities in Bagamoyo and Kisarawe districts in Pwani, Tanzania. Results: Participants’ occupations included housewives, small-scale farmers, and entrepreneurs. Most women were Muslim and had a primary school education. Five main themes were identified: use of modern and traditional family planning methods; my husband will love me more if I give birth to more children; men’s expected roles in family planning; provide education to dispel myths; and religious barriers. Associated sub-themes covered use of strings, snares and pigis; calendars; breastfeeding linked to family planning; men as heroes for having many children; men not having time to attend clinic; and conflicting sources of health information. Conclusion: Lack of adequate family planning information; beliefs on and use of traditional/unconventional methods; gender roles expectations that influence decision making and limit women’s choices of family planning methods and; socio-cultural and religious beliefs were main perceived barriers for family planning utilization in this study. Mitigation of these barriers depends on the sustained engagement of key stakeholders including religious and community leaders. Health education must be designed to adapt socio-cultural and religious doctrines with benefits of family planning and health outcomes. Health delivery services must also address women’s’ prevailing perceptions and beliefs with emphasize on the partner communication and their encouragement of men’s’ involvement in reproductive health services utilization

Religious beliefs, social pressure, and stigma: Rural women’s perceptions and beliefs about vasectomy in Pwani, Tanzania

Despite being a reliable and cost effective family planning method, vasectomy remains underutilized in many low resource settings such as East Africa. We explored rural women’s perceptions and beliefs regarding barriers to vasectomy use in the low resource setting of Pwani, Tanzania. The qualitative study used in-depth semi-structured interviews to obtain data. Purposive sampling was used to recruit 20 married/cohabiting women with two or more children. Thematic analysis guided the data analysis, with qualitative data reporting informed by COREQ guidelines. Most participants were Muslim and had between two and six children. Most had completed primary-level education and were engaged in small-scale farming. We extracted three main themes with associated sub-themes:1) lack of education, which included men’s education levels and inadequate knowledge and misinformation 2) religious beliefs, social pressure and stigma, which included community stigma and the belief that vasectomy was not good for men with multiple wives; and 3) promoting men’s involvement in family planning which included educating men and the women’s perceived role in promoting vasectomy. Participating women perceived vasectomy uptake to be affected by a lack of low knowledge (among men, women, and the community), misinformation, and various sociocultural barriers. Efforts to promote vasectomy and male involvement in reproductive health services should be directed to addressing deeply-rooted sociocultural barriers. Women may have an essential role in encouraging their partners’ vasectomy uptake. In addition, engaging couples in family planning education is critical to enhance knowledge. Ideally, such community based education should be conducted in partnership with communities and healthcare providers

Safer sex practices among newly diagnosed HIV-positive men who have sex with men in China: results from an ethnographic study

The study reported here sought to understand the rationales of safer sex practices adopted by newly diagnosed HIV-positive men who have sex with men (MSM). Guided by a socio-ecological framework, an ethnography was conducted among newly diagnosed HIV-positive MSM. In-depth interviews and participant observation were employed to produce an account of the social and cultural settings that was faithful to the perspectives of participants. A total of 31 participants with diverse backgrounds were recruited in a southern city of China. Participant observation was conducted in local healthcare settings, MSM venues, and NGO offices. Most participants (24/31) reported stopping unprotected anal intercourse (UAI) immediately after being diagnosed as HIV-positive. Factors associated with safer sex practices were identified at both individual and environmental levels, including self-protection, establishment of self-esteem, dignity, altruism and reciprocity, disease experience as a source of personal growth, and organizational culture and values. Newly diagnosed HIV-positive MSM navigate their sexual practices within the context of multiple competing factors. Implications for sustained behaviour change enabling safer sex practices include stimulating survival instinct, facilitating safer sex decision making, motivating and facilitating personal growth, and encouraging volunteerism to promote intentional activities for safer sex practices