Why do women not use skilled birth attendance service? An explorative qualitative study in north West Ethiopia

Abstract Background Having a birth attendant with midwifery skills during childbirth is an effective intervention to reduce maternal and early neonatal morbidity and mortality. Nevertheless, many women in Ethiopia still deliver a baby at home. The current study aimed at exploring and describing reasons why women do not use skilled delivery care in North West Ethiopia. Methods This descriptive explorative qualitative research was done in two districts of West Gojjam Zone in North West Ethiopia. Fourteen focus group discussions (FGDs) were conducted with pregnant women and mothers who delivered within one year. An inductive thematic analysis approach was employed to analyse the qualitative data. The data analysis adhered to reading, coding, displaying, reducing, and interpreting data analysis steps. Results Two major themes client-related factors and health system-related factors emerged. Factors that emerged within the major theme of client-related were socio-cultural factors, fear of health facility childbirth, the nature of labour, lack of antenatal care (ANC) during pregnancy, lack of health facility childbirth experience, low knowledge and poor early care-seeking behaviour. Under the major theme of health system-related factors, the sub-themes that emerged were low quality of service, lack of respectful care, and inaccessibility of health facility. Conclusions This study identified a myriad of supply-side and client-related factors as reasons given by pregnant women, for not giving birth in health institution. These factors should be redressed by considering the specific supply-side and community perspectives. The results of this study provide evidence that could help policymakers to develop strategies to address barriers identified, and improve utilisation of skilled delivery service

Modern contraceptive methods knowledge and practice among blind and deaf women in Ethiopia. A cross-sectional survey

Abstract Background Evidences from various parts of the world reveal that women with disabilities are facing widespread barriers in accessing public services. Service providers and program managers do not grasp the relevance of their work and interventions in addressing the sexual and reproductive health needs of women with disabilities. The present study therefore aimed to assess family planning knowledge and practice among women with sensory disabilities. Methods A mixed method approach using quantitative and qualitative methods was employed to collect the data. The study included 326 blind and deaf women using respondent driven sampling technique and 29 purposely selected key informants. We carried out the study from August 2016–April 2017. The quantitative data were analyzed using SPSS and the qualitative analysis was done using Open code software version 4.02 and triangulated with the quantitative findings. Results The findings showed that nearly two third of the respondents of were sexually active. The majority (97.2%) of study respondents had heard about FP methods, however the level of comprehensive knowledge on modern contraceptive methods was 32.5%. The prevalence of unwanted pregnancy was 67.0% and abortion was 44%. Almost half of sexually active respondents ever used modern contraceptive methods, yet the contraceptive prevalence at the time of survey was 31.1%. Implants were the most commonly used (51%) contraceptive method among current users. Conclusions The use of modern contraceptive methods among women with sensory disabilities was low. Thus, the government and concerned organizations need to address the attitudinal, social, and physical barriers women with sensory disabilities are facing while seeking, accessing to and using family planning services

A traumatic means of diagnosing gastrointestinal stromal tumour: A case report

Blunt abdominal trauma (BAT) is known to cause intra-abdominal organ damage and haemorrhage, especially after severe impact to the body. We present a case in which a gastrointestinal stromal tumour became symptomatic after BAT

‘I just do as expected’. Teachers’ implementation of continuous assessment and challenges to curriculum literacy

The paper reports on a study that clarifies the nature and scope of the challenges experienced by primary school teachers in Swaziland when using Continuous Assessment (CA) as a tool to improve teaching and learning. Through the use of classroom observations and stimulated recall interviews, we sought to understand the significance of the choices they made to meet the requirements of the prescribed lesson objectives. Their accounts for the assessment exercises they used reflect their understanding of the content they had to teach, the discipline from which it was drawn and intentions of CA programme. In conclusion, we provide cues that may be useful to further these teachers’ curriculum literacy.http://www.tandfonline.com/loi/rred20nf201

Women’s perspective of facility-based childbirth services in Ghana: A qualitative study

Background: Many policy makers at country level in both medium and low to middle-income countries still have great difficulty deciding which quality intervention would have the greatest impact on the health outcomes delivered by their health systems.   Aim: To investigate women’s perceptions about the factors that hinders or facilitates the provision of quality childbirth services in Ghana’s health care services to guide improvement efforts.   Setting: The study was conducted in the greater Accra region of Ghana in two primary level hospitals (district hospitals).   Methods: A qualitative study design, which is exploratory, descriptive and contextual in nature, was used. Semi-structured interviews were used to examine the perspectives of 15 women on the factors that influence the quality of childbirth services and how services could be improved in Ghana. Data were analysed through data reduction, data display and generation of themes.   Results: The findings in this study revealed two major themes, firstly, barriers to quality childbirth with five subthemes: high workload, shortage of health workers, non-availability of some services, as well as poor coordination, unacceptable staff behaviour and lack of cooperation from some clients, were identified by the participants as the major causes of poor quality. Secondly, ways to improve care reported, were encouraging health workers to be patient with clients, promoting open communication, friendliness and attentiveness. The need to reorganise service provision to make it more client centred, was also highlighted.   Conclusion: The study findings highlight the importance of paying attention to factors such as service organisation and coordination, high workload, inadequate number of staff, as well as limitations in infrastructure and logistics for quality services delivery. Equally important are institutionalisation of systems to continuously assess and improve staff competence and attitudes and the creation of an environment that can foster good interpersonal relationship between health care providers and patients

Penetrating trauma in rural areas – a public health disease: A report of 2 cases

It has been recommended that all penetrating trauma to the head, neck and torso, and to the extremities proximal to the elbow and knee, should be managed in specialised trauma centres. We present two cases of penetrating trauma that presented to Pietersburg Hospital, part of the Limpopo Academic Complex. Both of them were the result of interpersonal violence

Health Diplomacy the Adaptation of Global Health Interventions to Local Needs in sub-Saharan Africa and Thailand: Evaluating Findings from Project Accept (HPTN 043).

Study-based global health interventions, especially those that are conducted on an international or multi-site basis, frequently require site-specific adaptations in order to (1) respond to socio-cultural differences in risk determinants, (2) to make interventions more relevant to target population needs, and (3) in recognition of 'global health diplomacy' issues. We report on the adaptations development, approval and implementation process from the Project Accept voluntary counseling and testing, community mobilization and post-test support services intervention. We reviewed all relevant documentation collected during the study intervention period (e.g. monthly progress reports; bi-annual steering committee presentations) and conducted a series of semi-structured interviews with project directors and between 12 and 23 field staff at each study site in South Africa, Zimbabwe, Thailand and Tanzania during 2009. Respondents were asked to describe (1) the adaptations development and approval process and (2) the most successful site-specific adaptations from the perspective of facilitating intervention implementation. Across sites, proposed adaptations were identified by field staff and submitted to project directors for review on a formally planned basis. The cross-site intervention sub-committee then ensured fidelity to the study protocol before approval. Successfully-implemented adaptations included: intervention delivery adaptations (e.g. development of tailored counseling messages for immigrant labour groups in South Africa) political, environmental and infrastructural adaptations (e.g. use of local community centers as VCT venues in Zimbabwe); religious adaptations (e.g. dividing clients by gender in Muslim areas of Tanzania); economic adaptations (e.g. co-provision of income generating skills classes in Zimbabwe); epidemiological adaptations (e.g. provision of 'youth-friendly' services in South Africa, Zimbabwe and Tanzania), and social adaptations (e.g. modification of terminology to local dialects in Thailand: and adjustment of service delivery schedules to suit seasonal and daily work schedules across sites). Adaptation selection, development and approval during multi-site global health research studies should be a planned process that maintains fidelity to the study protocol. The successful implementation of appropriate site-specific adaptations may have important implications for intervention implementation, from both a service uptake and a global health diplomacy perspective