How should we manage infants at risk for group B streptococcal disease?

Asymptomatic term infants whose mothers received adequate intrapartum antibiotic prophylaxis (defined as intravenous penicillin or ampicillin at least 4 hours before delivery) for group B streptococcal disease do not need work-up or treatment (strength of recommendation [SOR]: B, based on retrospective, population-based study). These infants should be observed for 48 hours, but may be discharged after 24 hours in circumstances where close follow-up is available (SOR: D, based on expert opinion). Symptomatic infants, premature infants (gestational age <35 weeks) of mothers who did not receive prophylaxis, and infants whose mothers had chorioamnionitis should receive a full evaluation (complete blood count, blood culture, and chest x-ray with or without a lumbar puncture) and an initial empiric antibiotic treatment with ampicillin or penicillin and gentamycin. If a term infant is not symptomatic and maternal antibiotic prophylaxis was not adequate, opinions differ as to whether to perform limited evaluation with empiric treatment or close observation (SOR: D, based on expert opinion)

Provider and client perspectives on maternity care in Namibia: results from two cross-sectional studies

Abstract Background Disrespectful and abusive maternity care is a complex phenomenon. In Namibia, HIV and high maternal mortality ratios make it vital to understand factors affecting maternity care quality. We report on two studies commissioned by Namibia’s Ministry of Health and Social Services. A health worker study examined cultural and structural factors that influence maternity care workers’ attitudes and practices, and a maternal and neonatal mortality study explored community perceptions about maternity care. Methods The health worker study involved medical officers, matrons, and registered or enrolled nurses working in Namibia’s 35 district and referral hospitals. The study included a survey (N = 281) and 19 focus group discussions. The community study conducted 12 focus groups in five southern regions with recently delivered mothers and relatives. Results Most participants in the health worker study were experienced maternity care nurses. One-third (31%) of survey respondents reported witnessing or knowing of client mistreatment at their hospital, about half (49%) agreed that “sometimes you have to yell at a woman in labor,” and a third (30%) agreed that pinching or slapping a laboring woman can make her push harder. Nurses were much more likely to agree with these statements than medical officers. Health workers’ commitment to babies’ welfare and stressful workloads were the two primary reasons cited to justify “harsh” behaviors. Respondents who were dissatisfied with their workload were twice as likely to approve of pinching or slapping. Half of the nurses surveyed (versus 14% of medical officers) reported providing care above or beneath their scope of work. The community focus group study identified 14 negative practices affecting clients’ maternity care experiences, including both systemic and health-worker-related practices. Conclusions Namibia’s public sector hospital maternity units confront health workers and clients with structural and cultural impediments to quality care. Negative interactions between health workers and laboring women were reported as common, despite high health worker commitment to babies’ welfare. Key recommendations include multicomponent interventions that address heavy workloads and other structural factors, educate communities and the media about maternity care and health workers’ roles, incorporate client-centered care into preservice education, and ensure ongoing health worker mentoring and supervision

On missional medicine: institution building, fragile places, and sheep among wolves

From the healing narratives of Jesus in the Gospels to the genesis of the first hospital to the practice of modern medicine, questions surrounding health and care for those who are sick and dying run through the heart of the Christian story. One way that individuals and communities have sought to live into their faith has been through missional medicine, that is, seeking to intentionally use the tools of medicine in step with and to bear witness to the life of Christ, particularly in crosscultural and global contexts. In this commentary, we take up the incisive question of the late missionary physician Raymond Downing, “is there a distinctive Christian approach to global health?” Or, what sets (and should set) Christian approaches to global health apart from other interventions? Here, we argue that there are at least three distinctive Christian contributions to global health. First, missional medicine movements have been committed to the building of long-standing hospitals and academic medical institutions that have left indelible marks on long-term health outcomes for people and communities. Second, practitioners motivated by Christian convictions disproportionately serve and remain long-term in marginalized, rural, and underserved areas; many of which are connected to fragile or under-developed health systems. Thirdly, Christian medical missionaries and global health workers ought to be, in the words of Jacques Ellul: preserving salt, revealing light, and “sheep in the midst of wolves.” This is a theologically framed vocation that accepts suffering and sacrifice, embracing solidarity through accompaniment. This paper is not meant to be a comprehensive history of missional medicine nor a defence of its problematic manifestations over the centuries. Rather, we candidly explore examples of the distinctive contributions that have been made, and we hope will continue to be made, by medical missionaries and global health workers who are motivated by their faith

Provider and client perspectives on maternity care in Namibia: results from two cross-sectional studies

Abstract Background Disrespectful and abusive maternity care is a complex phenomenon. In Namibia, HIV and high maternal mortality ratios make it vital to understand factors affecting maternity care quality. We report on two studies commissioned by Namibia’s Ministry of Health and Social Services. A health worker study examined cultural and structural factors that influence maternity care workers’ attitudes and practices, and a maternal and neonatal mortality study explored community perceptions about maternity care. Methods The health worker study involved medical officers, matrons, and registered or enrolled nurses working in Namibia’s 35 district and referral hospitals. The study included a survey (N = 281) and 19 focus group discussions. The community study conducted 12 focus groups in five southern regions with recently delivered mothers and relatives. Results Most participants in the health worker study were experienced maternity care nurses. One-third (31%) of survey respondents reported witnessing or knowing of client mistreatment at their hospital, about half (49%) agreed that “sometimes you have to yell at a woman in labor,” and a third (30%) agreed that pinching or slapping a laboring woman can make her push harder. Nurses were much more likely to agree with these statements than medical officers. Health workers’ commitment to babies’ welfare and stressful workloads were the two primary reasons cited to justify “harsh” behaviors. Respondents who were dissatisfied with their workload were twice as likely to approve of pinching or slapping. Half of the nurses surveyed (versus 14% of medical officers) reported providing care above or beneath their scope of work. The community focus group study identified 14 negative practices affecting clients’ maternity care experiences, including both systemic and health-worker-related practices. Conclusions Namibia’s public sector hospital maternity units confront health workers and clients with structural and cultural impediments to quality care. Negative interactions between health workers and laboring women were reported as common, despite high health worker commitment to babies’ welfare. Key recommendations include multicomponent interventions that address heavy workloads and other structural factors, educate communities and the media about maternity care and health workers’ roles, incorporate client-centered care into preservice education, and ensure ongoing health worker mentoring and supervision