Weighing the options for delivery care in rural Malawi: community actors' perceptions of the 2007 policy guidelines and redefined traditional birth attendants roles

Despite significant recent improvements, maternal mortality remains high in Malawi. To address this, the Government prioritised strategies promoting skilled birth attendance. However, in a country where 80% of the population resides in rural areas, there are tremendous barriers to institutional deliveries. Historically rural women have been supported in childbirth by Traditional Birth Attendants (TBAs), and by skilled birth attendants (SBAs) at the health facility. In the past, TBAs were trained to help bridge the gaps in provision and accessibility of care but in the 1990's, the WHO recommended halting their training because it was perceived as ineffective for maternal mortality reduction. In 2007, the Government of Malawi issued Community Guidelines to promote skilled birth attendance and banned TBA utilization for routine deliveries. This grounded theory qualitative study used interviews and focus groups to explore community actors' perceptions of the 2007 Policy Guidelines and their implementation, and how the Policy affected the decisions and actions of rural women regarding their delivery care. Findings from this study indicate that although all actors may agree that delivering at facilities is safest when complications occur, this does not necessarily ensure their compliance. Women, men and TBAs particularly, perceived the Policy as prescriptive. Furthermore, the implementation of the policy aggravated some of the barriers women already faced. Issues of disrespectful and neglectful care at facilities also partly led women towards non-compliance. Furthermore, a view from the ground demonstrated that the Policy had led to a rupture of linkages between TBAs and SBAs, which have had a detrimental effect on the continuum of care. This study helps fill an important gap in research concerning maternal health policy implementation analysis in LICs, by focusing on the perceptions of those at the receiving end of policy change, and on their needs, and aspirations.sub_iihdunpub2618_ethesesunpu

Africa's treacherous roads are no safer after scores of initiatives - here's a new grassroots approach

First paragraph: Everyone knows that roads are dangerous, but many people are surprised when they find out just how deadly they can be. As many as 1.4m people are killed every year – about one every 23 seconds – while another 20m to 50m are injured but survive, often with life-changing disabilities. Road traffic collisions are currently the eighth biggest killer in the world.https://theconversation.com/africas-treacherous-roads-are-no-safer-after-scores-of-initiatives-heres-a-new-grassroots-approach-11670

Factors and motivations contributing to community volunteers' participation in a nursery feeding project in Malawi

This article reports on a study to explore the factors and motivations that contribute to community volunteers' participation in a nursery feeding project in Malawi. Semi-structured interviews were conducted with community volunteers in 14 of the 32 sites in the programme. The findings pointed to a mix of intrinsic motivations, namely a deep concern for orphans and vulnerable children, a moral obligation to help, and a declared love of the work undertaken, and also to external factors such as spirituality, links of reciprocity, and the building of social capital. Understanding what motivates volunteers to take part in resource-poor settings is crucial to recognising, facilitating, and sustaining the work that they do. Further research into volunteering in the South is crucially needed

Steady and delayed: explaining the different development of meta-ethnography in health care and education

Since its inception in the 1980s, the meta-ethnography approach for synthesising qualitative study accounts has been used extensively in health and social care research and to a lesser extent in educational research. The aim of this article is to reflect on the evolution of the method in both fields. It starts by describing the meta-ethnography approach, charts the rise of evidence-based research in health-related research, and explores the growth in the rate of published health-related meta-ethnographies. It proceeds by offering some explanation for the slower growth in the use of meta-ethnography in educational research. It explains this using the history of the early developments of qualitative approaches in Education and their underpinning paradigms. It then discusses key meta-ethnographies conducted in education, comparing those to more recent ones, in terms of methodological development. The article concludes by drawing lessons about how the conduct of meta-ethnography may be improved in any discipline

Drink Drive – taking stock, moving forward

Chapter 8: In-depth interviews with drink drivers, pages 51-7

Evaluating the progress of alcohol policies in Burundi against the WHO ‘best buy’ interventions: implications for public health.

Introduction: Alcohol use is a major global health risk, with Global South countries experiencing greater harm per litre of alcohol consumed than those in the Global North. In Burundi, a country with a low-income economy, 16.6% of people aged 15 and above binge drink, and over 30% of women drink during pregnancy. This paper examines current alcohol policies in Burundi, how well they match the WHO ‘best buy’ policy options, and stakeholder views on their implementation. Methods: We searched for policy documents via online searches, visits to government offices, and snowball sampling from contact with key stakeholders. Semi-structured interviews were conducted with ten stakeholders. The WHO-European Action Plan to Reduce the Harmful Use of Alcohol (EAPA) tool was used to analyse the extent to which Burundi has adopted recommended policy standards. Interviews were thematically analysed using NVivo software. Results: Only nine of the 34 WHO-EAPA indicators are addressed, seven out of 34 indicators are mentioned with no clear actions, and 18 are not addressed in the eight policy documents that met our inclusion criteria. The large proportion of indicators absent from Burundi policy relate to availability, pricing and taxation, drinking-driving, taxation, and marketing. An absence of legislation to support existing policies, industry interference, corruption, and cultural norms around alcohol were identified as key barriers to implementation. Conclusions: Burundi should enact laws to support existing policies and design regulations targeting marketing and advertising. Government and civil society coalitions should report and address any alcohol industry influence in policymaking and implementation

Evaluating the progress of alcohol policies in Burundi against the WHO ‘best buy’ interventions: implications for public health.

Introduction: Alcohol use is a major global health risk, with Global South countries experiencing greater harm per litre of alcohol consumed than those in the Global North. In Burundi, a country with a low-income economy, 16.6% of people aged 15 and above binge drink, and over 30% of women drink during pregnancy. This paper examines current alcohol policies in Burundi, how well they match the WHO ‘best buy’ policy options, and stakeholder views on their implementation. Methods: We searched for policy documents via online searches, visits to government offices, and snowball sampling from contact with key stakeholders. Semi-structured interviews were conducted with ten stakeholders. The WHO-European Action Plan to Reduce the Harmful Use of Alcohol (EAPA) tool was used to analyse the extent to which Burundi has adopted recommended policy standards. Interviews were thematically analysed using NVivo software. Results: Only nine of the 34 WHO-EAPA indicators are addressed, seven out of 34 indicators are mentioned with no clear actions, and 18 are not addressed in the eight policy documents that met our inclusion criteria. The large proportion of indicators absent from Burundi policy relate to availability, pricing and taxation, drinking-driving, taxation, and marketing. An absence of legislation to support existing policies, industry interference, corruption, and cultural norms around alcohol were identified as key barriers to implementation. Conclusions: Burundi should enact laws to support existing policies and design regulations targeting marketing and advertising. Government and civil society coalitions should report and address any alcohol industry influence in policymaking and implementation

From Global Rights to Local Relationships: Exploring Disconnects in Respectful Maternity Care in Malawi

Widespread reports of “disrespect and abuse” in maternity wards in low- and middle-income countries have triggered the development of rights-based respectful maternity care (RMC) standards and initiatives. To explore how international standards translate into local realities, we conducted a team ethnography, involving observations in labor wards in government facilities in central Malawi, and interviews and focus groups with midwives, women, and guardians. We identified a dual disconnect between, first, universal RMC principles and local notions of good care and, second, between midwives and women and guardians. The latter disconnect pertains to fraught relationships, reproduced by and manifested in mechanistic care, mutual responsibilization for trouble, and misunderstandings and distrust. RMC initiatives should be tailored to local contexts and midwife-client relationships. In a hierarchical, resource-strapped context like Malawi, promoting mutual love, understanding, and collaboration may be a more productive way to stimulate “respectful” care than the current emphasis on formal rights and respect

Women’s experiences of receiving care for pelvic organ prolapse: a qualitative study

Background Pelvic organ prolapse is a common urogenital condition affecting 41–50% of women over the age of 40. To achieve early diagnosis and appropriate treatment, it is important that care is sensitive to and meets women’s needs, throughout their patient journey. This study explored women’s experiences of seeking diagnosis and treatment for prolapse and their needs and priorities for improving person-centred care. Methods Twenty-two women receiving prolapse care through urogynaecology services across three purposefully selected NHS UK sites took part in three focus groups and four telephone interviews. A topic guide facilitated discussions about women’s experiences of prolapse, diagnosis, treatment, follow-up, interactions with healthcare professionals, overall service delivery, and ideals for future services to meet their needs. Data were analysed thematically. Results Three themes emerged relating to women’s experiences of a) Evaluating what is normal b) Hobson’s choice of treatment decisions, and c) The trial and error of treatment and technique. Women often delayed seeking help for their symptoms due to lack of awareness, embarrassment and stigma. When presented to GPs, their symptoms were often dismissed and unaddressed until they became more severe. Women reported receiving little or no choice in treatment decisions. Choices were often influenced by health professionals’ preferences which were subtly reflected through the framing of the offer. Women’s embodied knowledge of their condition and treatment was largely unheeded, resulting in decisions that were inconsistent with women’s preferences and needs. Physiotherapy based interventions were reported as helping women regain control over their symptoms and life. A need for greater awareness of prolapse and physiotherapy interventions among women, GPs and consultants was identified alongside greater focus on prevention, early diagnosis and regular follow-up. Greater choice and involvement in treatment decision making was desired. Conclusions As prolapse treatment options expand to include more conservative choices, greater awareness and education is needed among women and professionals about these as a first line treatment and preventive measure, alongside a multi-professional team approach to treatment decision making. Women presenting with prolapse symptoms need to be listened to by the health care team, offered better information about treatment choices, and supported to make a decision that is right for them