Safe start at home : what parents of newborns need after early discharge from hospital - a focus group study

The length of postpartum hospital stay is decreasing internationally. Earlier hospital discharge of mothers and newborns decreases postnatal care or transfers it to the outpatient setting. This study aimed to investigate the experiences of new parents and examine their views on care following early hospital discharge.; Six focus group discussions with new parents (n = 24) were conducted. A stratified sampling scheme of German and Turkish-speaking groups was employed. A 'playful design' method was used to facilitate participants communication wherein they used blocks and figurines to visualize their perspectives on care models The visualized constructions of care models were photographed and discussions were audio-recorded and transcribed verbatim. Text and visual data was thematically analyzed by a multi-professional group and findings were validated by the focus group participants.; Following discharge, mothers reported feeling physically strained during recuperating from birth and initiating breastfeeding. The combined requirements of infant and self-care needs resulted in a significant need for practical and medical support. Families reported challenges in accessing postnatal care services and lacking inter-professional coordination. The visualized models of ideal care comprised access to a package of postnatal care including monitoring, treating and caring for the health of the mother and newborn. This included home visits from qualified midwives, access to a 24-h helpline, and domestic support for household tasks. Participants suggested that improving inter-professional networks, implementing supervisors or a centralized coordinating center could help to remedy the current fragmented care.; After hospital discharge, new parents need practical support, monitoring and care. Such support is important for the health and wellbeing of the mother and child. Integrated care services including professional home visits and a 24-hour help line may help meet the needs of new families

Patterns of biomedical science production in a sub-Saharan research center

<p>Abstract</p> <p>Background</p> <p>Research activities in sub-Saharan Africa may be limited to delegated tasks due to the strong control from Western collaborators, which could lead to scientific production of little value in terms of its impact on social and economic innovation in less developed areas. However, the current contexts of international biomedical research including the development of public-private partnerships and research institutions in Africa suggest that scientific activities are growing in sub-Saharan Africa. This study aims to describe the patterns of clinical research activities at a sub-Saharan biomedical research center.</p> <p>Methods</p> <p>In-depth interviews were conducted with a core group of researchers at the Medical Research Unit of the Albert Schweitzer Hospital from June 2009 to February 2010 in Lambaréné, Gabon. Scientific activities running at the MRU as well as the implementation of ethical and regulatory standards were covered by the interview sessions.</p> <p>Results</p> <p>The framework of clinical research includes transnational studies and research initiated locally. In transnational collaborations, a sub-Saharan research institution may be limited to producing confirmatory and late-stage data with little impact on economic and social innovation. However, ethical and regulatory guidelines are being implemented taking into consideration the local contexts. Similarly, the scientific content of studies designed by researchers at the MRU, if local needs are taken into account, may potentially contribute to a scientific production with long-term value on social and economic innovation in sub-Saharan Africa.</p> <p>Conclusion</p> <p>Further research questions and methods in social sciences should comprehensively address the construction of scientific content with the social, economic and cultural contexts surrounding research activities.</p

Soziale Dimensionen biomedizinischer Forschung in einem südlich der Sahara gelegenen afrikanischen Land. Wahrnehmungen und Einstellungen von Studienteilnehmern der Medical Research Unit des Albert Schweitzer Krankenhauses in Lambaréné, Gabun

The ethical debate on biomedical research in sub-Saharan Africa gives the impression that scientific production in poor socioeconomic contexts naturally involves an “ethical dilemma”. Throughout the literature, this debate mainly concentrates on the research participants’ competence and compliance to transnational scientific and ethical requirements. This study intended to describe the patterns of participation in clinical research of the population of a poor region in sub-Saharan Africa. Using ethnological and quantitative approaches, we focused on the perceptions of the participants of ongoing and completed trials regarding clinical research activities and the functioning of health systems. The frequency of a particular perception and behaviour was calculated and reported in tables. Inter-individual interactions and relationships between the research participants and the research site and staff seem essential in understanding how the entire population is integrating clinical research principles and procedures. The performance of research procedures and activities as well as their integration within broader health concerns may take place through the constitution of social networks among the different actors, such as study participants, their friends and relatives, and the researchers. A paradigm shift towards research questions and methods that are neither limited in time nor restricted to conform to international standardized guidelines and regulations would facilitate understanding of biomedical science implementation and production in sub-Saharan Africa.Die ethische Debatte über klinische Forschung in Regionen Afrikas südlich der Sahara vermittelt den Eindruck, dass Forschung in ärmeren Ländern ein unabdingbares „ethisches Dilemma“ mit sich bringt. In der Literatur bezieht sich diese Argumentation hauptsächlich auf das mangelnde Verständnis seitens der Studienprobanden gegenüber klinischen Studien, wodurch international gültige ethische und wissenschaftliche Anforderungen nicht erfüllt werden könnten. Die vorliegende Studie hat das Ziel, die Einstellungen und Einschätzungen zu beschreiben, die Studienteilnehmer einer ärmeren Bevölkerung Afrikas klinischen Forschungsprojekten entgegenbringen. Mithilfe von ethnologischen und quantitativen Ansätzen haben wir uns darauf konzentriert, zu erfassen, wie klinische Studien und das Gesundheitssystem von den Studienteilnehmern, die an Impfstudien teilnehmen, wahrgenommen werden. Hierzu wurde die Häufigkeit einer bestimmten Wahrnehmung oder eines bestimmten Verhaltens berechnet und in Tabellen dargestellt. Persönliche Interaktionen und soziale Beziehungen zwischen den Studienteilnehmern untereinander, aber auch gegenüber dem Forschungsteam und der Forschungsabteilung scheinen unerlässlich zu sein, wenn man herausfinden will, wie klinische Forschung und die dazugehörigen Vorgänge von der Gesamtbevölkerung aufgenommen werden. Die Darstellung von Forschungsabläufen und die damit zusammenhängenden Aktivitäten und deren Bezug zu anderen gesundheitlichen Themen kann durch den Aufbau von sozialen Netzwerken zwischen den beteiligten Parteien, z.B. den Studienteilnehmern, ihren Freunden und Verwandten und dem Forschungsteam erleichtert werden. Ein Paradigmenwechsel in Bezug auf die relevanten Forschungsfragen und - methoden, die weder zeitlich befristet, noch auf international standardisierte Richtlinien beschränkt sind, würde dazu beitragen, dass biomedizinische Forschung und deren Umsetzung in Regionen Afrikas südlich der Sahara, besser verstanden und aufgenommen werden kann

Additional file 1: Picture S1. of Safe start at home: what parents of newborns need after early discharge from hospital – a focus group study

Care model developed by Turkish mothers: Midwife stands at the mother’s bed and makes regular home visits. Other health professionals (in the yellow car), such as a pediatrician, gynecologist and psychologist are on call and offer home visits if needed. (JPG 1231 kb

Additional file 2: Picture S2. of Safe start at home: what parents of newborns need after early discharge from hospital – a focus group study

Illustration of the health professional keeping a watchful eye upon the health and wellbeing of mother and child. (constructed by Aline, 29 years, first child, 1 month, cesarean). (JPG 426 kb

Additional file 4: Picture S4. of Safe start at home: what parents of newborns need after early discharge from hospital – a focus group study

Care model developed by German-speaking, first-time mothers: The family and the health professionals are arranged around the central office. The watch represents 24-hour availability and the computer in the foreground represents the telephone and bundled information available from the central office. (JPG 2982 kb