Maternal Health Care Delivery Research Articles

Selected Indicators of Immunothrombosis in Apparently Healthy Nigerian Women of Different Reproductive Status

Introduction: Women are considered to be vulnerable with regards to immunothrombotic conditions. Exploring this bidirectional susceptibility across the different female reproductive phases is important for effective maternal healthcare delivery. This study assessed selected indicators of immunothrombosis between premenopausal and postmenopausal women. Methods: Equal numbers of premenopausal and postmenopausal women totaling one hundred were recruited for this comparative study. Blood sample was collected from each participant into appropriate sample bottles. Blood cell counts were carried out by haemocytometry and microscopic blood film reading. Standard manual methods were also employed for prothrombin time, activated partial thromboplastin time and relative plasma viscosity tests, while blood cell ratios were calculated. Results are expressed as Mean ±SD following student t-test analysis of data on SPSS version 22.0. Statistical significance was drawn at a p≤ 0.05. Results: The eosinophils count (0.42±0.31x109/l), monocyte count (0.05±0.05x109/l) and platelets count (150.04±46.88x109/l) were significantly higher in premenopausal women than postmenopausal women (0.29±0.27x109/l, 0.03±0.03x109/l and 132.62±38.37x109/l respectively), while a significantly higher value was observed in the relative plasma viscosity of postmenopausal women (1.74±0.17mPa/s) than the premenopausal women (1.59±0.10mPa/s). The two derived indicators of inflammation (NLR) and thrombosis (PLR) correlated positively in both premenopausal (r=0.397, p=0.004) and postmenopausal (r=0.293, p=0.039) women. Conclusion: Immune and thrombotic parameters are largely comparable in apparently healthy adult females irrespective of their reproductive phase. However, eosinophil, monocyte and platelet counts were observed to be significantly higher in premenopausal women compared to postmenopausal women.

Introduction: Women are considered to be vulnerable with regards to immunothrombotic conditions. Exploring this bidirectional susceptibility across the different female reproductive phases is important for effective maternal healthcare delivery. This study assessed selected indicators of immunothrombosis between premenopausal and postmenopausal women. Methods: Equal numbers of premenopausal and postmenopausal women totaling one hundred were recruited for this comparative study. Blood sample

Introduction: Maternal healthcare takes into consideration the immediate state of an individual woman with regards to health status and subsequent management. Anaemia is a common maternal health challenge that is affected by hormonal shifts in women. Thus, this study focused on prevalence of anaemia and iron requirement across women of premenopausal and postmenopausal phases. Methods: This study enrolled apparently healthy 100 females with equal numbers of premenopausal and postmenopausal subjects. Blood sample was appropriately obtained from each subject for assessment of red cell and iron parameters. Microhaematocrit and cyanmethaemoglobin methods were employed for the measurement of packed cell volume and haemoglobin concentration respectively, while the iron parameters were assayed by colorimetric methods. Transferrin saturation was mathematically derived. Results are expressed as Frequencies and Mean ±SD, while student t-test was used for analysis of data on SPSS version 22.0. Statistical significance was drawn at a p≤ 0.05. Results: Postmenopausal women had significantly higher values of packed cell volume (0.38 ± 0.03 l/l), haemoglobin concentration (125.50 ± 9.30 g/l), serum iron (23.17 ± 0.93 µmol/l) and transferrin saturation (36.88 ± 2.00 %) than the premenopausal women (0.37 ± 0.02 l/l, 121.44 ± 7.83 g/l, 15.53 ± 2.60 µmol/l and 20.70 ± 3.60 % respectively) while the premenopausal women had significantly higher values in total iron binding capacity (75.24 ± 3.32 µmol/l) than the postmenopausal women (62.97 ± 1.88 µmol/l. Whereas 30% of the premenopausal women were anaemic and 10% had low transferrin saturation, anaemia in postmenopausal women occurred at a prevalence of 18% and the indicators of iron need were adequate. Conclusion: This study has shown that among apparently healthy individuals, prevalence of anaemia and iron requirement are lower in postmenopausal women than premenopausal women.

A socioecological description of the influencing factors to midwives' management of preeclampsia in a Ghanaian tertiary hospital.

In low-resource settings, midwives are the first contact for women with preeclampsia and lead the coordination of care. Unfavourable preeclampsia outcomes create a burden for women, families, and the health system. It is therefore important to understand the unique context of midwives' practice and the complex factors that influence the delivery of maternal healthcare. This qualitative study explored the perspectives of key stakeholders in a tertiary hospital in Ghana regarding the facilitators and barriers influencing midwives' provision of preeclampsia care using a socioecological model. Semi-structured interviews were conducted with 42 participants comprising senior managers (n = 7) and hospital midwives (n = 35) in 2021. Thematic analysis used Braun and Clarke's six-step method, and the findings were organised within four levels of the socioecological model: individual, interpersonal, organisational, and public policy. Two main themes were identified: 1) Facilitators of preeclampsia management, and 2) Barriers to preeclampsia management. Facilitators were identified at three levels (individual, interpersonal, and organisational) and included midwives' knowledge of preeclampsia; midwives' self-efficacy; midwives' skillset to enhance preeclampsia care; collaborative practice; and strategies for preeclampsia care quality improvement. At the individual level, the barriers were inadequate pre-service preparation, lack of evidence-based midwifery care, and colleagues' work attitudes. Hierarchical decision-making and staff views of women's risk perceptions were identified as barriers at the interpersonal level. At the organisational level, the barriers were: scarce resources and staff shortages, and a lack of midwifery-specific guidelines. Two barriers were identified within the public policy level: the high cost of preeclampsia care and issues with the referral system. Multi-faceted factors play a significant role in midwives' management of preeclampsia. Hence context-specific multi-level interventions have the potential to improve the quality-of-care women in Ghana receive.

Perinatal care: Integrative healthcare services

Background: Healthcare (HC) deliberations are under huge pressure during the perinatal period. Like other healthcare sub-sectors, maternal HC delivery has encountered substantial moderations over the years, similar to the commutive streak that swept across the healthcare field over twenty-five years. Aim: Our literature aims to examine scientific research on commutive professional care (PC) to inform procedural decisions. Results: By evaluating the effectiveness of various clinical practices and intervention programs, researchers interested in integrated perinatal care have focused primarily on continuity of care and clinical and professional integration.

Ensuring quality obstetric care in rural Ghana: Shared experiences of obstetric care providers

PurposeTo explore care provider lived experiences with obstetric care delivery in rural Ghana. MethodsThis interpretative phenomenological study utilised a semi-structured interview guide to collect data on care provider lived experiences with obstetric care delivery. Participants comprised purposively sampled obstetric care providers in selected health care facilities in the Northern Region of Ghana. Data processing and presentation followed interpretative phenomenological analysis procedure. ResultsFindings reveal four superordinate themes: being persuasive, striving to provide quality care, using evasive mechanisms and subtle preventive schemes. These specifically refer to the use of alternative care, soliciting partner involvement, voluntarily donating blood, stocking essential items and drugs, refusing care in some instances and performing unconsented interventions. ConclusionIn their quest to provide quality care, obstetric care providers in some of Ghana’s rural health facilities adopt a mix of altruistic, innovative, excessive and unethical approaches most of which are driven by systemic failures. A government-community collaboration and commitment to quality maternal health care delivery is essential to improving health outcomes of rural mothers.

The Importance of Empathy in Maternal Healthcare Delivery

A woman's vulnerability is never greater than during pregnancy, childbirth, and the postnatal period. Quality healthcare delivery rest on actual interactions between patients and providers. Empathy has been acknowledged as a crucial component of patient care, benefiting both patients and medical staff. The patient-centered approach is considered an effective strategy to deliver successful patient care when healthcare professionals are more sensitive and attentive to the requirements of patients. Empathy means sharing another person's feelings and showing kindness to alleviate their misery or anguish. It is widely acknowledged as the essential component of nursing and midwifery care and regarded as the component of quality care. However, because it varies from practitioner to practitioner and from patient to patient, it is difficult to understand how compassion presents itself in the delivery of treatment. Midwives' compassionate attitudes and actions have a direct impact on obstetric outcomes. Even though scholars are studying the concept of empathy in nursing, little is known about what empathy in midwifery entails and how patients see it. Many advantages for patient communication, patient satisfaction, and treatment adherence are linked to healthcare professionals' empathy. This paper aims to examine the works of literature on the concept of empathy and highlight how crucial it is to provide care in the context of maternal healthcare.

Telehealth Strategies for the Delivery of Maternal Health Care : A Rapid Review.

Telehealth strategies to supplement or replace in-person maternity care may affect maternal health outcomes. To conduct a rapid review of the effectiveness and harms of telehealth strategies for maternal health care given the recent expansion of telehealth arising from the COVID-19 pandemic, and to produce an evidence map. Systematic searches of MEDLINE, the Cochrane Library, CINAHL, Embase, and Scopus for English-language studies (January 2015 to April 2022). Randomized controlled trials (RCTs) and observational studies of maternal care telehealth strategies versus usual care. Dual data extraction and risk-of-bias assessment of studies, with disagreements resolved through consensus. 28 RCTs and 14 observational studies (n= 44894) were included. Maternal telehealth interventions supplemented in-person care for most studies of mental health and diabetes during pregnancy, primarily resulting in similar, and sometimes better, clinical and patient-reported outcomes versus usual care. Supplementing in-person mental health care with phone- or web-based platforms or mobile applications resulted in similar or better mental health outcomes versus in-person care. A reduced-visit prenatal care schedule using telehealth to replace in-person general maternity care for low-risk pregnancies resulted in similar clinical outcomes and higher patient satisfaction versus usual care. Overall, telehealth strategies were heterogeneous and resulted in similar obstetric and patient satisfaction outcomes. Few studies addressed disparities, health equity, or harms. Interventions varied, and evidence was inadequate for some clinical outcomes. Replacing or supplementing in-person maternal care with telehealth generally results in similar, and sometimes better, clinical outcomes and patient satisfaction compared with in-person care. The effect on access to care, health equity, and harms is unclear. Patient-Centered Outcomes Research Institute. (PROSPERO: CRD42021276347).

User and community coping responses to service delivery gaps in emergency obstetric care provision in a rural community in Ghana.

The study sought to explore user and community responses to service delivery gaps in emergency obstetric care provision in rural Ghana. A qualitative design was employed to draw evidence from observations, interviews and focus group discussion among healthcare providers, clients and community members. Data processing and analysis followed a thematic approach. Findings reveal community interference in obstetric care delivery processes, reliance on unskilled providers, recourse to local oxytocin use, non-compliance to prescribed treatment and mistrust in healthcare providers as user and community coping mechanisms to perceived poor quality obstetric care. These behaviours have serious consequences on the life chances of pregnant and parturient women. The need to adapt to a more responsive and affordable maternal healthcare delivery system is essential for uptake of services in rural areas. Also, standardised guidelines to regulate health worker behaviour is critical to instil trust in the healthcare system.

117A digital resource for enhancing parental health literacy during the transition to parenthood

Abstract Background While the transition to parenthood is critical for mother-child health, traditional antenatal education has been questioned. Digital resources provide opportunities for reducing social disparities and enhancing health literacy, particularly important in a medicalized and decentralized birth environment with high caesarean and low breastfeed rates. Methods Within a Participatory Action Research (PAR) framework, formative qualitative and quantitative methods were employed to assess the cross-national transferability of Baby Buddy (UK), and deliver a locally relevant resource to inform, enhance user-provider communications and support shared decision-making. Results Using consensus-building and priority-setting techniques, we engaged with the local health professional community and parents-to-be to assess available resources, identify gaps and priorities in an eDelphi survey (N = 275 mums, 193 professionals) and gain an in-depth understanding on information-seeking behaviours and participation in decision-making in a series of focus groups with antenatal educators (N = 20) and new mums/ mums-to-be (N = 62). New material was co-created with participants and an intervention for embedding the tool in clinical practice was proposed within the COM-B behavioural change framework. Conclusions The project is a “proof of concept” for exchange of innovation and a “complimentary” model of maternal healthcare delivery. Beyond a learning experience for the participants, the use of PAR provided ground for building transdisciplinary alliances. Key messages Other than enhancing health literacy, digital resources can support the educational role of health professionals PAR provides a framework to engage with the community, building a sense of common purpose

Pregnancy and birth in the United States during the COVID‐19 pandemic: The views of doulas

BackgroundMuch of the emerging research on the effects of SARS‐CoV‐2 disease (COVID‐19) on pregnant people and their infants has been clinical, devoting little attention to how the pandemic has affected families navigating pregnancy and birth. This study examined the perspectives of doulas, or nonclinical labor support professionals, on how pregnancy and birth experiences and maternal health care delivery systems changed in the early weeks of the COVID‐19 pandemic.MethodsSemi‐structured interviews using open‐ended questions were conducted over the phone with 15 birth doulas. Doulas were invited to participate because of their close relationships with pregnant and birthing people and the comprehensive support they offer. The interview transcripts were analyzed inductively.ResultsDoulas’ clients faced three predominant COVID‐19‐related pregnancy and birth challenges: (a) fear of exposure; (b) limited access to their expected support systems; and (c) uncertainties surrounding hospital restrictions on labor and birth. Doulas responded creatively to help their clients confront these challenges. Participants expressed various criticisms of how maternal health care systems handled the emerging crisis, argued that COVID‐19 exposed preexisting weaknesses in US maternity care, and called for a coordinated care model involving doulas.DiscussionDoulas' close relationships with pregnant people enabled them to be an important source of support during the COVID‐19 pandemic. Added to the larger body of work on the impacts of doula care, this study supports widespread calls for universally integrating doulas into maternity care systems as a targeted strategy to better support pregnant and birthing people in both crisis and noncrisis situations.

Maternal Satisfaction and Factors Associated with Institutional Delivery Care in Central Ethiopia: a Mixed Study

BackgroundWomen satisfaction recognized as an important outcome of the maternal health care delivery system. Despite the Ethiopian federal ministry of health implemented compassionate, respectful, and caring as one of the health sector transformation agendas to increase health service utilization, the level of maternal satisfaction of institutional delivery is still low. This study aimed to assess maternal satisfaction and factors associated with institutional delivery care in central Ethiopia.MethodsCommunity-based cross-sectional study, which involved quantitative study supplemented with qualitative methods were employed. Mothers were proportionally allocated to each selected kebele according to the number of their size. Data were collected by a face-to-face interview using a standardized questionnaire to determine the level of maternal satisfaction with birth care. The result was presented using texts, percentages, and tables. Bivariate and multivariate logistic regressions were performed between dependent and independent variables at 95% confidence intervals and a P-value < 0.05 to show a significant association. In the qualitative part, data were transcribed carefully and analyzed thematically.ResultsThe overall a total of 451 respondents participated in this study making a response rate of 98%. The level of maternal satisfaction was 36.6% in this study. Spontaneous vaginal deliveries (SVD) (AOR: 7.33, CI: 2, 26.79), being attended by female sex health workers (AOR: 1.54, CI: 1.04, 2.28), receiving ambulance service to arrive at health facilities (AOR: 7.84, CI: 2, 61.63), utilizing of maternal waiting areas AOR: 1.72, CI: 1.09, 2.66), and respectful care (AOR=1.55, CI: 1.03, 2.34) were factors associated with maternal satisfaction. From qualitative study, three themes and ten categories have emerged.ConclusionMaternal satisfaction towards the delivery service was low. SVD, being attended by female sex health workers, ambulance service, cleaned delivery room, and respectful care were factors associated with maternal satisfaction. The health facilities in the study areas need to work on improving health facility cleanliness, health workers’ compassionate and respectful care, and providing ambulance service as a main means of transportation for laboring mothers.

Perception of Mobile Health Maternal Healthcare Services among Pregnant Women in Nigeria

The daunting challenge of maternal deaths resulting from preventable causes has remained a major public health issue in the developing countries of Africa and it is yet to be fully tackled. Empirical knowledge of the awareness of mobile health (m-health) maternal healthcare services among pregnant women in these parts, therefore, holds an important key to achieving success in reproductive health issues across the affected populations. Despite the introduction of mobile health services, the desirable state of reduced maternal mortality figures is yet to be achieved. This study sought to ascertain the level of awareness, extent of adoption and the challenges of m-health maternal services in southeast Nigeria. Our analysis of questionnaire-survey data on pregnant women from three states of Nigeria shows that 89.7% of respondents were aware of m-health in the study areas. However, awareness of the existence of m-health for maternal healthcare is different from usage of m-health in maternal healthcare delivery. The major challenges to its use are network failure from service providers and lack of funds for subscription, which may also mean that mobile phone ownership alone does not determine the success of m-health maternal health services in these parts. This leads to one of the recommendations that those who design mobile health application should consider offline mechanism as an alternative to the recurring network failure, for ease of use of such technology.

Do health care providers give sufficient information and good counseling during ante-natal care in Lao PDR?: an observational study

BackgroundIt is increasingly recognized that improving the quality of maternal health care delivery is of utmost importance in many countries. In Laos, the quality of antenatal care (ANC) service remains inadequate, but it has never been assessed thoroughly. This study aims to determine the ANC quality at the urban and rural public health facilities in Laos and provides suggestions to improve health education and counseling in addition to other routine care in public ANC services.MethodsThis health-facility based, cross-sectional observation study included both health providers (n = 77) and pregnant women (n = 421) from purposively selected health facilities (n = 16). Information on the mothers’ current pregnancies, previous visits and their last children was collected. The time spent for each ANC session as well as ANC services provided were recorded. Descriptive and inferential statistics were applied to analyze the data.ResultsOverall performance of ANC services by health care providers was poor in both urban and rural areas. Insufficient provision of information on danger signs during pregnancy, nutrition, breast feeding and iron supplements was revealed. Generally the communication skills, behavior and attitude of health providers were very poor. Less than a quarter of pregnant women were treated with kindness and respect. Only 4% of the observed ANC session took privacy into consideration. Less than 10% of available information materials were used during each ANC session. None of the health providers in both rural and urban areas performed specific counseling. Overall mean (SD) time-spent for each ANC session was 16.21 (4.28) minutes. A positive correlation was identified between the length of working experience of health providers and their physical performance scores (adjusted R square = 0.017).ConclusionsThe overall performance of ANC services by health care providers was inadequate in both urban and rural areas. Insufficient provision of health education and poor communication skills of health care providers were revealed. Existing IEC materials were scarcely used. Taking action to improve the quality of ANC services by training and providing specific guidelines, creating dedicated rooms, and providing sufficient and effective materials for counseling are all greatly needed in public health facilities in Laos.

The Place of Politics in Social Protection Program: Focus on Infant and Maternal Health Care Delivery in Akure, Nigeria

&lt;p&gt;The study examines the place of politics in infant and maternal health care delivery in Akure. To achieve this, the following objectives were made: assess the magnitude of infant birth and death as well as maternal death in the study area from 2003-2017, identify the causes of infant and maternal death in Akure, examine the relationship between politics and infant and maternal health care through policies and programmes instituted by various administrations and identify challenges facing infant and maternal health care delivery in Akure. To successfully capture these objectives, two governments owned hospitals (Mother and Child Hospital and Ondo State Specialist Hospital Akure) were selected for the administration of questionnaires. In all, eighty (80) women that have made use of the hospitals during pregnancy and child care stage were randomly and purposefully selected from the record file of the hospitals for the purpose of questionnaire administration. Likewise, the Chief Medical Directors of the two hospitals were interviewed. Data obtained were collated and presented using the descriptive statistical method. Findings revealed the policies, programmes, and accomplishments of successive governments of Ondo State from 2003-2017. The study recommends that successive government at all levels irrespective of political or party affiliation should make infant and maternal health care free most especially to the poor and the vulnerable group in the society.&lt;/p&gt;

Maternal Health Service Delivery in Ghana: A Case Study of Korle-Bu Teaching Hospital

Maternal mortality has become one of the major problems that has plagued the world, particularly in developing countries including Ghana. The overarching objective of this paper is to explore the maternal health service delivery in Ghana. Specifically, the study assessed the performance of service delivery of maternal health care with regards to the MDG 5; examined patients satisfaction with maternal health service delivery; and analyzed the effectiveness and efficiency of maternal health service delivery in Korle-Bu. The Korle-Bu teaching hospital was chosen because it is the major national hospital in Ghana. Secondary data was collected from records of health facilities and primary data from the administration of a questionnaire with key variables that were studied including antenatal and postnatal care. A total sample size of 60 respondents was used in this study and the respondents comprised of women who visited the Korle-Bu teaching hospital for antenatal and post-natal services. The exploration of maternal service was done from two major perspectives, that is, women attitude towards attending antenatal care and post-natal care and the services provided by health care professionals towards achieving effective and efficient results. This approach was adopted because curbing maternal mortality is linked to attending proper and regular antenatal care. The study revealed that antenatal care related negatively with maternal mortality whiles post-natal care related positively to maternal mortality. Findings also indicated that education of the public about the maternal health policy will help reduce the misconceptions and misunderstandings presented by the introduction of the policy. The paper argues from the findings that most women remained unaware about certain features of the maternal health policy. Thus, they encounter several problems due to this situation and it however delays childbirth. Findings also indicated that there is a positive relationship between the services provided by the health service personnel’s and the level of satisfaction that the women receive about the services provided to them. The findings of this paper also indicated that, in as much as Ghana has introduced several measures to help the country reduce the maternal mortality rate, there exist several shortfalls in its maternal health service delivery system. These shortfalls as indicated above hinder the efficient and effective delivery of better services offered to pregnant women. Thus, the study recommended the implementation of proper measures and mechanism in the policy that will help curtail the high rate of maternal mortality in the country and help the country achieve the MDG target set by the United Nations. Keywords: Maternal Health, Maternal Health system, Maternal Mortality DOI : 10.7176/PPAR/9-4-11 Publication date : April 30 th 2019

Factors influencing the utilization of TBA services by women in the Tolon district of the northern region of Ghana

Maternal mortality issues have become a major cause for concern especially in developing counties as they struggle to attain the Sustainable Development Goals 3.1 and 3.2. Tradi tional Birth Attendants (TBAs) have played a significant role in providing maternal health services, especially in rural Africa. Health service providers have done a lot to provide ma- ternal health services to pregnant women in Ghana yet most women, especially in rural areas, still, patronize the services of (TBAs). The aim of this paper is to determine the fac- tors that influence women in the Tolon district of Ghana to patronize the services of TBAs. The paper employed a mixed research approach and adopted the cross-sectional survey design to collect and analyse data. The study involved 360 women who have sought the services of TBAs within the last five years. Data were collected with the use of question- naires containing both open-ended and closed-ended questions. The factors that influenced the patronage of TBAs included the fact that TBA services are cheaper, more culturally ac- cepted, nearer to the homes of pregnant women than the hospital, TBAs being more caring than orthodox health workers and being the only maternity care that women know. It is recommended that since the factors that influence the patronage of TBA services cannot easily be abolished the health authorities should integrate TBA services in mainstream maternal health care delivery.

Examining the unresolved conundrum of Traditional Birth Attendants’ involvement in maternal and child health care delivery in Ghana

Traditional Birth Attendants (TBAs) have been a critical human resource in maternal health care delivery in Ghana. However, following the World Health Organization’s directive for countries to discontinue using TBAs, the government of Ghana has since emphasized the use of skilled birth attendants. This policy shift created tensions between TBAs and Community Health Nurses. We examine this conundrum in this paper. We find that despite the ban, TBAs still attend a significant number of births – a situation which has produced intense contestations and continuous jostling for “functioning space” and clients between TBAs and nurses. We recommend a consensus-based partnership approach that promotes cultural competence and is sensitive to contextual cultural practices that underpin pregnancy and childbirth.

Experiences with Universal Health Coverage of Maternal Health Care in Ondo State, Nigeria, 2009-2017.

I am pleased that the theme of this maiden conference of the Association of Feto-Maternal Medicine Specialists of Nigeria (AFEMSON) is the reduction of maternal and perinatal mortality. Practising in our setting can be particularly challenging due to the weak health system which leads to frustrating outcomes, with high rates of avoidable maternal and perinatal morbidity and mortality. For practitioners of fetomaternal medicine to deal with this as a major public health concern, the focus should not just be some cold statistics, but rather it must be addressed as a true everyday human story and societal tragedy. In a recent publication1, Elliot Main, a Stanford Professor of Obstetrics and Gynaecology, and founder of California Maternal Quality Care Collaborative was reported as saying: ―When you‘ve had a maternal death, you remember it for the rest of your life - all the details‖ Perhaps, practicing in our setting (like in most low and middle income countries) you may not remember ―all the details‖ because of regularity of occurrence. However, I am sure that each of you, frontline practitioners here gathered, has had a few unfortunate human angle stories - details of which get imprinted in your memory for the rest of your life. In my practice, I also had my own experiences, which were part of the reasons that I decided to temporarily set aside the practice of clinical medicine to get involved in top policy formulation for health and overall societal development. As reported by Olu Obafemi2 in his recent publication of my experiences: “Those days I will tell people that I could never forget the cry of a woman when she loses her child at night, because at a stage, I was living within my clinic. It was harrowing, especially at night, between 1-2am.” As Governor of Ondo State, southwest Nigeria for 8 years (2009-2017), working with other stakeholders, we proved that even in resource-restricted settings like Nigeria, it is possible to achieve positive outcomes in terms of systematic reduction in maternal and perinatal death mortality. The Centre for Strategic and International Studies (CSIS), in its publication on the first year of ABIYE3, succinctly encapsulated this by saying ―With leadership, progress is possible.‖ Specifically, under my leadership as Governor of Ondo State, we commenced a unique Abiye maternal health program that offered free maternal and child health services to pregnant mothers and children less than five years old (including sophisticated referral care) that brought maternal and child health care to the doorstep of every citizen in the state. The consequence was a significant reduction in maternal mortality in the state, enabling the state to achieve the target of Goal-5 of the Millennium Development Goals. But this was not achieved without some noteworthy challenges. The purpose of this presentation therefore is to describe the philosophy that led us to focus on the delivery of free maternal health care, to summarize the methods and challenges in its implementation and to make recommendations on ways to build political will for improved delivery of maternal health care and the reduction of maternal and perinatal mortality in Nigeria. I believe that the recommendations made will be useful for policymakers elsewhere to understand the social context of health care and to prioritize the delivery of maternal health care as a social justice and human rights requirement of citizens.

Perceptions of women on workloads in health facilities and its effect on maternal health care: A multi-site qualitative study in Nigeria

Objectiveof the study was to explore women's perception of maternal health care providers’ workload and its effects on the delivery of maternal healthcare in secondary and tertiary hospitals in Nigeria. Research Design, setting, participantsfive focus groups discussions (FGDs) were conducted with women in each of eight secondary and tertiary hospitals in 8 States in four geo-political zones of the country. In all, 40 FGDs were held with women attending antenatal and post-natal clinics in the hospitals. We elicited information on women's perceptions of workloads of maternal health providers and the effects of the workloads on maternity care. The discussions were audio-taped and transcribed while thematic analysis was carried out using Atlas.ti computer software. Findingsthe majority of the participants submitted that the health providers are burdened with heavy workloads in the provision of maternal health care. Examples of heavy workload cited included complaints from health providers, evidence of stress and strain in care provision by providers and the sheer numbers of patients that are left unattended to in health facilities. Poor quality care, insufficient time to carry out necessary investigations on patients, and prolonged waiting time experienced by women in accessing care featured as consequences of heavy workload, with the secondary result that women are reluctant to seek care in the health facilities because of the belief that they would spend a long time in receiving care. Key conclusions and implications for practicewe conclude that women are concerned about heavy workloads experienced by healthcare providers and may partly account for the low utilization of referral health facilities for maternal health care in Nigeria. Efforts to address this problem should include purposeful human resource policy development, the development of incentives for health providers, and the proper re-organization of the health system.

Qualitative assessment of women\u2019s satisfaction with maternal health care in referral hospitals in Nigeria

BackgroundAvailable evidence suggests that the low use of antenatal, delivery, and post-natal services by Nigerian women may be due to their perceptions of low quality of care in health facilities. This study investigated the perceptions of women regarding their satisfaction with the maternity services offered in secondary and tertiary hospitals in Nigeria.MethodsFive focus group discussions (FGDs) were held with women in eight secondary and tertiary hospitals in four of the six geo-political zones of the country. In all, 40 FGDs were held with women attending antenatal and post-natal clinics in the hospitals. The questions assessed women’s level of satisfaction with the care they received in the hospitals, their views on what needed to be done to improve patients’ satisfaction, and the overall quality of maternity services in the hospitals. The discussions were audio-taped, transcribed, and analyzed by themes using Atlas ti computer software.ResultsFew of the participants expressed satisfaction with the quality of care they received during antenatal, intrapartum, and postnatal care. Many had areas of dissatisfaction, or were not satisfied at all with the quality of care. Reasons for dissatisfaction included poor staff attitude, long waiting time, poor attention to women in labour, high cost of services, and sub-standard facilities. These sources of dissatisfaction were given as the reasons why women often preferred traditional rather than modern facility based maternity care. The recommendations they made for improving maternity care were also consistent with their perceptions of the gaps and inadequacies. These included the improvement of hospital facilities, re-organization of services to eliminate delays, the training and re-training of health workers, and feedback/counseling and education of women.ConclusionA women-friendly approach to delivery of maternal health care based on adequate response to women’s concerns and experiences of health care will be critical to curbing women’s dissatisfaction with modern facility based health care, improving access to maternal health, and reducing maternal morbidity and mortality in Nigeria.Trial registrationTrial Registration Number NCTR No: 91540209. Nigeria Clinical Trials Registry. http://www.nctr.nhrec.net/. Registered April 14th 2016.