Districts In Timor-Leste Research Articles

Timorese women’s experiences and expectations of skilled birth attendance in Timor-Leste: A qualitative inquiry

ObjectiveThe study explores women’s experiences and expectations of maternity care in Timor-Leste. MethodQualitative, descriptive research using focused ethnography. Thirty women and seventeen health professionals from three districts in Timor-Leste were interviewed and/or participated in focus groups. ResultsWomen’s expectations of care include the provision of information, advice and clinical assessment from midwives who have the capacity to provide emergency obstetric care if required. Midwives’ access to technology (for example: the fetal doppler), increased the women’s confidence in services. The women also identified poor experiences, including angry, busy midwives, poor communication, and lack of privacy in antenatal and birthing services. The lack of privacy inhibits women’s communication with health professionals. An absence of covers and multiple staff present during labour and birth embarrass the women and their families. Many Timorese women live in poverty and have poor literacy skills. These women want knowledgeable, approachable, and clinically competent midwives who can support them through their pregnancies and childbirth. Poor communication, angry, busy midwives and lack of privacy cause discomfort and embarrassment and may discourage the women and their family’s uptake of skilled birth attendant (SBA) services. ConclusionMidwives have a critical primary role in the provision of advice, information and care of Timorese women during the childbirth continuum. Continuing education of midwives with an emphasis on communication and culturally congruent care will improve women’s satisfaction and childbirth outcomes. Impoverished women are particularly vulnerable when birthing in health care services. Attention to the women’s privacy and her additional needs can include a focus on the birthing space and the number of staff who have access to it.

Key factors deterring women's engagement with skilled birth attendants in three districts of Timor—Leste. A qualitative descriptive study

ObjectiveTo describe the barriers to women's access to maternity services in three districts of Timor-Leste. Research design/setting: Focused ethnography with data collection methods commensurate with a qualitative research design. Setting and participants: Data was collected in three districts in Timor-Leste. Participants included seventeen stakeholders, health professionals and managers providing skilled birth attendance (SBA) in Timor-Leste and thirty women who have given birth and are competent to give consent. Findings: Access to SBA services is seriously impeded by poor roads and lack of transportation, the poor condition and amenity of services, restricted hours of opening, the lack of availability of skilled SBA professionals and medical resources. Participants also commented upon the lack of privacy and multiple caregivers. Timorese patriarchal family structures, intergenerational decision-making and cultural attitudes towards reproductive health information and services potentially reduce women's access to reproductive health services. ConclusionThis data provides a comprehensive record of the multiple structural barriers to women's access to SBA services. The modified AAAQA framework provides categories and an organisational structure to these barriers to SBA services. Implications for practiceMaternity care in Timor-Leste is extremely poorly resourced. Midwives and other SBA will need to provide innovative low cost solutions if they are to consistently provide respectful culturally safe midwifery care. This includes the provision of privacy and a one to one midwifery relationship `with woman'. In addition, many women are unable to access SBA, where possible the MoH can consider strategies to improve the provision of SBA services to women birthing in community.

Working towards gender equality in rural Timor-Leste and Papua New Guinea: community health survey

The centrality of gender equality for sustainable human development is well recognised and reflected in the Sustainable Development Goals (SDGs), however in many countries in the Pacific region gender inequality is widespread. Working with men and boys presents an important opportunity to address gender inequality. A ‘Men’s Health Project’ was implemented in rural districts in Timor-Leste and Papua New Guinea (PNG) in 2014-17, which aimed to promote gender equality and improve sexual and reproductive health and maternal and child health outcomes by actively engaging men. Community surveys were undertaken in each community before and after project implementation to enable a greater understanding of men’s knowledge and attitudes at these different time points. This paper reports findings from the more recent surveys with 400 men in Timor-Leste in 2016 and 243 men in PNG in 2017, in order to provide a ‘snapshot’ of the situation in these rural communities at this time. In both countries, the vast majority of men reported that the husband makes the major decisions in the household (80% in Timor-Leste and 84% in PNG). In Timor-Leste, 5% of respondents felt it was okay for a husband to beat his wife, with 13% reporting this in PNG. Findings suggest that meeting SDGs 3 and 5 will require ongoing and concerted efforts in Timor-Leste and PNG.

What influences a woman’s decision to access contraception in Timor-Leste? Perceptions from Timorese women and men

Timor-Leste’s Maternal Mortality Ratio remains one of the highest in Asia. There is ample evidence that maternal deaths may be reduced substantially through the provision of good-quality modern methods of contraception. Many Timorese women wish to stop or delay having children. However, even when health services make contraception available, it does not mean that people will use it. Collaborating with Marie Stopes Timor-Leste, this qualitative research project used decolonising methodology to explore perceived influences contributing to contraceptive choices, and gain insight into how women’s decisions to access contraception in Timor-Leste occur. Over two fieldwork periods (2013 and 2015), we used focus group discussions and structured interviews to speak with 68 women and 80 men, aged 18–49 years, across four districts of Timor-Leste. Findings demonstrate that the decision to access contraception is often contentious and complicated. These tensions echo concerns and ambiguities contained within global and national reproductive health policy. Overwhelmingly, participants emphasised that despite her wishes, a woman can only rarely exercise her right to access contraception freely and independently. She is most often constrained by family, cultural, traditional and educational influences.

Body Mapping to Explore Reproductive Ethno-Physiological Beliefs and Knowledge of Contraception in Timor-Leste.

Maternal mortality remains a significant public health challenge for Timor-Leste. Although access to quality family planning measures may greatly reduce such deaths, consideration of indigenous perceptions, and how they influence reproductive health decision-making and behavior, is crucial if health services are to provide initiatives that are accepted and helpful in improving reproductive health outcomes. We aimed to demonstrate that body mapping is an effective method to traverse language and culture to gain emic insights and indigenous worldviews. The authors' two qualitative research projects (2013 and 2015) used a decolonizing methodology in four districts of Timor-Leste, body mapping with 67 men and 40 women to illuminate ethno-physiology and indigenous beliefs about conception, reproduction, and contraception. Body mapping provided a beneficial conduit for identifying established indigenous reproductive perceptions, understandings, and vocabulary, plus fears surrounding contraception. This may inform health service provision and engagement, ultimately improving the reproductive health of community members.

Analisis Disparitas dan Interaksi Spasial di Timor-Leste

Spatial planning is a tool to achieve braden goals of development. To support economic development in Timor Leste, it needs an optimal spatial structure planning that supports connectivities between districts through infrastructures network. This research aimed to analyze and explain disparities, interaction and optimal regional spatial structure using variables of infrastructures and public facilities on national and regional/districts/subnational activities center. This research used Scalogram and gravitation modelling analysis. The results showed that there is a high disparity level between districts in Timor-Leste that caused by the lack of public facilities and lack of access to public services. Moreover, the spatial structure interaction between districts are very weak. To cope with those problems, this research suggested the formulation of one national activity center located in the north (Dili) and three Regional (subnational) Activity Center (RAC) located at Ermera in the west, Baucau in the east and Manufahi in the south of Timor-Leste

Prevalence and correlates of explosive anger among pregnant and post-partum women in post-conflict Timor-Leste.

BackgroundLittle is known about explosive anger as a response pattern among pregnant and post-partum women in conflict-affected societies.AimsTo investigate the prevalence and correlates of explosive anger among this population in Timor-Leste.MethodWe assessed traumatic events, intimate partner violence, an index of adversity, explosive anger, psychological distress and post-traumatic stress disorder among 427 women (257 in the second trimester of pregnancy, 170 who were 3–6 months post-partum) residing in two districts of Timor-Leste (response >99%).ResultsTwo-fifths (43.6%) had explosive anger. Levels of functional impairment were related to frequency of explosive anger episodes. Explosive anger was associated with age (>35 years), being married, low levels of education, being employed, traumatic event count, ongoing adversity and intimate partner violence.ConclusionsA combination of social programmes and novel psychological therapies may assist in reducing severe anger among pregnant and post-partum women in conflict-affected countries such as Timor-Leste.Declaration of interestNone.Copyright and usage© The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

Pathways to perinatal depressive symptoms after mass conflict in Timor-Leste: a modelling analysis using cross-sectional data

The contributions of potentially traumatic events (PTEs) of mass conflict and post-traumatic stress disorder (PTSD) symptoms to perinatal depression in women living in low-income, post-conflict countries are unclear. We tested a model including these factors, intimate partner violence (IPV), and continuing adversity in women in Timor-Leste. Our modelling study used cross-sectional data from a sample of women living in two districts in Timor-Leste, identified through service registers, clinic records, village chiefs, and a door-to-door survey between June, 2012, and June, 2013. Eligible women were 3-6 months pregnant or 3-6 months postpartum. We assessed conflict-related PTEs, IPV, continuing adversity (poverty and insecurity), PTSD symptoms (the Harvard Trauma Questionnaire), and maternal depressive symptoms (the Edinburgh Postnatal Depression Scale [EPDS]) to develop a theoretical model to examine pathways leading directly and indirectly to depressive symptoms. We assessed 427 eligible women, of whom 258 (60%) were pregnant and 169 (40%) were postnatal. 87 (22%) of 387 women who were given the EPDS to complete were above the threshold used to define depression, and 40 (9%) of 427 were regarded as having PTSD. Our most comprehensive model showed that IPV and conflict-related deprivations led directly to depressive symptoms as well as to continuing adversity. Human rights-related trauma, witnessing murder, and a further path from IPV led to PTSD symptoms. Human rights-related trauma also led to continuing adversity. Paths from continuing adversity led to depressive symptoms, and PTSD symptoms, which was the predominant path. We noted a strong and unidirectional path from PTSD symptoms to depressive symptoms. Protection of women from human rights abuses, prevention of IPV, reduction in insecurity and poverty in the post-conflict period, and identification of and treatment for PTSD symptoms might reduce the risk of perinatal depression in post-conflict, low-income countries. Longitudinal studies are needed to confirm these findings. Australian National Health and Medical Research Council.

The role of wild foods in food security: the example of Timor-Leste

Many rural households in the developing world are subject to chronic seasonal food insecurity. Often cited among coping strategies is foraging for wild foods. This study was to understand the role of wild food in household food security in Timor-Leste. Information on wild food use comes from three sources: a) a longitudinal study of food consumption among 14 subsistence farmer households across four districts in 2006–2007; b) a survey in 2011 of 1,800 farmer households across all 13 districts in Timor-Leste; and c) a survey of 64 households from eight community seed groups in three districts in 2013. The consumption of wild food fluctuated widely across the year with consumption much reduced in the wet season (December – April) compared to the dry season (May – November). Wild food use in a normal year – 2006–2007 and a food-deficit year – 2011, characterized by a severe hungry season, were compared. In the normal year the maize grain store was exhausted in 50 % of households (expressed as cumulative percentage of ‘at risk’ households) during the month of August and the percent of households consuming wild food was 9.2 %. By contrast in the food deficit year, maize grain stores were typically exhausted 2 months earlier than in a normal year, and 50 % of all interviewed households were foraging for wild food by May in four districts. Clearly in the food deficit season wild food foraging was dramatically increased compared to a normal year, particularly by poor at-risk households. The early depletion of grains store stocks under food insecurity resulted in greater coincidence of the period of wild food foraging with the hungry season than in a normal year. In two surveys there were clear differences between districts in the extent of wild food foraging. The most widely eaten wild plant foods in Timor-Leste are lesser yam (Dioscorea esculenta considered wild in Timor-Leste) followed by elephant’s foot yam (Amorphophallus paeoniifolius) and bitter bean (Phaseolus lunatus). Looking to the future in Timor-Leste, the wild food resource will continue to provide an important food buffer in deficit years especially to poor at-risk households, increasing their resilience and reducing their vulnerability.

Estimation of roaming dog populations in Timor Leste

The continued spread of rabies through the eastern islands of Indonesia poses a risk of rabies introduction to Timor Leste. To prepare for such an incursion and to undertake surveillance activities, the size and distribution of the roaming dog population needs to be estimated. We present the results of the first such surveys ever undertaken in Timor Leste.Roaming dog surveys were undertaken in each capital of the 13 districts of Timor Leste, including the national capital, Dili. Within these locations, local urban areas (aldeias) were targeted and sight–re-sight counts were undertaken on consecutive days. Estimated dog populations were adjusted for the sampling fraction.Overall, counts were performed in a total of 53 of 131 (40.5%) sucos and in 192 of 797 (24.1%) aldeias in these selected sucos. Within the surveyed urban areas, there were an estimated 21.2 people per roaming dog, a ratio substantially higher than the World Health Organization's average global estimate of 10 people per dog. The highest populations of dogs were estimated in the cities of Dili (4919), Baucau vila (3449) and Lospalos (2536). The latter two are important because of their location in the northeast of Timor Leste, where the risk of rabies incursion from recently infected islands in eastern Indonesia, is likely greatest. The sight–resight method of estimating roaming dog populations is practical in developing countries; more use of photography to aid resighting of dogs could increase the accuracy of this method.

The prevalence of common skin infections in four districts in Timor-Leste: a cross sectional survey

BackgroundSkin infections are a common public health problem in developing countries; however, they are rarely managed using a population based approach. Recent data on the burden of skin infections in Timor-Leste are limited. Our survey appears to be the only widespread survey conducted in more than 30 years and was designed to determine the baseline prevalence of some common skin infections in Timor-Leste.MethodsWe conducted a cross sectional survey in 14 sites including community health clinics, schools and hospitals within four different geographical regions. Participants were examined for five conditions (scabies, pyoderma, fungal infections, leprosy and yaws) by a multidisciplinary team. Analyses were conducted using EpiInfo version 6.04d.ResultsWe examined the skin of 1535 participants aged between four months and 97 years. The majority of participants were male, aged between 11 and 20 years and had at least one condition of interest (56.0%, 56.0%, and 63.1%, respectively). Fungal infections were the most common presentation (39.0%) and males were more commonly affected than females (42.3% vs 34.0%, respectively, pvalue < 0.0001).Among those people with more than one condition the two most common co-infections were scabies with either pyoderma or a fungal infection (38.0% and 32.0%, respectively). The survey identified 29 previously undiagnosed cases of leprosy and six cases of yaws.ConclusionsOur findings indicate the need for a comprehensive programme to address these conditions. There are successful disease control programmes in place within the country and it is hoped a healthy skin programme could be integrated into an established disease control programme in order to maximise health benefits and resources.