Maternal Health Care Providers Research Articles

System barriers to the provision of quality maternal health care in two regional teaching and referral hospitals in Kenya: a qualitative study

ObjectiveSub-Saharan Africa accounts for 66% of global maternal deaths. In Kenya, 362 maternal deaths occur in every 100 000 live births. Most of these deaths occur as a result of suboptimal quality care of mothers during labor, delivery, or within 24 h of delivery. This study explored barriers that nurse-midwives encounter in trying to provide high-quality obstetric care during these periods. MethodsA qualitative research design utilizing focus group discussion as part of a mixed method study was used to find out the participants’ experiences. Data were collected between February and March 2022 in the maternity units of two regional teaching and referral hospitals in Kenya. Eligible participants were nurse-midwives in charge of the maternity unit. The discussion was conducted in English, tape-recorded, and transcribed verbatim. Data were analyzed thematically, following Braun and Clarke 6-step framework. Nvivo version 7.0 computer software was used to facilitate this process. ResultsTwo focused group discussions each involving seven participants were conducted. The participants agreed that maternal mortality due to postpartum hemorrhage and pregnancy-induced hypertension is a major health concern. Further, maternal care in the two hospitals was substandard. Themes that emerged as barriers were: inadequate supplies; inadequate obstetric knowledge and skills; shortage of nurse-midwives, and inadequate support supervision. The underlying factors include inadequate funding by the county government and high staff turnover. ConclusionThis study showed that nurse-midwives are working under very difficult circumstances which are hindering the provision of quality maternal care. This is mainly due to system failures and inadequate nurse-midwife numbers. Targeted strategies need to be urgently implemented to mitigate these challenges to improve the quality of maternal health care.

Exploring health and illness perceptions to identify the perceived cause of pregnancy-related pelvic girdle pain. A mixed-methods study among primiparous women in The Netherlands

BackgroundPregnancy-related pelvic girdle pain (PPGP) is common and considered a multifactorial condition with biomechanical and psychosocial contributions. The patient's perceived cause is an important aspect of illness perceptions, and a strong predictor of self-management and healthcare utilization. It is unknown what causal beliefs primiparae hold regarding PPGP. ObjectiveTo explore and describe health and illness perceptions among primiparae towards PPGP and its cause. DesignExploratory, convergent parallel mixed-methods. SettingAt the participants’ homes. ParticipantsSixteen primiparae with and without PPGP. FindingsPrimiparae with and without PPGP held comparable causal beliefs about PPGP. PPGP was described as the result of hormonal softening and loosening of the pelvis, and failure of the muscular system to compensate for that. Women who experienced similar physical symptoms attributed them differently, leading to different coping strategies. Interestingly, maternal healthcare providers reinforced the unidimensional- and predominantly biomechanical view when women sought healthcare. ConclusionThe causal mechanism of PPGP held by the women was not determined by their lived experience. It was primarily based on the concept of inevitable hormonal softening of the pelvis. This biomechanical belief is based on theories that are not in line with current knowledge of PPGP and contemporary pain science, yet they were reinforced by maternity healthcare providers. Implications for practiceHealthcare seeking behavior is influenced by illness beliefs. Maternity healthcare providers may play a key role in providing reassurance and addressing the multifactorial nature of PPGP when providing care and support to pregnant women.

The Racial Disparities in Maternal Mortality and Impact of Structural Racism and Implicit Racial Bias on Pregnant Black Women: A Review of the Literature.

The maternal mortality rate (MMR) in the United States (USA) continues to increase despite medical advances and is exacerbated by stark racial disparities. Black women are disproportionately affected and are three times more likely to experience a pregnancy-related death (PRD) compared to Non-Hispanic White (NHW) women. A literature review was conducted to examine the racial disparities in the United States' MMR, specifically among pregnant Black women. PubMed and key organizations (World Health Organization, Center for Disease Control and Prevention, American College of Obstetricians and Gynecologists, Alliance for Innovation on Maternal Health, Association of American Medical Colleges, U.S. Census Bureau, and U.S. Congress) were searched for publications after 2014. Forty-two articles were reviewed to identify the role of structural racism, implicit biases, lack of cultural competence, and disparity education on pregnant Black women. This review highlights that maternal health disparities for Black women are further impacted by both structural racism and racial implicit biases. Cultural competence and educational courses targeting racial disparities among maternal healthcare providers (MHCP) are essential for the reduction of PRDs and pregnancy-related complications (PRC) among this target population. Additionally, quality and proper continuity of care require an increased awareness surrounding the risk of cardiovascular diseases for pregnant Black women. The surging MMR for Black women is a public health crisis that requires a multi-tiered approach. Interventions should be implemented at the provider and healthcare institution level to dismantle implicit biases and structural racism. Improving patient-provider relationships through increased cultural competency and disparity education will increase patient engagement with the maternal healthcare (MHC) system.

Transfer learning for accurate fetal organ classification from ultrasound images: a potential tool for maternal healthcare providers

Ultrasound imaging is commonly used to aid in fetal development. It has the advantage of being real-time, low-cost, non-invasive, and easy to use. However, fetal organ detection is a challenging task for obstetricians, it depends on several factors, such as the position of the fetus, the habitus of the mother, and the imaging technique. In addition, image interpretation must be performed by a trained healthcare professional who can take into account all relevant clinical factors. Artificial intelligence is playing an increasingly important role in medical imaging and can help solve many of the challenges associated with fetal organ classification. In this paper, we propose a deep-learning model for automating fetal organ classification from ultrasound images. We trained and tested the model on a dataset of fetal ultrasound images, including two datasets from different regions, and recorded them with different machines to ensure the effective detection of fetal organs. We performed a training process on a labeled dataset with annotations for fetal organs such as the brain, abdomen, femur, and thorax, as well as the maternal cervical part. The model was trained to detect these organs from fetal ultrasound images using a deep convolutional neural network architecture. Following the training process, the model, DenseNet169, was assessed on a separate test dataset. The results were promising, with an accuracy of 99.84%, which is an impressive result. The F1 score was 99.84% and the AUC was 98.95%. Our study showed that the proposed model outperformed traditional methods that relied on the manual interpretation of ultrasound images by experienced clinicians. In addition, it also outperformed other deep learning-based methods that used different network architectures and training strategies. This study may contribute to the development of more accessible and effective maternal health services around the world and improve the health status of mothers and their newborns worldwide.

Modeling Pathways to Describe How Maternal Health Care Providers' Mental Health Influences the Provision of Respectful Maternity Care in Malawi.

Maternal health (MH) providers may experience traumatic events, such as maternal or fetal death, that can contribute to stress and burnout. Past trauma, poor working relationships, and under-resourced environments not only affect providers' own emotional well-being but also reduce their ability to provide respectful maternity care (RMC). Data were collected in mid-2021 as a cross-sectional survey with 302 MH providers working in 25 maternities in 3 districts in Malawi to measure burnout, depression, and post-traumatic stress disorder (PTSD). We present a pathway model describing how these factors interact and influence RMC. We used the provider-reported person-centered maternity care scale to measure RMC; the Maslach Burnout Inventory, which examines emotional exhaustion, depersonalization, and professional accomplishment; and standard validated screening tools to measure the prevalence of depression and PTSD. Although levels of burnout varied, 30% of MH providers reported high levels of exhaustion, feelings of cynicism manifesting as depersonalization toward their clients (17%), and low levels of professional accomplishment (42%). Moderate to severe depression (9%) and suicidal ideation within the past 2 weeks (10%) were also recorded. Many (70%) reported experiencing an event that could trigger PTSD, and 12% reported at least 4 of 5 symptoms in the PTSD scale. Path analysis suggests that depression and emotional exhaustion negatively influence RMC, and depersonalization is mediated through depression. PTSD has no direct effect on RMC, but increased PTSD scores were associated with increased burnout and depression scores. Positive relationships with facility managers were significantly associated with increased RMC and decreased emotional exhaustion and depersonalization. Burnout will continue to be a challenge among MH providers. However, pragmatic approaches for improving teamwork, psychosocial, and managerial support for MH providers working in challenging environments may help mitigate burnout, improve MH provider well-being, and, in turn, RMC for women seeking MH services.

The Experiences of Expectant and New Mothers in Accessing Maternal Healthcare Services during the COVID-19 Pandemic in Mmabatho, North-West, South Africa

Access to maternal healthcare has been a challenge for women of African descent. Similarly, to previous illness outbreaks such as the Ebola and Zika outbreaks, the Coronavirus pandemic effects vary from one demographic group to another. Women, compared to men, are left in a more vulnerable position due to long-existing social inequalities and disparities. Differentiated effects include, amongst others, access to health and healthcare, risk of infection and coping strategies. This study examined the experiences of expectant and new mothers in accessing maternal healthcare services during the COVID-19 pandemic. In-depth interviews were used, and participants were selected from Mmabatho, North-West Province in South Africa. The findings show that women accessing maternal healthcare services have had diverse experiences. Some expectant and new mothers experienced fear, anxiety, and frustration, while some had more positive experiences. The positive experiences included spending more time with their families and newborn babies. Some of the participants were worried because of the fear of being infected with the coronavirus. Furthermore, the unavailability and inadequacy of, as well as limited access to, maternal healthcare services during the COVID-19 pandemic negatively affected some of the women in the study. This study recommends that public and private sectors responsible for providing maternal healthcare should have emergency preparedness measures in place to ensure the continuous provision of maternal healthcare and cushion women in future disease pandemics.

Antenatal depression is associated with perceived stress, family relations, educational and professional status among women in South of China: a multicenter cross-sectional survey.

Antenatal depression is a commonly seen mental health concern for women. This study introduced a multicenter cross-sectional survey with a large sample to provide new insights into pregnant women's depression, its socio-demographic and obstetric characteristics correlates, and its perceived stress among Chinese pregnant women. This study conducted an observational survey according to the STROBE checklist. The multicenter cross-sectional survey was performed from August 2020 to January 2021 by distributing paper questionnaires among pregnant women from five tertiary hospitals in South China. The questionnaire included socio-demographic and obstetrics information, the Edinburgh Postnatal Depression Scale, and the 10-item Perceived Stress Scale. For the analyses, the Chi-square test and Multivariate logistic regression were utilized. Among 2014 pregnant women in their second/third trimester, the prevalence of antenatal depression was 36.3%. 34.4% of pregnant women reported AD in their second trimester of pregnancy, and 36.9% suffered from AD in third trimester of pregnancy. A multivariate logistic regression model indicated that unemployed women, lower levels of education, poor marital relationships, poor parents-in-law relationships, concerns about contracting COVID-19, and higher perceived stress could aggravate antenatal depression among participants (p<0.05). There is a high proportion of antenatal depression among pregnant women in South China, so integrating depression screening into antenatal care services is worthwhile. Maternal and child health care providers need to evaluate pregnancy-related risk factors (perceived stress), socio-demographic factors (educational and professional status), and interpersonal risk factors (marital relations and relationship with Parents-in-law). In future research, the study also emphasized the importance of providing action and practical support to reduce the experience of antenatal depression among disadvantaged sub-groups of pregnant women.

Mistreatment of women during childbirth and its influencing factors in public maternity hospitals in Tehran, Iran: a multi-stakeholder qualitative study

BackgroundMistreatment during labour and childbirth is a common experience for many women around the world. This study aimed to explore the manifestations of mistreatment and its influencing factors in public maternity hospitals in Tehran.MethodsA formative qualitative study was conducted using a phenomenological approach in five public hospitals between October 2021 and May 2022. Sixty in-depth face-to-face interviews were conducted with a purposive sample of women, maternity healthcare providers, and managers. Data were analyzed with content analysis using MAXQDA 18.ResultsMistreatment of women during labour and childbirth was manifested in four form: (1) physical abuse (fundal pressure); (2) verbal abuse (judgmental comments, harsh and rude language, and threats of poor outcomes); (3) failure to meet professional standards of care (painful vaginal exams, neglect and abandonment, and refusal to provide pain relief); and (4) poor rapport between women and providers (lack of supportive care and denial of mobility). Four themes were also identified as influencing factors: (1) individual-level factors (e.g., providers’ perception about women’s limited knowledge on childbirth process), (2) healthcare provider-level factors (e.g., provider stress and stressful working conditions); (3) hospital-level factors (e.g., staff shortages); and (4) national health system-level factors (e.g., lack of access to pain management during labour and childbirth).ConclusionsOur study showed that women experienced various forms of mistreatment during labour and childbirth. There were also multiple level drivers for mistreatment at individual, healthcare provider, hospital and health system levels. Addressing these factors requires urgent multifaceted interventions.

Disrespect and abuse in maternity care in a low-resource setting in Tanzania: Provider's perspectives of practice.

Globally, women experience disrespectful and abusive care from maternity healthcare providers at health facilities, committed intentionally or unintentionally, particularly during labor and delivery. Disrespectful care affects women's childbirth experience and birth outcomes. This study used a descriptive qualitative design to obtain thick and rich data on disrespect and abuse in maternity care in a low-resource setting in Tanzania. Three days workshop was conducted at the Aga Khan University comprising maternity healthcare providers from diverse settings. The workshop was designed based on the existing evidence and anecdotal data and inspired by the authors' experiences of disrespectful and abusive care (stereotyping clients, not listening to client's/relatives' concerns, unconsented care) as a client, relative, or observant of colleagues. The targeted audience was maternity healthcare providers from public and private health facilities in the Dar es Salaam region. Data collection encompassed individual responses (reflection of practice) obtained by individuals, anonymously written reflections of practice, and compiled notes from group discussions. Data were analysed thematically guided by six steps described by Braun and Clerk. A total of 80 maternity healthcare providers participated in the workshop from various health facilities, including dispensaries (n = 25), health centres (n = 2), and hospitals (n = 3) located in semi-urban Dar es Salaam. Four main themes were identified from the data: Physical and verbal abuse; Lack of professional ethics and integrity; Vulnerable working environment; Abuse and disrespect to care providers. In addition, several sub-themes were identified within these themes: Harsh and abusive language; Beating/slapping/pinching of the mother in labor; notably, Junior midwives also disrespected and abused women; Lack of privacy and confidentiality; Poor communication; No consent for maternity healthcare procedures; Lack of courtesy and poor interpersonal skills; and, negligence of care and woman's needs. The actions of disrespect and abuse are alarming in practice and are associated with ignorance of fundamental human rights by both providers and recipients of services. Conducting workshops seems a useful approach to revealing disrespect and abuse deep-rooted in practice and provides an opportunity to rectify the problem with providers. A more extensive interventional study will be crucial to address the widespread actions of disrespect and abuse.

Early initiation of breast feeding and associated factors among mother-baby dyads with immediate skin-to-skin contact: cross-sectional study based on the 2016 Ethiopian Demographic and Health Survey data

ObjectiveThe study aimed to assess the practice of early initiation of breast feeding (EIBF) and associated factors among mother-baby dyads who practiced immediate skin-to-skin contact in Ethiopia.DesignCross-sectional study.SettingThe study was...

Marshallese Mothers' and Marshallese Maternal Healthcare Providers' Perspectives on Contraceptive Use and Reproductive Life Planning Practices and Influences.

Pacific Islander communities experience significant maternal and infant health disparities including high maternal and infant mortality. Contraception and reproductive life planning prevent approximately one-third of pregnancy-related deaths and neonatal deaths. We report the results of formative research devoted to understanding Marshallese mothers' as well as their maternal healthcare providers' practices and influences related to contraceptive use and reproductive life planning. This study used an exploratory, descriptive qualitative design to explore Marshallese mothers' and maternal healthcare providers' practices and influences of contraception use and reproductive life planning. Twenty participants were enrolled in the study, 15 Marshallese mothers and five Marshallese maternal healthcare providers. For the Marshallese mothers, two themes emerged: (1) Reproductive Life Planning Practices and Information; and (2) Reproductive Life Planning Influences. For the Marshallese maternal healthcare providers, two themes emerged: (1) Reproductive Life Planning Practices; and (2) Reproductive Life Planning Influences. This is the first study to document Marshallese mothers' and maternal healthcare providers' practices and influences with contraceptive use and reproductive life planning. Study results will inform the development of a culturally-adapted contraception and reproductive life planning tool with an educational program for Marshallese family units and maternal healthcare providers serving Marshallese women.

Exploring body dissatisfaction in pregnancy and the association with gestational weight gain, obesity, and weight stigma

ObjectiveBody dissatisfaction in pregnancy has been associated with negative psychological maternal outcomes, including increased risk of postpartum depression. This study aimed to explore weight-related factors that influence body dissatisfaction in pregnancy, including gestational weight gain (GWG), weight stigma, obesity, and weight loss attempts before pregnancy. DesignSecondary analysis of a larger cross-sectional study. SettingOnline survey administered via Qualtrics. Participants≥12 weeks pregnant, ≥18 years of age, having a singleton pregnancy and residing in Canada. Measurements and FindingsA battery of questionnaires were completed, including the Body Image in Pregnancy Scale (BIPS) sub-scale. The BIPS scores were compared based on experiences of weight stigma in pregnancy, perception towards their GWG, weight loss attempts before pregnancy, obesity, and GWG category classified as excessive or not referring to Institute of Medicine (2009) guidelines. Significant differences were entered into a linear regression model with BIPS scores as the dependent variable. Significance was accepted as p<0.05. A total of 182 participants completed the survey. There were no differences in BIPS scores based on GWG category (p = 0.160), or obesity (p = 0.230). Poorer BIPS scores were reported by those who felt they had gained ‘too much’ pregnancy weight than ‘appropriate’ (p<0.001), and among those who were trying to lose weight before pregnancy compared to those who were not (p = 0.002). Poorer BIPS scores were also reported by individuals who indicated they had experienced weight stigma during pregnancy compared to those who had not (p<0.001). Regression results showed that significant variables were perceptions towards GWG (p = 0.003) and experiencing weight stigma in pregnancy (p = 0.011). Key Conclusions and Implications for PracticePerceptions towards GWG and experiencing weight stigma can influence body dissatisfaction in pregnancy. Given the detrimental physical and psychological consequences of body dissatisfaction, effective strategies to reduce prenatal weight stigma are needed, such as training maternal healthcare providers to offer sensitive preconception and prenatal weight counselling.

Sources of stress and coping mechanisms: Experiences of maternal health care providers in Western Kenya.

The dynamic and complex nature of care provision predisposes healthcare workers to stress, including physical, emotional, or psychological fatigue due to individual, interpersonal, or organizational factors. We conducted a convergent mixed-methods study with maternity providers to understand their sources of stress and coping mechanisms they adopt. Data were collected in Migori County in western Kenya utilizing quantitative surveys with n = 101 maternity providers and in-depth interviews with a subset of n = 31 providers. We conducted descriptive analyses for the quantitative data. For qualitative data, we conducted thematic analysis, where codes were deductively developed from interview guides, iteratively refined based on emergent data, and applied by a team of five researchers using Dedoose software. Code queries were then analysed to identify themes and organized using the socioecological (SE) framework to present findings at the individual, interpersonal, and organizational levels. Providers reported stress due to high workloads (61%); lack of supplies (37%), poor salary (32%), attitudes of colleagues and superiors (25%), attitudes of patients (21%), and adverse outcomes (16%). Themes from the qualitative analysis mirrored the quantitative analysis with more detailed information on the factors contributing to each and how these sources of stress affect providers and patient outcomes. Coping mechanisms adopted by providers are captured under three themes: addressing stress by oneself, reaching out to others, and seeking help from a higher power. Findings underscore the need to address organizational, interpersonal, and individual level stressors. Strategies are needed to support staff retention, provide adequate resources and incentives for providers, and ultimately improve patient outcomes. Interventions should support and leverage the positive coping mechanisms identified.

Implementation gaps in culturally responsive care for refugee and migrant maternal health in New South Wales, Australia

BackgroundRefugee and migrant women are at higher risk of childbirth complications and generally poorer pregnancy outcomes. They also report lower satisfaction with pregnancy care because of language barriers, perceived negative attitudes among service providers, and a lack of understanding of refugee and migrant women’s needs. This study juxtaposes health policy expectations in New South Wales (NSW), Australia on pregnancy and maternity care and cultural responsiveness and the experiences of maternal healthcare providers in their day-to-day work with refugee and migrant women from non-English speaking backgrounds.MethodsThis study used a qualitative framework method to allow for a comparison of providers’ experiences with the policy expectations. Sixteen maternal health service providers who work with refugee and migrant women were recruited from two local health districts in New South Wales, Australia and interviewed (November 2019 to August 2020) about their experiences and the challenges they faced. In addition, a systematic search was conducted for policy documents related to the provision of maternal health care to refugee and migrant women on a state and federal level and five policies were included in the analysis.ResultsFramework analysis revealed structural barriers to culturally responsive service provision and the differential impacts of implementation gaps that impede appropriate care resulting in moral distress. Rather than being the programmatic outcome of well-resourced policies, the enactment of cultural responsiveness in the settings studied relied primarily on the intuitions and personal responses of individual service providers such as nurses and social workers.ConclusionAuthentic culturally responsive care requires healthcare organisations to do more than provide staff training. To better promote service user and staff satisfaction and wellbeing, organisations need to embed structures to respond to the needs of refugee and migrant communities in the maternal health sector and beyond.

Maternal healthcare for women with physical disabilities in Northern Vietnam: perspectives of healthcare providers

BackgroundPregnancy among women with physical disabilities is common around the world; however, there are limited qualitative studies that explore the perspectives of healthcare providers toward pregnant women with disabilities outside of the Global North. ObjectiveThis article explores perspectives and experiences of maternal healthcare providers in the delivery of services to women with physical disabilities in Northern Vietnam. MethodsSemi-structured interviews were conducted with 14 healthcare providers who worked in public and/or private healthcare North Vietnamese facilities where maternal services were provided. Data were thematically analyzed. ResultsThe participants included six males and eight females. Ten were obstetricians/gynecologists, one was a doctor specializing in obstetric imaging diagnosis, three were midwives, and one was a midwife/assistant doctor. Four themes were identified. In the first theme, providers attached provisos to the right to motherhood including the view that the women were limited to one child and should undergo prenatal screenings for fetal abnormalities. In the second theme, the providers reported that disability was not incorporated into their education; this led to half of them lacking confidence in providing appropriate maternal healthcare services for women with physical disabilities. The third theme found that although women with physical disabilities were considered as a priority group, decisions around who was seen before others or provided with fee discount/exemption were left in the hands of staff. The fourth theme identified that some providers overlooked their needs for physical accessibility and independence. ConclusionThis study shows that maternal healthcare providers in Vietnam discounted the needs of women with physical disabilities. The needs of women with disabilities should be included in the training of maternal healthcare providers in Vietnam.

Assessment of the Quality of Obstetric Services From the Perspective of Maternity Patients and Service Providers in a Tertiary Care Obstetric Unit in Lithuania.

Although largely focused on the patient, the provision of healthcare services is a 2-way process and its success hinges on the interactions between patients and physicians. Given the growing role of subjective, patient-dependent assessment of the quality of care received, which is increasingly influenced by the individual aspects of the interaction between patients and care providers, in addition to the explicitly measurable, objective assessment of the quality of care received based on clinical indicators, quality assessment of services should especially consider and explore the attitudes, needs and dynamics of all the parties involved in the healthcare process. This study was designed to assess the attitudes of maternity patients and healthcare providers towards the quality of obstetric care. A quantitative questionnaire survey was conducted in a tertiary level healthcare facility providing obstetric services in Lithuania. Research findings suggested that maternity patients rate both the technical and functional quality of obstetric services higher than the staff providing it. Midwives and obstetricians-gynaecologists view quality assurance as a complex process, rather than focus solely on quantitative indicators. Since midwives were rated slightly higher than physicians in terms of services they provide, it may be appropriate to ensure and encourage a wider use of midwife-only deliveries in low-risk births. A comprehensive assessment of the quality assurance aspects as viewed by the patients and the staff should be included in the regular quality assessments of healthcare facilities as one of the most informative assessment tools on the service quality.

Effects of computerized decision support on maternal and neonatal health-worker performance in the context of combined implementation with performance-based incentivisation in Upper East Region, Ghana: a qualitative study of professional perspectives

BackgroundComputerized decision support systems (CDSS) and performance-based incentives (PBIs) can improve health-worker performance. However, there is minimal evidence on the combined effects of these interventions or perceived effects among maternal and child healthcare providers in low-resource settings. We thus aimed to explore the perceptions of maternal and child healthcare providers of CDSS support in the context of a combined CDSS-PBI intervention on performance in twelve primary care facilities in Ghana’s Upper East Region.MethodsWe conducted a qualitative study drawing on semi-structured key informant interviews with 24 nurses and midwives, 12 health facility managers, and 6 district-level staff familiar with the intervention. We analysed data thematically using deductive and inductive coding in NVivo 10 software.ResultsInterviewees suggested the combined CDSS-PBI intervention improved their performance, through enhancing knowledge of maternal health issues, facilitating diagnoses and prescribing, prompting actions for complications, and improving management. Some interviewees reported improved morbidity and mortality. However, challenges described in patient care included CDSS software inflexibility (e.g. requiring administration of only one intermittent preventive malaria treatment to pregnant women), faulty electronic partograph leading to unnecessary referrals, increased workload for nurses and midwives who still had to complete facility forms, and power fluctuations affecting software.ConclusionCombining CDSS and PBI interventions has potential to improve maternal and child healthcare provision in low-income settings. However, user perspectives and context must be considered, along with allowance for revisions, when designing and implementing CDSS and PBIs interventions.

Detection and management of postpartum haemorrhage: Qualitative evidence on healthcare providers' knowledge and practices in Kenya, Nigeria, and South Africa.

Postpartum haemorrhage (PPH) is the leading cause of maternal death globally. Most PPH deaths can be avoided with timely detection and management; however, critical challenges persist. A multi-country cluster-randomised trial (E-MOTIVE) will introduce a clinical care bundle for early detection and first-response PPH management in hospital settings. This formative qualitative study aimed to explore healthcare providers' knowledge and practices of PPH detection and management after vaginal birth, to inform design and implementation of E-MOTIVE. Between July 2020-June 2021, semi-structured qualitative interviews were conducted with 45 maternity healthcare providers (midwives, nurses, doctors, managers) of nine hospitals in Kenya, Nigeria, and South Africa. A thematic analysis approach was used. Four key themes were identified, which varied across contexts: in-service training on emergency obstetric care; limited knowledge about PPH; current approaches to PPH detection; and current PPH management and associated challenges. PPH was recognised as an emergency but understanding of PPH varied. Early PPH detection was limited by the subjective nature of visual estimation of blood loss. Lack of expertise on PPH detection and using visual estimation can result in delays in initiation of PPH management. Shortages of trained staff and essential resources, and late inter-hospital referrals were common barriers to PPH management. There are critical needs to address context-specific barriers to early and timely detection and management of PPH in hospital settings. These findings will be used to develop evidence-informed implementation strategies, such as improved in-service training, and objective measurement of blood loss, which are key components of the E-MOTIVE trial (Trial registration: ClinicalTrials.gov: NCT04341662).

The Association Between Severity of Anemia During Pregnancy and Severe Maternal Outcomes: A Retrospective Cohort Study.

Anemia is a worldwide common condition during pregnancy, conferring a number of health risks to mothers. However, very little is known about the association between severity of anemia and severe maternal outcomes. This study aimed to assess the association between severity of anemia during pregnancy and the risk of severe maternal outcomes. This retrospective cohort study was based on data from China's National Maternal Near Miss Surveillance System for the period 2017-2018, which included 18 hospitals in southern China. Pregnant women admitted for delivery were divided into 4 groups based on severity of anemia during pregnancy: no anemia, mild anemia, moderate anemia, and severe anemia groups. Severe maternal outcomes were a composite of life-threatening conditions (ie, organ dysfunction) as defined by the WHO criteria, occurring at any time after admission until discharge or death. Modified Poisson regression analyses and propensity score-weighted regression analyses were used to estimate the relative risks (RRs) and 95% confidence intervals (CIs) of severe maternal outcomes among women with anemia of varying severity during pregnancy. The incidence of severe maternal outcomes was 0.3% (417/138,556) in total, and the rates were 0.1% (85/99,755), 0.2% (30/18,502), 1.2% (234/19,697) and 11.3% (68/602) in no anemia, mild anemia, moderate anemia and severe anemia group, respectively. Compared with no anemia, the adjusted RR for severe maternal outcomes was 4.19 (95% CI, 3.20-5.50) in moderate anemia group and 22.12 (95% CI, 15.43-31.69) in severe anemia group; the weighted RR was 1.01 (95% CI, 1.01-1.01) in moderate anemia group and 1.11 (95% CI, 1.07-1.14) in severe anemia group. Moderate to severe anemia during pregnancy was independently associated with an increased risk of severe maternal outcomes. Maternal health care providers and pregnant women themselves should give more attention to the prevention and treatment of anemia during pregnancy, especially moderate to severe anemia.

Utilization Of Health Information Technology In Provision Of Maternal And Child Health Care Among Nurses In The University Of Calabar Teaching Hospital, Calabar

This study was assessed utilization of health information technology in provision of maternal and child health care among nurses in the University of Calabar Teaching Hospital, Calabar. The research design employed for the study was descriptive survey design. The sample of one hundred and ninety-six (196) registered nurses/midwives from the population of nurses providing maternal and child healthcare in maternity ward, children’s ward, pediatric ward, labour ward, antenatal clinic and postnatal clinic at UCTH, Calabar using simple random sampling technique. The instrument of data collection was a validated structured questionnaire. Data collected were analyzed using descriptive statistic, charts, frequencies tables and percentages. The findings of the study revealed that majority (87.2%) of nurses working in UCTH, Calabar use paper based routine health information system. The factors inhibiting utilization of health information technology among nurses to deliver maternal and child healthcare in UCTH, Calabar include: inadequate knowledge of informatics, lack of comprehensive training of nurses on ICT utilization, unavailability of health information technology tools, lack of constant power supply Based on the findings of the study the it was recommended that health policy makers, hospital managements and nurse leaders should ensure that electronic health information technology are utilized in healthcare service at UCTH, Calabar.&#x0D;