Maternal Health Workers Research Articles

Barriers and facilitators of screening postpartum depression by primary maternal health workers: A mixed methods study based on the normalization process theory

BackgroundPostpartum depression (PPD) significantly impacts mothers and children's health. China aims to incorporate PPD screening in postpartum home visits, but research on implementation barriers and facilitators is scarce. We designed and implemented a new PPD screening program in Changsha, China, requiring maternal health workers to integrate PPD screening into their postpartum home visits. AimsTo identify real-world barriers and facilitators associated with integrating PPD screening into routine home visits from the perspective of maternal health workers. MethodsWe employed a mixed-methods approach. Maternal health workers involved in the newly introduced PPD screening program were included. Guided by Normalization Process Theory (NPT), quantitative data were collected using the NoMAD instrument, and qualitative data were obtained through semi-structured interviews. Data were analyzed using descriptive statistics for the survey and thematic analysis for the interviews. ResultsAll 42 maternal health workers involved in the new PPD program completed the quantitative survey, and nine participated in qualitative interviews. The NoMAD survey revealed high scores for Coherence and Cognitive Participation, but lower scores for Collective Action, particularly regarding insufficient skills and resource adequacy. Thematic analysis identified several barriers, including workload concerns, the need for enhanced psychological healthcare capacity, and lack of economic incentives. Facilitators included the integration of structured feedback and clear referral pathways. ConclusionAddressing identified barriers through targeted skill training, well-defined referral pathways, and formal recognition of the screening program in performance evaluations could help achieve successful normalization.

Integrating trauma- and violence-informed care for adolescent mothers in Rwanda: a qualitative study with community health workers

IntroductionIn Rwanda, maternal community health workers play a critical role to improving maternal, newborn and child health, but little is known about their specific experiences with adolescent mothers, who face unique challenges, including trauma, ongoing violence, stigma, ostracism, mental health issues, barriers within the healthcare system, and lack of access to the social determinants of health. This study explored the experiences of maternal community health workers when caring for adolescent mothers in Rwanda to inform the delivery of trauma- and violence-informed care in community maternal services.MethodsInterpretive Description methodology was used to understand the experiences of 12 community health workers purposively recruited for interviews due to their management roles. To gain additional insights about the context, seven key informants were also interviewed.FindingsMaternal community health workers provided personalized support to adolescent mothers through the provision of continuity of care, acting as a liaison, engaging relationally and tailoring home visits. They reported feeling passionate about their work, supporting each other, and receiving support from their leaders as facilitators in caring for adolescent mothers. Challenges in their work included handling disclosures of violence, dealing with adolescent mothers’ financial constraints, difficulties accessing these young mothers, and transportation issues. Adolescent mothers’ circumstances are generally difficult, leading to self-reports of vicarious trauma among this sample of workers.ConclusionMaternal community health workers play a key role in addressing the complex needs of adolescent mothers in Rwanda. However, they face individual and structural challenges highlighting the complexities of their work. To sustain and enhance their roles, it is imperative for government and other stakeholders to invest in resources, mentorship, and support. Additionally, training in equity-oriented approaches, particularly trauma- and violence-informed care, is essential to ensure safe and effective care for adolescent mothers and to mitigate vicarious trauma among maternal community health workers.

Developing a Maternal Health Worker Training Program in Rural Mississippi [ID 2683576

INTRODUCTION: Mississippi faces the highest infant mortality rate and maternal mortality rate in the United States, with rates for Black women four times higher than for White women. Using community maternal health workers (MHWs) to support patients during pregnancy and postpartum has proven beneficial in other locations and could be transformative in rural Mississippi. We aimed to identify key patient needs to create a MHW training program in the rural Mississippi Delta, as a component of a broader maternal health quality improvement project. METHODS: We conducted quality improvement interviews with 18 obstetric patients (10 prenatal, 8 postpartum) at Delta Health Center, a federally qualified health center in Mound Bayou, Mississippi. We queried patients about strengths and gaps in their prenatal care and their opinions on MHWs. We also queried the obstetrics and gynecology and pediatrics teams at Delta Health Center to identify key pregnancy, postpartum, and infant care and development topics needed for MHW training. RESULTS: 17/18 (94%) of the patients interviewed were in support of the MHW program. The following themes emerged in patient interviews: desire for psychologic support, connection to community resources, and help managing high-risk pregnancy conditions. We designed a 2-week training for MHWs that covers: MHW Responsibilities, Pregnancy Care, Childbirth, Postpartum Care, and Newborn Care and Infant Development. Based on patient feedback, the training prioritizes content related to psychological support and high-risk pregnancy care. CONCLUSION: Patients expect MHWs to be valuable assets for their care. Maternal health workers have the potential to support pregnant women in rural health care settings, ultimately enhancing maternal–fetal health outcomes.

Healthcare providers’ perceived barriers to providing breastfeeding support in Northwest rural China

BackgroundHealthcare providers play important roles in supporting breastfeeding. Although there has been insufficient actual breastfeeding support from healthcare providers in China, little research has been conducted to understand Chinese healthcare providers’ perceived barriers to providing breastfeeding support, especially in rural China. This study aims to identify these perceived barriers to providing breastfeeding support in Northwestern rural China.MethodsThis study was conducted during the period from March 2018 to December 2018. Forty-one healthcare providers were recruited through purposive sampling in two rural counties in Northwest China that are in close proximity to each other and share similar demographic features. Participants included obstetrician-gynecologists, midwives, nurses, “village doctors”, and township and village maternal and child health workers. Qualitative data were collected through one-on-one in-depth semi-structured interviews and focus group discussions. Transcripts were thematically analyzed.ResultsAnalysis of interview data resulted in four themes that the participants perceived as barriers to supporting breastfeeding: (1) lack of medical resources, within which inadequate staffing, and lack of financial incentives were discussed, (2) lack of clear and specific responsibility assignment, within which no one takes the lead, and mutual buck-passing were discussed, (3) healthcare providers’ lack of relevant expertise, within which lack of knowledge and skills, and low prestige of village healthcare providers were discussed, (4) difficulties in accessing mothers, within which medical equipment shortages reduce services utilization, mothers’ housing situation, mothers’ mobility, and cultural barriers were discussed.ConclusionsThe study identified HCPs perceived barriers to providing breastfeeding support. Unique to China’s Tri-Level Healthcare System, challenges like staffing and financial incentives are hard to swiftly tackle. Recommendations include mHealth enhancement and clarified responsibilities with incentives and tailored training. Further research is crucial to evaluate these strategies in rural Northwestern China and comparable underdeveloped areas nationwide.

Refugee women’s and providers’ perceptions of person-centered maternity care: a qualitative study in two refugee camps in Chad

BackgroundGlobally, mistreatment of women during labor and delivery is a common human rights violation. Person-centered maternity care (PCMC), a critical component of quality of care, is respectful and responsive to an individual’s needs and preferences. Factors related to poor PCMC are often exacerbated in humanitarian settings.MethodsWe conducted a qualitative study to understand Sudanese refugee women’s experiences, including their perceptions of quality of care, during labor and delivery at the maternities in two refugee camps in eastern Chad, as well as maternity health workers’ perceptions of PCMC and how they could be better supported to provide this. In-depth interviews were conducted individually with 22 women who delivered in the camp maternities and five trained midwives working in the two maternities; and in six dyads with a total of 11 Sudanese refugee traditional birth attendants and one assistant midwife. In addition, facility assessments were conducted at each maternity to determine their capacity to provide PCMC.ResultsOverall, women reported positive experiences in the camp maternities during labor and delivery. Providers overwhelmingly defined respectful care as patient-centered and respect as being something fundamental to their role as health workers. While very few reported incidents of disrespect between providers and patients in the maternity, resource constraints, including overwork of the providers and overcrowding, resulted in some women feeling neglected.ConclusionsDespite providers’ commitment to offering person-centered care and women’s generally positive experiences in this study, one of few that explored PCMC in a refugee camp, conflict and displacement exacerbates the conditions that contribute to mistreatment during labor and delivery. Good PCMC requires organizational emphasis and support, including adequate working conditions and ensuring suitable resources so health workers can effectively perform.

Analysis of Needs and Weaknesses of The Maternal and Child Health Surveillance System

The maternal and child health program in Sukoharjo district includes several reports on childbirth, postpartum, immunization reports, nutritional counseling, midwife courses, home visit reports, and family planning services, both in hospitals, health centers, maternity homes, and midwives. The maternal and child health surveillance that has been carried out so far has only been carried out to fill in data reports to health agencies at the central level. It has not been presented and analyzed properly, let alone disseminated the information to those who need it. Therefore, efforts are needed to improve the quality of epidemiological data and information so that planning and evaluation are well coordinated to improve the quality of the analysis results of surveillance data studies in terms of timeliness and sensitivity of reports. This research aims to determine the weaknesses in the need for a maternal-child health surveillance system and a maternal-child health surveillance system. The intervention method used is through on-the-job training. Meanwhile, district officers who have been trained previously (tiered training) train maternal and child health workers at community health centers. From the results of the analysis, it can be concluded that the maternal and child health program surveillance system is generally running well.

Provision and utilization of maternal health services during the COVID-19 pandemic in 16 hospitals in sub-Saharan Africa.

Maintaining provision and utilization of maternal healthcare services is susceptible to external influences. This study describes how maternity care was provided during the COVID-19 pandemic and assesses patterns of service utilization and perinatal health outcomes in 16 referral hospitals (four each) in Benin, Malawi, Tanzania and Uganda. We used an embedded case-study design and two data sources. Responses to open-ended questions in a health-facility assessment survey were analyzed with content analysis. We described categories of adaptations and care provision modalities during the pandemic at the hospital and maternity ward levels. Aggregate monthly service statistics on antenatal care, delivery, caesarean section, maternal deaths, and stillbirths covering 24 months (2019 and 2020; pre-COVID-19 and COVID-19) were examined. Declines in the number of antenatal care consultations were documented in Tanzania, Malawi, and Uganda in 2020 compared to 2019. Deliveries declined in 2020 compared to 2019 in Tanzania and Uganda. Caesarean section rates decreased in Benin and increased in Tanzania in 2020 compared to 2019. Increases in maternal mortality ratio and stillbirth rate were noted in some months of 2020 in Benin and Uganda, with variability noted between hospitals. At the hospital level, teams were assigned to respond to the COVID-19 pandemic, routine meetings were cancelled, and maternal death reviews and quality improvement initiatives were interrupted. In maternity wards, staff shortages were reported during lockdowns in Uganda. Clinical guidelines and protocols were not updated formally; the number of allowed companions and visitors was reduced. Varying approaches within and between countries demonstrate the importance of a contextualized response to the COVID-19 pandemic. Maternal care utilization and the ability to provide quality care fluctuated with lockdowns and travel bans. Women's and maternal health workers' needs should be prioritized to avoid interruptions in the continuum of care and prevent the deterioration of perinatal health outcomes.

Student nurse-midwives' knowledge and practice conducting normal labour in Windhoek, Namibia

Background/Aims It is crucial that maternity health workers understand how to prevent complications during labour. A lack of knowledge and the skills required to manage uncomplicated physiological labour (‘normal’ labour) may result in unanticipated complications, such as vaginal lacerations and perineal tears. This study's aim was to assess the knowledge and practices of undergraduate nurse-midwife students at the University of Namibia in conducting normal labour. Methods This quantitative study used a descriptive, non-experimental design to gather data from a total of 64 student nurse-midwives. A questionnaire was used to gather participants' sociodemographics and assess their knowledge and practice of normal labour. Descriptive statistics were used to analyse the data. Results The majority of the participants (87.3%) knew the correct supporting technique to prevent perineal tears. Most (84.1%) correctly indicated that a partograph is used to monitor labour progress. However, the majority (87.3%) did not practice episiotomy to prevent perineal tears. Conclusions Most students were knowledgeable on the use of a partograph, practices to prevent perineal tears and care of a newborn after birth. Students should receive continual education during clinical allocations, and be supervised and guided to improve practice and competency. Provision of sufficient preceptors is needed to cater for the high number of students. Future research should be conducted on the experiences and perspectives of students on conducting births and prevention of labour complications.

In-service Training of Maternal Health Workers in Rural Areas in Vietnam: Is it Relevant, Timely and Effective? A Mixed-method Study

Training is widely considered to contribute to the ‘can do’ and ‘will do’ capacities of health workers. Having appropriately skilled health workers is recognised as critical to assuring quality health services. This study examined the relevance of in-service training (IST) provided to maternal health workers (MHW) in rural Vietnam. A mixed method approach was used involving a survey of 240 health workers providing maternal health services and managers and 43 in-depth interviews of health workers and managers from 5 health districts across two provinces in Vietnam. Although two thirds of participants reported accessing IST within the previous 12 months, only 53.3% attended maternal health training. Factors related to the self-reported ability to perform Essential Obstetric Care (EOC) include: Being trained on EOC; Work experience; and Qualifications of MHWs. Participants reported that the IST was irrelevant to their actual needs, while managers reported frustration that IST programs were scheduled haphazardly, dependent on budget availability. In conclusion, in-service training programs should be designed taking into account the needs of the workforce and managers in terms of content, mode of delivery, scheduling and follow-up. Poorly planned and inappropriately delivered training may contribute to a perceived inability to provide EOC.

Readiness and Motivation of ASHAs towards Their Participation in Non-Communicable Disease Control Programmein North India:A Cross Sectional Study.

ASHAs (Accredited Social Health Activist)role is evolving beyond maternal and child health workers. They are engaged in NCD (Non-communicable Diseases)control activities. This study investigated their preparedness for this new task.The aim of the study was to assess the preparedness (knowledge, attitude, practices & patient navigation) of ASHAs in delivering community-based NCD prevention and control services under NPCDCS (National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke)program. And the study also assessed the challenges faced by ASHAs in fulfilling their roles and responsibilities towards common NCDs. Cross sectional descriptive conducted in Delhi. Total 464 ASHAs randomly selected from 54 Primary Health Centres from 3 districts of Delhi. A self-administered, pre-tested, validated and piloted semi structured questionnaire was filled by enrolled ASHAs. It assessed their knowledge, attitude and practices related to NCD screening. descriptive statistics, chi square test and logistic regression analysis were used. Two-third ASHAs had moderate to good knowledge about NCDs. They had positive inclination towards NCD screening and risk mitigation. Their practices for hypertension and diabetes screening were adequate but common cancer screening practices were inadequate. Challenges encountered in performing these tasks were lack of appropriate referral linkages, minimal supportive supervision and no ear marked incentives. ASHAs showed willingness to work for NCD control provided they have optimum training, supportive supervision from their superiors, and screening facilities in functional state and appropriate incentives for the new tasks.

Maternal health during the COVID-19 pandemic: Experiences of health workers in three Brazilian municipalities.

To analyze the experiences of maternal health workers in three Brazilian cities, located in the Northeast (São Luís), Southeast (Niterói), and South (Pelotas) regions during the first year of the COVID-19 pandemic. Qualitative research carried out between December 2020 and February 2021. Interviews were conducted, in person or remotely, with 30 health workers, doctors and nurses, working in maternity hospitals of different degrees of complexity. Sociodemographic characteristics, employment relationships and professional qualification of the interviewees were described. Two thematic axes were identified: 1) changes in hospital organization and dynamics in the pandemic; 2) Illness and suffering of health workers. The majority of respondents were women. Most physicians had work relationships in the public and private sectors. In Niterói, health workers had better professional qualifications and more precarious work relationships (as temporary hires), compared to São Luís and Pelotas. In the context of the uncertainties resulting from the pandemic, this situation generated even more insecurity for those workers. The statements at the beginning of the pandemic covered topics such as changes in the organizational dynamics of services, healthcare, telemedicine, and interaction between health workers and users. In the health workers' perception, the initial period of the health emergency, which resulted in intense changes in the provision of services, was marked by an increase in preterm births, perinatal mortality, and fetal losses. Work overload, fear of contamination, concern for family members and uncertainties regarding the new disease caused intense suffering in health workers who had little institutional support in the cities studied. The suffering experienced by health workers went beyond the work dimension, reaching their private life. Changes caused by the pandemic required immediate adjustments in professional practices, generating insecurities in healthcare regardless of the location studied. The method of hiring health workers remained the same as the previously practiced one in each city. Due to the risk of disease transmission, measures contrary to humanization practices, and more restrictive in São Luís, were reported as harmful to obstetric care. The Covid-19 pandemic was a huge challenge for the Brazilian health system, aggravating the working conditions experienced by health workers. In addition to the work environment, it was possible to briefly glimpse its effects on private life.

The role of maternal serum alpha-fetoprotein in preterm birth: A literature review

Preterm birth is one of the most important global issues. Mortality and morbidity among children under 5 years, including neonates, is affected by preterm birth. A good maternal care, health workers, and health facilities play an important role in the outcome of pregnancy, including preterm birth. An early screening test for pregnancy is crucial to find any abnormality thus preterm birth can be predicted and the following treatment may be applied without delay. One of potential biomarker for the screening test is alpha-fetoprotein (AFP) that can be found in maternal serum. Web-based literature search was carried out using several keywords. This literature review aims to collect data and articles to conclude the correlation of the potential biomarkers in diagnostic of preterm birth.

Maternity Health Workers’ Views on the Effect of Social Conditions on The Maternal Mortality Rate in Hyderabad District, Pakistan

The objective of the study was to find out the leading social factors causing maternal mortality in Hyderabad district A total of 125 maternity health workers including qualified gynecologists /obstetricians and undergraduate trained obstetricians from Hyderabad district (Sindh, Pakistan) were interviewed on the effect of social conditions on the maternal mortality rate with a predesigned close ended questionnaire. The period of study was four months from November 2016 to February 2017. It has been found that majority of the respondents revealed that a good number of complicated maternity cases are refused for admission due to unavailability of required facilities to treat such patients. This is considered one of the major reasons for maternal mortality death. Unavailability of required transport on an urgent basis is considered yet another cause. Leading causes of maternal mortality were poverty 41.6%), negligence of family men (27.2%), illiteracy (12%), malnutrition (11.2%) and non-availability of medical facilities (8%) at the center of primary care. It is a fact that socio cultural factor does influence the maternal mortality. Our findings resonate with the findings elsewhere. This necessitates to take corrective measures to improve the healthcare conditions of pregnant mother.

Factors influencing the motivation of maternal health workers in conflict setting of Mogadishu, Somalia.

Motivated health workers play an important role in delivering high-quality maternal health services, especially in low-income countries where maternal mortality rates are high, and shortages of human resource for health is prevalent. The aim of this study is to investigate maternal health workers' motivation in three tertiary hospitals in Mogadishu Somalia. We used a semi-structured questionnaire that was validated and widely used in Sub-Saharan Africa to collect data from 220 health workers across three tertiary hospitals in Mogadishu between February and April 2020. Health worker motivation was measured using seven constructs: general motivation, burnout, job satisfaction, intrinsic job satisfaction, organizational commitment, conscientiousness, timeliness and attendance. A multiple linear regression analysis was performed to determine the predictors of health worker motivation. The results show that male health workers have a higher work motivation, with a mean score of 92.75 (SD 21.31) versus 90.43 (SD 21.61) in women. As regards to profession, significant correlation was found between health workers' motivation and being an assistant (coeff, 6.873, p = 0.001), nurse (coeff, 5.111, p = 0.000), physicians (coeff, 2.898 p = 0.042), pediatric assistants (coeff, 2.878, p = 0.048), midwife (coeff, 3.822, P = 0.01), and others (supervisor and pharmacist) (coeff, 5.623, P = 0.001). Unexpectedly, the gynecologists and midwives were the least motivated groups among the different professions, with mean scores of 83.63, (SD: 27.41) and 86.95 (SD: 21.08), respectively. Of the aforementioned seven motivation constructs, the highest mean motivation scores (from 1-5) were observed in conscientiousness and intrinsic job satisfaction. These results highlight the importance of targeted interventions that increase female health workers' motivation, particularly gynecologists and midwives. This can be done by providing non-financial incentives, in addition to encouraging their participation in the decision-making process. Further research is needed to investigate the effect of a lack of motivation among gynecologists and midwives on maternal health in Somalia.

The Impact of an Educational Intervention on Neonatal Care and Survival.

Under-5 mortality has declined globally; however, proportion of under-5 deaths occurring within the first 28 days after birth has increased significantly. This study aims to determine the impact of an educational intervention on neonatal care and survival rates in Nigeria. This was a sequential exploratory mixed-methods design involving 21 health workers in the preintervention phase, while 15 health workers and 30 mother-baby dyads participated in the postintervention phase. Data were collected using semistructured interviews and nonparticipatory observation. Qualitative data were analyzed using thematic analysis, while quantitative data were analyzed using descriptive and inferential statistics. Healthy newborns were routinely separated from their mothers in the preintervention period. During this time, non-evidence-based practices, such as routine nasal and oral suctioning, were performed. Skin-to-skin contact and early initiation of breastfeeding were frequently interrupted. After the intervention, 80.6% were placed in skin-to-skin contact with their mothers, and 20 of these babies maintained contact with the mother until breastfeeding was established. There was decline in neonatal deaths post-intervention. Independent t -test analysis of the day of neonatal death demonstrates a significant difference in mean ( P = .00, 95% confidence interval -5.629; -7.447 to -4.779). Newborn survival can be improved through regular training of maternity health workers in evidence-based newborn care.

Knowledge, Attitudes and Practices of Maternity Health Workers Regarding Breast Self- Examination in the Governmental Hospitals at Sana'a City, Yemen

Background: Breast cancer is the most common cause of cancer death among women worldwide. Breast self-examination (BSE) is a simple very low cost and non-invasive adjuvant screening method for the detection of early breast cancer in women. Accordingly, women who correctly practice breast self-examination monthly are more likely to obtain better treatment and survival rate. 
 Aim: This study aimed to assess maternity health workers’ knowledge, attitudes and practices (KAP) regarding breast self-examination in Sana'a city, Yemen. 
 Methods: A cross-sectional study was conducted, and self-administered structured questionnaire was adapted to collect data from a convenient sample. Informed verbal consent was obtained from participants. Confidentiality of information was maintained throughout the study. KAP survey was carried out among 168 maternity health workers from governmental hospitals. 
 Results: It was found that 56.5% know about BSE and 50.0% know that it should be performed monthly. The majority (93.5%) believed that BSE is important for early detection of breast cancer. However, only 50.7% perform BSE monthly and 59.2% performed at the second week of menstrual cycle. 
 Conclusion: Unfortunately, almost only half of the study subject knows about BSE and how many times it should be performed and again only half of them performed monthly. Therefore, there is need for awareness creation on the benefits of BSE as an early detection for breast cancer among female health workers. 

An exploratory study of client and provider experience and perceptions of facility-based childbirth care in Quich\xe9, Guatemala

IntroductionRespectful maternity care (RMC) is fundamental to women’s and families’ experience of care and their decision about where to give birth. Studies from multiple countries describe the mistreatment of women during facility-based childbirth, though only a small number of studies from Guatemala have been published. Less information is available on women’s negative and positive experiences of childbirth care and health workers’ perceptions and experiences of providing maternity care.MethodsAs part of a program implemented in the Western Highlands of Guatemala to improve quality of reproductive maternal newborn and child health care, a mixed methods assessment was conducted in three hospitals and surrounding areas to understand women’s and health workers’ experience and perceptions of maternity care. The quantitative component included a survey of 31 maternity health workers and 140 women who had recently given birth in these hospitals. The qualitative component included in-depth interviews (IDIs) and focus group discussions (FGDs) with women and maternity health workers and managers.ResultsWomen reported a mix of positive and negative experiences of childbirth care related to interpersonal and health system factors. 81% of surveyed women reported that health workers had treated them with respect while 21.4% of women reported verbal abuse. Fifty-five percent and 12% of women, respectively, reported not having access to a private toilet and bath or shower. During IDIs and FGDs, many women described higher rates of verbal abuse directed at women who do not speak Spanish. A regression analysis of survey results indicated that speaking Ixil or K’iche at home was associated with a higher likelihood of women being treated negatively during childbirth in a facility. Health worker survey results corroborated negative aspects of care described by women and also reported mistreatment of health workers by clients and families (70.9%) and colleagues (48.2%).ConclusionsThis study adds to the literature on women’s experience of institutional childbirth and factors that influence this experience by triangulating experience and perceptions of both women and health workers. This assessment highlights opportunities to address mistreatment of both women and health workers and to build on positive care attributes to strengthen RMC for all women.

Impact of reliable light and electricity on job satisfaction among maternity health workers in Uganda: A cluster randomized trial

BackgroundMaintaining a motivated health workforce is critical to health system effectiveness and quality of care. Scant evidence exists on whether interventions aimed to strengthen health infrastructure in low-resource settings affect health workers. This study evaluated the impact of an intervention providing solar light and electricity to rural maternity facilities in Uganda on health workers’ job satisfaction.MethodsWe used a mixed-methods design embedded in a cluster randomized trial to evaluate whether and how the We Care Solar Suitcase intervention, a solar electric system providing lighting and power, affected health workers in rural Ugandan maternity facilities with unreliable light. Facilities were randomly assigned to receive the intervention or not without blinding in a cluster-randomized controlled trial. Outcomes were assessed through two rounds of surveys with health workers. We used regression analyses to examine the intervention’s impact on job satisfaction. We used an inductive approach to analyze qualitative data to understand the study context and interpret quantitative findings.ResultsWe interviewed 85 health workers across 30 facilities, the majority of whom were midwives or nurses. Qualitative reports indicated that unreliable light made it difficult to provide care, worsened facility conditions, and harmed health workers and patients. Before the intervention, only 4% of health workers were satisfied with their access to light and electricity. After the installation, satisfaction with light increased by 76 percentage points [95% confidence interval (CI): 61–92 percentage points], although satisfaction with electricity did not change. Experience of negative impacts of lack of overhead light also significantly decreased and the intervention modestly increased job satisfaction. Qualitative evidence illustrated how the intervention may have strengthened health workers’ sense of job security and confidence in providing high-quality care while pointing towards implementation challenges and other barriers health workers faced.ConclusionsReliable access to light and electricity directly affects health workers’ ability to provide maternal and neonatal care and modestly improves job satisfaction. Policy makers should invest in health infrastructure as part of multifaceted policy strategies to strengthen human resources for health and to improve maternal and newborn health services.Trial registration socialscienceregistry.org: AEARCTR-0003078. Registered June 12, 2018, https://www.socialscienceregistry.org/trials/3078Additionally registered on: ClinicalTrials.gov: NCT03589625, Registered July 18, 2018, https://clinicaltrials.gov/ct2/show/NCT03589625)

Exploring health provider\u2019s knowledge on the home-based maternal and neonatal health care package in Rwanda

BackgroundRwanda implemented post-natal care home visits by maternal community health workers (M-CHWs) in charge of maternal and newborn health care in 2010 as a component of a home–based maternal and neonatal health care package (HB-MNHCP), this being a complementary strategy to facility-based postnatal care to improve survival. The country has not met its Sustainable Development Goal (SDG) 3 target of less than 70 maternal mortalities per 100,000 live births and less than 12 neonatal deaths per 1,000 live births. This study therefore aimed to establish the knowledge of the health providers, providing HB-MNHC services as part of their antenatal, delivery and postnatal care program, specifically the M-CHWs services.MethodsThe cross-sectional descriptive study included 79 purposively sampled health care providers who were directly involved in the various components of the HB-MNHCP, namely: professional nurses, midwives, M-CHW, social workers, supervisors and data managers. The Kibogora, Muhima and Nyamata District Hospitals and two rural, semi-urban and urban health facility were included. Data was collected using questionnaires from April to July 2018. This study followed the STROBE checklist form: Cross –sectional studies.ResultsOverall, 88.6% (n=70/79) of participants knew about the M-CHW three home visits scheduled during pregnancy, 73.4% (n=58/79) about the three postnatal home visits after birth when the weight was normal, and 64.6% (n=51/79) about the five PNC home visits for low birth weights. Most (97.5%, n=77/79) knew that the mother and newborn should be screened during the same M-CHW home visits, and 87.2% (n= 68/79) were aware of the seven postnatal core competencies of delivering key maternal and newborn interventions during PNC home visits.ConclusionsThere were varying levels of knowledge among the HB-MNHCP staff, indicating the need for ongoing monitoring and training to ensure that the correct information is provided to the mothers throughout the antenatal and postnatal periods. While most of the M-CHWs appear to have had the correct knowledge, their executing of some activities needs to be monitored to ensure that they provide the required services, as this is an important step in lowering the maternal and infant mortality and enabling Rwanda to meet its SDG 3. Home visits by the M-CHWs could increase referrals and reduce maternal and newborn mortality.

The Relationship between Maternal Characteristics and Health Workers Role on Early Complementary Feeding in the Era of the COVID-19 Pandemic

Background: Early complementary feeding in Indonesia, especially in Palu city, is still relatively high and should focus. Early complementary feeding can negatively affect babies, such as being more susceptible to disease than babies who only get breast milk. This study aims to analyze the relationship between maternal characteristics and the role of health workers on early complementary feeding in the Pantoloan Public Health Center, Palu City. Subjects and Method: This research is quantitative research with a cross-sectional study. The study was conducted in all Integrated Healthcare Centers in the Pantoloan Health Center working area from April to October 2021. The research sample was mothers aged 0-6 months with inclusion and exclusion criteria. Sampling is done by total sampling. Complementary feeding was the depen­dent variable in this study. The independent variables in this study were the mother's characteristics in the form of age, education, occupation, maternal parity, and the role of health workers. This Data was collected using a questionnaire and analyzed by univariate and bivariate tests. Results: The results showed that there was a significant relationship between maternal charac­teristics in the form of age (p= 0.031), education (p= 0.002), occupation (p= 0.035), parity (p= 0.027), and the role of health workers (p= 0.046) in the provision of early complementary feeding in the work area of the Pantoloan Public Health Center, Palu City. Conclusion: Early complementary feeding can be influenced by maternal characteristics such as age, education, occupation, and parity, as well as the influence of the role of health workers.