Midwives In Uganda Research Articles

An exploration of midwives' understanding of antibiotic resistance and stewardship in Uganda

Background/Aims A shortage of healthcare professionals has led to task shifting. Antibiotic prescribing is one such task that has been informally shifted to midwives in Uganda. This study aimed to explore the understanding of Ugandan midwives about antibiotic resistance and stewardship and where this knowledge is drawn from. Methods A mixed method approach was used to collect data from 29 midwives working across four healthcare facilities between February 2017 and January 2018. Interviews, observational work and secondary data were analysed to identify themes arising. Results Knowledge held by midwives about antibiotic resistance and antibiotic stewardship was found to be limited. The midwives attributed this to inadequate preparation during their training. Midwives used ‘learning in the field’ as an alternative method to inform their antibiotic prescribing practices. Conclusions Midwives are critical actors in the prevention of antibiotic resistance. Improvements in initial and continuing education are required to adequately prepare midwives for their role as antibiotic stewards.

Open and Distance Learning Programs for Nursing and Midwifery Education in East Africa: Protocol for a Scoping Review.

BackgroundIn the face of growing modernity and the coronavirus disease 2019 (COVID-19) pandemic, open and distance learning (ODL) is considered to play an important role in increasing access to education worldwide. There is a robust evidence base demonstrating its cost effectiveness in comparison with conventional class-based teaching; however, the transition to this new paradigm of learning for nursing and midwifery courses has been difficult in low-income countries. While there are notable efforts to increase internet and education access to health care professionals, not much is known about ODL for nurses and midwives in East African countries.ObjectiveThe objective of this scoping review is to understand whether ODL programs for nursing and midwifery education exist, the drivers of their adoption, their implementation, the topics/courses covered, their acceptability, and their impacts in East African countries.MethodsThe scoping review methodology employs the framework developed by Arksey and O’Malley. Using an exploratory approach, a two-stage screening process consisting of a title and abstract scan and a full-text review will be used to determine the eligibility of articles. To be included, articles must report on an existing ODL initiative for nurses and midwives in Uganda, Tanzania, and Kenya. All articles will be independently assessed for eligibility by pairs of reviewers, and all eligible articles will be abstracted and charted in duplicate using a standardized form.ResultsDetails of ODL for nursing and midwifery education initiatives and study outcomes will be summarized in a table. The extracted data will undergo exploratory descriptive analysis, and the results will be classified into learner and clinical outcomes.ConclusionsEvidence on ODL for nursing and midwifery education will inform the ongoing development and restructuring of health care professional education in East Africa amidst the COVID-19 pandemic.International Registered Report Identifier (IRRID)PRR1-10.2196/17765

Recently graduated midwives in Uganda: Self-perceived achievement, wellbeing and work prospects

Objectiveto investigate how recent graduates from a combined work/study midwifery degree programme in Uganda viewed its effects on their wellbeing and work prospects. DesignUsing an adapted version of the Qualitative Impact Protocol (QuIP), a phenomenological approach was applied to thematic analysis to examine semi-structured interviews and WhatsApp group discussion. SettingIntroduction of enhanced midwifery training (from Diploma to Degree level) combining study with professional practice within a low income country health system facing extreme capacity constraints. Participants14 members of the first cohort of graduates from the degree programme. FindingsThe graduates were overwhelmingly positive about improved professional knowledge, clinical skills, confidence, career commitment and prospects. They also had to contend with resentment from colleagues, increased workload and debt. Counselling training, peer support, and experience of managing stress during the training helped them to cope with these challenges. ConclusionsQualitative feedback from those receiving advanced midwifery training highlights the importance of addressing social as well as technical skills, including leadership capacity and resilience in handling working relationships.

\u201cPractice so that the skill does not disappear\u201d: mixed methods evaluation of simulator-based learning for midwives in Uganda

BackgroundPostpartum hemorrhage and neonatal asphyxia are leading causes of maternal and neonatal mortality, respectively, that occur relatively rarely in low-volume health facilities in sub-Saharan Africa. Rare occurrence of cases may limit the readiness and skills that individual birth attendants have to address complications. Evidence suggests that simulator-based training and practice sessions can help birth attendants maintain these life-saving skills; one approach is called “low-dose, high-frequency” (LDHF). The objective of this evaluation is to determine the facilitating factors and barriers to participation in LDHF practice, using qualitative and quantitative information.MethodsA trial in 125 facilities in Uganda compared three strategies of support for LDHF practice to improve retention of skills in prevention and treatment of postpartum hemorrhage and neonatal asphyxia. Birth attendants kept written logs of their simulator-based practice sessions, which were entered into a database, then analyzed using Stata to compare frequency of practice by the study arm. The evaluation also included 29 in-depth interviews and 19 focus group discussions with birth attendants and district trainers. Transcripts were entered in Atlas.ti software for coding, then analyzed using content analysis to identify factors that motivated or discouraged simulator-based practice.ResultsPractice log data indicated that simulator-based practice sessions occurred more frequently in facilities where one or two practice coordinators helped schedule and lead the practice sessions and in health centers compared to hospitals. The qualitative data suggest that birth attendants who practiced more were motivated by a desire to maintain skills and be prepared for emergencies, external recognition, and establishing a set schedule. Barriers to consistent practice included low staffing levels, heavy workloads, and a sense that competency can be maintained through routine clinical care alone. Some facilities described norms around continuing education and some did not.ConclusionsDesignating practice coordinators to lead their peers in simulator-based practice led to more consistent skills practice within frontline health facilities. Ongoing support, scheduling of practice sessions, and assessment and communication of motivation factors may help sustain LDHF practice and similar forms of continuing professional development.Trial registrationRegistered with clinicaltrials.gov #NCT03254628 on August 18, 2018 (registered retrospectively).

Exploring the Pedagogical Practices used in Competence Based Education Training of Nurses and Midwives in Uganda

In Uganda CBE was introduced in 2006 and since then no study has been done to find out its suitability in the preparation of competent nurses and midwives. In recent years, there is increased attention given to Competence Based Education (CBE) in nursing and midwifery training programs as means of improving quality healthcare services. The use of suitable pedagogical practices in CBE training is critical for assisting students to effectively learn important concepts needed for their practice. The purpose of this study was to explore the suitability of pedagogical practices utilized in the CBE training programs in Uganda. The study was conducted from March to June 2015, at Mulago National Referral Hospital (MNRH). Concurrent mixed methods were used to gather both quantitative and qualitative data from respondents. A total of 193 participants were drawn from nurses and midwives trained under the CBE program and other key stakeholders, namely school principals, nursing and midwifery tutors, hospital administrators/medical consultants, officials at both Uganda Nursing and Midwifery Examination Board (UNMEB) and Uganda Nurses and Midwives Council (UNMC). Results by the majority of nurses and midwives who benefitted from the CBE training, revealed that the pedagogical practices used were suitable to enable them become competent nurses and midwives. However, the opinion of some key stakeholders differed. They noted that the implementation of suitable pedagogical practices in CBE training faced numerous challenges that needed to be addressed. These challenges included inadequate resources in terms of medical supplies and equipment as well as insufficient support given to trainees during clinical training due to shortage of staffing. This resulted into big workloads due to large student numbers, coupled with insufficient follow up by their tutors who are poorly motivated and have negative attitudes towards students. The study recommended the necessity to sensitize all implementers and stakeholders on the best pedagogical practices for CBE programs. There is also need to improve resources and conditions of students’ practicum training sites as well as to recruit more clinical instructors to specifically support the increasing numbers of students during their practicum training sites. https://doi.org/10.26803/ijlter.17.1.8

Neonatal resuscitation training for midwives in Uganda: Strengthening skill and knowledge retention

The objective of this project was to improve birth outcomes for babies in a regional referral hospital in Uganda by strengthening factors that influence the retention and application of neonatal resuscitation skills. Initial training in neonatal resuscitation is not enough on its own. In order to better understand the gap between training and effective practice, an evaluation of a neonatal resuscitation program was carried out. This included practical skill testing of local midwives using a neonatal resuscitation doll pre- and post-training, as well as follow up testing at 1 month and 12 months, followed by focus groups and interviews. Test scores revealed that participants’ knowledge grew significantly immediately following the workshop, and remained high after 1 month, but fell by 12 months post-training. Interviews with hospital staff revealed a number of facilitators and barriers to practice, namely knowledge retention and skill application. The most important barrier identified is the lack of refresher training post-workshop. Importantly, the findings demonstrated a need not for refresher training alone, but for improved organizational and administrative support for the newly assigned trainers.

Addressing Obstetrical Challenges at 12 Rural Ugandan Health Facilities: Findings from an International Ultrasound and Skills Development Training for Midwives in Uganda.

Like much of Sub-Saharan Africa, Uganda is facing significant maternal and fetal health challenges. Despite the fact that the majority of the Uganda population is rural and the major obstetrical care provider is the midwife, there is a lack of data in the literature regarding rural health facilities' and midwives' knowledge of ultrasound technology and perspectives on important maternal health issues such as deficiencies in prenatal services. A survey of the current antenatal diagnostic and management capabilities of midwives at 12 rural Ugandan health facilities was performed as part of an international program initiated to provide ultrasound machines and formal training in their use to midwives at antenatal care clinics. The survey revealed that the majority of pregnant women attend less than the recommended minimum of four antenatal care visits. There were significant knowledge deficits in many prenatal conditions that require ultrasound for early diagnosis, such as placenta previa and macrosomia. The cost of providing ultrasound machines and formal training to 12 midwives was $6,888 per powered rural health facility and $8,288 for non-powered rural health facilities in which solar power was required to maintain ultrasound. In order to more successfully meet Millennium Development Goal 4 (reduce child mortality), 5 (improve maternal health) and 6 (combat HIV) through decreasing maternal to child transmission of HIV, the primary healthcare provider, which is the midwife in Uganda, must be competent at the diagnosis and management of a wide spectrum of obstetrical challenges. A trained ultrasound-based approach to obstetrical care is a cost effective method to take on these goals.

Exploring the Role of Midwives in Uganda’s Postabortion Care: Current Practice, Barriers, and Solutions

Annually, upward of 100,000 Ugandan women receive care after a spontaneous or induced abortion. Abortion-related complications account for up to 26% of maternal deaths. Pilot projects have trained Ugandan midwives in the use of manual vacuum aspiration (MVA) for postabortion care (PAC), but to date there is no published literature exploring midwifery training and PAC practices. To better understand how PAC is provided in public Ugandan hospitals, the midwife’s training and role in PAC and the perceived barriers to providing PAC, interviews with midwives were conducted at 3 public hospitals. A framework analysis of emergent and a priori themes was conducted. Fewer than half of midwives interviewed had received formal PAC training. Current clinical practice in PAC includes MVA, dilatation and curettage, and medical management with misoprostol. Participants identified barriers to providing PAC, which include shortage of staff and equipment, transportation, cultural issues, and gender inequality. Solutions include increased staffing on maternity wards, training more midwives to perform MVA, and improved planning and communication with National Medical Stores. Community sensitization and support for young pregnant women is needed.

Knowledge and Attitudes of Ugandan Midwives Regarding HIV

In Uganda, 60% of HIV-infected adults are women of childbearing age. Considering this, midwives in Uganda play a pivotal role in reducing HIV transmission and providing high quality care to the many women and families affected by the disease. In this pilot study, investigators described the knowledge and attitudes of Uganda's private midwives regarding HIV. Overall knowledge levels were reported to be low, and the majority of participants reported overwhelming fear of contracting the disease from practice. Despite these challenges, the midwives' attitudes regarding HIV were positive. The results of this study support previous results. Additional studies focusing on midwives and traditional birth attendants in Uganda are warranted. The initiation of HIV continuing education programs and professional support for Ugandan midwives is also recommended.

The Impact of a Microfinance Program on Client Perceptions of the Quality of Care Provided by Private Sector Midwives in Uganda

To assess the impact of a microfinance program that provided business skills training and revolving loans to private sector midwives on perceived quality of services and client loyalty. A quasi-experimental study with a pretest, posttest design was used to evaluate the impact of the intervention. Exit interviews were conducted at 15 clinics that received the intervention and 7 clinics that did not. Baseline exit interviews were conducted between November and December 2000. Five days of business skills training were provided to midwives, and loans (averaging $454) were given during January and February 2001. A follow-up clinic visit was made to assess whether midwives were implementing what was emphasized during the training. The loans were to be repaid with interest within 6 to 12 months, at an interest rate that is standard within the local commercial market. For those who repaid the first set of loans (11 clinics), a second set of loans (averaging $742) was provided after June 2001. Follow-up exit interviews were conducted at the same clinics between February and March 2002. We assessed the effect of the intervention at both clinic and client levels. T-tests, the analysis of variance, and multivariate logistic regression analysis were conducted. These findings should be interpreted cautiously since secular trends were observed during the study period. The intervention was associated with improvement in clients' perceptions of the quality of care received at intervention clinics. The intervention was also associated with a higher level of client loyalty. The enthusiastic response of midwives and the high loan repayment rate indicate that midwives were very receptive to the microfinance program. Overall, these findings suggest that microfinance may have an important role in strengthening private sector health services by increasing private providers' business skills and clients' satisfaction with services.

Uganda.

Nurses and midwives in Uganda are becoming involved in a national programme to bring AIDS under control.