Public Health Midwives Research Articles

Implementing newborn screening for sickle cell disease in Korle Bu Teaching Hospital, Accra: Results and lessons learned.

Early diagnosis of sickle cell disease (SCD) through newborn screening (NBS) is a cost-effective intervention, which reduces morbidity and mortality. In sub-Saharan Africa (SSA) where disease burden is greatest, there are no universal NBS programs and few institutions have the capacity to conduct NBS. We determined the feasibility and challenges of implementing NBS for SCD in Ghana's largest public hospital. The SCD NBS program at Korle Bu Teaching Hospital (KBTH) is a multiyear partnership between the hospital and the SickKids Center for Global Child Health, Toronto, being implemented in phases. The 13-month demonstration phase (June 2017-July 2018) and phase one (November 2018-December 2019) focused on staff training and the feasibility of universal screening of babies born in KBTH. During the demonstration phase, 115 public health nurses and midwives acquired competency in heel stick for dried blood spot sampling. Out of 9990 newborns, 4427 babies (44.3%) were screened, of which 79 (1.8%) were identified with presumptive SCD (P-SCD). Major challenges identified included inadequate nursing staff to perform screening, shortage of screening supplies, and delays in receiving screening results. Strategies to overcome some of the challenges were incorporated into phase one, resulting in increased screening coverage to 83.7%. Implementing NBS for SCD in KBTH presented challenges with implications on achieving and sustaining universal NBS in KBTH and other settings in SSA. Specific steps addressing these challenges comprehensively will help build on the modest initial gains, moving closer toward a sustainable national NBS program.

Postnatal care coverage and its determinants in Sri Lanka: analysis of the 2016 demographic and health survey

BackgroundPostnatal care (PNC) is important for preventing morbidity and mortality in mothers and newborns. Even though its importance is highlighted, PNC received less attention than antenatal care. This study determines the level of PNC coverage and its determinants in Srilanka.MethodsThis is a secondary analysis of the 2016 Demographic and Health Survey. Receiving full postnatal care (FPNC) was defined with a set of indicators to detect adequate care for mother and newborn. Demographic and socio-economic associated factors for receiving FPNC were identified using binary and multiple logistic regression. Variables that had marginal relationship with receiving FPNC which p-value less than or equal to 0.2 at binary analysis were selected and included in the multiple logistic regression models. We used manual backward stepwise regression to identify variables which had independent association with receiving FPNC on the basis of adjusted odds ratios (AOR), with 95% confidence interval (CI) and p-value less than 0.05. All analyses were performed in SPSS 25.ResultsOf the 8313 women with a live birth in the last 5 years, more than 98% had received postnatal care at facility at least 24 h. More than three-fourth of mothers (n = 5104) received the FPNC according to WHO guideline. Four factors were positively associated with receiving FPNC: mothers received antenatal home visits by Public health midwife (AOR = 1.98, 95% CI 1.65–2.39), mothers who got information about antenatal complications and places to go at antenatal clinics (AOR = 1.56, 95% CI 1.27–1.92), been Sinhala (AOR = 1.89, 95% CI 1.35–2.66) and having own mobile phone (AOR = 1.19, 95% CI 1.02–1.38). Mothers who are residing in rural area (AOR = 0.697 95% CI = 0.52–0.93] compared to those who reside in urban areas and maternal age between 20 and 34 years [AOR = 0.72, 95% CI 0.54–0.97] compared to maternal age less than 20 years were detected as negatively associated.ConclusionReceiving FPNC in Srilanka is high. However, inequity remains to be a challenge. Socio-demographic factors are associated with FPNC coverage. Strategies that aim to improve postnatal care should target improvement of non-health factors as well.

Barriers for early initiation and exclusive breastfeeding up to six months in predominantly rural Sri Lanka: a need to strengthen policy implementation

BackgroundSri Lanka was named as the first-ever ‘Green’ breastfeeding nation status by the World Breastfeeding Trends Initiative (WBTi) in January 2020. However, improvements are still needed. This study aims to identify barriers and facilitators for early initiation of breastfeeding and exclusive breastfeeding for 6 months in rural Sri Lanka.MethodsWe conducted in-depth interviews with 16 mothers with infants, who had been unable to practice early initiation of breastfeeding and/or exclusive breastfeeding (EBF), in six child-welfare clinics in Anuradhapura, Sri Lanka. Three focus group discussions were held with public health midwives (PHMs). Initial thematic analysis that built upon force field and social learning theories was performed.ResultsMain barriers for EBF were clustered at three time periods; during the first 2–3 days, 2–3 weeks, and 4–5 months postpartum. Early barriers included cesarean section pain, poor breast latch, maternal exhaustion, suboptimal maternity ward environment, and lack of support for breastfeeding. Around 2–3 weeks postpartum mothers introduced water or infant formula due to social norms and poor support. On-demand feeding was misunderstood. Around 4 and 5 months postpartum, EBF ended due to return to work. PHMs reported a heavy workload limiting their time to support breastfeeding.ConclusionEBF interruption was due to diverse individual- and environnmental- level barriers that varied across the first 6 months. To improve EBF, Sri Lanka should focus on strengthening policies for reducing the excessive rates of cesarean section, improving support in maternity ward facilities, fostering on-demand breastfeeding, enhancing support for working mothers and reducing the work load of PHMs.

Perception of Cervical Cancer Screening Program among Healthcare Workers in a District of Sri Lanka: A Qualitative Study

The aim of this study was to explore the perception of cervical cancer screening programs among healthcare workers in a district of Sri Lanka. Focus group discussion (FGD) sessions (n=4) and in-depth interviews (n=10) were used to collect data. Eight public health midwives (PHMM) were selected for one FGD session. Public health midwives for each focus group were selected from MOH areas according to their seniority and the sector of community representation. Key informants were selected among health care workers, who engaged in the cervical cancer screening program. A convenient sampling technique was used to select participants. Triangulation methodology was used to improve the quality of the information. Descriptive codes were identified as common themes and categories. Codes and categories were revised repeatedly until they gave an accurate representation of the data gathered. Finally, an amalgamated list of codes was developed with FGDs. In the last summary, results were prepared. The analysis was made by manual content. Majority of the participants were Sinhalese (n=41, 97.6%), Buddhist (n=39, n=92.9%) and over 40 years of age (n=31, n=73.8%). Some had >20 years of service in the field(n=14, n=33.3%).Some participants mentioned the low sensitivity of pap smears, unsatisfactory smears, and reporting delay as disadvantages of the pap smear screening method. Increase community awareness, supervision of Well Woman Clinic (WWC) activities, conduction of mobile clinics indicated as pathways to improve the coverage by participants. Healthcare workers expressed their positivity for HPV/DNA test as its high sensitivity, while the majority stated to improve the coverage by vaginal specimens. Increase community awareness, supervision of activities, conducting mobile clinics to cover hard to reach population, and providing mobile pap kits were mainly stated to improve the quality of the program. Healthcare workers in the Kalutara district were highly accepted the HPV/DNA new screening test for quality improvement and to increase the coverage of the program. Keywords Cervical cancer screening, healthcare workers, perceptions

Implementing nursing education based on the revision of rules for the designation of public health nurses, midwives, nursing schools, and training schools among nursing universities in Japan

In 2020, the number of nursing universities in Japan increased to 274. One out of three universities has a nursing school, and the number of nursing universities continues to increase. The Ministry of Education, Culture, Sports, Science and Technology introduced the "Model Core Curriculum for Nursing Science Education in Japan" (MCCNSE) in 2017. The MCCNSE aims to include indispensable nursing competencies to the undergraduate course, enumerating the learning targets that will be useful for students. The MCCNSE includes seven aspects that aim to develop the qualities and abilities of a nurse for a lifetime. A consists of the basic qualities/abilities required by nursing professionals. B comprises social and nursing science. C consists of the basic knowledge necessary for understanding the objectives of nursing, including pharmacological science. D includes basic knowledge of the specialty underlying nursing practice. E comprises the basic knowledge necessary for nursing practice in various settings. F relates to clinical and regional training practice, and G includes research in nursing science. Nursing universities are required to comply with both the School Education Act and the Act on Public Health Nurses, Midwives, and Nurses. Nursing universities are expected to formulate a more complete and original curriculum based on the revision of Rules for the Designation of Public Health Nurses, Midwives, Nursing Schools, and Training Schools.

Sri Lanka needs more Public Health Midwives

Sri Lanka needs more Public Health Midwives

Are women safe in disaster? Competency in handling gender-based violence by public health staff in Galle district

Introduction: Gender-based violence (GBV) is a human right issue that is common but under reported. It is noted that GBV incidence increases in disaster situations. As the public health staff is the key responsible personnel in post-disaster health management, their competencies in managing GBV in crisis situation are extremely important. Methods: A descriptive cross-sectional study was conducted in conveniently selected 8 Medical Officer of Health (MOH) areas in Galle district. All four categories of public health workers (medical officers, nursing sisters, public health inspectors and midwives) working at selected MOH offices were assessed by a selfadministrated questionnaire regarding knowledge on identification, prevention and management of GBV victims in disaster situations. Results: Among 200 public health workers, only 23.5% had training on disaster management. Among the trained MOH staff, only 34.0% were taught on handing GBV in disaster situation. Knowledge on GBV was average in the staff (mean = 72.3, SD = 7.7). There was no significant difference observed in identification, prevention and management of GBV between different employment categories of the MOH staff (all ps > 0.05). Knowledge on GBV showed no difference between the trained and untrained staff (t (198,200) = 0.8, p = 0.4) on disaster management. Conclusions and Recommendations: Knowledge on identification, prevention and management of GBV in disaster situations among the public health staff was average, and was not sufficient. Only a minority have obtained training and all these programmes have not addressed GBV management. Thus, it is recommended to hold regular training programmes to the public health staff in GBV management in disaster situations.

Modelling the Use of Traditional Family Planning by Women in Sri Lanka

Family planning plays a crucial role in enhancing the health of the mother and the child. Contraceptives are used by most women in the reproductive age span (15-49 years). Sri Lanka has been named as one of the countries with high usage of traditional family planning (TFP) methods than the other Asian countries. However, the reasons for that have not been investigated. Therefore, this study is carried out to identify the significant factors influencing on usage of TFP by using data from Sri Lanka Demographic and Health Survey in 2016 with a sample size of 10835. The percentages of women using TFP is 16.3% compared to 83.7% of using modern family planning (MFP). Among TFP users, the withdrawal method and the rhythm method are 35% and 57% respectively. The balance 8% uses both methods. A binary logistic regression model was developed to capture the factors influencing the use of TFP by considering all variables simultaneously. The fitted model was invariant on the type of selection method and selection criteria. The overall predictive power is 82.9%. The knowledge on family planning, having advice from public health midwives, attendance to well-women clinics, religion, ethnicity, decision to use family planning, husband’s occupation, women’s age, women’s occupation, women’s education level, number of children, and wealth quantile are the significantly associated factors with the usage of TFP. The odds of the usage of TFP among the women having no children and women having 1 or 2 children are respectively 1.4 and 4.0 times higher than the women having 3 or more children. The factors identified are geared towards providing robust evidence based on data driven decision making (DDDM) and therefore the key population groups in need of contraceptive services can be targeted more effectively and efficiently. Organizing counselling programmes and promotions on family planning and conducting media awareness programmes to avoid some myths on modern contraceptives can be suggested.

STRATEGI PEMERINTAH DALAM MENGURANGI ANGKA KEMATIAN IBU (AKI) MELAHIRKAN DI KABUPATEN ENREKANG

This study purposed to find out how the institutionalization of government strategy in reducing maternal mortality rate (AKI) and how to operationalize the government strategy in reducing maternal mortality rate (AKI) in Enrekang Regency. This study used descriptive qualitative research . Data collection techniques were observation, interviews with 5 informants and documentation. Data analysis used interactive analysis models and used 3 types of triangulation in data validation. The results of this study showed that the role of public health midwives in reducing maternal mortality was very important, especially in the role of community empowerment, optimizing Integrated Healthcare Center activities, and leadership roles in public health and health cadres were expected to be able to encourage the community to carry out self-help activities in improving health status. The role of community health workers in empowering cadres was very important by increasing the ability of community knowledge and awareness regarding prevention of maternal mortality in Enrekang Regency

Burden of work and workload indicator-based staffing needs of public health midwives in the primary health care system in Sri Lanka

Introduction: Sri Lanka has a well-established primary health care system in which the public health midwives (PHMs) play a pivotal role. Sri Lanka has a total of 7087 field PHMs. Many stakeholders and public health experts believe that full-time equivalents of existing PHMs in the system are not adequate for performing all the tasks assigned to them by various programmes. Furthermore, the country is now facing several added challenges such as rapidly ageing population and increased non-communicable diseases, which also expand the PHMs role. To date, a systematic assessment of PHMs' workload-based staffing needs that consider traditional and newly emerging roles of PHMs has not been carried out. Objectives: To define the current workload of field public health midwives in Sri Lanka and estimate their workload indicator-based staffing needs Methods: This study used a Workload Indicators of Staffing Needs (WISN) methodology to estimate the PHMs' staffing needs in Sri Lanka. The scope of work and workload components of PHMs were determined using a desk review and a consultative process. The workload and total interventions to be implemented by the PHMs were assessed using One Health Tool. Activity standards were set using a time motion study. Finally, WISN software was used to estimate the staffing requirements. Results: The analysis of time requirements of various programs related interventions indicated that the major share of PHM's time is utilized by the maternal and new-born program (45%), childcare programs (45%) and nutrition care (7%). Study showed that at least one field PHM is required per 1878 population to meet the current service demands, implying that Sri Lanka needs further 4525 field PHMs to meet the current needs. Conclusions: Currently, there is an acute shortage of field PHMs in Sri Lanka. The Ministry of Health should take steps to train more PHMs, in order to provide an optimum service.

Implementation, Monitoring and Evaluation of a Novel In-Service Training Strategy of Public Health Staff: Evidence from Colombo Regional Directorate of Health Services, Sri Lanka

Introduction: Continuous in-service training sessions help in updating and upgrading the competency of the public health field staff. Implementation of these sessions with the uniform delivery of the quality assured content has been a challenge in the Sri Lankan well-established preventive healthcare system. Aim: To describe the implementation, monitoring and evaluation of a novel in-service training strategy of public health staff including Pubic Health Inspectors (PHI) and Public Health Midwives (PHM) conducted in the Colombo Regional Directorate of Health, Sri Lanka from January to June 2018. Methods: A consultative meeting and a workshop was conducted with the participation of all stakeholders in reviewing the existing in-service training methodology and in recommending the strategies of overcoming the limitations of it. A novel strategy was developed for the implementation of in-service sessions with multi-level implementation and evaluation components. The in-service training sessions were conducted to improve the knowledge and quality of service provision by Public Health Inspectors, Public Health Midwives and other public health staff. Four evaluation indicators were defined. Descriptive statistics and the Wilcoxon signed rank test were used in the evaluation. Results: By the consultative meetings and workshops, four main weaknesses of the existing in-service training system were revealed, and three characteristics of an ideal system were defined. Two process indicators have shown a coverage of the intervention of 100% while the median satisfaction scores were observed to be 85% or above. Two output/outcome indicators have shown that the interventions have yielded significantly higher post-intervention scores compared to the pre-intervention scores as perceived by the staff members (p<0.05), while the reception of feedback reports was 100%. Conclusions and Recommendations: The novel strategy is seemingly effective in relation to the four evaluation indicators used. Possibility of implementing similar strategies in other areas must be explored with the view of disseminating quality assured content with uniformity among the public health field staff categories in the monthly in-service sessions.

Awareness, knowledge and the factors that affect the use of folic acid among pregnant and non-pregnant women in the reproductive age in a selected area in Colombo district, Sri Lanka

<strong>Background: </strong>The prevalence of neural tube defects in Sri Lanka is estimated to be 1.21 per 1000 births. According to the WHO, programs to increase folic acid (FA) consumption among women of reproductive age may benefit countries where the NTD rate is higher than 0.6/1,000 live births. Food fortification is an effective method but there is still no mandatory fortification policy in Sri Lanka. Therefore, improving knowledge and voluntary use of FA remains a high priority. The study aimed to determine the awareness and knowledge on FA among pregnant and non pregnant women. <strong> </strong> <strong>Methods: </strong>A comparative cross-sectional study was conducted among 400 pregnant and 400 non-pregnant women aged 18-45 years from Colombo District in Sri Lanka. Data were collected using an anonymous, standardized, interviewer administered questionnaire, which included questions about socio-demographic data, obstetric history, FA knowledge and use. <strong> </strong> <strong>Results: </strong>FA awareness and knowledge on its pre-conceptional use were significantly low among non-pregnant women younger than 25 years (OR=0.120, 95% CI=0.068-0.211, p=0.000; OR=0.153, 95% CI=0.090-0.262, p=0.000). Pregnant women with knowledge that FA prevents birth defects were significantly more likely to take FA during pregnancy (OR=10.760, 95% CI=1.244-93.068, p=0.007) and the pre-conceptional period (OR=1.807, 95% CI=1.172-2.786, p=0.007). Women who received information from field clinics were significantly more likely to have FA awareness (OR=4.779, 95% CI=0.913-25.021, p=0.042), knowledge on pre-conceptional use of FA (OR=2.972, 95% CI=1.179-7.491, p=0.016) and took FA during pregnancy (OR=39.773, 95% CI=4.542-348.271, p=0.000). Those who received information from home visits were significantly more likely to have knowledge on the role of FA in preventing birth defects (OR=1.958, 95% CI=1.133-3.384, p=0.015), took FA during their pregnancy (OR=15.102, 95% CI=1.743-130.841, p=0.001) and in the pre-conceptional period (OR=2.117, 95% CI=1.316-3.405, p=0.002). Women who got information through media were also significantly more likely to have knowledge on the role of FA in preventing birth defects. (OR=2.487, 95% CI=1.006-6.149, p=0.042). <strong> </strong> <strong>Conclusions: </strong>Health education campaigns have to be specifically targeted for younger women from ethnic minorities and from low household income families. Field clinics and home visits from public health midwives have been a significant sources of information and media campaigns can be an effective means of promoting health education regarding use of preconceptional folic acid.

Policy Study and Stunting Prevention in Surabaya

Background: Nutritional Status Survey in 2017 showed prevalence of stunting toddlers in Indonesia wasstill high, which was 29,6% above the limitation determined by WHO (20%).8 Conducted study by Ricardoin Bhutta in 2013 stated that stunting toddler contributed against 1,5 million (15%) of toddler mortality in theworld and caused 55 millions of children had lost their healthy life time every year..2 Result of Basic healthresearch (Riskesdas) in 2013 stated that condition of consuming food for pregnant woman and toddlers in2016-2017 showed in Indonesia, 1 from 5 pregnant women was malnutrition. Decrease of stunting rateonly reached 4% in 1992 until 2013. Presidential Regulation number 42/2013 had determined NationalMovement of First Thousand Days of Life for increasing toddler’s nutritional status that was followed bydevelopment program, including its budget.7Method: This research was mix method research, which was a step in the research by combining two kindsof approaches, qualitative and quantitative. Besides, this research utilized gradual mix technique. Populationin this research was Public Health Centers in Surabaya area. Meanwhile, the sample was all of policyholdersin Surabaya, who were Head of Public Health Centers and midwives. This research utilized data analysisin gradual qualitative-quantitative. Not conflict of interest, source of funding self and ethical clearancetaken from committee ethic.Hence, the analysis was conducted on qualitative data, then, it was followed byquantitative data.Result and Analysis: Public Health Center of Pucang Surabaya still had the highest stunting rate among 10Public Health Centers. Public Health Center of Tanah Kali Kedinding Surabaya had quite high increasingrate against stunting from 2017 until 2018. Almost all programs were appropriate with 1000 HPK (1000first day of life) guidelines in area of Public Health Centers Surabaya that had been done by the midwives.According to FGD result, regulation and policies which were related to 1000 HPK, particularly for regulationof exclusive breast milk and PMBA which had been quite many either in was statute law, GovernmentRegulation, Minister of Health Regulation, Decree of Minister of Health, or Regional Regulation. Handlingstunting was done by synergy among central government, regional government, entrepreneur and communityorganization. High commitment from all health professions was much needed so that it could be able tohasten the decrease of stunting.Conclusion and Suggestion: the implementation of 1000 HPK program had been conducted as an effortin reducing stunting rate. However, stunting problem still had not been solved. Therefore, it was neededcooperation mutually in cross sector for handling stunting problem, particularly in Surabaya City, East JavaProvince, Indonesia.

Knowledge and Attitudes toward HIV and People Living with HIV (PLWH) among Public Health Midwives in the Galle District, Sri Lanka

This cross-sectional study aimed to assess HIV-related knowledge and attitudes of PHMs, the frontline community health workers in Sri Lanka. Two-hundred and ninety-one PHMs were recruited. PHMs’ knowledge level was good (79.9% of answers were correct) but could be improved. Those more knowledgeable about HIV and with higher education demonstrated a more positive attitude toward PLWH. A more negative attitude, less training and older age were associated with having a stronger intention to engage in extra precautionary behaviors. PHMs need further HIV training to improve their knowledge to better educate the community. By reducing PHMs misperceptions about HIV, they may develop a more positive attitude and thus help reduce the general public’s stigma associated with PLWH.&#x0D; &#x0D; Keywords: HIV, PLWH, Stigma, attitude, community health workers, midwives, Asia, Sri Lanka

Knowledge, attitude, and preparedness toward IPV care provision among nurses and midwives in Tanzania

BackgroundWith increasing recognition of intimate partner violence (IPV) as a public health challenge, nurses and midwives are recognized for their crucial role in providing front-line healthcare services for IPV. This study aimed to evaluate knowledge, attitude, and preparedness related to IPV care provision in health facilities among nurses and midwives in Tanzania.MethodsA self-administered anonymous questionnaire survey was conducted among nurses and midwives working in health facilities in the Mbeya region between December 2018 and January 2019. The questionnaire consisted of questions on their perceived and actual knowledge, attitudes, and preparedness to provide care in relation to IPV.ResultsA total of 662 (50.1%) of 1321 nurses and midwives who worked in hospitals and/or health centers in the Mbeya region participated in this study, and 461 (69.6%) completed questionnaires were included in the analysis. The proportion of nurses and midwives with high scores in IPV perceived knowledge, actual knowledge, attitude, and preparedness to provide care was 59.9%, 53.1%, 54.2%, and 54.0%, respectively. Regardless of the type of facility, gender, educational level, and work experience, the use of IPV guidelines was significantly associated with high scores in IPV perceived knowledge (P < 0.001), actual knowledge (P = 0.004), and preparedness to provide care (P < 0.001), but not attitude, which was negatively associated (P = 0.048). Regardless of the type of facility, gender, educational level, and work experience, receiving preservice IPV training was associated with high scores in IPV perceived knowledge (P < 0.001), actual knowledge (P = 0.049), and preparedness to provide care (P = 0.002), but not attitude (P = 0.192). Regardless of the type of facility, gender, educational level, and work experience, in-service IPV training was associated with high scores in IPV perceived knowledge (P < 0.001), actual knowledge (P = 0.043), and preparedness to provide care (P = 0.001), but not attitude (P = 0.063).ConclusionsAlthough guidelines and training could improve nurses’ and midwives’ knowledge and preparedness to provide care regarding IPV, attitudes against IPV care are a challenge. To improve attitudes regarding IPV among front-line nurses and midwives, it is necessary to address concepts of IPV care and sympathy with potential and actual victims of IPV in pre- and in-service training in addition to providing recall-level knowledge.

Public Health Midwives as a Family Health Care Worker to Promote Vaginal Health: Evidence from a Community Study in Sri Lanka

The article's abstract is no available.

Strengths and Barriers in Achieving “Green Status” of Breastfeeding; The Story of Frontline Health Care Workers in Sri Lanka

Abstract Objectives The achievements in breastfeeding in Sri Lanka are due to multiple factors and the work of frontline health care workers: public health midwives (PHMs) was crucial. Objective of this study is to explore the strengths and constraints of PHMs in optimizing breastfeeding practices in the Sri Lankan community. Methods We conducted a series of focus group discussions with PHMs in three different areas in Anuradhapura district Sri Lanka. Transcribed data were analyzed thematically to identify the types of strengths and constraints. Results Thirty six PHMs participated in the focus groups conducted. The well-established public health system that introduces and reinforce knowledge and skills on breastfeeding assured that mothers will adhere to the current recommendations on EBF. PHMs agreed on the support given by the hospital labor room, theatres and Lactation Management Center on early initiation and EBF. However, emphasis on attachment to breast rather than discharging a newborn on cup feeding was mentioned. PHMs devotion on establishing proper breastfeeding during the early postpartum home visits, the respect and acceptance of PHM by the mother and the community and the knowledge and skills they possess on breastfeeding counseling were highlighted. Irrational prescription of formula by medical practitioners, negative verbal comments by in-laws and unfavorable attitudes of mothers of high social class were seen as social obstacles to promote EBF. The PHMs seem to work with many barriers which could compromise care provision for mothers and children. Inability to attend for the home visit early due to scheduled work, the increased time needed to spent to counsel mothers and subsequent restriction of the daily duties, high population density and having to cover the vacant areas through out, excessive documentation work were problems needed to be addressed with regard to service enhancement. Conclusions The PHMs role is inevitable and Sri Lanka needs to enhance and facilitate service provision of grass root level health workers to optimize promotion, protection and support for EBF. Funding Sources No funding source.

Community intervention for cardiovascular disease risk factors in Kalutara, Sri Lanka

BackgroundThe effectiveness of a 2015–17 community intervention to reduce cardiovascular disease (CVD) and type 2 diabetes (T2DM) risk factors is assessed in a Sri Lanka adult population, using a before-and-after study design.MethodsFour contiguous Public Health Midwife (PHM) areas in Kalutara district (Western Province) were exposed to a Sri Lankan designed community health promotion initiatives (without screening) to lower CVD and T2DM risk factors. Pre- and post-intervention surveys (2014, n=1,019; 2017, n=908) were of 25–64 year males (M) and females (F) from dissimilar randomly selected clusters (villages or settlements) from PHMs, with probability of selection proportional to population size, followed by household sampling, then individual selection to yield equal-probability samples. Differences in resting blood pressure (BP), fasting plasma glucose (FPG), total cholesterol, body mass index and tobacco smoking, adjusting for cluster sampling, age and socio-economic differences, were examined.ResultsHypertension prevalence declined from 25% to 16% (F) (p<.0001), and 21% to 17% (M). Both mean systolic and diastolic BP declined. T2DM declined from 18% to 13% (F), and 18% to 15% (M), as did mean fasting plasma glucose. Elevated total cholesterol declined from 21% to 15% in women (p=0.003) and mean cholesterol declined. Frequency distributions, medians and means of these continuous CVD risk factors shifted to lower levels, and were mostly statistically significant (p< 0.05).ConclusionsCommunity health promotion can lower key CVD and T2DM risk factors. Lowering tobacco consumption in males and obesity remain challenges in Sri Lanka.

Health information needs and information seeking behavior of pregnant women attending antenatal clinics of Jaffna Teaching Hospital

Pregnant women face many challenges during the pregnancy period. They need quality, reliable and easily accessible information in order to face the challenges. The aim of this study was to identify the information needs and information-seeking behaviour of pregnant women attending antenatal clinics of Jaffna teaching hospital. The descriptive survey research strategy was used in the study. The data was collected by using intervieweradministered questionnaire. A sample of four hundred pregnant women was selected from the pregnant women attending antenatal clinics of Jaffna teaching hospital using a systematic sampling technique. Collected data from the questionnaires were analyzed using quantitative techniques in SPSS software. Correspondence analysis was performed to find out the association between the information sources that pregnant mothers used and other study variables. Majority of the pregnant women (61%) searched for information either always or often. Family members and friends were the main sources of information used by the greatest number of pregnant women (63%). It was followed by public health midwives (61%) and doctors (49%). Internet was also identified as one of the sources of information used by 29% of the participants. Participants showed less interest in mass media, books and journals. The most needed types of information were pregnancy complications (55.8%), delivery complications (54%), methods of child delivery (52%) and special tests required during pregnancy (48%). The least important type of information was exercise during pregnancy. Unavailability of information was the most restricting barrier in accessing information.

Activation of the nursing education through utilizing revision of Rules for Designation of Public Health Nurse, Midwife and Nurse Schools and Training Schools among nursing universities in Japan

Activation of the nursing education through utilizing revision of Rules for Designation of Public Health Nurse, Midwife and Nurse Schools and Training Schools among nursing universities in Japan