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Joy, struggle, and support; postpartum experiences of mothers in a Tanzanian suburb. A qualitative study.
(Women and Birth, 2011) Mbekenga, Columba K.
Objectives To explore and describe postpartum experiences of first-time mothers in a Tanzanian, multiethnic, low-income suburb. Methods Individual qualitative interviews with 10 first-time mothers, 4–10 weeks postpartum in Ilala suburb, Dar es Salaam, Tanzania. Results The first-time mothers enjoyed motherhood and the respectful status it implied. To understand and handle the infant's needs and own bodily changes were important during postpartum. The tradition of abstaining from sex up to 4 years during breastfeeding was a concern as male's faithfulness was questioned and with HIV a threat to family health. Partner relationship changed towards shared parental and household work and the man's active participation was appreciated. Support from family members and others in the neighbourhood were utilised as a resource by the mothers. In instances of uncertainties on how to handle things, their advice was typically followed. The new mothers generally had good experiences of health care during the childbearing period. However, they also experienced insufficiencies in knowledge transfer, disrespectful behaviour, and unofficial fees. Key conclusions and implication for practice The mothers’ perspective of postpartum revealed that they actively searched for ways to attain infants’ and own health needs, and family health in general. Prolonged sexual abstinence was considered a risk for the partner having other sexual partners and contracting HIV. The mothers relied heavily on the informal support network, which sometimes meant risking family health due to misinformation and harmful practices. Health care and informal support systems should complement each other to attain adequate support for the families postpartum.
Informal support to first-parents after childbirth: a qualitative study in low-income suburbs of Dar es Salaam, Tanzania
(BMC pregnancy and childbirth, 2011) Mbekenga, Columba K.
Background In Tanzania, and many sub-Saharan African countries, postpartum health programs have received less attention compared to other maternity care programs and therefore new parents rely on informal support. Knowledge on how informal support is understood by its stakeholders to be able to improve the health in families after childbirth is required. This study aimed to explore discourses on health related informal support to first-time parents after childbirth in low-income suburbs of Dar es Salaam, Tanzania. Methods Thirteen focus group discussions with first-time parents and female and male informal supporters were analysed by discourse analysis. Results The dominant discourse was that after childbirth a first time mother needed and should be provided with support for care of the infant, herself and the household work by the maternal or paternal mother or other close and extended family members. In their absence, neighbours and friends were described as reconstructing informal support. Informal support was provided conditionally, where poor socio-economic status and non-adherence to social norms risked poor support. Support to new fathers was constructed as less prominent, provided mainly by older men and focused on economy and sexual matters. The discourse conveyed stereotypic gender roles with women described as family caretakers and men as final decision-makers and financial providers. The informal supporters regulated the first-time parents' contacts with other sources of support. Conclusions Strong and authoritative informal support networks appear to persist. However, poverty and non-adherence to social norms was understood as resulting in less support. Family health in this context would be improved by capitalising on existing informal support networks while discouraging norms promoting harmful practices and attending to the poorest. Upholding stereotypic notions of femininity and masculinity implies great burden of care for the women and delimited male involvement. Men's involvement in reproductive and child health programmes has the potential for improving family health after childbirth. The discourses conveyed contradicting messages that may be a source of worry and confusion for the new parents. Recognition, respect and raising awareness for different social actors' competencies and limitations can potentially create a health-promoting environment among families after childbirth.
Postpartum experiences and concerns of first-time fathers in Ilala suburb, Dar es Salaam, Tanzania. A qualitative interview study.
(Midwifery, 2011) Mbekenga, Columba K.
Objectives: to explore postpartum experiences of first-time fathers in a multicultural, low-income, suburban Tanzanian setting. Design, setting and participants: individual qualitative interviews with ten first-time fathers, four to ten weeks post partum in Ilala suburb, Dar es Salaam, Tanzania. Findings: these first-time fathers enjoyed fatherhood and revealed a sincere concern for the well-being of the mother and infant during the postpartum period. They described themselves as active in mother and infant care and household chores; however, they were limited by breadwinning responsibilities. The families were supported by relatives or laypersons. The mothers’ and infants’ nutrition had high priority but poverty was an obstacle. Timing of resumption of sex after childbirth was problematic as traditions prescribed abstinence while the woman is breast feeding. The risk of contracting HIV to the family was a concern. Reproductive and child health care often excluded fathers and gave unclear information. Conclusion: these new fathers struggled to gain confidence and experience while engaging in family matters during post partum. Changing gender roles in the suburban Tanzanian society in general and their personal experiences of transition to fatherhood both facilitated and made the postpartum period problematic. The health sector does not respond with respect to fathers’ concerns for family health and needs for support. Recommendations: these findings call for programmes on gender relations, which are supporting constructive masculinities and facilitate new fathers’ active participation and responsibilities in parenting, family health and their relations with their partners. Such programmes should not only target people in childbearing age but also their potential support persons. Health workers should welcome fathers and discuss strategies for good family health during post partum. Counselling couples together could facilitate their support for each other in optimising health post partum
Developing an international multidisciplinary research collaboration: Lessons learned
(In APHA Meetings: Online Program, 2012) Mbekenga, Columba K.
Background: Improving global health through international research collaboration is increasingly becoming a common pathway of transferring knowledge across cultures. Developing such collaborations, however, is challenging. This presentation will discuss the ongoing process, challenges, and lessons learned for developing a multidisciplinary HIV/AIDS research partnership between American and Tanzanian universities. Process of Partnership: To date, HIV prevention programs in Tanzania have not been entirely successful, and numerous investigators have called for multidisciplinary models. For this reason, an investigator from the Wright State University (WSU) College of Nursing partnered with researchers from WSU's school of medicine and schools of nursing and public health at the Muhimbili University of Health and Allied Sciences (MUHAS) in Tanzania. Initially, two WSU investigators travelled to Tanzania in June 2011 to confer with MUHAS investigators to get support for developing a collaborative research project. The meeting resulted in a WSU-funded needs-assessment project to be conducted in Tanzania in December 2011. Observations and Conclusions: Taking a project to an international level involves practical considerations. Partnership expectations on data sharing and dissemination, leadership and authorship should be made explicit. Understanding all the steps for research approval and the ethical boards involved is also essential. Budgetary issues should be anticipated, as international research is expensive. For example, costs for the local investigators must be covered in the budget because data collection is best accomplished by local researchers, who have no local funding. Other potential barriers such as power outages, unreliable internet access, language differences, and cultural insensitivity should be considered.
Prolonged sexual abstinence after childbirth: gendered norms and perceived family health risks. Focus group discussions in a Tanzanian suburb
(BMC international health and human rights, 2013) Mbekenga, Columba K.
Background Prolonged sexual abstinence after childbirth is a socio-cultural practice with health implications, and is described in several African countries, including Tanzania. This study explored discourses on prolonged postpartum sexual abstinence in relation to family health after childbirth in low-income suburbs of Dar es Salaam, Tanzania. Methods Data for the discourse analysis were collected through focus group discussions with first-time mothers and fathers and their support people in Ilala, Dar es Salaam, Tanzania. Results In this setting, prolonged sexual abstinence intended at promoting child health was the dominant discourse in the period after childbirth. Sexual relations after childbirth involved the control of sexuality for ensuring family health and avoiding the social implications of non-adherence to sexual abstinence norms. Both abstinence and control were emphasised more with regard to women than to men. Although the traditional discourse on prolonged sexual abstinence for protecting child health was reproduced in Ilala, some modern aspects such as the use of condoms and other contraceptives prevailed in the discussion. Conclusion Discourses on sexuality after childbirth are instrumental in reproducing gender-power inequalities, with women being subjected to more restrictions and control than men are. Thus, interventions that create openness in discussing sexual relations and health-related matters after childbirth and mitigate gendered norms suppressing women and perpetuating harmful behaviours are needed. The involvement of males in the interventions would benefit men, women, and children through improving the gender relations that promote family health.
Birth preparedness and complication readiness - a qualitative study among community members in rural Tanzania.
(Global health action, 2015) Mbekenga, Columba K.
Background Birth preparedness and complication readiness (BP/CR) strategies are aimed at reducing delays in seeking, reaching, and receiving care. Counselling on birth preparedness is provided during antenatal care visits. However, it is not clear why birth preparedness messages do not translate to utilisation of facility delivery. This study explores the perceptions, experiences, and challenges the community faces on BP/CR. Design A qualitative study design using Focused Group Discussions was conducted. Twelve focus group discussions were held with four separate groups: young men and women and older men and women in a rural community in Tanzania. Qualitative content analysis was used to analyse the data. Results The community members expressed a perceived need to prepare for childbirth. They were aware of the importance to attend the antenatal clinics, relied on family support for practical and financial preparations such as saving money for costs related to delivery, moving closer to the nearest hospital, and also to use traditional herbs, in favour of a positive outcome. Community recognised that pregnancy and childbirth complications are preferably treated at hospital. Facility delivery was preferred; however, certain factors including stigma on unmarried women and transportation were identified as hindering birth preparedness and hence utilisation of skilled care. Challenges were related to the consequences of poverty, though the maternal health care should be free, they perceived difficulties due to informal user fees. Conclusions This study revealed community perceptions that were in favour of using skilled care in BP/CR. However, issues related to inability to prepare in advance hinder the realisation of the intention to use skilled care. It is important to innovate how the community reinforces BP/CR, such as using insurance schemes, using community health funds, and providing information on other birth preparedness messages via community health workers.
“We have been working overnight without sleeping”: traditional birth attendants’ practices and perceptions of post-partum care services in rural Tanzania
(BMC pregnancy and childbirth, 2015) Mbekenga, Columba K.
Background In many low-income countries, formal post-partum care utilization is much lower than that of skilled delivery and antenatal care. While Traditional Birth Attendants (TBAs) might play a role in post-partum care, research exploring their attitudes and practices during this period is scarce. Therefore, the aim of this study was to explore TBAs’ practices and perceptions in post-partum care in rural Tanzania. Methods Qualitative in-depth interview data were collected from eight untrained and three trained TBAs. Additionally, five multiparous women who were clients of untrained TBAs were also interviewed. Interviews were conducted in February 2013. Data were digitally recorded and transcribed verbatim. Qualitative content analysis was used to analyze data. Results Our study found that TBAs take care of women during post-partum with rituals appreciated by women. They report lacking formal post-partum care training, which makes them ill-equipped to detect and handle post-partum complications. Despite their lack of preparation, they try to provide care for some post-partum complications which could put the health of the woman at risk. TBAs perceive that utilization of hospital-based post-partum services among women was only important for the baby and for managing complications which they cannot handle. They are poorly linked with the health system. Conclusions This study found that the TBAs conducted close follow-ups and some of their practices were appreciated by women. However, the fact that they were trying to manage certain post-partum complications can put women at risk. These findings point out the need to enhance the communication between TBAs and the formal health system and to increase the quality of the TBA services, especially in terms of prompt referral, through provision of training, mentoring, monitoring and supervision of the TBA services.
Women's perceptions of antenatal, delivery, and postpartum services in rural Tanzania
(Global health action, 2015) Mbekenga, Columba K.
Background Maternal health care provision remains a major challenge in developing countries. There is agreement that the provision of quality clinical services is essential if high rates of maternal death are to be reduced. However, despite efforts to improve access to these services, a high number of women in Tanzania do not access them. The aim of this study is to explore women's views about the maternal health services (pregnancy, delivery, and postpartum period) that they received at health facilities in order to identify gaps in service provision that may lead to low-quality maternal care and increased risks associated with maternal morbidity and mortality in rural Tanzania. Design We gathered qualitative data from 15 focus group discussions with women attending a health facility after child birth and transcribed it verbatim. Qualitative content analysis was used for analysis. Results ‘Three categories emerged that reflected women's perceptions of maternal health care services: “mothers perceive that maternal health services are beneficial,” “barriers to accessing maternal health services” such as availability and use of traditional birth attendants (TBAs) and the long distances between some villages, and “ambivalence regarding the quality of maternal health services” reflecting that women had both positive and negative perceptions in relation to quality of health care services offered’. Conclusions Mothers perceived that maternal health care services are beneficial during pregnancy and delivery, but their awareness of postpartum complications and the role of medical services during that stage were poor. The study revealed an ambivalence regarding the perceived quality of health care services offered, partly due to shortages of material resources. Barriers to accessing maternal health care services, such as the cost of transport and the use of TBAs, were also shown. These findings call for improvement on the services provided. Improvements should address, accessibility of services, professionals' attitudes and stronger promotion of the importance of postpartum check-ups, both among health care professionals and women.
Global Collaboration Between Tanzania and Japan to Advance Midwifery Profession: A case report of Partnership Model.
(Journal of Nursing Education and Practice, 2015) Mbekenga, Columba K.
The global health agenda to reduce maternal mortality is delayed in Sub-Saharan Africa. The shortage of skilled birth attendants in Tanzania hinders the improvement of midwifery care to prevent maternal mortality and morbidity. It is urgently neccesary to develop midwifery leaders capable of working as educators, researchers, administrators, and advanced practitioners, contributing to the improvement of midwifery care and maternal child health in their own country. This report describes the process of establishing the first midwifery master’s program in Tanzania through the efforts of two academic institutions, one in Tanzania and one in Japan. The collaboration developed a sustainable partnership model for the advancement of midwifery education. This partnership model was based upon the professional relationships corresponding with our values of humanized childbirth and people-centered care. The key elements for the project success included: (1) spending adequate time for in-person communication with the collaborative partner; (2) sharing the same goals and concepts; (3) understanding different values and norms for working and living; (4) learning ways of communication and project implementation in the partner’s culture and (5) confirming the feasibility, which could increase team members’ motivation and commitment. Midwives from the two institutions both gained knowledge and research outcomes as well as the satisfaction of establishing the midwifery master’s program. To improve the remaining global maternal health issues, this win-win collaboration should be considered as the 21st century’s partnership model for the global health community
Fear, blame and transparency: Obstetric caregivers' rationales for high caesarean section rates in a low-resource setting
(Social Science & Medicine, 2015) Mbekenga, Columba K.
In recent decades, there has been growing attention to the overuse of caesarean section (CS) globally. In light of a high CS rate at a university hospital in Tanzania, we aimed to explore obstetric caregivers' rationales for their hospital's CS rate to identify factors that might cause CS overuse. After participant observations, we performed 22 semi-structured individual in-depth interviews and 2 focus group discussions with 5–6 caregivers in each. Respondents were consultants, specialists, residents, and midwives. The study relied on a framework of naturalistic inquiry and we analyzed data using thematic analysis. As a conceptual framework, we situated our findings in the discussion of how transparency and auditing can induce behavioral change and have unintended effects. Caregivers had divergent opinions on whether the hospital's CS rate was a problem or not, but most thought that there was an overuse of CS. All caregivers rationalized the high CS rate by referring to circumstances outside their control. In private practice, some stated they were affected by the economic compensation for CS, while others argued that unnecessary CSs were due to maternal demand. Residents often missed support from their senior colleagues when making decisions, and felt that midwives pushed them to perform CSs. Many caregivers stated that their fear of blame from colleagues and management in case of poor outcomes made them advocate for, or perform, CSs on doubtful indications. In order to lower CS rates, caregivers must acknowledge their roles as decision-makers, and strive to minimize unnecessary CSs. Although auditing and transparency are important to improve patient safety, they must be used with sensitivity regarding any unintended or counterproductive effects they might have.
The Challenges of Providing Postpartum Education in Dar es Salaam, Tanzania: Narratives of Nurse-Midwives and Obstetricians
(Qualitative Health Research, 2017) Mbekenga, Columba K.
Postpartum education can save lives of mothers and babies in developing countries, and the World Health Organization recommends all mothers receive three postpartum consultations. More information is needed to better understand how postpartum education is delivered and ultimately improves postpartum health outcomes. The purpose of this qualitative study was to examine how postpartum care was delivered in three postnatal hospital clinics in Dar es Salaam, Tanzania. Semistructured interviews with 10 nurse-midwives and three obstetricians were conducted. Feminist poststructuralism guided the research process. Postpartum education was seen to be an urgent matter; there was a lack of supportive resources and infrastructure in the hospital clinics, and nurse-midwives and obstetricians had to negotiate conflicting health and traditional discourses using various strategies. Nurse-midwives and obstetricians are well positioned to deliver life-saving postpartum education; however, improvements are required including increased number of nurse-midwives and obstetricians.
Why do women not adhere to advice on maternal referral in rural Tanzania? Narratives of women and their family members
(Global health action, 2017) Mbekenga, Columba K.
Background: In most low-income countries, many women with high-risk pregnancies and complications do not reach the referral hospitals despite the provision of referral advice. Objective: To explore how antenatal maternal referral advice is understood and handled in a rural Tanzanian community. Methods: Individual in-depth interviews were conducted with six women who did not go to hospital and 13 people who were involved in the referral advice. Narrative analysis was used to describe and create meanings out of the decision-making process. Results: In all interviews, not following the referral advice was greatly influenced by close family members. Three main traits of how referral advice was understood emerged: convinced referral is not necessary, accepting referral advice but delayed by others, and passive and moving with the wind. The main reasons given for declining the referral advice included discrediting midwives’ advice, citing previous successful deliveries despite referral advice; being afraid of undergoing surgery; lack of support for care of siblings at home; and high costs incurred during referral. Conclusions: Declining maternal referral advice centred around the pregnant women’s position and their dependence on the family members around them, with a decreased ability to show autonomy. If they were socially and economically empowered, women could positively influence decision making during maternal referrals.
Perceptions about the cultural practices of male partners during postpartum care in rural Tanzania: a qualitative study
(Global health action, 2017) Mbekenga, Columba K.
Background: Men play an important role in maternal health. The postpartum period is a critical stage, yet there is a scarcity of research that explores men’s involvement during this stage. Objective: The aim of the study was to explore male partners’ perceptions of the cultural practices during postpartum care in rural Tanzania. Methods: Fourteen focus group discussions were conducted with 93 men, with an age range of 19–65 years, in August 2013. The study was conducted in the Kongwa District, located in the Dodoma region in central Tanzania. Qualitative data were digitally recorded, transcribed verbatim and analyzed using content analysis. Results: Four categories emerged, namely: ‘Men as providers and, occasionally, care takers’, ‘Men as decision makers’, ‘Diverse perceptions of sexual abstinence’ and ‘Barriers for men in using/accompanying partners to use reproductive and child healthcare services’. The cross-category theme ‘Men during postpartum: remaining powerful but excluded’ refers to how men are in a powerful position above women in different aspects of life. Elderly women played an important role in caring for postpartum mothers and their newborns, but men were the ones making the final decision about where to seek care. Traditional practices isolated men from their partners for a certain period, and enforced sexual abstinence for the women during the postpartum period. However, cultural norms permitted men to engage in extramarital relations. Reproductive and child healthcare services were perceived by men as not welcoming the male partners, and local gender norms discouraged men from accompanying their partners to seek services. Conclusions: In this study, we found that men perceived their role during the postpartum period as financial providers, decision makers and, occasionally, care givers. Men also held diverse perceptions with regard to sexual abstinence and felt excluded from participating in maternal healthcare services.
Stakeholder perspectives on public health genomics applications for sickle cell disease: a methodology for a Human Heredity and Health in Africa (H3Africa) Qualitative Research Study.
(A Journal of Integrative Biology, 2017) Mbekenga, Columba K.
Advances in omics technologies alone are not a guarantee that science will translate to robust responsible innovation that is firmly grounded in societal values. This study aimed to identify best practices for Ethical, Legal, and Social Implications (ELSI) research in Africa that allows for optimal integration of community perspectives into the design and implementation of genomics research. In a large sample of 346 stakeholders in Cameroon, Ghana, and Tanzania (59% women), we used a qualitative study design with a phenomenological approach and conducted 32 group and 74 individual interviews (25% rural). We imported interview recordings into NVivo software for analysis. We created a “concept map” to organize the coded information, with Perspectives on Genomics and Sickle Cell Disease (SCD) Public Health Interventions as the central themes. We found that (1) analyses of major subthemes across and within countries revealed differential knowledge and experiences of SCD, and perspectives on various aspects of research and genomics; (2) we were able to gather empirical data efficiently from urban and rural stakeholders, to study the issues related to sample sharing, consent processes, and return of clinical and genomic study results; (3) the concept of nondirectiveness in modern genetic medicine practice can be challenged by the views of stakeholders in the context of a high-burden disease such as SCD; and (4) linking community views to current and proposed public health interventions could be understood within the context of each specific country. Our work informs future qualitative social science and technology policy research designs on genomics applications in Africa.
‘If really we are committed things can change, starting from us’ Healthcare providers’ perceptions of postpartum care and its potential for improvement in low-income suburbs in Dar es Salaam, Tanzania.
(Sexual & Reproductive Healthcare, 2017) Mbekenga, Columba K.
Objective To explore healthcare providers' perceptions of the current postpartum care (PPC) practice and its potential for improvement at governmental health institutions in low-resource suburbs in Dar es Salaam, Tanzania. Design Qualitative design, using focus group discussions (8) and qualitative content analysis. Setting Healthcare institutions (8) at three levels of governmental healthcare in Ilala and Temeke suburbs, Dar es Salaam. Participants Registered, enrolled and trained nurse-midwives (42); and medical and clinical officers (13). Results The healthcare providers perceived that PPC was suboptimal and that they could have prevented maternal deaths. PPC was fragmented at understaffed institutions, lacked guidelines and was organized in a top-down structure of leadership. The participants called for improvement of: organization of space, time, resources, communication and referral system; providers' knowledge; and supervision and feedback. Their motivation to enhance PPC quality was high. Key conclusions The HCP awareness of the suboptimal quality of PPC, its potential for promoting health and their willingness to engage in improving care are promising for the implementation of interventions to improve quality of care. Provision of guidelines, sensitization of providers to innovate and maximize utilization of existing resources, and supportive supervision and feedback are likely to contribute to the sustainability of any improvement.
A baseline mixed-methods study on postpartum care among health professionals in Tanzania
(African Journal of Midwifery and Women's Health, 2017) Mbekenga, Columba K.
Background: Globally, postpartum care (PPC) is a neglected part of maternal and neonatal health, despite 50% of maternal deaths occuring in the first weeks after childbirth. Aim: The study aimed to assess knowledge, attitudes and practices among providers of PPC in government institutions in two low-resource suburbs of Dar es Salaam: Ilala and Temeke. Methods: Health professionals (n=149) at all levels of care completed a knowledge and attitudes questionnaire. A checklist was used to observe 25 health professionals at reproductive and child health units, and 38 mothers were interviewed on exit. χ2 - and logistic regression tests were used to analyse the outcomes. Field notes were analysed qualitatively. Findings: Overall, 64% of health professionals had high knowledge and most had positive attitudes towards PPC. Level of education was found to be positively associated with positive attitudes towards PPC (OR=2.5 CI 95% 1.03–6.13). PPC consultations with mothers and newborns during the first week after childbirth were found to be few or nonexistent. Mothers who came with newborns for BCG immunisation were mostly satisfied with the services. Conclusion: Quality improvement is required at the structure and process levels of the health system in order to provide holistic PPC consultations.
Saving lives with caring assessments: how Tanzanian nurse-midwives and obstetricians negotiate postpartum practices.
(Journal of Clinical Nursing, 2017) Mbekenga, Columba K.
Aims and objectives To explore the nurse-midwives’ and obstetricians’ experiences delivering postpartum care assessments and how it was constructed through personal, social and institutional discourses. Introduction The Tanzanian Government has prioritised maternal and child health as an urgent healthcare issue. Nurse-midwives and obstetricians are the two main providers of care throughout the prenatal and postpartum periods. Design A qualitative design guided by a feminist poststructuralist methodology. Methods Ten nurse-midwives and three obstetricians from three Regional Hospitals in Dar es Salaam participated in individual semi-structured in-depth interviews. Results Assessment emerged as a significant theme with three subthemes. Nurse-midwives shared their beliefs and values about assessments that focused on the safety of mothers and babies. They felt proud working with mothers and babies and shared their frustrations having to deal with inadequate working conditions. Guidelines and practices were part of the institutional discourse that impacted the day-to-day experiences of nurse-midwives and obstetricians. The nurse-midwives held the belief that it was vital to complete a comprehensive assessment to identify danger signs, keep mothers and babies safe and look for any abnormalities. They were concerned that mothers were being sent home too early. Conclusions Nurse-midwives’ experiences in the provision of postpartum care portray that these health providers work heartedly to make sure that the mothers and their newborns receive the best care they can provide. The health system is challenged to address the needed supplies and equipment for reproductive health in particular postpartum care services.
Women’s experiences of having had, and recovered from, eclampsia at a tertiary hospital in Tanzania
(Women and Birth, 2017) Mbekenga, Columba K.
Background Eclampsia is a major cause of maternal and perinatal mortality that requires advanced care and long hospital stays with uncertain outcomes for mother and baby. Care of eclamptic women is particularly challenging in low-income settings. Standards for medical care for eclampsia are established but the psychosocial needs of women are under-researched. Aim To explore and describe women’s experiences of having had, and recovered from, eclampsia at a tertiary hospital in Tanzania. Methods Qualitative semi-structured interviews were held with a purposive sample of 10 women recovering from eclampsia. Thematic analysis informed the interpretation of the data. Findings The women had experienced eclamptic seizure as painful and unreal as they were unable to control their body or actions despite sensing what happened. At hospital they felt being cared for and recovered but concerned because they had not been provided with enough information about the disorder. Being separated from the baby during hospitalisation was troublesome and they worried about infant feeding and health. The women experienced being connected to God and they were grateful for being alive and having recovered. However, they expressed fears over the possible recurrence of eclampsia in future pregnancies and wanted information about prevention strategies. Conclusion Experiencing eclampsia is painful and gives a sense of bodily disconnectedness. It involves worrisome separation from the newborn, not being adequately informed and concerns over future health. More holistic care would benefit eclamptic women and their newborns.
Informed Consent Process When Conducting Genomic Research in Populations Characterized to Have Low Literacy Levels
(Journal of Empirical Research on Human Research Ethics, 2017) Mbekenga, Columba K.
Background Conducting genomic research in low- and middle-income countries cannot be underestimated because of the high disease burden found in these countries and because genomic approaches can be a powerful tool in improving population health. However, conducting genomic research in populations with low literacy presents specific challenges in obtaining quality informed consent. Method This study was designed to explore the challenges associated with obtaining a valid informed consent when conducting genomic research with populations characterized as having low literacy levels. Qualitative methodologies were used to collect information including focus group discussions, in-depth interviews, and participant observations. This study was embedded in a genomic study on sickle cell disease conducted at a hospital. Participants were recruited using purposeful sampling. In total, there were 47 participants. Five focus group discussions were conducted with at least six participants in each, and 17 in-depth interviews were conducted. All the interviews were recorded using digital recorders and also captured in the field notes. All data were analyzed using thematic content analysis. Findings The findings indicated that literacy level was not a key factor influencing participants’ understanding. However, adequacy of the information provided to the participants and the methods used to communicate the information were important contributing factors to help participants’ understanding. The preferred mode of the provision of information was through group sessions in the presence of nurses or doctors. The benefits of the research and returning results were considered by the participants to be important sections of the consenting process. Discussion As a qualitative approach was utilized, the results cannot be generalized to the population. This study was also a hospital based study and that, in some ways, might have an influence on the results. The relevance of the findings to other types of studies (non-genomics) requires further investigation. Gaining informed consent in populations with low literacy levels requires novel approaches to ensure that the information is fully comprehended. Our research indicates that individuals with low literacy levels require special consideration in the method for delivering materials and information. Group sessions with trusted medical personnel present are desirable for the target population. Using group sessions requires careful consideration to protect the identity of potential participants. The findings from this study will be used to develop a tool and strategies to guide researchers in the context of genomic research. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Improved postpartum care after a participatory facilitation intervention in Dar es Salaam, Tanzania: a mixed method evaluation.
(Global health action, 2017) Mbekenga, Columba K.
Background: In order to improve the health and survival of mothers/newborns, the quality and attendance rates of postpartum care (PPC) must be increased, particularly in low-resource settings. Objective: To describe outcomes of a collegial facilitation intervention to improve PPC in government-owned health institutions in a low-resource suburb in Dar es Salaam, Tanzania. Methods: A before-and-after evaluation of an intervention and comparison group was conducted using mixed methods (focus group discussions, questionnaires, observations, interviews, and field-notes) at health institutions. Maternal and child health aiders, enrolled nurse midwives, registered nurse midwives, and medical and clinical officers participated. A collegial facilitation intervention was conducted and healthcare providers were organized in teams to improve PPC at their workplaces. Facilitators defined areas of improvement with colleagues and met regularly with a supervisor for support. Results: The number of mothers visiting the institution for PPC increased in the intervention group. Some care actions were noted in more than 80% of the observations and mothers reported high satisfaction with care. In the comparison group, PPC continued to be next to non-existent. The healthcare providers’ knowledge increased in both groups but was higher in the intervention group. The t-test showed a significant difference in knowledge between the intervention and comparison groups and between before and after the intervention in both groups. The difference of differences for knowledge was 1.3. The providers perceived the intervention outcomes to include growing professional confidence/knowledge, improved PPC quality, and mothers’ positive response. The quality grading was based on the national guidelines and involved nine experts and showed that none of the providers reached the level of good quality of care. Conclusions: The participatory facilitation intervention contributed to improved quality of PPC, healthcare providers’ knowledge and professional confidence, awareness of PPC among mothers, and increased PPC attendance.

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