Reproductive and Child Health Nursing

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Browsing Reproductive and Child Health Nursing by Subject "Childbirth care"

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    "It is because the treatment of this lady is a cascade": Accumulation of delays and the occurrence of obstetric emergencies in an urban maternity unit in Tanzania. Midwifery.
    (Midwifery, 2024-03) Mbekenga, Columba K.
    Objective To explore healthcare workers’ and women's experiences of providing and seeking childbirth care in a busy urban maternity facility in Tanzania. Design A qualitative study with observations, in-depth interviews, and informal conversations, using thematic network analysis. Setting This study was conducted in a busy urban maternity unit in Dar es Salaam, Tanzania which is a low-resource setting with a need to improve childbirth care. Participants Six frontline healthcare providers and four hospital managers from the facility, along with six postpartum women who gave birth at the facility. Findings Delays were observed throughout the childbirth care cascade, encompassing various stages. During antenatal care, timely provision of care was hindered by a high patientto-provider ratio, resulting in inadequate monitoring of risk factors. At the onset of labor, women delayed seeking care, sometimes, attempting a trial of labor after a previous Caesarean section. Within the facility, delays in care decision-making and patient management were evident due to insufficient resources. The accumulation of these delays over time influenced the quality of care provided and challenged the management of obstetric emergencies at the study facility. Key conclusions The study findings show that delays are prevalent throughout the entire childbirth care cascade. The accumulation of these delays over time has influenced the quality of care provided at the facility and increased the vulnerability of women experiencing obstetric emergencies. To effectively address the imperative of reducing maternal mortality in low-resource settings, it is essential to develop appropriate interventions that span the entire spectrum of childbirth care. Additionally, further research is needed to delve into the complexities of care decision-making and the quality of care delivered within urban maternal facilities. Implications for practice Our findings stress the need for comprehensive childbirth interventions and contextspecific guidelines to address challenges across the care cascade, particularly in lowresource settings. Urgent attention is required to prioritize care during patient triage and address systemic challenges within the healthcare system to improve birth outcomes and ensure effective facility-based care provision. Keywords Maternal healthChildbirth careUrban healthDelaysObstetric emergencyTanzania
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    The Dilemmas and Opportunities of Co‐Creating Health Interventions to Fit Local Contexts: An Ethnographic Study on the Adaptation of Clinical Guidelines in Tanzania
    (Health Expectations, 2024-10-24) Mbekenga,Columba K.
    Introduction: Healthcare providers' role in co‐creating health interventions and implementation strategies has evolved sig- nificantly, and yet, there is little documentation of this from low‐resource settings. This study aims to share the dilemmas of engaging healthcare providers in co‐creating locally adapted clinical guidelines for maternity facilities in Dar es Salaam, Tanzania, and strategies used to address them. Methods: An ethnographic study explored the co‐creation of locally adapted clinical guidelines for childbirth care within five maternity facilities in Dar es Salaam. Participant observations were conducted during 11 co‐creation workshops. Six in‐depth interviews explored participant experiences. Data were analyzed using Attride‐Stirling's thematic network analysis framework. Results: The analysis revealed four themes representing dilemmas in the co‐creation process and strategies to improve co‐ creation: (i) navigating diverse contexts: adapting a single set of guidelines to various, diverse facilities was challenging; this was addressed through engaging in dialogue and flexibility while adjusting care practices. (ii) Competing knowledge systems and sources: differing knowledge sources between researchers and healthcare providers challenged discussions on recommended practices. However, validating scientific recommendations with practical care experience in this context helped bridge this gap. (iii) Fostering meaningful participation: participation was time‐consuming for some. However, early stakeholder engagement and facility‐led participant selection facilitated the meaningful involvement of healthcare providers. (iv) Power imbalances: power dynamics influenced the co‐creation process; involving stakeholders in planning and co‐facilitating workshops helped mitigate these imbalances and encourage more equal participation. Conclusion: Navigating contextual variation, differences in knowledge systems, meaningful participation and power dynamics were key challenges in the co‐creation process. However, reflexivity, open and honest dialogue with stakeholders and early engagement enhanced the co‐creation process. Co‐creating locally adapted clinical guidelines with frontline healthcare workers and scientific experts is essential for feasibility and safety. Further research is needed to explore context specificity, decision‐ making and the efficacy of co‐creation in low‐resource settings.