Implementation of preconception care is vital to improve maternal health and enhance perinatal outcomes. In most low- and middle-income countries, coverage and implementation of preconception care is low. This review aimed to explore the implementation of preconception care in southern African countries and barriers and enablers to implementation. This scoping review searched Google Scholar, Science Direct and PubMed for studies published between 2014 and 2023 in English that focused on implementation of preconception care or reported on factors promoting or hindering implementation across nine countries in southern Africa. Data extracted from selected studies were analysed thematically. A total of 12 studies were included in the review. Most countries in the southern African region have not implemented preconception care and those that had were targeting specific sub-groups of women. Barriers to implementation included lack of awareness among women of childbearing age, inadequate knowledge among healthcare professionals, and the lack of policy and clear guidelines. Promoting factors were awareness being raised through research, healthcare professionals’ knowledge, the use of a reproductive lifeplan and positive attitudes to and perceptions of preconception care. There is inadequate implementation of preconception care in southern Africa, and there are more barriers to implementation than factors enabling it. Countries in this region should develop clear policies and guidelines regarding preconception care and equip healthcare professionals with knowledge in this area. There is a need for countries in the southern African region to develop clear policies and guidelines regarding preconception care and ensure that healthcare professionals are provided with appropriate training to fast-track implementation of preconception care recommendations.
Meconium-stained amniotic fluid is associated with adverse perinatal outcomes, and occurs in approximately 7–22% of all live births. The aim of this study was to determine the proportion of births with infected meconium-stained amniotic fluid and explore associated bacteriological patterns and perinatal outcomes in a tertiary teaching hospital in Dar es Salaam, Tanzania. This cross-sectional study was conducted at Muhimbili National Hospital between August and December 2018 with women at ≥28 weeks' gestation about to give birth to a singleton baby with longitudinal lie and cephalic presentation. A sample of fluid was collected from each woman and transported for Gram staining at a university teaching microbiology laboratory. Univariate and bivariate analysis were used to calculate associations between variables and meconium-stained amniotic fluid. In total, 222 (8.7%) women out of 2566 births had meconium-stained amniotic fluid, 155 of whom (69.8%) had infected meconium. Mixed bacterial morphology was found in 59 cases (38.1%). Newborns from infected meconium-stained amniotic fluid were more likely to be admitted to the neonatal intensive care unit (32.9% vs 7.5%, P<0.001), to be fresh stillbirth (15.5% vs 3.0%, P=0.008) and to have an Apgar score ≤7 at 5 minutes (38.7% vs 7.5%, P=0.001). There is an increased risk of neonatal morbidity and mortality among mothers diagnosed with meconium-stained amniotic fluid. Detecting bacteria in the fluid raises concerns related to bacterial inoculation during routine obstetric vaginal examinations. Assessing antimicrobial culture and sensitivity pattern is highly recommended in future studies to improve current antimicrobial protocols when caring for babies born to mothers with meconium-stained amniotic fluid. Healthcare professionals supervising labour and birth should be aware of the risks of neonatal morbidity in cases of meconium-stained amniotic fluid. Parenteral broad-spectrum antibiotics should be given to mothers with this diagnosis before birth to reduce neonatal morbidity. Ensuring sterile vaginal examinations is important to reduce the chances of mixed bacterial inoculation.
Midwives play a critical role in preparation and response during maternal and newborn emergencies. However, many public health facilities have demonstrated poor service delivery marked by delays in care and referral of pregnant women, often resulting in poor maternal and neonatal outcomes. This study's aim was to explore the factors influencing referral of pregnant women seeking care in Nairobi County. This cross-sectional mixed methods study was carried out in Nairobi County's level three and four public health facilities with maternity units and county referral facilities that included the Nairobi County emergency response unit. Data were collected from 67 randomly sampled midwives at the facilities via questionnaires, from 23 purposively sampled key informants (13 members of the emergency response teams and 10 facility in-charges) via interviews, and from 45 purposively sampled mothers using focus group discussions. Quantitative data were analysed using descriptive and inferential statistics, while qualitative data were analysed thematically. Understaffing was a major issue that affected referral procedures. The participants' median knowledge score for their skills and competence was 41 out of 50. Approximately half (53.7%) of the midwives had a score equal to or above the median score, indicating the need for capacity building. It was reported that ambulance services faced frequent emergencies on weekends, increasing demand for emergency services. A number of health facilities were located in areas with poor infrastructure, making access to ambulance services a challenge. The referral process for pregnant women is influenced by multiple factors that include understaffing, inefficient ambulance services and the average capacity of midwives for referral procedures. There is a need for better systems and resources for effective and efficient referrals. Referring midwives must ensure that the receiving facility has the resources and services that the patient requires at the expected level or condition. Additionally, decentralisation of referral and ambulance services may improve care, as well as training for midwives on the referral process.
Preconception care aims to address issues that could affect pregnancy outcomes. However, in Kenya, many women do not seek care until after conception and so do not receive the benefits of these services. The aim of this study was to determine institutional factors correlated with the use of preconception care at Thika Level Five Hospital. This descriptive cross-sectional mixed-methods study collected data from 316 systematically sampled women of reproductive age and 16 purposively sampled key informants (healthcare professionals) at Thika Level Five Hospital in Kenya. Quantitative data were collected using an interviewer-administered questionnaire and analysed using multivariate analysis. Qualitative data were gathered through in-depth interviews and analysed thematically. Half of the women of reproductive age were unaware that the hospital offered preconception care services (50.3%), although the majority had received one or more interventions (62.0%). These participants highlighted that use of preconception care was influenced by long queues (67.4%), lack of awareness (50.3%), the cost of reproductive health services (52.8%) and the distance to the health facility (52.2%). Those who were unaware of the preconception care services offered (P=0.005) and who believed that long queues impacted use (P=0.049) were less likely to use preconception care services. Healthcare professionals reported a lack of knowledge about preconception care and felt they would require training before they could provide these services. These participants reported that factors influencing the provision of preconception care included staff shortages, as well as a lack of dedicated space and clear policies/guidelines. Healthcare professionals' lack of knowledge is a major barrier to the provision of preconception care services and needs to be addressed, as does the lack of awareness of these services among women of reproductive age. Institutional factors, such as the long queues and cost of services in hospitals, also prohibit women from engaging with preconception care services. Healthcare professionals should be trained on preconception care to bridge the knowledge gap and promote awareness among women of reproductive age. Human resource and infrastructure challenges must be addressed to reduce long queues at the hospital and enhance use of preconception care. Specific guidelines on preconception care for healthcare professionals will also have an important role in implementation of services.
The rate of exclusive breastfeeding in the first 6 months is still low, despite global active promotion of the practice. The exclusive breastfeeding rate among first-time mothers is much lower than among multiparous women, which has been attributed to difficulties assuming the new role and a lack of breastfeeding skills. This study aimed to gain an in-depth understanding of first-time mothers' breastfeeding experiences and the factors that influence these experiences during the early postpartum period in Nairobi, Kenya. This qualitative explorative, descriptive study involved 17 purposively sampled first-time mothers at 4–6 weeks postpartum. In-depth, face-to-face semi-structured interviews were used to collect data, which were analysed using content analysis. Three major themes were identified: initiating and establishing breastfeeding, maintaining and continuing with breastfeeding and breastfeeding support. All mothers reported difficulties initiating breastfeeding, such as breast pain caused by cracked nipples and engorgement, a lack of proficiency in infant feeding and care and perceived milk insufficiency. Despite enabling factors, potential barriers to continuing exclusive breastfeeding persisted. Professional support was mainly received when initiating breastfeeding. Family, friends and peers offered support at initiation and maintenance of breastfeeding, however, some supportive gestures, such as suggesting supplementary feeds, were potential barriers to exclusive breastfeeding. First-time mothers experienced breastfeeding difficulties when initiating and maintaining breastfeeding, and although there were enablers for practicing exclusive breastfeeding up to 6 months, potential barriers also existed. This demonstrates the importance of addressing these problems and barriers at an individual and personal level. Promoting family-centered care should involve implementing community strategies to support and promote exclusive breastfeeding. Addressing gaps in the health system, such as the lack of antenatal breastfeeding education, inconsistent breastfeeding messages and the lack of support continuity for first-time mothers throughout breastfeeding, will mitigate some of the barriers to exclusive breastfeeding up to 6 months.
Neonatal jaundice is associated with increased morbidity and mortality among neonates. In Namibia, 12.4% of neonates experience neonatal jaundice, with those 3–6 days old being most affected. The aim of this study was to assess third-year nursing students' knowledge of the causes, impact and management of neonatal jaundice in Windhoek, Namibia. This cross-sectional descriptive research design was conducted with 58 randomly sampled third-year nursing students. A semi-structured questionnaire was used to collect data on students' knowledge, which were analysed using descriptive statistics. The participants demonstrated awareness of the concept of neonatal jaundice (94.8%), its causes (98.3%) and treatment (98.3%). However, only 63.8% of students were aware that physiological jaundice is the most common type of neonatal jaundice. The majority of student nurses possessed good knowledge and understanding of neonatal jaundice, as well as its causes, management and treatment. However, there were some gaps in their knowledge. A refresher course or training manual on neonatal jaundice may be beneficial for fourth-year students, as training institutions only offer midwifery topics to nursing students up to third year.
Early postnatal care can have a significant impact on maternal and neonatal health and wellbeing, especially through timely identification and management of postpartum complications. However, many mothers and their newborns do not receive early postnatal care from healthcare professionals during the essential first days after delivery. The aim of this study was to establish factors affecting use of postnatal care services within 6 days of birth in health facilities in Mpongwe District, Zambia. This cross-sectional descriptive study explored factors affecting use of postnatal care among 152 randomly sampled postnatal mothers attending postnatal care within 6 weeks of birth at health facilities in the district. A structured questionnaire was used to collect data on the participants' sociodemographic, obstetric and health facility characteristics. Bivariate and multivariate regression analyses were used to analyse factors associated with use in the first 6 days of the postnatal period. Less than half of the participants received postnatal care within 6 days of birth (43.4%). Factors associated with early postnatal care use were number of children (1 child: P<0.001; 2–3 children: P=0.001), attending 6 or more antenatal care appointments (P=0.009), having adequate knowledge of postnatal care (P=0.023) and living within 5km of a health facility (P=0.008). The majority of the study's participants did not attend postnatal care within the recommended timeframe. Early uptake of postnatal care is intricately linked to a combination of factors, including antenatal attendance and knowledge of postnatal care, highlighting the importance of antenatal education in promoting early postnatal care attendance. There is a need for a structured follow-up system for mothers in the 6 days after birth and the importance of improving women's awareness of the importance of early attendance at postnatal care.
Low postpartum contraception uptake is a major public health concern, as it contributes to the rising incidence of unintended pregnancies among postpartum women. This results in increased maternal and infant morbidity and mortality rates. This study's aim was to assess the influence of client-related factors on the uptake of postpartum contraception among postpartum women. This mixed-methods study was carried out in two purposively selected health facilities in Kitui County, Kenya. For quantitative data, 228 randomly sampled postpartum women completed semi-structured questionnaires and responses were analysed using Chi-squared and Fisher's exact tests to establish factors related to postpartum contraceptive uptake. For qualitative data, four focus group discussions were held with 40 postpartum women and key informant interviews were carried out with department in-charges at the two health facilities, exploring perceptions of factors influencing postpartum contraceptive uptake. The qualitative data were analysed thematically. There was a significant association between uptake of postpartum contraception and multiple factors, including: age (P=0.004), ethnicity (P=0.036), religion (P=0.027), education (P=0.013), residence (P<0.001) and employment (P<0.001). The qualitative findings highlighted individual and sociocultural factors that influenced uptake of postpartum contraception, including previous use of contraception, cultural beliefs and women's age, religion and education. There were multiple predictors of postpartum contraception uptake among women, including employment, parity, age, ethnicity, religion, residence and education. These constitute useful targets for interventions to improve postpartum contraception use. It is important to educate women on contraception during postnatal, immunisation and wellbeing visits by providing information on the effectiveness and side effects of different methods. Efforts to encourage postpartum contraception use should also target partner and religious leader engagement to address misconceptions and support women in rural areas or those with lower education levels to overcome barriers to uptake. Tailored strategies are needed, possibly incorporating mobile reminders to support women in Kitui County and similar settings in their choice to use contraception.
Vaginal microbiota plays a crucial role in maintaining women's health and reproductive wellbeing. It is affected by hormonal changes, sexual activity and overall health. Lactobacillus species are typically dominant and help maintain a low pH to prevent infections. This study's aim was to investigate antibiotic-resistant bacteria in the vaginal microbiota of women at a hospital in Bayelsa State, Nigeria. High vaginal swab samples were taken from 55 randomly sampled women of reproductive age at Niger Delta University Teaching Hospital in Okolobiri, Bayelsa State, Nigeria. The samples were analysed to identify bacteria and their susceptibility to antibiotics. Overall, 29.1% of isolates were Lactobacilli, with Staphylococcus aureus (20.0%), non-pathogenic staphylococci (23.6%), Gardnerella vaginalis (14.5%) and Escherichia coli (12.7%) also present. There were significant antibiotic resistance patterns, with Staph. aureus showing 100.00% resistance to Pefloxacin, Zinnacef, Amoxicillin, Rocephin and Streptomycin. G. vaginalis and E. coli also exhibited varied resistance profiles. Antibiotic-resistant bacteria can disrupt the balance of the vaginal microbiome, increasing susceptibility to infection, the risk of other infections, pregnancy complications and public health concerns. High resistance rates make treatment of common vaginal infections more challenging, potentially leading to persistent and recurrent infections. This study emphasises the need for careful antibiotic use and improved antimicrobial stewardship in reproductive healthcare. Clinicians should perform microbial culture and sensitivity testing before prescribing antibiotics for vaginal infections to ensure effective treatment. Healthcare professionals should also advocate for public education on hygiene, safe sex and the dangers of self-medicating with antibiotics.
Severe maternal outcomes refer to life-threatening obstetric complications that are near-fatal or result in maternal mortality. This systematic review and meta-analysis aimed to estimate the pooled magnitude of severe maternal outcomes and their predictors in Ethiopia. A comprehensive search of PubMed, CINAHL, Global Health, Global Index Medicine, Hinari and Google Scholar was conducted. Cross-sectional, case control and cohort studies carried out between 2000 and 2022 that explored severe maternal outcomes in Ethiopia were screened for inclusion. Selected studies were subject to quality appraisal and analysis. Heterogeneity was assessed via the I 2 test. Funnel plots and Egger's test were used to assess publication bias between studies. Significant predictors of severe maternal outcomes were assessed using odds ratios. Of the 222 articles identified, 13 were included in the review and meta-analysis. The pooled magnitude of severe maternal outcomes was 24%. The identified predictors for severe maternal outcomes were living in rural residences, experiencing a delay in receiving care and lack of attendance at antenatal care services. The pooled magnitude of severe maternal outcomes in Ethiopia was high, indicating a pressing need to address this rate. Healthcare professionals should consider the identified predictors of severe maternal outcomes when implementing interventions to reduce obstetric complications among women in Ethiopia. Policymakers should prioritise addressing severe maternal outcomes as part of current national public health agendas. The Ethiopian Federal Ministry of Health and other stakeholders should work toward reducing adverse maternal and perinatal outcomes to achieve sustainable development goals.
Despite attempts to reduce the incidence of maternal and child morbidity and mortality in Nigeria, rates are still high. The World Health Organization's Safe Childbirth Checklist is a tool for healthcare professionals to ensure they perform the necessary care that is known to reduce the risk of preventable maternal and newborn deaths, as well as improve the quality of maternal care and the overall birth experience. This study aimed to assess the use of the checklist, including how appropriate and adaptable it was, in tertiary hospitals of Ibadan, Nigeria. This mixed-methods study used an explanatory quantitative and qualitative approach. A total of 107 nurses and midwives working in the obstetric unit of two tertiary hospitals were assessed on their knowledge of the checklist using a structured questionnaire and observational checklist. A further 20 participated in a focus group discussion, with an interview guide, on the checklist's adaptability and appropriateness. Quantitative data were using descriptive statistics and the qualitative data were analysed thematically. Only 13.1% of participants were aware of the Safe Childbirth Checklist before training, with 54.2% deemed to have adequate knowledge of the tool's components. After training, it was found that the checklist had been used in 65.5% of births between January and March 2024, and completed adequately in 94.3% of these cases. The majority of participants described the tool as adaptable, attractive and readable, although there were some challenges to using it, including the time needed to complete it and the high workload. The World Health Organization's Safe Childbirth Checklist was found to be user-friendly and adaptable to practice in Ibadan, Nigeria. The study identified a clear gap in the use and correct application of the tool to practice. Implementation of the checklist promotes high-quality care, but is challenging when workloads are high and there are staff shortages. Healthcare professionals should be familiarised with the checklist's benefits and content before it is implemented to ensure they understand how to use it to complement existing practices and promote positive outcomes.
High rates of neonatal mortality have been recorded in Namibia, although efforts have seen these rates drop in recent years. The most common causes of neonatal mortality are birth asphyxia, prematurity, congenital abnormalities and neonatal sepsis. This study aimed to assess student nurse-midwives’ knowledge of risk factors associated with neonatal mortality in Namibia. This descriptive, cross-sectional study used a convenience sample of 78 undergraduate third-year student nurse-midwives. Data were collected through a structured self-administered questionnaire and analysed descriptively. Almost all of the participants (96.2%) demonstrated good or excellent knowledge of the risk factors associated with neonatal death. However, 23.1% did not recognise the correct definition of neonatal death. The third-year student nurse-midwives demonstrated good knowledge of the risk factors associated with neonatal death. However, there were gaps in their knowledge. Higher education institutions should provide more training and education incentives for student nurses to improve their knowledge. More simulation time would allow them to acquire additional knowledge. The Ministry of Health and Social Services should implement policies on registered nurses assisting with teaching during students’ practical allocations.
Background/Aims Both globally and in Nigeria, the incidence of caesarean section births has increased, prompting the need for in-depth investigation. This study's aim was to forecast the occurrence of caesarean section births in Osun, Nigeria, with a primary focus on examining contributing factors. Methods This retrospective cross-sectional study was conducted between February and December 2023, using questionnaires to collect data from 754 pregnant women who attended a teaching hospital in Osun, Nigeria and had a caesarean section. The Box-Jenkins method and predictive modelling were used to analyse the data. Results Neonatal mortality was higher among babies born to unbooked women compared to those born to booked women, meaning women who were registered during their pregnancy to have a caesarean section in case of an emergency. A notable prevalence of caesarean section births was observed in women who had previously had a caesarean section. The predictive models underscored that pre- and post-term pregnancies had notably higher probabilities of culminating in caesarean section. The 5-year forecast indicated that most future women who had caesarean sections would be 25–30 years old and have a gestational age 35–40 weeks, potentially influenced by previous caesarean sections. Conclusions Maternal age and gestational age can influence the likelihood of giving birth via caesarean section. The rate of caesarean sections is likely to continue to increase, meaning that government policies should be developed at national and sub-national levels to provide clear guidelines for caesarean sections. Implications for practice Healthcare professionals should actively promote early booking at antenatal care and consistent follow-up. Timely interventions and individualised birth planning may reduce risks associated with pre- and post-term pregnancies. There is an urgent need for standardised, context-sensitive caesarean section guidelines at both national and sub-national levels in Nigeria. With most future caesarean sections projected among women aged 25–30 years, reproductive health programmes should tailor educational and clinical interventions to address the unique needs and risk profiles of this age group.
Cervical cancer is the most common cancer among women in Tanzania, with the human papillomavirus vaccine being the primary prevention method. Although the vaccine is available for free in Tanzania, uptake remains low. The aim of this study was to assess the implementation of a human papillomavirus vaccine programme at secondary schools in Dar es Salaam, Tanzania. This descriptive qualitative study involved 16 purposively selected participants, including five health schoolteachers, nine healthcare professionals and two council representatives. In-depth interviews were used to collect data, which were recorded, transcribed and translated into English. Thematic analysis was used to explore the role of teachers, healthcare professional and council management in implementation of the vaccine programme. Teachers, healthcare professionals and council management each had distinct roles and responsibilities in relation to implementing the vaccine programme. However, some teachers and healthcare professionals lacked sufficient knowledge and training on the vaccine, and some private schools did not cooperate with the programme, which were barriers to widespread uptake of vaccinations. Teachers, healthcare professionals and council management play important roles in the human papillomavirus programme. However, a lack of awareness, insufficient training and reluctance among those at private schools are ongoing issues that require resolution. Implementation of vaccine programmes in schools should be scaled up. Challenges such as staff shortages, time constraints and limited space can hinder service delivery. Therefore, it is crucial to improve planning and allocate resources effectively. To ensure that girls return for their second dose, it is important to have clear referral and tracking systems established between schools and health facilities. Regular training and support for healthcare professionals, teachers and school staff are vital.
Caesarean section rates are increasing worldwide, which is concerning because of the associated adverse postoperative effects or complications. This study's aim was to assess third year nursing students’ knowledge of caesarean section and their practices. This cross-sectional descriptive study involved 60 third-year nursing students at the University of Namibia, selected using simple random sampling. Data were collected via self-administered questionnaires and analysed descriptively. All participants had witnessed a caesarean section during their course and had good knowledge on factors contributing to high rates of caesarean section. The participants showed good practices, such as obtaining consent, a good understanding of complications associated with caesarean section and were able to give proper health education to mothers. Most students were knowledgeable about caesarean section and factors contributing to high rates. Caesarean section rates could be reduced if obstetric protocols were implemented for antenatal care and interventions during labour. Initiatives such as educational discussions with student nurses on proper antenatal care screening are needed to identify avoidable factors that increase the rate of caesarean section. Further research is needed on factors linked with high rates of caesarean section.
The increasing burden of haemolytic disease of the newborn as a result of Rhesus incompatibility has raised global concern, prompting the need for targeted research to better understand pregnant women's knowledge. This study was carried out to assess knowledge, attitude and perceived dangers of Rhesus incompatibility among pregnant women attending primary healthcare centres in Ogun State, Nigeria. This cross-sectional, descriptive study used simple random sampling to select 366 pregnant women attending antenatal clinics at selected centres in Ogun State, Nigeria. Data were collected using a structured questionnaire and analysed descriptively. More than half of the participants were aware of their blood group (56.8%) and knew how to identify Rhesus positive and Rhesus negative antigens (50.5%). Overall, 61.4% of participants were classed as having good knowledge about Rhesus incompatibility. Almost all of the participants agreed that a Rhesus compatibility test is very important for pregnant women (92.9%), with over three-quarters agreeing that all women should have a maternal-fetal compatibility test, whether recommended or not (76.2%). Over half (56.0%) of the participants were classed as having a positive attitude. A large proportion of the participants had poor knowledge and a negative attitude regarding Rhesus incompatibility. More education and awareness is needed at antenatal clinics and marital counselling units to ensure women are aware of the risks of Rhesus incompatibility and the benefits of testing. Health talks on Rhesus incompatibility should be included in safe motherhood initiatives. The Nigerian government should subsidise the injection used to prevent postpartum issues in Rhesus negative women for affected pregnant mothers attending government hospitals.
Maternal mortality and morbidity remain significant concerns globally, particularly in sub-Saharan Africa where most maternal deaths occur during childbirth. Quality intrapartum care is crucial for enhancing maternal and newborn health outcomes. This review aimed to map, synthesise and summarise findings from existing literature regarding the quality of care during childbirth in sub-Saharan Africa. Arksey and O'Malley's scoping review framework was used to search and synthesise studies from Medline, CINAHL, PsycINFO and the Maternal-Infant Database. The narrative summary was based on themes derived from the Donabedian quality of care model. The review included 66 studies and identified aspects of structure, process and outcomes related to the quality of care. The structure included the availability of services, resources and infrastructure. The process encompassed service users’ experiences, disrespectful care, maternity care providers’ experiences and routine care management. The outcomes included satisfaction with care, service use and health outcomes. The quality of maternity care in sub-Saharan Africa varies, with deficiencies noted particularly in peripheral health facilities. Structural issues play a significant role in the identified quality of care challenges. To enhance maternal healthcare, stakeholders must develop comprehensive interventions addressing these interrelated issues. This review emphasises the need to improve intrapartum care in sub-Saharan Africa by enhancing healthcare infrastructure, ensuring access to essential resources and promoting respectful care and adherence to clinical protocols. Addressing rural-urban disparities, strengthening referral systems and carrying out regular audits are vital for reducing maternal and neonatal mortality and improving care quality.
Current models of maternity care often fall short of women's expectations for a safe, empowering and personalised birth experience. To improve maternal and newborn outcomes while respecting women's preferences, there is a growing need for innovative models, especially in low- and middle-income settings. This study explored the potential of a new model in Uasin Gishu County, Kenya. The model was designed using Appreciative Inquiry and Human Scale Development frameworks, based on data collected from 85 women, 32 midwives, four health service managers and three county health service managers. Data on their experiences of maternity care were gathered through focus group discussions and in-depth interviews. Data were analysed thematically, with the themes fed back to participants, whose responses guided formulation of the core components of the model. The UPENDO-S model was developed, focusing on the key themes of user-friendliness, person (woman)-focused care, excellence in evidence-based practice, networking, dedicated supported midwives, organised care and supportive leadership. In Swahili, upendo means ‘love’. The UPENDO-S model enhances maternal and neonatal health by providing compassionate, evidence-based and well-organised maternity care through user-friendliness, person-centred approaches, strong networking, dedicated midwives and supportive leadership. Implementing the UPENDO-S model in practice requires a holistic approach that prioritises compassionate, evidence-based maternity care. Strengthening midwife support and leadership, enhancing resource availability and fostering collaboration with communities and policymakers will improve maternal and neonatal outcomes.
Despite recommendations that pregnant women should give birth in hospitals or other healthcare institutions, some women give birth before they are able to access a healthcare facility. This study aimed to examine the prevalence and factors associated with giving birth before arriving at labour units in the Mohokare sub-district of the Free State Province in South Africa. This retrospective descriptive cross-sectional study used data from admissions, birth registers and maternity case records of women who gave birth before arriving at the labour facilities of the sub-district's two hospitals between April 2020 and March 2022. Data were collected using a self-administered audit tool and analysed using descriptive statistics. Overall, 18.0% of births took place before arrival at a labour facility. Most of these women had attended antenatal care (73.4%) at between 12 and 20 weeks (38.3%) and attended an average of three antenatal care visits during pregnancy. Most of the babies born before arrival weighed 2500–3500g (66.0%) and almost all were alive at the time of birth (96.8%). The proportion of babies born before arrival in the Mohokare sub-district was higher than the national average and warrants further research to guide the development of appropriate policies to reduce this rate. Health initiatives should focus on expanding coverage and care for pregnant women. Patient education and counselling on early antenatal booking are important for reducing adverse outcomes among babies born before arrival at a health facility. Further research should explore the context, organisation, conditions and other factors affecting the use of maternity waiting homes.
Clinical decision-making intervention tools have the potential to improve midwifery care and childbirth outcomes. Decision making is a key part of midwifery management and is taught to students during training, guiding them on problem solving and how to use critical thinking. Although students learn about clinical decision making, there is no tool to assess achievement of this skill. This study aimed to adapt the ‘enhancing decision-making assessment in midwifery’ tool for use among midwifery students in Malawi. This psychometric study adapted an existing tool and validated it for use among midwifery students in Malawi. Data collection was done in two phases between October 2020 and August 2023. Phase 1 involved 12 midwifery experts who measured the face and content validity of the 19 items on the original tool using a consensus agreement form. In phase 2, the adapted tool was sent to 101 qualified midwives from training colleges, clinical practice and decision-making bodies. These participants assessed the internal consistency (using Cronbach's alpha) and inter-rater reliability (using intraclass correlation) of the tool. All but two items in the original tool were rated as important for inclusion in the adapted tool. For the adapted tool, Cronbach's alpha was 0.93, signifying high internal consistency. There was very good inter-rater agreement with high intraclass correlations for the clinical reasoning (0.90) and midwifery practice sections (0.87). The adapted tool was found to be reliable and valid for use to evaluate clinical decision making among students in midwifery training colleges in order to improve midwifery care. The adapted tool may be used in assessing clinical decision making among qualified registered midwives. It may also be useful during in-service training of registered midwives to update their knowledge and skills.
