Women are the thread: Keetoowah elders' experiences of becoming a mother.

Becoming a mother can simultaneously be a shared experience while having cultural distinctions. Indigenous motherhood, for example, has been heavily influenced by colonisation, medicalisation and Western imperialism. Historical and generational trauma has contributed to shifts in Indigenous practices surrounding becoming a mother and a disconnection from traditional birthing practices that has impacted maternal mental health. Nevertheless, recovering traditions can be beneficial for contemporary Indigenous mothers. This study utilised a culturally appropriate method, Story Inquiry. Using this approach, the paper coalesces community stories about a health challenge across time to better understand elders' experiences of becoming a mother in one Indigenous tribe, the United Keetoowah Band of Cherokee. The results of this inquiry illustrate the acute effects of colonialism and the historical trauma that resulted from it on Keetoowah experiences of Becoming a Mother and the cultural transmission of practices and beliefs surrounding maternal role transition. At the same time, it demonstrates the strategies that have shaped women's experiences of motherhood and made possible community persistence: especially the relationships between female kin within the Keetoowah tribe that have been integral to tribal resilience. Findings stress the value of healthcare approaches that include cultural traditions surrounding becoming a mother and more culturally informed perinatal care.

Compliance with focused antenatal care services: do health workers in rural Burkina Faso, Uganda and Tanzania perform all ANC procedures?

OBJECTIVE: To assess health workers' compliance with the procedures set in the focused antenatal care (ANC) guidelines in rural Uganda, Tanzania and Burkina Faso; to compare the compliance within and among the three study sites; and to appraise the logistic and supply of the respective health facilities (HF). METHODS: The cross-sectional study was conducted in the rural HF in three African countries. This descriptive observational study took place in HF in Nouna, Burkina Faso (5), Iganga, Uganda (6) and Rufiji, Tanzania (7). In total, 788 ANC sessions and service provisions were observed, the duration of each ANC service provision was calculated, and the infrastructures of the respective HF were assessed. RESULTS: Health workers in all HF performed most of the procedures but also omitted certain practices stipulated in the focused ANC guidelines. There was a substantial variation in provision of ANC services among HF within and among the country sites. The findings also revealed that the duration of first visits was <15 min and health workers spent even less time in subsequent visits in all three sites. Reagents for laboratory tests and drugs as outlined in the focus ANC guidelines were often out of stock in most facilities. CONCLUSION: Health workers in all three country sites failed to perform all procedures stipulated in the focused ANC guideline; this could not be always explained by the lack of supplies. It is crucial to point out the necessity of the core procedures of ANC repeatedly.

Antenatal care services in rural Uganda: missed opportunities for good-quality care.

Experience from countries that have achieved low maternal mortality suggests that access to good-quality maternity services is critical to improve maternal health. In this article we appraise the quality of antenatal care (ANC) services in a rural district of Uganda. We used a mixed methods approach, relying on a combination of semistructured interviews with both clients and providers, structured observations of provider-patient interactions, and infrastructure assessment of selected health facilities. We found several bottlenecks in health service delivery, including ineffective organization of educational sessions; selective omission of certain services; lack of explanation of important clinical and laboratory procedures; failure to link the performed procedures with preventive information; and occasional lack of respect for clients. The policy implications of these findings are discussed in relation to the need to (a) ensure an adequate supply of medical equipment and drugs, (b) enhance health workers' compliance with ANC guidelines, and (c) combine medical procedures with educational messages.

Assessing the Needs of Urban American Indians in North Texas: A Community-Based Participatory Research Project.

This article discusses a community-based participatory research project with university researchers, an urban inter-tribal center, and other community partners to develop, administer, and deliver a community needs assessment of an urban American Indian (AI) community. In the development process, community focus groups identified major domains of inquiry for a needs assessment survey: mental health and substance abuse, medical care, and social services, including cultural programming. Results are presented and discussed in each domain. Overall, this community needs assessment contributes to a better understanding of American Indian and Alaska Native (AI/AN) urban challenges by providing information about the AI/AN population in a large southwest metropolitan area. Specifically, it highlights the relevance of local and state contexts for understanding issues facing AI/AN populations. A growing body of research indicates that AI/AN populations demonstrate some similar challenges in terms of health, social service needs, and mental health and substance abuse needs due to shared histories of colonization and misguided or underfunded government programs, among other factors. It remains true that AI/AN communities nonetheless are each distinctive and face unique challenges and opportunities within the local, state, and regional contexts in which they reside. The process described in this paper will inform policy, practice, and research communities interested in understanding the unique realities of an urban community representing many different AI tribes.

Opt-out HIV testing during antenatal care: experiences of pregnant women in rural Uganda.

Two years after the introduction of provider-initiated, opt-out HIV counselling and testing during antenatal care (ANC) in Uganda, HIV testing uptake is still low. This study was carried out to explore pregnant women's experiences of, and views on, the policies for opt-out, and couple HIV testing, and to understand how the policy implementation could be improved in order to increase access to prevention of mother-to-child-transmission (PMTCT) services. The study was conducted at three ANC health facilities at different levels of care in rural eastern Uganda. Data were collected through sit-in observations during ANC and 18 semi-structured interviews with pregnant women receiving ANC, and thereafter analysed using latent content analysis. Pregnant women who received ANC from facilities that provided HIV testing on-site perceived HIV testing as compulsory without actually fully realizing the benefits of HIV testing and PMTCT. No referral for HIV testing or information about testing was given at ANC facilities that lacked HIV testing on-site. A major challenge of couple HIV testing was that pregnant women were made responsible for recruiting their spouses for testing, a precarious dilemma for many women who tried to fulfil health workers' requests without having the power to do so. In order to increase uptake of PMTCT services, the pre-test counselling in groups that precedes the provider-initiated HIV testing should be adjusted to inform women about the benefits of PMTCT. Further, if testing is perceived as compulsory it could potentially deter some women from seeking ANC services. In order to increase HIV testing of male partners new strategies are needed, for example peer-sensitization and male clinics. Moreover, to achieve the desired outcomes of the PMTCT programme, monitoring and evaluation should be built into the programme.

Living with a large reduction in permited loading by using a hydrograph-controlled release scheme.

The Total Maximum Daily Load (TMDL) for ammonia and biochemical oxygen demand for the Pee Dee, Waccamaw, and Atlantic Intracoastal Waterway system near Myrtle Beach, South Carolina, mandated a 60-percent reduction in point-source loading. For waters with a naturally low background dissolved-oxygen concentrations, South Carolina anti-degradation rules in the water-quality regulations allows a permitted discharger a reduction of dissolved oxygen of 0.1 milligrams per liter (mg/L). This is known as the "0.1 rule." Permitted dischargers within this region of the State operate under the "0.1 rule" and cannot cause a cumulative impact greater than 0.1 mg/L on dissolved-oxygen concentrations. For municipal water-reclamation facilities to serve the rapidly growing resort and retirement community near Myrtle Beach, a variable loading scheme was developed to allow dischargers to utilize increased assimilative capacity during higher streamflow conditions while still meeting the requirements of a recently established TMDL. As part of the TMDL development, an extensive real-time data-collection network was established in the lower Waccamaw and Pee Dee River watershed where continuous measurements of streamflow, water level, dissolved oxygen, temperature, and specific conductance are collected. In addition, the dynamic BRANCH/BLTM models were calibrated and validated to simulate the water quality and tidal dynamics of the system. The assimilative capacities for various streamflows were also analyzed. The variable-loading scheme established total loadings for three streamflow levels. Model simulations show the results from the additional loading to be less than a 0. 1 mg/L reduction in dissolved oxygen. As part of the loading scheme, the real-time network was redesigned to monitor streamflow entering the study area and water-quality conditions in the location of dissolved-oxygen "sags." The study reveals how one group of permit holders used a variable-loading scheme to implement restrictive permit limits without experiencing prohibitive capital expenditures or initiating a lengthy appeals process.