Tande nou gwonde! (Hear us roar!)- Youth perspectives of maternal near-misses: Protocol for a photovoice study of young childbearing people's perspectives of maternal near-misses in northwest Haiti.

INTRODUCTION: Globally, a shift is occurring to recognize the importance of young peoples' health and well-being, their unique health challenges, and the potential they hold as key drivers of change in their communities. In Haiti, one of the four leading causes of death for those 20-24 years old is pregnancy, childbirth, and the weeks after birth or at the end of a pregnancy. Important gaps remain in existing knowledge about youth perspectives of maternal health and well-being within their communities. Youth with lived experiences of maternal near-misses are well-positioned to contribute to the understanding of maternal health in their communities and their potential role in bringing about change. OBJECTIVES: To explore and understand youth perspectives of maternal near-miss experiences that occurred in a local healthcare facility or at home in rural Haiti. METHODS: We will conduct a qualitative, community-based participatory research study regarding maternal near-miss experiences to understand current challenges and identify solutions to improve community maternal health, specifically focused on youth maternal health. We will use Photovoice to seek an understanding of the lived experiences of youth maternal near-miss survivors. Participants will be from La Pointe, a Haitian community served by their local healthcare facility. We will undertake purposeful sampling to recruit approximately 20 female youth, aged 15-24 years. Data will be generated through photos, individual interviews and small group discussions (grouped by setting of near-miss experience). Data generation and analysis are expected to occur over a three-month period. ETHICS AND DISSEMINATION: Ethics approval will be sought from Centre Médical Béraca in La Pointe, Haiti, and from the Hamilton Integrated Research Ethics Board in Hamilton ON, Canada. We will involve community stakeholders, especially youth, in developing dissemination and knowledge mobilisation strategies. Our findings will be disseminated as an open access publication, be presented publicly, at conferences, and defended as part of a doctoral thesis.

Community level youth-led interventions to improve maternal-neonatal outcomes in low- and middle-income countries: A systematic review of randomised trials.

Background: Evidence on the effectiveness of youth-led interventions for improving maternal-neonatal health and well-being of women and gender diverse childbearing people in low-income and middle-income countries (LMICs) is incomplete. We aimed to summarise the evidence on whether community level youth-led interventions can improve maternal and neonatal outcomes in LMICs. Methods: We included experimental studies of youth-led interventions versus no intervention, standard care, or another intervention. Participants were women and gender diverse childbearing people during antepartum, intrapartum, and postpartum periods. MEDLINE, Embase, CINAHL, Global Health, Web of Science, and Cochrane Library, and grey literature were searched to January 2023. All interventions addressing and targeting maternal-neonatal health and well-being that were youth-led and community level were included. Primary outcomes of interest were maternal death and neonatal death. We excluded based on population, intervention, comparison, and outcome (PICO) and design. Two reviewers independently extracted key information from each included study and assessed risk of bias. Random-effects meta-analysis was performed where there were sufficient data. The certainty of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). A narrative synthesis was done for results that could not be pooled. Results: Of the 8054 records retrieved, four trials (21 813 enrolled participants) met the inclusion criteria. The Cooperative for Assistance and Relieve Everywhere, Inc. (CARE) Community Score Card intervention compared to standard reproductive health services control did not significantly improve Antenatal Care coverage (difference-in-differences estimate ß = 0.04; 95% confidence interval (CI) = -0.11, 0.18, P = 0.610; one study, low certainty of evidence). The multi-component social mobilisation interventions compared to standard of care had no effect on adolescent/youth pregnancy (adjusted odds ratio estimate = 1.08; 95% CI = 0.87, 1.33; three studies; low certainty of evidence). Conclusions: Youth-led interventions in LMICs did not show a significant improvement in maternal outcomes. More studies are required to make more precise conclusions. Registration: PROSPERO: CRD42021288798.

Decolonization in Sexual and Reproductive Health Research Methods: Protocol for a Scoping Review.

BACKGROUND: As researchers and implementors begin to acknowledge the repercussions of institutionalized colonialism on community and individual health, the need to decolonize research has become clear. Despite this, there is neither a singular definition of decolonizing methodologies nor an overview of the shared principles and characteristics of decolonized research needed to codify this work as common practice in global health. OBJECTIVE: The review will identify papers that reference principles of decolonization and identify shared characteristics between them. The aim of this scoping review is to review decolonized research methodologies through the lens of sexual health as a step in creating a shared understanding of best practices. We will further examine the tools and methods used to collect and analyze data within the included studies. METHODS: The protocol for this scoping review was developed using the framework from the Joanna Briggs Institute and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). The search strategy will comprise a search of electronic databases (JSTOR, Embase, EMCare, MEDLINE [Ovid], Global Health Database, Web of Science), gray literature sources, and key studies. Titles and abstracts will be reviewed by 2 or more independent reviewers against inclusion criteria. Bibliometric details, study design, methodology, community involvement, and other indicators will be collected using a data extraction tool developed for this review. Extracted data will be analyzed using descriptive statistics and qualitative analysis of content and themes to identify common practices in decolonized methodologies within sexual health. Narrative summaries will be used to describe results in relation to the research question, and identified gaps will be discussed. RESULTS: The initial title or abstract review of 4967 studies identified by the search strategy was completed in November 2022. In total, 1777 studies met initial inclusion criteria and were sent to a second round of title or abstract review, which was completed in January 2023. In total, 706 studies were downloaded for full-text inclusion, which is expected to be completed by April 2023. We aim to complete data extraction and analysis by May 2023 and expect to publish the findings by the end of July 2023. CONCLUSIONS: There remains a gap in the research on the meaning and application of decolonized research strategies, particularly within sexual and reproductive health. The findings of this study will contribute to a shared definition of decolonized methodologies and how they can be applied as a common practice in global health research. Applications include the development of decolonized frameworks, theoretical discourses, and methodologies. The study will inform the design and implementation of future decolonized research and evaluation strategies, particularly around sexual and reproductive health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/45771.

Community Level Youth-Led Interventions to Improve Maternal-Neonatal Outcomes in Low- and Middle-Income Countries: Protocol for a Systematic Review.

Introduction: On a global scale, women and childbearing people and neonates continue to die from preventable causes related to pregnancy or childbirth. Sustained and accelerated efforts are critical to improve maternal and neonatal health and well-being. Globally, youth are a growing population and have strength in their numbers. Youth are critical, key drivers of change in their communities. Young people hold the potential to affect positive change, and their meaningful engagement is important to improving maternal health and well-being in low- and middle-income countries. Objectives: To assess the effects of community level youth-led interventions for improving maternal-neonatal health and well-being compared with no interventions or another intervention. Methods: We will undertake a literature search that is comprehensive, complete, and exhaustive. This will include databases such as MEDLINE, EMBASE, and the Cochrane Library, as well as a grey literature search. In our systematic review, we will include experimental studies evaluating maternal-neonatal health and well-being associated with or because of the implementation of community level youth-led interventions. Participants will include women and childbearing people (of any age) during antepartum, intrapartum, and postpartum periods (up to 42 days postpartum). We will examine all interventions addressing and targeting maternal-neonatal health and well-being that are youth-led and community-based and aimed at the members of the community. Our comparators will be no intervention or another intervention. Our primary outcomes are maternal deaths and neonatal deaths. Our review will include only studies in low- and middle-income countries conducted in urban or rural areas. Ethics and Dissemination. Ethics approval is not required as we will use secondary data that is publicly available. There are no active participants in our study. We will involve key stakeholders and experts in maternal-neonatal health regarding dissemination and knowledge mobilization strategies. Our findings will be disseminated as an open access publication, be presented publicly, and defended as part of a doctoral thesis. This trial is registered with CRD42021288798.

The effect of a new maternity unit on maternal outcomes in rural Haiti: an interrupted time series study.

BACKGROUND: In Haiti where there are high rates of maternal and neonatal mortality, efforts to reduce mortality and improve maternal newborn child health (MNCH) must be tracked and monitored to measure their success. At a rural Haitian hospital, local surveillance efforts allowed for the capture of MNCH indicators. In March 2018, a new stand-alone maternity unit was opened, with increased staff, personnel, and physical space. We aimed to determine if the new maternity unit brought about improvements in maternal and neonatal outcomes. METHODS: We conducted an interrupted time series analysis using data collected between July 2016 and October 2019 including 20 months before the opening of the maternity unit and 20 months after. We examined maternal-neonatal outcomes such as physiological (vaginal) births, caesarean birth, postpartum hemorrhage (PPH), maternal deaths, stillbirths and undesirable outcomes (eclampsia, PPH, perineal laceration, postpartum infection, maternal death or stillbirth). RESULTS: Immediately after the opening of the new maternity, the number of physiological births decreased by 7.0% (ß = - 0.070; 95% CI: - 0.110 to - 0.029; p = 0.001) and there was an increase of 6.7% in caesarean births (ß = 0.067; 95% CI: 0.026 to 0.107; p = 0.002). For all undesirable outcomes, preintervention there was an increasing trend of 1.8% (ß = 0.018; 95% CI: 0.013 to 0.024; p < 0.001), an immediate 14.4% decrease after the intervention (ß = - 0.144; 95% CI: - 0.255 to - 0.033; p = 0.012), and a decreasing trend of 1.8% through the postintervention period (ß = - 0.018; 95% CI: - 0.026 to - 0.009; p < 0.001). No other significant level or trend changes were noted. CONCLUSIONS: The new maternity unit led to an upward trend in caesarean births yet an overall reduction in all undesirable maternal and neonatal outcomes. The new maternity unit at this rural Haitian hospital positively impacted and improved maternal and neonatal outcomes.

More pilot trials could plan to use qualitative data: a meta-epidemiological study.

BACKGROUND: Pilot trials often use quantitative data such as recruitment rate and retention rate to inform the design and feasibility of a larger trial. However, qualitative data such as patient, healthcare provider, and research staff perceptions of an intervention may also provide insights for a larger trial. METHODS: As part of a larger study investigating the reporting of progression criteria in pilot studies, we sought to determine how often pilot studies planned to use qualitative data to inform the design and feasibility of a larger trial and the factors associated with plans to use qualitative data. We searched for protocols of pilot studies of randomized trials in PubMed between 2013 and 2017. RESULTS: We included 227 articles. Only 92 (40.5%; 95% confidence interval [CI] 34.1-47.2) reported plans to collect qualitative data. The factors associated with collecting qualitative data were large studies (defined as sample size ≥ 60; adjusted odds ratio [aOR] 2.77; 95% CI 1.47-5.23; p = 0.002) and studies from Europe (aOR 3.86; 95% CI 1.68-8.88; p = 0.001) compared to North America and the rest of the world. Pilot trials with pharmacological interventions were less likely to plan to collect qualitative data (aOR 0.20; 95% CI 0.07-0.58; p = 0.003). CONCLUSIONS: Qualitative data is not used enough in pilot trials. Large pilot trials, pilot trials from Europe, and pilot trials of non-pharmacological interventions are more likely to plan for qualitative data.

The fourth delay and community-driven solutions to reduce maternal mortality in rural Haiti: a community-based action research study.

BACKGROUND: In Haiti, the number of women dying in pregnancy, during childbirth and the weeks after giving birth remains unacceptably high. The objective of this research was to explore determinants of maternal mortality in rural Haiti through Community-Based Action Research (CBAR), guided by the delays that lead to maternal death. This paper focuses on socioecological determinants of maternal mortality from the perspectives of women of near-miss maternal experiences and community members, and their solutions to reduce maternal mortality in their community. METHODS: The study draws on five semi-structured Individual Interviews with women survivors of near-misses, and on four Focus Group Discussions with Community Leaders and with Traditional Birth Attendants. Data collection took place in July 2013. A Community Research Team within a resource-limited rural community in Haiti undertook the research. The methods and analysis process were guided by participatory research and CBAR. RESULTS: Participants identified three delays that lead to maternal death but also described a fourth delay with respect to community responsibility for maternal mortality. They included women being carried from the community to a healthcare facility as a special example of the fourth delay. Women survivors of near-miss maternal experiences and community leaders suggested solutions to reduce maternal death that centered on prevention and community infrastructure. Most of the strategies for action were related to the fourth delay and include: community mobilization by way of the formation of Neighbourhood Maternal Health/Well-being Committees, and community support through the provision/sharing of food for undernourished women, offering monetary support and establishment of a communication relay/transport system in times of crisis. CONCLUSIONS: Finding sustainable ways to reduce maternal mortality requires a community-based/centred and community-driven comprehensive approach to maternal health/well-being. This includes engagement of community members that is dependent upon community knowledge, political will, mobilization, accountability and empowerment. An engaged/empowered community is one that is well placed to find ways that work in their community to reduce the fourth delay and in turn, maternal death. Potentially, community ownership of challenges and solutions can lead to more sustainable improvements in maternal health/well-being in Haiti.