Outcomes of interventions in neonatal sepsis: A systematic review of qualitative research.

BACKGROUND: While a systematic review exists detailing neonatal sepsis outcomes from clinical trials, there remains an absence of a qualitative systematic review capturing the perspectives of key stakeholders. OBJECTIVES: Our aim is to identify outcomes from qualitative research on any intervention to prevent or improve the outcomes of neonatal sepsis that are important to parents, other family members, healthcare providers, policymakers, and researchers as a part of the development of a core outcome set (COS) for neonatal sepsis. SEARCH STRATEGY: A literature search was carried out using MEDLINE, EMBASE, CINAHL, and PsycInfo databases. SELECTION CRITERIA: Publications describing qualitative data relating to neonatal sepsis outcomes were included. DATA COLLECTION AND ANALYSIS: Drawing on the concepts of thematic synthesis, texts related to outcomes were coded and grouped. These outcomes were then mapped to the domain headings of an existing model. MAIN RESULTS: Out of 6777 records screened, six studies were included. Overall, 19 outcomes were extracted from the included studies. The most frequently reported outcomes were those in the domains related to parents, healthcare workers and individual organ systemas such as gastrointestinal system. The remaining outcomes were classified under the headings of general outcomes, miscellaneous outcomes, survival, and infection. CONCLUSIONS: The outcomes identified in this review are different from those reported in neonatal sepsis clinical trials, thus highlighting the importance of incorporating qualitative studies into COS development to encapsulate all relevant stakeholders' perspectives.

Protocol for the development of a core outcome set for neonatal sepsis (NESCOS).

Neonatal sepsis is a serious public health problem; however, there is substantial heterogeneity in the outcomes measured and reported in research evaluating the effectiveness of the treatments. Therefore, we aim to develop a Core Outcome Set (COS) for studies evaluating the effectiveness of treatments for neonatal sepsis. Since a systematic review of key outcomes from randomised trials of therapeutic interventions in neonatal sepsis was published recently, we will complement this with a qualitative systematic review of the key outcomes of neonatal sepsis identified by parents, other family members, parent representatives, healthcare providers, policymakers, and researchers. We will interpret the outcomes of both studies using a previously established framework. Stakeholders across three different groups i.e., (1) researchers, (2) healthcare providers, and (3) patients' parents/family members and parent representatives will rate the importance of the outcomes in an online Real-Time Delphi Survey. Afterwards, consensus meetings will be held to agree on the final COS through online discussions with key stakeholders. This COS is expected to minimize outcome heterogeneity in measurements and publications, improve comparability and synthesis, and decrease research waste.

An integrative literature review on the impact of COVID-19 on maternal and child health in Africa.

Africa has the highest rates of maternal deaths globally which have been linked to poorly functioning health care systems. The pandemic revealed already known weaknesses in the health systems in Africa, such as workforce shortages, lack of equipment and resources. The aim of this paper is to review the published literature on the impact of the COVID-19 pandemic on maternal and child health in Africa. The integrative review process delineated by Whittemore and Knafl (2005) was used to meet the study aims. The literature search of Ovid Medline, CINAHL, PubMed, WHO, Google and Google scholar, Africa journals online, MIDIRS was limited to publications between March 2020 and May 2022. All the studies went through the PRISMA stages, and 179 full text papers screened for eligibility, 36 papers met inclusion criteria. Of the studies, 6 were qualitative, 25 quantitative studies, and 5 mixed methods. Thematic analysis according to the methods of Braun and Clark (2006) were used to synthesize the data. From the search the six themes that emerged include: effects of lockdown measures, COVID concerns and psychological stress, reduced attendance at antenatal care, childhood vaccination, reduced facility-based births, and increase maternal and child mortality. A review of the literature revealed the following policy issues: The need for government to develop robust response mechanism to public health emergencies that negatively affect maternal and child health issues and devise health policies to mitigate negative effects of lockdown. In times of pandemic there is need to maintain special access for both antenatal care and child delivery services and limit a shift to use of untrained birth attendants to reduce maternal and neonatal deaths. These could be achieved by soliciting investments from various sectors to provide high-quality care that ensures sustainability to all layers of the population.

Parental experiences with changes in maternity care during the Covid-19 pandemic: A mixed-studies systematic review.

BACKGROUND: During the COVID-19 pandemic, pregnant women were identified as a high-risk and vulnerable group. To reduce risk of transmission, maternity healthcare services were modified to limit exposure but maintain services for pregnant women. However, the change in hospital practice may have compromised quality maternal care standards. Therefore, this review aims to explore parental experiences and views with maternity care received from healthcare institutions during the COVID-19 pandemic. METHODS: A mixed studies systematic review was conducted. Six electronic databases (Medline, CINAHL, Embase, PsycInfo, Web of Science, and Maternity and Infant Care) were searched for qualitative, observational, and mixed method studies from the year 2019 to February 2022. Study quality was appraised using the Mixed Methods Appraisal Tool. Quantitative findings were converted to narrative findings. Data was synthesised thematically using a convergent synthesis design. RESULTS: Fifty-eight articles were included. Four themes were generated: (1) Distress associated with COVID-19 regulations (perception of hospital restrictions, confusion with ever changing policies), (2) adaptability with maternity services (prenatal: changes in birth plans, prenatal: altered antenatal appointments, education, and care, intrapartum: medicalization of birth, postpartum: varied views on care received and Breastfeeding woes, postpartum: skin-to-skin contact and mother infant bonding) (3) importance of support persons, and (4) future direction for maternity services. CONCLUSIONS: Parental experiences highlighted how maternity care during the COVID-19 pandemic did not adhere to WHO standards of quality maternity care. This calls for healthcare institutions to continuously appraise the implementation of restrictive practices that deviate from evidence-based frameworks underpinning quality care.

Socio-economic factors associated with adolescent pregnancy and motherhood: Analysis of the 2017 Ghana maternal health survey.

BACKGROUND: Adolescent pregnancy and motherhood have been linked to several factors stemming from social, cultural and to a large extent economic issues. This study examined the socio-economic factors associated with adolescent pregnancy and motherhood in Ghana. DESIGN: This was a secondary analysis of the 2017 Ghana Maternal Health Survey, which was a nationally representative cross-sectional survey. Data from 4785 adolescents aged between 15-19 years were included in the analysis. Adolescent pregnancy was defined as adolescents who have ever been pregnant, whiles adolescent motherhood was defined as adolescents who have ever given birth. Weighted logistic regression was used to assess the association between the socio-economic variables and adolescent pregnancy and motherhood. RESULTS: Of the 25062 women aged between 15 and 49 years included in the 2017 maternal health survey, 4785 (19.1%) were adolescents between 15-19 years. Adolescent pregnancy was reported in 14.6% (CI:13.2% -16.1%) of the respondents, whereas 11.8% (CI: 10.5% -13.1%) of the respondents had ever given birth. In the multivariate regression analysis, zone (p<0.001), wealth index (p<0.001), age (p<0.001), marital status (p<0.001) and level of education (p<0.001) were all significantly associated with adolescent pregnancy and motherhood. The odds of pregnancy and motherhood were significantly higher in the Middle and Coastal zones (p<0.001), and among older adolescents (p<0.001). However, the odds of pregnancy and motherhood was significantly lower among adolescents from households with the highest wealth index (p<0.001), among those who were never married (p<0.001) and among adolescents who had secondary/higher education (p<0.001). CONCLUSION: Several socio-economic variables including education, household wealth, marital status and zone of residence were significantly associated with adolescent pregnancy and adolescent motherhood. Sexual and reproductive health education should be intensified among these populations. Adolescent friendly corners should be made available and accessible to all adolescents in Ghana irrespective of where they live or their age.

Midwives' views of traditional birth attendants within formal healthcare in Nigeria.

BACKGROUND: Discourses around the journey to motherhood in many poorly-resourced countries, particularly in the sub-Saharan African region, with no link to death and danger are limited. The custodians of traditional practices - the traditional birth attendants - are often blamed for the high maternal deaths in this region. Conventional institutional and international thinking about traditional birth attendants is that they are dangerous and therefore should no longer be allowed to practice. AIM: To explore midwives' views of traditional birth attendants' place within formal healthcare settings in Nigeria. METHODS: Hermeneutic phenomenological and poststructural feminist approaches were used. Seven midwives volunteered for semi-structured individual face to face interviews. FINDINGS: The responses of the midwives were diverse and conflicting. Some midwives believe that the traditional birth attendants should be banned, arguing that they are responsible for low uptake of hospital-based maternity care by women which in turn leads to an increase in maternal deaths. Contrastingly, other midwives expressed a view that the traditional birth attendants 'cannot be phased out' due to their valid contributions, particularly in the rural areas where access to formal maternity care is limited by intractable structural problems. CONCLUSION: Policy makers need to reconsider the role of traditional birth attendants. This should involve not only their integration into formal healthcare to work alongside formally trained maternity care providers, but also fostering a healthcare atmosphere where respect and recognition of each practitioner's skill is paramount.

Unilateral collaboration: The practices and understandings of traditional birth attendants in southeastern Nigeria.

BACKGROUND: Despite the promotion of hospital-based maternity care as the safest option, for less developed countries, many women particularly those in the rural areas continue to patronise indigenous midwives or traditional birth attendants. Little is known about traditional birth attendants' perspectives regarding their pregnancy and birth practices. AIM: To explore traditional birth attendants' discourses of their pregnancy and birthing practices in southeast Nigeria. METHOD: Hermeneutic phenomenology guided by poststructural feminism was the methodological approach. Individual face to face semi-structured interviews were conducted with five traditional birth attendants following consent. FINDINGS: Participants' narratives of their pregnancy and birth practices are organised into two main themes namely: 'knowing differently,' and 'making a difference.' Their responses demonstrate evidence of expertise in sustaining normal birth, safe practice including hygiene, identifying deviation from the normal, willingness to refer women to hospital when required, and appropriate use of both traditional and western medicines. Inexpensive, culturally sensitive, and compassionate care were the attributes that differentiate traditional birth attendants' services from hospital-based maternity care. CONCLUSION: The participants provided a counter-narrative to the official position in Nigeria about the space they occupy. They responded in ways that depict them as committed champions of normal birth with ability to offer comprehensive care in accordance with the individual needs of women, and respect for cultural norms. Professional midwives are therefore challenged to review their ways of practice. Emphasis should be placed on what formal healthcare providers and traditional birth attendants can learn from each other.

Safe motherhood initiative: what is next?

When in 1987, the Safe motherhood initiative was launched, the aim was to reduce global maternal mortality by half by the year 2000. However this goal was not achieved and consequently the 5th Millennium Development Goal (MDG-5) was dedicated to maternal health which aimed at a three quarters reduction of maternal mortality by 2015. The international figures indicate that 287,000 women continue to die from complications relating to pregnancy and childbirth, mostly in poorly-resourced countries. As 2015 draws closer and with MDG-5 lagging behind, there is increased tension amongst those concerned about poor maternal health because of missed targets and a fear that it has slipped off policy agenda. The need to refocus discussion in this area becomes ever more vital. This article aims to do just that.

Group marking and peer assessment during a group poster presentation: the experiences and views of midwifery students.

Traditionally, written examination and clinical practice assessments are the main ways of deeming midwifery students fit and competent for practice. Contemporary academics in an effort to engage the students in the learning process have employed alternative teaching and assessment strategies. Among the alternative strategies are group projects after which members of the group are awarded the same grade, and peer assessment. With the purpose of informing the midwifery curricular, we utilised a qualitative descriptive approach to explore midwifery students' experiences and views on the use of group poster presentation for learning and assessment. The participants consisted of a purposive sample of 14 higher diploma midwifery students who were registered in a third level institution in Ireland. Semi-structured individual interviews were conducted following the completion of the poster presentation assessment. Permission to undertake the study was obtained from the college ethics committee. In this paper, we focus on the participants' views of group marking and peer assessment which are among the key elements that emerged in this study. While awarding a group mark was overall accepted, peer assessment proved a more contentious issue. Most of the participants found it challenging marking their friends. Reactions to group marks were very much influenced by the group dynamics.