'God is the one who give child': An abductive analysis of barriers to postnatal care using the Health Equity Implementation Framework.

Background: Postnatal care is recommended as a means of preventing maternal mortality during the postpartum period, but many women in low- and middle-income countries (LMICs) do not access care during this period. We set out to examine sociocultural preferences that have been portrayed as barriers to care. Methods: We performed an abductive analysis of 63 semi-structured interviews with women who had recently given birth in three regions of Ethiopia using the Health Equity Implementation Framework (HEIF) and an inductive-deductive codebook to understand why women in Ethiopia do not use recommended postnatal care. Results: We found that, in many cases, health providers do not consider women's cultural safety a primary need, but rather as a barrier to care. However, women's perceived refusal to participate in postnatal visits was, for many, an expression of agency and asserting their needs for cultural safety. Trial registration: n/a. Conclusions: We propose adding cultural safety to HEIF as a process outcome, so that implementers consider cultural needs in a dynamic manner that does not ask patients to choose between meeting their cultural needs and receiving necessary health care during the postnatal period.

"Even though they insult us, the delivery they give us is the greatest thing": a qualitative study contextualizing women's experiences with facility-based maternal health care in Ethiopia.

BACKGROUND: Globally, amidst increased utilization of facility-based maternal care services, there is continued need to better understand women's experience of care in places of birth. Quantitative surveys may not sufficiently characterize satisfaction with maternal healthcare (MHC) in local context, limiting their interpretation and applicability. The purpose of this study is to untangle how contextual and cultural expectations shape women's care experience and what women mean by satisfaction in two Ethiopian regions. METHODS: Health center and hospital childbirth care registries were used to identify and interview 41 women who had delivered a live newborn within a six-month period. We used a semi-structured interview guide informed by the Donabedian framework to elicit women's experiences with MHC and delivery, any prior delivery experiences, and recommendations to improve MHC. We used an inductive analytical approach to compare and contrast MHC processes, experiences, and satisfaction. RESULTS: Maternal and newborn survival and safety were central to women's descriptions of their MHC experiences. Women nearly exclusively described healthy and safe deliveries with healthy outcomes as 'satisfactory'. The texture behind this 'satisfaction', however, was shaped by what mothers bring to their delivery experiences, creating expectations from events including past births, experiences with antenatal care, and social and community influences. Secondary to the absence of adverse outcomes, health provider's interpersonal behaviors (e.g., supportive communication and behavioral demonstrations of commitment to their births) and the facility's amenities (e.g., bathing, cleaning, water, coffee, etc) enhanced women's experiences. Finally, at the social and community levels, we found that family support and material resources may significantly buffer against negative experiences and facilitate women's overall satisfaction, even in the context of poor-quality facilities and limited resources. CONCLUSION: Our findings highlight the importance of understanding contextual factors including past experiences, expectations, and social support that influence perceived quality of MHC and the agency a woman has to negotiate her care experience. Our finding that newborn and maternal survival primarily drove women's satisfaction suggests that quantitative assessments conducted shortly following delivery may be overly influenced by these outcomes and not fully capture the complexity of women's care experience.

Provider perspectives on emotional health care for adults with type 2 diabetes mellitus in the Dominican Republic.

The emotional burden of type 2 diabetes mellitus (T2D) can complicate self-management. Exploring the feasibility of mental and physical health co-management in limited-resourced settings is needed. Thus, we assessed providers' awareness of the emotional burden their patients experience and their roles in supporting their patients with T2D. We conducted a formative qualitative study using in-depth interviews with 14 providers, including physicians, nurses, and community health workers recruited at two rural health clinics in the Dominican Republic. We coded transcripts using inductive and deductive codes and developed themes through iterative comparative analysis. All providers recognized that patients experience an emotional burden managing life with T2D. Some providers viewed the provision of emotional support as integral to their role and believed that they could do so. Others viewed it as the responsibility of the family or expressed the need for additional guidance on how to provide emotional support. Providers also identified several barriers to integrating emotional support into routine clinical care including personality characteristics, lack of training, and insufficient staffing. While providers recognize the need for emotional support, they identified individual, clinical, and systems-level barriers. Strategies to address these barriers include training specific providers on emotional support provision, balancing workload, and building or strengthening referral systems.

Foliar mineral content of five shrub species with nutritional potential for small ruminants in semiarid regions in northeastern Mexico / Conteúdo mineral foliar de cinco espécies de arbustos com potencial nutricional para pequenos ruminantes em regiões semiáridas do nordeste do México

ABSTRACT: This study was conducted to determine the monthly composition of the minerals Ca, P, K, Mg, Cu, Fe, Mn and Zn in five shrub species that are consumed by small ruminants in the semi-arid regions of northeastern Mexico. Leaves samples of shrub species; Celtis pallida, Croton suaveolens, Forestiera angustifolia, Guaiacum angustifolium and Parkinsonia aculeata were randomly collected during twelve consecutive months from July 2018 to June 2019 in two sites, located in Linares and Los Ramones counties, in the state of Nuevo Leon, Mexico. Mineral content was analyzed using an atomic absorption spectrophotometer, while phosphorus was measured by the colorimetry method. The Linares county showed the highest content of macro- and micro-minerals. Among species, C. pallida showed the highest values of macro-minerals and P. aculeata content of micro-minerals was highest. Ca (total mean = 40.0 g kg-1 DM), K (15.4 g kg-1), Mg (3.7 g kg-1), Fe (87.2 mg kg-1), Mn (35.5 mg kg-1) were available in adequate quantities, while P (1.3 g kg-1 DM), Cu (6.4 mg kg-1) and Zn (17.7 mg kg-1) were found deficient. Shrub species in this study can be considered as a good source of Ca, K, Mg, Fe and Mn except in C. suaveolens. However, P, Cu and Zn must be supplemented.

RESUMO: O presente estudo foi realizado com o intuito de determinar os teores dos minerais Ca, P, K, Mg, Cu, Fe, Mn e Zn, ao longo do ano, em cinco espécies de arbustos consumidas por pequenos ruminantes nas regiões semiáridas do nordeste do México. Amostras de folhas de espécies arbustivas; Celtis pallida, Croton suaveolens, Forestiera angustifolia, Guaiacum angustifolium e Parkinsonia aculeata foram coletadas aleatoriamente durante doze meses consecutivos, de Julho de 2018 a Junho de 2019, em dois locais, nos municípios de Linares e Los Ramones, no estado de Nuevo Leon, México. O conteúdo mineral foi analisado através de um espectrofotômetro de absorção atômica, enquanto o fósforo foi medido pelo método da colorimetria. O município de Linares apresentou o maior conteúdo de macro e microminerais. Entre as espécies, C. pallida apresentou os maiores valores de macrominerais, enquanto o teor de microminerais foi maior na P. aculeata. Ca (média = 40.0 g kg-1 MS), K (15.4 g kg-1), Mg (3.7 g kg-1), Fe (87.2 mg kg-1), Mn (35.5 mg kg-1) estavam disponíveis em quantidades adequadas, enquanto P (1.3 g kg-1 MS), Cu (6.4 mg kg-1) e Zn (17.7 mg kg-1) foram encontrados deficientes. As espécies arbustivas deste estudo podem ser consideradas uma boa fonte de Ca, K, Mg, Fe e Mn, exceto na espécie C. suaveolens. No entanto, P, Cu e Zn devem ser suplementados.

Classification and ordination of main plant communities along an altitudinal gradient in the arid and temperate climates of northeastern Mexico.

Quantitative data on the ecology of the main plant communities along an altitudinal gradient in northeastern Mexico were obtained with the aim of identifying the most important environmental variables that affect plant distribution and composition. The main threats to these communities were also investigated. Importance value index (IVi) of the 39 most important species and 16 environmental variables were recorded at 35 altitudinal gradients each spaced at intervals of at least 100-m altitude. Classification and ordination of vegetation showed six well-differentiated but overlapping plant communities: alpine meadow, cold conifer forest, mesic mixed forest, xeric scrub, Tamaulipan piedmont scrub, and halophytic grassland. Altitude, minimum and average temperatures, and organic matter content are the main variables affecting the plant distribution in northeastern Mexico. Urban growth, mechanized agriculture, and changes in land use are the main threats in the short and medium term to plant communities in this area. Climate change also seems to be having an impact at present or in the near future as shown by the presence of exotic shrubs from warmer areas in mesic and temperate areas inhabited by oak and oak-pine forest.