Maternity healthcare providers' self-perceptions of well-being during COVID-19: A survey in Tshwane Health District, South Africa

Background: Mental health manifestations such as depression and anxiety disorders became more marked during the coronavirus disease 2019 (COVID-19) pandemic as frontline healthcare workers struggled to maintain high-quality intrapartum care and essential health services. Aim: This study aimed to identify maternity healthcare providers' self-perceptions of changes in their feelings of mental well-being. Setting: Ten midwife obstetric units and the labour wards of four district hospitals in Tshwane Health District, South Africa. Methods: We conducted an anonymous, cross-sectional survey amongst a convenience sample of 114 maternity healthcare workers to gauge the changes in healthcare workers' experience and perceptions of well-being during the COVID-19 pandemic. Four items measured the perceived changes on a scale of 0­10 for the periods before and during COVID-19, respectively, namely feelings of fear or anxiety, stress, depression and anger. Results: The majority of participants were professional nurses (37%) and advanced midwives (47%). They reported a significant change in well-being from before the pandemic to during the pandemic with regard to all four items (p < 0.0001). The biggest 'before-during' difference was in perceptions of fear or anxiety and the smallest difference was in perceptions of anger. A framework was constructed from the open-ended responses to explain healthcare workers' understanding and perceptions of increased negative feelings regarding their mental well-being. Conclusion: The observed trends in the changes in healthcare workers' self-perceptions of their mental well-being highlight the need for further planning to build resilient frontline healthcare workers and provide them with ongoing mental health support and improved communication pathways.

Implementing the Family-Led Care model for preterm and low birth weight newborns in Malawi: experience of healthcare workers

Background: Every Preemie­SCALE developed and piloted the Family-Led Care model, an innovative, locally developed model of care for preterm and low birth weight babies receiving kangaroo mother care. Aim: The aim of this study was to describe healthcare workers' experience using Family-Led Care. Setting: This study was conducted in five health facilities and their catchment areas in Balaka district, Malawi. Methods: The mixed-methods design, with two data collection periods, included record reviews, observations and questionnaires for facility staff and qualitative interviews with health workers of these facilities and their catchment areas. The total convenience sample comprised 123 health professionals, support staff and non-professional community health workers. Results: Facility-based staff generally had positive perceptions of Family-Led Care (83%). Knowledge and application-of-knowledge scores were 69% and 52%, respectively. A major change between the first and the second data periods was improvement in client record-keeping. Documentation of newborn vital signs increased from 62% to 92%. Themes emerging from the qualitative interview analysis were the following: benefits of Family-Led Care; activities supporting the implementation of Family-Led Care; own care practices; and families' reaction to and experience of Family-Led Care. Conclusion: This article reports improved quality of care through better documentation and better follow-up of preterm and low birth weight babies receiving kangaroo mother care according to the Family-Led Care model. Overall, health workers were positive about their involvement, and they reported positive reactions from families. Lessons learned have been incorporated into a universal Family-Led Care package that is available for adaptation by other countries

CLEVER maternity care: a before-and-after study of women's experience of childbirth in Tshwane, South Africa

Background: Birthing care matters to women and some women experience mistreatment during childbirth. Aim: To determine the effect the 'CLEVER Maternity Care' package, a multi-faceted intervention to improve respectful, quality obstetric care. Setting: Ten midwife-led obstetric units in Tshwane health district, South Africa; five intervention and five control units. Methods: We conducted an anonymous baseline and end-line survey to measure the change in women's perceptions and experiences of childbirth care after the implementation of the CLEVER package. A convenience sample of women returning for a postnatal follow-up visit was obtained at baseline (n = 653) and after implementation of CLEVER (n = 679). Results: Six survey items were selected as proxies for respectful clinical care. There was no significant change in proportions of responses regarding one question, and with regard to patients receiving attention within 15 min of arrival, both the intervention and control group units showed a significant increase in positive responses (odds ratios of 8.4 and 6.1, respectively, and p values of 0.0001 and 0.0007). For the remaining four items (asking permission before doing an examination, positive communication, respectful treatment and overall satisfaction), only the intervention group showed a significant positive change (odds ratios ranging from 2.4 to 4.3; p ≤ 0.0018), with no significant change for the control group (odds ratios between 1.0 and 1.8; p ≥ 0.0736). Conclusion: After the implementation of CLEVER Maternity Care, women reported a more positive experience of childbirth. The CLEVER intervention is a potential strategy for addressing respectful, quality obstetric care that warrants further investigation

Medical education and the quality improvement spiral: a case study from Mpumalanga, South Africa

Background: The short timeframe of medical students' rotations is not always conducive to successful; in-depth quality-improvement projects requiring a more longitudinal approach.Aim: To describe the process of inducting students into a longitudinal quality-improvement project; using the topic of the Mother- and Baby-Friendly Initiative as a case study; and to explore the possible contribution of a quality-improvement project to the development of student competencies.Setting: Mpumalanga clinical learning centres; where University of Pretoria medical students did their district health rotations.Method: Consecutive student groups had to engage with a hospital's compliance with specific steps of the Ten Steps to Successful Breastfeeding that form the standards for the Mother- and Baby-Friendly Initiative. Primary data sources included an on-site PowerPoint group presentation (n = 42); a written group report (n = 42) and notes of individual interviews in an end-of-rotation objectively structured clinical examination station (n = 139). Results: Activities in each rotation varied according to the needs identified through the application of the quality-improvement cycle in consultation with the local health team. The development of student competencies is described according to the roles of a medical expert in the CanMEDS framework: collaborator; health advocate; scholar; communicator; manager and professional. The exposure to the real-life situation in South African public hospitals had a great influence on many students; who also acted as catalysts for transforming practice.Conclusion: Service learning and quality-improvement projects can be successfully integrated in one rotation and can contribute to the development of the different roles of a medical expert. More studies could provide insight into the potential of this approach in transforming institutions and student learning

Medical Student Participation in Community-based Experiential Learning: Reflections From First Exposure to Making the Diagnosis

Background: Fifth-year medical students from the University of Pretoria participated in a four-week rotation in the primary care clinics of a large metropolitan centre. An academic service-learning (ASL) approach was introduced into this rotation to improve the integration of theoretical learning and clinical practice through relevant community service and structured reflection.Methods: Students wrote semi-structured reflective journals as a means to gaining greater insight into their learning experiences. These reflections were analysed qualitatively with a view to improving the community-based curriculum.Results: Four major themes were identified: expectations and the reality of primary care; service and learning; becoming a doctor; and making a difference.Conclusion: While students gained a deeper insight into their development as clinicians; using an ASL approach also assisted the faculty in making an informed educational diagnosis of the curriculum