An Inclusive Framework for Collaboration between Midwives and Traditional Birth Attendants and Optimising Maternal and Child Healthcare in Restricted Rural Communities in South Africa: Policy Considerations.

Collaboration between midwives and traditional birth attendants for maternal and child healthcare is a challenge in rural South African communities due to the absence of a guiding framework. To address this, this study sought to develop and validate an inclusive framework informed by the Donabedian structure-process-outcome (SPO) framework for collaboration between these healthcare professionals. METHOD: Key stakeholders were invited to participate in a co-creation workshop to develop the framework. Twenty (20) participants were purposively sampled based on their maternal and child healthcare expertise. A consensus design using the nominal group technique was followed. RESULTS: Participants identified the components needed in the framework, encompassing (i) objectives, (ii) structures, (iii) processes, and (iv) outcomes. CONCLUSION: This paper will contribute to the development of an inclusive healthcare framework, providing insights for stakeholders, policymakers, and practitioners seeking to improve maternal and child healthcare outcomes in resource-constrained, rural settings. Ultimately, the proposed framework will create a sustainable and culturally sensitive model that optimises the strengths of midwives and TBAs and fosters improved healthcare delivery to rural South African communities.

Knowledge and attitudes of midwives towards collaboration with traditional birth attendants for maternal and neonatal healthcare services in rural communities in South Africa.

OBJECTIVES: We assessed the knowledge and attitude of registered midwives towards collaborating with traditional birth attendants for maternal and neonatal healthcare services in rural communities. DESIGN: A descriptive cross-sectional survey was followed in this study. PARTICIPANTS: Registered midwives in selected clinics in the City of Tshwane Municipality. Participants were recruited by stratified random sampling. Data was collected at the Thirty-four primary healthcare facilities in Gauteng province, South Africa. MEASUREMENT AND RESULTS: A self-assessment questionnaire was administered to 304 registered midwives. Two-hundred and sixty respondents returned the questionnaire representing a response rate of 86.6 % which was statistically significant. The majority of Midwives in South Africa displayed a low level of knowledge (mean = 41.8, SD=1.7) on the role and practices of traditional birth attendants). Only 30.8 % (n = 80) of midwives knew of the roles of traditional birth attendants for maternal and neonatal healthcare (MNH) services. With respect to knowledge, there was significant associated with the Professional category (p < 0.015). In terms of attitude, registered midwives displayed negative attitudes towards collaborating with traditional birth attendants (mean = 46.8, SD=2.1). Approximately half (54.2 %, n = 140) of midwives were amenable towards collaborating in the provision of antenatal care, and 70.4 % (n = 183) of midwives agreed to collaborate with traditional birth attendants for extended roles such as accompanying women to health facilities. Association of demographic data and level of attitude showed there was significant relationship (p < 0.05) between registered midwives' level of education and their attitude towards collaboration. KEY CONCLUSIONS: Midwives demonstrated positive attitude towards collaborating with traditional birth attendants at the antenatal care level only. Midwives were not amenable to collaboration at the level of intrapartum and postpartum care. IMPLICATIONS FOR PRACTICE: Based on our results, collaboration should be at antenatal care level to allow for early detection, treatment, and prevention of antenatal complications thus reducing maternal mortality and morbidity.

The training of midwives to perform obstetric ultrasound scan in Africa for task shifting and extension of scope of practice: a scoping review.

INTRODUCTION: Ultrasound scan is one of the essential assessments that is crucial in the early identification of health risks during antenatal care. Its accessibility to women in low-and middle-income countries remains a serious challenge because ultrasound scans are not within the scope of practice for midwives. However, task shifting and extension of scope of practice aim to train midwives to assess pregnant women through an ultrasound scan. This paper aims to report the findings of a scoping review on the training of midwives to perform obstetric ultrasound scans in Africa. METHODS: The 6-step iterative framework for scoping reviews by Arksey and O'Malley was used to determine the extent of qualitative and quantitative evidence available on the training of midwives on obstetric ultrasound scans, which includes specifying the research question, identifying relevant studies, selecting studies, extracting and charting data, collating, summarising, and synthesising and reporting findings. RESULTS: A total of 12 articles from eight African countries were included in this scoping review. Three main themes and 13 sub-themes emerged and they are: obstetric ultrasound scan training, challenges experienced by midwives from task shifting and extension of scope of practice regarding obstetric ultrasound scan, and the value of task shifting and extension of scope of practice regarding obstetric ultrasound scan to midwives. DISCUSSION: Despite the available evidence that the training of midwives on obstetric ultrasound scans is essential to ensure the accessibility of quality antenatal health services, the training of midwives on obstetric ultrasound scans in some African countries remains a serious challenge. It is evident from this scoping review results that there is a need for African countries to incorporate obstetric ultrasound scans as part of the scope of practice of midwives. Task shifting necessitates prioritising the training of midwives on the use of obstetric ultrasound scans as one of the steps towards the achievement of the United Nations Sustainable Development Goal number 3 targets by 2030.

Ubuntu as an Instrument to Foster Holistic Nursing: The Views of South African Student Nurses.

Introduction: Ubuntu is an African philosophy that reflects holistic and comprehensive care among people in the community. Holistic nursing is a philosophy of caring that focuses on holistic healing and humanism. The purpose of the study was to explore the views of the South African final-year student nurses on the ability of Ubuntu to foster holistic nursing. Methods: An exploratory descriptive qualitative method was used. Eight focus group interviews were conducted with final-year student nurses at selected universities. Colaizzi seven steps process of data analysis was utilized. Results: One of the themes that emerged was that Ubuntu can be an instrument to foster holistic nursing Ubuntu and holistic nursing share many common attributes, hence, the teaching and learning of Ubuntu could foster the type of caring embodied by holistic nursing. Discussion: Ubuntu represents an important care philosophy that can foster holistic nursing, especially when the inner driving force of the nurses is primarily to care for patients.

Household Factors of Foodborne Diarrhea in Children under Five in Two Districts of Maputo, Mozambique.

Household factors involved in the disease of diarrhea are multifaceted. This study aimed to explore and describe the household factors affecting foodborne diarrhea in children younger than 5 years old using structured questionnaire data based on quantitative tools. The sample size was calculated based on a binomial distribution. A total of 300 children, together with their caregivers, participated, and the data were descriptively and mathematically analyzed using Epi Info modelling. The caregivers were mostly female and included 93.3% rural and 84% urban dwellers of ages between 18 and 38, who were single but living with someone. Of the children who were under six months of age, 23.3% in rural areas and 16.6% in urban areas had diarrhea, while of the children between 12 and 23 months of age, 36.6% in urban areas and 30% in rural areas had diarrhea. The relatives had similar symptoms before the child became ill, with 12.6% of relatives in rural areas and 13.3% in urban areas reporting this. Before receiving medical assistance, 51.3% of children in rural areas and 16% of children in urban areas were treated with traditional medication. Water was not treated before drinking in 48% of rural cases and 45.3% of urban cases. A total of 24.6% of infants in urban areas and 12.6% of infants in rural areas used a bottle for feeding. The factors affecting foodborne diarrhea were the use of traditional medication in rural areas, bottle feeding in urban areas and untreated water used for drinking in both areas.

Indigenous beliefs and practices that influence the delayed attendance of antenatal clinics by women in the Bohlabelo district in Limpopo, South Africa.

OBJECTIVE: To explore and describe the indigenous beliefs and practices that influence the attendance of antenatal clinics by women in the Bohlabelo district in Limpopo, South Africa RESEARCH DESIGN AND METHODS: A qualitative design was used to enable participants to share their beliefs and practices in their own words. Purposive sampling was used. SETTING: Women who were attending antenatal clinics for the first time were targeted. Data were collected via unstructured in-depth interviews. Twelve women were interviewed. FINDINGS: The findings were grouped into six main categories: pregnancy is a honour; pregnancy needs to be preserved; the unborn infant is protected; the knowledge that clients have; trust in indigenous perinatal practices; and perceptions regarding clinic or hospital services. It became clear that the indigenous beliefs and practices of pregnant women have an influence on their attendance of antenatal clinics. For example, factors such as fear of bewitchment cause delayed attendance of antenatal clinics. Women use herbs to preserve and protect their unborn infants from harm. They also trust the knowledge of traditional birth attendants, and prefer their care and expertise to the harsh treatment that they receive from midwives in hospitals and clinics who look down on their indigenous beliefs and practices. CONCLUSIONS: It is recommended that indigenous beliefs and practices should be incorporated into the midwifery curriculum, so that the health sector is able to meet the needs of all members of the community.

Tradition meets technology: building caring community online.

Community has historically provided an essential psycho-spiritual framework for nursing. Changes in communication technology pose challenges for nurses internationally who create communities across borders. This article discusses The Bamboo Bridge online community, a project responding to the global call for nursing education about the complementarity of nursing and healing traditions. The project explores how technologies such as Centra and Ning promote community building and encourage belonging in members from 5 continents and 10 countries. This article includes detailed accounts of the project design, examples of cultural diplomacy as the emerging theoretical framework, and an African member's perspective of online community.