Parents as carers on a neonatal unit: Qualitative study of parental and staff perceptions in a low-income setting.

Aim To determine parents' experiences on a neonatal unit in a low-income country, how they and staff perceive the role of parents and if parents' role as primary carers could be extended. BACKGROUND: A busy, rural district hospital in Rwanda. Rwandan neonatal mortality is falling, but achieving Sustainable Development Goal target is hampered by trained staff shortage. METHODS: Qualitative thematic content analysis of semi-structured interviews with 12 parents and 16 staff. RESULTS: Parental concerns were around their baby's survival, stress and discharge. They were satisfied with their baby's care but feared their baby may die. Mothers described stress from remaining in hospital throughout baby's stay, providing all non-technical care including tube or breast feeds day and night, followed by kangaroo mother care until discharge. They expressed loneliness from lack of visitors, difficulty finding food and somewhere to sleep, financial worries, concern about family at home, and were desperate to be discharged. Staff focused on shortage of nurses limiting technical care, ability to educate parents and provide follow-up. Neither groups thought parents' role could be extended. CONCLUSION: Staff, including senior management, were mainly focused on increasing nursing numbers. Parents' concerns were psychosocial and about coping emotionally with their baby's care and practical concerns about inpatient facilities, particularly lack of food and accommodation and absence from home. Staff preoccupation with nurse numbers made them concentrate on medical care, but parental issues identified are more likely to be provided by experienced mothers, allied health professionals, mothers' groups or community health workers.

Using multi-country household surveys to understand who provides reproductive and maternal health services in low- and middle-income countries: a critical appraisal of the Demographic and Health Surveys.

OBJECTIVE: The Demographic and Health Surveys (DHS) are a vital data resource for cross-country comparative analyses. This study is part of a set of analyses assessing the types of providers being used for reproductive and maternal health care across 57 countries. Here, we examine some of the challenges encountered using DHS data for this purpose, present the provider classification we used, and provide recommendations to enable more detailed and accurate cross-country comparisons of healthcare provision. METHODS: We used the most recent DHS surveys between 2000 and 2012; 57 countries had data on family planning and delivery care providers and 47 countries had data on antenatal care. Every possible response option across the 57 countries was listed and categorised. We then developed a classification to group provider response options according to two key dimensions: clinical nature and profit motive. RESULTS: We classified the different types of maternal and reproductive healthcare providers, and the individuals providing care. Documented challenges encountered during this process were limitations inherent in household survey data based on respondents' self-report; conflation of response options in the questionnaire or at the data processing stage; category errors of the place vs. professional for delivery; inability to determine whether care received at home is from the public or private sector; a large number of negligible response options; inconsistencies in coding and analysis of data sets; and the use of inconsistent headings. CONCLUSIONS: To improve clarity, we recommend addressing issues such as conflation of response options, data on public vs. private provider, inconsistent coding and obtaining metadata. More systematic and standardised collection of data would aid international comparisons of progress towards improved financial protection, and allow us to better characterise the incentives and commercial nature of different providers.

Gender biases and discrimination: a review of health care interpersonal interactions.

A good interpersonal relationship between a patient and provider, as characterized by mutual respect, openness, and a balance in their respective roles in decision-making, is an important marker of quality of care. This review is undertaken from a gender and health equity perspective and illustrates that gender biases and discrimination occur at many levels in the healthcare delivery environment, and affects the patient-provider interaction which can result in health inequities affecting individual health seeking behaviour, access to good quality healthcare, and, ultimately, health outcomes. Interventions will have to be introduced at multiple levels, from health system legislation and policy and gender sensitive training to the development of women and men centred services and health literacy programmes.

Women's experiences of and preferences for services after rape in South Africa: interview study.

OBJECTIVES: To describe aspects of delivery of health services after rape, including trade-offs, that would most influence choice of service, and to compare views of patients who had used such services with views of members of the community who may be future users or may have experienced barriers to service use. DESIGN: Discrete choice analysis of stated preferences with interviews. Attributes included travel time to the service, availability of HIV prophylaxis, number of returns to the hospital, medical examination, and counselling skills and attitude of the provider. SETTING: One rural and one urban site in South Africa. PARTICIPANTS: 319 women: 155 who had been raped and four carers recruited through health facilities and 160 comparable women recruited from the community. Of these, 156 were from an urban site and 163 from a rural site. MAIN OUTCOME MEASURES: Strength of preferences over a range of attributes through the estimation of a benefit function through random effects probit modelling. RESULTS: Factors such as the availability of prophylactic treatment for HIV infection and having a sensitive healthcare provider who could provide counselling are more important in women's decisions to seek care after rape than the travel time necessary to access those services. CONCLUSION: Our findings support the need for holistic rape services.

Prevalence of emotional, physical and sexual abuse of women in three South African provinces.

INTRODUCTION: There is growing recognition in the ranks of the South African government that violence against women is a serious problem facing us all. Until now data on the epidemiology of violence against women in South Africa have been scanty. This report presents the findings of the first major community-based prevalence study. OBJECTIVES: To describe the prevalence of physical, sexual, financial, and emotional abuse of women. METHODS: A cross-sectional study conducted in the Eastern Cape (EC), Mpumalanga (MP) and the Northern Province (NP). The sample included one randomly selected woman aged 18-49 years living in each of 2,232 households. The sample was drawn using stratified, multistage, random methods, and 1,306 questionnaires were completed, giving a 90.3% response rate after adjusting for households without an eligible woman. RESULTS: The prevalences of ever having been physically abused by a current or ex-partner were 26.8% (EC), 28.4% (MP) and 19.1% (NP). The prevalences of abuse in the last year were 10.9% (EC), 11.9% (MP) and 4.5% (NP). The prevalences of rape were 4.5% (EC), 7.2% (MP) and 4.8% (NP). Considerable emotional and financial abuse was also reported, e.g. the prevalences of a partner having boasted about or brought home girlfriends in the previous year were 5.0% (EC), 10.4% (MP) and 7.0% (NP): The prevalences of physical abuse during a pregnancy were 9.1% (EC), 6.7% (MP) and 4.7% (NP). The proportions of abused women who were injured in the year before the survey were 34.5% (EC), 48.0% (MP) and 60.0% (NP). CONCLUSIONS: This study is the first large-scale, community-based prevalence study to be undertaken in South Africa.

Ethical and methodological issues in conducting research on gender-based violence in Southern Africa.

International experience of carrying out research on violence against women among women who may have experienced such violence and among men who may have been violent has raised a number of ethical issues, which appear in sharp focus. This paper is based on the collective experiences derived from involvement in three large gender-based violence surveys in South Africa and one in Zimbabwe. These are broadly concerned with the safety of researchers and research subjects from violence arising because of the research project, risks of traumatisation of both respondents and researchers as violent experiences are recounted; impact of work on violence as an issue in researchers' own relationships; risks of under-reporting the extent of violence experienced or perpetrated; and the need for research efforts to be followed up in ways beneficial to women experiencing violence, such as increased support, public information, and law and policy changes. This paper discusses how these issues have pertained and been addressed in research on gender-based violence in Southern Africa and consider lessons for this and other sensitive areas of reproductive and sexual health research.