Rural Origin and Exposure Drives Ghanaian Midwives Reported Future Practice

A primary cause of Ghana’s higher than global average maternal mortality rate is limited access to maternal care in rural areas. To date, few studies have examined how rural background/training of midwives impacts their future willingness to work in remote areas. The purpose of this paper is to describe the relationship between Ghanaian student midwife place of origin and rural training on their willingness to choose a future rural practice location. A cross-sectional computer-based survey was completed by 238 final year Ghanaian midwifery students from two public midwifery training schools located in urban Ghana between October and December 2009. The relationship between rural exposure and willingness to work in rural Ghana was analyzed using independent t-test, chi-square, and bivariate logistic regression. Participants who experienced a rural rotation (OR: 1.51, 95% CI: 0.71, 3.22) and those born in a rural area (OR: 2.24, 95% CI: 0.74, 6.75) resulted in greater odds ratio to choose rural practice following graduation. This study indicates an association between midwifery students’ place of origin and training and their willingness to practice in a rural area after graduation. (Afr J Reprod Health 2014; 18[3]: 95-100)Keywords: Midwifery, Ghana, human resources for health, maldistribution, rural practice, rural incentive

Healthcare providers’ perspectives of disrespect and abuse in maternity care facilities in Nigeria: a qualitative study

Objectives To explore healthcare providers’ perspectives of disrespect and abuse in maternity care and the impact on women’s health and well-being. Methods Qualitative interpretive approach using in-depth semi-structured interviews with sixteen healthcare providers in two public health facilities in Nigeria. Interviews were audio-recorded, transcribed, and analysed thematically. Results Healthcare providers’ accounts revealed awareness of what respectful maternity care encompassed in accordance with the existing guidelines. They considered disrespectful and abusive practices perpetrated or witnessed as violation of human rights, while highlighting women’s expectations of care as the basis for subjectivity of experiences. They perceived some practices as well-intended to ensure safety of mother and baby. Views reflected underlying gender-related notions and societal perceptions of women being considered weaker than men. There was recognition about adverse effects of disrespect and abuse including its impact on women, babies, and providers’ job satisfaction. Conclusions Healthcare providers need training on how to incorporate elements of respectful maternity care into practice including skills for rapport building and counselling. Women and family members should be educated about right to respectful care empowering them to report disrespectful practices

Ghanaian midwifery students' perceptions and experiences of disrespect and abuse during childbirth

AbstractBackgroundOne strategy to reduce maternal and neonatal mortality in low-income and middle-income countries is to increase the rate of deliveries in health clinics and hospitals. However, reports of disrespect and abuse of women during birth are becoming common. When women are disrespected or abused during childbirth, they are less likely to choose facility-based births in the future. We did an exploratory qualitative study to investigate midwifery students' experiences and perceptions of how women are treated during labour and delivery.MethodsFinal year midwifery students (n=160) from Ghana's 16 public midwifery training colleges were invited to participate in a focus group at their institution. Students were asked to describe disrespect and abuse of women that they had observed, and about their definitions of respectful patient care and the consequences of disrespectful and abusive practices by health-care providers. Focus groups were conducted in English by the study team, tape recorded, and transcribed verbatim.FindingsStudent midwives reported that they had seen high levels of disrespect and abuse during their training. They discussed the consequences of disrespect and abuse and spoke of what respectful patient care meant to them; that is, treating every patient with respect, regardless of her background or ability to pay. While participants agreed that respectful care is important, they were also able to justify disrespectful or abusive practices they had witnessed or participated in themselves. For example, one student said, “the health of the child was at risk because of her attitude. To save the child, or to save the infant, she was being yelled at to push. To me, she understood the reasons why she was being yelled at to push because if not so, definitely it would have ended in a stillbirth.”InterpretationWhile student midwives understand the reasons why respectful care is important, they believe that there are instances where abusive behaviour is necessary to ensure both the woman and her child survive childbirth. Midwives in training could benefit from increased training on ways to communicate with and motivate women during labour and delivery.FundingThis project was funded by the African Studies Center, University of Michigan

The validity of the South African Triage Scale at a tertiary care centre, Kumasi, Ghana

IntroductionTriage is the process of sorting patients based on level of acuity to ensure the most severely injured and ill patients receive timely care before their condition worsens. The South African Triage Scale (SATS) was developed out of a need for an accurate and objective measure of urgency based on physiological parameters and clinical discriminators that is easily implemented in low resource settings. SATS was introduced in the Accident and Emergency Centre (AEC) of Komfo Anokye Teaching Hospital (KATH) in January 2010. This study seeks to evaluate the accurate use of the SATS by nurses at KATH.MethodsThis cross-sectional study was conducted in the AEC at KATH in Kumasi, Ghana. Patients 12 and over with complete triage information were included in this study. Each component of SATS was calculated (i.e. for heart rate of 41–50, a score of 1 was given) and summed. This score was compared to the original triage score. When scores did not equate, the entire triage record was reviewed by an emergency physician and an advanced practice emergency nurse separately to determine if the triage was appropriate. These reviews were compared and consensus reached.Results52 of 903 adult patients (5.8%) were judged to have been mis-triaged by expert review; 49 under-triaged (sent to a zone that corresponded to a lower acuity level than they should have been, based on their vital signs) and 3 over-triaged. Of the 49 patients who were under-triaged, 34 were under-triaged by one category and 7 by two categories.ConclusionWhile under-triage is a concern to patient care and safety, the under-triage rate of 5.7% in this sample falls within the 5–10% range considered unavoidable by the American College of Surgeons Committee on Trauma. SATS has been implemented successfully in the AEC at KATH by triage nurses