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Ferede, A. J., Gezie, L. D., Geda, B., Erlandsson, K. & Wettergren, L. (2024). Perceptions of caring behaviors: Experiences of nurses in Ethiopia. Nursing and Health Sciences, 26(1), Article ID e13096.
Open this publication in new window or tab >>Perceptions of caring behaviors: Experiences of nurses in Ethiopia
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2024 (English)In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 26, no 1, article id e13096Article in journal (Refereed) Published
Abstract [en]

Caring is a universal phenomenon that influences nurse-patient interactions and feelings, forming the foundation of the nursing profession. How nurses perceive and experience caring in low-income settings is not well understood. Therefore, the purpose of this study was to explore Ethiopian nurses' perceptions and experiences of caring using a qualitative descriptive design. Individual semi-structured interviews were conducted with 13 nurses aged 28-57. Interviews were analyzed inductively using reflexive thematic analysis guided by the recommendations of Braun and Clarke. The analysis resulted in three themes: caring is the heartbeat of patient care, constraints to the provision of care, and ways to overcome constraints. The results revealed that nurses were committed to fulfilling their professional obligations and meeting patients' needs despite experiencing multiple constraints. The findings provide a comprehensive perspective in understanding nurses' experiences of caring. Their narratives demonstrate that they face constraints in their clinical practice, which limit the quality of care, including rotation and lack of resources. Cooperation between health policymakers and nurse authorities is essential for shifting the clinical environment from the prevailing traditional task-oriented approach to patient-centered care.

Keywords
Ethiopia, caring, caring behaviors, nurses, reflexive thematic analysis
National Category
Nursing
Identifiers
urn:nbn:se:du-48070 (URN)10.1111/nhs.13096 (DOI)38369316 (PubMedID)
Available from: 2024-02-21 Created: 2024-02-21 Last updated: 2024-02-21Bibliographically approved
Erlandsson, K., Byrskog, U., Borneskog, C. & Pedersen, C. (2023). Bangladesh to take over the training of midwifery educators: A Commentary Paper. Journal of Asian Midwives, 10(1), 44-47
Open this publication in new window or tab >>Bangladesh to take over the training of midwifery educators: A Commentary Paper
2023 (English)In: Journal of Asian Midwives, ISSN 2409-2290, Vol. 10, no 1, p. 44-47Article in journal (Refereed) Published
Abstract [en]

While Bangladesh has made gains in maternal health provisions, there are still gaps and unmet need for services. Bangladesh has trained over 7 000 midwives, and many more midwifery educators are needed to serve the country’s population of 140 million with midwifery services. In April 2016 the first nursing faculty teaching midwifery students at nursing institutes across Bangladesh were enrolled in a blended online and onsite master’s programme with the Dalarna University, Sweden. The programme content focused the subject sexual, reproductive and perinatal health and was the first of its kind in Asia. The graduating faculty members were expected to be in a position to deliver higher quality education to the midwifery students (1, 2). To date, the team of teachers from Dalarna University has trained 150 midwifery educators (3). The current proposal from the University is that an equivalent to the Swedish Master's programme should be established in Bangladesh. While Bangladesh has made gains in education of midwives, there are still gaps and unmet need for educators with skills and knowledge in the subject of midwifery. During a period of transition, open seminars will be held at Dalarna University for all alumni who want to attend, with the hope on the part of the team of Dalarna university teachers being that they provide inspiration for high-quality midwifery education in Bangladesh. © 2023, South Asian Midwives Association (SAMA). All rights reserved.

Place, publisher, year, edition, pages
South Asian Midwives Association (SAMA), 2023
National Category
Nursing Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:du-47067 (URN)2-s2.0-85171660681 (Scopus ID)
Available from: 2023-10-02 Created: 2023-10-02 Last updated: 2023-10-03
Mekonnen, H. S., Lindgren, H., Geda, B., Azale, T. & Erlandsson, K. (2023). Being an Elderly Person Living in Metropolitan Cities of Northwestern Ethiopia: A Descriptive Phenomenological Study. Clinical Interventions in Aging, 18, 205-218
Open this publication in new window or tab >>Being an Elderly Person Living in Metropolitan Cities of Northwestern Ethiopia: A Descriptive Phenomenological Study
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2023 (English)In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 18, p. 205-218Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: As people grow old, they pass through various life courses. Thus, it is important to realize aging in the context of each of these stages, as aging is not only physiological and psychological processes. To understand the lifeworld experiences of the phenomenon "being an elderly person" from the individual perspective was important, in this study, within day-to-day life in Metropolitan cities of northwestern Ethiopia.

OBJECTIVE: The aim of this study was to describe the lifeworld of elderly persons living in Bahir Dar and Gondar Cities, Northwest Ethiopia.

METHODS: A community based qualitative study conducted from October 29, 2021 to November 6, 2021. A purposive sampling technique and in-depth interviews were used for sampling and data collection, respectively. To explore the life experience /life-world/ of the elderly, a descriptive phenomenological study was conducted among 15 elderly persons. The audio records were transcribed and the field notes incorporated. Transcribed texts were translated into the English language, and a descriptive phenomenological analysis was done.

RESULTS: In this study, the essence of the phenomenon, being an elderly person, means, in an ebb and flow motion, balancing a life change characterized by changing perspective, ambiguity to body functions, and preparing for being released. The elderly experienced physical, mental, and psychosocial changes. They had encountered positive and negative situations throughout their life span. They also expressed that their time was over and wished to prepare for God's Kingdom.

CONCLUSION: The use of phenomenology for this research provided an opportunity for a deeper understanding of the experiences of elderly persons. With knowledge from this study, nurses and other health professionals can understand and support the elderly from an individual point of view.

Keywords
Ethiopia, elderly person, lifeworld, phenomenology
National Category
Nursing
Identifiers
urn:nbn:se:du-45521 (URN)10.2147/CIA.S389305 (DOI)000964138000001 ()36814539 (PubMedID)2-s2.0-85148549597 (Scopus ID)
Available from: 2023-02-28 Created: 2023-02-28 Last updated: 2023-04-25Bibliographically approved
Bogren, M., Jha, P., Sharma, B. & Erlandsson, K. (2023). Contextual factors influencing the implementation of midwifery-led care units in India. Women and Birth, 36(1), e134-e141
Open this publication in new window or tab >>Contextual factors influencing the implementation of midwifery-led care units in India
2023 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 36, no 1, p. e134-e141Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The Government of India has committed to educate 90,000 midwives functioning in midwifery-led care units (MLCUs) to care for women during labour and birth. There is a need to consider local circumstances in India, as there is no 'one size fits all' prescription for MLCUs.

AIM: To explore contextual factors influencing the implementation of MLCUs across India.

METHOD: Data were collected through six focus group interviews with 16 nurses, midwives, public health experts and physicians, representing six national and international organisations supporting the Indian Government in its midwifery initiative. Transcribed interviews were analysed using content analysis.

FINDINGS: Four generic categories describe the contextual factors which influence the implementation of MLCUs in India: (i) Perceptions of the Nurse Practitioner in Midwifery and MLCUs and their acceptance, (ii) Reversing the medicalization of childbirth, (iii) Engagement with the community, and (iv) The need for legal frameworks and standards.

CONCLUSION: Based on the identified contextual factors in this study, we recommend that in India and other similar contexts the following should be in place when designing and implementing MLCUs: legal frameworks to enable midwives to provide full scope of practice in line with the midwifery philosophy and informed by global standards; pre- and in-service training to optimize interdisciplinary teamwork and the knowledge and skills required for the implementation of the midwifery philosophy; midwifery leadership acknowledged as key to the planning and implementation of midwifery-led care at the MLCUs; and a demand among women created through effective midwifery-led care and advocacy messages.

Keywords
Hospital setting, Implementation research, India, Low- and middle-income countries, Maternal and new-born health, Midwifery-led care
National Category
Nursing
Identifiers
urn:nbn:se:du-41671 (URN)10.1016/j.wombi.2022.05.006 (DOI)000923976000001 ()35641395 (PubMedID)2-s2.0-85131140838 (Scopus ID)
Available from: 2022-06-20 Created: 2022-06-20 Last updated: 2023-03-17Bibliographically approved
Kiragu, J. M., Osika Friberg, I., Erlandsson, K., Wells, M. B., Wagoro, M. C., Blomgren, J. & Lindgren, H. (2023). Costs and intermediate outcomes for the implementation of evidence-based practices of midwifery under a MIDWIZE framework in an urban health facility in Nairobi, Kenya. Sexual & Reproductive HealthCare, 37, Article ID 100893.
Open this publication in new window or tab >>Costs and intermediate outcomes for the implementation of evidence-based practices of midwifery under a MIDWIZE framework in an urban health facility in Nairobi, Kenya
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2023 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 37, article id 100893Article in journal (Refereed) Published
Abstract [en]

Background: Three evidence-based midwife-led care practices: dynamic birth positions (DBP), immediate skin-to-skin contact (SSC) with zero separation between mother and newborn, and delayed cord clamping (DCC), were implemented in four sub-Saharan African countries after an internet-based capacity building program for midwifery leadership in quality improvement (QI). Knowledge on costs of this QI initiative can inform resource mobilization for scale up and sustainability. Methods: We estimated the costs and intermediate outcomes from the implementation of the three evidence-based practices under the midwife-led care (MIDWIZE) framework in a single facility in Kenya through a pre- and post-test implementation design. Daily observations for the level of practice on DBP, SSC and DCC was done at baseline for 1 week and continued during the 11 weeks of the training intervention. Three cost scenarios from the health facility perspective included: scenario 1; staff participation time costs ($515 USD), scenario 2; staff participation time costs plus hired trainer time costs, training material and logistical costs ($1318 USD) and scenario 3; staff participation time costs plus total program costs for the head trainer as the QI leader from the capacity building midwifery program ($8548 USD). Results: At baseline, the level of DBP and SSC practices per the guidelines was at 0 % while that of DCC was at 80 %. After 11 weeks, we observed an adoption of DBP practice of 36 % (N = 111 births), SSC practice of 79 % (N = 241 births), and no change in DCC practice. Major cost driver(s) were midwives’ participation time costs (56 %) for scenario 1 (collaborative), trainers’ material and logistic costs (55 %) in scenario 2(collaborative) and capacity building program costs for the trainer (QI lead) (94 %) in scenario 3 (programmatic). Costs per intermediate outcome were $2.3 USD per birth and $0.5 USD per birth adopting DBP and SSC respectively in Scenario 1; $6.0 USD per birth adopting DBP and $1.4 USD per birth adopting SSC in Scenario 2; $38.5 USD per birth adopting DBP and $8.8 USD per birth adopting SSC in scenario 3. The average hourly wage of the facility midwife was $4.7 USD. Conclusion: Improving adoption of DBP and SSC practices can be done at reasonable facility costs under a collaborative MIDWIZE QI approach. In a programmatic approach, higher facility costs would be needed. This can inform resource mobilization for future QI in similar resource-constrained settings. © 2023

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Costs, Evidence-based, Intermediate outcomes, Midwife-led care, MIDWIZE, Quality improvement, Resource mobilization, adoption, article, capacity building, controlled study, delayed cord clamping, health care facility, human, Kenya, leadership, major clinical study, midwife, practice guideline, pretest posttest design, skin, total quality management, urban health
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:du-46829 (URN)10.1016/j.srhc.2023.100893 (DOI)001063116900001 ()37586305 (PubMedID)2-s2.0-85168236615 (Scopus ID)
Available from: 2023-08-28 Created: 2023-08-28 Last updated: 2023-10-03Bibliographically approved
Jha, P., Jha, V. K., Sharma, B., Jha, A., Erlandsson, K. & Bogren, M. (2023). Cultural adaptation and psychometric evaluation of Childbirth Experience Questionnaire 2 in Karnataka state, India. PLOS ONE, 18(11), Article ID e0291591.
Open this publication in new window or tab >>Cultural adaptation and psychometric evaluation of Childbirth Experience Questionnaire 2 in Karnataka state, India
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2023 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 18, no 11, article id e0291591Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Women's birthing experience is a sensitive indicator of the quality of childbirth care and can impact the physical and mental health of both women and their neonates. Negligible evidence exists on Indian women's birth experiences and-to the best of authors' knowledge-no questionnaire has been tested in India for measuring women's birthing experiences. This study aimed to test the construct validity and reliability of the Kannada-translated Revised Childbirth Experience Questionnaire.

METHODOLOGY: A cross-sectional survey was carried out among postnatal women (n = 251, up to six months postpartum, with a live healthy neonate) who had given birth at a public or private health facility using the Kannada-translated CEQ2 in two districts of Karnataka. Data were collected at participants' homes after seeking written informed consent. Model fit was determined by Confirmatory Factor Analyses.

RESULTS: The 4-factor model of the CEQ2 showed good fit after deletion of one item (item 8, subcategory "participation") with CMIN = 1.33; SRMR = 0.04; GFI = 0.92, CFI = 0.98, TLI = 0.99, RMSEA = 0.037 and p value 0.002). The Cronbach alpha values were acceptable for the four subscales (0.92, 0.93, 0.97, 0.91) as well as for the overall 21-item scale (0.84).

CONCLUSIONS: The Kannada-translated CEQ2 is a reliable tool to measure the childbirth experiences among Kannada-speaking women and can serve as a reliable ongoing evaluation of women's birth experiences.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:du-47435 (URN)10.1371/journal.pone.0291591 (DOI)38015907 (PubMedID)2-s2.0-85178498578 (Scopus ID)
Available from: 2023-12-05 Created: 2023-12-05 Last updated: 2023-12-11Bibliographically approved
Asaye, M. M., Gelaye, K. A., Matebe, Y. H., Lindgren, H. & Erlandsson, K. (2023). Effect of fetal malposition, primiparous, and premature rupture of membrane on Neonatal Near miss mediated by grade three meconium-stained amniotic fluids and duration of the active first stage of labor: Mediation analysis. PLOS ONE, 18(5), Article ID e0285280.
Open this publication in new window or tab >>Effect of fetal malposition, primiparous, and premature rupture of membrane on Neonatal Near miss mediated by grade three meconium-stained amniotic fluids and duration of the active first stage of labor: Mediation analysis
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2023 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 18, no 5, article id e0285280Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In many low-income countries, including Ethiopia, neonatal mortality remains a major concern. For every newborn that dies, many more neonates survived (near-miss neonates) the first 28 days after birth from life-threatening conditions. The generation of evidence on neonatal near-miss determinants could be a critical step in reducing neonatal mortality rates. However, studies causal pathway determinants are limited in Ethiopia. This study aimed to investigate the Neonatal Near-miss determinants in public health hospitals in Amhara Regional State, northwest Ethiopia.

METHOD: A cross-sectional study was conducted on 1277 mother-newborn pairs at six hospitals between July 2021 and January 2022. A validated interviewer-administered questionnaire and a review of medical records were used to collect data. Data were entered into Epi-Info version 7.1.2 and exported to STATA version 16 in California, America for analysis. The paths from exposure variables to Neonatal Near-Miss via mediators were examined using multiple logistic regression analysis. The adjusted odds ratio (AOR) and ß-coefficients were calculated and reported with a 95% confidence interval and a p-value of 0.05.

RESULTS: The proportion of neonatal near-misses was 28.6% (365/1277) (95% CI: 26-31%). Women who could not read and write (AOR = 1.67,95%CI:1.14-2.47), being primiparous (AOR = 2.48,95% CI:1.63-3.79), pregnancy-induced hypertension (AOR = 2.10,95% CI:1.49-2.95),being referred from other health facilities (AOR = 2.28,95% CI:1.88-3.29), premature rupture of membrane (AOR = 1.47,95% CI:1.09-1.98), and fetal malposition (AOR = 1.89,95% CI:1.14-3.16) were associated with Neonatal Near-miss. Grade III meconium stained amniotic fluid partially mediated the relationship between primiparous (ß = 0.517), fetal malposition (ß = 0.526), pregnant women referred from other health facilities (ß = 0.948) and Neonatal Near-Miss at P-value < 0.01. Duration of the active first stage of labour partially mediated the relationship between primiparous (ß = -0.345), fetal malposition (ß = -0.656), premature rupture of membranes (ß = -0.550) and Neonatal Near-Miss at P- value <0.01.It had also a significant indirect effect (ß = 0.581, P<0.001) on NNM with variables (primiparous, fetal malposition, and premature rupture of membranes).

CONCLUSIONS: The relationship between fetal malposition, primiparous, referred from other health facilities, premature rupture of membrane, and Neonatal Near miss were partially mediated by grade III meconium stained amniotic fluid and duration of the active first stage of labour. Early diagnosis of these potential danger signs and appropriate intervention could be of supreme importance in reducing NNM.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:du-46006 (URN)10.1371/journal.pone.0285280 (DOI)001022284200001 ()37146028 (PubMedID)2-s2.0-85157963435 (Scopus ID)
Available from: 2023-05-10 Created: 2023-05-10 Last updated: 2023-08-04Bibliographically approved
Asaye, M. M., Gelaye, K. A., Matebe, Y. H., Lindgren, H. & Erlandsson, K. (2023). Experience and perceptions of healthcare providers on clinical management and care of near-miss infants: a qualitative content analysis. BMC Health Services Research, 23(1), Article ID 1403.
Open this publication in new window or tab >>Experience and perceptions of healthcare providers on clinical management and care of near-miss infants: a qualitative content analysis
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2023 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 1403Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Neonatal Near Miss (NNM) refers to neonates with severe complications who almost died but survived immediately after birth. In Ethiopia, the prevalence of NNM has been assessed using a validated Neonatal Near-Miss Assessment Scale. However, understanding the experiences and perceptions of healthcare providers in the clinical management and care of NNM infants remains unexplored. The aim was to investigate the determinants contributing to the survival of neonatal near-miss babies and to identify any barriers encountered, as reported by the experiences of healthcare providers in public hospitals of Amhara Regional State, northwest Ethiopia.

METHODS: Semi structured interviews were used to collect data from 25 midwives, nurses, and pediatricians with at least six months of prior experience in one of the labor wards or neonatal intensive care units at one of the four public health hospitals in the Amhara Regional state of northwest Ethiopia included in a large intervention study assessing a NNM scale. Purposeful sampling was used, selecting participants based on their experiences related to the aim of this study. The participants had a varying level of education and years of experience to care for NNM infants. The average age of the healthcare providers was 31 years, with 7 years of work experience. The transcripts of the interviews with the healthcare providers were analyzed using qualitative content analysis.

RESULTS: The experience and perceptions of healthcare providers was described in the main category "A sense of hopelessness when caring for the baby" capturing a broader emotional and professional aspect, while the subcategories "Unclear responsibilities discharging one's mission", "Provision of kangaroo mother care" and "Quick action required at birth" are more specific and practical. Healthcare providers perceived a sense of hopelessness when caring for the NNM infant, particularly providing Kangaroo Mother Care (KMC) and quick actions when required at birth to save the life of the infant.

CONCLUSION: Unclear responsibilities and a sense of hopelessness could have acted as barriers, hindering the ability of healthcare providers to fulfill their mission of taking swift actions and providing KMC to NNM infants, thus impacting their ability to save the lives of these infants. Healthcare providers' and parents' attitudes must be changed towards hope rather than hopelessness when caring for NNM infants.

Keywords
Attitudes, Clinical care, Ethiopia, Experiences, Management, Midwives, Near Miss Infants, Perceptions, Qualitative content analysis
National Category
Nursing
Identifiers
urn:nbn:se:du-47536 (URN)10.1186/s12913-023-10097-3 (DOI)001124044300002 ()38093259 (PubMedID)2-s2.0-85179767516 (Scopus ID)
Available from: 2023-12-19 Created: 2023-12-19 Last updated: 2024-01-15Bibliographically approved
Sattar, S. M., Akeredolu, O., Bogren, M., Erlandsson, K. & Borneskog, C. (2023). Facilitators influencing midwives to leadership positions in policy, education and practice: A systematic integrative literature review.. Sexual & Reproductive HealthCare, 38, Article ID 100917.
Open this publication in new window or tab >>Facilitators influencing midwives to leadership positions in policy, education and practice: A systematic integrative literature review.
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2023 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 38, article id 100917Article in journal (Refereed) Published
Abstract [en]

The development of midwives as leaders is a crucial step towards achieving equality in sexual, reproductive, maternal, and neonatal health, Universal Health Coverage (UHC) and Sustainable Development Goals (SDG). However, many midwives work only to implement policies made by others rather than being drivers of policy changes. Little is known and researched about why midwives are not involved in decision and policymaking related to sexual, reproductive, maternal, and neonatal health. Hence, with a focus on midwifery leadership within the global community and the limited opportunities for women to hold leadership positions, this research explores the facilitators influencing midwives' opportunities to become leaders in policy development, education and practice. Inspired by Whittemore and Knafl, this integrative literature review was conducted after twenty-two relevant articles were identified through a search of the following databases: PubMed, CINAHL, and Scopus. Inductive content analysis was applied to analyze data. The result indicates that for midwives to become influential leaders, they must be active in strategic planning at the highest level. This inevitably effects how far midwives can act as agents for change, even if they possess the knowledge and skills for a leadership position. Policies and regulations influence how midwives' status in society is acknowledged and recognized. A clearly articulated educational pathway will enable their professional growth and expertise, making them knowledgeable and skillful as leaders. Enabling midwives to step into leadership positions at government level requires reforms which include midwives in decision-making. Excluding midwives from decision-making processes is detrimental to the goal of achieving universal health coverage. The first step is to provide midwives with a protected title, enabling them to work autonomously in an enabling environment with normal pregnancy and birth to achieve the SDG 2030 goals.

Keywords
Clinical leadership, Education leadership, Midwifery leadership, Policy leadership
National Category
Nursing Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:du-47068 (URN)10.1016/j.srhc.2023.100917 (DOI)001088533700001 ()37769484 (PubMedID)2-s2.0-85173019522 (Scopus ID)
Available from: 2023-10-03 Created: 2023-10-03 Last updated: 2023-11-16Bibliographically approved
Egal, J. A., Essa, A., Osman, F., Klingberg-Allvin, M. & Erlandsson, K. (2023). Facility-based maternal deaths: Their prevalence, causes and underlying circumstances. A mixed method study from the national referral hospital of Somaliland. Sexual & Reproductive HealthCare, 37, Article ID 100862.
Open this publication in new window or tab >>Facility-based maternal deaths: Their prevalence, causes and underlying circumstances. A mixed method study from the national referral hospital of Somaliland
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2023 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 37, article id 100862Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Somaliland has one of the highest rates of maternal deaths in the world. An estimated 732 women die for every 100,000 live births. This study aims to identify the prevalence of facility-based maternal deaths, the causes and their underlying circumstances by interviewing relatives and health care providers at the main referral hospital.

METHOD: A hospital-based mixed method study. The prospective cross-sectional design of the WHO Maternal Near Miss tool was combined with narrative interviews with 28 relatives and 28 health care providers in direct contact with maternal deaths. The quantitative data was analysed with descriptive statistics using SPSS and the qualitative part of the study was analysed with content analysis using NVivo.

RESULTS: From the 6658 women included 28 women died. The highest direct cause of maternal death was severe obstetric haemorrhage (46.4%), followed by hypertensive disorders (25%) and severe sepsis (10.7%). An indirect obstetric cause of death was medical complications (17.9%). Twenty-five per cent of these cases were admitted to ICU and 89% had referred themselves to the hospital for treatment. The qualitative data identifies two categories of missed opportunities that could have prevented these maternal mortalities: poor risk awareness in the community and inadequate interprofessional collaboration at the hospital.

CONCLUSION: The referral system needs to be strengthened utilizing Traditional Birth Attendants as community resource supporting the community facilities. The communication skills and interprofessional collaboration of the health care providers at the hospital needs to be addressed and a national maternal death surveillance system needs to be commenced.

Keywords
Low-income country, Maternal deaths, Maternal near miss, Mixed methods, Somaliland
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:du-46125 (URN)10.1016/j.srhc.2023.100862 (DOI)001013205700001 ()37269618 (PubMedID)2-s2.0-85165675469 (Scopus ID)
Available from: 2023-06-08 Created: 2023-06-08 Last updated: 2023-08-07Bibliographically approved
Projects
Överbrygga klyftor mellan retorik och verklighet i barnmorskeutbildning genom triangulering med alumner från Bangladesh, Somaliland och PuntlandBygga kapacitet bland östafrikanska ledare i barnmorskeledd vård- ett samarbete mellan Karolinska Institutet och Högskolan DalarnaStärkt integrering av barnmorskeprofessionen i hälso-och sjukvårdsystem i Södra Asien: Ett ledar-till-ledar samarbete mellan Sverige, Indien och NepalKvalitetssäkra barnmorskeutbildningen i BangladeshHållbarhet bortom kapacitetsuppbyggnadsprogram för barnmorskor - en modell som inkluderar ledarskap, mentorskap och kaskadutbildning av livräddande färdigheter
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-6910-7047

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