Aim: Encouraging women to deliver in facility settings is one strategy to improve maternal and neonatal outcomes in the developing world. However, in much of sub-Saharan Africa, fewer than half of pregnant women deliv...Aim: Encouraging women to deliver in facility settings is one strategy to improve maternal and neonatal outcomes in the developing world. However, in much of sub-Saharan Africa, fewer than half of pregnant women deliver in health facilities. Fear of maltreatment during labor and delivery has been shown to be one barrier to facility delivery, yet previous studies have focused solely on reports from women, rarely seeking insights from practicing midwives. Method: All seven practicing midwives from a rural hospital in Ghana and ten pregnant women seeking antenatal care from the same hospital were recruited to participate in in-depth interviews regarding their perceptions of care during labor and delivery. A semi-structured interview tool and qualitative field interviewing approach were utilized. All interviews were audio taped, transcribed, and analyzed using NVivo 9.0. Results: Respondents described situations that precipitate abuse during facility deliveries, yet not all abuse was seen as acceptable. Two overarching themes emerged: 1) The interaction between midwives and their patients is analogous to a mother/daughter relationship, including both a knowledge imbalance and the need for disciplinary action when necessary;and 2) Midwives feel a strong sense of responsibility for the delivery outcomes and as a result, they will do whatever it takes to deliver a live baby to a healthy mother. Hitting, yelling, and neglecting women were reported as common occurrences in the labor and delivery ward. However, each was undertaken to encourage women to do what was needed to deliver safely. Conclusion: These findings suggest that the issue of patient maltreatment in low-resource labor and delivery settings is complex and may be undertaken in what is perceived to be the laboring woman’s best interest. The exploration of alternative strategies to facilitate labor and delivery is warranted, as well as the provision of adequate support and resources for practicing midwives in rural settings.展开更多
Background:Dog bites are common in developing countries including Ghana,with the victims often being children.Although some breeds of dogs have been identified as being more aggressive than others,all dog bites carry ...Background:Dog bites are common in developing countries including Ghana,with the victims often being children.Although some breeds of dogs have been identified as being more aggressive than others,all dog bites carry a risk of infection.Immediate and initial assessment of the risk for tetanus and rabies infection with appropriate interventions such as wound management and subsequent selection of prophylactic antibiotics are essential in the management of dog bites.This study examined the management of patients with dog bites by frontline service providers at primary healthcare facilities in the Greater Accra Region,Ghana.Methods:We conducted a cross-sectional study in 66 public health facilities in the Greater Accra Region from July 2014 to April 2015.Up to four frontline service providers were randomly selected to participate from each facility.A structured questionnaire was administered to all consenting participants.Continuous variables were presented as means and standard deviations.The frontline service providers’knowledge was assessed as a discrete variable and values obtained presented as percentages and proportions.The chi-square test of proportions was used to determine any significant associations between the various categories of the frontline service providers and their knowledge about the management of rabies.Results:Regarding the frontline service providers’knowledge about rabies,57.8%(134/232)were correct in that the rabies virus is the causative agent of rabies,39.2%(91/232)attributed it to a dog bite,2.6%(6/232)did not know the cause,and one person(0.4%)attributed it to the herpes virus.Only 15.5%(36/232)knew the incubation period in dogs and the period required to observe for signs of a rabies infection.With respect to the administration of rabies immunoglobulin,42.2%(98/232)of the frontline service providers did not know how to administer it.Of the facilities visited,76%(50/66)did not have the rabies vaccines and 44%(102/232)of frontline service providers did not know where to get the rabies vaccines from.Most of the service providers(87.9%;204/232)had never reported either a dog bite or a suspected case of rabies.Overall,there was gross underreporting of dog bites and suspected rabies cases at public healthcare facilities in the Greater Accra Region of Ghana.Conclusions:In view of the high morbidity and mortality associated with bites from rabid dogs and the poor knowledge and practices of frontline service providers,there is an urgent need for capacity-building such as training in the management of dog bites and subsequent potential rabies infection.展开更多
文摘Aim: Encouraging women to deliver in facility settings is one strategy to improve maternal and neonatal outcomes in the developing world. However, in much of sub-Saharan Africa, fewer than half of pregnant women deliver in health facilities. Fear of maltreatment during labor and delivery has been shown to be one barrier to facility delivery, yet previous studies have focused solely on reports from women, rarely seeking insights from practicing midwives. Method: All seven practicing midwives from a rural hospital in Ghana and ten pregnant women seeking antenatal care from the same hospital were recruited to participate in in-depth interviews regarding their perceptions of care during labor and delivery. A semi-structured interview tool and qualitative field interviewing approach were utilized. All interviews were audio taped, transcribed, and analyzed using NVivo 9.0. Results: Respondents described situations that precipitate abuse during facility deliveries, yet not all abuse was seen as acceptable. Two overarching themes emerged: 1) The interaction between midwives and their patients is analogous to a mother/daughter relationship, including both a knowledge imbalance and the need for disciplinary action when necessary;and 2) Midwives feel a strong sense of responsibility for the delivery outcomes and as a result, they will do whatever it takes to deliver a live baby to a healthy mother. Hitting, yelling, and neglecting women were reported as common occurrences in the labor and delivery ward. However, each was undertaken to encourage women to do what was needed to deliver safely. Conclusion: These findings suggest that the issue of patient maltreatment in low-resource labor and delivery settings is complex and may be undertaken in what is perceived to be the laboring woman’s best interest. The exploration of alternative strategies to facilitate labor and delivery is warranted, as well as the provision of adequate support and resources for practicing midwives in rural settings.
基金The study was funded by University of Ghana’s Office of Research,Innovation and Development.URF/7/ILG-037/2013–2014.
文摘Background:Dog bites are common in developing countries including Ghana,with the victims often being children.Although some breeds of dogs have been identified as being more aggressive than others,all dog bites carry a risk of infection.Immediate and initial assessment of the risk for tetanus and rabies infection with appropriate interventions such as wound management and subsequent selection of prophylactic antibiotics are essential in the management of dog bites.This study examined the management of patients with dog bites by frontline service providers at primary healthcare facilities in the Greater Accra Region,Ghana.Methods:We conducted a cross-sectional study in 66 public health facilities in the Greater Accra Region from July 2014 to April 2015.Up to four frontline service providers were randomly selected to participate from each facility.A structured questionnaire was administered to all consenting participants.Continuous variables were presented as means and standard deviations.The frontline service providers’knowledge was assessed as a discrete variable and values obtained presented as percentages and proportions.The chi-square test of proportions was used to determine any significant associations between the various categories of the frontline service providers and their knowledge about the management of rabies.Results:Regarding the frontline service providers’knowledge about rabies,57.8%(134/232)were correct in that the rabies virus is the causative agent of rabies,39.2%(91/232)attributed it to a dog bite,2.6%(6/232)did not know the cause,and one person(0.4%)attributed it to the herpes virus.Only 15.5%(36/232)knew the incubation period in dogs and the period required to observe for signs of a rabies infection.With respect to the administration of rabies immunoglobulin,42.2%(98/232)of the frontline service providers did not know how to administer it.Of the facilities visited,76%(50/66)did not have the rabies vaccines and 44%(102/232)of frontline service providers did not know where to get the rabies vaccines from.Most of the service providers(87.9%;204/232)had never reported either a dog bite or a suspected case of rabies.Overall,there was gross underreporting of dog bites and suspected rabies cases at public healthcare facilities in the Greater Accra Region of Ghana.Conclusions:In view of the high morbidity and mortality associated with bites from rabid dogs and the poor knowledge and practices of frontline service providers,there is an urgent need for capacity-building such as training in the management of dog bites and subsequent potential rabies infection.
