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Meeting  Thursday, February 22, 2018 Meeting  Thursday, February 22, 2018

Meeting Thursday, February 22, 2018 - PowerPoint Presentation

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Meeting Thursday, February 22, 2018 - PPT Presentation

1200 100 p m Agenda Welcome and Update Allison Campbell Instructor and Interim Program Lead UBC Midwifery Program Agenda Factors Affecting the U se of M idwifery S ervices in Remote Nepal ID: 780045

rural birth skilled care birth rural care skilled birthing remote centers health nepal themes research factors areas services facilities

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Presentation Transcript

Slide1

Meeting

Thursday, February 22, 2018

12:00 – 1:00

p

m

Slide2

AgendaWelcome and UpdateAllison Campbell, Instructor

and Interim Program LeadUBC Midwifery Program

Slide3

Agenda

Slide4

Factors Affecting the Use of Midwifery Services in Remote Nepal

SFU doctoral research February 22, 2018

Cathy Ellis, BFA, RM, MSc, doctoral candidate

Slide5

BackgroundUse of Skilled birth attendants (SBAs) less in rural areas than urban areas: 67.7% urban compared to 46.8% rural (NHDS, 2016).Mountainous area 43.3% uses SBA, Lowest quintile 33.9% use SBA Gov’t of Nepal has trained providers in skilled birth attendance and set up birthing centers in rural areas but they are under-utilized. No midwives to date.

Gov’t has begun to educate professional midwives but it is not known how they will function optimally (

SBA Policy, 2006)

Slide6

Nepal Situation MMR is decreasing, correspondent to lower fertility rate, but without skilled care in rural areas may not be able to decrease further: 258 [158 – 425] per 100,000 live births (

WHO, 2015). Perinatal mortality rate 36 per 1000 births in rural area and 27 per 1000 births in urban (NDHS, 2016)

Only 35% of births are registered with the state

Slide7

My role A partner with Midwifery Society of Nepal in providing midwifery skills refresher workshops and mentoring for rural and remote midwives and nurses since 2007. We involve UBC midwifery students through credit course and global placements.

A doctoral researcher working with local midwife partners to learn about and increase ‘enabling factors’ for safe birthing for women in remote areas.

Slide8

Research objectivesTo assess attitudes and practices around birth and how this affects mothers’ and families’ willingness to use skilled attendants in healthcare facilities;

To assess the readiness of Nepal’s rural heath system to provide services to parturient women;

To discover the links between mothers’ perceptions around birth and their use of the health system.

Slide9

Research questions1. What are the factors (barriers, facilitators) women report that affect their use of skilled birth attendants in rural and remote Nepal?

2. What are the barriers to establishing skilled care at birth in rural and remote settings?

3. What are the gaps in skill sets and enabling factors in health care facilities to providing culturally acceptable and safe birth attendance?

Slide10

Research design‘Concurrent mixed methods’ research

involves: (Creswell, 2009)

Concurrent embedded design (Creswell, 2009)Participant and site

observation (Bernard, 2002)Semi-structured Interviews in and around

6 remote health facilitiesWHO Service Availability and Readiness Assessment Survey (6 birthing facilities)

Skilled Birth A

ttendant skills surveys (12 nurses)

Slide11

 Interviews n=67

In 6

sites

Mothers

FCHVs; Shamans

Mat

Care Workers

Participant observation

While

travelling

In Birthing centers and hospitals

In homes

WHO System

Survey

n=6

Hospital

n=1

Primary Health Centers n=2

Rural Birthing Centers n=3

SBA

Survey

(nurses) n=12

Hospital

n= 4

Primary Health Centers n=4

Rural Birthing centers n=4

Mixed Methods Study: Sept. to Dec. 2016

Slide12

InterviewsResearch questions: What are the factors (barriers, facilitators) women report that affect their use of skilled birth attendants in rural and remote

Nepal?

What are the barriers to establishing skilled care at birth in rural and remote settings?

Slide13

Translation methodInterview questions for mothers/families and Nepalese-only speaking health workers have been translated into Nepalese

and pre-tested using ‘WHO Process of forward-backward translation and adaptation of instruments’.

http://www.who.int/substance_abuse/research_tools/translation/en

/

Slide14

Demographics of Mothers for Interviews

Slide15

Analysis of interviewsThematic analysis (1) discover themes and sub-themes, (2) decide which main themes are important, (3) build hierarchies of themes or code books, and (4) link themes into a theoretical model (Ryan & Bernard, 2003).

NVIVO

for a second tool for thematic analysis. If different discovery techniques are used with the same set of data,

more themes may be found.

Slide16

Cost and

Distance

Human Resources

Provision of Services

Socio-cultural

Remote area

Lack of roads, transportation

Lack of people to help mother to health facility

Cost to be carried to facility

AAMA program as

incentive

Being a local maternal care worker

Cooperation among staff

Incentives for mat care workers

Mat care workers satisfaction

Quality of care of ANC

Skilled care at birth

Safety in hospital for complications

Enabling factors such as adequate buildings, space, supplies

Fear, reluctance to use facility birth

Monitoring, evaluation of facilities or HR

Mother, family satisfaction with services

Shortage of materials/supplies

Birth planning preparedness

Dealing with blood and pollution problems

Education or awareness of services

Feel confident to deliver at home

Personal Agency

Respect and cultural humility

Shame and shyness

Son preference

Traditional birthing practices

Traditional midwives and TBAs

Role of shamans

Themes from Semi-structured Interviews

Slide17

Credibility and DependabilityCredibility: descriptions must be recognized as accurate by participants (Chilisa, 2012). Dependability (is data analysis reliable?). If study were to be done again, would they find the same answers?

Slide18

Using two surveys:To assess the readiness of Nepal’s rural heath system to provide services to parturient women;

What are the barriers to establishing skilled care at birth in rural and remote settings?

What are the gaps in skill sets and enabling factors in health care facilities to providing culturally acceptable and safe birth attendance?

Slide19

1. Skilled Birth Attendance (SBA) SurveyA skilled birth attendant enhancement project assessed skills and needs in some areas of Nepal (Gov’t of Nepal and Nick Simon Institute).I assessed 12 nurses in the research area. Each individual assessment took 4 hours, with 4 to 8 hours ‘gap training’ following the assessment.

Found poor capacity in managing eclampsia, shock due to PPH and

vacuum, especially if not recently trained.

Slide20

2. WHO Service Availability and Readiness Assessment SurveyCheck-list examining infrastructure, communications such as phone for referrals, lab facilities, basic equipment, supplies, medications.

Added respectful childbirth questions including companion during delivery, choice of labour and birthing positions. Earthquake affected area; most basic supplies available

Did not assess abortion availability

Slide21

Linking Findings of Mixed MethodsTo discover the links between mothers’ perceptions around birth and their use of the health system:

Mothers judged quality of care by way they were treated, and by doctor and supplies availability; birthing centers basic care only

Few deliveries, few human resources, lack of mentoring led to poor skill performance (rural birthing centers)Some birthing centers were not accessible nor had 24 hr. skilled care available

Slide22

Closing CommentsAllison Campbell