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Evaluation of Midwives’ and Nurses’ Continuing Professional Development in Reducing Maternal and Neonatal Mortality in Embu County, Kenya  [PDF]
Lucy K. Gitonga, Njogu Samson Muriuki
Open Journal of Obstetrics and Gynecology (OJOG) , 2014, DOI: 10.4236/ojog.2014.46041
Abstract:

Continuing professional development (CPD) is one of the principal means by which health professionals (Nurses and midwives) maintain, improve, and broaden the knowledge and skills required for optimal patient care and safety, to be more specific reduction of maternal and neonatal mortality and morbidity. However, the lack of a widely accepted instrument to assess the impact of CPD activities on clinical practice thwarts researchers’ assessment of the effectiveness of CPD activities. The objective of the study is to develop a theory and practice-based, valid, reliable national instrument to assess the impact of accredited CPD activities on reducing maternal and neonatal mortality in Kenya using an integrated model for the study of healthcare professionals’ behavior through environmental scanning of the factors that promote good performance. The researcher will analyze the instruments identified in a systematic review of factors motivating and demotivating nurses and midwives’ behaviours using criteria that reflect the literature on measurement development of CPD leaders and providers’ priorities. The outcome of this phase will be an inventory of instruments using a competence-based model. Working from this inventory, the most relevant items for assessing the concepts listed will be selected. Then, the researcher will verify whether these items are acceptable or need modification, what aspects need revision, and whether important items are missing and should be added. The outcome of this phase will be a new national instrument integrating the most relevant tools to fit our integrated model of healthcare professionals’ behavior. Two data collections are planned: 1) pretesting of the new instrument, to assess its reliability and validity and 2) a study using the instrument before and after CPD activities with randomly selected groups, one acting as control group to assess measurement effect. The researcher will conduct individual interviews and focus groups with CPD providers and leaders to identify anticipated barriers and enablers for implementing the new instrument in CPD practice. Drawing on the results from the previous phases, we will use consensus-building methods with the decision makers to develop a plan to implement the new instrument.

The role of midwives in the maternal safety and reproductive health
T . Mirmolaei,M . Shakari
Hayat Journal of Faculty of Nursing & Midwifery , 2001,
Abstract: In an international project in 1987, the world health organization (WHO), UNICEF, UNFPA and the world bank suggested the maternal safety program and the following objectives were considered:"n1. Reducing maternal mortality from 1990 to 2000 to the half of the"npresent rate throughout the prenatal care"n2. Availability of the whole pregnant women to the prenatal care,"nqualified personnel during the delivery and required facilities for"ntransferring women in high risk pregnancies and midwifery emergencies."n3. Availability of appropriate services and information to prevent low age"nand high age pregnancies ,short interval pregnancies and multiparous."nSince 1987, an international cooperation has been established to support the maternal safety program."nRelating to this program, essential changes in the structure of the health services system, in laws and policies and also in training programs of medical doctors ,midwives and other related professions have been made."nThe international confederation of midwifery (ICM), a professional organization of midwifery, and also midwifery societies in the developed countries are the most active organizations involved in providing maternal safety program. Some researches relating to this program was performed in some undeveloped and developing countries such as Africa, Asia and latin America. Some confernces and congresses were also held."nResearchers have indicated that traditional midwifery can not be successed in reducing the rate of maternal mortality unless be supervised by qualified midwives."nSince in our country and some other developing countries, the rate of maternal mortality and morbidity is high, therefore the maternal safety program should be perfectly performed and midwives should do their best in applying this program."nWHO declared midwives are responsible for the maternal safety program performance, and they will be supported by WHO in different ways, WHO also announced the year 1998 as the maternal safety year."nThus, as midwives, we should recognize our essential role in this program and in other national and international reproductive health programs.
Maternal Predictors of Newborn Somatometrics  [PDF]
Satwanti Kapoor,Prerna Bhasin,Meenal Dhall,Deepali Verma,Shilpi Gupta,Mary Grace Tungdim
Journal of Anthropology , 2012, DOI: 10.1155/2012/639345
Abstract: The objective of the study was to ascertain the influence of various maternal factors like age, BMI, anthropometry, parity, and so forth on body dimensions of newborn and to discover determinants of neonatal subcutaneous fat distribution pattern. 94 Khatri and Arora new borns along with their biological mothers hailing from upper/middle socioeconomic status families were selected against several criteria: only liveborn, healthy full term babies (37–41 gestational weeks), singletons, born through vaginal delivery and for whom all data were available, for the study. Numerous biometric variables were chosen for this study: weight, stature (for mothers), birth length (for neonates), circumferences (head, chest, abdomen, hip, upper arm, and wrist), and skinfolds at different sites (biceps, triceps, subscapular, suprailiac, chest, thigh anterior, and calf posterior) along with newborn’s birth weight. All LBW infants were found to be significantly associated with maternal nutritional status and age, when controlled for other factors. Chances of having an LBW infant varies with mother’s nutritional status as determined by BMI and MUAC. Fat profiling has genetic implications because fat tracking patterns have shown that, irrespective of maternal nutritional status and age, most neonate skinfolds are guided by mother’s skinfold thicknesses. We conclude that early teenage pregnancies should be discouraged so as to reduce the incidence of LBW and larger ethnic-specific studies should be taken to find determinants of subcutaneous fat pattern in neonates. 1. Introduction Various genetic and environmental factors are known to influence the size of newborns. Numerous studies have shown the significant effects of various maternal factors on the somatometrics characteristics of the newborns [1–5]. Some of the biometric maternal predictors reflect the genetic blueprint laid down for the newborn, while other predictors are more of an expression of the environmental influences. Hence, most of the newborn characteristics echo a complex combination of both genetic and nutritional (maternal) factors. Maternal body dimensions are first determinants of neonate biometrics, predominantly their birth weight and length, which are closely related to perinatal morbidity and mortality. While among the nonbiometric maternal factor, two factors known to play a decisive role in fetal growth are maternal age and parity [6]. Mother’s nutritional status is also known to be a key indicator of infant’s body dimensions and its early growth features. Birth weight and length are clearly based on
Ten-Year Evaluation of Maternal Mortalities in Kohgiluyeh and Boyerahmad Province  [PDF]
Mahshid GHolami-Taramsari
Knowledge & Health Journal , 2008,
Abstract: Introduction: Maternal mortality rate (MMR) is one of the most important health indicators in almost all of the countries. This research was conducted in a less developed region of Iran for better evaluation of risk factors and hidden causes of maternal mortalities. Methods: This study was conducted as a cross- sectional investigation based on Kohgiluyeh and Boyerahmad health system’s data. Also the data was verified according to Maternal Health Department of Iran Health Ministry. Results: Due to results of this research during the study period (from 1997 till 2007) the average MMR was about 57.7 per 1000 live births (66 cases). Maximum and minimum number of cases were reported in 2000 (13 cases) and 2004 (1 case), respectively. Bleeding was the most prevalent cause of maternal death (41% of maternal mortality causes). Conclusion: Based on our findings; gravidity more than 4, inhabitation in rural and remote area, poor prenatal cares, high distance to emergency obstetrician facilities and maternal illiteracy are most important determinants of maternal mortality.
Maternal Predictors of Newborn Somatometrics  [PDF]
Satwanti Kapoor,Prerna Bhasin,Meenal Dhall,Deepali Verma,Shilpi Gupta,Mary Grace Tungdim
Journal of Anthropology , 2012, DOI: 10.1155/2012/639345
Abstract: The objective of the study was to ascertain the influence of various maternal factors like age, BMI, anthropometry, parity, and so forth on body dimensions of newborn and to discover determinants of neonatal subcutaneous fat distribution pattern. 94 Khatri and Arora new borns along with their biological mothers hailing from upper/middle socioeconomic status families were selected against several criteria: only liveborn, healthy full term babies (37–41 gestational weeks), singletons, born through vaginal delivery and for whom all data were available, for the study. Numerous biometric variables were chosen for this study: weight, stature (for mothers), birth length (for neonates), circumferences (head, chest, abdomen, hip, upper arm, and wrist), and skinfolds at different sites (biceps, triceps, subscapular, suprailiac, chest, thigh anterior, and calf posterior) along with newborn’s birth weight. All LBW infants were found to be significantly associated with maternal nutritional status and age, when controlled for other factors. Chances of having an LBW infant varies with mother’s nutritional status as determined by BMI and MUAC. Fat profiling has genetic implications because fat tracking patterns have shown that, irrespective of maternal nutritional status and age, most neonate skinfolds are guided by mother’s skinfold thicknesses. We conclude that early teenage pregnancies should be discouraged so as to reduce the incidence of LBW and larger ethnic-specific studies should be taken to find determinants of subcutaneous fat pattern in neonates.
Physical assessment ability of nurses and midwives on maternal care in Mongolia  [PDF]
Sakumi Akao, Keiko Tanabe, Bayarkhuu Dorjsuren, Michiyo Higuchi
Health (Health) , 2013, DOI: 10.4236/health.2013.53065
Abstract:

This study examined the physical assessment ability of Mongolian nurses and midwives engaged in maternal care and the factors that could influence this ability. We found that nurses and midwives from prefectural hospitals had higher scores than those from national and district (soum) hospitals. The latter group could not perform more than half of the 28 tested procedures on their own, even though most had over 10 years’ experience. Therefore, to decrease the Mongolian maternal mortality ratio, we argue that in-service training for nurses and midwives in both the capital city and peripheral areas is needed.

Perspectives of Continuing Professional Development (CPD) for Kenyan Midwives  [PDF]
Lucy Gitonga, Njogu Samson Muriuki
Open Journal of Clinical Diagnostics (OJCD) , 2014, DOI: 10.4236/ojcd.2014.42015
Abstract: Continuing Professional Development (CPD) provides an important strategy for reduction of maternal morbidity and mortality with the aim of attaining Millennium Development goals (MDG) four and five. However, there is lack of information about how Kenyan midwives understand and perceive CPD and how this is situated in the practice and social context. This research aimed to explore Kenyan midwives’ experience and perceptions of CPD. A descriptive explorative approach gathered focus group discussion and questionnaire data on beliefs, opinions, and perceptions, demotivating and motivating factors to CPD of a total of 25 midwives in a level five hospital in Kenya. Questionnaires were piloted and self-administered after cleaning and focus groups taped and transcribed verbatim. Data were analyzed thematically using inductive approach with the aid of SPSS computer program. Results: Four key themes emerged from the data: Midwives’ views of CPD, their motivators for undertaking CPD, the choices they made around CPD, their demotivators for undertaking CPD. Congruence with the issues evident in the literature were: the difficulties with role diversity, the importance of CPD in personal and professional growth, the importance of flexible modes of study and the importance of a supportive culture for ongoing learning. The study findings helped in identifying gaps in the literature about Kenyan midwives’ perspectives on CPD.
Human resources for maternal, newborn and child health: from measurement and planning to performance for improved health outcomes
Neeru Gupta, Blerta Maliqi, Adson Fran?a, Frank Nyonator, Muhammad A Pate, David Sanders, Hedia Belhadj, Bernadette Daelmans
Human Resources for Health , 2011, DOI: 10.1186/1478-4491-9-16
Abstract: We collected and analysed cross-nationally comparable data on HRH availability, distribution, roles and functions from new and existing sources, and information from country reviews of HRH interventions that are associated with positive impacts on health services delivery and population health outcomes.Findings from 68 countries demonstrate availability of doctors, nurses and midwives is positively correlated with coverage of skilled birth attendance. Most (78%) of the target countries face acute shortages of highly skilled health personnel, and large variations persist within and across countries in workforce distribution, skills mix and skills utilization. Too few countries appropriately plan for, authorize and support nurses, midwives and community health workers to deliver essential maternal, newborn and child health-care interventions that could save lives.Despite certain limitations of the data and findings, we identify some key areas where governments, international partners and other stakeholders can target efforts to ensure a sufficient, equitably distributed and efficiently utilized health workforce to achieve MDGs 4 and 5.In June 2010, leaders of the G8 nations announced a comprehensive and integrated approach to accelerate progress towards the Millennium Development Goals (MDGs) 4 and 5 for maternal and child health (known as the Muskoka Declaration) [1]. The initiative aimed to support strengthening of national health systems in developing countries, in order to enable accelerated delivery of key interventions for improved maternal, newborn and child health (MNCH) outcomes along the continuum of care. The Global Strategy for Women's and Children's Health, launched at the United Nations MDG Summit on 22 September 2010, provided a significant opportunity to broaden these commitments [2]. With only four years left until the 2015 deadline to achieve the MDGs, this year presents a critical opportunity for action to increase investment and support to countrie
Maternal obesity support services: a qualitative study of the perspectives of women and midwives
Penny J Furness, Kerry McSeveny, Madelynne A Arden, Carolyn Garland, Andy M Dearden, Hora Soltani
BMC Pregnancy and Childbirth , 2011, DOI: 10.1186/1471-2393-11-69
Abstract: A purposive sample of 6 women and 7 midwives from Doncaster, UK, participated in two separate focus groups. Transcripts were analysed thematically.Two overarching themes were identified, 'Explanations for obesity and weight management' and 'Best care for pregnant women'. 'Explanations' included a lack of knowledge about weight, diet and exercise during pregnancy; self-talk messages which excused overeating; difficulties maintaining motivation for a healthy lifestyle; the importance of social support; stigmatisation; and sensitivity surrounding communication about obesity between midwives and their clients. 'Best care' suggested that weight management required care which was consistent and continuous, supportive and non-judgemental, and which created opportunities for interaction and mutual support between obese pregnant women.Women need unambiguous advice regarding healthy lifestyles, diet and exercise in pregnancy to address a lack of knowledge and a tendency towards unhelpful self-talk messages. Midwives expressed difficulties in communicating with their clients about their weight, given awareness that obesity is a sensitive and potentially stigmatising issue. This indicates more could be done to educate and support them in their work with obese pregnant women. Motivation and social support were strong explanatory themes for obesity and weight management, suggesting that interventions should focus on motivational strategies and social support facilitation.Obesity (body mass index (BMI) ≥ 30 kg/m2) is identified as a major public health challenge of the 21st century across the globe [1]. In the UK, 23% of the population are obese and it is predicted that more than half of the adult population will be obese by 2050 [2]. Obesity is also a growing problem for women of childbearing age [3] and about one fifth of pregnant women in the UK are obese [4].According to the Confidential Enquiry into Maternal and Child Health [5], obesity is associated with over half of the to
Assessing midwives' breastfeeding knowledge: Properties of the Newborn Feeding Ability questionnaire and Breastfeeding Initiation Practices scale
Debra K Creedy, Ruth M Cantrill, Marie Cooke
International Breastfeeding Journal , 2008, DOI: 10.1186/1746-4358-3-7
Abstract: A national postal survey of Australian midwives (n = 3500) was conducted in October 2001. Reliability was determined through Cronbach's alpha coefficient and stability determined by a test-retest. Content validity was established through a critical review of literature and review by an expert panel. Construct validity was informed by an exploratory factor analysis and principle component analysis with varimax rotation. Correlations between NFA and BKQ knowledge subscale scores and BIP and BKQ practice subscale scores assessed criterion validity. A multiple hierarchical regression analysis determined predictive validity of the NFA and BIP.A response rate of 31.6% (n = 1107) was achieved. Adequate internal consistency was established for both instruments. Five factors on the NFA questionnaire were congruent with knowledge about effects of skin-to-skin contact, physiological stability, newborn innate abilities, work practices and effective breastfeeding. The BIP revealed three factors related to observing pre-feeding behavior, mother/baby care and attachment and positioning practices. Predictive validity of knowledge was moderate (r = 0.481, p < 0.01) and contributed to 31.5% of variance in reported practice. Midwives with high knowledge scores were more likely to report best practice when assisting mothers to initiate breastfeeding. Midwives with more personal breastfeeding experience scored higher on all scales.The Newborn Feeding Ability questionnaire and the Breastfeeding Initiation Practices scale can contribute to practice development by assessing lactation and infant feeding knowledge and practice deficits. Individual learning needs can be identified, and effectiveness of education interventions evaluated using these tools. Further testing is required with other samples of midwives and health professionals involved in the promotion of breastfeeding.Healthcare service providers play a key support and educative role to mothers about human lactation and infant feed
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