Access to quality emergency obstetric and newborn care (EmONC); having a skilled attendant at birth (SBA); adequate antenatal care; and efficient referral systems are considered the most effective interventions in preventing stillbirths. We determined the influence of travel time from mother’s area of residence to a tertiary health facility where women sought care on the likelihood of delivering a stillbirth. We carried out a prospective matched case-control study between 1st January 2019 and 31st December 2019 at the Federal Teaching Hospital Gombe (FTHG), Nigeria. All women who experienced a stillbirth after hospital admission during the study period were included as cases while controls were consecutive age-matched (ratio 1:1) women who experienced a live birth. We modelled travel time to health facilities. To determine how travel time to the nearest health facility and the FTHG were predictive of the likelihood of stillbirths, we fitted a conditional logistic regression model. A total of 318 women, including 159 who had stillborn babies (cases) and 159 age-matched women who had live births (controls) were included. We did not observe any significant difference in the mean travel time to the nearest government health facility for women who had experienced a stillbirth compared to those who had a live birth [9.3 mins (SD 7.3, 11.2) vs 6.9 mins (SD 5.1, 8.7) respectively, p = 0.077]. However, women who experienced a stillbirth had twice the mean travel time of women who had a live birth (26.3 vs 14.5 mins) when measured from their area of residence to the FTHG where deliveries occurred. Women who lived farther than 60 minutes were 12 times more likely of having a stillborn [OR = 12 (1.8, 24.3), p = 0.011] compared to those who lived within 15 minutes travel time to the FTHG. We have shown for the first time, the influence of travel time to a major tertiary referral health facility on the occurrence of stillbirths in an urban city in, northeast Nigeria.
many found the process of finger-prick blood sampling extremely challenging and this contributed to concerns that test results may be inaccurate. A minority of participants also missed the opportunity clinic-based testing offered to discuss symptoms or concerns with staff. Participants overwhelmingly found the process of receiving test results by SMS acceptable and preferable to alternatives. Conclusions Internet-based testing is viewed positively by most users but uptake may be improved if providers emphasise the privacy and convenience it offers, as well as the accuracy of self-sampling. Providers should also consider measures to address user concerns around blood sampling and the lack of specialist advice. Further research involving larger numbers of users, and focusing specifically on populations with low uptake of internet-based testing, would be worthwhile.
Challenges of conducting field research in predominantly rural communities and conflict-prone settings are common because of low literacy, insecurity and frequent views of mistrust and fear among the inhabitants. These settings put inexperienced and unprepared researchers into enormous physical and psychological difficulties. There is limited training for conducting fieldwork, including published materials to guide new researchers looking to conduct research in these settings. This article narrates the reflections from doctoral research fieldwork highlighting the main methodological and ethical challenges encountered during mixed-methods research – participant survey and stakeholder interview, conducted in Gombe State, Nigeria in the last quarter of the year 2019. The 4 main challenges encountered in the fieldwork were: ensuring researcher and participant safety; choosing study locations and gaining access; recruiting participants and building trust; and maintaining participants’ privacy and confidentiality of data. The approaches employed to address these challenges were drawn from the prior knowledge and links with local players in the settings, field note keeping, comprehensive institutional ethical review, periodic debriefing with Research Assistants (RA),contact persons, advisers, supervisors, and the literature. It is hoped that these reflections will benefit future researchers facing similar challenges and address information gap in conducting fieldwork in rural and conflict-prone settings in developing nations.
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