Evidence‐based intrapartum care in Cali, Colombia: a quantitative and qualitative study

Conde-Agudelo, Agustín; Rosas-Bermúdez, Anyeli; Gülmezoglu, A Metin

doi:10.1111/j.1471-0528.2008.01930.x

Cited by 17 publications

(29 citation statements)

References 23 publications

(29 reference statements)

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“…Staff shortages and work overload jeopardised health workers’ ability to provide timely care, and manage routine care as well as emergency cases. In addition, shortage of staff sometimes led health workers to exceed their scope of practice, and influenced a health facility's ability to provide 24-hour care.Afsana 2001; Anwar 2009; Barua 2011; Bradley 2009; Conde-Agudelo 2008; Fränngård 2006; Fujita 2012; Graner 2010; Hassan-Bitar 2011; Ith 2012; Khalaf 2009; Lugina 2001; Maputle 2010; Mathole 2006; Mondiwa 2007; Spangler 2012; Thorsen 2012; VSO 2012Moderate confidenceDue to minor concerns about coherence; and minor concerns about methodological limitationsA lack of specialists or experienced staff, including absence of health workers with key skills such as anaesthetists, influenced the provision of care and supervision of junior staff. When no specialists were available, some tasks such as emergency obstetric care were not delivered at all, or tasks were transferred to health workers who were not properly qualified or trained to deliver them.…”

Section: Summary Of Findings For the Main Comparisonmentioning

confidence: 99%

“…When no specialists were available, some tasks such as emergency obstetric care were not delivered at all, or tasks were transferred to health workers who were not properly qualified or trained to deliver them. When senior experienced health workers were not available, junior health workers lacked supervision.Afsana 2001; Anwar 2009; Blum 2006; Bradley 2009; De Brouwere 2009; Fränngård 2006; Hassan-Bitar 2011; Khalaf 2009; Penfold 2013; Pitchforth 2010; Spangler 2012; VSO 2012Moderate confidenceDue to moderate concerns about methodological limitationsHealth workers had vague job descriptions that sometimes led them to perform tasks that were beyond their expertise or scope of practice.Bradley 2009Very low confidenceDue to minor concerns about methodological limitations; and serious concerns about relevance and adequacyStaff shortages and work overload could jeopardise health workers’ ability to display support, empathy, and friendliness to women in labour.Conde-Agudelo 2008; Maputle 2010; VSO 2012Very low confidenceDue to minor concerns about methodological limitations; and moderate concerns about relevance and adequacyStaff shortages and increased workload, as well as living and work conditions, sometimes caused stress and frustration, affected health workers' family life, and led to concerns about personal safety.Anwar 2009; Blum 2006; Fränngård 2006; Graner 2010; Lester 2003; VSO 2012Moderate confidenceDue to moderate concerns about methodological limitations; and minor concerns about relevance and adequacyA wide range of interlinked reasons for staff shortages were suggested. These included limited funds to recruit health workers; bureaucratic processes of the recruitment process, e.g.…”

Section: Summary Of Findings For the Main Comparisonmentioning

confidence: 99%

“…Secondly, health workers' flexibility, attitudes, and beliefs about medical knowledge and skills sometimes influenced their receptivity to new practice knowledge. For example, health worker attitudes did not view medical education as dynamic; held beliefs that no significant progress had been made and clinical practice was similar to techniques learnt many years ago; or were not flexible or willing to implement alternative positions of delivery, even though these were preferred by women.Conde-Agudelo 2008; Pettersson 2006; Pitchforth 2010Low confidenceDue to moderate concerns about relevance and adequacyLack of time, infrastructure, and skills limited health workers' ability to seek knowledge and practice new clinical skills. For instance, chronic staff shortages meant less time available for health workers to seek information.…”

Section: Summary Of Findings For the Main Comparisonmentioning

confidence: 99%

“…This was sometimes further compounded by lack of information sources such as internet access, and poorly resourced hospital libraries. In addition, lack of training and skills in networking, epidemiology, research appraisal, or critical thinking about clinical practice limited health workers' awareness and receptivity to clinical practice changes, and this lack of skills led some professionals to prefer old, familiar procedures.Afsana 2001; Belizan 2007; Conde-Agudelo 2008; Lugina 2001Low confidenceDue to moderate concerns about relevance and adequacy; and minor concerns about methodological limitations STANDARDS AND PROTOCOLS Lack of guidelines/protocols, or where they were inconsistent or health workers were not aware or were uncertain of them, could impact patient care and outcomes and cause harm.Barua 2011; de Carvalho 2012; Khalaf 2009; Lugina 2001; Mathole 2006Low confidenceDue to moderate concerns about adequacy; and minor concerns about methodological limitationsHealth workers did not always adhere to protocols/guidelines, even when they were aware of them. Guidelines/protocols were not followed for a number of reasons.…”

Section: Summary Of Findings For the Main Comparisonmentioning

confidence: 99%

“…Some studies described how health workers continued to practice ineffective procedures because they were considered routine; due to lack of time; because they lacked the autonomy to avoid using what they knew to be inappropriate care; because the resources at the institution were not aligned with the protocols for postpartum care; or when it was unclear who was professionally responsible, e.g. in using the partograph.Belizan 2007; de Carvalho 2012; Conde-Agudelo 2008; Molina 2011; Pettersson 2006Low confidenceDue to moderate concerns about methodological limitations, relevance, and adequacyHealth workers sometimes used unnecessary diagnostic tests and did not follow recommended practice when they feared malpractice suits. This fear could lead to practitioners retaining practices they believed were ‘safer’.Belizan 2007Very low confidenceDue to moderate concerns about relevance; serious concerns about adequacy; and minor concerns about methodological limitationsSome health workers did not use recommended interventions when delivering care because of concerns about negative outcomes for the baby or the mother.…”

Section: Summary Of Findings For the Main Comparisonmentioning

confidence: 99%

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Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis

Munabi‐Babigumira

Glenton

Lewin

et al. 2017

Cochrane Database of Systematic Reviews

159

163

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BackgroundIn many low- and middle-income countries women are encouraged to give birth in clinics and hospitals so that they can receive care from skilled birth attendants. A skilled birth attendant (SBA) is a health worker such as a midwife, doctor, or nurse who is trained to manage normal pregnancy and childbirth. (S)he is also trained to identify, manage, and refer any health problems that arise for mother and baby. The skills, attitudes and behaviour of SBAs, and the extent to which they work in an enabling working environment, impact on the quality of care provided. If any of these factors are missing, mothers and babies are likely to receive suboptimal care.ObjectivesTo explore the views, experiences, and behaviours of skilled birth attendants and those who support them; to identify factors that influence the delivery of intrapartum and postnatal care in low- and middle-income countries; and to explore the extent to which these factors were reflected in intervention studies.Search methodsOur search strategies specified key and free text terms related to the perinatal period, and the health provider, and included methodological filters for qualitative evidence syntheses and for low- and middle-income countries. We searched MEDLINE, OvidSP (searched 21 November 2016), Embase, OvidSP (searched 28 November 2016), PsycINFO, OvidSP (searched 30 November 2016), POPLINE, K4Health (searched 30 November 2016), CINAHL, EBSCOhost (searched 30 November 2016), ProQuest Dissertations and Theses (searched 15 August 2013), Web of Science (searched 1 December 2016), World Health Organization Reproductive Health Library (searched 16 August 2013), and World Health Organization Global Health Library for WHO databases (searched 1 December 2016).Selection criteriaWe included qualitative studies that focused on the views, experiences, and behaviours of SBAs and those who work with them as part of the team. We included studies from all levels of health care in low- and middle-income countries.Data collection and analysisOne review author extracted data and assessed study quality, and another review author checked the data. We synthesised data using the best fit framework synthesis approach and assessed confidence in the evidence using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. We used a matrix approach to explore whether the factors identified by health workers in our synthesis as important for providing maternity care were reflected in the interventions evaluated in the studies in a related intervention review.Main resultsWe included 31 studies that explored the views and experiences of different types of SBAs, including doctors, midwives, nurses, auxiliary nurses and their managers. The included studies took place in Africa, Asia, and Latin America.Our synthesis pointed to a number of factors affecting SBAs’ provision of quality care. The following factors were based on evidence assessed as of moderate to high confidence. Skilled birth attendants reported that they were not always...

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