Nursing and Midwifery Research Output in Africa: A Review of the Literature

Abstract

BACKGROUNDNurses and midwives form the backbone of health service delivery and satisfaction with care often depends on the competencies of nurses and midwives who provide the care (World Health Organization [WHO], 2002). Healthcare has become complex, challenging, and demanding across diverse sociocultural and socioeconomic changes and environments. To optimize their impact, nurses and midwives therefore need to be prepared with evidence-based competences. Nursing research therefore, is the cornerstone for evidence-based practice and for establishing the professional status of nursing and building research capacity. However, although nursing research began in the 19th century, it is limited in Africa, with little evidence generated to inform policy and practice. Although nursing and midwifery education in the region has advanced with graduate and postgraduate level education, little is known about nursing and midwifery research conducted in universities and where to find such research.OBJECTIVESThe literature review aimed at quantifying and identifying the types and gaps in nursing and midwives' research and publications in Africa.METHODSArticles published between January 1, 2007 and January 31, 2017 were retrieved from PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) with a search strategy that employed four sets of terms: (a) terms identifying published research done by nurses or midwives, or both; (b) terms identifying types of publications; (c) terms identifying filters for African countries; and (d) filters for publication dates. We also searched Google Scholar to capture nonindexed sources.RESULTS AND CONCLUSIONSThere is evidence of an increasing number of African nurses and midwives publishing research; however, much of this research may not be readily available. The promotion of nursing research and capacity building/mentorship in research for nurses and midwives is recommended to increase nurses' and midwives' skills to critically evaluate research and apply the best evidence to their practice.

A critical interpretive synthesis of the roles of midwives in health systems

“…consumer and religious groups), researchers, professional and international associations, and donor agencies • Policies are influenced by interests that have concentrated benefits and diffuse costs • Interest groups play a role in supporting or opposing the integration of midwifery in the health system • In LMICs, bilateral and multilateral donors work alongside local governments • In HICs, professional associations play a strong role in political lobbying • Interests are closely related to institutions (policy networks) as well as ideas as interest groups often reflect and/or can influence societal values • Interest groups play an important role in advancing midwifery in the health system by (1) creating partnerships to improve SRHR [ 45 , 67 ]; (2) promoting regulation and accreditation (e.g. accreditation requirements, setting standards, policies and guidelines) [ 63 , 68 – 70 ]; (3) capacity-building, including midwifery research [ 71 , 72 ]; (4) policy leadership and decision-making [ 43 ]; and (5) lobbying governments/advocacy [ 73 , 74 ] • Strong physician and hospital interest groups created a monopoly over maternity care (United States, Canada, Australia, and Mexico) [ 37 , 38 , 51 , 55 , 75 – 77 ] and impede midwives from practicing to their full scope [ 78 , 79 ] • Tensions within the profession between nurse midwives and midwives (United States) [ 80 ] • Marginalisation of midwifery through dominant stakeholder groups [ 50 ] • Competing interests from nursing organisations created interprofessional tensions (Nepal) and limited establishing midwifery as an independent profession [ 81 ] • Barriers existed in accessing evidence published by African midwives (e.g. African nursing and midwifery research is often published in non-indexed journals) [ 72 ] • Creation of interest groups to participate in the policy-making process [ 4 ] and strengthening existing groups in order to participate in the decision-making process (Nepal) [ 81 , 82 ] • Consultations with interest groups to create culturally safe midwifery care (Canada) [ 34 , 56 – ...…”

“…accreditation requirements, setting standards, policies and guidelines) [ 63 , 68 – 70 ]; (3) capacity-building, including midwifery research [ 71 , 72 ]; (4) policy leadership and decision-making [ 43 ]; and (5) lobbying governments/advocacy [ 73 , 74 ] • Strong physician and hospital interest groups created a monopoly over maternity care (United States, Canada, Australia, and Mexico) [ 37 , 38 , 51 , 55 , 75 – 77 ] and impede midwives from practicing to their full scope [ 78 , 79 ] • Tensions within the profession between nurse midwives and midwives (United States) [ 80 ] • Marginalisation of midwifery through dominant stakeholder groups [ 50 ] • Competing interests from nursing organisations created interprofessional tensions (Nepal) and limited establishing midwifery as an independent profession [ 81 ] • Barriers existed in accessing evidence published by African midwives (e.g. African nursing and midwifery research is often published in non-indexed journals) [ 72 ] • Creation of interest groups to participate in the policy-making process [ 4 ] and strengthening existing groups in order to participate in the decision-making process (Nepal) [ 81 , 82 ] • Consultations with interest groups to create culturally safe midwifery care (Canada) [ 34 , 56 – 58 ] • Professional interest groups came together to strengthen health systems through (1) awareness campaigns; (2) lobbying (agenda-setting); and (3) training, advocacy and coalitions of interested stakeholders to inform education and policy [ 11 , 66 – 68 , 83 ] • Midwifery organisations used counter social movements to influence public opinion [ 49 ] • Researchers advocated for evidence-informed policies on midwifery [ 47 ] • Collaborative networks of health professional groups raised awareness of rising caesarean rates (Latin America) [ …”

“…• Interest groups play an important role in advancing midwifery in the health system by (1) creating partnerships to improve SRHR [ 45 , 67 ]; (2) promoting regulation and accreditation (e.g. accreditation requirements, setting standards, policies and guidelines) [ 63 , 68 – 70 ]; (3) capacity-building, including midwifery research [ 71 , 72 ]; (4) policy leadership and decision-making [ 43 ]; and (5) lobbying governments/advocacy [ 73 , 74 ]…”

“…• Barriers existed in accessing evidence published by African midwives (e.g. African nursing and midwifery research is often published in non-indexed journals) [ 72 ]…”

“…Interest groups advanced the integration of midwifery in the health system by (1) creating partnerships to improve SRHR [ 45 , 67 ]; (2) promoting regulation and accreditation (e.g. accreditation requirements, setting standards, policies and guidelines) [ 63 , 68 – 70 ]; (3) capacity-building including midwifery research [ 71 , 72 ]; (4) policy leadership and decision-making [ 43 ]; and (5) lobbying governments and advocacy [ 73 , 74 ]. Strong leadership from midwifery professional associations engaged in policy dialogue and decision-making has helped advance agendas related to universal health coverage and meeting health-related United Nations Sustainable Development Goals [ 8 , 63 , 66 , 71 , 90 ].…”