The Better Births Initiative: South Africa pilot study report

Smith, Helen; Brown, Heather Lee; Hofmeyr, Justus; Garner, Paul; Rees, Helen; Dickson-Tetteh, Kim

doi:10.1186/2048-4623-1-s3-pb057

Cited by 2 publications

(2 citation statements)

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“… Richard et al (2008) [ 39 ] Interviews Doctors (gynaecologist/obstetricians; other), midwives (35 participants) Audit (facility-based case reviews) [ 36 ] (intervention type f) Burkina Faso Hospital (26 bed obstetric unit in a district hospital in Ouagadougou) (7.) Smith et al (2004) [ 40 ] FGD, interviews Labour ward staff (14 participants)) Educational intervention (better births initiative—targets practices where there is good evidence from systematic reviews of benefits or harm) [ 41 ] (intervention types a and b) South Africa Hospital (10 government maternity units in Gauteng) (8.) Van Hamersveld et al (2012) [ 42 ] Interviews, participant observation (of audit sessions) Doctors (obstetrician; paediatricians; other), midwives (23 participants) Audit (type of audit not specifically stated—includes critical incident audit/maternal death reviews) [ 36 ] (intervention type f) Tanzania Hospital (1 district hospital with approximately 5000 deliveries annually in Morogoro region) (9.)…”

Section: Resultsmentioning

confidence: 99%

Barriers and enablers to guideline implementation strategies to improve obstetric care practice in low- and middle-income countries: a systematic review of qualitative evidence

et al. 2016

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BackgroundMaternal mortality remains a major international health problem in low- and middle-income countries (LMIC), and most could have been prevented by quality improvement interventions already demonstrated to be effective, such as clinical guideline implementation strategies. The aim of this systematic review was to synthesise qualitative evidence on guideline implementation strategies to improve obstetric care practice in LMIC in order to identify barriers and enablers to their successful implementation.MethodsWe searched MEDLINE and CINAHL databases for articles reporting research findings on barriers and enablers to guideline implementation strategies in obstetric care practice in LMIC. We conducted a “best fit” framework synthesis of the included studies. We used an organisational “stages of change” model as our a priori framework for the synthesis.ResultsNine studies were included: all were based in Sub-Saharan Africa and in hospital health care facilities. The majority of studies (seven) evaluated one particular guideline implementation strategy: clinical audit and feedback (both criterion-based audit and maternal death reviews), and a minority (two) evaluated educational interventions. A range of barriers and enablers to successful guideline implementation was identified. A key finding of the framework synthesis was that “high” and “low” intrinsic health care professional motivation are overall enablers and barriers, respectively, of successful guideline implementation. We developed a modified “stages of change” model to take account of these findings.ConclusionWe have identified a number of quality improvement processes that are amenable to change at limited or no additional cost, although some identified barriers may be difficult to address without increased resources. We note the pathways to implementation may be complex and require further research to develop our understanding of individual and organisational behaviours and motivation in LMIC settings.Trial registrationPROSPERO CRD42015016062 Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0508-1) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Barriers and enablers to guideline implementation strategies to improve obstetric care practice in low- and middle-income countries: a systematic review of qualitative evidence

et al. 2016

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“…These recommendations are difficult to fulfill in African maternity wards, where outdated obstetric practices, such as perineal shaving, episiotomy, enemas, and birth in the supine position, are still routine in many settings. Supportive companions are rarely allowed, and due to staff shortages, women often remain alone and uncomforted during labor 16 . Such practices will hopefully begin to change for all women as PMTCT programs promote evidence‐based practice and encourage midwives and facilities to assess and improve labor and delivery care.…”

Section: Prevention Of Mother To Child Transmission Programsmentioning

confidence: 99%

Mothers, Midwives, and HIV/AIDS in Sub‐Saharan Africa

Raisler

Cohn²

2005

J Midwife Womens Health

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This article reviews clinical and program issues in the prevention of mother to child transmission (PMTCT) of HIV in sub-Saharan Africa. Topics include prevention of infection, voluntary counseling and testing, prenatal care, labor and birth, postpartum, family planning, infant feeding, and the role of traditional birth attendants. Programs providing short-course antiretroviral therapy to prevent infant infection are contrasted with comprehensive programs offering antiretroviral therapy and medical care to mothers, children, and families. Feminization of the epidemic is related to gender inequalities that facilitate the spread of HIV and make pregnant women an especially vulnerable group. Nurses and midwives are the primary health care providers for most of the population in sub-Saharan Africa. They are the backbone of the new PMTCT programs and will be the largest group of health workers available to diagnose and treat opportunistic infections and dispense antiretroviral therapy. But they have received little training and support to provide AIDS care and treatment and are rarely consulted when plans are made about workforce issues and capacity development in the health sector. Clinical training, leadership skills, salary support, expansion of the nursing workforce, and development of expanded roles for nurses and midwives in AIDS care are needed to help them turn the tide of the epidemic.

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The Better Births Initiative: South Africa pilot study report

Cited by 2 publications

References 0 publications

Barriers and enablers to guideline implementation strategies to improve obstetric care practice in low- and middle-income countries: a systematic review of qualitative evidence

Barriers and enablers to guideline implementation strategies to improve obstetric care practice in low- and middle-income countries: a systematic review of qualitative evidence

Mothers, Midwives, and HIV/AIDS in Sub‐Saharan Africa

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