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Biomedical subjects

Julia Hussein

Publications and source records attributed to Julia Hussein.

10 recordsLinked to original sources
PubMed2006

Going to scale with professional skilled care.

Because most women prefer professionally provided maternity care when they have access to it, and since the needed clinical interventions are well known, we discuss in their paper what is needed to move forward from apparent global stagnation in provision and use of maternal health care where maternal mortality is high. The main obstacles to the expansion of care are the dire scarcity of skilled providers and health-system infrastructure, substandard quality of care, and women's reluctance to use maternity care where there are high costs and poorly attuned services. To increase the supply of professional skilled birthing care, strategic decisions must be made in three areas: training, deployment, and retention of health workers. Based on results from simulations, teams of midwives and midwife assistants working in facilities could increase coverage of maternity care by up to 40% by 2015. Teams of providers are the efficient option, creating the possibility of scaling up as much as 10 times more quickly than would be the case with deployment of solo health workers in home deliveries with dedicated or multipurpose workers.

Africa South of the Sahara↗
PubMed2005

Please understand when I cry out in pain: women's accounts of maternity services during labour and delivery in Ghana.

BACKGROUND: This study was undertaken to investigate women's accounts of interactions with health care providers during labour and delivery and to assess the implications for acceptability and utilisation of maternity services in Ghana. METHODS: Twenty-one individual in-depth interviews and two focus group discussions were conducted with women of reproductive age who had delivered in the past five years in the Greater Accra Region. The study investigated women's perceptions and experiences of care in terms of factors that influenced place of delivery, satisfaction with services, expectations of care and whether they would recommend services. RESULTS: One component of care which appeared to be of great importance to women was staff attitudes. This factor had considerable influence on acceptability and utilisation of services. Otherwise, a successful labour outcome and non-medical factors such as cost, perceived quality of care and proximity of services were important. Our findings indicate that women expect humane, professional and courteous treatment from health professionals and a reasonable standard of physical environment. Women will consciously change their place of delivery and recommendations to others if they experience degrading and unacceptable behaviour. CONCLUSION: The findings suggest that inter-personal aspects of care are key to women's expectations, which in turn govern satisfaction. Service improvements which address this aspect of care are likely to have an impact on health seeking behaviour and utilisation. Our findings suggest that user-views are important and warrant further investigation. The views of providers should also be investigated to identify channels by which service improvements, taking into account women's views, could be operationalised. We also recommend that interventions to improve delivery care should not only be directed to the health professional, but also to general health system improvements.

Adult↗
PubMed2005

Message in a bottle: sinking in a sea of safe motherhood concepts.

The experiences of implementing maternal health programmes over the last two decades have resulted in the development of many approaches and concepts to address the problems of maternal death and disability in developing countries. These safe motherhood "messages" are generally conveyed from international organisations to implementers of programmes working in developing countries. The messages are sometimes unclear, ambiguous and open to misinterpretation. Case studies are used to describe varying interpretations of messages on essential and emergency obstetric care, skilled attendance at delivery and measurement of progress. Limited technological access to information, rapidly changing ideology, overly complicated terminology, inadequate evidence, poor international and inter-agency consensus are key reasons contributing to confusion in implementation. Policy-implementation gaps can be bridged with better needs-based evidence, improved consistency and means of delivery of global messages, building capacity, strengthening partnerships and more inclusive participation in the global arena.

Communication↗
PubMed2005

How do women identify health professionals at birth in Ghana?

OBJECTIVE: the percentage of births attended by health professionals is widely used to measure skilled attendance. This indicator is based on women's reports of their birth attendant. This study explores how women identify health professionals attending their births. DESIGN: exit interviews, focus groups, in-depth interviews and a community survey. Qualitative data were analysed by topic. Frequency of women's responses on how they identify the birth attendant and other characteristics of birth care were generated through the community survey. SETTING AND PARTICIPANTS: women in Ghana who had birthed with a health professional in the last 5 years. MEASUREMENTS AND FINDINGS: role, prior knowledge and uniform are the most common means by which women identify their attendant. These means of identification do not distinguish accurately between different types of health professional. Delivery events are more complex than is suggested through use of the indicator 'percentage of deliveries with health professionals'. Fifty-five per cent of births were attended by more than one person. In 11.6% of births, women were attended only after the partial birth of their baby. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: there is potential for incorrect identification of birth attendant by the use of women's reports. None of the methods used could verify women's reporting. Methodological developments in this area are necessary along with improved recording systems. Opportunities for women to identify health professionals should be enhanced.

Adolescent↗
PubMed2005

Current strategies for the reduction of maternal mortality.

The purpose of this article is to review current strategies for the reduction of maternal mortality and the evidence pertinent to these strategies. Historical, contextual and current literature were examined to identify the evidence base upon which recommendations on current strategies to reduce maternal mortality are made. Current safe motherhood strategies are designed based mostly on low grade evidence which is historical and observational, as well as on experience and a process of deductive reasoning. Safe motherhood strategies are complex public health approaches which are different from single clinical interventions. The approach to evidence used for clinical decision making needs to be reconsidered to fit with the practicalities of research on the effectiveness of strategies at the population level. It is unlikely that any single strategy will be optimal for different situations. Strengthening of the knowledge base on the effectiveness of public health strategies to reduce maternal mortality is urgently required but will need concerted action and international commitment.

Abortion, Induced↗
PubMed2004

The skilled attendance index: proposal for a new measure of skilled attendance at delivery.

Increasing the proportion of deliveries with skilled attendance is widely regarded as key to reducing maternal mortality and morbidity in developing countries. The percentage of deliveries with a health professional is commonly used to assess skilled attendance, but measures only the presence of an attendant, not the skills used or the enabling environment To supplement currently available information on the presence of an attendant at delivery, a method to measure the extent of skilled attendance at delivery through use of clinical records was devised. Data were collected from 416 delivery records in hospitals, government health centres and private non-hospital maternity facilities servicing Kintampo District, Ghana, using a case extraction form. Based on the defined criteria, summary measures of skilled attendance were calculated. Between 32.6% and 93.0% of the criteria for skilled attendance were met in the sample, with a mean of 65.5%. No delivery met all the criteria. A Skilled Attendance Index (SAI) was developed as a composite measure of delivery care. The SAI revealed that 26.9% of delivery records met at least three-quarters of the criteria for skilled attendance. Documentation of haemoglobin, current pregnancy complications, post-partum vital signs and completed partographs were amongst the criteria most poorly recorded. The purpose of applying these measures should be seen not as an end in itself but to advance improvements in delivery care.

Delivery, Obstetric↗
PubMed2003

Improving skilled attendance at delivery: a preliminary report of the SAFE strategy development tool.

BACKGROUND: Increasing the proportion of births with skilled attendance is advocated by international agencies as a key factor in reducing maternal and perinatal mortality and morbidity. The SAFE Strategy Development Tool is designed to enable policy makers and planners to gather and interpret information systematically to develop strategies for improving skilled attendance at birth. METHOD: Five modules were developed with partners in Bangladesh, Ghana, Jamaica, Malawi, and Mexico to guide the identification of problems related to skilled attendance, the collection of primary and secondary evidence, and the synthesis of this evidence to formulate strategies. The involvement of key players, including policy makers, is emphasized throughout the application of the tool and is vital to its success. RESULTS: The SAFE Strategy Development Tool was field tested in five collaborating countries. The methods employed by this tool were found to be feasible and produced evidence that will be useful in the formulation of strategies. Application of the tool can be completed in 3 to 5 months, and was estimated to cost between US$12,938 and US$15,627 for applications at district or subdistrict level. The final strategy options developed from the findings were presented at an international workshop in Aberdeen, Scotland, in February 2003. CONCLUSION: The SAFE Strategy Development Tool is now available to governments, organizations, and institutions involved in the implementation of maternal health programs.

Data Collection↗
PubMedDate not supplied

Safe motherhood program evaluation: theory and practice.

Debate on the evaluation of safe motherhood programs has mainly focused on the outcome or process measure to be used. Less attention is paid to the application of different approaches to evaluation. This article reviews current theories of evaluation and provides examples of the extent to which these theories have been applied in the actual practice of evaluation. Most evaluations use multiple methods and approaches, but the rationale and intention behind these choices are often not made explicit. Factors are identified that need to be taken into consideration when planning and conducting safe motherhood program evaluations. Safe motherhood programs are complex interventions, requiring evaluation by different theoretical approaches and multiple methods. Awareness of these approaches will allow health professionals to plan for evaluation and to use evaluation findings more effectively. If cognizant of the different approaches to evaluation, evaluation frameworks can be developed to improve assessment of the effectiveness of these programs.

Female↗