People with disability experience multidimensional inequalities, which heighten their vulnerability to climate change. An understanding of the vulnerability and adaptive capacity of people with disability can be gained through considering how they have fared during the types of events associated with climate change, such as droughts, floods, heat waves, hurricanes, and wildfires. A systematic review was conducted to identify factors associated with climate change vulnerability and adaptive capacity of people with disability. Papers were sourced from 12 electronic databases, the Google search engine, the websites of 21 organizations, and the reference lists of included papers; 34 papers (relating to 28 studies) met the selection criteria. Most studies were located in the United States, and almost half were focused on hurricane events. Factors contributing to vulnerability included personal factors (e.g., female gender, uncoupled or living alone, nonwhite ethnicity, and low income), environmental factors (commonly, limited practical support from government agencies and disability organizations), bodily impairments (cognitive impairments, hearing impairments, progression of impairments, relapse/exacerbation of symptoms, and thermoregulation difficulties), and activity limitations and participation restrictions (limited preparedness, difficulties with evacuation, and difficulties reassembling individual accommodations and repairing or replacing adaptive equipment). Factors relating to their adaptive capacity included personal factors (e.g., formal education), environmental factors (practical support from mainstream organizations, disability organizations, family, and friends), and activities and participation (emergency planning, keeping an emergency pack, and seeking information). People with disability are vulnerable to climate change largely due to inequalities and their exclusion from adaptation and mitigation efforts.

Objective: Sierra Leone has one of the highest maternal mortality and infant mortality rates globally. We share findings from a Midwifery Clinical Training Needs Assessment, conducted in 2021 as a collaboration between the Government of Sierra Leone and Seed Global Health. The assessment identified existing needs and gaps in midwifery clinical training at health facilities in Sierra Leone from various stakeholders' perspectives. Methods:The descriptive needs assessment utilized mixed methods, including surveys, focus group discussions (FGDs), interviews, and reviews of maternal medical records. Results:The following showed needs and gaps in labor and delivery management; record keeping; triage processes; clinical education for students, recent graduates, and preceptors; and lack of infrastructure and resources. Conclusion:The knowledge gained from this needs assessment can further the development of midwifery clinical training programs in Sierra Leone and other low-income countries facing similar challenges. We discuss the implication of our findings.

No abstract

No abstract

Background In midwifery education, the clinical learning experience (CLE) is a critical component to gaining competency and should comprise greater than 50% of a student’s education. Many studies have identified positive and negative factors affecting students’ CLE. However, few studies have directly compared the difference in CLE based on placement at a community clinic versus a tertiary hospital. Methods The aim of this study was to examine how clinical placement site, clinic or hospital, impacts students’ CLE in Sierra Leone. A once 34-question survey was given to midwifery students attending one of four public midwifery schools in Sierra Leone. Median scores were compared for survey items by placement site using Wilcoxon tests. The relationship between clinical placement and student’s experience were assessed using multilevel logistic regression. Results Two-hundred students (hospitals students = 145 (72.5%); clinic students = 55 (27.5%) across Sierra Leone completed surveys. Most students (76%, n = 151) reported satisfaction with their clinical placement. Students placed at clinics were more satisfied with opportunities to practice/develop skills (p = 0.007) and more strongly agreed preceptors treated them with respect (p = 0.001), helped improve their skills (p = 0.001), provided a safe environment to ask questions (p = 0.002), and had stronger teaching/mentorship skills (p = 0.009) than hospital students. Students placed at hospitals had greater satisfaction in exposure to certain clinical opportunities including completing partographs (p < 0.001); perineal suturing (p < 0.001); drug calculations/administration (p < 0.001) and estimation of blood loss (p = 0.004) compared to clinic students. The odds of students spending more than 4 h per day in direct clinical care were 5.841 (95% CI: 2.187–15.602) times higher for clinic students versus hospital students. There was no difference between clinical placement sites in regards to number of births students attended (OR 0.903; 95% CI: 0.399, 2.047) or number of births students managed without a preceptor/clinician present (OR 0.729; 95% CI: 0.285, 1.867). Conclusion The clinical placement site, hospital or clinic, impacts midwifery students’ CLE. Clinics offered students significantly greater attributes of a supportive learning environment and access to direct, hands-on opportunities for patient care. These findings may be helpful for schools when using limited resources to improve the quality of midwifery education.