BackgroundLuapula Province has the highest maternal mortality and one of the lowest facility-based births in Zambia. The distance to facilities limits facility-based births for women in rural areas. In 2013, the government incorporated maternity homes into the health system at the community level to increase facility-based births and reduce maternal mortality. To examine the experiences with maternity homes, formative research was undertaken in four districts of Luapula Province to assess women’s and community’s needs, use patterns, collaboration between maternity homes, facilities and communities, and promising practices and models in Central and Lusaka Provinces.MethodsA cross-sectional, mixed-methods design was used. In Luapula Province, qualitative data were collected through 21 focus group discussions with 210 pregnant women, mothers, elderly women, and Safe Motherhood Action Groups (SMAGs) and 79 interviews with health workers, traditional leaders, couples and partner agency staff. Health facility assessment tools, service abstraction forms and registers from 17 facilities supplied quantitative data. Additional qualitative data were collected from 26 SMAGs and 10 health workers in Central and Lusaka Provinces to contextualise findings. Qualitative transcripts were analysed thematically using Atlas-ti. Quantitative data were analysed descriptively using Stata.ResultsWomen who used maternity homes recognized the advantages of facility-based births. However, women and community groups requested better infrastructure, services, food, security, privacy, and transportation. SMAGs led the construction of maternity homes and advocated the benefits to women and communities in collaboration with health workers, but management responsibilities of the homes remained unassigned to SMAGs or staff. Community norms often influenced women’s decisions to use maternity homes. Successful maternity homes in Central Province also relied on SMAGs for financial support, but the sustainability of these models was not certain.ConclusionsWomen and communities in the selected facilities accept and value maternity homes. However, interventions are needed to address women’s needs for better infrastructure, services, food, security, privacy and transportation. Strengthening relationships between the managers of the homes and their communities can serve as the foundation to meet the needs and expectations of pregnant women. Particular attention should be paid to ensuring that maternity homes meet quality standards and remain sustainable.Electronic supplementary materialThe online version of this article (10.1186/s12884-017-1649-1) contains supplementary material, which is available to authorized users.
Swaziland's prevention of mother-to-child transmission (PMTCT) programme is linked to maternal and newborn health (MNH) services, but is mainly focussed on HIV/AIDS. Existing MNH services are inadequate, especially postnatal care (PNC) of mothers and babies, with delayed postnatal visits occurring at 4-6 weeks after delivery. Fifty-seven percent of staff in seven Swazi health facilities were trained in promoting and providing early PNC. A final evaluation showed a 20-fold increase in the number of visits coming for an early postnatal visit (within the first three days after birth). A direct observation of the client-provider interaction showed a significant increase in the competence of the health workers related to postnatal examinations, and care of mothers and babies (p<0.05- < 0.01). The percentage of women breastfeeding within one hour of delivery increased by 41% in HIV-positive mothers and 52% in HIV-negative mothers. Cotrimoxazole prophylaxis for HIV-exposed infants increased by 24%. Although, health workers were observed providing counselling, maternal recall of messages was deficient, suggesting the need for additional strategies for promoting healthy behaviours. High-quality integrated PMTCT programmes and MNH postnatal services are feasible and acceptable, and can result in promoting early postnatal visits and improved care of both HIV-positive and HIV-negative mothers and their babies.
A nurse leader has the capacity to influence, coordinate and integrate nursing care for patients and families and advocate for the nursing profession to achieve positive health outcomes. In Zambia, nurse leaders operate at all levels of the health system and can contribute significantly to alleviating the negative outcomes of diseases of epidemic potential. The COVID-19 pandemic has provided an opportunity to strengthen nursing leadership efforts towards the reduction of morbidity and mortality from this outbreak. A cross-sectional survey of nurse leaders in six provinces of Zambia was conducted. The data was collected through telephone interviews and self-administered questionnaires on roles and responsibilities, nursing leadership, involvement in policy advice and overall experience with the COVID-19 outbreak. Quantitative variables were analyzed for descriptive statistics while qualitative data were summarized into emerging themes. Nurse leaders played a key role in motivating nurses despite response hesitancy due to risk of infection. Ensuring compliance to infection prevention and control standards was a key responsibility for all nurse leaders. Challenges included their late involvement in planning for service delivery, lack of dedicated resources for performing supervisory functions and the absence of a nursing operational plan for COVID-19. The inability to provide for psychological needs of nurses and unclear incentives policy were important factors for the lack of motivation. Enhanced interprofessional collaboration, professional development in critical care nursing, change management and expanded partnerships with community organizations were among opportunities identified. The role of nurse leaders can be maximized by ensuring their early involvement in strategic planning. A funded operational plan inclusive of dedicated resources for monitoring and supervisory functions of the nurse leaders is indispensable. To sustain motivation, facilities for psychological support, medical care, mentoring and a clear policy on incentives are required, as well as, a continuous professional development programme that addresses competences in nursing leadership and critical care.
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