A qualitative document analysis of policies influencing preeclampsia management by midwives in Ghana

Garti, Isabella; Gray, Michelle; Bromley, Angela; Tan, Jing‐Yu

doi:10.1016/j.wombi.2022.01.006

Cited by 6 publications

(4 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this study, the midwives were committed to evidence-based practice by following the protocol and guidelines for managing preeclampsia/eclampsia. This finding is consistent with a current review in Ghana that indicated that hospitals provided protocols and guidelines for the management of preeclampsia ( Garti et al, 2022 ). Similarly, in South Africa, midwives knew and followed the guidelines for managing severe preeclampsia ( Ramavhoya et al, 2019 ).…”

Section: Discussionsupporting

confidence: 91%

Midwives Experiences of Managing Clients with Eclampsia in a low Resource Setting: A Qualitative Descriptive Study

et al. 2022

View full text Add to dashboard Cite

Objective Eclampsia remains a public health issue, especially in low-resource countries worldwide. Midwives are the backbone of the pregnancy and delivery process. Midwives trained in the necessary knowledge and skills are more likely to notice early warning signals of preeclampsia and immediately help clients in such emergencies. This study explored midwives’ experiences in managing patients with eclampsia in Ghana. Methods This study was conducted among eight registered midwives at maternity units of two district hospitals in the Eastern Region of Ghana, using an exploratory, descriptive qualitative research design. A purposive sampling technique was adopted to select and interview participants. Interviews were audio-recorded, transcribed, and analyzed using qualitative thematic analysis. The right of participation and withdrawal from the study was respected. Findings The three emerged overriding themes are: 1. Midwives have knowledge (warning signs, regimens, and prevention of complications) about the management of eclampsia. 2. Challenges in managing clients included inadequate equipment, staffing, and access to drugs. 3. Strategies for mitigating barriers to care for women with eclampsia (adherence to protocols, teamwork, peer mentoring and supervision, midwives’ attitude, and client education. Conclusion Midwives working in underserved facilities have the knowledge and skill to monitor and manage pregnant women experiencing eclampsia. However, they need to be supported with appropriate resources and advanced equipment to ensure adherence to protocols on managing eclampsia promptly referred. Continuous training and workshops for midwives in the management of hypertension in pregnancy are recommended and the public educated on the dangers of eclampsia.

show abstract

Section: Discussionsupporting

confidence: 91%

Midwives Experiences of Managing Clients with Eclampsia in a low Resource Setting: A Qualitative Descriptive Study

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Magnesium sulfate availability may have been less of a problem in our study since our study site was a tertiary hospital in a capital city. A qualitative study in Ghana also showed inconsistencies in national management guidelines that led to confusion and poor adherence amongst midwives and community health nurses not well-trained in obstetric complications [ 21 ]. Our study specifically sheds light on how inadequate patient counseling due to low provider-patient ratios contributes to patients’ low health literacy, infrequent ANC attendance, and poor adherence to recommendations.…”

Section: Discussionmentioning

confidence: 99%

“…Systemic policies allowing for training of more healthcare providers is the long-term solution to this challenge. However, our study shows there is opportunity for better training of existing providers, such as midwives and non-obstetric doctors in primary health facilities, that still may lead to the desired result of improved clinical outcomes [ 21 ]. Interventions should focus on creating simple but comprehensive management guidelines and plan workshops with healthcare providers at all levels and settings to disseminate these guidelines.…”

Section: Healthcare and Policy Implicationsmentioning

confidence: 99%

Challenges to diagnosing and managing preeclampsia in a low-resource setting: A qualitative study of obstetric provider perspectives from Ghana

Atluri

Beyuo

Oppong

et al. 2023

PLOS Glob Public Health

View full text Add to dashboard Cite

Preeclampsia is a leading cause of global maternal morbidity and mortality. The greatest burden of disease is in low- and middle-income countries where healthcare providers face significant, understudied, challenges to diagnosing and managing preeclampsia. This qualitative study used semi-structured interviews to explore the challenges of diagnosing and managing preeclampsia from the perspectives of obstetric doctors. Participants were doctors who provide obstetric care at the Korle Bu Teaching Hospital, an urban tertiary hospital in Ghana. Purposive sampling identified doctors with meaningful experience in managing patients with preeclampsia. Thematic saturation of data was used to determine sample size. Interviews were audio recorded, transcribed verbatim, coded using an iteratively-developed codebook, and thematically analyzed. Interviews were conducted with 22 participants, consisting of 4 house officers, 6 junior obstetrics/gynecology residents, 8 senior obstetrics/gynecology residents, and 4 obstetrics/gynecology consultants. Doctors identified critical challenges faced at the patient, provider, and systems levels in detecting and managing preeclampsia, each of which mediates the health outcomes of a pregnancy complicated by preeclampsia. Challenges centered around three overarching global themes: (1) low education levels and health literacy among women, (2) insufficient number of healthcare providers highly trained in obstetric care, and (3) inadequate health infrastructure to support critically ill patients with preeclampsia. Recognizing and addressing root challenges to preeclampsia care has great potential to improve outcomes in pregnancies complicated by preeclampsia in low-resource settings.

show abstract

“…Despite the availability of free antenatal care and high antenatal coverage in Ghana, women often choose traditional birth attendants for home births, a preference driven by the high costs associated with hospital-based care [ 17 ]. The lack of Ghanaian preeclampsia guidelines that reflect current recommendations is reported in another paper which highlights that Ghana lacks consistent implementation of international recommendations for midwives in managing preeclampsia [ 18 ]. Also documented are the numerous challenges in the referral system, such as the inaccessibility of health centres and lack of ambulances [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

A socioecological description of the influencing factors to midwives’ management of preeclampsia in a Ghanaian tertiary hospital

Garti,

Gray,

Bromley

et al. 2023

PLoS ONE

Self Cite

View full text Add to dashboard Cite

Introduction In low-resource settings, midwives are the first contact for women with preeclampsia and lead the coordination of care. Unfavourable preeclampsia outcomes create a burden for women, families, and the health system. It is therefore important to understand the unique context of midwives’ practice and the complex factors that influence the delivery of maternal healthcare. Aim This qualitative study explored the perspectives of key stakeholders in a tertiary hospital in Ghana regarding the facilitators and barriers influencing midwives’ provision of preeclampsia care using a socioecological model. Methods Semi-structured interviews were conducted with 42 participants comprising senior managers (n = 7) and hospital midwives (n = 35) in 2021. Thematic analysis used Braun and Clarke’s six-step method, and the findings were organised within four levels of the socioecological model: individual, interpersonal, organisational, and public policy. Results Two main themes were identified: 1) Facilitators of preeclampsia management, and 2) Barriers to preeclampsia management. Facilitators were identified at three levels (individual, interpersonal, and organisational) and included midwives’ knowledge of preeclampsia; midwives’ self-efficacy; midwives’ skillset to enhance preeclampsia care; collaborative practice; and strategies for preeclampsia care quality improvement. At the individual level, the barriers were inadequate pre-service preparation, lack of evidence-based midwifery care, and colleagues’ work attitudes. Hierarchical decision-making and staff views of women’s risk perceptions were identified as barriers at the interpersonal level. At the organisational level, the barriers were: scarce resources and staff shortages, and a lack of midwifery-specific guidelines. Two barriers were identified within the public policy level: the high cost of preeclampsia care and issues with the referral system. Conclusion Multi-faceted factors play a significant role in midwives’ management of preeclampsia. Hence context-specific multi-level interventions have the potential to improve the quality-of-care women in Ghana receive.

show abstract

A qualitative document analysis of policies influencing preeclampsia management by midwives in Ghana

Cited by 6 publications

References 23 publications

Midwives Experiences of Managing Clients with Eclampsia in a low Resource Setting: A Qualitative Descriptive Study

Midwives Experiences of Managing Clients with Eclampsia in a low Resource Setting: A Qualitative Descriptive Study

Challenges to diagnosing and managing preeclampsia in a low-resource setting: A qualitative study of obstetric provider perspectives from Ghana

A socioecological description of the influencing factors to midwives’ management of preeclampsia in a Ghanaian tertiary hospital

Contact Info

Product

Resources

About