DETERMINAN KULTURAL DAN STRUKTURAL DALAM KEMITRAAN BIDAN DENGAN DUKUN BAYI (BHISA/SANDO) DI KABUPATEN WAKATOBI, SULAWESI TENGGARA

Background: Births assisted by skilled health personnel in health facilities is the prevention of maternal mortality. Wakatobi District has a low coverage of birth attendance by skilled health personnel, and the community has a powerful culture in all aspects of life, including visiting traditional birth attendants known as Bhisa/Sando in caring for women from pregnant to childbirth. Objective: To identify the cultural and structural determinants that affect the partnership between Bhisa/Shando and midwives in maternal and child health services (MCH). Methods: This study used an operational research design with a qualitative approach. A total of 68 informants were involved in focus group discussions, in-depth interviews, and participatory observations. Thematic analysis was used in processing all information. Results: Cultural determinants that affect the partnership between Bhisa/Shando and midwives were hereditary traditions and a powerful belief in Bhisa/Shando's ability to take care for pregnant women, labor women, postpartum women, and newborns. Meanwhile, structural determinants included inadequate facilities and health personnel for MCH services and suboptimal supports from related parties. These results may cause the partnership between Bhisa/Shando and midwives will not be optimal. Conclusion: Cultural and structural factors have a strong influence in realizing the partnership between Bhisa/Sando and midwives. The involvement of Bhisa/Sando in MCH services conducted by midwives, adequate MCH service infrastructure, and support from community leaders, cadres, and related agencies is essential to be carried out to improve Bhisa/Sando's partnership with midwives in improving MCH services. Keywords: Bhisa/Shando, partnership of midwives and traditional birth attendants, maternal and child health Abstrak Latar belakang: Persalinan yang ditolong oleh tenaga kesehatan di fasilitas kesehatan merupakan upaya untuk mencegah kematian ibu. Kabupaten Wakatobi memiliki cakupan penolong persalinan oleh tenaga kesehatan yang rendah, dan masyarakatnya memiliki budaya yang sangat kuat dalam segala aspek kehidupan, termasuk mendatangi dukun bayi yang disebut sebagai Bhisa/Sando dalam menangani ibu hamil hingga bersalin. Tujuan: Mengidentifikasi determinan kultural dan struktural yang memengaruhi kemitraan antara Bhisa/Shando dengan bidan dalam pelayanan kesehatan ibu dan anak (KIA). Metode: Studi ini menggunakan desain riset operasional dengan pendekatan kualitatif. Total 68 informan terlibat dalam diskusi grup terarah, wawancara mendalam, dan observasi partisipasi. Analisis tematik digunakan dalam mengolah seluruh informasi. Hasil: Determinan kultural yang memengaruhi kemitraan antara Bhisa/Shando dengan bidan yaitu tradisi turun temurun dan kepercayaan yang kuat terhadap kemampuan Bhisa/Shando dalam menangani ibu hamil, ibu bersalin, ibu nifas, dan bayi baru lahir. Sedangkan determinan struktural meliputi fasilitas dan tenaga kesehatan untuk pelayanan KIA yang belum memadai serta dukungan dari pihak terkait yang belum optimal. Hal ini menyebabkan kemitraan antara Bhisa/Shando dengan bidan belum optimal. Kesimpulan: faktor kulturan dan struktural berpengaruh kuat dalam mewujudkan kemitraan antara Bhisa/Sando dengan bidan. Keterlibatan Bhisa/Sando dalam pelayanan KIA yang dilakukan bidan, infrastruktur pelayanan KIA yang memadai, dan dukungan dari tokoh masyarakat, kader, dan instansi terkait perlu dilakukan untuk meningkatkan kemitraan Bhisa/Sando dengan bidan dalam meningkatkan pelayanan KIA. Kesimpulan: Kualitas hidup ibu hamil dan ibu nifas relatif sama dengan kecenderungan lebih rendah pada kualitas hidup ibu nifas Kata kunci: Bhisa/Shando, kemitraan bidan dan dukun bayi, kesehatan ibu dan anak

The knowledge and use of misoprostol among women in a Nigerian population

Background: Increasing the availability and accessibility of misoprostol in low resource settings has been advocated to reduce maternal deaths from primary postpartum haemorrhage (PPH). WHO recommends a strategy of antenatal distribution of misoprostol to pregnant women, for self-administration for the prevention of PPH, in settings where women are likely to give birth outside of a health facility or in the absence of skilled health personnel. The success of such strategies depends on the current knowledge and acceptability of misoprostol among women in such population. The aim of this study was that we assessed the knowledge and use of misoprostol among Nigerian women.Methods: It was a prospective cross-sectional population based survey in which 16445 consenting women, from randomly selected households and communities across the 20 local government areas (LGA) of Lagos state, had in-depth interview with the aid of an interviewer administered structured questionnaire to assess their knowledge and use of misoprostol. Data obtained were presented in frequency and proportions.Results: Thirteen per cent and 6.5% of the respondents were aware of drugs that could be used to terminate pregnancy and stop bleeding following childbirth, respectively. Only 5.2% of the women were aware of misoprostol, two-third (67%) of which knew it could be used to terminate pregnancy and 5% of women aware of misoprostol knew it could be used to reduce or stop bleeding following childbirth. Only 2.3% of the entire study population admitted to personal use of misoprostol.Conclusions: Knowledge about the safe, life-saving and effective use of misoprostol among Nigerian women is low. There is need to disseminate information about misoprostol especially in settings where women are likely to give birth outside of a health facility or in the absence of skilled health personnel.

The development of the WHO Labour Care Guide: an international survey of maternity care providers

Background The partograph is the most commonly used labour monitoring tool in the world. However, it has been used incorrectly or inconsistently in many settings. In 2018, a WHO expert group reviewed and revised the design of the partograph in light of emerging evidence, and they developed the first version of the Labour Care Guide (LCG). The objective of this study was to explore opinions of skilled health personnel on the first version of the WHO Labour Care Guide. Methods Skilled health personnel (including obstetricians, midwives and general practitioners) of any gender from Africa, Asia, Europe and Latin America were identified through a large global research network. Country coordinators from the network invited 5 to 10 mid-level and senior skilled health personnel who had worked in labour wards anytime in the last 5 years. A self-administered, anonymous, structured, online questionnaire including closed and open-ended questions was designed to assess the clarity, relevance, appropriateness of the frequency of recording, and the completeness of the sections and variables on the LCG. Results A total of 110 participants from 23 countries completed the survey between December 2018 and January 2019. Variables included in the LCG were generally considered clear, relevant and to have been recorded at the appropriate frequency. Most sections of the LCG were considered complete. Participants agreed or strongly agreed with the overall design, structure of the LCG, and the usefulness of reference thresholds to trigger further assessment and actions. They also agreed that LCG could potentially have a positive impact on clinical decision-making and respectful maternity care. Participants disagreed with the value of some variables, including coping, urine, and neonatal status. Conclusions Future end-users of WHO Labour Care Guide considered the variables to be clear, relevant and appropriate, and, with minor improvements, to have the potential to positively impact clinical decision-making and respectful maternity care.

The Development of the WHO Labour Care Guide: An International Survey of Maternity Care Providers

BackgroundThe partograph is the most commonly used labour monitoring tool globally. However, it is used incorrectly or inconsistently in many settings. In 2018, a WHO expert group reviewed and revised the design of the partograph in view of emerging evidence and developed the first version of the Labour Care Guide (LCG). The objective of this study was to explore views and opinions of skilled health personnel on the first version of the WHO Labour Care Guide.MethodsSkilled health personnel (including obstetricians, midwives and general practitioners) of any age and gender from Africa, Asia, Europe and Latin America were identified through a large global research network. Country coordinators from the network invited 5 to 10 mid-level and senior skilled health personnel who have worked in labour wards anytime in the last 5 years. A self-administered, anonymous, structured, online questionnaire including closed and open-ended questions was designed to assess the clarity, relevance, appropriateness of the frequency of recording, and the completeness of the variables on the LCG. ResultsA total of 110 respondents from 23 countries completed the survey between December 2018 and January 2019. Variables included in the LCG were generally considered clear, relevant and with appropriate recording frequency. Most sections of the LCG were considered complete. Respondents agreed or strongly agreed with the overall design, structure of the LCG, and the usefulness of reference thresholds to trigger further assessment and actions. They also agreed that LCG will potentially impact positively on clinical decision-making and respectful maternity care. Respondents disagreed with the value of some variables including coping, urine, and neonatal status.ConclusionsFuture end-users of WHO next generation partograph considered the variables to be clear, relevant and appropriate, and to have the potential to positively impact on clinical decision-making and respectful maternity with minor improvements.

Quality intrapartum care and partnerships

And that is where our biggest problem with pregnancy and intrapartum care lies in the Pacific – there is an outrageous underinvestment in training opportunities to increase the numbers of nurses, midwives and doctors. We simply do not have enough nurses, midwives and doctors to have engaging discussions on relationships and guaranteeing every woman in labour has a skilled health personnel practitioner. In 2011, it was estimated that 5000 newborns and 1500 women died in childbirth in PNG per annum and there were only 152 practicing midwives.<a title="PACNEWS (PINA), 2011 #13041" href="#_ENREF_5">⁵</a> Australian government investment in capacity building has seen 500 midwives trained in PNG in the last four years and a paper from the University of Technology Sydney team tasked with building capacity is published in this issue.