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Article ; Online: Self-reported vomiting during pregnancy in North-east Nigeria: perceptions, prevalence, severity and impacts.

Yargawa, Judith / Hill, Zelee / Fottrell, Edward

2022 Volume 22, Issue 1, Page(s) 614

Abstract: Background: Vomiting is a common ailment during pregnancy, often linked to negative impacts on women's quality of life. Very little is known about the issue in low income settings, particularly Sub-Saharan Africa, with studies from high income settings ... ...

Abstract	Background: Vomiting is a common ailment during pregnancy, often linked to negative impacts on women's quality of life. Very little is known about the issue in low income settings, particularly Sub-Saharan Africa, with studies from high income settings predominantly informing the evidence base. This study aimed to explore how women perceive vomiting during pregnancy and to measure its prevalence, severity and impacts in North-east Nigeria. Methods: Qualitative in-depth interviews, focus group discussions, family interviews and a cross-sectional household survey were carried out between December 2015 and November 2016 with women who had given birth within the past two years. Purposive sampling and thematic analysis were used in the qualitative studies. A three-staged cluster sampling with 640 women and descriptive analyses were used in the survey. Results: Women in the qualitative studies reported that vomiting was a normal part of pregnancy, unless a woman vomits after eating, has poor appetite, is not well-nourished, cannot perform chores, is overwhelmed by it or has to go to hospital. In the survey, 35.4% (95% CI 26.5-45.5) of women reported any vomiting during their last pregnancies and of these only 21.1% said it had stopped entirely within the first trimester. Over half of women who reported vomiting did so at least three times per day most days and 34.7% were vomiting five or more times per day during the most severe period. Care-seeking was reported by 61.5%. Both the qualitative and quantitative data found that vomiting impacted women in multiple ways including nutritionally, physiologically, mentally, financially and martially; 50.8% of women with any vomiting in the survey perceived the overall severity of the condition negatively. Conclusion: Vomiting during pregnancy is dually seen as normal and problematic depending on its characteristics and impacts. The burden appears to be high with many women seeking care for the condition.
MeSH term(s)	Cross-Sectional Studies ; Female ; Humans ; Nigeria/epidemiology ; Pregnancy ; Prevalence ; Quality of Life ; Self Report ; Vomiting/epidemiology ; Vomiting/etiology
Language	English
Publishing date	2022-08-04
Publishing country	England
Document type	Journal Article
ZDB-ID	2059869-5
ISSN	1471-2393 ; 1471-2393
ISSN (online)	1471-2393
ISSN	1471-2393
DOI	10.1186/s12884-022-04916-4
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Article ; Online: 'The objective was about not blaming one another': a qualitative study to explore how collaboration is experienced within quality improvement collaboratives in Ethiopia.

Hill, Zelee / Keraga, Dorka / Kiflie Alemayehu, Abiyou / Schellenberg, Joanna / Magge, Hema / Estifanos, Abiy

Health research policy and systems

2023 Volume 21, Issue 1, Page(s) 48

Abstract: Background: Quality improvement collaboratives are a common approach to improving quality of care. They rely on collaboration across and within health facilities to enable and accelerate quality improvement. Originating in high-income settings, little ... ...

Abstract	Background: Quality improvement collaboratives are a common approach to improving quality of care. They rely on collaboration across and within health facilities to enable and accelerate quality improvement. Originating in high-income settings, little is known about how collaboration transfers to low-income settings, despite the widespread use of these collaboratives. Method: We explored collaboration within quality improvement collaboratives in Ethiopia through 42 in-depth interviews with staff of two hospitals and four health centers and three with quality improvement mentors. Data were analysed thematically using a deductive and inductive approach. Results: There was collaboration at learning sessions though experience sharing, co-learning and peer pressure. Respondents were used to a blaming environment, which they contrasted to the open and non-blaming environment at the learning sessions. Respondents formed new relationships that led to across facility practical support. Within facilities, those in the quality improvement team continued to collaborate through the plan-do-study-act cycles, although this required high engagement and support from mentors. Few staff were able to attend learning sessions and within facility transfer of quality improvement knowledge was rare. This affected broader participation and led to some resentment and resistance. Improved teamwork skills and behaviors occurred at individual rather than facility or systems level, with implications for sustainability. Challenges to collaboration included unequal participation, lack of knowledge transfer, high workloads, staff turnover and a culture of dependency. Conclusion: We conclude that collaboration can occur and is valued within a traditionally hierarchical system, but may require explicit support at learning sessions and by mentors. More emphasis is needed on ensuring quality improvement knowledge transfer, buy-in and system level change. This could include a modified collaborative design to provide facility-level support for spread.
MeSH term(s)	Humans ; Ethiopia ; Quality Improvement ; Qualitative Research ; Learning ; Health Facilities
Language	English
Publishing date	2023-06-13
Publishing country	England
Document type	Journal Article
ZDB-ID	2101196-5
ISSN	1478-4505 ; 1478-4505
ISSN (online)	1478-4505
ISSN	1478-4505
DOI	10.1186/s12961-023-00986-8
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Article ; Online: Women's perceptions and self-reports of excessive bleeding during and after delivery: findings from a mixed-methods study in Northern Nigeria.

Yargawa, Judith / Fottrell, Edward / Hill, Zelee

BMJ open

2021 Volume 11, Issue 10, Page(s) e047711

Abstract: Objectives: To explore lay perceptions of bleeding during and after delivery, and measure the frequency of self-reported indicators of bleeding.: Setting: Yola, North-East Nigeria.: Participants: Women aged 15-49 years who delivered in the ... ...

Abstract	Objectives: To explore lay perceptions of bleeding during and after delivery, and measure the frequency of self-reported indicators of bleeding. Setting: Yola, North-East Nigeria. Participants: Women aged 15-49 years who delivered in the preceding 2 years of data collection period (2015-2016), and their family members who played key roles. Methods: Data on perceptions of bleeding were collected through 7 focus group discussions, 21 in-depth interviews and 10 family interviews. Sampling was purposive and data were analysed thematically. A household survey was then conducted with 640 women using cluster sampling on postpartum bleeding indicators developed from the qualitative data; data were analysed descriptively. Results: Perceptions of excessive bleeding fell under four themes: quantity of blood lost; rate/duration of blood flow; symptoms related to blood loss and receiving birth interventions/hearing comments from birth attendants. Young and less educated rural women had difficulty quantifying blood loss objectively, including when shown quantities using bottles. Respondents felt that acceptable blood loss levels depended on the individual woman and whether the blood is 'good' or 'diseased/bad.' Respondents believed that 'diseased' blood was a normal result of delivery and universally took steps to help it 'come out.' In the quantitative survey, indicators representing less blood loss were reported more frequently than those representing greater loss, for example, more women reported staining their clothes (33.6%) than the bed (18.1%) and the floor (6.2%). Overall, indicators related to quantity and rate of blood flow had higher frequencies compared with symptom and intervention-related/comment-related indicators. Conclusion: Women quantify bleeding during and after delivery in varied ways and some women do not see bleeding as problematic. This suggests the need for standard messaging to address subjectivity. The range of indicators and varied frequencies highlight the challenges of measuring excessive bleeding from self-reports. More work is needed in improving and testing validity of questions.
MeSH term(s)	Female ; Humans ; Nigeria ; Perception ; Postpartum Hemorrhage/epidemiology ; Pregnancy ; Qualitative Research ; Rural Population ; Self Report
Language	English
Publishing date	2021-10-11
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2020-047711
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Article: Are verbatim transcripts necessary in applied qualitative research: experiences from two community-based intervention trials in Ghana.

Hill, Zelee / Tawiah-Agyemang, Charlotte / Kirkwood, Betty / Kendall, Carl

Emerging themes in epidemiology

2022 Volume 19, Issue 1, Page(s) 5

Abstract: Conducting qualitative research within public health trials requires balancing timely data collection with the need to maintain data quality. Verbatim transcription of interviews is the conventional way of recording qualitative data, but is time ... ...

Abstract	Conducting qualitative research within public health trials requires balancing timely data collection with the need to maintain data quality. Verbatim transcription of interviews is the conventional way of recording qualitative data, but is time consuming and can severely delay the availability of research findings. Expanding field notes into fair notes is a quicker alternative method, but is not usually recommended as interviewers select and interpret what they record. We used the fair note methodology in Ghana, and found that where research questions are relatively simple, and interviewers undergo sufficient training and supervision, fair notes can decrease data collection and analysis time, while still providing detailed and relevant information to the study team. Interviewers liked the method and felt it made them more reflective and analytical and improved their interview technique. The exception was focus group discussions, where the fair note approach failed to capture the interaction and richness of discussions, capturing group consensus rather than the discussions leading to this consensus.
Language	English
Publishing date	2022-06-28
Publishing country	England
Document type	Journal Article
ZDB-ID	2164388-X
ISSN	1742-7622
ISSN	1742-7622
DOI	10.1186/s12982-022-00115-w
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Article ; Online: How valid are women's reports of the antenatal health services they receive from Community Health Workers in Gombe State north-eastern Nigeria?

Olal, Emmanuel / Umar, Nasir / Anyanti, Jennifer / Hill, Zelee / Marchant, Tanya

BMC pregnancy and childbirth

2022 Volume 22, Issue 1, Page(s) 898

Abstract: Background: Community health workers (CHWs) in low- and middle-income countries are key to increasing coverage of maternal and newborn interventions through home visits to counsel families about healthy behaviours. Household surveys enable tracking the ... ...

Abstract	Background: Community health workers (CHWs) in low- and middle-income countries are key to increasing coverage of maternal and newborn interventions through home visits to counsel families about healthy behaviours. Household surveys enable tracking the progress of CHW programmes but recent evidence questions the accuracy of maternal reports. We measured the validity of women's responses about the content of care they received during CHW home visits and examined whether the accuracy of women's responses was affected by CHW counselling skills. Methods: We conducted a criterion validity study in 2019, in Gombe State-Nigeria, and collected data from 362 pregnant women. During accompanied CHW home visits the content of CHW care and the presence or absence of 18 positive counselling skills were observed and documented by a researcher. In a follow-up interview three months later, the same women were asked about the care received during the CHW home visit. Women's reports were compared with observation data and the sensitivity, specificity, and area under receiver curve (AUC) calculated. We performed a covariate validity analysis that adjusted for a counselling skill score to assess the variation in accuracy of women's reports with CHW counselling skills. Results: Ten indicators were included in the validity analysis. Women consistently overestimated the content of care CHWs provided and no indicator met the condition for individual-level accuracy set at AUC ≥ 0.6. The CHW counselling skill score ranged from 9-18 points from a possible 18, with a mean of 14.3; checking on client history or concerns were the most frequently missed item. There was evidence that unmarried women and the relatively most poor women received less skilled counselling than other women (mean counselling scores of 13.2 and 13.7 respectively). There was no consistent evidence of an association between higher counselling skill scores and better accuracy of women's reports. Conclusions: The validity of women's responses about CHW care content was poor and consistently overestimated coverage. We discuss several challenges in applying criterion validity study methods to examine measures of community-based care and make only cautious interpretation of the findings that may be relevant to other researchers interested in developing similar studies.
MeSH term(s)	Pregnancy ; Infant, Newborn ; Female ; Humans ; Male ; Community Health Workers ; Nigeria ; Health Services ; House Calls ; Data Collection
Language	English
Publishing date	2022-12-03
Publishing country	England
Document type	Journal Article
ZDB-ID	2059869-5
ISSN	1471-2393 ; 1471-2393
ISSN (online)	1471-2393
ISSN	1471-2393
DOI	10.1186/s12884-022-05220-x
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Article ; Online: Cost-effectiveness of a radio intervention to stimulate early childhood development: protocol for an economic evaluation of the SUNRISE trial in Burkina Faso.

Palmer, Tom / Clare, Abbie / Fearon, Pasco / Head, Roy / Hill, Zelee / Kagone, Bassirou / Kirkwood, Betty / Manu, Alexander / Skordis, Jolene

BMJ open

2024 Volume 14, Issue 4, Page(s) e080905

Abstract: Introduction: Approximately 250 million children under 5 years of age are at risk of poor development in low-income and middle-income countries. However, existing early childhood development (ECD) interventions can be expensive, labour intensive and ... ...

Abstract	Introduction: Approximately 250 million children under 5 years of age are at risk of poor development in low-income and middle-income countries. However, existing early childhood development (ECD) interventions can be expensive, labour intensive and challenging to deliver at scale. Mass media may offer an alternative approach to ECD intervention. This protocol describes the planned economic evaluation of a cluster-randomised controlled trial of a radio campaign promoting responsive caregiving and opportunities for early learning during the first 3 years of life in rural Burkina Faso ( Methods and analysis: The economic evaluation of the Ethics and dissemination: The Trial registration number: The
MeSH term(s)	Child ; Female ; Pregnancy ; Humans ; Child, Preschool ; Cost-Benefit Analysis ; Burkina Faso ; Child Development ; Hygiene ; Labor, Obstetric ; Randomized Controlled Trials as Topic
Language	English
Publishing date	2024-04-16
Publishing country	England
Document type	Clinical Trial Protocol ; Journal Article
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2023-080905
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Article ; Online: "Everything is from God but it is always better to get to the hospital on time": A qualitative study with community members to identify factors that influence facility delivery in Gombe State, Nigeria.

Hill, Zelee / Scheelbeek, Pauline / Schellenberg, Joanna / Hamza, Yashua

Global health action

2020 Volume 13, Issue 1, Page(s) 1785735

Abstract: Background: Nigeria has one of the highest maternal mortality rates in the world, but facility delivery levels are relatively low and stagnant. Few qualitative studies have explored this issue and most have focused on barriers to utilization, much can ... ...

Abstract	Background: Nigeria has one of the highest maternal mortality rates in the world, but facility delivery levels are relatively low and stagnant. Few qualitative studies have explored this issue and most have focused on barriers to utilization, much can be learnt from women who already deliver in facilities. Objectives: We aimed to identify facilitators and barriers to facility delivery in Gombe State in North East Nigeria with a focus on women who have had a facility delivery. Methods: We conducted 24 narrative and in-depth interviews with mothers, and 16 focus-group-discussions with mothers, fathers, grandmothers and community health workers. Data were collected in Hausa, and transcribed and translated into English. Preliminary data analysis was conducted through team workshops, followed by systematic coding of the transcripts. Initial themes were identified a priori from the research questions and others emerged during coding. Results: A safe delivery was the main motivator for facility delivery, with facilities considered safe because of the presence of a trained health worker, the detection and management of problems, the availability of medicines and good hygiene. Those who delivered in a facility had a desire to be modern and rejected traditional practices. Decision-making power, social norms, accessibility, cost and perceived poor quality of care were reported as barriers. Community health workers, when they reached households, provided information on the benefits of facility delivery, stressed that times were changing, provided practical help such as arranging transport and, by accompanying families to the facility, brokered better quality of care and provided social support. Conclusion: This study highlights both the facilitators and barriers to facility delivery, and demonstrates the need for interventions to address a wide range of issues at multiple levels.
MeSH term(s)	Delivery, Obstetric ; Female ; Focus Groups ; Hospitals ; Humans ; Maternal Health Services/organization & administration ; Mothers ; Motivation ; Nigeria ; Pregnancy ; Qualitative Research ; Social Support
Language	English
Publishing date	2020-07-15
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2540569-X
ISSN	1654-9880 ; 1654-9880
ISSN (online)	1654-9880
ISSN	1654-9880
DOI	10.1080/16549716.2020.1785735
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Article: 'The false reporter will get a praise and the one who reported truth will be discouraged': a qualitative study on intentional data falsification by frontline maternal and newborn healthcare workers in two regions in Ethiopia.

Estifanos, Abiy Seifu / Gezahegn, Rediet / Keraga, Dorka Woldesenbet / Kifle, Abiyou / Procureur, Fanny / Hill, Zelee

BMJ global health

2022 Volume 7, Issue 4

Abstract: Introduction: Health Management Information Systems (HMIS) are vital to ensure accountability and for making decisions including for tracking the Sustainable Development Goals. The Ethiopia Health Sector Transformation Plan II includes preventing data ... ...

Abstract	Introduction: Health Management Information Systems (HMIS) are vital to ensure accountability and for making decisions including for tracking the Sustainable Development Goals. The Ethiopia Health Sector Transformation Plan II includes preventing data falsification as a major strategic initiative and our study aimed to explore the reasons why healthcare providers intentionally falsify maternal and newborn health (MNH) data in two regions of Ethiopia. Methods: We conducted a qualitative study in two hospitals, four health centres and their associated health posts in Oromia and Amhara regions. We conducted 45 in-depth interviews with health facility managers, quality improvement (QI) focal persons, health information technicians, MNH care providers, Health Extension Workers and QI mentors. Data were collected in local languages and transcribed in English. During analysis we repeatedly read the transcripts, coded them inductively using NVivo V.12, and categorised the codes into themes. Results: Participants were hesitant to report personal data falsification but many reported that falsification is common and that they had experienced it in other facilities or had been told about it by other health workers. Falsification was mostly inflating the number of services provided (such as deliveries). Decreasing the number of deaths or reclassifying neonatal death into stillbirths was also reported. An overarching theme was that the health system focuses on, and rewards, the number of services provided over any other metric. This focus led to both system and individual level incentives for falsification and disincentives for accurate reporting. Conclusion: Our finding suggests that to reduce facility level data falsification policy makers might consider disentangling reward and punishments from the performance reports based on the routine HMIS data. Further studies examining the high-level drivers of falsification at regional, national and global levels and effective interventions to address the drivers of data falsification are needed.
MeSH term(s)	Ethiopia ; Female ; Health Personnel ; Humans ; Infant, Newborn ; Maternal Health ; Maternal Health Services ; Pregnancy ; Qualitative Research
Language	English
Publishing date	2022-04-17
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2059-7908
ISSN	2059-7908
DOI	10.1136/bmjgh-2021-008260
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Article ; Online: Parental experiences of childcare in an informal urban settlement: qualitative interview findings from the Nairobi Early Childcare in Slums (NECS) project.

Hughes, Robert C / Muendo, Ruth / Bhopal, Sunil S / Onyango, Silas / Kimani-Murage, Elizabeth W / Kirkwood, Betty R / Hill, Zelee / Kitsao-Wekulo, Patricia

BMJ open

2023 Volume 13, Issue 4, Page(s) e071627

Abstract: Objectives: To gain an in-depth understanding of parent/carers' perspectives on, and decision-making about, early childhood care in general, and paid childcare specifically, in informal settlements in Nairobi.: Design: In-depth telephone interviews, ... ...

Abstract	Objectives: To gain an in-depth understanding of parent/carers' perspectives on, and decision-making about, early childhood care in general, and paid childcare specifically, in informal settlements in Nairobi. Design: In-depth telephone interviews, conducted using a topic guide, were analysed through a combination of deductive and inductive thematic analysis and regular reflexivity meetings. We explored parents' childcare needs and experiences over time, and their perspectives on the provision of paid childcare in the slums. Setting: Three informal settlements or slums in Nairobi: Kibera; Kawangware; and Mukuru-Viwandani. Participants: A purposively selected sample of 21 parental and non-parental carers of children aged under 5 years who were currently living in three Nairobi slums, including men and women, and users and non-users of paid childcare. Results: Childcare is complex, with a plurality of approaches being used. Common strategies include family member provided care (often but not exclusively by mothers, at home or at a place of work), paid childcare and informal or ad hoc arrangements with neighbours. Childcare decision-making in these settings is constrained by economics and the broader context of living in the slum. Paid childcare is frequently used, but is widely understood to be lacking in quality, especially for the poorest. Quality of childcare is understood to comprise a combination of structural factors, such as the physical space, play and learning resources and processes such as interactions between the care provider and children or parents. Conclusions: These findings suggest a need, and opportunity, to improve early childhood care in slums. Understanding parental perspectives on both the deficiencies and valued features of childcare is likely to be vital to informing efforts to improve childcare in these settings.
MeSH term(s)	Child ; Male ; Humans ; Female ; Child, Preschool ; Child Care ; Poverty Areas ; Kenya ; Parents ; Mothers
Language	English
Publishing date	2023-04-27
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2023-071627
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Article ; Online: Antiretroviral Adherence Perspectives of Pregnant and Postpartum Women in Guyana.

Vitalis, Deborah / Hill, Zelee

Journal of the International Association of Providers of AIDS Care

2017 Volume 16, Issue 2, Page(s) 180–188

Abstract: The Caribbean region has the second highest HIV prevalence after Sub-Saharan Africa. Guyana's adult HIV prevalence is 1.9% among pregnant women, with women accounting for an estimated 58% of all persons living with HIV. However, there are few studies on ... ...

Abstract	The Caribbean region has the second highest HIV prevalence after Sub-Saharan Africa. Guyana's adult HIV prevalence is 1.9% among pregnant women, with women accounting for an estimated 58% of all persons living with HIV. However, there are few studies on ART adherence in the Caribbean, none from Guyana, and none focusing on adherence in pregnancy and the postpartum period. The objective of this study was to explore the perspectives of HIV-infected pregnant and postpartum women and healthcare providers in Guyana about barriers and facilitators to ART adherence. Data was collected using semi-structured interviews with 24 HIV-infected pregnant and postpartum women and nine healthcare professionals at five clinics between February and April 2012. The Framework Method for analysing qualitative data identified facilitators and barriers related to five core themes: (i) Concern for wellbeing of children; (ii) ART-related factors; (iii) Disclosure; (iv) Socio-economic issues; and (v) Religious and cultural beliefs. Non-disclosure did not adversely affect adherence, contrary to other studies in the literature. Two broad categories emerged from the lived experiences of women in Guyana. The first is related to the act of actually taking their medication where their tenacity is displayed in efforts made to ensure ART is taken. The second relates to the significance of ART to them in terms of reduced risk of MTCT, and the possibility of better health for themselves to enable them to care for their children. However, issues related to poverty, food insecurity and side effects reduced adherence need to be adequately addressed.
MeSH term(s)	Adolescent ; Adult ; Anti-Retroviral Agents/adverse effects ; Anti-Retroviral Agents/therapeutic use ; Disclosure ; Female ; Guyana ; HIV Infections/drug therapy ; HIV Infections/ethnology ; HIV Infections/psychology ; Health Knowledge, Attitudes, Practice ; Health Personnel/psychology ; Humans ; Medication Adherence/statistics & numerical data ; Middle Aged ; Postpartum Period/psychology ; Pregnancy ; Pregnancy Complications, Infectious/drug therapy ; Pregnancy Complications, Infectious/ethnology ; Pregnancy Complications, Infectious/psychology ; Young Adult
Chemical Substances	Anti-Retroviral Agents
Language	English
Publishing date	2017-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2709037-1
ISSN	2325-9582 ; 2325-9574
ISSN (online)	2325-9582
ISSN	2325-9574
DOI	10.1177/2325957416680297
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