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Article ; Online: Challenges and needed reforms in midwifery and nursing regulatory systems in India

Kaveri Mayra / Sabu S Padmadas / Zoë Matthews

PLoS ONE, Vol 16, Iss 5, p e

Implications for education and practice.

2021 Volume 0251331

Abstract: Background In India, nursing regulation is generally weak, midwifery coexists with nursing, and 88% of nursing and midwifery education is provided by the private health sector. The Indian health system faces major challenges for health care provision due ...

Abstract	Background In India, nursing regulation is generally weak, midwifery coexists with nursing, and 88% of nursing and midwifery education is provided by the private health sector. The Indian health system faces major challenges for health care provision due to poor quality, indeterminate regulatory functions and lack of reforms. Methods We undertook a qualitative investigation to understand midwifery and nursing education, and regulatory systems in India, through a review of the regulatory Acts, and an investigation of the perceptions and experiences of senior midwifery and nursing leaders representing administration, advocacy, education, regulation, research and service provision in India with an international perspective. Results There is a lack of importance accorded to midwifery roles within the nursing system. The councils and Acts do not adequately reflect midwifery practice, and remain a barrier to good quality care provision. The lack of required amendment of Acts, lack of representation of midwives and nurses in key governance positions in councils and committees have restrained and undermined leadership positions, which have also impaired the growth of the professions. A lack of opportunities for professional practice and unfair assessment practices are critical concerns affecting the quality of nursing and midwifery education in private institutions across India. Midwifery and nursing students are generally more vulnerable to discrimination and have less opportunities compared to medical students exacerbated by the gender-based challenges. Conclusions India is on the verge of a major regulatory reform with the National Nursing and Midwifery Commission Bill, 2020 being drafted, which makes this study a crucial and timely contribution. Our findings present the challenges that need to be addressed with regulatory reforms to enable opportunities for direct-entry into the midwifery profession, improving nursing education and practice by empowering midwives and nurses with decision-making powers for nursing and midwifery workforce governance.
Keywords	Medicine ; R ; Science ; Q
Subject code	360
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Inequalities in Human Well-Being in the Urban Ganges Brahmaputra Meghna Delta

Sylvia Szabo / Rituparna Hajra / Angela Baschieri / Zoe Matthews

Sustainability, Vol 8, Iss 7, p

2016 Volume 608

Abstract: The recently endorsed Sustainable Development Goals (SDGs) agenda unanimously agrees on the need to focus on inclusive development, the importance of eradicating extreme poverty and managing often complex human well-being impacts of rapid urban growth. ... ...

Abstract	The recently endorsed Sustainable Development Goals (SDGs) agenda unanimously agrees on the need to focus on inclusive development, the importance of eradicating extreme poverty and managing often complex human well-being impacts of rapid urban growth. Sustainable and inclusive urbanisation will accelerate progress towards the SDGs and contribute to eradicating extreme poverty. In tropical delta regions, such as the Ganges Brahmaputra Meghna delta region, urban growth and resulting intra-urban inequalities are accelerated by the impact of environmental and climate change. In this context, the present study uses the 2010 Household Income and Expenditure Survey to analyse the extent of wealth-based inequalities in human well-being in the urban delta region and the determinants of selected welfare measures. The results suggest that the extent of intra-urban inequalities is greatest in educational attainment and access to postnatal healthcare and relatively low in the occurrence of gastric disease. The paper concludes by providing policy recommendations to reduce increasing wealth inequalities in urban areas, thus contributing to sustainable development of the region.
Keywords	inequalities ; human well-being ; urbanisation ; sustainable development ; Bangladesh ; Ganges Brahmaputra Meghna delta ; Environmental effects of industries and plants ; TD194-195 ; Renewable energy sources ; TJ807-830 ; Environmental sciences ; GE1-350
Subject code	710
Language	English
Publishing date	2016-06-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Assessing safe and personalised maternity and neonatal care through a pandemic

Sarah Neal / Lucy Stone / Gill Moncrieff / Zoë Matthews / Carol Kingdon / Anastasia Topalidou / Marie-Clare Balaam / Sarah Cordey / Nicola Crossland / Claire Feeley / Deborah Powney / Arni Sarian / Alan Fenton / Alexander E P Heazell / Ank de Jonge / Alexandra Severns / Gill Thomson / Soo Downe

BMC Health Services Research, Vol 23, Iss 1, Pp 1-

a case study of outcomes and experiences in two trusts in England using the ASPIRE COVID-19 framework

2023 Volume 18

Abstract: Abstract Background The COVID-19 pandemic has resulted in profound and far-reaching impacts on maternal and newborn care and outcomes. As part of the ASPIRE COVID-19 project, we describe processes and outcome measures relating to safe and personalised ... ...

Abstract	Abstract Background The COVID-19 pandemic has resulted in profound and far-reaching impacts on maternal and newborn care and outcomes. As part of the ASPIRE COVID-19 project, we describe processes and outcome measures relating to safe and personalised maternity care in England which we map against a pre-developed ASPIRE framework to establish the potential impact of the COVID-19 pandemic for two UK trusts. Methods We undertook a mixed-methods system-wide case study using quantitative routinely collected data and qualitative data from two Trusts and their service users from 2019 to 2021 (start and completion dates varied by available data). We mapped findings to our prior ASPIRE conceptual framework that explains pathways for the impact of COVID-19 on safe and personalised care. Results The ASPIRE framework enabled us to develop a comprehensive, systems-level understanding of the impact of the pandemic on service delivery, user experience and staff wellbeing, and place it within the context of pre-existing challenges. Maternity services experienced some impacts on core service coverage, though not on Trust level clinical health outcomes (with the possible exception of readmissions in one Trust). Both users and staff found some pandemic-driven changes challenging such as remote or reduced antenatal and community postnatal contacts, and restrictions on companionship. Other key changes included an increased need for mental health support, changes in the availability and uptake of home birth services and changes in induction procedures. Many emergency adaptations persisted at the end of data collection. Differences between the trusts indicate complex change pathways. Staff reported some removal of bureaucracy, which allowed greater flexibility. During the first wave of COVID-19 staffing numbers increased, resolving some pre-pandemic shortages: however, by October 2021 they declined markedly. Trying to maintain the quality and availability of services had marked negative consequences for personnel. Timely routine ...
Keywords	COVID-19 ; Maternal health services ; Midwifery ; Crises ; Case study ; Organisational evaluation framework ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2023-06-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Health workforce demography

Sylvia Szabo / Andrea Nove / Zoë Matthews / Ashish Bajracharya / Ibadat Dhillon / Devendra Raj Singh / Aurora Saares / James Campbell

Human Resources for Health, Vol 18, Iss 1, Pp 1-

a framework to improve understanding of the health workforce and support achievement of the Sustainable Development Goals

2020 Volume 10

Abstract: Abstract The ambition of universal health coverage entails estimation of the number, type and distribution of health workers required to meet the population need for health services. The demography of the population, including anticipated or estimated ... ...

Abstract	Abstract The ambition of universal health coverage entails estimation of the number, type and distribution of health workers required to meet the population need for health services. The demography of the population, including anticipated or estimated changes, is a factor in determining the ‘universal’ needs for health and well-being. Demography is concerned with the size, breakdown, age and gender structure and dynamics of a population. The same science, and its robust methodologies, is equally applicable to the demography of the health workforce itself. For example, a large percentage of the workforce close to retirement will impact availability, a geographically mobile workforce has implications for health coverage, and gender distribution in occupations may have implications for workforce acceptability and equity of opportunity. In a world with an overall shortage of health workers, and the expectation of increasing need as a result of both population growth in the global south and population ageing in the global north, studying and understanding demographic characteristics of the workforce can help with future planning. This paper discusses the dimensions of health worker demography and considers how demographic tools and techniques can be applied to the analysis of the health labour market. A conceptual framework is introduced as a step towards the application of demographic principles and techniques to health workforce analysis and planning exercises as countries work towards universal health coverage, the reduction of inequities and national development targets. Some illustrative data from Nepal and Finland are shown to illustrate the potential of this framework as a simple and effective contribution to health workforce planning.
Keywords	Human resources for health ; Health workforce planning ; Health needs ; Demand for health care ; Nepal ; Finland ; Medicine (General) ; R5-920 ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Are women deciding against home births in low and middle income countries?

Fiifi Amoako Johnson / Sabu S Padmadas / Zoë Matthews

PLoS ONE, Vol 8, Iss 6, p e

2013 Volume 65527

Abstract: Background Although there is evidence to tracking progress towards facility births within the UN Millennium Development Goals framework, we do not know whether women are deciding against home birth over their reproductive lives. Using Demographic and ... ...

Abstract	Background Although there is evidence to tracking progress towards facility births within the UN Millennium Development Goals framework, we do not know whether women are deciding against home birth over their reproductive lives. Using Demographic and Health Surveys (DHS) data from 44 countries, this study aims to investigate the patterns and shifts in childbirth locations and to determine whether these shifts are in favour of home or health settings. Methods and findings The analyses considered 108,777 women who had at least two births in the five years preceding the most recent DHS over the period 2000-2010. The vast majority of women opted for the same place of childbirth for their successive births. However, about 14% did switch their place and not all these decisions favoured health facility over home setting. In 24 of the 44 countries analysed, a higher proportion of women switched from a health facility to home. Multilevel regression analyses show significantly higher odds of switching from home to a facility for high parity women, those with frequent antenatal visits and more wealth. However, in countries with high infant mortality rates, low parity women had an increased probability of switching from home to a health facility. Conclusions There is clear evidence that women do change their childbirth locations over successive births in low and middle income countries. After two decades of efforts to improve maternal health, it might be expected that a higher proportion of women will be deciding against home births in favour of facility births. The results from this analysis show that is not the case.
Keywords	Medicine ; R ; Science ; Q
Subject code	300
Language	English
Publishing date	2013-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The State of the World’s Midwifery 2021 report

Andrea Nove / Petra ten Hoope-Bender / Martin Boyce / Sarah Bar-Zeev / Luc de Bernis / Geeta Lal / Zoë Matthews / Million Mekuria / Caroline S. E. Homer

Human Resources for Health, Vol 19, Iss 1, Pp 1-

findings to drive global policy and practice

2021 Volume 7

Abstract: Abstract The third global State of the World’s Midwifery report (SoWMy 2021) provides an updated evidence base on the sexual, reproductive, maternal, newborn and adolescent health (SRMNAH) workforce. For the first time, SoWMy includes high-income ... ...

Abstract	Abstract The third global State of the World’s Midwifery report (SoWMy 2021) provides an updated evidence base on the sexual, reproductive, maternal, newborn and adolescent health (SRMNAH) workforce. For the first time, SoWMy includes high-income countries (HICs) as well as low- and middle-income countries. This paper describes the similarities and differences between regions and income groups, and discusses the policy implications of these variations. SoWMy 2021 estimates a global shortage of 900,000 midwives, which is particularly acute in low-income countries (LICs) and in Africa. The shortage is projected to improve only slightly by 2030 unless additional investments are made. The evidence suggests that these investments would yield important returns, including: more positive birth experiences, improved health outcomes, and inclusive and equitable economic growth. Most HICs have sufficient SRMNAH workers to meet the need for essential interventions, and their education and regulatory environments tend to be strong. Upper-middle-income countries also tend to have strong policy environments. LICs and lower-middle-income countries tend to have a broader scope of practice for midwives, and many also have midwives in leadership positions within national government. Key regional variations include: major midwife shortages in Africa and South-East Asia but more promising signs of growth in South-East Asia than in Africa; a strong focus in Africa on professional midwives (rather than associate professionals: the norm in many South-East Asian countries); heavy reliance on medical doctors rather than midwives in the Americas and Eastern Mediterranean regions and parts of the Western Pacific; and a strong educational and regulatory environment in Europe but a lack of midwife leaders at national level. SoWMy 2021 provides stakeholders with the latest data and information to inform their efforts to build back better and fairer after COVID-19. This paper provides a number of policy responses to SoWMy 2021 that are ...
Keywords	Midwives ; Midwifery ; Human resources for health ; Health workforce ; Sexual ; reproductive ; maternal ; newborn and adolescent health ; Medicine (General) ; R5-920 ; Public aspects of medicine ; RA1-1270
Subject code	306 ; 360
Language	English
Publishing date	2021-11-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: A review of geospatial methods for population estimation and their use in constructing reproductive, maternal, newborn, child and adolescent health service indicators

Kristine Nilsen / Natalia Tejedor-Garavito / Douglas R. Leasure / C. Edson Utazi / Corrine W. Ruktanonchai / Adelle S. Wigley / Claire A. Dooley / Zoe Matthews / Andrew J. Tatem

BMC Health Services Research, Vol 21, Iss S1, Pp 1-

2021 Volume 10

Abstract: Abstract Background Household survey data are frequently used to measure reproductive, maternal, newborn, child and adolescent health (RMNCAH) service utilisation in low and middle income countries. However, these surveys are typically only undertaken ... ...

Abstract	Abstract Background Household survey data are frequently used to measure reproductive, maternal, newborn, child and adolescent health (RMNCAH) service utilisation in low and middle income countries. However, these surveys are typically only undertaken every 5 years and tend to be representative of larger geographical administrative units. Investments in district health management information systems (DHMIS) have increased the capability of countries to collect continuous information on the provision of RMNCAH services at health facilities. However, reliable and recent data on population distributions and demographics at subnational levels necessary to construct RMNCAH coverage indicators are often missing. One solution is to use spatially disaggregated gridded datasets containing modelled estimates of population counts. Here, we provide an overview of various approaches to the production of gridded demographic datasets and outline their potential and their limitations. Further, we show how gridded population estimates can be used as alternative denominators to produce RMNCAH coverage metrics in combination with data from DHMIS, using childhood vaccination as examples. Methods We constructed indicators on the percentage of children one year old for diphtheria, pertussis and tetanus vaccine dose 3 (DTP3) and measles vaccine dose (MCV1) in Zambia and Nigeria at district levels. For the numerators, information on vaccines doses was obtained from each country’s respective DHMIS. For the denominators, the number of children was obtained from 3 different sources including national population projections and aggregated gridded estimates derived using top-down and bottom-up geospatial methods. Results In Zambia, vaccination estimates utilising the bottom-up approach to population estimation substantially reduced the number of districts with > 100% coverage of DTP3 and MCV1 compared to estimates using population projection and the top-down method. In Nigeria, results were mixed with bottom-up estimates having a higher ...
Keywords	RMNCAH ; Subnational estimation ; Universal coverage ; Denominators ; Gridded data sets ; Geospatial modelling ; Public aspects of medicine ; RA1-1270
Subject code	310
Language	English
Publishing date	2021-09-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Food and nutrition security trends and challenges in the Ganges Brahmaputra Meghna (GBM) delta

Arnout van Soesbergen / Kristine Nilsen / Neil D. Burgess / Sylvia Szabo / Zoë Matthews

Elementa: Science of the Anthropocene, Vol

2017 Volume 5

Abstract: The population of the Ganges Brahmaputra Meghna (GBM) delta is highly vulnerable to food insecurity and malnutrition due to the specific environmental, climatic and human development factors affecting agricultural production and fisheries. To better ... ...

Abstract	The population of the Ganges Brahmaputra Meghna (GBM) delta is highly vulnerable to food insecurity and malnutrition due to the specific environmental, climatic and human development factors affecting agricultural production and fisheries. To better understand the impacts of climate and environmental change on food security and nutrition in this delta, this study combines spatially explicit data from the 2007 and 2011 Bangladesh Demographic and Health Survey (BDHS) with a standard satellite remotely sensed vegetation greenness index (Normalised Difference Vegetation Index, NDVI), used as a proxy for rice production. The strength of association between NDVI and child nutrition in this tropical mega-delta were tested, showing correlations between two widely used indicators of child malnutrition; stunting and wasting, and deviations from a 10 year mean NDVI (anomalies) for rice crop growing seasons – regarded as critical to individual children’s early lives. For children surveyed in 2007 we found that the likelihood of being stunted decreased with increased NDVI as a measure of food production. Similarly, for children surveyed in 2011, the likelihood of being wasted reduced with increased NDVI. However, regression results for stunting in 2011 and wasting in 2007 were not statistically significant. Our findings suggest that NDVI can be regarded as indicative of climatic variability and periods of low food production but is only partly successful as an indicator of climate related impacts on child nutrition in the GBM delta. Furthermore, our study highlights some of the uncertainties and challenges with linking environmental indicators such as the NDVI with household survey data across spatial and temporal scales.
Keywords	GBM Delta ; nutrition ; climate change ; NDVI ; stunting ; wasting ; Environmental sciences ; GE1-350
Subject code	333
Language	English
Publishing date	2017-09-01T00:00:00Z
Publisher	BioOne
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Unravelling the association between the impact of natural hazards and household poverty: evidence from the Indian Sundarban delta

Hajra, Rituparna / Sylvia Szabo / Zachary Tessler / Tuhin Ghosh / Zoe Matthews / Efi Foufoula-Georgiou

Sustainability science. 2017 May, v. 12, no. 3

2017

Abstract: Coastal regions have long been settled by humans due to their abundant resources for livelihoods, including agriculture, transportation, and rich biodiversity. However, natural and anthropogenic factors, such as climate change and sea-level rise, and ... ...

Abstract	Coastal regions have long been settled by humans due to their abundant resources for livelihoods, including agriculture, transportation, and rich biodiversity. However, natural and anthropogenic factors, such as climate change and sea-level rise, and land subsidence, population pressure, developmental activities, pose threats to coastal sustainability. Natural hazards, such as fluvial or coastal floods, impact poorer and more vulnerable communities greater than more affluent communities. Quantitative assessments of how natural hazards affect vulnerable communities in deltaic regions are still limited, hampering the design of effective management strategies to increase household and community resilience. Drawing from Driving ForcesâPressureâStateâImpactâResponse (DPSIR), we quantify the associations between household poverty and the likelihood of material and human loss following a natural hazard using new survey data from 783 households within Indian Sundarban Delta community. The results suggest that the poorest households are significantly more likely to endure material and human losses following a natural hazard and repeated losses of livelihood make them more vulnerable to future risk. The results further suggest that salinization, tidal surge, erosion, and household location are also significant predictors of economic and human losses. Given the current and projected impact of climate change and importance of delta regions as the worldâs food baskets, poverty reduction and increase societal resilience should be a primary pathway to strengthen the resilience of the poorest populations inhabiting deltas.
Keywords	biodiversity ; climate change ; coasts ; floods ; households ; humans ; livelihood ; poverty ; risk ; sea level ; subsidence ; surveys ; transportation ; India
Language	English
Dates of publication	2017-05
Size	p. 453-464.
Publishing place	Springer Japan
Document type	Article
ZDB-ID	2260333-5
ISSN	1862-4057 ; 1862-4065
ISSN (online)	1862-4057
ISSN	1862-4065
DOI	10.1007/s11625-016-0420-2
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Excess risk of maternal mortality in adolescent mothers – Authors' reply

Andrea Nove / Zoë Matthews / Sarah Neal / Alma Virginia Camacho

The Lancet Global Health, Vol 2, Iss 4, p e

2014 Volume 202

Keywords	Public aspects of medicine ; RA1-1270
Language	English
Publishing date	2014-04-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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