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Mother-child health in Lacor-South Sudan (IMCHA)

Implementing comprehensive, community-focused primary health care is a major challenge in post-conflict regions such as South Sudan and neighbouring Northern Uganda. South Sudan is recovering from two decades of civil war that have destroyed education and health infrastructure. Torit Hospital, one of the major hospitals in the region, is poorly staffed and lacks specialists and basic equipment. The situation is similar in Northern Uganda. In the District of Gulu, the burden of disease has largely been managed through St. Mary's Hospital Lacor. This region has not been able to achieve the progress in maternal and child health that has been reached in the central part of Uganda.

This project assesses the implementation and scale of community-focused reproductive and child health interventions in post-conflict settings. It focuses on establishing evidence to promote sustainability and resilience, with the goal of ensuring access to essential health services by vulnerable populations. The researchers will explore strategies for improved maternal care and child nutrition services, cervical cancer screening, and support for women's empowerment through outreach efforts from the two hospitals.

Research findings will be validated through ministries of health at the local, district, and national levels to optimize engagement and to encourage adoption of the project's recommendations to strengthen systems. The results of the study will directly inform the ministries of health in South Sudan and in Uganda on related interventions, including a scalable model for improved community-based services. This will address barriers to interventions, reduce maternal and child mortality, and extend the reach of health services to communities that have faced shocks and stressors.

This is part of the Innovating for Maternal and Child Health in Africa (IMCHA) initiative, a seven year, $CA36 million multi-donor partnership funded by Global Affairs Canada, the Canadian Institutes of Health Research, and Canada's International Development Research Centre.
Objectives /

Identificador del Proyecto
108032
Estado de Proyecto
Completed
Fecha de finalización
Duración
54 months
Funcionario del IDRC
Qamar Mahmood
Total del financiamiento
CA$ 972,593.00
Ubicación
South Sudan
Uganda
Programas
Global Health
Innovating for Maternal and Child Health in Africa
País de la Institución
Canada
Líder del proyecto
Christina Zarowsky
Institución
Teasdale-Corti Foundation/Fondation Teasdale-Corti
País de la Institución
Uganda
Líder del proyecto
Emmanuel Ochola
Institución
St. Mary's Hospital Lacor

Publicaciones

Community views on short birth interval in Northern Uganda : a participatory grounded theory

Community views on short birth interval in Northern Uganda : a participatory grounded theory

Article

Women, men, and youth have clear understandings of the benefits of adequate child spacing. As women are disempowered to exercise child spacing, this knowledge is difficult to translate into practice. Women who use contraceptives without their husbands’ consent risk losing financial and social assets and are likely to be subject to intra-partner violence including forced intercourse. This detailed paper explores women’s experiences and community views on short birth intervals, to inform and promote culturally safe child spacing in Northern Uganda. A shorter breastfeeding period and the female gender of the previous child have been factors consistently associated with short birth intervals.

Autor(es) : Belaid, Loubna, Atim, Pamela, Ochola, Emmanuel, Omara, Bruno, Atim, Eunice

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Lenguaje: Inglés

Health policy mapping and system gaps impeding the implementation of reproductive, maternal, neonatal, child, and adolescent health programs in South Sudan : a scoping review

Health policy mapping and system gaps impeding the implementation of reproductive, maternal, neonatal, child, and adolescent health programs in South Sudan : a scoping review

Article

Conflict-affected settings impact the implementation of effective reproductive, maternal, newborn, child, and adolescent health (RMNCAH) programs and policies. Pregnant women, neonates, children, and adolescents are at higher risk of dying in fragile and conflict-affected settings. The article provides health policy background and context details charting RMNCAH data. South Sudan remains one of the most volatile states in the world. Ministry of Health (MoH) leadership along with enhanced governance and accountability mechanisms are key determinants for strengthened health systems. Due to the instability of the country and multiple international partner dynamics, the policy context changes quickly.

Autor(es) : Belaid, Loubna, Bayo, Pontius, Kamau, Lynette, Nakimuli, Eva, Omoro, Elijo

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Lenguaje: Inglés

Pro-equity legislation, health policy and utilisation of sexual and reproductive health services by vulnerable populations in sub-Saharan Africa : a systematic review

Pro-equity legislation, health policy and utilisation of sexual and reproductive health services by vulnerable populations in sub-Saharan Africa : a systematic review

Article

The study reviews original primary research that examined relationships between equity-focused legislation and policy, and the utilisation of sexual and reproductive health (SRH) services by vulnerable populations in sub-Saharan Africa. Findings show that health-related legislation and policy promoted an increase in service utilisation, over time, especially for antenatal care, skilled birth attendance and facility-based delivery. However, social health inequalities persist among subgroups of women. Neither the reviewed studies or policies specifically addressed youth, people living with HIV and people with disabilities. Compared to other regions worldwide, sub-Saharan Africa had the highest average maternal mortality ratio (2017) and HIV prevalence (2018).

Autor(es) : Mac-Seing, Muriel, Zinszer, Kate, Omenka, Charity Oga, Beaudrap, Pierre de, Mehrabi, Fereshteh, Zarowsky, Christina

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Lenguaje: Inglés

Mothers’ perceptions of the practice of kangaroo mother care for preterm neonates in sub-Saharan Africa : a qualitative systematic review protocol

Mothers’ perceptions of the practice of kangaroo mother care for preterm neonates in sub-Saharan Africa : a qualitative systematic review protocol

Article

Kangaroo mother care (KMC) has been identified as an alternative way to care for low-birthweight (LBW) and preterm neonates. It promotes parent-child bonding and breastfeeding, and stabilizes the vital signs of the neonate, particularly body temperature and heart and respiratory rates, leading to increased weight gain and improved growth. KMC reduces the need for expensive conventional medical care, improves parental involvement in care provision and offers opportunities for health education. The article proposes a systematic review of the literature to identify barriers and to facilitate uptake of KMC.

Autor(es) : Bayo, Pontius, Alobo, Gasthony, Feyissa, Garumma Tolu, Belaid, Loubna

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Lenguaje: Inglés

Exploring the impact of a community participatory intervention on women’s capability : a qualitative study in Gulu Northern Uganda

Exploring the impact of a community participatory intervention on women’s capability : a qualitative study in Gulu Northern Uganda

Article

Community-based women’s groups using a participatory learning and action (PLA) cycle are effective in promoting maternal and child health. The PLA women’s group intervention encouraged health promotion activities and community mobilization in Gulu district, Uganda (2017). This area has a high burden of unmet needs in family planning, neonatal mortality, teenage pregnancy, and child mortality. The women’s group enabled participants to adopt behaviours to protect their health and their children’s health at individual and community levels. Women extended their agency to control financial resources and developed strategies to stop domestic violence. As a result, there was a reduction in mistreatment of children.

Autor(es) : Belaid, Loubna, Ochola, Emmanuel, Bayo, Pontius, Alii, George William, Ogwang, Martin

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Lenguaje: Inglés

Intersectional jeopardy of disability, gender and sexual and reproductive health : experiences and recommendations of women and men with disabilities in Northern Uganda

Intersectional jeopardy of disability, gender and sexual and reproductive health : experiences and recommendations of women and men with disabilities in Northern Uganda

Article

The study works to better understand and document how people with disabilities perceive the relationships between their use of sexual and reproductive health (SHR) services, legislation and health policy in three Northern districts of post-conflict Uganda (Gulu, Amuru, Omoro). Findings from interview participants reveal that disabled people’s access to SHR services is shaped by intersections of gender, disability, and violence. They experience discrimination across both private-for-profit and public health facilities. The voices of participants reflected in this article add clarity to the findings. The 2030 Sustainable Development Goals committed to “Leave No One Behind” regardless of social identity.

Autor(es) : Mac-Seing, Muriel, Zinszer, Kate, Eryong, Bryan, Ajok, Emma, Ferlatte, Olivier, Zarowskye, Christina

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Lenguaje: Inglés

Policy implementation challenges and barriers to access sexual and reproductive health services faced by people with disabilities : an intersectional analysis of policy actors’ perspectives in post-conflict Northern Uganda

Policy implementation challenges and barriers to access sexual and reproductive health services faced by people with disabilities : an intersectional analysis of policy actors’ perspectives in post-conflict Northern Uganda

Article

Emerging from 20 years of armed conflict, Uganda adopted laws and policies to protect the rights of people with disabilities, including sexual and reproductive health (SRH) rights. This study reflects on the difficulty of implementing disability-focused policy in Uganda. One fifth of the country’s population was estimated to live with some disability (2008). Armed conflict between the Government and the Lord’s Resistance Army caused breakdowns in social systems, and generated widespread trauma for Northern Ugandans. An intersectionality-informed analysis enables policy makers and researchers to examine intersecting social identities and diverse sources of knowledge that can contribute to improved policy solutions.

Autor(es) : Mac-Seing, Muriel, Ochola, Emmanuel, Ogwang, Martin, Zinszer, Kate, Zarowsky, Christina

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Lenguaje: Inglés

Méta-synthèse sur le genre, le handicap et la santé reproductive en Afrique subsaharienne

Méta-synthèse sur le genre, le handicap et la santé reproductive en Afrique subsaharienne

Articles de revue

Autor(es) : Mac-Seing, Muriel, Zarowsky, Christina

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Lenguaje: French

Communities and service providers address access to perinatal care in postconflict Northern Uganda : socialising evidence for participatory action

Communities and service providers address access to perinatal care in postconflict Northern Uganda : socialising evidence for participatory action

Article

Participatory service improvement is feasible and acceptable in post-conflict settings like Northern Uganda. The study engaged stakeholder participants who identified obstructions to accessing perinatal care: lack of savings for childbirth costs in facility-based delivery, lack of male partner support, and poor service provider attitudes. The civil war in Northern Uganda (1986– 2006) displaced more than 90% of the population of that region. Northern Uganda has among the highest global maternal mortality rates (610 per 100,000 live births). Engaging communities in identifying perinatal service delivery issues can generate community-led solutions and increases trust between community members and service providers.

Autor(es) : Belaid, Loubna, Atim, Pamela, Atim, Eunice, Ochola, Emmanuel, Ogwang, Martin

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Lenguaje: Inglés

“Midwives do not appreciate pregnant women who come to the maternity with torn and dirty clothing” : institutional delivery and postnatal care in Torit County, South Sudan - a mixed method study

“Midwives do not appreciate pregnant women who come to the maternity with torn and dirty clothing” : institutional delivery and postnatal care in Torit County, South Sudan - a mixed method study

Article

This detailed study examines the prevalence of factors that affect utilization of health facilities for routine delivery and postnatal care in Torit County, South Sudan. Women were more likely to plan and prepare for home delivery than for institutional delivery, and sought institutional delivery when complications arose. Perceived poor quality of care due to absence of health personnel and lack of supplies was reported as a major barrier to institutional delivery. Women emphasized fear of discrimination based on social and economic status. All categories of participants reported insecurity, distance and the lack of transport as important deterrents to access for health care services.

Autor(es) : Bayo, Pontius, Belaid, Loubna, Tahir, Elijo Omoro, Ochola, Emmanuel, Dimiti, Alexander

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Lenguaje: Inglés

Why women die after reaching the hospital : a qualitative critical incident analysis of the ‘third delay’ in postconflict northern Uganda

Why women die after reaching the hospital : a qualitative critical incident analysis of the ‘third delay’ in postconflict northern Uganda

Article

After reaching the health facility, a pregnant woman goes through a complex pathway that leads to delays in receiving emergency obstetrics and newborn care (EmONC). Five reasons were identified: shortage of medicines and supplies, lack of blood and functionality of operating theatres, gaps in staff coverage, gaps in staff skills, and delays in the interfacility referral system. Shortage of medicines and supplies was central in most of the pathways. Improvement of skills, better management of meagre human resources, and availability of essential medical supplies in health facilities may help increase emergency readiness.

Autor(es) : Alobo, Gasthony, Ochola, Emmanuel, Bayo, Pontius, Muhereza, Alex, Nahurira, Violah, Byamugisha, Josaphat

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Lenguaje: Inglés