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Santé des mères et des enfants à l'hôpital Lacor, au Soudan du Sud (ISMEA)

La mise en ¿uvre d'un système communautaire complet de soins de santé primaires constitue un important défi dans des régions comme le Soudan du Sud et le nord de l'Ouganda qui ont été marquées par des conflits. Le Soudan du Sud se rétablit après deux décennies de guerre civile durant lesquelles l'infrastructure des soins de santé et du système d'éducation a été détruite. L'hôpital Torit, l'un des principaux hôpitaux de la région, manque de personnel qualifié, et surtout de spécialistes et de l'équipement de base. La situation est semblable dans le nord de l'Ouganda. Dans le district de Gulu, c'est l'hôpital St. Mary's Lacor qui assume la plus grande partie de la charge de morbidité. Cette région n'a pas été en mesure de réaliser les progrès en matière de santé des mères et des enfants obtenus dans le centre de l'Ouganda.

Ce projet vise à évaluer la mise en ¿uvre et la portée des interventions communautaires en matière de santé génésique et infantile dans les régions qui ont été marquées par des conflits. Il se concentre sur l'établissement de données probantes afin de promouvoir la durabilité et la résilience, dans le but d'assurer à des populations vulnérables l'accès à des services de santé essentiels. Les chercheurs examineront des stratégies visant à mettre en ¿uvre des services améliorés de soins de santé maternelle et de nutrition infantile, de dépistage du cancer du col de l'utérus et de soutien en vue de l'autonomisation des femmes grâce à des activités d'interventions communautaires menées par les deux hôpitaux.

Les résultats des recherches seront validés par les administrations responsables de la santé à l'échelle locale, nationale et du district en vue d'optimiser la mobilisation et d'encourager l'adoption des recommandations du projet visant à renforcer les systèmes. Les résultats de l'étude orienteront directement les administrations responsables de la santé du Soudan du Sud et de l'Ouganda relativement aux interventions connexes, dont un modèle évolutif pour des services communautaires améliorés. Ce dernier se penchera sur les obstacles aux interventions, réduira la mortalité maternelle et infantile, et élargira la portée des services de santé dans les collectivités qui ont subi des bouleversements et des tensions.

Ce projet s'inscrit dans le cadre de l'initiative Innovation pour la santé des mères et des enfants d'Afrique (ISMEA), un projet de 36 millions CAD sur sept ans, financé par plusieurs bailleurs de fonds dont Affaires mondiales Canada, les Instituts de recherche en santé du Canada et le Centre de recherches pour le développement international.
Objectifs/

No projet
108032
État du projet
Terminé
Date de fin
Durée
54 months
Agent(e) responsable du crdi
Qamar Mahmood
Financement total
CA$ 972,593.00
Emplacement
Soudan du Sud
Ouganda
Programmes
Santé mondiale
Innovation pour la santé des mères et des enfants d’Afrique
Pays de l’institution
Canada
Chargé(e) de projet
Christina Zarowsky
Institution
Teasdale-Corti Foundation/Fondation Teasdale-Corti
Pays de l’institution
Uganda
Chargé(e) de projet
Emmanuel Ochola
Institution
St. Mary's Hospital Lacor

Résultats

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.

Auteur ou autrice(s) : Bayo, Pontius, Alobo, Gasthony, Feyissa, Garumma Tolu, Belaid, Loubna

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Langage : Anglais

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.

Auteur ou autrice(s) : Belaid, Loubna, Ochola, Emmanuel, Bayo, Pontius, Alii, George William, Ogwang, Martin

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Langage : Anglais

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.

Auteur ou autrice(s) : Mac-Seing, Muriel, Zinszer, Kate, Eryong, Bryan, Ajok, Emma, Ferlatte, Olivier, Zarowskye, Christina

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Langage : Anglais

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.

Auteur ou autrice(s) : Mac-Seing, Muriel, Ochola, Emmanuel, Ogwang, Martin, Zinszer, Kate, Zarowsky, Christina

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Langage : Anglais

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

Auteur ou autrice(s) : Mac-Seing, Muriel, Zarowsky, Christina

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Langage : 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.

Auteur ou autrice(s) : Belaid, Loubna, Atim, Pamela, Atim, Eunice, Ochola, Emmanuel, Ogwang, Martin

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Langage : Anglais

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.

Auteur ou autrice(s) : Belaid, Loubna, Atim, Pamela, Ochola, Emmanuel, Omara, Bruno, Atim, Eunice

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Langage : Anglais

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.

Auteur ou autrice(s) : Belaid, Loubna, Bayo, Pontius, Kamau, Lynette, Nakimuli, Eva, Omoro, Elijo

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Langage : Anglais

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).

Auteur ou autrice(s) : Mac-Seing, Muriel, Zinszer, Kate, Omenka, Charity Oga, Beaudrap, Pierre de, Mehrabi, Fereshteh, Zarowsky, Christina

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Langage : Anglais

“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.

Auteur ou autrice(s) : Bayo, Pontius, Belaid, Loubna, Tahir, Elijo Omoro, Ochola, Emmanuel, Dimiti, Alexander

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Langage : Anglais

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.

Auteur ou autrice(s) : Alobo, Gasthony, Ochola, Emmanuel, Bayo, Pontius, Muhereza, Alex, Nahurira, Violah, Byamugisha, Josaphat

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Langage : Anglais