Pope, Charlene

Background The neonatal mortality rate in rural Uganda is 38/1000 births as compared to 6/1,000 in the United States. Hypoxic events, also referred to as birth asphyxia, represent 24% of neonatal deaths in Sub-Saharan Africa. Nearly 60% of birth asphyxia worldwide occurs in home-based deliveries with informally trained birth attendants. The World Health Organization has defined two categories of birth attendants in low- and middle-income countries (LMICs): i) midwife skilled birth attendants, who are formally educated; and, ii) traditional birth attendants (TBAs) who usually acquire skills through apprenticeship and have home-based practices in rural areas. Thus, there is an urgent need to provide neonatal resuscitation education and build capacity in rural areas, where access to healthcare is poor and the burden of long-term impairment due to hypoxic brain effects is substantial. Methods We collected data using a focused ethnographic approach to incorporate: i) field-notes; ii) informal interviews while observing five Ugandan midwives providing perinatal care; iii) semi-structured interviews with medical center managers and clinic coordinators; and, iv) a focus group with seven traditional birth attendants in Uganda. This qualitative study used a feminist theoretical stance to show the lived reality of women taking care of other women’s health with limited resources during childbirth and neonatal airway management. Results Our findings showed that the more formally trained midwives exhibited competence in providing neonatal airway management. In contrast, the traditional birth attendants experienced barriers to performing optimal neonatal airway management due to lack of resources, limited knowledge, and cultural practices. The traditional birth attendants identified their learning preferences as demonstration, poem, or song, and by using local spoken language to learn and implement neonatal airway management. Conclusions Findings will contribute to development and dissemination of a culturally tailored educational intervention to enhance TBAs’ understanding of effective neonatal airway management. The joint effort of midwives and traditional birth attendants as a foundation for creating a training intervention with their preferred learning method constitutes a scaled-up team approach to meet the World Health Organization’s Sustainable Development Goal #3 to decrease neonatal mortality. Building on the internationally recognized Helping Babies Breathe model, this integrative initial analysis can be replicated to develop sustainable intervention for other rural areas of low- and middle-income countries.

OBJECTIVE: To determine the reasons adolescents are not vaccinated for specific vaccines and how these reasons have changed over time. METHODS: We analyzed the 2008–2010 National Immunization Survey of Teens examining reasons parents do not have their teens immunized. Parents whose teens were not up to date (Not-UTD) for Tdap/Td and MCV4 were asked the main reason they were not vaccinated. Parents of female teens Not-UTD for human papillomavirus vaccine (HPV) were asked their intent to give HPV, and those unlikely to get HPV were asked the main reason why not. RESULTS: The most frequent reasons for not vaccinating were the same for Tdap/Td and MCV4, including “Not recommended” and “Not needed or not necessary.” For HPV, the most frequent reasons included those for the other vaccines as well as 4 others, including “Not sexually active” and “Safety concerns/Side effects.” “Safety concerns/Side effects” increased from 4.5% in 2008 to 7.7% in 2009 to 16.4% in 2010 and, in 2010, approaching the most common reason “Not Needed or Not Necessary” at 17.4% (95% CI: 15.7–19.1). Although parents report that health care professionals increasingly recommend all vaccines, including HPV, the intent to not vaccinate for HPV increased from 39.8% in 2008 to 43.9% in 2010 (OR for trend 1.08, 95% CI: 1.04–1.13). CONCLUSIONS: Despite doctors increasingly recommending adolescent vaccines, parents increasingly intend not to vaccinate female teens with HPV. The concern about safety of HPV grew with each year. Addressing specific and growing parental concerns about HPV will require different considerations than those for the other vaccines.