Karlijn Massar

Reasons for home delivery and use of traditional birth attendants in rural Zambia: a qualitative study

BackgroundDespite the policy change stopping traditional birth attendants (TBAs) from conducting deliveries at home and encouraging all women to give birth at the clinic under skilled care, many women still give birth at home and TBAs are essential providers of obstetric care in rural Zambia. The main reasons for pregnant women’s preference for TBAs are not well understood. This qualitative study aimed to identify reasons motivating women to giving birth at home and seek the help of TBAs. This knowledge is important for the design of public health interventions focusing on promoting facility-based skilled birth attendance in Zambia.MethodsWe conducted ten focus group discussions (n = 100) with women of reproductive age (15–45 years) in five health centre catchment areas with the lowest institutional delivery rates in the district. In addition, a total of 30 in-depth interviews were conducted comprising 5 TBAs, 4 headmen, 4 husbands, 4 mothers, 4 neighbourhood health committee (NHC) members, 4 community health workers (CHWs) and 5 nurses. Perspectives on TBAs, the decision-making process regarding home delivery and use of TBAs, and reasons for preference of TBAs and their services were explored.ResultsOur findings show that women’s lack of decision- making autonomy regarding child birth, dependence on the husband and other family members for the final decision, and various physical and socioeconomic barriers including long distances, lack of money for transport and the requirement to bring baby clothes and food while staying at the clinic, prevented them from delivering at a clinic. In addition, socio-cultural norms regarding childbirth, negative attitude towards the quality of services provided at the clinic, made most women deliver at home. Moreover, most women had a positive attitude towards TBAs and perceived them to be respectful, skilled, friendly, trustworthy, and available when they needed them.ConclusionOur findings suggest a need to empower women with decision-making skills regarding childbirth and to lower barriers that prevent them from going to the health facility in time. There is also need to improve the quality of existing facility-based delivery services and to strengthen linkages between TBAs and the formal health system.

Improving access to skilled facility-based delivery services: Women’s beliefs on facilitators and barriers to the utilisation of maternity waiting homes in rural Zambia

BackgroundMaternity waiting homes (MWHs) are aimed at improving access to facility-based skilled delivery services in rural areas. This study explored women’s experiences and beliefs concerning utilisation of MWHs in rural Zambia. Insight is needed into women’s experiences and beliefs to provide starting points for the design of public health interventions that focus on promoting access to and utilisation of MWHs and skilled birth attendance services in rural Zambia.MethodsWe conducted 32 in-depth interviews with women of reproductive age (15–45 years) from nine health centre catchment areas. A total of twenty–two in-depth interviews were conducted at a health care facility with a MWH and 10 were conducted at a health care facility without MWHs. Women’s perspectives on MWHs, the decision-making process regarding the use of MWHs, and factors affecting utilisation of MWHs were explored.ResultsMost women appreciated the important role MWHs play in improving access to skilled birth attendance and improving maternal health outcomes. However several factors such as women’s lack of decision-making autonomy, prevalent gender inequalities, low socioeconomic status and socio-cultural norms prevent them from utilising these services. Moreover, non availability of funds to buy the requirements for the baby and mother to use during labour at the clinic, concerns about a relative to remain at home and take care of the children and concerns about the poor state and lack of basic social and healthcare needs in the MWHs − such as adequate sleeping space, beddings, water and sanitary services, food and cooking facilities as well as failure by nurses and midwives to visit the mothers staying in the MWHs to ensure their safety prevent women from using MWHs.ConclusionThese findings highlight important targets for interventions and suggest a need to provide women with skills and resources to ensure decision-making autonomy and address the prevalent gender and cultural norms that debase their social status. Moreover, there is need to consider provision of basic social and healthcare needs such as adequate sleeping space, beddings, water and sanitary services, food and cooking facilities, and ensuring that nurses and midwives conduct regular visits to the mothers staying in the MWHs.

Understanding the psychosocial and environmental factors and barriers affecting utilization of maternal healthcare services in Kalomo, Zambia: a qualitative study

This qualitative study aimed to identify psychosocial and environmental factors contributing to low utilization of maternal healthcare services in Kalomo, Zambia. Twelve focus group discussions (n = 141) and 35 in-depth interviews were conducted in six health centre catchment areas. Focus group discussions comprised women of reproductive age (15-45 years), who gave birth within the last year; in-depth interviews comprised traditional leaders, mothers, fathers, community health workers and nurse-midwives. Perspectives on maternal health complications, health-seeking behaviour and barriers to utilization of maternal healthcare were explored. Most women showed insight into maternal health complications. Nevertheless, they started antenatal care visits late and did not complete the recommended schedule. Moreover, most women gave birth at home and did not use postnatal care. The main reasons for the low utilization were the low perceived quality of maternal healthcare services in clinics (negative attitude), negative opinion of important referents (subjective norms), physical and economic barriers such as long distances, high transport and indirect costs including money for baby clothes and other requirements. To improve, our findings suggest need for an integrated intervention to mitigate these barriers. Our findings also suggest need for further research to measure the elicited beliefs and determine their relevance and changeability.

Personal and environmental predictors of the intention to use maternal healthcare services in Kalomo, Zambia

Low maternal healthcare service utilization contributes to poor maternal and new born health outcomes in rural Zambia. The purpose of this study was to identify important factors influencing womens intention to use these services in Kalomo, Zambia. An interviewer-administered questionnaire was used to collect data from 1007 women of reproductive age (15-45 years) from 13 rural health centres with the lowest service utilization rates in the district. Questions included measures of (past) healthcare seeking behaviour, psychosocial variables (attitude, perceived social norms, perceived behavioural control), logistical barriers (e.g., distance to the clinic) and sociodemographic variables (e.g., age, income and education level). Overall, our findings showed that most respondents had high intention to use healthcare services. Intention was positively associated with attitude, personal norms, behavioural control, education and income levels. Conversely, intention was negatively related to perceived social norms, age and distance. Multivariate regression analysis showed that, together, these variables accounted for 41.8% of the variance in intention, with perceived behavioural control being the strongest predictor of intention, followed by geographical distance and perceived social norms. These findings suggest that public health programmes mitigating these important factors are likely to motivate pregnant women to use maternal healthcare services.

Husbands’ experiences and perceptions regarding the use of maternity waiting homes in rural Zambia

To explore mens experience and beliefs regarding the use of maternity waiting homes (MWHs) in Kalomo District, Zambia.

Predicting guild commitment in World of Warcraft with the investment model of commitment

Abstract Many MMORPG offer players the possibility to become a member of a guild, a hierarchical organization of characters with common objectives. Guild membership can be beneficial to game progress, and offer opportunities for social interaction. In the current study we focus on the MMORPG World of Warcraft (WoW), with the main aim to examine whether guild commitment and players’ intention to remain in their guild can be predicted by players’ satisfaction, investments, and perceptions of alternatives to their guild. To this end, 165 WoW players completed an online questionnaire and answered questions related to their guild membership. They also completed the investment model scale which was reworded so all questions pertained to their guild and their fellow guild members. Results show that satisfaction level, quality of alternatives, and investment size significantly predict commitment level (p’s

Increasing utilisation of skilled facility-based maternal healthcare services in rural Zambia: the role of safe motherhood action groups

BackgroundCommunity-centred health interventions, such as Safe Motherhood Action groups (SMAGs), have potential to lead to desired health behavioural change and favourable health outcomes. SMAGs are community-based volunteer groups that aim to reduce critical delays that occur at household level with regard to decision-making about seeking life-saving maternal care at health facilities. The aim of this study was to explore perspectives, roles, achievements and challenges of the SMAG programme in Kalomo, Zambia.MethodsIn-depth interviews (IDIs) were conducted in 7 health centres in Kalomo district between 1st April and 20th May, 2015 with 46 respondents comprising 22 SMAG members, 5 headmen, 10 mothers, 3 husbands, 5 nurses, and 1 district maternal and child health coordinator. Perspectives on the selection, training, roles, achievements and challenges of the SMAG programme were explored.ResultsRespondents were aware of the presence, selection, training and roles of the SMAG members and had a positive attitude towards the programme. They believed that the SMAG programme led to an increase in women’s risk perception about pregnancy and childbirth-related complications. Further, participants believed that the programme resulted in increased utilisation of facility-based antenatal, delivery and postnatal care, and improvement in maternal and newborn health outcomes. However, various challenges affected implementation of the SMAG programme. Among these were insufficient material and financial support to the programme, lack of refresher training for SMAG members, poor quality of care in health care facilities due to a lack of maternity waiting homes, low staffing levels in health facilities, the poor state and small size of the labour wards, and lack of equipment to handle obstetric emergencies.ConclusionThe SMAG programme has potential to be an important community intervention for increasing utilisation of facility-based skilled care and improving maternal and newborn health outcomes.

Intrasexual competition within organizations.

Intrasexual competition refers to rivalry with same-sex others that is, ultimately, driven by the motive to obtain and maintain access to mates. In the present chapter we provide evidence that intrasexual competition also plays an important role in workers’ behaviours, emotions and preferences in the relationship with other workers, and, as a result, may have far reaching consequences for organizations. More specifically, we discuss the types of intrasexual competition that exist, the way these types of intrasexual competition translate into employees’ emotions and behaviours, and the extent to which men and women adopt different intrasexual competitive strategies. Problems in the workplace may occur because intrasexual competition has taken on a dynamic of its own, and influences behaviours and preferences of employees even when this may be maladaptive for the individual or the organization.

Personal and environmental factors associated with the utilisation of maternity waiting homes in rural Zambia

BackgroundAlthough the association between the presence of maternity waiting homes (MWHs) and the personal and environmental factors that affect the use of MWHs has been explained in qualitative terms, it has never been tested in quantitative terms. The aim of this study was to test the association between the presence of MWHs and personal and environmental factors that affect the use of MWHs.MethodsA cross-sectional study was conducted using an interviewer-administered questionnaire from 1st July to 31st August, 2014 among 340 women of reproductive age in 15 rural health centres in Kalomo district, Zambia. Tests of association (chi square, logistic regression analysis, odds ratio) were conducted to determine the strength of the association between the presence of MWHs and personal and environmental factors. Differences between respondents who used MWHs and those who did not were also tested.ResultsCompared to respondents from health centres without MWHs, those from centres with MWHs had higher odds of expressing willingness to use MWHs (adjusted odds ratio [aOR] = 4.58; 95% confidence interval [CI]:1.39–15.17), perceived more benefits from using a MWH (aOR =8.63; 95% CI: 3.13–23.79), perceived more social pressure from important others to use MWH (aOR =27.09; 95% CI: 12.23–60.03) and higher personal risk from pregnancy and childbirth related complications (aOR =11.63; 95% CI: 2.52–53.62). Furthermore, these respondents had higher odds of staying at a health centre before delivery (aOR =1.78; 95% CI: 1.05–3.02), giving birth at a health facility (aOR = 3.36; 95% CI: 1.85–6.12) and receiving care from a skilled birth attendant (aOR =3.24; 95% CI: 1.80–5.84). In contrast, these respondents had lower odds of perceiving barriers regarding the use of MWHs (aOR =0.27; 95% CI: 0.16–0.47). Factors positively associated with the use of MWHs included longer distances to the nearest health centre (p = 0.004), higher number of antenatal care (ANC) visits (p = 0.001), higher proportions of complications during ANC (p = 0.09) and women’s perception of benefits gained from staying in a MWH while waiting for delivery at the health centre (p = 0.001).ConclusionThese findings suggest a need for health interventions that focus on promoting ANC use, raising awareness about the risk and severity of pregnancy complications, promoting family and community support, and mitigating logistical barriers.

A night on the town: when the importance of mate acquisition overrides intrasexual competition

Abstract: It is argued that, while men may be intrasexually more competitive than women, to attract potential mates, men will, more than women, associate with same-sex friends who are attractive to the opposite sex. Therefore, more than women, men will choose more physically attractive and dominant companions in a mating context than in a neutral context. In Study 1 among 262 participants a mating scenario (going to a party) and a neutral scenario (seeing a movie) were developed, and it was shown that the mating scenario did indeed induce more a mating context than the neutral scenario. In Study 2 among 167 participants the hypotheses were tested by examining the preferences for a companion in both scenarios. The findings from Study 2 supported the predictions. In response to the mating as compared to the neutral scenario, men, but not women, found the attractiveness of a companion more important, preferred a more socially dominant companion, and found the social dominance of a companion more important. Men as well as women preferred in general companions who were less attractive than themselves, but preferred a more attractive companion in a mating than in a neutral context. The effects for social dominance were in general more pronounced among individuals high in sociosexual orientation (SOI). To conclude especially mens’ attitude towards same sex others in a mating context may be driven by the desire to associate, rather than to compete, with same-sex others who are attractive to the opposite sex.