Barriers to implementation of placental transfusion of babies at birth in Zambia
Abstract
Delayed cord clamping (DCC) and umbilical cord milking (CM) have many benefits. However, a previous study done in Zambia showed that it was not a common practice among midwives. This study investigated possible barriers to DCC and CM, at the University Teaching Hospital in Lusaka. This was a qualitative study. A convenience sample was chosen, and snowball sampling was used. The midwives were interviewed using semi-structured interviews. Burnard’s method of thematic content analysis was used. Through 14 interviews it became clear that the midwives were aware of DCC and used it whenever possible. The participants reported that the main barriers were the high workload and a variation in knowledge. A lack of facilities, such as heaters and resuscitation equipment in the delivery room also led to earlier cord clamping. The midwives were motivated to continue improving the routines. They expressed a need for more training as well as equipment and resources to facilitate DCC. (Afr J Reprod Health 2022; 26[2]: 58-67).
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WHO. WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Delayed Umbilical Cord Clamping for Improved Maternal and Infant Health and Nutrition Outcomes. Geneva: World Health Organization. Copyright World Health Organization 2014; 2014. Available from: https://www.who.int/nutrition/publications/guidelines/cord_clamping/en/
Katheria AC, Lakshminrusimha S, Rabe H, McAdams R and Mercer JS. Placental transfusion: a review. Journal of Perinatology. 2016 Sep 22; 37(2):105-111. Available from: doi:10.1038/jp.2016.151 https://www.nature.com/articles/jp2016151#citeas
Fogarty M, Osborn DA, Askie L, Seidler AL, Hunter K, Lui K, Simes J and Tarnow-Mordi W. Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis. American Journal of Obstetrics & Gynecology. 2018 Jan;218(1):1-18. Available from: doi:10.1016/j.ajog.2017.10.231 https://www.sciencedirect.com/science/article/pii/S0002937817314394
Mwamba B. Implementation of Delayed Cord Clamping in
Seven Midwifery Training Schools of Zambia. Newborn and Infant Nursing Reviews. 2015 Sep;15(4):163-164. Available from: doi:10.1053/j.nainr.2015.09.011 https://www.researchgate.net/publication/282534943_Implentation_of_Delayed_Cord_Clamping_in_Seven_Midwifery_Training_Schools_of_Zambia
Vivio D, Fullerton JT, Forman R, Mbewe RK, Musumali M and Chewe PM. Integration of the Practice of Active Management of the Third Stage of Labor Within Training and Service Implementation Programming in Zambia. JMWH. 2010 Jan 21;55(5): 447-454. Available from: doi: 10.1016/j.jmwh.2010.02.015. https://onlinelibrary.wiley.com/doi/full/10.1016/j.jmwh.2010.02.015
WHO. WHO Guideline On Use Offerritin Concentrationsto Assess Iron Status In Individuals And Populations. Switzerland: World Health Organization. Copyright World Health Organization; 2020 [cited 2021 Oct10]. Available from: https://www.who.int/publications/i/item/9789240000124
McDonald SJ, Middleton P, Dowswell T and Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database System Reviews [Internet]. 2013 [cited 2019 Jul 20] Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002
/14651858.CD004074.pub3/epdf/full
Peven K, Bick D, Purssell E, Rotevatn TA, Nielsen JH and Taylor C. Evaluating implementation strategies for essential newborn care interventions in low- and low middle-income countries: a systematic review. Health Policy Planning. 2020;35(2):47-65. Available from: doi:10.1093/heapol/czaa122 https://pubmed.ncbi.nlm.nih.gov/33156939/
Rabe H, Jewison A, Alvarez RF, Crook D, Stilton D, Bradley R and Holden, D. Milking Compared With Delayed Cord Clamping to Increase Placental Transfusion in Preterm Neonates. Obstet Gynecol. 2011 Feb;117(2): 205-211. Available from: doi:10.1097/aog.0b013e3181fe46ff https://pubmed.ncbi.nlm.nih.gov/21252731/
Onalo R. Neonatal hypothermia in sub-Saharan Africa: A review. Niger J Clin Pract. 2013 Apr 6;16(2): 129-138. Available from: doi:10.4103/1119-3077.110120. http://www.njcponline.com/article.asp?issn=1119-3077;year=2013;volume=16;issue=2;spage=129;epage=138;aulast=Onalo
McAdams RM, Backes CH and Hutchon DJ. Steps for implementing delayed cord clamping in a hospital setting. Matern health, neonatol and perinatol. 2015 Feb 18;11:10. Available from: doi:10.1186/s40748-015-0011-8. https://mhnpjournal.biomedcentral.com/track/pdf/10.1186/s40748-015-0011-8?site=mhnpjournal.biomedcentral.com
Anton O, Jordan H and Rabe H. Strategies for implementing placental transfusion at birth: A systematic review. Birth. 2018 Sep 27;46(3): 411-427. Available from: doi:10.1111/birt.12398. https://onlinelibrary.wiley.com/doi/10.1111/birt.12398
Liu LY, Feinglass J, Kern-Goldberger A, Khan Y and Yee LM. Evaluation of implementation of a delayed cord clamping protocol for premature infants in a high volume maternity center. Obstet Gynecol. 2017 May;129(5):835-843. Available from: doi:10.1016/j.ajog.2016.11.849.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400681/
Oddie S and Rhodes P. Barriers to deferred cord clamping in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2014 Sep;99(5):391-394. Available from: doi:10.1136/archdischild-2014-305968. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145419/
Hill AL and Fontenot HB. Beliefs and Practices of Obstetric Care Providers Regarding Umbilical Cord Clamping. Nurs Womens Health. 2014 Nov;18(5):413-419. Available from: doi:10.1111/1751-486x.12149. https://pubmed.ncbi.nlm.nih.gov/25316541/
WHO. NLiS Country Profile: Zambia. [Internet] 2018 [cited
Jun 30] Available from: http://apps.who.int/nutrition/landscape/report.aspx?iso=zmb.
Braun V and Clarke V. Successful Qualitative Research; A Practical Guide for Beginners. London: SAGE Publications; 2013.
Creswell JW. Research Design; Qualitative, Quantitative and Mixed Methods Approaches. 4th ed. London: SAGE Publications; 2014.
Bryman, Alan. Social Research Methods. 5th ed. New York: Oxford University Press; 2016.
Matthews B and Ross L. Research Methods; A practical guide for the social sciences. London: Pearson Education Limited; 2010.
Burnard P. A method of analysing interview transcripts in qualitative research. Nurse Educ Today. 1991 Dec;11(6):461-466. Available from: doi:10.1016/0260-6917(91)90009-y. https://pubmed.ncbi.nlm.nih.gov/1775125/
Association of Chartered Certified Accountants. Key health challenges for Zambia [Internet] 2013 [cited 2018 Jul 13]. Available from: https://www.accaglobal.com/us/en/technical-activities/technical-resources-search/2013/april/key-health-challenges-for-zambia.html.
Braddick L, Tuckey V, Abbas Z, Lissauer D, Ismail K, Manaseki‐Holland S, Ditai J and Stokes T. A mixed‐methods study of barriers and facilitators to the implementation of postpartum hemorrhage guidelines in Uganda. International Journal of Gynecology and Obstetrics. 2015 Sep 28;132(1):89-93. Available from: doi:10.1016/j.ijgo.2015.06.047. https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1016/j.ijgo.2015.06.047
Pogliani L, Erba P, Nannini P, Giacomet V and Zuccotti GV. Effects and safety of delayed versus early umbilical cord clamping in newborns of HIV-infected mothers. The Journal of Matern Fetal Neonatal Med. 2017 Oct 16;32(4):646-649. Available from: doi:10.1080/14767058.2017.1387896. https://pubmed.ncbi.nlm.nih.gov/28969479/.
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