Dr Virginia Stulz

This study assesses the role of family planning (FP) in resilience building among youths and women in Ethiopia's drought-affected and food-insecure regions. A mixed-method comparative cross-sectional study design with a total of 1712 study participants with an equal 1:1 ratio of the intervention and control groups was used. Binary logistic regression analysis was carried out to identify factors associated with community resilience. More participants in the intervention districts (58.3%) than in the control districts (49%) were currently using FP services. Approximately 54.1% of the intervention group and 43.6% of the control group were able to pay for food and shelter. Two-thirds of the intervention respondents and half of the control respondents had good social cohesion. The food consumption scores for the intervention and control districts were 26.2 and 24.9, respectively. Additionally, 62.5% of the intervention and 53.5% of the control respondents were found to have a good level of community level resilience. FP use (AOR = 3.4, 95% CI: 1.78¿6.49), good social cohesion (AOR = 7.9, 95% CI: 6.09¿10.23) and productive assets (AOR = 1.4, 95% CI: 1.07¿1.92) were significantly associated with community resilience. To enhance community resilience comprehensively, expanding FP services should empower women in decision-making processes, cultivate ties and promote collaborative efforts across different sectors.

This study examined relationship between menstrual hygiene management (MHM), water, sanitation, and hygiene (WASH) services, and girls' academic performance in Ethiopia. This study employed cross-sectional mixed study design with 912 public schoolgirls. Also, 22 key informants, and six focus group discussions in 37 randomly selected public schools. The median age of the schoolgirls was 16 years. Two of the five schoolgirls reported missing classes during menstruation. Out of 912 schoolgirls, 82.5% (95% CI; 81%-84%) achieved good academic performance during the academic year. Schoolgirls who attended class regularly during menstruation (AOR=14.82, 95% CI 8.652-25.391), schoolgirls who were informed about menstrual hygiene before menarche (AOR=1.81, 95% CI 1.011-3.229), schoolgirls whose mothers were educated (AOR=1.88, 95% CI 1.063-3.313), schoolgirls who had basic water services (AOR=4.72, 95% CI 2.315-9.618), schoolgirls who had basic sanitation services (AOR=6.32, 95% CI 4.643-33.670) and who had limited sanitation services (AOR=1.56, 95% CI 1.768-6.636) were significantly associated with good academic performance. Educating mothers about menstrual hygiene, increasing access to WASH, and providing safe spaces for girls can have positive ripple effect on their daughters' academic success. The findings of study provide critical evidence to inform decision makers to address MHM challenges in alignment with Sustainable Development Goals (SDGs) 2030.

BACKGROUND: Music has been effectively used to address anxiety associated with medical treatments across broad applications. However, scant evidence exists about using music to reduce the significant anxiety experienced by women undergoing gynaecological procedures and fertility treatments. Such anxiety relates to the nature of procedures/examinations, invasiveness of the procedures, uncertainty around expectations, and intimate body part exposure, potentially affecting outcomes in triggering sympathetic nervous system responses. Music potentially contributes to anxiety management via known physiological and emotional effects. This funded collaborative project investigates therapeutic uses of music to address anxiety before and during gynaecology and fertility procedures, in order to assist participants with reducing their anxiety. METHODS: Participants attending office, day surgery and other hospital procedures (N¿=¿41) completed validated self-report surveys before and after procedures, listening to specific music via a purpose-designed Music Star. Additional contextual and qualitative data was sought to understand the nature of the experience for the women. RESULTS: Results of this study indicated that the music intervention appeared to have a significant effect of reducing anxiety for women awaiting gynaecological and fertility procedures (p¿<¿.001, r¿=¿.82). CONCLUSIONS: The use of music forms an acceptable intervention to decrease anxiety in this context and can enhance the experience of women during treatment. Such an increased use of music can provide anxiety management benefits to women undergoing gynaecological and fertility treatments, with these experiences suggesting potential educational benefits to support women through this extremely stressful and complex stage of their life.

Problem: Evidence suggests new midwifery graduates are leaving the profession prematurely during the initial graduate years due to workplace stress. Background: Graduate midwives are essential to provide a future midwifery workforce. Support for new graduates in the initial years of practice is essential in retaining them in the midwifery profession. Aim: The aim of this study was to explore midwives' perspectives of the support they provide new graduates within existing midwifery graduate programs, and their experiences and perceptions of the health service processes to support midwifery graduates. Methods: A cross-sectional study was undertaken with a purposive sample of Australian midwives. Descriptive statistics were used to analyse frequencies and percentages of responses. Spearman's correlational analyses were used to determine associations between the variables. Responses to open-ended questions were analysed by content analysis. Findings: In total, 167 midwives responded to the survey. Just over a third (34.1 %) of midwives felt they had sufficient resources to support a midwifery graduate. Half (50.9 %) of the midwives engaged in reflective practice with midwifery graduates. The majority (97 %) of midwives reported that they felt it was important for midwifery graduates to have a mentor. Discussion: A lack of protected time to provide mentoring opportunities and support new graduates to gain further experience and education was identified. These findings support the need for a formal mentorship program to be introduced. Conclusion: This study offers insights into the perspective of midwives dealing with the realities of striving to support midwifery graduates in their initial years of practice.

Background: This integrative review summarises original research that explores women's experiences of escaping domestic violence to achieve safe housing. Methods: Integrative review. A robust search strategy was conducted using the following databases: Scopus, Cumulative Index to Nursing and Allied Health (CINAHL), Cochrane, Medline and PubMed. All articles were assessed for quality using the Mixed Methods Appraisal Tools (MMAT) scoring. Whittemore and Knafl's (2005) five stage approach was used to analyse the primary literature related to women's and stakeholders' experiences of escaping domestic violence to achieve safe housing. Results: A total of 41 articles were retrieved and 12 papers were included in this review (six qualitative, one quantitative and five mixed methods) that fulfilled the inclusion criteria. Four overarching themes were identified: 'Experiences of leaving domestic violence', 'Barriers to achieving safe housing', 'Facilitators to achieving safe housing' and 'The road to recovery'. The 'Experiences of leaving domestic violence' theme included two subthemes: 'the losses' and 'ongoing contact with the perpetrator'. The 'Barriers to achieving safe housing' theme included three subthemes: 'financial insecurity', 'being judged by others for leaving and service availability'. The 'Facilitators to achieving safe housing' theme included two sub-themes: 'support, partnership, and collaboration between women and service providers' and 'feeling respected and heard'. The 'Road to recovery' theme included two sub-themes: 'being a good mother' and 'empowerment after leaving domestic violence'. Conclusions: This review has highlighted the need for service and health care providers to work together and collaborate effectively with the woman experiencing and escaping domestic violence, especially in rural and remote areas. This means giving women access to the most suitable educational resources and services that are appropriate for their unique situation. Tailoring support for women is crucial to enable women to achieve safe housing and to be able to live a safe life with their children, away from the perpetrator of the domestic violence.

Aims: To review and assess the literature about the safety and appropriateness of weaning small babies from incubators to open cots weighing less than 1600 g. Design: A systematic review. Review methods: The Critical Appraisal Skills Programme tool was used to assess the relevance and quality of the available literature from May 1994 until November 2023. Data sources: Google Scholar, PubMed, Ovid, Scopus, Cumulative Index of Nursing and Allied Health, and PsycInfo. Results: A total of 164 articles were retrieved, of which 14 studies met the inclusion criteria and are included in this review. Randomised controlled trials have proven that babies could safely wean from incubators to cots at 1600 g. Retrospective chart review studies have shown that babies can successfully transition from a crib into an open cot at 1500 g or even 1400 g. One retrospective study also identified babies transitioning successfully at 1200 g. Eight studies showed no adverse outcomes for early weaning. Eight studies showed no difference or a shorter length of stay in smaller babies. Conclusions: With the improving capacity of incubator technology to maintain a stable temperature in babies, it seems evident that using a specific and controlled approach to weaning small babies from an incubator to an open cot can lead to earlier discharge. Small babies can be weaned safely from an incubator to a cot, and those who are weaned more effectively and expediently may have better outcomes, such as better weight gain, reduced length of stay, and earlier discharge home. Tweetable abstract: Small babies can be weaned successfully from an incubator into a cot at 34 weeks gestation or 1600 g or less without any adverse effects @Vskinner9.

This study aimed to explore the sociocultural determinants of family planning (FP) utilization among women in pastoralist areas of Ethiopia. A community-based cross-sectional survey was conducted involving 682 reproductive-aged women selected from three regions in pastoralist districts. Hierarchical logistic regression was used to identify factors associated with women who did not use FP. This study revealed that 47% of women did not use FP. Women who did not use FP were more likely to have shorter spacing between births, lack their partner's support, not be involved in decisions regarding large household purchases, and have low household expenditures. Overall, the prevalence of not using FP is significantly high in pastoralist communities in Ethiopia. The authors recommend that investment in women's health and FP be targeted at educational campaigns to raise awareness about FP and its importance. Engaging men and community leaders, promoting their support for FP and contraceptive use, and providing financial assistance to address financial barriers, such as transportation costs and healthcare fees, are important aspects that can increase the utilization of FP methods.

After discharge from a neonatal unit, families of preterm infants may require therapeutic support to address challenges related to their infant/s' development, changed family circumstances, and/or parent wellbeing. This integrative review (IR) sought to examine the impact of music therapy on preterm infants and their families post-hospital discharge. A systematic search encompassing seven databases resulted in 83 citations, with six studies initially meeting the inclusion criteria. A further six studies were evaluated and selected upon their publication during the review process. Each study was assessed using the Mixed Methods Appraisal Tool (MMAT), followed by the identification of major themes and sub-themes. Our results suggest that music therapy contributed to creating supportive physical and metaphorical environments for preterm infants and their families, in which they could acquire essential skills, tools, and resources for fostering communication and connection with one another. Preterm infants and toddlers may have also enhanced their developmental skills through music therapy sessions post-discharge. Further investigation into the impact of music therapy on preterm infants and their caregivers at different timepoints after hospital discharge is recommended, as well as a comparison of individual and group music therapy outcomes on infant development and parent health. Future research should include a broader spectrum of family members, along with caregivers from diverse family structures and gender identities, reflecting practices already established in some clinical settings.

This study assessed vaccination coverage and its associated factors among children aged 12¿23 months in pastoralist Ethiopia. It was conducted in three woredas of the Afar region using a community-based cross-sectional mixed methods design with quantitative and qualitative methods. A total of 413 mothers with children aged 12¿23 months participated in the quantitative study via a simple random sampling technique. Logistic regression was used to identify factors associated with vaccination, and thematic analysis techniques were used for qualitative data. The percentage of patients who received full vaccination was 25%. Based on vaccination card observations, the dropout rate from Pentavalent-1 to Pentavalent-3 was found to be 2.9%. Logistic regression analysis revealed significant associations between mothers and caretakers with formal education, those who owned mobile phones, had antenatal care (ANC) visits, and birthed at a health facility with full vaccination. The overall proportion of full immunization is lower than the target set by the World Health Organization (WHO). The findings suggest that programs and policy makers should prioritize improving the access and enrolment of women and caretakers, promoting mobile phone ownership, and encouraging ANC visits and the promotion of health facility deliveries, as these are associated with higher rates of immunization.

INTRODUCTION Midwives in an Australian birth unit undertook a project to develop a resource for women and their support person. The aim of this study was to explore how the women, support persons and midwives viewed the introduction of this resource designed to guide and support women in their choice of support person. METHODS A quantitative survey study was used to explore how three participant groups viewed the introduction of a support person information resource. A hospital designed survey was developed for women, support people and midwives. Data were analyzed using SPSS, version 26 and Braun and Clarke's guide for thematic analysis. RESULTS More than half (55%) of the midwives believed that the information resource presented influenced women's choice of support people during labor. Almost three-quarters (72%) of the women did not change their choice of number of support people that they wanted during their labor. The majority (83%) of women would recommend the support person brochure to other women. The majority (83%) of support people stayed the entire duration of labor. Four themes were generated from open-ended questions: value of the information sheet, knowing how to be a support person, connecting midwives with being woman-centered, and choosing the support person. CONCLUSIONS The availability of an information resource was of benefit for women, support people and midwives, contributing to women feeling more informed in choosing their support person. Midwives felt they had evidence to support conversations with women, contributing to the feeling of being woman-centered. Support people had increased confidence.

INTRODUCTION Women experience medical interventions, episiotomy, and perineal lacerations during childbirth, impacting their physical, psychological, and sexual well-being. This study compares the perineal status of prospective women who had the midwifery intervention of perineal myofascial release during childbirth, to a matched retrospective control sample of women who received standard care during childbirth. METHODS A non-randomized pilot study with prospective data collected for 50 women after informed verbal consent was obtained to having the midwifery intervention of perineal myofascial release during childbirth, and the matched retrospective data for the control group of 49 women were collected from a random sample generated from the medical records. Quantitative analyses included descriptive statistics, independent t-tests, regression, and chi-squared analyses. Retrospective trial registration was granted with The Australian New Zealand Clinical Trials Registry ANZTR. RESULTS Women were six times (OR=0.15; 95% CI: 0.0¿0.37) less likely to have a nonintact perineum and twice (OR=0.44; 95% CI: 0.35¿0.56) less likely to have an episiotomy if they were in the intervention group. Chi-squared analysis found no statistically significant differences between groups for normal vaginal birth and instrumental births, excluding cesareans and waterbirth [¿2(1)= -0.37, p=0.542]. CONCLUSIONS This study found perineal myofascial release benefits women by reducing perineal trauma and episiotomy. However, there were no significant differences in the duration of the active pushing stage of labor or mode of birth. This study has shown some promise in obtaining data for a larger, definitive, randomized controlled trial.

Background: Prevention of mother-to-child transmission (PMTCT) of HIV service is conceptualized as a series of cascades that begins with all pregnant women and ends with the detection of a final HIV status in HIV-exposed infants (HEIs). A low rate of cascade completion by mothers' results in an increased risk of HIV transmission to their infants. Therefore, this review aimed to understand the uptake and determinants of key PMTCT services cascades in East Africa. Methods: We searched CINAHL, EMBASE, MEDLINE, Scopus, and AIM databases using a predetermined search strategy to identify studies published from January 2012 through to March 2022 on the uptake and determinants of PMTCT of HIV services. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. A random-effects model was used to obtain pooled estimates of (i) maternal HIV testing (ii) maternal ART initiation, (iii) infant ARV prophylaxis and (iv) early infant diagnosis (EID). Factors from quantitative studies were reviewed using a coding template based on the domains of the Andersen model (i.e., environmental, predisposing, enabling and need factors) and qualitative studies were reviewed using a thematic synthesis approach. Results: The searches yielded 2231 articles and we systematically reduced to 52 included studies. Forty quantitative, eight qualitative, and four mixed methods papers were located containing evidence on the uptake and determinants of PMTCT services. The pooled proportions of maternal HIV test and ART uptake in East Africa were 82.6% (95% CI: 75.6¿88.0%) and 88.3% (95% CI: 78.5¿93.9%). Similarly, the pooled estimates of infant ARV prophylaxis and EID uptake were 84.9% (95% CI: 80.7¿88.3%) and 68.7% (95% CI: 57.6¿78.0) respectively. Key factors identified were the place of residence, stigma, the age of women, the educational status of both parents, marital status, socioeconomic status, Knowledge about HIV/ PMTCT, access to healthcare facilities, attitudes/perceived benefits towards PMTCT services, prior use of maternal and child health (MCH) services, and healthcare-related factors like resource scarcity and insufficient follow-up supervision. Conclusion: Most of the identified factors were modifiable and should be considered when formulating policies and planning interventions. Hence, promoting women's education and economic empowerment, strengthening staff supervision, improving access to and integration with MCH services, and actively involving the community to reduce stigma are suggested. Engaging community health workers and expert mothers can also help to share the workload of healthcare providers because of the human resource shortage.

Background: Intimate partner violence (IPV) affects millions of women each year and has been recognized as a leading cause of poor health, disability, and death among women of reproductive age. However, the existing studies about the association between IPV and contraceptive use have been found to be conflicting and relatively less studied, particularly in low and middle income countries, including Eastern Sub Saharan Africa (SSA). This study examines the relationship between IPV and contraceptive use in Eastern SSA countries. Methods: The Demographic and Health Surveys (DHS) from 2014 to 2017 were a multi-stage cluster sample survey of 30,715 ever married (or cohabitating) women of reproductive age from six countries. The six Eastern SSA datasets were pooled and multivariable logistic regression using a hierarchical approach was performed to examine the association between IPV and contraceptive use after adjusting for women, partners, and household and health facility factors. Result: Two thirds of women 67% [66.55, 67.88] were not using any modern contraceptive methods and almost half (48%) of the women had experienced at least one form of IPV from their partners. Our analysis showed a strong association with decreased odds of physical violence [adjusted odds ratios (aOR) = 0.72, 95%CI: 0.67, 0 0.78] among women not using any contraceptive methods. Other factors associated with women not using any contraceptive methods were older women (35¿49 years), illiterate couples and women from poorest households. Women who had no access to any form of communication [aOR = 1.12, 95%CI: 1.08, 1.36], unemployed partner [aOR = 1.55, 95%CI: 1.23, 1.95] and women who travelled long distances to access health services [aOR = 1.16, 95%CI: 1.06, 1.26] significantly reported increased odds of not using any contraceptive methods. Conclusion: Our study indicated that physical violence was negatively associated with not using any contraceptive method among married women in Eastern SSA countries. Tailored intervention messages to reduce IPV including physical violence among women not using contraceptive methods in East Africa should target those from low-socioeconomic groups especially, older women with no access to any form of communication, unemployed partners, and illiterate couples.

Objective: To explore midwifery students' (and as new graduates') experiences and level of satisfaction about a student-led midwifery model of care. Methods: This was a qualitative study to elicit rich descriptive data from the participants. Thematic analysis was used. The students were interviewed at the end of their final year of study and they were subsequently interviewed at the end of their graduate year. Results: Two overarching themes were identified from the qualitative findings from the first and second interviews including the students building and sustaining important relationships and transitioning from a student to new graduate. Conclusions: The midwifery students valued the opportunity to spend one year in a student-led model of care so that they could build and sustain important relationships with women and their team including the mentor midwife as new graduates. The students developed confidence by being respected by midwives and enabled them to advocate for women.

Intimate partner violence (IPV) adversely affects female reproductive health in various ways. Similarly, it plays a critical role in women's unintended pregnancy. This study examines the relationship between IPV and unintended pregnancy in Eastern Sub-Saharan Africa (SSA) countries. This study uses data from the nationally representative Demographic and Health Surveys (DHS) in six Eastern African SSA countries. The original sample size was restricted to ever married (or cohabitating) women of reproductive age who completed the survey's Domestic Violence Module and had a pregnancy in the previous 5 years. Svyset proportion was used to estimate the prevalence and 95% confidence intervals (CI) of the study outcomes and multiple logistic regression was used to compare outcomes of last pregnancy by exposure to lifetime IPV committed by the most recent partner. The prevalence of unintended pregnancy in Eastern SSA was 38% [36.4, 40.34] among married women with high disparity among countries. This prevalence was 45% [42.05, 48.15] and 55% [50.0, 59.87] among women who had experienced any form of IPV and sexual violence, respectively. After adjusting for potential confounding factors, women with a history of sexual violence had a higher risk of unintended pregnancy [AOR: 1.80, 95% CI: 1.39, 2.33] and increased odds of unintended pregnancy for women who had more than five living children [AOR: 4.93, 95% CI: 3.40, 7.15], women who lived in rural residences [AOR: 1.42, 95% CI: 1.07, 1.90], and women who reported they had financial barriers for health care [AOR: 1.36, 95% CI: 1.13, 1.64]. Our findings suggest that IPV, particularly sexual violence, is a key player for higher risk of unintended pregnancy in Eastern SSA countries. This study highlights the need for developing programs and implementation of policies that integrate sexual reproductive health and IPV to reduce unintended pregnancy among married and single women.

Objective: To gain insight into the benefits, shortcomings, and practical considerations when using the peanut ball for women during labour. Design & setting: We used a descriptive qualitative approach using semi-structured, in-depth interviews to explore the experiences of eight midwives working in a tertiary hospital birth unit in New South Wales, Australia when using the peanut ball for women during labour. Participants: Participants were recruited from the birthing unit of a tertiary hospital in New South Wales. The final sample included eight midwives working in the birth unit. Findings: Three overarching themes were identified: 'Education and encouragement', 'benefits and disadvantages of peanut ball' and 'techniques'. The 'Education and encouragement' theme included three sub-themes: 'selling it to the woman', 'educating midwives' and 'becoming usual practice and improving confidence'. The 'Benefits and disadvantages of peanut ball' theme included two sub-themes: 'facilitates labour and birth' and 'discomfort'. The 'Techniques' theme included three subthemes: 'positioning', 'sizing' and 'using alternative techniques'. Midwives are confident in their practice with the peanut ball and acknowledge the importance of educating midwives and women to promote its use. Midwives also discussed favoured techniques when using the ball, especially relating to size and maternal positioning. Conclusion: Our study provides insight into midwives' experiences about using a peanut ball for women during labour. The midwives reported that the peanut ball encourages vaginal births and shortens labour times, whilst enabling women to participate actively in the birth. Education for midwives and women is vital for using peanut balls. Implications for practice: Peanut balls are not usual practice in birthing units in Australia and they are a novel intervention to improve labour and birthing outcomes for women, especially when using an epidural.

Aim: This review sought to discover how community nurses globally provide palliative care, with specific focus on how they manage the personal and professional stressors associated with caring for dying clients in the home. Design: An integrative review methodology was used to gain insight into how community palliative care is delivered worldwide. Background: The provision of home palliative care by community nurses gives clients the ability to spend their final days in familiar surroundings. Research has focussed on the provision of palliative care in the inpatient setting, with little known about the community setting. Methods: Data were collected through a literature search, then a critical analysis approach was used to evaluate the strengths of palliative care literature by analysing recurrent themes to stimulate further research on the topic. Data Sources: The following databases were used to conduct the literature search: CINAHL, Medline, Pubmed, Scopus, Ovid. Results: The results highlighted the importance of building a skilled palliative community nursing workforce and the need to offer specialised palliative care training to nurses, particularly around difficult conversations and service coordination. Conclusion: The literature identified the challenges implicit within the community nursing role in delivering palliative care, but it did not identify the factors that enhance the nurses' ability to manage the stressors associated with this role. The input of nurses must be sought to understand the development of resilience. Implications for the profession: Community palliative care nursing requires time spent with clients and family members who are suffering, therefore predisposing nurses to stress. Effort must be made to provide palliative care nurses with support to enhance professional resilience.

Background: Perinatal mental health disorders are one of the leading causes of maternal illness and suffering and care and services need to be well coordinated by an interprofessional team who are skilled in working collaboratively. Aim: The aim of this paper is to describe the design and evaluation of an innovative interprofessional education initiative to increase midwives and other health professional students' knowledge and skills in caring collaboratively for women with psychosocial issues in the perinatal period, including women experiencing domestic and family violence. Methods: The Psychosocial Interprofessional Perinatal Education workshop was designed for midwifery, psychology, social work and medical students. It provided a simulated learning experience with case studies based on real life situations. Students undertook pre and post surveys to measure changes in students' perceptions of interprofessional collaboration and their experiences of participating in the interprofessional simulation-based learning activity. Quantitative survey data were analysed using paired t-tests and a qualitative content analysis was undertaken on the open-ended questions in the survey. Findings: Comparison of pre and post surveys found students from all disciplines reported feeling more confident working interprofessionally following the workshop. The following categories were generated from analysis of the open ended survey data: Greater understanding of each others' roles; Recognising benefits of interprofessional collaboration; Building on sense of professional identity; Respecting each other and creating a level playing field; and Filling a pedagogical gap. Conclusion: Through this innovative, simulated interprofessional education workshop students developed skills essential for future collaborative practice to support women and families experiencing psychosocial distress.

This study aims to explore the effects of voluntary family planning (FP) utilization on food security in selected districts of Ethiopia. Quantitative research methods were used to conduct a community-based study among a sample of 737 women of reproductive age. The data were analyzed using a hierarchical logistic regression constructed in three models. The findings showed 579 (78.2%) were using FP at the time of the survey. According to the household-level food insecurity access scale, 55.2% of households experienced food insecurity. The likelihood of food security was lower by 64% for women who used FP for less than 21 months (AOR = 0.64: 95%CI: 0.42¿0.99) in comparison to mothers who used FP for more than 21 months. Households having positive adaptive behaviors were three times more likely (AOR = 3.60: 95%CI 2.07¿6.26) to have food security in comparison to those not having positive adaptive behaviors. This study also revealed that almost half of the mothers (AOR: 0.51: 95%CI: 0.33¿0.80) who reported being influenced by other family members to use FP had food security, in comparison to their counterparts. Age, duration of FP use, positive adaptive behaviors, and influence by significant others were found to be independent predictors of food security in the study areas. Culturally sensitive strategies need to be considered to expand awareness and dispel misconceptions that lead to hesitancy around FP utilization. Design strategies should take into account households' resilience in adaptive skills during shocks, natural disasters, or pandemics which will be invaluable for food security.

The current healthcare system's efforts to reduce the spread of COVID-19 in Ethiopia and limit its effects on human lives are being hampered by hesitancy toward the COVID-19 vaccine. The aim of this study was to assess the knowledge levels, attitudes, and prevention practices of COVID-19, in the context of the level of vaccine hesitancy with other associated factors in Ethiopia. A community-based cross-sectional design with mixed-method data sources was employed. It comprised 1361 study participants for the quantitative survey, with randomly selected study participants from the studied community. This was triangulated by a purposively selected sample of 47 key informant interviews and 12 focus group discussions. The study showed that 53.9%, 55.3%, and 44.5% of participants had comprehensive knowledge, attitudes, and practices regarding COVID-19 prevention and control, respectively. Similarly, 53.9% and 47.1% of study participants had adequate knowledge and favorable attitudes toward the COVID-19 vaccine. Only 29.0% of the total survey participants had been vaccinated with at least one dose of vaccine. Of the total study participants, 64.4% were hesitant about receiving the COVID-19 vaccination. The most frequently reported reasons were a lack of trust in the vaccine (21%), doubts regarding the long-term side effects (18.1%), and refusal on religious grounds (13.6%). After adjusting for other confounding factors, geographical living arrangements, the practices of COVID-19 prevention methods, attitudes about the vaccine, vaccination status, perceived community benefit, perceived barriers toward vaccination, and self-efficacy about receiving the vaccine were significantly associated with vaccine hesitancy. Therefore, to improve vaccine coverage and reduce this high level of hesitancy, there should be specifically designed, culturally tailored health education materials and a high level of engagement from politicians, religious leaders, and other community members.

Evidence on the relative importance of geographical distribution and associated factors with intimate partner violence (IPV) can inform regional and national health programs on women's health. Four thousand seven hundred and twenty married women aged 15-49 years were interviewed in 2016 about IPV and this data was extracted from the Ethiopian Demographic Health Survey (EDHS) in 2020. The sample was selected by a two-staged cluster survey of women. The analysis was conducted using logistic regression that adjusted for clustering and sampling weights. Moreover, weighted proportions of IPV were exported to ArcGIS to conduct autocorrelations to assess the clustering of IPV. Amongst the 4469 married women who were 15 to 49 years of age included in the analysis, 34% (95% CI, 31.4%-36.3%) experienced IPV, 23.5% (95% CI, 21.5%-25.7%) experienced physical violence, 10.1% (95% CI, 8.7%- 11.7 %) experienced sexual violence and 24% (95% CI, 21.7%-26.4 %) experienced emotional violence. Partners' controlling behaviour [AOR: 3.94; 95% CI, 3.03- 5.12], partner's alcohol consumption [AOR: 2.59; 95% CI, 1.80- 3.71], partner educational qualifications [AOR: 2.16; 95% CI, 1.26- 3.71], a woman birthing more than five children [AOR: 1.70; 95% CI, 1.12- 2.56] and a history of the woman's father being physically violent towards her mother [AOR: 1.99; 95% CI, 1.52- 2.59] were associated with an increased risk of IPV amongst married women in Ethiopia. Western and Central Oromia, Western Amhara, Gambella and Central Tigray and Hararri were identified as hot spot areas in Ethiopia (p<0.001). In this study, there was a significant geographic clustering of IPV in Ethiopia. Controlling and drinking behaviour and partners' unemployment status were identified as important factors for married women experiencing IPV. Hence, there is a need for a context- driven evidence-based design intervention to reduce the impact of IPV.

Background: Gestational diabetes mellitus is associated with higher risk for developing type 2 diabetes. Breastfeeding is protective against the development of type 2 diabetes after gestational diabetes. There are no data regarding the effect of breastfeeding on the development of recurrent gestational diabetes. Objective: Investigate the relationship of previous breastfeeding duration and intensity with the recurrence of gestational diabetes, and second pregnancy glucose tolerance test results. Methods: We conducted a questionnaire-based pilot cohort study, enrolling 210 women during a subsequent second pregnancy, after a gestational diabetes-affected first pregnancy. Models for length and intensity of breastfeeding as predictors of the oral glucose tolerance test and for diagnosis of gestational diabetes in second pregnancy were fitted and then adjusted for possible confounders. Results: Recurrent gestational diabetes rate in the study cohort was 70% (n = 146). In a fully adjusted model high intensity breastfeeding was associated with a lower 2-hour glucose level on the oral glucose tolerance test (by 0.66 mmol/L, 95% CI [0.15¿1.17]; p = 0.01) and breastfeeding greater than six months with a lower 1-hour glucose on the oral glucose tolerance test (by 0.67 mmol/L, 95% CI [0.16¿1.19]; p = 0.01), compared to women who breastfed less intensively or for a shorter duration respectively. There was an 18% reduction in the risk of gestational diabetes if a woman breastfed for more than six months (RR 0.82, 95% CI [0.69¿0.98]; p = 0.03). The association was attenuated in the fully adjusted model (RR 0.89, 95% CI [0.78¿1.02]; p = 0.09). Conclusions and implications for practice: We found the risk of recurrent gestational diabetes was reduced by both increased duration and intensity of breastfeeding. Antenatal lactation education should be embedded into care pathways for women diagnosed with gestational diabetes.

Aim: This study sought to explore nurses' perceptions of clinical handover in a regional health care facility to better understand the local context and identify the most appropriate clinical handover models. Background: Clinical handover is an essential aspect of clinical care, and yet using accurate spoken and written communication can be neglected in nursing, potentially resulting in patient harm. Although much information is available on clinical handover in metropolitan settings, few studies have examined the regional context. Methods: This study was an exploratory qualitative study based at one small regional health care facility located 100 km from a metropolitan Australian centre. The study utilized an Appreciative Inquiry approach to identify how nurses perceive the use of standardized oral and written clinical handover. Focus groups were engaged to explore the perceptions of nurses "handing over" in the smaller regional facility. Results: Through focus group interviews with Registered and Enrolled Nurses, the data revealed that the cultural context of the ward influenced perceptions of clinical handover and that handover served as a light in the dark for all nursing staff; as an evolving communication tool illuminating patient care needs. Conclusion: This study facilitated understanding of the handover needs of smaller Australian regional hospitals. This study identified gaps in perception about handover practices between junior and senior nurses. New graduate nurses develop confidence in supportive clinical environments. A transition to practice programme would need to address the challenges new graduates face in the regional setting. Implications for Nursing Management: Nurse managers in regional facilities can champion supportive senior nurses to mentor new graduate nurses and enhance the transition to practice for the new nurse.

Background: Mental health and psychosocial concerns such as domestic violence in pregnancy and after birth are significant issues. Maternal health, social and environmental contexts have a direct influence on child development and long-term health. However, midwives, nurses and other health professionals lack confidence and skills in assessing, supporting and referring women with perinatal psychosocial concerns. Aim and objectives: The aim of the scoping review is to review educational innovations and teaching strategies used to build skills and knowledge in health professionals and students to address psychosocial concerns including perinatal mental health, domestic violence and drug and alcohol misuse. Design: A scoping review was undertaken to help identify the breadth of papers reporting educational innovations and strategies particularly to address psychosocial concerns. Method: Four databases CINAHL, PsychoInfo, PubMed, OvidMedline and the grey literature were searched using a diverse range of terms for papers published in English between January 2009 and December 2020. This yielded 2509 papers and after review, 34 papers were included in the scoping review. Results: The 34 papers in this review found a diversity of educational initiatives and strategies delivered either face-to-face, online or in a blended mode addressing the learning needs of health professionals working with women with complex psychosocial concerns. The following characteristics in the papers were examined; focus of education, design and development, length, target audience including interprofessional focus, self-care, sensitive topics, debriefing, involving lived experience consumers and evaluation measures. Participants: In the studies indicated that they benefited from hearing about the individuals' lived experiences, opportunities for simulated practice and valued interprofessional learning experiences for both content and teamwork. The emergence of virtual modes offered some innovative and engaging ways to create a safe space for psychosocial education. However, the research does not provide guidance as to the best mode of delivery or length of program Conclusion: This scoping review provides a broad overview of innovative and diverse educational methods and strategies being used in the nursing, midwifery and health disciplines to engage students and practitioners in learning in the areas of perinatal mental health and psychosocial care. Involvement of lived experience consumers in the design and delivery of education programs can positively impact learners' knowledge and understandings of sensitive psychosocial topics. These diverse approaches could be used to shape the development and evaluation of future education programs.

Background: The aim of this research was to analyze midwives' job satisfaction and intention to leave in developing regions of Ethiopia. Methods: A facility-based cross-sectional study was conducted amongst 107 midwives in four developing regions of Ethiopia. All midwives who were working in 26 health facilities participated in the study. A structured self-administered questionnaire, and in depth key informant interview guides, were used to collect data. Job satisfaction was measured by nine dimensions and intention to leave their current position was measured using three questions. Results: More than two-thirds (67%) of the midwives were female, with a mean age of 26.1 (sd ± 4.2) years old. Less than half (45%) of the midwives were satisfied with their job, less than half (42%) were satisfied with 'work environment' and less than half (45%) were satisfied with 'relationship with management' and 'job requirements'. Relatively better satisfaction rates were reported regarding 'professional status', of which more than half (56%) of midwives were satisfied, followed by more than half (54%) of midwives being satisfied with 'staff interaction'. Almost two-fifths (39%) of midwives intended to leave their current position. Conclusion: Job dissatisfaction and intention to leave rates amongst midwives in developing regions in Ethiopia are a source of concern. The majority of midwives were most dissatisfied with their working environment and issues related to payment. Their intention to leave their current position was inversely influenced by job satisfaction. The introduction of both financial and nonfinancial mechanisms could improve midwives' job satisfaction, and improve retention rates within the profession.

Problem: Women having an elective caesarean birth are often separated from their babies at birth with newborns transferred to a postnatal ward with the significant other. Background: Two midwives were employed in 2019 to provide skin-to-skin contact for women who planned for elective caesarean births in a public hospital in metropolitan New South Wales with 4000 births per year and a 39% CB rate (57.8% of these births being elective). Aim: To compare the outcomes for women and their newborns on the effects of skin-to-skin contact at elective caesarean births within the first five minutes of birth to those who did not have skin-to-skin contact and to explore the lived experiences of women having skin-to-skin contact during their elective caesarean births. Methods: A quasi-experimental design study with a qualitative component of in-depth interviews. Quantitative analyses included independent t-tests, chi square and logistic regression. Thematic analysis was used for the qualitative data. Findings: In the quantitative results, there was a reduction in the time to the first feed (t(100) = -11.32, p < 0.001) (M = 38.9, SE = 20.7) (M = 124.9, SE = 50.1) and the first breastfeed (t(100) = -5.2, p < 0.001) (M = 53.2, SE = 82.5) (M = 277, SE = 295.8) with increased breastfeeding on discharge for women that had skin-to-skin contact at caesarean birth in comparison to those who did not receive skin-to-skin contact ¿2(1) = 10.22, p < 0.05. In the qualitative results, women who had skin-to-skin contact during their caesarean birth had a positive experience with improved bonding and reported less anxiety and depression than their previous caesarean birth. Conclusion: This study provides evidence of the benefits of skin-to-skin contact during a caesarean birth.

Background: Antiretroviral therapy for pregnant women infected with HIV has evolved significantly over time, from single dosage antiretroviral and zidovudine alone to lifelong combination of antiretroviral therapy, but the effect of the intervention on population-level child HIV infection has not been well studied in sub-Saharan Africa. Therefore, this study aimed to establish the trend and effect of ART coverage during pregnancy on mother-to-child HIV transmission in sub-Saharan Africa from 2010 to 2019. Methods: Country-level longitudinal ecological study design was used. Forty-one sub-Saharan Africa countries were included using publicly available data from the United Nations Programme on HIV/AIDS, World Health Organization, and World Bank. We created a panel dataset of 410 observations for this study from the years 2010¿2019. Linear fixed effects dummy variable regression models were conducted to measure the effect of ART coverage during pregnancy on MTCT rate. Regression coefficients with their 95% confidence intervals (CIs) were estimated for each variable from the fixed effects model. Results: ART coverage during pregnancy increased from 32.98 to 69.46% between 2010 and 2019. Over the same period, the rate of HIV transmission from mother to child reduced from 27.18 to 16.90% in sub-Saharan Africa. A subgroup analysis found that in southern Africa and upper-middle-income groups, higher ART coverage, and lower MTCT rates were recorded. The fixed-effects model result showed that ART coverage during pregnancy (ß = -¿0.18, 95% CI -¿0.19¿-¿0.16) (p < 0.001) and log-transformed HIV incidence-to-prevalence ratio (ß = 5.41, 95% CI 2.18¿8.65) (p < 0.001) were significantly associated with mother-to-child HIV transmission rate. Conclusions: ART coverage for HIV positive pregnant women and HIV incidence-to-prevalence ratio were significantly associated with MTCT rate in sub-Saharan Africa. Based on these findings we suggest countries scale up ART coverage by implementing varieties of proven strategies and control the HIV epidemic to achieve the global target of eliminating MTCT of HIV in the region.

Background Despite efforts made towards the elimination of mother-to-child HIV transmission, socioeconomic inequality in prenatal HIV test uptake in East Africa is not well understood. Therefore, this study aimed at measuring socioeconomic inequalities in prenatal HIV test uptake and explaining its main determinants in East Africa Method We analysed a total weighted sample of 45,476 women aged 15-49 years who birthed in the two years preceding the survey. The study used the most recent DHS data from ten East African countries (Burundi, Comoros, Ethiopia, Kenya, Malawi, Mozambique, Rwanda, Uganda, Zambia, and Zimbabwe). The socioeconomic inequality in prenatal HIV test uptake was measured by the concentration index and illustrated by the concentration curve. Then, regression based Erreygers decomposition method was applied to quantify the contribution of socioeconomic factors to inequalities of prenatal HIV test uptake in East Africa. Results The concentration index for prenatal HIV test uptake indicates that utilization of this service was concentrated in higher socio-economic groups with it being 15.94% higher among these groups in entire East Africa (p <0.001), 40.33% higher in Ethiopia (p <0.001) which was the highest and only 1.87% higher in Rwanda (p <0.01) which was the lowest. The decomposition analysis revealed that household wealth index (38.99%) followed by maternal education (13.69%), place of residence (11.78%), partner education (8.24%), watching television (7.32%), listening to the radio (7.11%) and reading newsletters (2.90%) made the largest contribution to socioeconomic inequality in prenatal HIV test in East Africa. Conclusion In this study, pro-rich inequality in the utilization of prenatal HIV tests was evident. The decomposition analysis findings suggest that policymakers should focus on improving household wealth, educational attainment, and awareness of mother-to-child transmission of HIV (MTCT) through various media outlets targeting disadvantaged sub-groups.

Objective: To identify, critique and synthesise the evidence about the impact of Appreciative Inquiry on improving nursing and midwifery students as they transition into becoming new graduates. Design: An integrative review. Data sources: The databases were: Pubmed, Ovid Medline, Cumulative Index of Nursing and Allied Health and Scopus. Review methods: A Whittemore and Knafl's (2005) five stage approach was used to appraise the primary literature related to nursing and midwifery students transitioning into becoming new graduates. Results: A total of 805 articles were retrieved and six studies met the inclusion criteria and included in this review. These studies have shown that Appreciative Inquiry as an intervention can be used to improve nursing and midwifery students' experiences as they transition into becoming new graduates. Three overarching themes were identified: caring, connecting and nurturing, transforming the workplace and work practices and appreciating and enabling nurses and midwives as a profession. Conclusion: Appreciative Inquiry offers a creative, exploratory and compassionate method to improve positive change for nursing and midwifery students as they transition into becoming new graduates. The impact of caring, nurturing nurses and midwives who mentor nursing and midwifery students makes a difference in increasing the likelihood that graduates will remain in the profession and establish fulfilling relationships with both colleagues and people.

A systematic review and meta-analysis were employed to address the associated factors of gender-based violence (GBV) in sub-Saharan African (SSA) countries. The Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines were followed. Ovid Medline, CINAHL, Cochrane Central, Embase, Scopus and Web of Science were used to source articles with stringent eligibility criteria. A total of 4931 studies were found and 50 studies met the inclusion criteria. Pooled meta-analyses revealed that low educational attainment, higher alcohol consumption, substance use, history of child and family abuse, limited decision-making skills, experiencing depres-sion, males having multiple sexual partners, and younger age were found to be individual-and family-associated factors that increase the experiences of GBV. Community tolerant attitudes to vi-olence, women's unemployment, being Muslim, lower socioeconomic class, food and social insecurity were found to be community-and societal-associated factors of GBV. Alcohol consumption, low educational attainment, experiencing depression, being younger, a history of child and family abuse, tolerant attitudes to violence, and low socioeconomic status were poignant factors associated with GBV amongst women in SSA countries. The need to develop a multipronged approach of in-tervention is a top priority in SSA to reach the Sustainable Development Goals' (SDGs) target of 2030 to eliminate all forms of violence. Socio-behavioural change communication interventions at individual and community levels need to be introduced, and interventions need to address the prevention of child and family abuse and increase women's feelings of empowerment in order to prevent GBV in SSA.

This study examines the associations between women's empowerment and family planning use in Jimma Zone, Western Ethiopia. A total of 746 randomly selected married women of reproductive age were interviewed. The data were employed by structural equation modelling (SEM) to investigate the complex and multidimensional pathways to show women's empowerment domains in family planning utilisation. Results of the study revealed that 72% of married women had used family planning. Younger women, having access to information, having access to health facilities and being aware about family planning methods, living in a rural area, having an older partner and increased household decision-making power were associated with using family planning methods. Women's empowerment is an important determinant of contraceptive use. Women's empowerment dimensions included increased household decision-making power, socio-demographic variables and having access to information about family planning and accessible health facilities. These were found to be important determinants of contraceptive use. Future interventions should focus on integrating women's empowerment into family planning programming, particularly in enhancing women's autonomy in decision making. Further research is warranted on the socio-cultural context of women that influences women's empowerment and family planning use to establish an in-depth understanding and equity of women in society.

Background: / Objective: This integrative review summarises original research that explores the experiences and perceptions of midwives and women using sterile water injections (SWI's) during labour. Design: Integrative review. Methods: A robust search strategy was conducted using the following databases: Scopus, Cumulative Index to Nursing and Allied Health (CINAHL), Ovid Medline and PubMed. All articles were assessed for quality using the Joanna Briggs Institute Critical Appraisal Tools (2017) scoring. Whittemore and Knafl's (2005) five stage approach was used to analyse the primary literature related to midwives and women's experiences of sterile water injections (SWI's) for back pain during labour. Findings: A total of 291 articles were retrieved and 13 papers were included in this review (four qualitative including one case report and nine quantitative) that fulfilled the inclusion criteria. Three overarching themes were identified: 'Assessment, perception and communication of pain', 'Techniques of administration of SWI's' and 'Barriers and resistance to using SWI's'. The 'Assessment, perception and communication of pain' theme included four subthemes: 'balancing the expectation of the injection pain against pain relief'; 'using appropriate language to prepare women'; 'rapid onset and increased pain relief with SWI's in comparison to saline'; and 'midwives high considerations for using SWI's as a form of pain relief'. The 'Techniques of administration of SWI's' theme included two subthemes: 'intradermal is better than subcutaneous injections'; and, 'four injections is better than one'. The 'Barriers and facilitators to using SWI's' theme included four subthemes: 'guidelines and evidence'; 'level of experience'; 'midwifery philosophy challenges'; and 'resistance from colleagues'. For example, 'midwifery philosophy challenges' included midwives being conflicted about providing an invasive, painful procedure as counter-intuitive to supporting women through the pain of labour. Midwives need opportunities to learn and develop skills for using SWI's. Women described feeling more empowered during their labour and appreciated the use of SWI's including the rapid onset of pain relief and the absence of side effects. The ability for women to exert some control over their pain whilst still being able to experience the physical sensations of labour and birth was important. Conclusions and implications for practice: The review supports the evidence for the use of SWI's however, there is limited evidence available and more information needs to be provided about the benefits of this non-pharmacological technique for back pain during labour. Generalised guidelines are needed to ensure consistent practice in the provision of care for women experiencing back pain during labour.

Identifying the socioeconomic and structural issues that act as enablers and/or barriers to HIV testing services is critical in combatting HIV/AIDS amongst mothers and children in Africa. In this study, we used a weighted sample of 46,645 women aged 15¿49 who gave birth in the two years preceding the survey from the recent DHS dataset of ten East African countries. Multivariable logistic regression was used to investigate the factors associated with prenatal HIV test uptake in East Africa. The overall prenatal HIV test uptake for the prevention of mother-to-child transmission (PMTCT) of HIV was 80.8% (95% CI: 74.5¿78.9%) in East Africa, with highest in Rwanda (97.9%, 95% CI: 97.2¿98.3%) and lowest in Comoros (17.0%, 95% CI: 13.9¿20.7%). Common factors associated with prenatal HIV test service uptake were higher maternal education level (AOR = 1.29; 95% CI: 1.10¿1.50 for primary education and AOR = 1.96; 95% CI: 1.53¿2.51 for secondary or higher education), higher partner education level (AOR = 1.24; 95% CI: 1.06¿1.45 for primary education and AOR = 1.56; 95% CI: 1.26¿1.94 for secondary or higher school), women from higher household wealth index (AOR = 1.29; 95% CI: 1.11¿1.50 for middle wealth index; AOR= 1.57; 95% CL: 1.17¿2.11 for rich wealth index), improved maternal exposure to the media, and increased awareness about MTCT of HIV. However, residents living in rural communities (AOR=0.66; 95% CI: 0.51¿0.85) and travelling long distances to the health facility (AOR = 0.8; 95% CI: 0.69¿0.91) were associated with non-use of prenatal HIV test service in East African countries. In each East African country, factors associated with prenatal HIV test uptake for PMTCT varied. In conclusion, the pooled prenatal HIV test uptake for PMTCT of HIV was low in East Africa compared to the global target. Scaling up interventions to improve enablers whilst addressing barriers to the use of prenatal HIV test services are essential to end the HIV/AIDS epidemic in East African countries.

This study aimed to systematically review studies that examined the prevalence of gender based violence (GBV) that included intimate partner violence (IPV) and non-IPV among women in sub-Saharan Africa (SSA). This evidence is an important aspect to work towards achieving the Sustainable Development Goals (SDG's) target of eliminating all forms of violence in SSA. The Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines were followed. Ovid Medline, CINAHL, Cochrane Central, Embase, Scopus and Web of Science were used to source articles with stringent eligibility criteria. Studies on GBV in SSA countries that were published in English from 2008 to 2019 were included. A random effect meta-analysis was used. Fifty-eight studies met the inclusion criteria. The pooled prevalence of IPV among women was 44%, the past year-pooled prevalence of IPV was 35.5% and non-IPV pooled prevalence was 14%. The highest prevalence rates of IPV that were reported included emotional (29.40%), physical (25.87%) and sexual (18.75%) violence. The sub-regional analysis found that women residing in Western (30%) and Eastern (25%) African regions experienced higher levels of emotional violence. Integrated mitigation measures to reduce GBV in SSA should focus mainly on IPV in order to achieve the SDG's that will lead to sustainable changes in women's health.

Background:. Objective: To evaluate women's experiences of a student-led midwifery group practice. Design: A mixed methods design was used to examine women's experiences and level of satisfaction about a student-led midwifery model of care. An on-line survey elucidated women's levels of satisfaction and experiences with the student-led midwifery group practice. The online survey was sent to all women (n = 25) who were receiving care from third year Bachelor of Midwifery students in 2018 via email up to 6 weeks postnatally. The online survey was distributed in the first instance to obtain baseline information about the importance of this student-led midwifery group practice and so the survey information was linked to the in-depth interview in the analysis for the purpose of identifying if the women were primiparous or multiparous. Women (n = 9) were invited to participate in an in-depth interview by self-opting on the survey and this extra data provided a richer understanding about the level of satisfaction about woman-centred care led by midwifery students. Retrospective data were also collected from the Maternity database - E-Maternity about birth outcomes. Setting: A tertiary teaching public hospital in New South Wales (NSW). Participants: Fifteen women participated in an online survey. Five primiparous and four multiparous women opted to be involved in the in-depth interviews on the online survey. Measurements and findings: Analysis in SPSS provided descriptive statistics including frequencies and percentages of data including birth outcomes. Simple correlations enabled associations to be established between levels of satisfaction, individualised care, quality of care, benefits and anxiety during pregnancy. The overarching themes from the qualitative findings identified the students' presence for the women as the most important component of the women's journey. The four main themes that emerged from the study included: familiarity of the caregiver, staying informed on the journey, feeling supported and reassured by their expertise, and control and decisions over birth events. Key conclusions: For a variety of reasons, women valued the presence of the students throughout their childbearing journey, including valuing the woman's private space during labour and her time with her partner. This combination of pedagogical approaches provides an alternative to the current placement approach, which includes working shifts in all areas of maternity. This approach will better support midwifery students to achieve the skills necessary to provide a continuity of care experience (CoCE) amongst a small team by a student-led midwifery group practice that is supported by a registered midwife in the antenatal clinic. The midwifery student is able to develop a relationship with the woman as a component of the CoCE under the guidance of a registered midwife and this is an important underpinning of the philosophy of woman-centred care. Implications for practice: This model of care provides evidence that women do value the students' support and presence throughout their experience and that the benefits of this model should be offered to all women as a normal component of their midwifery care.

Background: Midwives provide care to women across the childbearing journey from pre-conception to the post-partum period in various clinical settings. Due to the increasing incidence of diabetic pregnancies, midwives are now in a position to support other health professionals, as part of a team, to reduce the stress and / or demand on the health care services. Objective: This integrative review synthesises original research that explores the experiences and perceptions of midwives in the provision of care for women with diabetes. Design: Integrative review. Methods: Whittemore and Knafl's (2005) systematic approach was used to search for primary literature related to the research question. Studies meeting the following criteria were included: primary qualitative, quantitative and mixed methods research studies published in peer reviewed journals between January 2009 to October 2019. The population of interest being midwives or nurse-midwives and the outcomes of interest included their perceived role in the management of women with diabetes from the pre conceptual to the postpartum period. The methodological quality of the studies was assessed using the appropriate CASP (Critical Appraisal Skills Programmes, 2014) criteria for qualitative and quantitative research studies. A robust search strategy was conducted using the following databases: EBCSO host (all data bases), Embase, Scopus, and Science Direct (see Table 1). Findings: A total of 7275 articles were retrieved and ten papers were included in this review (five qualitative and five quantitative) that fulfilled the inclusion criteria. Two overarching themes were identified: professional and personal impacts on midwifery practice. The professional impact theme included three sub themes: organisational issues, professional development and holistic support. The personal impact theme also included three themes: limited diabetes knowledge, limited clinical practice skills and mental attitude. Conclusions and implications for practice: The findings indicate that midwives need opportunities to learn and develop skills specific to their role so that each individual's needs can be met. These opportunities include provision of education at a university level, offering work based training and increasing the number of post registration courses targeted at midwives who are willing to upskill to provide appropriate care to women with diabetes. Courses are required to address the knowledge, attitudes to diabetes, appropriate assessment skills and innovative communication skills for midwives.

The main purpose of this research was to analyze gender context in the Afar region of Ethiopia and propose a set of strategies or actions to improve adolescent and youth health. Using a pre-established gender analysis framework, an explorative qualitative study was conducted in five districts. Sixteen key informants and eight focus group discussions were conducted among adult women and men of young adolescents and youth. The study revealed that younger and older women are the most disadvantaged groups of the society. This is due to the high workload on women and girls (housekeeping, building a house and taking care of cattle and children), they also are less valued, have no control over resources and have no part in decision making, including their personal life choices. As a result, they rarely access school and health facilities. They are forced get married according to arranged marriage called "absuma." As such, they suffer from multiple reproductive health problems. Women have poor decision-making autonomy, lack control over resources, have limited participation in socio-economic practices, and experience child and early forced marriage, and this poor service utilization has exposed them to the worst sexual and reproductive health outcomes.

In this paper, we discuss findings from a research project in which barriers to and facilitators for promotion with women academics were explored. Four focus groups of women academics at an Australian university were held. Data including responses to semi-structured questions were analysed and interpreted using coding and thematic analysis. We found that multiple barriers and facilitators still exist in the university sector for women applying for promotion, covering structural, organisational, and individual levels. The barriers for promotion included workloads and huge expectations, the multi-pronged promotion process, competition, not being valued, juggling family life and not wanting to risk happiness. Facilitators for promotion included mentoring and collaborative nurturing, giving back to others including the university and flexibility.

Complementary and Alternative Medicine/Therapies (CAM) options have increasingly been used by pregnant women, however literature describing midwives' views and beliefs towards CAM is sparse. This study aimed to investigate Australian midwives' views and beliefs about CAM. Methods: A national survey of Australian College of Midwives midwife members (n = 3552) (UTSHREC 2015000614) included questions on midwives' views and support of CAM, and beliefs using a validated CAM Health Belief Questionnaire (CHBQ). Results: The response rate was 16%. Most respondents believed women should have the right to choose CAM (93.3%); and didn't view CAM a threat to public health (91.7%). Nearly half (49.5%) believed that their hospital/service did not have guidelines/procedures on CAM. The CHBQ mean score was 45.43 (SD9.98). Conclusion: Most respondents agreed with the fundamental beliefs of CAM. This study confirms the need for a national CAM policy for midwives; and research on midwives' CAM training.

Complementary and Alternative Medicine (CAM) have increasingly been used by pregnant women with a steady rise in interest by midwives. Literature describing CAM and self-help options midwives recommend to women experiencing a post-date pregnancy is sparse. This study aimed to investigate if Australian midwives' personal CAM use impacts on discussions and recommendations of CAM/Self-help strategies. Methodology/design: A survey of a national midwifery association midwifery members (n = 3,552) was undertaken at a midwifery conference (October 2015) and via e-bulletins (November 2015¿March 2016). The self-administered survey included questions on what self-help and CAM strategies midwives discuss and recommend to women with a post-date pregnancy, midwives' confidence levels on discussing or recommending CAM, midwives' own personal use of CAM. Findings: A total of 571 registered midwives completed the survey (16%). Demographics (age, years as a midwife, state of residence) reflected Australian midwives and the midwifery association membership. Most respondents discuss (91.2%) and recommend (88.6%) self-help/CAM strategies to women with a post-date pregnancy. The top five CAM recommended were Acupuncture (65.7%), Acupressure (58.1%), Raspberry Leaf (52.5%), Massage (38.9%) and Hypnosis/Calmbirthing/Hypnobirthing (35.7%). Midwives were more likely to discuss strategies if they personally used CAM (p <.001), were younger (p <.001) or had worked less years as midwives (p =.004). Midwives were more likely to recommend strategies if they used CAM in their own pregnancies (p =.001). Conclusion: Midwives' personal use of CAM influenced their discussions and recommendations of CAM/self-help strategies to women experiencing a post-date pregnancy. This study has implications for inclusion of CAM in midwifery education curricula.

Objective This research set out to develop and validate a tool to assess the self-reported progress of Australian publicly funded maternity services towards the goal of culturally competent maternity care for Indigenous women. The tool aimed to measure the degree to which these services had incorporated actions towards achieving 14 identified characteristics into the current fabric of their organisation. Design An online exploratory survey was distributed to consenting respondents nationally. Setting Public maternity services in each State and Territory of Australia. Subjects The survey was distributed to 149 public maternity organisations, with 85 organisational consents and 44 respondents completing the survey. Main outcome measure Construct validity of a survey designed to describe progress in working towards organisational cultural competence in maternity services was assessed by principal factor analysis and varimax with Kaiser rotation. Results The results support the two subscales identified as appropriate groups of questions to address 1) assessment of cultural competence and 2) assessment of the survey. Reliability was assessed by Cronbach's reliability and results established evidence of a reliable survey. Conclusion The results of this study show that the survey assessing and identifying organisational cultural competence in public maternity care for Indigenous women demonstrated acceptable reliability and validity for a newly developed instrument. Responses to the survey provided participants of this study with a baseline for assessing further progress. Upon further testing and refinement, the survey can provide a validated tool to guide both national and local activity to improve the maternity experiences of Indigenous women.

Background: The peanut ball has only been recently used as a support for women labouring with epidurals. The peanut ball is shaped like a peanut and fits snugly between the woman's legs so that both legs are maintained as opening the pelvic outlet to increase the progress of labour and facilitate descent of the fetal head. Using position changes during labour to enhance widening of the pelvic outlet can be beneficial but a woman who has an epidural is limited in the number of positions she can adopt. No randomised controlled trial has been implemented in Australia to establish the effectiveness of a peanut ball specifically for women using epidurals during labour, and this project addresses this gap. The main aim of this pilot study is to assess the feasibility and practicality of conducting and replicating this trial to a definitive randomised controlled trial (RCT). Methods: A minimum number of 50 women (25 in each trial arm), who are using an epidural in labour at two hospitals in NSW over a 1-year period, will be recruited and randomly allocated into a group that uses the peanut ball or into a group that does not use the peanut ball. Primary study objectives include assessing the proportion of women willing to be randomised, retention/attrition rates, and with associated reasons. Data will be collected on key clinical outcomes (natural birth rate, length of stay) with means and variances estimated between trial arms. This will inform the appropriate powering of a future definitive RCT. Secondary study objectives will include investigating the completion and acceptability of health and satisfaction surveys and assess the feasibility of conducting an economic evaluation alongside a future trial. Discussion: This is a two-armed randomised controlled pilot trial. Outcomes from this pilot will inform a larger trial at a tertiary hospital. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12618000662268.

There is a rapidly accumulating body of evidence regarding the influential role of early life stress (ELS) upon medical and psychiatric conditions. While self-report instruments, with their intrinsic limitations of recall, remain the primary means of detecting ELS in humans, biological measures are generally limited to a single biological system. This paper describes the design, rationale and feasibility of a study to simultaneously measure neuroendocrine, immune and autonomic nervous system (ANS) responses to psychological and physiological stressors in relation to ELS. Five healthy university students were recruited by advertisement. Exclusion criteria included chronic medical conditions, psychotic disorders, needle phobia, inability to tolerate pain, and those using anti-inflammatory medications. They were clinically interviewed and physiological recordings made over a two-hour period pre, during and post two acute stressors: the cold pressor test and recalling a distressing memory. The Childhood Trauma Questionnaire and the Parental Bonding Index were utilised to measure ELS. Other psychological measures of mood and personality were also administered. Measurements of heart rate, blood pressure, respiratory rate, skin conductance, skin blood flow and temporal plasma samples were successfully obtained before, during and after acute stress. Participants reported the extensive psychological and multisystem physiological data collection and stress provocations were tolerable. Most (4/5) participants indicated a willingness to return to repeat the protocol, indicating acceptability. Our protocol is viable and safe in young physically healthy adults and allows us to assess simultaneously neuroendocrine, immune and autonomic nervous system responses to stressors in persons assessed for ELS.

Objectives The aim of this study was to determine if implementation of a regular journal club improves critical appraisal confidence and facilitates integrating research literature into nursing practice. Design A survey was distributed to all paediatric nurses across two wards who had potentially attended the journal club in the previous two years. Setting This small scale study was undertaken at a northern Australian hospital. Sample The surveys were distributed to 58 nurses from the two paediatric wards and 33 of them responded but only 29 of these had attended the journal club leaving 29 surveys to be analysed for this study. Results The majority of responses to the survey questions were positive. When statistically analysed by Pearson's correlation, four variables showed a strong association: increased confidence with interpreting research literature, developing critical appraisal skills, the sharing of knowledge and integrating evidence-based practice into nurses' workplace. A number of changes in practice have occurred as a direct result of the journal club. Conclusion The results from this study support the benefits of utilising nursing journal clubs to promote clinical practice that is informed by research evidence.

Purpose: The aim of this study is to explore whether a methylation diet influences risk for adenomatous polyps (AP) either independently, or interactively with one-carbon metabolism-dependent gene variants, and whether such a diet modifies blood homocysteine, a biochemical phenotype closely related to the phenomenon of methylation. Methods: 249 subjects were examined using selective fluorescence, PCR and food frequency questionnaire to determine homocysteine, nine methylation-related gene polymorphisms, dietary methionine, 5-methyltetrahydrofolate, vitamins B6 and B12. Results: 1). Both dietary methionine and 5-methyltetrahydrofolate intake are significantly associated with plasma homocysteine. 2). Dietary methionine is related to AP risk in 2R3R-TS wildtype subjects, while dietary B12 is similarly related to this phenotype in individuals heterozygous for C1420T-SHMT, A2756G-MS and 844ins68-CBS, and in those recessive for 2R3R-TS. 3). Dietary methionine has a marginal influence on plasma homocysteine level in C1420T-SHMT heterozygotes, while B6 exhibits the same effect on homocysteine in C776G-TCN2 homozygote recessive subjects. Natural 5-methyltetrahydrofolate intake is interesting: Wildtype A1298C-MTHFR, heterozygote C677T-MTHFR, wildtype A2756G-MS and recessive A66G-MSR individuals all show a significant reciprocal association with homocysteine. 4). Stepwise regression of all genotypes to predict risk for AP indicated A2756G-MS and A66G-MSR to be most relevant (p= 0.0176 and 0.0408 respectively). Results were corrected for age and gender. Conclusion: A methylation diet influences methyl group synthesis in the regulation of blood homocysteine level, and is modulated by genetic interactions. Methylation-related nutrients also interact with key genes to modify risk of AP, a precursor of colorectal cancer. Independent of diet, two methylation-related genes (A2756G-MS and A66G-MSR) were directly associated with AP occurrence.

Background: The C1561T variant of the glutamate carboxypeptidase II (GCPII) gene is critical for natural methylfolylpolyglutamte (methylfolate) absorption, and has been associated with perturbations in folate metabolism and disease susceptibility. However, little is known on C1561T-GCPII as a risk factor for colorectal cancer. Therefore, this study examined whether C1561T-GCPII influences folate metabolism and adenomatous polyp occurrence. Materials and Methods: 164 controls and 38 adenomatous polyp cases were analysed to determine blood folate and plasma homocysteine (Hcy) level, dietary intake of natural methylfolate, synthetic pteroylglutamic acid (PteGlu), vitamin C and C1561T-GCPII genotype. Results: In controls and cases, 7.3 and 18.4 percent of subjects respectively, were found to have the CT genotype, increasing the risk for adenomatous polyp occurrence 2.86 times (95% CI:1.37-8.0, p=0.035). Total dietary folate, methylfolate and PteGlu intake and the level of erythrocyte folate and plasma Hcy did not predict the occurrence of an adenomatous polyp. However, dietary natural vitamin C intake was associated with adenomatous polyp risk within C1561T-GCPII CT genotype subjects (p=0.037). Conclusions: The findings suggest that C1561T-GCPII variation may be associated with risk for adenomatous polyp, and vitamin C may modify risk by interacting with the variant gene, its expression product and/or folate substrates.

Objective: to examine the effect of skin-to-skin contact and breast feeding within 30 minutes of birth, on the rate of primary postpartum haemorrhage (PPH) in a sample of women who were at mixed-risk of PPH. Design: retrospective cohort study. Setting: two obstetric units plus a freestanding birth centre in New South Wales (NSW) Australia. Participants: after excluding women (n=3671) who did not have opportunity for skin to skin and breast feeding, I analysed birth records (n=7548) for the calendar years 2009 and 2010. Records were accessed via the electronic data base ObstetriX. Intervention: skin to skin contact and breast feeding within 30 minutes of birth. Measures: outcome measure was PPH i.e. blood loss of 500 ml or more estimated at birth. Data was analysed using descriptive statistics and logistic regression (unadjusted and adjusted). Findings: after adjustment for covariates, women who did not have skin to skin and breast feeding were almost twice as likely to have a PPH compared to women who had both skin to skin contact and breast feeding (aOR 0.55, 95% CI 0.41-0.72, p<0.001). This apparently protective effect of skin to skin and breast feeding on PPH held true in sub-analyses for both women at 'lower' (OR 0.22, 95% CI 0.17-0.30, p<0.001) and 'higher' risk (OR 0.37 95% CI 0.24-0.57), p<0.001. Key conclusions and implication for practice: this study suggests that skin to skin contact and breastfeeding immediately after birth may be effective in reducing PPH rates for women at any level of risk of PPH. The greatest effect was for women at lower risk of PPH. The explanation is that pronurturance promotes endogenous oxytocin release. Childbearing women should be educated and supported to have pronurturance during third and fourth stages of labour.