Soutien à la recherche et concours FR/EN: Lauréats du concours hiver 2017-2018 de soutien à la publication - Winners of the competition "Support for the writing of scientific work" - Winter 2017-2018

Ag Ahmed Mohamed Ali, ULaval

Co-auteures : Louise Hamelin-Brabant, Marie-Pierre Gagnon

Sociocultural determinants of nomadic women’s utilization of assisted childbirth in Gossi, Mali: A qualitative study

En Afrique subsaharienne (ASS), les nomades sont très nombreux (30- 60 millions) et marginalisés du fait de leur mode et milieu de vie qui les rendent très vulnérables. Peu de femmes nomades ont recours aux soins ce qui rend le risque de décès maternel élevé. Au Mali, pour les 3 régions nomades, seules 2 à 4% des femmes accouchent avec une assistance qualifiée. Les raisons pour lesquelles elles n’y ont pas recours ont été très peu documentées. L’objectif de cette étude est de comprendre les déterminants socioculturels du recours à l’accouchement assisté par ces femmes. Il s’agit d’une étude qualitative qui s’est déroulée dans la commune de Gossi (Mali). Une revue documentaire, 26 entretiens semi-dirigés avec des parturientes nomades, le journal de bord et l’observation non participante ont permis de collecter les données. L’analyse de contenu thématique a été privilégiée et le logiciel QDA Miner utilisé. L’étude a permis d’identifier une combinaison complexe de déterminants dont la résultante est le recours ou non à l’accouchement assisté par les nomades de cette commune. Plusieurs participantes ont reconnu l’intérêt de l’accouchement assisté, mais accouchent à domicile. Elles ont identifié des déterminants socioculturels en lien d’une part avec leurs représentations et expériences corporelles, les risques et les émotions (peur, stress, angoisse) qui y sont associées, et d’autre part leur faible autonomie de mouvement, de décision et économique. Cette recherche a aussi permis de proposer des pistes de stratégies innovantes et intégrées dont la conjonction peut améliorer ce recours.

English abstract:

Introduction: In sub-Saharan Africa (SSA), nomads account for 30 to 60 million. Their mobility, due to search for pastures and water points, makes health services less accessible to them. Few nomadic women use assisted delivery, which increases the risk of maternal mortality. The reasons behind this limited use have been poorly documented. The objective of this study was to understand the sociocultural determinants of assisted childbirth by nomadic women.

Methods: We conducted a qualitative research in the health area of Gossi (Mali) mainly populated by nomads. Data were collected through a literature review, 26 semi-structured interviews, logbook and non-participant observation. Nomadic women who gave birth in the past three months were included in the study, whether they used assisted delivery or not. A thematic content analysis was performed with the QDA Miner software.

Results: The study identified a complex combination of determinants which results in the use or not of assisted childbirth by the nomads of Gossi. Several participants recognized the value of assisted delivery, but gave birth at home. They identified sociocultural determinants related to their representations and bodily experiences, the risks and emotions (fear, stress, anxiety) associated with pregnancy, the onset of labor and delivery, and their weak autonomy of movement, decision and economy. Nomadic women are not free of their movements and in order to seek care, they require the permission and support of a man (husband, brother or father). Also, all participants are housewives and men control family resources and decide for all financial matters. The use of assisted delivery is often only considered in case of complications.

Conclusion: This research has made it possible to understand the sociocultural determinants of the use of assisted childbirth among nomadic women, which should be taken into account when organizing health services for these populations.

Keywords: Nomads, Maternal Health, Assisted Delivery, Sociocultural Determinants, Mali, Sub-Saharan Africa.

 

Bourque Mélanie, Grenier Josée, UQO

Co-auteurs : François Aubry, Denis Bilodeau, Louise Boivin, François Bolduc, Yvon Boucher, Julie Bourgault, Guy Bourgeault, Denis Bourque, Manon Chamberland, Yves Couturier, Dominique Gagnon, Audrey Gonin, Christian Jetté, Claude Larivière, Geneviève Pagé, Amélie Quesnel-Vallée, Stéphane Richard.

LA NOUVELLE GESTION PUBLIQUE EN ACTION. REGARDS CROISÉS SUR LE TRAVAIL SOCIAL À L’ÈRE MANAGÉRIALE.
Livre. Presse de l'Université Laval. 

Cet ouvrage s'intéresse aux réformes du réseau de la santé et des services sociaux et à leurs impacts sur l'intervention sociale. Les répercussions de ces réformes sont importantes en matière de santé des populations. On a qu'à penser aux travailleurs de rue ou aux interventions en matière d'agressions sexuelles ou de suicide pour souligner l'importance de l'intervention sociale en matière de prévention et comme instruments dans les politiques de santé et services sociaux.  Jusqu’ici, peu d’attention a été portée aux transformations de l’action publique en fonction des acteurs œuvrant dans le système de santé et des services sociaux du Québec et de leur vision du monde. Pourtant, l’analyse de l’action publique montre que les mutations des politiques publiques passent par les idées des acteurs qui redéfinissent les rapports de pouvoir au sein des institutions (Hassentaufel, 2008). Le livre discute des enjeux des services sociaux dans les secteurs public et communautaire à l’ère de la réforme Barette. Il traite plus spécifiquement de l’impact de la nouvelle gestion publique sur la profession du travail social dans les divers secteurs : CISSS/CIUSSS, CLSC, centre jeunesse, centre hospitalier, CHSLD, Groupe de médecine familiale, organismes communautaires. Les différents chapitres soulèvent les enjeux éthiques et déontologiques provoqués par une gestion axée sur la reddition compte en fonction de la performance.

 

Cockcroft Anne, McGill University

Co-auteurs : Khalid Omer, Yagana Gidado, Md Chadi Baba, Amar Aziz, Adamu Ibrahimn Gamawa, Neil Andersson

Universal home visits to pregnant women and their spouses reduce maternal morbidity: cluster randomised controlled trial in Bauchi State, Nigeria

The objective of the trial is to test the impact on maternal and newborn health of a program of universal home visits to pregnant women, to discuss actionable factors related to maternal health outcomes, with and without added video edutainment, in six wards of Toro Local Government Area of Bauchi State, Nigeria.

The work is taking place in Nigeria, which has one of the highest rates of maternal mortality in the world, especially in the North, where Bauchi state is located. Poor, isolated, marginalised women are most at risk for maternal mortality, and least likely to be able to access services such as antenatal care. The UNIVERSAL home visits reach these most vulnerable women, accompanying them during pregnancy and providing them with the same level of support as their more fortunate neighbours. 

The publication follows the CONSORT guidelines for reporting of randomised controlled trials. It covers the background and setting of the study, the trial design (a stepped-wedge cluster randomised controlled trial), the methods (including participants, sample size calculation, the intervention, and statistical methods for the impact assessment), the results (impact on maternal morbidity and on secondary/intermediate outcomes), and discussion of the limitations, generalisability and interpretation of the findings. The trial is a stepped-wedge design; this article reports on the impact of the home visits comparing the two wave 1 (intervention) wards, with the two wave 2 wards as control. The intervention comprised universal 2-monthly home visits to  all pregnant women and their spouses in the intervention wards, to collect information about the pregnancy progress, and share local research findings about risk factors for maternal outcomes (heavy work during pregnancy, experience of partner violence, lack of spousal communication about pregnancy, and lack of knowledge of danger signs). The impact assessment compares maternal outcomes of completed pregnancies in the intervention and control wards.

The key findings are a large, statistically significant, reduction in reported complications during pregnancy and delivery in the intervention wards, improvements in intermediate outcomes (such as attitudes and discussion with the spouse), and improvements in the identified risk factors (heavy work in pregnancy, experience of violence, and lack of knowledge of danger signs), with little difference in use of health services during pregnancy and delivery between the intervention and control wards. Our conclusion is that the intervention worked by encouraging male involvement and by supporting households to implement changes addressing identified "upstream" risk factors for maternal morbidity. This has potentially important implications for reducing maternal mortality, in the context of very poor available health services.

 

Duhoux Arnaud, UdeM - Le soutien à ce projet est financé par le RS TIC & Santé

Co-auteurs : Damien Contandriopoulos, Isabelle Brault, Caroline Larue, Jacinthe Pépin, Clémence Dallaire, Bernard Roy, Maxime Amar, Emmanuelle Jean, Lily Lessard, Luc Mathieu, Mélanie Perroux et Dominique Laroche.

Quatre vidéos ESPI – Innover en première ligne pour répondre aux besoins de la population

Le projet ESPI (Équipes de soins primaires intégrés - http://pocosa.ca/recherche-et-enseignement/projets-de-recherche-en-cours/projet-espi/) propose quatre vidéos sur ses résultats de recherche sur l’évaluation de milieux de soins de première ligne innovants.

Leur format est court (3, 4 minutes maximum) afin de privilégier leur circulation dans les réseaux sociaux. Ces vidéos peuvent aussi constituer des outils pour amorcer une discussion et ainsi être utilisées dans différents contextes académiques, professionnels ou pédagogiques.

Produites avec le financement du RRSPQ, elles visent à présenter des innovations et des modèles originaux dans l’organisation des services de première ligne et à exposer les effets de ces innovations sur les trajectoires de soins et la santé des populations. Ces vidéos permettront de faire circuler ces expériences positives dans le domaine des PPSP afin d’alimenter et de favoriser une prise de décision la plus éclairée possible et, à terme, améliorer les conditions d'accès aux soins de la population.

 

Loutfi David, McGill University

Co-authors: Susan Law, Neil Andersson, Leagajang Kgakole, Jeannie Haggerty, Jon Salsberg, Anne Cockcroft

"Can social network analysis help to include marginalised young women in structural support programmes in Botswana? A mixed methods study." International Journal for Equity in Health 2019; 18:12

Authors’ abstract

Background

In Botswana, one fifth of the adult population is infected with HIV, with young women most at risk. Structural factors such as poverty, poor education, strong gender inequalities and gender violence render many young women unable to act on choices to protect themselves from HIV. A national trial is testing an intervention to assist young women to access government programs for returning to education, and improving livelihoods. Accessing marginalised young women (aged 16–29 and not in education, employment or training) through door-to-door recruitment has proved inefficient. We investigated social networks of young women to see if an approach based on an understanding of these networks could help with recruitment.

Methods

This mixed methods study used social network analysis to identify key young women in four communities (using in-degree centrality), and to describe the types of people that marginalised young women (n = 307) turn to for support (using descriptive statistics and then generalized linear mixed models to examine the support networks of sub-groups of participants). In discussion groups (n = 46 participants), the same young women helped explain results from the network analysis. We also tracked the recruitment method for each participant (door to door, peers, or key community informants).

Results

Although we were not able to identify characteristics of the most central young women in networks, we found that marginalised young women went most often to other women, usually in the same community, and with children, especially if they had children themselves. Rural women were better connected with each other than women in urban areas, though there were isolated young women in all communities. Peer recruitment contributed most in rural areas; door-to-door recruitment contributed most in urban areas.

Conclusions

Since marginalised young women seek support from others like themselves, outreach programs could use networks of women to identify and engage those who most need help from government structural support programs. Methods that rely on social networks alone may be insufficient, and so a combination of approaches, including, for instance, peers, door-to-door recruitment, and key community informants, should be explored as a strategy for reaching marginalised young women for supportive interventions.