Perceptions of long-term impact and change following a midwife-led biomass smoke education program for mothers in rural Uganda: A qualitative study

• Published in: Rural and remote health 2022-01, Vol.22 (1), p.1-15
• Main Authors: Cartwright, Lucy L, Callaghan, Lynne E, Jones, Rupert Cm, Nantanda, Rebecca, Fullam, James
• Format: Article
• Language: English
• Subjects: Air pollution; Biomass; Biomass energy; Biomass stoves; cookstove; Data collection; Education; Environmental aspects; Ethics; Evaluation; Focus groups; Health and hygiene; Health aspects; Health education; Health facilities; health intervention; Health risks; household air pollution; implementation; Indoor air pollution; Interviews; lung health; Malaria; maternal health; Maternal health services; Medical personnel; Midwifery; Mothers; Planning; Qualitative research; Rural areas; Rural children; Rural health care; Vector-borne diseases; Womens health
• ISSN: 1445-6354; 1445-6354
• DOI: 10.22605/RRH6893

Introduction: Women and children in Uganda and other low- and middle-income countries are exposed to disproportionately high levels of household air pollution from biomass smoke generated by smoke-producing cookstoves, especially in rural areas. This population is therefore particularly vulnerable to the negative health effects caused by household air pollution, including negative pregnancy outcomes and other health issues throughout life. The Midwife Project, a collaboration between research and health teams in the UK and Uganda, began in 2016 to implement an education program on lung health for mothers in Uganda, to reduce the health risks to women and children. Education materials were produced to guide midwives in the delivery of health messages across four rural health centres, and mixed-methods results of knowledge questionnaires and interviews demonstrated knowledge acquisition, acceptability and feasibility. This qualitative follow-up study aimed to improve understanding of the longer term impact of this education program from the perspective of midwives, village health team members and mothers, in consideration of rolling the program out more widely in rural Uganda. Methods: Purposive sampling was carried out to recruit consenting antenatal or postnatal women, midwives and village health team members who had been involved in an education session. Individual interviews were conducted with 12 mothers and four village health team members, and four focus groups were conducted with 10 midwives in total. Interviews and focus groups were conducted across all four health centres by two researchers and six translators as appropriate depending on language spoken (English or Lusoga). These were semistructured and directed by topic guides. Reflective and observational notes were also made. A thematic analysis was carried out by two researchers, along with production of a narrative for each mother, to enrich understanding of each individual story. Results: Midwives and village health teams had continued with the program well past the project end date and all mothers expressed making, or intending to make, changes, suggesting long-term feasibility and acceptability. Main themes generated were ability to change and changes made, ability to change dictated by money, importance of practical education, perceived health improvements, and passing on knowledge. Additional findings were that some education topics seemed to be overlooked, and there was a lack of clarity