Feasibility and acceptability of a midwife-led health education strategy to reduce exposure to biomass smoke among pregnant women in Uganda, A FRESH AIR project

ABSTRACT

Biomass smoke exposure is a threat to child and maternal health in many resource-limited countries and is associated with poor pregnancy outcomes and serious lung diseases in the offspring. We aimed to assess the feasibility, acceptability and impact of a midwife-led education programme on biomass risks and prevention for women attending maternity clinics in Uganda. Education materials were co-developed through an iterative process by midwives and other stakeholders. The materials were serially tested and approved by the Ministry of Health and used by midwives and village health teams (VHTs). The district health team, 12 midwives and 40 VHTs were sensitised on biomass smoke. Two hundred and forty-four women were educated about biomass smoke by midwives; pre- and post-session questionnaires showed major improvements in knowledge of biomass smoke risks. Qualitative interviews with women three months after the sessions showed that they made behavioural changes such as avoiding smoke while cooking, using dry wood, solar power for lighting and improved ventilation. The major barrier to behavioural changes was poverty, but some improvements cost no money. The programme delivered by midwives was feasible and acceptable; implementing this programme has the potential to reduce exposure to smoke with major benefits to mother, foetus, and children throughout their lives.

KEYWORDS:

• Biomass smoke exposure
• respiratory health
• antenatal education programme

Acknowledgements

RJ, BK, GN, AB. JKT and RN participated in the conception of the idea and writing the proposal. RJ, BK, RN, SB, LC participated in stakeholder engagement. RJ, RN, SB, JM, SK, LC, collected and analysed the data. SK drafted the manuscript and RN extensively reviewed the first draft. RJ, BK, SB, JM, AB, LC, JP, GN, JKT, SK and LC read and approved the final manuscript. We acknowledge the contributions of the participants (midwives, VHTs, women and community members) in the process of developing the health education materials and implementing the intervention. Many thanks to the District Health Office team members for their great collaboration and support throughout this study and to the Ministry of Health of Uganda for their expertise in reviewing the educational materials and approving them for use within the Uganda healthcare system. Dr Jones is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PENCLAHRC).

Disclosure statement

No potential conflict of interest was reported by the authors.

Availability of data and material

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

ORCID

Jill Pooler http://orcid.org/0000-0001-8624-0117

Additional information

Funding

The research leading to these results has received support from the EU Research and Innovation program Horizon2020 (H2020 European Research Council) under grant agreement no. 680997, part of the Health, Medical Research and the Challenge of Ageing Horizon 2020 action.