Impact of an unrestricted clear liquid fasting protocol on pediatric perioperative outcomes: a prospective interventional study.

Around 1.9 million babies are stillborn, and 2.5 million newborns die soon after birth each year, the overwhelming majority in low and middle-income countries (LMICs) [,]. Sub-Saharan Africa and South Asia account for more than 75% of global perinatal deaths [,]. Each death is a profound tragedy for parents and has far-reaching adverse social and economic consequences, impacting communities and wider society []. Studies demonstrate that sensitive and compassionate support from healthcare workers in the period immediately after the death of a baby is crucial in supporting grief and adjustment for parents and families and reducing negative health and social outcomes [,]. However, across global settings, including sub-Saharan Africa, many parents do not receive respectful care and support after stillbirth or neonatal death, including during the immediate postnatal period in facilities []. Insensitive communication from staff, lack of information and limited opportunities for parenting, such as seeing and holding the baby after birth, are reported []. Poor care contributes to disenfranchised grief. Where the death of the baby is not socially validated, social stigma and isolation particularly impact women []. Improving perinatal bereavement support has been identified as a priority for global action in maternal and newborn care [,]. Healthcare workers in LMIC maternity settings have acknowledged that providing bereavement support is among the most challenging aspects of their role and often lack confidence in this aspect of care []. Confidence, defined in this context, as the perception of having knowledge and skills to provide bereavement support, is recognized as a key attribute underpinning quality care []. Studies in high‑income countries suggest that a combination of factors including access to continuing education, support to develop practice skills and robust organisational endorsement is crucial influences []. Studies of healthcare workers’ experiences in caring for parents after stillbirth or neonatal death in sub‑Saharan Africa suggest some transferability of these issues [,]. However, contextual and cultural diversity impacting bereavement care in LMIC settings supports the need to better understanding of factors impacting healthcare workers in sub-Saharan Africa. The current study is part of a larger mixed-methods study, and findings will inform the development and validation of a context‑specific tool to assess healthcare workers’ clinical confidence in providing perinatal bereavement care in LMICs. Studies from high‑income countries have informed the conduct of this study due to the paucity of reported evidence from LMICs on health worker clinical confidence in providing perinatal support. The aim of this study was to explore healthcare workers’ views and experiences of factors influencing their confidence to provide perinatal bereavement care in Malawi and Zimbabwe. This study, part of a wider project, adopted a qualitative descriptive approach. Healthcare workers were recruited from four urban public maternity facilities, in central Malawi (2) and north-eastern Zimbabwe (2) which provide maternity and neonatal care at no cost to service users. Community Engagement and Involvement (CEI) and stakeholder groups, including parents with experience of the death of a baby, clinicians and policy makers, supported the research in both countries from study design to interpretation of the data. This included reviewing interview topic guides to ensure key areas of interest were covered. Following data analysis, the main themes were presented to the stakeholders and CEI groups for discussion and confirmation of the congruence of description. The research team comprised of nurse-midwife educators (Malawi, Zimbabwe, UK), who all had experience of providing perinatal bereavement care and a health psychologist with research experience of bereavement care. To minimize the influence of own assumptions on the research process, researchers maintained awareness of their influences and assumptions during data collection, analysis and interpretation.