A quantitative study of antenatal care, access barriers and maternal health vulnerability in rural Sindh, Pakistan

BackgroundThe benefits of maternal health care to maternal and neonatal health outcomes have been well documented. Antenatal care attendance, institutional delivery and skilled attendance at delivery all help to improve maternal and neonatal health. However, use of maternal health services is still very low in developing countries with high maternal mortality including Ethiopia. This study examines the association of unintended Pregnancy with the use of maternal health services in Southwestern Ethiopia.MethodsData for this study come from a survey conducted among 1370 women with a recent birth in a Health and Demographic Surveillance Site (HDSS) in southwestern Ethiopia. An interviewer administered questionnaire was used to gather data on maternal health care, pregnancy intention and other explanatory variables. Data were analyzed using STATA 11, and both bivariate and multivariate analyses were done. Multivariate logistic regression was used to assess the association of pregnancy intention with the use of antenatal and delivery care services. Unadjusted and adjusted odds ratio and their 95% confidence intervals are reported.ResultsMore than one third (35%) of women reported that their most recent pregnancy was unintended. With regards to maternal health care, only 42% of women made at least one antenatal care visit during pregnancy, while 17% had four or more visits. Institutional delivery was only 12%. Unintended pregnancy was significantly (OR: 0.75, 95% CI, 0.58-0.97) associated with use of antenatal care services and receiving adequate antenatal care (OR: 0.67, 95% CI, 0.46-0.96), even after adjusting for other socio-demographic factors. However, for delivery care, the association with pregnancy intention was attenuated after adjustment. Other factors associated with antenatal care and delivery care include women’s education, urban residence, wealth and distance from health facility.ConclusionsWomen with unintended pregnancies were less likely to access or receive adequate antenatal care. Interventions are needed to reduce unintended pregnancy such as improving access to family planning information and services. Moreover, improving access to maternal health services and understanding women’s pregnancy intention at the time of first antenatal care visit is important to encourage women with unintended pregnancies to complete antenatal care.

BackgroundSeasonality of food availability, physical activity, and infections commonly occurs within rural communities in low and middle-income countries with distinct rainy seasons. To better understand the implications of these regularly occurring environmental stressors for maternal and child health, this study examined seasonal variation in nutrition and health care access of pregnant women and infants in rural South Africa.MethodsWe analyzed data from the Venda Health Examination of Mothers, Babies and their Environment (VHEMBE) birth cohort study of 752 mother-infant pairs recruited at delivery from August 2012 to December 2013 in the Vhembe District of Limpopo Province, the northernmost region of South Africa. We used truncated Fourier series regression to assess seasonality of antenatal care (ANC) attendance, dietary intake, and birth size. We additionally regressed ANC attendance on daily rainfall values. Models included adjustment for sociodemographic characteristics.ResultsMaternal ANC attendance, dietary composition, and infant birth size exhibited significant seasonal variation in both unadjusted and adjusted analyses. Adequate frequency of ANC attendance during pregnancy (≥ 4 visits) was highest among women delivering during the gardening season and lowest during the lean (rainy) season. High rainfall during the third trimester was also negatively associated with adequate ANC attendance (adjusted OR = 0.59, 95% CI: 0.40, 0.86). Carbohydrate intake declined during the harvest season and increased during the vegetable gardening and lean seasons, while fat intake followed the opposite trend. Infant birth weight, length, and head circumference z-scores peaked following the gardening season and were lowest after the harvest season. Maternal protein intake and ANC ≤ 12 weeks did not significantly vary by season or rainfall.ConclusionsSeasonal patterns were apparent in ANC utilization, dietary intake, and fetal growth in rural South Africa. Interventions to promote maternal and child health in similar settings should consider seasonal factors.

Reducing Maternal and Perinatal Mortality Through a Community Collaborative Approach: Introduction to a Special Issue on the Maternal and Newborn Health in Ethiopia Partnership (MaNHEP)

ObjectiveThis study aimed at assessing factors associated with first antenatal care (ANC) attendance within 12 weeks of pregnancy among women in Lira City.DesignA cross-sectional study.SettingsThe study was conducted in health...

Petra ten Hoope-Bender: a “midwife's midwife”

Criminal acts in drug abuse tend to increase every year. Some of the most frequently abused drugs in recent years are psychotropic drugs and certain prescription drugs. (OOT). In generally, the factors that cause these crimes can be divided into two factor, first personal factors ( originate from within the individual) and situational factors. Studies related to the analysis of the causes of drug abuse crime have not been much done, especially in the province of Bali. The study aims to analyze the relationship between the personal factors of the perpetrators and drug abuse crimes in the province of Bali. The data used is data of pro-justicia cases related to drug abuses crimes handled by BBPOM in Denpasar and the Local Office in Buleleng (as an investigator and expert) during the period January 2021 to February 2024. Spearman's descriptive analysis and correlation tests were carried out against these factors. The result was that the frequency of drug crimes was dominated by the abuse of OOT commodities (89.5%) with the predominant personal factors, namely the age group 20-24 years (31.6%), the type of occupation (57.9%), and the level of high school education (36.8%). Spearman's correlation test results showed that there was a correlationship between the commodity of this crime drug with the age of the perpetrator (0.551) and the kind of job (0.604), whereas on the factor level of education there was no relationship (0.033) (P = 95%). A correlation value > Alpha (0,05) indicates that between compared factors there is a correlationship. The absence of correlation to the educational level factor, indicates that any level of education, has equal chances of being exposed to drug abuse crime. Similarly, in connection with the correlation between the age factor and the type of job, it becomes a reference and consideration for BPOM, the Bali Regional Police, and the Bali Provincial Government in determining a more effective, effective, and targeted preventive action strategy to reduce the rate of drug abuse.

ABSTRACTBackgroundThe COVID-19 pandemic disrupted essential maternal health services in low-resource settings, with uncertain impacts on antenatal care (ANC) utilization and delivery.ObjectiveTo evaluate the impact of COVID-19 on ANC service utilization in the Tamale Metropolitan Area, Northern Ghana, focusing on access barriers, healthcare provider experiences, and the feasibility of alternative delivery models.DesignFacility-based, convergent mixed-methods cross-sectional study.SettingFour public health facilities in Tamale, Ghana.Participants240 pregnant women aged 18–45 years receiving ANC and 25 maternal healthcare providers (midwives and nurses).MethodsStructured surveys with women and five focus group discussions with providers were conducted. Secondary ANC attendance data from the District Health Information Management System (DHIMS2) were reviewed. Quantitative data were analyzed using descriptive statistics, chi-square tests, and logistic regression in Stata 16. Qualitative data were thematically analyzed.ResultsIn 2020, antenatal care (ANC) attendance experienced a significant decline of 67.5%. Approximately 73.3% of women reported reduced visits, primarily due to fear of infection, transportation barriers (67.5%), or misinformation. Women who perceived a higher risk of infection at healthcare facilities were significantly more likely to decrease attendance (p<0.05). Healthcare providers reported challenges including staff shortages, increased workloads, and emotional stress, although improvements in infection control measures and shift systems were noted. Virtual care was utilized by 52.5% of women; however, 77.8% encountered internet-related challenges. No stock-outs of ANC medications were reported.ConclusionThe COVID-19 pandemic exposed vulnerabilities in ANC delivery in Tamale, driven by access barriers and systemic constraints. Investments in digital health infrastructure, risk communication, and provider support are critical to enhance maternal healthcare resilience during public health crises.

BackgroundExamining skilled attendance throughout pregnancy, delivery and immediate postnatal period is proxy indicator on the progress towards reduction of maternal and neonatal mortality in developing countries.MethodsWe conducted a cross-sectional baseline survey of households of mothers with at least 1 child under-5 years in 2012 within the KEMRI/CDC health and demographic surveillance system (HDSS) area in rural western Kenya.ResultsOut of 8260 mother-child pairs, data on antenatal care (ANC) in the most recent pregnancy was obtained for 89% (n = 8260); 97% (n = 7387) reported attendance. Data on number of ANC visits was available for 89% (n = 7140); 52% (n = 6335) of mothers reported ≥4 ANC visits. Data on gestation month at first ANC was available for 94% (n = 7140) of mothers; 14% (n = 6690) reported first visit was in1sttrimester (0-12 weeks), 73% in 2nd trimester (14-28 weeks) and remaining 13% in third trimester. Forty nine percent (n = 8259) of mothers delivered in a Health Facility (HF), 48% at home and 3% en route to HF. Forty percent (n = 7140) and 63% (n = 4028) of mothers reporting ANC attendance and HF delivery respectively also reported receiving postnatal care (PNC). About 36% (n = 8259) of mothers reported newborn assessment (NBA). Sixty eight percent (n = 3966) of mothers that delivered at home reported taking newborn for HF check-up, with only 5% (n = 2693) doing so within 48 h of delivery. Being ≤34 years (OR 1.8; 95% CI 1.4-2.4) and at least primary education (OR 5.3; 95% CI 1.8-15.3) were significantly associated with ANC attendance. Being ≤34 years (OR 1.7; 95% CI 1.5-2.0), post-secondary vs primary education (OR 10; 95% CI 4.4-23.4), ANC attendance (OR 4.5; 95% CI 3.2-6.1), completing ≥4 ANC visits (OR 2.0; 95% CI 1.8-2.2), were strongly associated with HF delivery. The continuum of care was such that 97% (n = 7387) mothers reported ANC attendance, 49% reported both ANC and HF delivery attendance, 34% reported ANC, HF delivery and PNC attendance and only 18% reported ANC, HF delivery, PNC and NBA attendance.ConclusionUptake of services drastically declined from antenatal to postnatal period, along the continuum of care. Age and education were key determinants of uptake.

BackgroundUganda experiences high maternal mortality ratios, with suboptimal utilization of maternal health services like antenatal care (ANC), especially in rural areas. Community Health Workers (CHWs), known as Village Health Teams (VHTs), have shown the potential to enhance maternal and child health (MCH) outcomes in Uganda by educating pregnant women in the community. However, their training models need to be refined to boost their performance.ObjectiveWe evaluated the effectiveness of a contextually tailored educational intervention delivered by VHTs on the knowledge, attitudes, and antenatal care attendance of pregnant women in Eastern Uganda.MethodsWe performed a quasi-experimental study using a pre-post-intervention evaluation conducted over six months in Eastern Uganda. We included pregnant women in their first trimester who consented to participate and excluded those in later trimesters. We performed multistage sampling with villages randomly selected and participants enrolled by trained VHTs. The VHTs were trained using a Maternal Newborn Child Health curriculum developed by a multidisciplinary team of healthcare professionals. The VHTs delivered educational sessions to the participants during home visits throughout their pregnancy. Data was collected on pregnant women’s knowledge, attitudes, and antenatal care attendance before and after the intervention. A score of ≥ 75% was considered sufficient knowledge. The Chi-square test was used to test the difference in the proportional change in knowledge and attitude of pregnant women. A paired two-sample t-test assessed changes in ANC attendance pre- and post-intervention. A p < 0.05 was considered statistically significant.Results228 participants were included, with a mean age of 27 ± 5.90 years and gravidity of 2.92 ± 1.47. There was a 60.7% increase in the proportion of participants with sufficient MCH knowledge after the intervention (19.6–80.3%, p < 0.001). Attitudes toward healthy MCH behaviors also improved. The proportion agreeing that attending eight or more ANC visits is crucial increased by 10.6% (88.1–98.7%, p < 0.001). Recognition of health facilities as the best place for ANC increased by 9.7% (89.9–99.6%, p < 0.001). The average number of ANC visits significantly increased from 1.22 to 6.38 (p < 0.001).ConclusionContextually tailored education delivered by trained VHTs significantly improved maternal health knowledge, attitudes, and ANC attendance among pregnant women in rural Uganda.

Antenatal care (ANC) is essential for maternal and neonatal health, where ANC acceptance varies significantly across different socioeconomic and demographic groups. This study aims to dissect the factors influencing ANC visits Madhesh Province, Nepal, using data from the 2022 Nepal Demographic and Health Survey (NDHS). The NDHS provides a rich dataset, the women of reproductive age who had at least one live birth in the preceding five years. The study focuses on a range of variables such as age, education, household wealth, and proximity to healthcare facilities, analyzing their impact on ANC visits, with the World Health Organization recommending a minimum of four visits for a healthy pregnancy. This study indicates that while age, religion, caste/ethnicity, and rural versus urban residency do not significantly impact ANC attendance, educational attainment shows a non-significant trend towards higher ANC visit rates among better-educated women. Interestingly, economic status does not generally affect ANC attendance except in the wealthiest group, which shows a near-significant increase in visit. Furthermore, significant negative relationship between birth order and ANC visits, suggesting that women with subsequent pregnancies are less likely to seek frequent antenatal care. The dynamics of ANC attendance targeted interventions aimed at improving maternal health services. By identifying the specific barriers and facilitators to ANC access, policymakers and healthcare providers can develop more effective strategies to boost ANC interest and improve pregnancy results. This study highlights the necessity of addressing both socio-economic differences and educational needs to ensure inclusive maternal health coverage.

This article discusses a population-based study from rural eastern Uganda that examines the uptake and determinants for HIV testing among pregnant women in Iganga/Mayuge Demographic Surveillance Site (DSS) where field assistants regularly collect data from households on vital events and other variables in a population of 67200 inhabitants. It finds that intensified counseling at health facilities and referral follow-up are needed as well as HIV testing services at ANC facilities to increase the coverage of HIV testing among pregnant women.

BackgroundLow birthweight is a major contributor to infant mortality. We evaluated the association between antenatal care (ANC) attendance and low birthweight among newborns in 5 regions of Burkina Faso.MethodsWe utilized data from the baseline assessment of a randomized controlled trial evaluating azithromycin distribution during the neonatal period for prevention of infant mortality. Neonates were eligible for the trial if the weighed at least 2500 g at enrollment and were 8–27 days of age. Data on ANC attendance and birthweight was extracted from each child’s carnet de santé, a government-issued health card on which pregnancy and birth-related data are recorded. We used linear and logistic regression models adjusting for potentially confounding variables to evaluate the relationship between ANC attendance (as total number of visits and ≥ 4 antenatal care visits) and birthweight (continuously and categorized into < 2500 g versus ≥2500 g).ResultsData from 21,223 births were included in the analysis. The median number of ANC visits was 4 (interquartile range 3 to 5) and 69% of mothers attended at least 4 visits. Mean birthweight was 2998 g (standard deviation 423) and 8.1% of infants were low birthweight (< 2500 g). Birthweight was 63 g (95% CI 46 to 81 g, P < 0.001) higher in newborns born to mothers who had attended ≥4 ANC visits versus < 4 visits. The odds of low birthweight among infants born to mothers with ≥4 ANC visits was 0.71 (95% CI 0.63 to 0.79, P < 0.001) times the odds of low birthweight among infants born to mothers who attended < 4 ANC visits.ConclusionsWe observed a statistically significant association between ANC attendance and birthweight, although absolute differences were small. Improving access to ANC for all women may help improve birth outcomes.Trial registrationThe parent trial is registered at clinicaltrials.gov: NCT03682653; first registered 24 September 2018.

Background/Objectives: Emerging evidence suggests that multiple micronutrient supplements (MMS) provide additional benefits for maternal and neonatal health compared with iron and folic acid (IFA) supplements. To achieve effective coverage, acceptability, and adherence—and to inform a nationwide rollout of MMS—it is essential to understand the context-specific factors that shape implementation. This study evaluated the pilot implementation of MMS in Rwanda to identify key enablers, areas for improvement, and challenges related to antenatal care (ANC) attendance and MMS use. Methods: Data were collected through a survey of 3257 women who attended ANC services, seven focus group discussions with 35 ANC attendees, and key informant interviews with 20 ANC nurses and 21 community health workers. Results: Pregnant women reported high ANC attendance (74%) and MMS consumption (79%), largely driven by strong motivation and awareness of MMS benefits. Strategies to remember daily intake and to manage side effects supported adherence, as did reminders, motivation, and information from family members and healthcare providers. Limited patient-centered counselling, financial constraints, barriers to accessing ANC services, and product stock-outs were key areas for strengthening service delivery in Rwanda. Conclusions: Sustaining high ANC attendance and MMS adherence as the program transitions from the pilot phase to national scale-up is essential. Improving counseling quality and strengthening supply chains may reinforce ANC services and support sustained MMS adherence, with benefits for maternal and child health.

Background: Antenatal care (ANC) is vital for maternal and infant health, yet women in Zanzibar frequently delay their first ANC visit and struggle with adherence to visits to ANC. This study investigates the socio-demographic factors contributing to these delays. It will describe pregnancy characteristics and assess the timing of the first ANC consultations. Methodology: The research employed a descriptive cross-sectional design at Mwembeladu Hospital, targeting pregnant women receiving ANC. Simple random sampling was used to gather data from 260 participants, with analysis focusing on socio-demographic factors and their impact on ANC attendance. Results: The majority of participants were multigravida (75.8%), and a significant portion attended their first antenatal care (ANC) visit during the second trimester (54.2%). Notably, despite a high level of education among participants, there was no correlation between educational attainment and timely ANC attendance. Similarly, marital status and partner support did not significantly impact the timing of ANC visits. Conclusion: This study highlights that many women in Zanzibar experience delays in antenatal care (ANC) attendance and have a low number of ANC visits, primarily due to the influence of multigravidity. Nearly half of the participants attended fewer than four consultations. Analysis of the timing of the first ANC visit shows that multigravid women seek care later. Additionally, an adequate level of education was not associated with improved attendance at antenatal consultations. There is a critical need for early detection of poor compliance and intervention during pregnancy.

Ana Langer: global leader in women's health