ANC Care Research Articles

Women's autonomy and utilization of maternal healthcare in India: Evidence from a recent national survey.

ObjectiveThe present study aims to examine the association between women’s decision-making autonomy and utilization of maternal healthcare services among the currently married women in India.MethodsA total of 32,698 currently married women aged 15–49 years who had at least one live birth in the past five years preceding the survey and had information regarding autonomy collected by the National Family Health Survey 2015–16 were used for analysis. Bivariate and multivariate logistic regression models were employed for the analyses of this study.ResultsUtilization of maternal healthcare services was higher among the women having a high level of decision-making autonomy compared to those who had a low autonomy in the household. The regression results indicate that women’s autonomy was significantly associated with increased odds of maternal healthcare services in India. Women with high autonomy had 37% and 33% greater likelihood of receiving ANC (AOR: 1.37, 95% CI: 1.25–1.50) and PNC care (AOR: 1.33, 95% CI: 1.24–1.42) respectively compared to women having low autonomy. However, no significant association was observed between women’s autonomy and institutional delivery in the adjusted analysis.ConclusionThis study recommends the need for comprehensive strategies involving improvement of women’s autonomy along with expansion of education, awareness generation regarding the importance of maternity care, and enhancing public health infrastructure to ensure higher utilization of maternal healthcare services that would eventually reduce maternal mortality.

Factors Affecting the Utilization of Maternal and Child Health Care Services in Tribal Dominated Population States of India.

The present study intended to examine that factors affecting the utilization of maternal health services in the Three tribal-dominated states of India namely Madhya Pradesh, Jharkhand and Chhattisgarh. The study used National Family Health Survey (NFHS-4) data. Both bivariate and multivariate techniques have been applied for data analysis. Logistic regression techniques and concentration curve and index have been used . Findings of the study indicate that there were wider socio-economic differential exits in the utilization of MCH services (full ANC, Safe delivery and post-natal care) in all the three states under study. The regression result shows that the tribal population is less likely to utilize maternal and child health care services than other Caste groups. The economic inequality in accessing the all three components of maternal health care utilization was higher in the Jharkhand than Madhya Pradesh and Chhattisgarh. Further, economic inequality was higher in accessing the full ANC than safe delivery and post-natal care across all the states under study. From policy point of view, the government schemes to provide maternal health services to tribal communities should consider the community-level factors affecting maternal health care utilization and should extend its operations in the small villages.

Breastfeeding Week Celebrations at ESI Hospitals

In August 2014, the Department of Community Medicine celebrated breastfeeding week in our hospital(ESIC hospital, Joka) and field practice area (ESI hospital budge budge) which is our Urban health training centre in southern part of Kolkata. The theme for this year is “Breastfeeding: A Winning Goal for Life!” The theme for this year's World Breastfeeding Week asserts the importance of increasing and sustaining the Protection, Promotion and Support of Breastfeeding for achieving the Millenium Development Goals (MDGs) and improving child survival and nutrition in the Post 2015 development agenda of sustainable development goals.1To begin with, we referred to National Family Health Survey-3 data and tried to find out the status of breastfeeding practices in our areas. We found that percentage of children who received breastfeeding in one hour was just 23.7%.2 . District level health survey shows that percentage of children who received breastfeeding in one hour is 38.5% only while that the Mothers who received any antenatal check-up is 96.1% 3 This signifies poor implementation of breastfeeding policies in health care facilities and also signifies the missed opportunity to health educate the mother and her relatives about importance of exclusive breastfeeding. In the settings, where the ANC check up is high, the staff of healthcare facilities should ensure education of the mothers regarding exclusive breastfeeding, positioning, and attachment of infant to the breast while providing the ANC care and same should be continued after delivery. To achieve this, staff of the health care facility should be educated and trained in the importance of exclusive breastfeeding, positioning, and attachment of breast. Hence, as a part of breastfeeding week celebrations, we decided to conduct one-day workshop for the staff nurse working in maternity and paediatric wards and OPD of the ESIC hospital Joka and ESI hospital budge budge. We used this time to explain how important is exclusive breastfeeding and how does it influences neonatal mortality by decreasing it six times if exclusive breastfeeding is given.4 We showed how the mother can position the child and attach the child to the breast. We used an Integrated Management of Neonatal and Childhood Illness (IMNCI) guidelines, which is recommended under National Rural Health Mission (NRHM). We could offer these skills-based training to 44 staff nurse of two hospital and 4 ward ayaa from ESI budge budge hospital. We used photographs, Power Point presentations and videos. We also emphasized the importance of breastfeeding week and its theme. We also emphasize on stopping or discontinuation of use of infant milk substitute, feeding bottles and infant foods which is also stated by government of India, in 1992 (IMS act) as provided by Ministry of Health and Family Welfare (MoHFW), India. Faculty of Community Medicine department, of which one is trained in IMNCI strategy, conducted the sessions.

Early initiation of breast feeding and its associated factors among 0-23 months children in Haldwani, District Nainital

Introduction: Breastfeeding benefits both the mother and infant. It contains all the essential nutrients in an adequate amount that fulfils the infant first six month’s needs. Early initiation of breastfeeding is necessary to ensure consumption of colostrum having multiple protective factors. Aim and Objectives: To estimate the prevalence of early initiation of breast feeding and to determine its associated factors among 0- 23 months children. Methodology: A community-based cross- sectional study was carried out among 339 children aged 0-23 months in field practice areas of Rural & Urban Health Training Centres (RHTC & UHTC), Department of Community Medicine, Govt. Medical College, Haldwani, District Nainital for a period of 6 months using simple random sampling. Questions related to Early initiation of breast feeding and its associated factors were asked through Epicollect software. Wald’s statistics, Chi- square test, Fisher’s exact test were applied. P value of less than 0.05 was considered as significant. Results: The prevalence of Early Initiation of Breastfeeding was 45.1% (95% CI= 39.9%-50.5%) which was significantly associated with place of delivery, mode of delivery, mother’s education & ANC care. Conclusion: Early Initiation of Breastfeeding practice was found in almost half of children which were significantly associated with various factors highlighting the importance of addressing these factors to improve Early Initiation of Breastfeeding practices.

High dropout rate from maternity continuum of care after antenatal care booking and itsassociated factors among reproductive age women in Ethiopia, Evidence fromDemographic and Health Survey 2016.

Maternal continuums of care were vital to reducing maternal and neonatal mortalities. While the dropout rate remains high and limited studies were found on risk factors associated with a high dropout rate of the maternal continuum of care. This study aimed to assess the magnitude of dropout rate and its associated factors of maternity continuum of care in Ethiopia, 2016. An in-depth secondary data analysis was conducted from the Ethiopian Demographic and Health Survey 2016 data. A total of 4,693 women who were booked for antenatal care visit were included to the final analysis. A community-based cross-sectional study design and a pre-tested and standardized questionnaire were used to collect the survey data. Data were weighted using women data weighting variables. Chi-square and multicollinearity assumptions were checked for independent variables. Bi-variable and multivariable logistics regression used to identify associated factors with a cut of the p-value of 0.2 and 0.05 respectively. Adjusted Odds Ratio (AOR) with 95%CI was reported for the final model. Of the total 4,693 women who were booked for antenatal care visits, 2,092(44.58%), 2,183 (46.52%), and 4,086(87.07%) dropped from a recommended number of ANC, Institutional delivery and postnatal care visit respectively. Only 308 (6.56%, 95%CI: 5.89, 7.31) women used all the complete continuum of care. Not married, and poorest wealth index were significantly associated with dropout from ANC visit. Being a protestant religious follower was significantly associated with dropout from PNC after antenatal care booking. While not exposed to media, distance from health facility as a big problem, protestant affiliation, parity of 2 to 4 and above4, Wealth index of the poorest, poorer, middle, and richer significantly associated with dropout from institutional delivery. Not being informed about pregnancy complications during their ANC visit was significantly associated with dropout from ANC, PNC, and institutional delivery. Dropout of women from the maternity continuum of care after antenatal care booking was a public health problem in Ethiopia. Socio-demographic, pregnancy, and health service-related factors were significant determinants of dropout from the maternity continuum of care. Improving the family wealth index, increasing access to health facilities, media exposure, and giving more information during the antenatal care visit is important to reduce the dropout rate from the maternity continuum of care.

Quality-Adjusted Coverage of Nutrition Interventions Across the Continuum of Care: Insights from Household and Health Facility Data in Bangladesh

Abstract Objectives Improving the impact of nutrition interventions requires adequate measurement of both reach and quality of interventions, but limited evidence exists on advancing coverage measurement. We adjust crude health coverage estimates, taking into consideration the inputs required to deliver quality nutrition services, across the continuum of care in Bangladesh. Methods We used data from Bangladesh Demographic and Health Surveys 2014 to assess use of maternal and child health services and Service Provision Assessments 2014 to determine facility readiness to deliver nutrition interventions during antenatal (ANC), institutional delivery, and postnatal care (PNC). Service readiness was computed as the mean availability of four nutrition-specific inputs, capturing human resources and training, equipment, diagnostics, and medicines. Crude coverage was combined with service readiness to create a measure of input-adjusted nutrition coverage at the national and regional levels, across place of residence, and by maternal educational and household socio-economic quintiles. Results Crude coverage varied, with greater use of any ANC (79%) and postnatal care (61–81%), than institutional delivery (37%). Nutrition service readiness was lower than crude coverage at each time point, such that nutrition input-adjusted coverage was 45% for ANC, 25% for institutional delivery, and 38–49% for preventive and sick child postnatal care, respectively. Input-adjusted coverage varied by 10–22 percentage points (pp) between regions within the country. Inequalities in input-adjusted coverage were large during ANC and institutional delivery (12–17 pp between urban and rural areas, ∼17pp between low and high education, and 30–36pp between highest and lowest wealth quintiles), and less variable for postnatal care (<10%). Conclusions Nutrition input-adjusted coverage was suboptimal and varied sub-nationally and across the continuum of care in Bangladesh. Special efforts are needed to improve the reach as well as the quality of health and nutrition services to achieve the Sustainable Development Goals. Funding Sources Bill & Melinda Gates Foundation through A4NH.

PIH37 INEQUALITY OF OPPORTUNITY IN MATERNAL HEALTH AMONG ADOLESCENTS

Adolescent maternal health remains a major public health and economic burden to Kenya, with maternal morbidity and mortality being highest among adolescent mothers. The Government of Kenya has adopted several policies to improve maternal health, however, demand for these services remain less than optimal. Studies shows that circumstances beyond the adolescence like stigma and discrimination, parental socioeconomic status etc influence utilization of health services. The objective of this study was to estimate inequality of opportunity (IOp) in maternal health among the adolescence ages 15-19 year in Kenya and estimate percentage contribution of each circumstance to IOp. Three waves of pooled Kenya Demographic Health Survey (KDHS) data for 2003, 2008/09 and 2014 were used in the study. This study used Human Opportunity Index (HOI) to examine the equality of opportunity three adolescent maternal health service (i) Antenatal care (ii) facility delivery (iii) skilled birth attendant (iv) ever pregnant. In addition, the Shapley decomposition method was used to capture the contribution of each circumstance to inequality of these opportunities. The percentage of adolescent girls who had ever been pregnant were 18%, those who sought ANC care, delivered in the facility and received post-natal care were 53%, 71% and 60% respectively. The inequality measured by dissimilarity index (D) was lowest among adolescent facility delivery (11.1%) and highest among ever pregnant (20.24%). The opportunities for access to these services also varied ranging from 14% for ever pregnant to 62.4% for facility delivery. Wealth Status, education and location were the major contributors to IOp. To ensure all women access their socioeconomic rights including reproductive health as stated in the Kenyan Constitution and achieve universal health care, the government of Kenya needs to address the causes of IOp including increased access to education, improved health services in rural areas and reduction of poverty.

Prevalence and Predictors of Postpartum Depression: Northwest Ethiopia

Background Postpartum depression is an umbrella, which encompasses several mood disorders that follow childbirth within 6 weeks. Screening for postpartum depression would improve the ability to recognize these disorders and enhance care that ensures improved clinical outcomes. Early identification of postpartum depression is important in order to plan for implementation strategies that allow for timely treatment and support of women with postpartum depression. Objective To determine the prevalence and associated factors of postpartum depression among women who gave birth in the last six weeks in Gondar town, Northwest Ethiopia, 2018. Methods A community based cross-sectional study was conducted among 526 women who gave birth in the last 6 weeks from July 1 to 30, 2018 in Gondar town. Cluster sampling technique was used. Data were collected by semi-structured and pretested questionnaire and entered into epi-Info version 7.0 and then analyzed by SPSS version 20.0. Both bivariate and multivariable logistic regression model were fitted. Adjusted odds ratio with 95% confidence interval has been computed and variables with p-value <0.05 were considered statistically significant. Results The prevalence of postpartum depression among 526 postnatal women was 25% (95% CI: 21, 28). Abortion history (AOR = 1.79, 95% CI: 1.07, 2.97), birth weight <2.5 kg (AOR = 3.12, 95% CI: 1.78, 5.48), gestational age below 36 weeks (AOR = 2.18, 95% CI: 1.22, 3.88) unplanned pregnancy (AOR = 2.02, 95% CI: 1.24, 3.31), relatives' mental illness (AOR = 1.20: 1.09–3.05), had no antenatal visit (AOR = 4.05, 95% CI: 1.81, 9.05), had no postnatal visit (AOR = 1.82, 95% CI: 1.11, 3.00) were factors significantly associated with postpartum depression. Conclusion and Recommendations. The prevalence of PPD was found to be higher. Variables like abortion history, low birth weight, gestational age below 36 weeks, unplanned pregnancy, relatives' mental illness, had no antenatal visit, and had no postnatal visit were predisposing factors to postpartum depression. Preventive measures to avoid low birth weight and pregnancy complications are also identified as proactive ways to reduce postpartum depression. Early identification and treatment of depression during ANC and postpartum care can mitigate the impact of PPD on the mother-baby dyad. Emphasis must be given women to have ANC and PNC follow up.

Gaps in facilities available at Community Health Centers/Rural Hospitals as per Indian public health standards - Study from Western Maharashtra.

Background:The launch of the National Rural Health Mission (NRHM) gives us the opportunity to review the functioning and bring up the Community Health Centers (CHC) services to the level of Indian Public Health Standards and thus improve the lives of citizens.Objectives:Assessment of the gaps in the facilities available at Community health centers/Rural hospitals as per Indian Public health standards.Methods:Facility based cross-sectional study was conducted in the Satara district of Maharashtra.Results:This study in the majority showed that the gap in the delivery of healthcare according to IPHS. It was observed that the Funded CHCs had a better quality of services than the non-funded CHCs. The non-funded CHCs lacked essential emergency services. Along with ANC care, newborn care in the first few minutes of life is very crucial, but very little priority was given to the newborn care as those services were not as per norms. Specialists as well as paramedical and other support staff are deficient in both funded and non funded CHCs/rural hospitals (RHs).Conclusion:Standards were greatly influenced by funds delivered by IPHS itself. A staffing pattern is one of the important pillars in delivering various health services. A better salary, working place with continuous water supply, electricity, and cleanliness will improve the staffing pattern. Therefore, competent manpower and well-built infrastructure will help in the standard delivery of healthcare at CHC/RH and will thus serve the purpose of dispensing basic health services to every individual in the remotest areas.

Factors Associated with the Death of Preterm Babies Admitted to Neonatal Intensive Care Units in Ethiopia: A Prospective, Cross-sectional, and Observational Study.

Aim. To determine the risk factors for death among preterm neonates. Methods and materials. The data set used was derived from a prospective, multi-center, observational clinical study conducted in 5 tertiary hospitals in Ethiopia from July, 2016 to May, 2018. Subjects were infants admitted into neonatal intensive care unit. Results. Risk factors were determined using statistical model developed for this study. The mean gestational age was 32.87 (SD ± 2.42) weeks with a range of 20 to 36 weeks. There were 2667 (70.69%) survivors and 1106 (29.31%) deaths. The significant risk factors for preterm death were low gestational age, low birth weight, being female, feeding problem, no antenatal care visits and vaginal delivery among mothers with higher educational level. Conclusions. The study identified several risk factors for death among preterm neonates. Most of the risk factors are preventable. Thus, it is important to address neonatal and maternal factors identified in this study through appropriate ANC and optimum infant medical care and feeding practices to decrease the high rate of preterm death.

KAP on Obstetrics Danger Signs of Pregnancy Among ANC Attending Pregnant Mother in Gununno Health Center, Gununo Town, Wolaita Zone, Southern Ethiopia April: 2019

Danger signs of pregnancies are a warning signs that women encounter during pregnancy, child birth and postpartum. It is important, to know this warning signs for women and health care providers to rule out serious complications and initiate treatment immediately. Pregnancy is normal process that results a series of both psychological and physiological changes in pregnant mother. However pregnancy is accompanied with some problems and complications which is life threatening for mother and the fetus. Awareness of obstetric danger sign is first step in accepting appropriate and timely health care service. However there is high maternal death in developing countries due the lack of adequate awareness about danger signs of pregnancy. Yet its factors are not well known in Ethiopia where maternal mortality is high. METHODOLOGY: Descriptive cross sectional study design was conducted for assessment of KAP of obstetric danger sign among pregnant mother at Gununo town, Gununo health center from May10 to June 20, 2019. The pregnant to be interviewed was selected by systematic random sampling ANC registration book at the time of data collection. The total sample size was 420. Structured interviewer administered questionnaire was used to collect data. Data was entered in to STATA 14 statistical software for analysis. Finally, results were presented in texts, graphs and tables. RESULT: A total of 420 pregnant women were included in the study making the response rate 100%. From those who were included in the study 302 (71.56%) identified severe vaginal bleeding at any time during pregnancy as danger sign. In general 248 (58.77%) of the study participants were found to have good knowledge by scoring above the mean value. overall assessment for attitude shows 203 (48.1%) of the study participants had negative attitude by scoring the mean value and below the mean value and 60% were found to have good practice. Conclusion: Knowledge on danger signs during pregnancy is low and greater than half of respondents have unacceptable attitude. The quality of ANC care particularly health education should be evaluated. Further studies are recommended to address the gaps of knowledge and attitude.

STUDY TO DETERMINE THE FETAL AND MATERNAL OUTCOME IN ACUTE VIRAL HEPATITIS

Acute viral hepatitis is the commonest cause of jaundice in pregnant women with clinical evidence of hepatitis with HEV being the predominant cause. Acute viral hepatitis is a systemic infection caused by six distinct types of viruses A, B, C, D, E and G. The present study was a prospective observational study done in the Department of Obstetrics and Gynaecology, Patna Medical College &amp; Hospital, Patna over a 2 years period with 100 pregnant patients suffering from acute viral hepatitis. This study was conducted to know the prevalence, obstetric complications and maternal, perinatal outcome in pregnant women presenting with acute viral hepatitis. In our setup most common cause of acute viral hepatitis with adverse fetomaternal outcome was found to be with Hepatitis E .HBV was found to be the 2rd most common etiological factor followed by HAV. Adverse fetomaternal outcome like abortion, preterm, LBW, IUGR, IUD, higher NICU admissions, coagulation derangement, PPH, hepatic encephalopathy were mostly associated with HEV infection. Acute viral hepatitis was associated with a maternal mortality of 17% mostly attributable to HEV infection. In a developing country like India, awareness of pregnant women about viral hepatitis, regular ANC care, cost effectiveness and easy accessibility to health care system and treatment plays a key role in improving the current situation.&#x0D; Keywords: Viral hepatitis, Maternal, Fetal, Pregnancy

Maternal outcome in teenage pregnancy

Maternal outcome in teenage pregnancy - IJOGR- Print ISSN No: - 2394-2746 Online ISSN No:- 2394-2754 Article DOI No:- 10.18231/j.ijogr.2019.061, Indian Journal of Obstetrics and Gynecology Research-Indian J Obstet Gynecol Res

STRATEGI KOPING DALAM KESIAPAN MENGHADAPI PERSALINAN PADA IBU HAMIL PREEKLAMPSIA

&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; ABSTRACT Each mother needs the readiness of laborespecially in preeclampsia pregnant women.Based on preliminary study indicated manyunreadiness of mother in facing childbirth inpreeclampsia pregnant mother in obstetric andgynecologic poly that is influenced by severalfactors such as age, education, parity, work,etc. The purpose of this research is to analyzethe relationship between coping strategies andthe readiness to face labor in preeclampsiapregnant women.This study is a kind of analytic research withcross sectional design. Population in this studyis 45 in preeclampsia pregnant women and 40respondents as sample by using simple randomsampling tehnique. Independent variable iscoping strategy and dependent variable is readiness to face labor in preeclampsiapregnant mother.The results of this study indicated mostrespondents had less coping strategy (55%)and most pregnant women who hadpreeclampsia unreadiness (77,55). Based onthe results of spearman rank test statisticalanalysis significant value of 2-tailed 0,001 soH0 rejected and H1 accepted therefore there isa relationship between coping strategies withthe readiness to face labor in preeclampsiapregnant women Midwives are expected to be able to provideintegrated ANC care in service, one of which iscounseling about the readiness of mothers inthe face of childbirth

Factors associated with the use of antenatal care in Sindh province, Pakistan: A population-based study.

BackgroundAntenatal care (ANC) is critical to decrease maternal and neonatal mortality. However, little is known about the utilization of ANC services in Pakistan. This study assessed the utilization of ANC in Sindh province, Pakistan, and identified the factors that affect its use.MethodsWe analysed a subset of data from Maternal and Child Health (MCH) Program Indicator Surveys conducted in Sindh province, Pakistan in 2013 and 2014. Respondents included 10,200 women who had given birth in the past two years. The outcome measure was making at least four ANC visits. Logistic regression models were used to identify demographic, socioeconomic, characteristics of ANC, and informational factors associated with ANC use.ResultsMost women (83.5%) received one or more ANC, mostly by doctors (95%), but only 57.3% of them made the recommended four or more visits, and just 53.7% received their initial ANC care during the first trimester. Making four or more ANC visits was associated with: fewer household occupants (odds ratio [OR] = 0.98; 95% confidence interval [CI] = [0.97, 0.99]), large city residence (OR = 1.92; 95% CI = [1.57, 2.35]), higher women’s education (OR = 1.70; 95% CI = [1.33, 2.15]), greater household wealth (OR = 5.66; 95% CI = [4.22, 7.60]), and receiving MCH information from lady health worker (OR = 1.17; 95% CI = [1.00, 1.37]), mother-in-law (OR = 1.17; 95% CI = [1.01, 1.36]), other relatives/friends (OR = 1.19; 95% CI = [1.03, 1.38]), or nurse/midwife (OR = 1.31; 95% CI = [1.06, 1.61]).ConclusionsThis study demonstrates that both socioeconomic factors and health information sources are associated with women’s use of ANC. Therefore, programs should target socially disadvantaged and vulnerable groups, particularly rural, less educated, and poor women, to improve utilization of ANC. In addition, strategies to increase exposure to MCH information sources should be a priority in Sindh, Pakistan.

“MANTRAS IN PREGNANCY- MONTHWISE”

In today world different forms of Supraja sanskar, garbha sanskar , some thing additional to the regular ANC care have become very popular amongst the People as well as Healthcare providers .Along with Yoga , Diet and medicines, Mantra and music are an integral part of all these programmes. Mantra-shakti is proven to be very powerful for pregnant women even in this materialistic world. It creates a high vibration, a sacred sound, and a deep, loving peace for yourself and your growing baby. Chanting mantras can uplift your soul and you may feel a close connection to specific mantras during pregnancy. This process is also known as ‘Garbha Sanskar’ as per ancient Indian tradition. In Garbhini Paricharya also, our texts have advised mangal swasti vachan for the garbhini to create positivity and ward off evil forces.&#x0D; Mantras generate positive energy and all the mantras have specific purposes. Chanting mantras provide peace of mind and purity at heart. Mantra is a powerful tool for peace and joy during these days of tremendous changes of pregnancy and motherhood and you must chant them throughout your pregnancy for an easy delivery and a healthy you and a healthy baby. Month wise mantras have also been described in our ancient texts. For eg. During the first month the fertilized ovum is in the liquid state and this process takes place through intercourse for the purpose of the birth of life this month is ruled by planet Venus. Hence Om Shukray Namah mantra should be chanted.&#x0D; &#x0D; Use of mantra chanting has positive effects and calming effects on the mother and the baby. The purpose of this article is to describe the different mantras and their effects in pregnancy. using mantra in pregnancy and in birth can create a healthy mother and baby and hence Supraja .

A Study of Causes and Factors Responsible for Maternal Mortality in a Tertiary Care Institute of Central Gujarat

Maternal mortality is still a big health concern in developing world. The state of maternal health represents overall state of women’s right in health, social and economic realms. If the causes of death can be addressed and are found to be preventable it indicates negligence on the part of government and the entities that have the power to implement the changes. To determine factors and causes of maternal mortality this retrospective observational study was conducted in the department of obstetrics and gynaecology, BJ medical college. Maternal mortalities from October 2016 to March 2018 (18 months) were analysed with respect to factors like locality, literacy, parity, ANC care, time after admission, type of delay (according to maternal death review form) and causes of death (direct and indirect causes of MMR). Total 92 maternal deaths were studied and that gave a MMR of 468 per 1,00,000 live births. Maximum deaths occurred in patients who were in the age group of 20-34 (83.1%), rural locality (71%), Irregular with ANC visits (74%), multigravida (56.5%), within 24 hours of delivery (46.7%) and those who had type 1 delay (delay in decision making to seek help, 78.3%). More of deaths occurred in post partum (84.8%) and in vaginal mode of delivery (47.4) Vs Caesarean section (46.3). Direct obstetric causes of death (57.6%) were of deaths which included hypertensive disorders (29.3%), haemorrhage (19%) and others. Indirect causes accounted for 42.4% deaths which included hepatitis (21.7%), heart diseases (9.8%) etc. Early intervention and diagnosis with timely management are essential to reduce morbidity and hence maternal mortality. Special attention should be given to Routine Antenatal care (RANC) and more specifically to Focussed Antenatal Care (FANC)). Lack of expertise at primary level with lack of proper referral system adds to the cause.

Two decades of antenatal and delivery care in Uganda: a cross-sectional study using Demographic and Health Surveys

BackgroundUganda halved its maternal mortality to 343/100,000 live births between 1990 and 2015, but did not meet the Millennium Development Goal 5. Skilled, timely and good quality antenatal (ANC) and delivery care can prevent the majority of maternal/newborn deaths and stillbirths. We examine coverage, equity, sector of provision and content of ANC and delivery care between 1991 and 2011.MethodsWe conducted a repeated cross-sectional study using four Uganda Demographic and Health Surveys (1995, 2000, 2006 and 2011).Using the most recent live birth and adjusting for survey sampling, we estimated percentage and absolute number of births with ANC (any and 4+ visits), facility delivery, caesarean sections and complete maternal care. We assessed socio-economic differentials in these indicators by wealth, education, urban/rural residence, and geographic zone on the 1995 and 2011 surveys. We estimated the proportions of ANC and delivery care provided by the public and private (for-profit and not-for-profit) sectors, and compared content of ANC and delivery care between sectors. Statistical significance of differences were evaluated using chi-square tests.ResultsCoverage with any ANC remained high over the study period (> 90% since 2001) but was of insufficient frequency; < 50% of women who received any ANC reported 4+ visits. Facility-based delivery care increased slowly, reaching 58% in 2011. While significant inequalities in coverage by wealth, education, residence and geographic zone remained, coverage improved for all indicators among the lowest socio-economic groups of women over time. The private sector market share declined over time to 14% of ANC and 25% of delivery care in 2011. Only 10% of women with 4+ ANC visits and 13% of women delivering in facilities received all measured care components.ConclusionsThe Ugandan health system had to cope with more than 30,000 additional births annually between 1991 and 2011. The majority of women in Uganda accessed ANC, but this contact did not result in care of sufficient frequency, content, and continuum of care (facility delivery). Providers in both sectors require quality improvements. Achieving universal health coverage and maternal/newborn SDGs in Uganda requires prioritising poor, less educated and rural women despite competing priorities for financial and human resources.

Association of antenatal care and place of delivery with newborn care practices: evidence from a cross-sectional survey in rural Uttar Pradesh, India

BackgroundAppropriate immediate newborn care is vital for neonatal survival. Antenatal period is a crucial time to impart knowledge and awareness to mothers regarding newborn care, either during facility visits or during home visits by community health workers (CHWs) especially in the rural context. In this paper, we report newborn care practices in rural Uttar Pradesh (UP) and have explored association between newborn care practices with antenatal care, contact with community health workers during pregnancy and place of childbirth.MethodsWe use cross-sectional baseline data (which is part of a larger intervention project) collected from 129 gram panchayats (GPs) from 15 administrative blocks spread over five districts of UP in 2013. From currently married women (n = 2208) of 15–49 years, who delivered 15 months prior to the survey, we collected information on women’s demographic and socio-economic characteristics, knowledge and practice of reproductive, maternal, newborn, child health and nutrition behaviours. Association of newborn practices with antenatal care, contacts by community health worker during pregnancy and place of childbirth were tested using random intercept logistic regression, adjusting for socio-economic and demographic factors and accounting for clustering at the GP and block levels.ResultsEighty-three percent of 2208 mothers received ANC, but only half of the respondents received a minimum of three ANC visits. More than two thirds of respondents delivered at a health facility. Practice of newborn care was poor: merely one fourth of women practised clean cord care, one third of women followed good breastfeeding practices (initiation with an hour of birth, fed colostrum and did not give pre-lacteal feeds) and one third provided adequate thermal care (kept baby warm and delayed bathing). Only 5% followed all above practices with evidence of clustering of newborn care practices at the block and GP levels. While facility-based childbirth was strongly associated with appropriate newborn care practices, ANC visits and contacts with CHWs was not associated with all newborn care practices.ConclusionThe quality of ANC care provided needs to be improved to have an impact on newborn care practices. Our finding emphasizes the importance of facility-based birthing. There is a need for training CHWs to strengthen their counselling skills on newborn care. Variation of newborn care practices between communities should be taken into consideration while implementing any intervention to optimize benefits.

Inequalities in nutritional status among under five children in Haryana state, India: Role of social determinants

Background: Under-nutrition is a major cause of ill health and childhood mortality in India. So far, little attempt has been made to assess whether improvements in nutritional status have masked widening socioeconomic inequalities or produced slower progress among the poor and the disadvantaged. Aims &amp; objective: We undertook this study to estimate the burden of under-nutrition among children less than five years in four districts of Haryana and explore the inequalities in rates of malnutrition across different social and economic groups. Material &amp; Methods: A community based cross-sectional survey was carried out in four districts of Haryana namely Ambala, Karnal, Panchkula and Yamunanagar. Multi-stage stratified random sampling technique was used to select 2763 children under 5 years of age. Standard anthropometric methods were used. Rates of underweight (WAZ ? -2 z-score), wasting (WHZ ? -2 z-score) and stunting (HAZ ? -2 z-score) were estimated. Multivariate logistic regression was used to determine risk factors and evaluate inequalities across population by social and economic sub-groups. Results: The prevalence of underweight, stunting and wasting in four districts of Haryana was 37.4%, 38.2% and 16.4% respectively. Similarly, 12.7%, 13.2% and 3.5% of under-weight children were severely underweight, stunted and wasted respectively. Age of the child, social group and wealth status were significant predictors of malnutrition. The odds of underweight and stunting increased among the poorest by 2.3 and 1.8 times respectively as compared to the richest category. Conclusion: There is persistent problem of under-nutrition in Haryana mostly among the poor, uneducated, and among children of women who do not take ANC care/ breastfeed. Actions on social determinants need urgent prioritization.