Antenatal Care Services Research Articles

Impact of COVID-19 on essential service provision for reproductive, maternal, neonatal, and child health in the Southeast Asia region: a systematic review

There is increasing evidence that the COVID-19 pandemic has impacted adversely on the provision of essential health services globally. The Southeast Asia region (SEAR) has experienced extremely high rates of COVID-19 infection, with potential adverse impacts on provision of reproductive, maternal, neonatal, and child health (RMNCH) services. We conducted a systematic literature review of quantitative evidence to characterise the impact of COVID-19 on the provision of essential RMNCH services across the SEAR. Studies published between December 2019 and May 2022 were included in the study. The quality of studies was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist. We reviewed 1924 studies and analysed data from 20 peer-reviewed studies and three reports documenting quantitative pre-post estimates of RMNCH service disruption because of the COVID-19 pandemic. Eleven studies were of low methodological quality, in addition to seven and five studies of moderate and high methodological qualities respectively. Six countries in the region were represented in the included studies: India (11 studies), Bangladesh (4), Nepal (3), Sri Lanka (1), Bhutan (1) and Myanmar (1). These countries demonstrated a wide reduction in antenatal care services (-1.6% to-69.6%), facility-based deliveries (-2.3% to-52.4%), child immunisation provision (-13.5% to-87.7%), emergency obstetric care (+4.0% to-76.6%), and family planning services (-4.2% to-100%). There have been large COVID-19 pandemic related disruptions for a wide range of RMNCH essential health service indicators in several SEAR countries. Notably, we found a higher level of service disruption than the WHO PULSE survey estimates. If left unaddressed, such disruptions may set back hard-fought gains in RMNCH outcomes across the region. The absence of studies in five SEAR countries is a priority evidence gap that needs addressing to better inform policies for service protection. WHO Sri Lanka Country Office.

Assessment of nutritional status with its associated factors in pregnant women attending antenatal care at Ambo Health Centers, Oromia Region, Ethiopia

Nutritional status during pregnancy, maternal nutrition requires considerable attention; however, pregnant women’s nutritional knowledge and practices are less understood. The objective of this study was to assess nutritional knowledge and practices among pregnant women who attend antenatal care at Ambo and Awaro Health Center of Ambo Town, Oromia Region, Ethiopia. The study was conducted from January to May of the year 2022, using a cross-sectional descriptive study on a sample of 284 pregnant women who attended antenatal care services in Awaro and Ambo health centers. Systematic sampling techniques were used to select pregnant mothers by using Health center registration lists. Socio-demographic and socio-economic data were collected using a structured interviewer-administered questionnaire. Mid-Upper Arm Circumference (MUAC) was measured by standard nonstretchable MUAC tape. Binary and multiple logistic regression analysis was conducted using the Statistical Package for Social Sciences (SPSS) program version 20 for further analysis. The finding of associated factors that affect the nutritional status of mothers was the income level of the family has a strong statistical association with the nutritional status of mothers (p<0.001), occupational status of the respondent has a significant association with nutritional status (p<0.05) and also knowledge about the importance of food for growth and development of fetus of mother have significant association (p<0.05). Hence, the government in collaboration with concerned bodies should focus on nutritional education and information of pregnant mothers on maternal nutrition during pregnancy in the study area.

Understanding coverage of antenatal care in Palestine: Cross-sectional analysis of Palestinian Multiple Indicator Cluster Survey, 2019-2020.

Antenatal care is an essential component of primary healthcare, providing opportunities to screen, prevent, and treat morbidity to preserve the health of mothers and offspring. The World Health Organization now recommends a minimum of eight antenatal care contacts, instead of four, which is challenging in countries exposed to political violence and structural disparities in access to social, economic and healthcare resources as exist in Palestine. This study examines the compliance of the recommend standard of antenatal care in Palestine. We analyzed data from the UNICEF's Palestinian Multiple Indicator Cluster Survey (MICS) 2019-2020. The eligible sample consisted of 2,028 women, 15-49 years of age, living in Palestine, on whom data were available on reported antenatal care services received during the most recent pregnancy within the last two years. Outcome variables of interest were the reported frequencies of antenatal care visits, gestational timing of 1st visit, and services received. Potential risk factors were assessed in women attending less than eight versus eight or more antenatal contacts, as recommended by WHO, by estimating prevalence ratios with 95% Confidence Intervals. Overall, 28% of women did not meet the WHO's recommendation of eight or more antenatal contacts, varying from 18% in Central West Bank to 33% in South West Bank across the four areas of Palestine (North, Central, and South West Bank and Gaza Strip). Twelve percent of women reported having had no antenatal contacts in the 1st trimester, and these women were two- to three-folds more unlikely to meet WHO recommendation of antenatal contacts than mothers who initiated the antenatal contact in the 1st trimester. Women who had less than eight antenatal contacts were generally poorer, higher in parity, lived in North and South West Bank, sought ANC from either doctor or nurse/midwife only, and initiated antenatal contact in 2nd-to-3rd trimesters. There were considerable socioeconomic and geographic inequalities in the prevalence of not meeting WHO recommended number of antenatal contacts in Palestine, offering the opportunity to inform, improve and continuously reassess coverage of antenatal care.

Navigating antenatal care: The lived experiences of adolescent girls and young women and caregiver perspectives in Zambia.

Adolescent pregnancy remains a global concern, especially in low- and middle-income countries. Sub-Saharan African nations, including Zambia, bear a disproportionate burden of adolescent pregnancies, contributing to high rates of maternal and child mortality. Despite efforts to improve antenatal care (ANC) services, utilization rates remain suboptimal, especially among adolescent girls and young women (AGYW). To explore the barriers and facilitators to ANC services among AGYW and how these factors might differ by age and HIV status. This qualitative study employs a combination of in-depth interviews (IDIs) and focus group discussions (FGDs) to gather comprehensive insights into the experiences of AGYW regarding ANC services. The study design follows a socio-ecological framework (SEF) to identify multiple levels of influence on ANC utilization. We conducted 40 IDIs with AGYW aged 15-24; and 2 FGDs with caregivers of AGYW (n = 16). IDIs explored AGYWs barriers and facilitators to accessing and utilizing healthcare services during pregnancy, as well as social support and HIV treatment and prevention. FGD topics included social support, barriers and facilitators to ANC, and HIV services. We developed a codebook based on the SEF and coded transcripts using Dedoose software. Results showed that early pregnancy knowledge did not always translate to AGYW seeking ANC services right away or within the first trimester. More than half of the AGYW did not initiate ANC until well into the second trimester. Factors including lack of motivation, denial of pregnancy, desires to terminate pregnancies, social norms, policies, clinic environment, and financial constraints contributed to delays in ANC initiation. Social support from family, partners, peers, and the community were crucial motivators for early ANC. Lastly, challenges to ANC continuation included lack of transportation, long clinic waiting times, perceived provider indifference, and stigma at both community and clinic levels. In conclusion, gaining insights from qualitative data is essential for comprehensively understanding the barriers and challenges to accessing ANC among this specific age group. By identifying and addressing these barriers while enhancing facilitators, effective programs can be developed and implemented to improve the health and well-being of young mothers and their children.

Perceptions and attitudes of women in the perinatal period towards male midwives in a rural district of Ghana: a descriptive, exploratory qualitative study

ObjectiveThe study sought to explore the perceptions and attitudes of women in the perinatal period towards the reproductive health services of male midwives.DesignThe study adopted an in-depth exploratory descriptive design...

Faktor-Faktor Yang Berhubungan Dengan Kunjungan K4 Ibu Hamil Di Puskesmas Lubuk Buaya Tahun 2023

An antenatal care visit is a visit of a pregnant woman to a health worker as early as possible since she must trust her to get antenatal care services. An assesment of the implementation of antenatal care services can be done by looking at the coverage of K1 and K4. This study was conducted in Lubuk Buaya Primary Health Centre at december 28th 2022- February 20th2023 with a cross sectional design. Thirty nine sample was taken by total population technique to all pregnant women who give birth in Lubuk Buaya Primary Health Centre. Data was collected use questionnaire, processed data and analyzed by univariate and bivariate. Results of this study found 23.5% respondents did not have complete visit, 12.5% respondents had a low level of knowledge, 56.4% respondents have negative attitude, and 33.3% respondents did not have husband’s support. Statistical analysis shows correlation between complete visit (p<0.05) with knowledge (p=0.007) and husband’s support (p=0.039) and no correlation with attitude (p=0.052). We can conclude that there is a correlation between knowledge and family support with complete visit coverage. However, there is no correlation between attitude and complete visit.

Anemia in Pregnant Women and Its Determinants: A Cross-Sectional Study at Ummu Hani Mother and Children's Hospital, Purbalingga Regency

Anemia in pregnant women is still a global problem, almost half of all pregnant women throughout the world experience anemia. Ummi Hani Mother and Children Hospital is one of the referral hospitals for mothers and children in Purbalingga that provides the antenatal care service. This research aimed to identify the determinants of anemia in pregnant women at Ummi Hani Mother and Children Hospital, Purbalingga. This research was an analytical observational study with a cross-sectional design. The total sample was 100 pregnant women. Data sources were obtained from medical records, parturition registers, and cohorts of pregnant women at Ummi Hani Mother and Children Hospital. Primary data collection used a structured questionnaire. Bivariate analysis used chi square and/or Fisher exact, and multivariate analysis used logistic regression. This research found that 51% of pregnant women suffered from anemia. The results of multivariate analysis showed that educational level (p value=0.002; OR=5.07; 95% CI=1.79-14.37) and employment status (p value=0.045; OR=2.73; 95% CI=1.02-7.29) were determinants of anemia in pregnant women. This research highlights importance of improving health promotion regarding dangers of anemia and prevention measures such as consuming nutritious and varied foods at affordable prices which is focused on groups of low-educated and unemployed pregnant women.

Determinants of Exclusive Breastfeeding Among Mothers of Infants Less Than Six Months of Age in Mogadishu: A Facility-Based Cross-Sectional Study

Background Breastfeeding is a vital practice for infant health and well-being, with exclusive breastfeeding (EBF) during the first six months being particularly crucial. Despite its benefits, EBF is sub-optimally practiced in many low-to-middle income countries. This study focuses on Somalia, a country with historical political instability and poor health indicators, aiming to identify the prevalence and determinants of exclusive breastfeeding among women with infants under six months attending SOS Mother and Child Hospital in Mogadishu. Methods A hospital-based cross-sectional design was used, and data were collected through a structured questionnaire. The study sample consisted of 345 mothers, selected using a systematic sampling technique. Descriptive, bivariate, and multivariate analyses were conducted to assess breastfeeding practices and determine factors influencing exclusive breastfeeding prevalence. Result The study found that the prevalence of exclusive breastfeeding among the study population in Somalia was 44%, influenced by factors such as maternal education, employment, and utilization of antenatal and postnatal care services. Male infants and younger infants had higher odds of being exclusively breastfed. Conclusion and recommendations The study emphasizes the importance of promoting exclusive breastfeeding as the optimal feeding practice for infants in Somalia, highlighting the need for comprehensive health education during antenatal care visits and postnatal counseling. It recommends the development of supportive policies, such as maternity leave and workplace accommodations, along with community-based initiatives and support groups to facilitate and encourage exclusive breastfeeding practices.

Choice of Healthcare Facilities for Antenatal Care, Delivery Services and Satisfaction Received by Mothers of Infants in Lagos, Nigeria

Introduction: Increased utilisation of Antenatal Care (ANC) and delivery with a skilled birth attendant helps to prevent or effectively manage the majority of complications of pregnancy and delivery. This will improve the maternal mortality ratio nationally and globally. This study assessed the choice of healthcare facilities for ANC, child delivery services and satisfaction with the care received by mothers of infants attending child immunization clinics at selected Primary Healthcare Centres (PHCs) in Lagos, Nigeria.
 Materials/Methods: A descriptive cross-sectional study was conducted among mothers who attended antenatal care (ANC) in a health facility during pregnancy, delivered at the same facility, and brought their infants for immunization at the selected PHCs in Lagos, Nigeria. A total of 355 respondents were recruited from the five selected PHCs. Data were collected with an interviewer-administered questionnaire. Descriptive and inferential statistics were conducted and the level of significance (p) was set at less than or equal to 5% (p≤0.05).
 Results: Less than half of the respondents 170 (47.9%) registered for ANC in the first trimester, 206 (58.0%) of the respondents utilised private hospitals only while very few 55 (15.5%) utilised PHCs for ANC and delivery. Most of the respondents (59.1%) had between 9 to 15 ANC visits during pregnancy, with a mean attendance of 11.3 ± 4.7. Some of the reasons given for the choice of ANC and delivery centre by the respondents were quality service 325 (91.6%), availability of skilled healthcare staff 276 (77.7%), clean environment 236 (66.5%), and good staff attitude 234 (65.9%) among others. The majority of the respondents 349 (98.3%) were satisfied with the overall care received in the health facilities utilised for ANC and delivery services during pregnancy. Statistically significant associations were found between respondents’ monthly income, spousal’s level of education, enrolment in health insurance scheme and the choice of health facility used for ANC and delivery (p<0.05).
 Conclusion: Continuous health educational programs are recommended for women of reproductive age and their spouses on the benefits and importance of antenatal care in pregnancy at healthcare facilities and skilled birth attendants at delivery. Improved funding for government hospitals may enhance public trust in healthcare facilities and increase utilization.

Impact of the COVID-19 pandemic and policy response on access to and utilization of reproductive, maternal, child and adolescent health services in Kenya, Uganda and Zambia.

Global health crises can negatively impact access to and utilisation of essential health services. Access to and utilisation of reproductive health services were already challenged in Sub-Saharan Africa with the COVID-19 pandemic further complicating the critical situation. This cross-sectional qualitative study aimed to assess the impact of the COVID-19 pandemic and policy responses to it on the access to, and utilization of reproductive, maternal, child and adolescent health services in Kenya, Uganda, and Zambia. It sought to explore the perspectives of women of reproductive age (18-49), frontline health workers and government representatives, all from geographies that are under-researched in this context. Using purposive sampling, key informant and in-depth interviews were carried out with 63 participants across the three countries between November 2020 and February 2021. The study population included women of reproductive age (18-49 years), front-line health service providers, and government representatives We established that COVID-19 and the policy response to it affected access to and utilization of services in the three countries, the most affected being antenatal care, delivery, family planning, and immunization services. Women reported not accessing the health facilities for various reasons. Barriers to access and utilization of services cut across all the socioecological levels. Movement restrictions, particularly in Uganda where they were most severe, and fear of contracting COVID-19 at health facilities were the most reported barriers. Weak structures at community level and inadequate supply of commodities in health facilities exacerbated the situation. Mitigation factors were put in place at different levels. There is need to strengthen the health system, particularly the supply chain and to have services closer to the community to enhance access to and utilisation of services at all times and particularly during crises such as the Covid-19 pandemic.

Do community-level predictors have more impact than individual/family-level predictors on receiving the desired number of ANC services in Bangladesh?

BackgroundBangladesh has improved maternal and child health, but healthcare indicators and access still need enhancement. Factors that contribute to increased antenatal care (ANC) need to be explored to inform healthcare policies. The study examined whether community-level (supply-side) predictors outperform individual/family-level (demand-side) predictors for the desired number of ANC services. MethodsThis cross-sectional study collected primary data from 630 pregnant and lactating women (PLW) in seven upazilas in Rangpur and Nilphamari districts of Bangladesh in 2022. The individual/family and community-level factors as predictors of desired antenatal care services were investigated using a semi-structured questionnaire. Various statistical techniques including the Student t-test, z-test, Chi-square test, and logistic regression model were employed in analyzing the data. ResultsOut of the total 630 participants, the majority were literate women who belong to higher pregnancy order and received benefits from SSNPs. In addition to this, these women did not earn and neither were the empowered. The outcome variable was the receiving status of 4+ ANC services by PLWs, which varied by different covariates. The desired 4+ ANC service received by 73 % PLWs. The significant (p < 0.05) predictors of receiving 4+ ANC services were secondary-level education (95 % CI:0.97–7.55), knowledge on danger signs (95 % CI:1.02–1.48), empowered women (95 % CI:0.99–2.69), community clinics as place of services (95 % CI:1.52–3.49), sources of information through SMS (95 % CI:2.63–7.04) and fully functional community clinic (95 % CI:1.0–2.347). The statistical evidence through the values of pseudo R2 of the reduced models of community level (0.09), individual level (0.03) and family level (0.01) revealed that the community level predictors are more influential than individual/family level predictors. ConclusionThe findings indicate that community level predictors played a dominant role in receiving the 4+ ANC services in Bangladesh. In short, the well-functioning of community clinics in tandem with government forums/bodies and awareness raising through SMS messages, are sufficient for ensuring the desired number of ANC services in rural areas of Bangladesh.

To leave no one behind: Assessing utilization of maternal newborn and child health services by all the 13 particularly vulnerable tribal groups (PVTGs) of Odisha, India.

Indigenous tribal people experience lower coverage of maternal, newborn and child healthcare (MNCH) services worldwide, including in India. Meanwhile, Indian tribal people comprise a special sub-population who are even more isolated, marginalized and underserved, designated as particularly vulnerable tribal groups (PVTGs). However, there is an extreme paucity of evidence on how this most vulnerable sub-population utilizes health services. Therefore, we aimed to estimate MNCH service utilization by all the 13 PVTGs of the eastern Indian state of Odisha and compare that with state and national rates. A total of 1186 eligible mothers who gave birth to a live child in last 5years, were interviewed using a validated questionnaire. The weighted MNCH service utilization rates were estimated for antenatal care (ANC), intranatal care (INC), postnatal care (PNC) and immunization (for 12-23-month-old children). The same rates were estimated for state (n = 7144) and nationally representative samples (n = 176843) from National Family Health Survey-5. The ANC service utilization among PVTGs were considerably higher than national average except for early pregnancy registration (PVTGs 67% versus national 79.9%), and 5 ANC components (80.8% versus 82.3%). However, their institutional delivery rates (77.9%) were lower than averages for Odisha (93.1%) and India (90.1%). The PNC and immunization rates were substantially higher than the national averages. Furthermore, the main reasons behind greater home delivery in the PVTGs were accessibility issues (29.9%) and cultural barriers (23.1%). Ours was the first study of MNCH service utilization by PVTGs of an Indian state. It is very pleasantly surprising to note that the most vulnerable subpopulation of India, the PVTGs, have achieved comparable or often greater utilization rates than the national average, which may be attributable to overall significantly better performance by the Odisha state. However, PVTGs have underperformed in terms of timely pregnancy registration and institutional delivery, which should be urgently addressed.

Barriers and enablers to antenatal care attendance for women referred to social work services in a Victorian regional hospital: A qualitative descriptive study

BackgroundWomen referred to social work services during pregnancy are more likely to experience social disadvantage than those who are not, resulting in reduced antenatal care attendance. Lack of antenatal care engagement leads to poor identification and management of concerns that can have immediate and long-term health consequences for women and their babies. Identifying the barriers and enablers to antenatal care attendance for women referred to social work services is important for designing models of care that promote effective engagement. AimsThis study aimed to explore the barriers and enablers to antenatal care attendance by women referred to social work services from the perspectives of women, and clinicians who provide antenatal healthcare. MethodsA qualitative descriptive study using constructivist grounded theory methods was undertaken. Ten women referred to social work services and 11 antenatal healthcare providers were purposively recruited for interviews from a regional maternity service in Victoria, Australia. FindingsContinuity of care and healthcare providers partnering with women were central to effective engagement with antenatal care services. Three interrelated concepts were identified: 1) experiences of the hospital environment and access to care; 2) perceptions of care influence engagement, and 3) motivations for regularly attending services. ConclusionsContinuity of care is essential for supporting women referred to social work services to attend antenatal appointments. Women are better equipped to overcome other barriers to antenatal service attendance when they have a strong partnership with clinicians involved in their care.

Determinants of early neonatal mortality: secondary analysis of the 2012 and 2017 Indonesia Demographic and Health Survey.

Most neonatal deaths occur during the first week of life (i.e., early neonatal deaths). In this analysis, we aimed to investigate the determinants of early neonatal deaths in a nationally representative sample of births in Indonesia over the five years before each survey. Data were obtained from the 2012 and 2017 Indonesia Demographic and Health Survey (IDHS), including information from 58,902 mothers of children aged <5 years of age. The outcome variable was early neonatal death (death of a newborn within the first six days of life). Explanatory variables were categorized into environmental, household, maternal, pregnancy, childbirth, and child characteristics. Multivariate regression methods were employed for analysis. Increased odds of early neonatal deaths were associated with mothers who lacked formal education or had incomplete primary schooling (adjusted odd ratio [OR] = 2.43, 95% confidence interval [CI]: 1.18-5.01), worked outside the house in agricultural (aOR = 5.94, 95% CI: 3.09-11.45) or non-agricultural field (aOR = 2.98, 95% CI: 1.88-4.72), and were required to make a joint decision about health care with their partner or another household member (aOR = 1.79, 95% CI: 1.12-2.84). Increased odds were also observed in smaller-than-average infants, particularly those who received low-quality antenatal care services (aOR = 9.10, 95% CI: 5.04-16.41) and those whose mothers had delivery complications (aOR = 1.72, 95% CI: 1.10-2.68) or who were delivered by cesarean section (aOR = 1.74, 95% CI: 1.07-2.82). Furthermore, male infants showed higher odds than female infants (aOR = 1.85, 95% CI: 1.23-2.76). A multifaceted approach is essential for curtailing early neonatal mortality in Indonesia. Enabling workplace policies, promoting women's empowerment, strengthening the health system, and improving the uptake of high-quality antenatal care services are among the critical steps toward preventing early neonatal deaths in Indonesia.

A study on utilization of ANC services and Psychological status of mothers during Covid–19 pandemic in five adopted villages of KSRDPR University, Gadag, Karnataka

Antenatal care is also known as prenatal care is a type of preventive and primitive health care during the period of whole pregnancy to ensure a better birthing outcome for mother and baby. Improving the utilization of maternal health care services is a global challenge for the health system in low and middle-income countries. The goal set by the United Nations, Millennium Developmental goals to reduce the maternal mortality ratio by three quarters during the period 1990-2015. WHO's new SMART guidelines approach, which includes the ANC Digital Adaptation Kit and WHO digital ANC module to support countries through the process of adapting and applying. With the emergence of the COVID - 19 outbreak, it is not impossible that access to quality antenatal care services in the region will be further compromised due to competition for limited health care services. COVID -19 pandemic affects routine service delivery, which may have an impact on antenatal care (ANC) utilization among pregnant women.To assess the utilization of Antenatal Check-ups before to and during the Covid -19 Pandemic period.After obtaining permission from the District Health Office and the appropriate officer in the health force, a community-based cross-sectional study was conducted. To select study participants who are both convenient and cooperative, the purposive sampling technique was used. A semi-structured questionnaire was used to collect data, information about mothers' socio-demographic details, Antenatal service utilization before and during the Covid - 19 pandemic, An interview schedule was developed in order to identify the Antenatal Care utilization Gap in the eyes of prospective pregnant mothers and the challenges faced by health workers in providing Antenatal services. The data was entered into an excel sheet, and the results were expressed as frequency, percentage.The study included 360 pregnant and delivered mothers aged 18 to 45 years. The majority of mothers (68.33 percent) are between the ages of 18 and 25. Half of the mothers are Primi (51.94%), a quarter of the mothers are Para 1 (33.61%), and more than one-fourth of the mothers are mildly anemic (38.06%). Few mothers have high blood pressure (8.89 percent), the majority of spouses supported their wives' Antenatal natal services visits (93.89 percent), and the majority of mothers received ANC services at no cost (99.44 percent).The current study discovered that due to the COVID - 19 pandemics, antenatal care utilization was lower than before the pandemic period.

Factors Influencing Successful Implementation of Antenatal Care Services in Selected Health Centre IV’s in Jinja District Eastern Uganda

Maternal mortality is a global public health issue, with an estimated 830 women dying daily due to pregnancy and childbirth-related causes, primarily in the developing world. The use of antenatal care from trained providers is crucial to monitor pregnancy and reduce morbidity and mortality risks for both mother and child during pregnancy and delivery. A prospective descriptive cross-sectional study was conducted among health workers in five health Centre IVs in Jinja district, eastern Uganda. The study found that only 17.65% of antenatal care services were implemented fairly. Factors influencing successful implementation included service duration above five years, formal training on implementing guidelines and having facility interventions in place. Factors such as seeing 30 or fewer antenatal clients on each clinic day, not attending antenatal reproductive health training, not having knowledge of antenatal care guidelines, and not using antenatal care guidelines also influenced successful implementation. However, these factors did not show statistical significance in logistic regression analysis. More efforts are needed to improve antenatal service implementation among healthcare providers to achieve the new WHO antenatal care model for a positive pregnancy experience. Keywords: Women, Pregnancy, Antenatal care services, Antenatal health.

Coverage of Antenatal Care Services in a Rural Area of District Nuh, Haryana

Background: The district Nuh has been declared as the most backward district of Haryana state and is also listedamong the 108 most backward districts of India identified by the National Institute for Transformation of India(NITI) Aayog. National Family Health Survey-4 (NFHS-4) conducted during 2015-16 reported that only 6.5% ofmothers utilize four antenatal check-ups in district Nuh. This study was carried out to estimate the coverage ofantenatal care services in district Nuh.Methods: A total of 300 pregnant women who were in their 1st trimester were recruited from the rural area ofPrimary Health Centre Nagina starting from January 2022 till December 2022. All eligible study participants wereinterviewed through house-to-house visits to assess the coverage of antenatal care received by them.Results: A total of 83 (27.6%) participants were primigravida, and 217 (72.3%) were multigravida. Only 25 (8.33%)participants reported receiving full antenatal care services which include early registration of pregnancy (within12 weeks), a minimum of four ANC visits, at least one dose of diphtheria-tetanus toxoid vaccine, and 100 days ofiron &amp; folic acid supplementation.Conclusion: The coverage of antenatal care services received by pregnant women is low despite the availabilityof free government services.

Usage of Maternal Health Services for Fertility Regulation in India: A Retrospective Study

The use of maternal health services in India is influenced by various socioeconomic factors, with higher maternal morbidity during reproductive ages 15 to 49. The Indian government has launched programs like Maternity Safety Scheme (Janani Suraksha Yojana) and Maternity and Child Protection Programme (Janani Shishu Suraksha Karyakaram) to provide free health services to women. However, the burden of these services is disproportionately high among the poorest women, leading to high mother and newborn death rates. In the study, secondary data from the National Family Health Survey (NFHS-3) found that place of residence, exposure to mass media, education, caste, religion, and wealth were all significant predictors of maternal health care utilization. The study also found that location of residence; age, birth order, education, caste, religion, and wealth were substantially and significantly associated with the use of antenatal care, skilled attendants at birth, and postnatal care in India. Women aged 25-34 were 54.8% more likely to receive antenatal care (ANC) services than those aged 15-24. Women aged 35-49 experienced a 52.7% increase in ANC services. Rural women were 23.8% less likely to use ANC than urban women. Muslims were 43.8% less likely to seek ANC assistance compared to Hindus. Women with the highest education levels were 5 times more likely to seek ANC than those who were not educated. Schedule Tribes were 1.5 times more likely to participate in ANC than Schedule Castes. Women aged 35-49 had an 86.8% higher likelihood of seeking postnatal care than those aged 15-24 years. Media exposure had a 1.3 times higher chance of receiving this care than those who had none. Muslim women were 17.8% less likely to choose PNC services than Hindu women.

Magnitude, disparity, and predictors of poor-quality antenatal care service: A systematic review and meta-analysis.

Antenatal care is directed toward ensuring healthy pregnancy outcomes. Quality antenatal care increases the likelihood of receiving an effective intervention to maintain maternal, fetal, and neonatal well-being, while poor quality is linked to poor pregnancy outcomes. However, owing to the complex nature of quality, researchers have followed several approaches to systematically measure it. The evidence from these variable approaches appears inconsistence and poses challenges to programmers and policymakers. Hence, it is imperative to obtain a pooled estimate of the quality of antenatal care. Therefore, considering the scarcity of evidence on the quality of antenatal care, this study aimed to review, synthesize, and bring pooled estimates of accessible evidence. This study aimed to estimate the pooled magnitude and predictors of quality of antenatal care services and compare regional disparity. We conducted a comprehensive systematic three-step approach search of published and unpublished sources from 2002 to 2022. The methodological quality of eligible studies was checked using Joanna Briggs Institute critical appraisal tool for cross-sectional studies. Meta-analysis was carried out using STATA version 16. Statistical heterogeneity was assessed using Cochran's Q test. In the presence of moderate heterogeneity (I2 more than 50%), sensitivity and subgroup analyses were conducted and presented in a forest plot. Effect size was reported using standardized mean difference and its 95% confidence interval. Funnel plots and Egger's regression test were used to measure publication bias at the 5% significance level. A trim-and-fill analysis was conducted to adjust for publication bias. Pooled estimates were computed using random-effects models and weighted using the inverse variance method in the presence of high heterogeneity among studies. A 95% CI and 5% significance level were considered to declare significance variables. The global pooled poor-quality antenatal care was 64.28% (95% CI: 59.58%-68.98%) (I2 = 99.97%, p = 0.001). The identified pooled predictors of good-quality antenatal care service were: number of antenatal care visits (fourth and above antenatal care visit) (Adjusted odds ratio (AOR) = 2.6, 95% CI: 1.37-3.84), family wealth index (AOR = 2.72, 95% CI: 1.89-3.55), maternal education attainment (AOR = 3.03, 95% CI: 2.24-3.82), residence (urban dwellers) (AOR = 4.06, 95% CI: 0.95-7.17), and confidentiality antenatal care (AOR = 2.23, 95% CI: -0.36 to -4.82). The study found regional and country-level disparities in the quality of antenatal care services for pregnant women, where poor-quality antenatal care services were provided for more than two-thirds to three-fourths of antenatal care attendants. Therefore, policymakers and health planners should put a great deal of emphasis on addressing the quality of antenatal care services.

Mapping the Role of Digital Health Interventions to Enhance Effective Coverage of Antenatal Care: A Scoping Review.

Antenatal care (ANC) is a core component of maternal health services. However, only half of the pregnant women in LMICs obtain WHO recommended minimum of four antenatal contacts. In addition, ANC 4+ is a commonly used indicator in monitoring ANC utilization. However, contact coverage alone provides no indications of service quality. In recent years, digital health interventions bring opportunities to provide quality maternal health care. Yet, there are few reviews on how digital health interventions contribute to improving effective coverage of antenatal care. A rigorous review that examines the role of digital health interventions in improving effective coverage of antenatal care is needed to examine how digital health solutions were rapidly deployed to support quality antenatal care service delivery. This review aimed to map evidence on the role of digital health solutions on quality of antenatal care service to enhance effective ANC coverage. A scoping review approach was used and four Databases (PubMed, Cochrane Library, Scopus and Embase) as well as search engines like Advanced Google Search and Google Scholar were searched from September 1 to 8, 2022. Thematic content analysis was used to present the findings. A total of 1701 articles were searched. A total of 27 full-text studies were included in the final analysis. The most reported use of digital health was for client education and behavior change communication. Most studies showed that digital health interventions have proven effective in improving antenatal care. However, most of the studies did not address to assess the quality of ANC services. In this review, we found out that digital health solutions targeted at pregnant women can improve antenatal care services. There is body of evidence showing the effectiveness of digital health interventions on a range of maternal health outcomes. Few pieces of literature exist on the use of digital health interventions on the quality of antenatal care services. There is a need for more trial and program evaluation studies that examine the role of digital health interventions on the quality of ANC.