Antenatal Care Sessions Research Articles

An empirical analysis of socioeconomic risk factors associated with antenatal care attendance in Bangladesh

Maternal mortality and morbidity reduction constitute policy priorities, facilitated by prenatal care and World Health Organization (WHO)-endorsed antenatal care (ANC) utilization during pregnancy. Progress in Bangladesh is hindered as only 47% of expectant women participated in a minimum of four ANC sessions according to the latest maternal mortality survey. This study, utilizing 2018 Bangladesh Demographic and Health Survey (BDHS) data, undertakes an assessment of the socioeconomic determinants influencing the utilization or non-utilization of ANC services. Additionally, the study investigates socioeconomic factors significantly impacting the attainment of the WHO-recommended four or more ANC sessions. A Hurdle Negative Binomial Model is employed to ascertain ANC risk variables and their frequency, while the utilization characteristics of WHO ANC services are discerned through the Binary Logistic Regression Model. Noteworthy among the statistically significant determinants influencing the reception of any antenatal care (ANC) in Bangladesh are the sex of the household head, place of residence, wealth index, husband/partner's education, the highest educational attainment of women, decision-making regarding the expenditure of women's earnings, ease of obtaining medical assistance permission, mobile phone ownership, and media exposure. Furthermore, this empirical inquiry reveals that income inequality, the highest educational attainment of women, decision-making regarding the expenditure of women's earnings, distance to health facilities, mobile phone ownership, utilization of phones for financial transactions, and media exposure significantly determine adherence to WHO-recommended ANC guidelines. This study identifies four crucial determinants for the initiation of ANC services and adherence to recommended prenatal care: a pregnant woman's wealth index ranking, highest educational attainment, ownership of a mobile phone, and exposure to media. The findings of this study can aid Bangladeshi healthcare programmers and policymakers in devising strategies to achieve comprehensive ANC coverage for all pregnant women.

Intimate partner violence and the spatial pattern of maternal healthcare services utilization among parous married women in northern Nigeria

The low uptake of maternal healthcare services (MHS) in Nigeria is implicated in the country’s poor maternal health outcomes. In northern Nigeria where these outcomes are poorest, not much is known about the contribution of violence within unions on married women’s uptake of MHS. Using data on antenatal care (ANC) utilisation and place of delivery, and their sociodemographic confounders from the Nigerian Demographic and Health Survey, this study investigates this relationship. Results of univariate, bivariate and multivariate analyses show that 46.4% and 22.1% of the women had at least four ANC sessions and had health facility delivery respectively. At the subregional level however, the North-Central zone had the highest utilisation rates while the North-West zone had the lowest. The prevalence of intimate partner violence (IPV) ranged from 8.2% (sexual violence) to 16.7% (physical violence) and 35.8% (emotional violence). Subregional analysis of IPV shows that the North-West zone had the lowest prevalence rates. Contrary to some literature evidence, women who experienced IPV in the study area had higher odds of utilising MHS (P < 0.001). When the sociodemographic characteristics of the women were adjusted for, the relationship became statistically insignificant however. The association between the women’s socioeconomic characteristics and their MHS uptake suggests that attention be paid to the wealth and educational status of the population because of their propensity for sustaining the higher uptake recorded. The role of religion in the outcomes further suggests that it be used as a tool to promote the uptake of MHS in the region.

Provision of inadequate information on postnatal care and services during antenatal visits in Busega, Northwest Tanzania: a simulated client study

BackgroundMost (94%) of global maternal deaths occur in low- and middle-income countries due to preventable causes. Maternal health care remains a key pillar in improving survival. Antenatal care (ANC) guidelines recommend that pregnant women should be provided with information about postnatal care in the third trimester. However, the utilization of postnatal care services is limited in developing countries including Tanzania. The aim of this study was to investigate the practice of health care workers in providing information on postnatal care to pregnant women during antenatal care visits.MethodsA cross sectional study was conducted among health care workers from 27 health facilities that offer reproductive and child health services in Busega district Northwest Tanzania. A simulated client approach was utilized to observe quality of practice among health care workers with minimal reporting bias (i.e., the approach allows observing participants at their routine practices without pretending). Selected pregnant women who were trained to be simulated clients from the community within facility catchment area attended antenatal care sessions and observed 81 of 103 health care workers. Data analyses were carried out using STATA 13.ResultsOnly 38.73% (95% CI; 28.18–49.49%) of health care workers were observed discussing subtopics related to postnatal care during the ANC visit. Few health care workers (19.35%), covered all eight subtopics recommended in the ANC guidelines. Postnatal danger signs (33.33%) and exclusive breast feeding (33.33%) were mostly discussed subtopics by health care workers. Being a doctor/nurse/clinical officer is associated by provision of postnatal education compared to medical attendant, aOR = 3.65 (95% CI; 1.21–12.14).ConclusionThe provision of postnatal education during ANC visits by health care workers in this district was limited. This situation could contribute to the low utilization of postnatal care services. Health care workers need to be reminded on the importance of delivering postnatal education to pregnant women attending ANC clinic visits. On job training can be used to empower health care workers of different cadres to deliver postnatal health education during ANC visits. These efforts could increase women’s utilization of postnatal care and improve outcomes for mothers and newborns.

Determinants of pentavalent and measles vaccination dropouts among children aged 12\u201323 months in The Gambia

BackgroundEvery year, vaccination averts about 3 million deaths from vaccine-preventable diseases (VPDs). However, despite that immunization coverage is increasing globally, many children in developing countries are still dropping out of vaccination. Thus, the present study aimed to identify determinants of vaccination dropouts among children aged 12–23 months in The Gambia.MethodsThe study utilized cross-sectional data obtained from the Gambia Demographic and Health Survey 2019–20 (GDHS). The percentage of children aged 12–23 months who dropped out from pentavalent and measles vaccination were calculated by (1) subtracting the third dose of pentavalent vaccine from the first dose of Pentavalent vaccine, and (2) subtracting the first dose of measles vaccine from the first dose Pentavalent vaccine. Generalized Estimating Equation models (GEE) were constructed to examine the risk factors of pentavalent and measles vaccinations dropout.ResultsApproximately 7.0% and 4.0% of the 1,302 children aged 12–23 months had dropped out of measles and pentavalent vaccination respectively. The multivariate analyses showed that when caregivers attended fewer than four antenatal care sessions, when children had no health card or whose card was lost, and resided in urban areas increased the odds of pentavalent dropout. On the other hand, when women gave birth in home and other places, when children had no health card, and being an urban areas dweller increased the odds of measles dropout.ConclusionTailored public health interventions towards urban residence and health education for all women during ANC are hereby recommended.

Prevalence and factors associated with preterm birth in a rural district hospital, Rwanda

globally, the leading cause of neonatal mortality is preterm birth which may hinder the achievement of Sustainable Development Goal 3.2 target. We aimed to determine the prevalence and factors associated with preterm delivery at Kabutare hospital, Rwanda. a cross-sectional study was conducted between August and September 2020. Mothers were interviewed using a standard pretested semi-structured questionnaire and additional data were extracted from medical records of obstetric files. Gestational age was assessed using the Ballard score. Adjusted Odds Ratios and their 95% confidence intervals were calculated for multivariable logistic regression analysis to take care of all potential confounders. the prevalence of preterm birth was 17.5% (95% CI: 12.9% - 22.9%). The independent factors associated with preterm birth after considering multiple logistic regression were husband being a smoker (adjusted Odds Ratio (aOR) = 5.9; 95% CI; 1.9-18; p= 0.002), antenatal care (ANC) attendance ≤ 3 visits (aOR=3.9; 95% CI; 1.1-13.8; p=0.04) and low mother's Mid Upper Arm Circumference (MUAC) < 23cm (aOR=5.6, 95% CI; 1.8-18.9; p=0.004). Conclusion: preterm delivery was high in Huye district. Thus, we recommend ANC sessions to emphasize on maternal nutritional education which is of good quality and quantity, discourage maternal alcohol consumption as well as passive smoking.

Birth Preparedness and Complication Readiness (BPACR) among brick kiln workers in Indore, India

Abstract Background Birth preparedness and complication readiness (BPACR), promotes utilization of skilled maternal and neonatal care. Preparing for childbirth reduces delays in seeking care. Brick-kiln workers constitute a vulnerable social group who contribute to city infrastructure by laboring at low wages. 37% of the sample were Scheduled Castes, 49% Scheduled Tribes. Methods 139 mothers of children &amp;lt; 2 years, residing temporarily in brick kilns of Indore were asked about preparedness for birth of youngest child. Birth preparedness was assessed by enquiring about saving money, arranging transport, identifying health facility for delivery, identified family member to accompany for labor/emergency. Findings 10% did &amp;gt;3 BPACR practices implying good level of preparedness; 50% did 1-2 BPACR practices; 40% did no birth preparedness. Access to maternity benefit scheme was twice as likely to result in reasonable birth preparedness as compared to no access. Those with primary to class XII were twice as likely to practice birth preparedness as compared to those with no formal education. &amp;gt;3 ANC was associated with 8 percentage points greater practice of reasonable BPACR as compared to &amp;lt; 2 or no ANC. Mothers with knowledge of one danger sign each of pregnancy and delivery were 3 times more likely to practice BPACR than those without this knowledge. FGDs revealed challenges in access to bank account, obtaining required documents to apply for and access state maternity benefit. Lack of family support led to low BPCAR and low institutional delivery. Conclusions Brick-kiln women face risk of low utilization of government healthcare services. The health systems should conduct outreach antenatal care sessions in brick-kilns on knowledge of key danger signs and BPACR during health education and ANC counselling can help promote BPACR and hospital delivery. Information on requisite steps to apply for maternity benefit schemes should be shared among brick-kiln workers. Key messages It is crucial to promote BPACR among urban vulnerable sections, through NUHM’s outreach sessions by ANMs/ASHAs in brick-kiln, construction workers and similar groups. Access to maternity benefit cash transfer scheme should be enhanced particularly among excluded temporary urban groups such as brick-kiln workers as it is a motivation to avail hospital care.

Determinants of appropriate complementary feeding practices among women with children aged 6-23 months in Iseyin, Nigeria

Malnutrition and poor complementary feeding are more predominant in rural than urban areas. Yet, little attention has been given to these discrepancies and the use of validated composite index to explore determinants of complementary feeding practices. Hence, this study was aimed at identifying the determinants of appropriate complementary feeding practices among mothers with children aged 6-23 months in Iseyin, Nigeria.A community based cross sectional survey involving 390 mother-child dyads was conducted using a three-stage simple random sampling. Information on household sociodemographic characteristics, complementary feeding practices, 24-hour dietary intake and anthropometric characteristics of youngest child in the household were obtained using a semi-structured questionnaire. Complementary feeding indicators and anthropometric indices were estimated using the 2008 World Health Organization recommendations and WHO Anthro, respectively. Data were analysed using descriptive statistics and logistic regression at p<0.05.Mothers’ mean age was 28.7± 5.6 years, 99.4% were married, and 92.1% attended antenatal care sessions. Mean age of children was 14.5±5.1 months, 56.2% were male and 31.0% were firstborn. Of all the children, 72.3% had timely introduction of complementary food, 17.7% had minimum dietary diversity, 46.9% had minimum meal frequency and 14.9% had minimum acceptable diet. Grains, root and tubers (91.3%) constituted the mostly consumed complementary foods. Overall, only 10.0% of children had appropriate complementary feeding; child's age, birth order and mother's income were determinants of appropriate complementary feeding.Appropriate complementary feeding practices remain very low and this is influenced by the child's age, birth order and mother's income.

Urban-rural differences in factors associated with incomplete basic immunization among children in Indonesia: A nationwide multilevel study

Identifying risk factors of incomplete immunization among children is crucial to developing relevant policies to improve immunization coverage. In this study, we investigated factors associated with incomplete immunization among children in Indonesia and elucidated differences in risk factors between urban and rural areas. The data came from a national-wide survey, the 2017 Indonesia Demographic Health Surveys. In total, 3264 children aged 12-23 months were included in the study. An incomplete immunization status was defined as a child who did not complete the ten doses of basic vaccinations, consisting of one dose of bacille Calmette-Guérin, one dose of hepatitis B, three doses of pentavalent vaccine (diphtheria, pertussis, tetanus, hemophilus influenza type B, and hepatitis B vaccine), four doses of polio vaccine, and one dose of measles vaccine. Generalized linear mixed models were constructed to examine the effects of different levels of risk factors on the incomplete immunization status. We further conducted stratified analyses by urban and rural areas. About 40% of the 3264 children were incompletely immunized, among whom 45.3% were in urban areas and 54.7% were in rural areas. Eight of the 34 provinces had incomplete immunization rates exceeding 50%, and the Papua and Maluku regions had the highest rates of incomplete child immunization. The multivariate analyses showed that when women attended fewer than four antenatal care sessions and resided outside the Nusa Tenggara region, their children were more likely to have incomplete immunization in both urban and rural areas. On the other hand, having no health insurance was positively associated with incomplete immunization in urban areas, whereas having received a tetanus vaccination during pregnancy was negatively associated with incomplete immunization in rural areas. Results of this study suggest that tailored interventions should be developed to address significant risk factors in rural and urban areas.

Equity in Essential Maternal, Newborn, and Child Health Interventions in Northeastern China, 2008 to 2018.

Objectives: We aim to analyze equity in maternal, newborn, and child health (MNCH) interventions in Jilin, a northeastern province of China, 2008–2018.Study design: Cross-sectional study.Methods: We used provincially representative survey data from 2008, 2013, and 2018. We included 18 essential MNCH interventions, analyzed equity, and calculated the composite coverage score. We used logistic and multiple linear regressions to adjust sampling clusters and covariates.Results: Coverage of hospital-based interventions, such as hospital delivery and antenatal B-ultrasound tests, was nearly universal in Jilin province. Cesarean sections persisted at alarmingly high rates (57.6%). Enormous unmet needs and rural–urban inequalities existed for community-based interventions, such as improved drinking water sources (85.4 vs. 97.9%, p < 0.01), improved sanitation facilities (52.5 vs. 94.2%, p < 0.01), four government-funded antenatal care services (55.8 vs. 84.1%, p < 0.01), and at least eight antenatal care sessions (26.8 vs. 46.3%, p < 0.05). Compared to rural–urban inequity, individual-level disparities across income and education were either small in scale or statistically insignificant. The inequity in coverage of maternal and newborn care shrank during 2008–2018.Conclusions: Despite its success in reducing mortality, China's unique obstetrician-led safe motherhood strategy may come at the cost of over-medicalization and health inequity. Jilin province's recent efforts to revitalize primary health care show the potential to make a change. An integrated system that links families, communities, and all levels of health care organizations seems to be the most effective and efficient model to offer continuing MNCH care.

An Exploratory Study of the Gaps and Barriers to Nutrition Education for Pregnant Women in Tamale, Ghana

Abstract Objectives Nutrition education (NE) remains a popular intervention to improve maternal health literacy (MHL), with the promise of behavior change and improved maternal and child health outcomes. However, there continue to be gaps and barriers that impede the delivery of NE to women, and/or affect maternal compliance to NE guidelines. This is the first phase of a larger project that examines the role of NE on MHL and pregnancy outcomes. Specifically, this phase aimed to identify the gaps in, and barriers to current NE delivered at hospitals to women in Tamale, Ghana. Methods A series of focus group discussions were used to engage health providers and pregnant women. Field observations of the antenatal care (ANC) process and informal interviews with focal personnel were also employed. Data were thematized using recurrent themes from field notes and audio loggings. Results Preliminary analysis of discussions with 33 health providers and 13 pregnant women identified 3 thematic areas describing gaps and challenges to successful delivery and implementation of NE: 1) Sociocultural: Women's adherence to NE advice was affected by constrained autonomy resulting from patriarchal norms including spousal control, polygamy, coercion, and financial abuse. Food insecurity resulting from low socioeconomic status and a lack of social safety nets also impacted maternal ability to access and comply with NE 2) Communication: Midwives were cited as the most common sources of information for women at ANC sessions, yet owing to dissatisfaction with the hospital set up, some mothers preferred and continued to seek health information from traditional birth attendants. Also, more emphasis was placed on anemia prevention at ANC visits compared to other salient topics like weight gain during pregnancy. 3) Administrative: Lack of professional language translation, health professional workload and inadequate health worker retraining also affected the quality of NE. Conclusions Attention should be paid especially to the sociocultural factors plaguing vulnerable women in low-middle income settings like Tamale when designing NE interventions. The study investigators will continue to engage community members in exploring ways of incorporating these in the design of a NE intervention for pregnant women in the area. Funding Sources N/A.

Prenatal care: missed opportunity for HBV prevention in women of childbearing age in rural Senegal

Abstract Background Perinatal transmission of hepatitis B virus (HBV) constitutes an important risk in highly endemic countries including Senegal. Although the prevalence of chronic HBV infection is estimated at 11% in this country, specific data on women of childbearing age are sorely lacking. We described in this study the prevalence of the HBV antigen (HbsAg) in women of childbearing age in rural Senegal, as well as general knowledge on HBV and hepatitis B status awareness. Methods A cross-sectional study including HBV screening was conducted at home in the rural Niakhar area. Chronic HBV infection was determined through HBsAg detection using dried blood spots. Socio-demographic and behavioral data were collected through standardized face-to-face questionnaires. The analyzes included 368 women aged 15-49 (67% married; 65% with at least 1 child) enrolled from October 2018 to March 2019. Results Preliminary results show that 49 women (13%) had positive HBsAg. Only 68 women (18%) have already heard about HBV. Among them, 53% knew that there exists an HBV vaccine and 78%, 75% and 67% correctly answered that HBV can be transmitted through blood contact, childbirth and sexual intercourse, respectively. Among the 233 (63%) women who had already given birth, 76% had attended at least 4 antenatal care sessions and 74% had given birth in a healthcare facility for their last pregnancy. However, only 1% reported to have already been screened for HBV. Main reasons reported for not having been screened were having never heard about this test (80%) and not having been offered screening during antenatal care sessions (10%). Conclusions General knowledge and awareness of HBV status are particularly low in women of childbearing age living in rural Senegal, despite high antenatal care sessions attendance. Given the high prevalence of chronic HBV infection found in this population, it is urgent to ensure systematic HVB screening and to provide adequate information to women during pregnancy. Key messages The prevalence of chronic HBV is high in women of childbearing age in Senegal. National recommendations for women attending antenatal care sessions should include HBV screening and counselling.

Assessment of Knowledge and Attitudes of Expectant Mothers towards HIV Screening and Counselling at Jachie-Pramso in the Ashanti Region of Ghana

Background: The prevention of mother to child transmission (PMTCT) of human immunodeficiency virus (HIV) is paramount in safeguarding the lives of unborn children and young babies. The study sought to examine the knowledge and attitudes of expectant mothers towards HIV screening and testing in the Jachie-Pramso Community of the Ashanti Region. Methods: The study adopted a descriptive survey approach as its research design. The population of the study comprised 158 expectant mothers who were registered and attended regular antenatal care sessions at the community hospital. The census approach to sampling was adopted for the study. A structured questionnaire was used as the tool for data collection. Chi-square and descriptive statistics were used to analyse the data. Results: The findings from the study indicated that awareness level of HIV and its related issues were high among expectant mothers. It was also found that attitude of healthcare workers, community members and sexual partners are the main factors that prevent expectant mothers from patronising voluntary counselling and testing (VCT) services. It was generally, recommended that intensive educational programmes be instituted to sensitize both healthcare workers and the general public on discriminative behaviours. Conclusion: Most of the expectant mothers have knowledge of HIV and attitudes of the expectant mothers towards VCT of HIV were positive. The healthcare facility and its professionals may consider training the expectant mothers so they can act as snow-ballers in the dissemination of relevant health education and coerce other expectant mothers in the community to participate in the VCT and HIV programmes.

A qualitative study to explore the attitudes of women and obstetricians towards caesarean delivery in rural Bangladesh

BackgroundCaesarean section is a lifesaving surgical intervention for women and their newborns, though overutilization is a public health concern. The caesarean rate in Bangladesh is approximately 23% overall, and in private facilities it is over 70%. It is essential to know both the supply side (obstetricians) and demand side (parturient women) views on caesarean birth in order to formulate specific interventions to address the escalating rate of caesareans.MethodsThis qualitative study took place in Matlab, a rural sub-district in Bangladesh. We interviewed women attending their 3rd antenatal visit, those with recent caesareans, and obstetricians from both public and private health facilities. In total there were twenty in-depth interviews and four focus group discussions. Study participants were asked about their preferences on birthing mode and knowledge of the caesarean section process. Thematic data analysis was done following a deductive approach.ResultsWomen from this rural community had a strong preference for normal vaginal birth. However, they were willing to accept the attending health care provider’s decision for caesarean birth. Antenatal care sessions did not provide information on the medical indications for caesarean section. Furthermore, some women had the misconception that episiotomy itself is a ‘small caesarean.’ Primary health care providers and clinic agents (brokers) had a strong influence on women’s decision to choose a health facility for giving birth. However, obstetricians, having a preference for caesarean section, were receiving more patients from these brokers which may be an important reason for the high rate of clinically non-indicated caesareans at private hospitals in Bangladesh. Improper labour monitoring and inadequate staffing at health facilities were additional influences on the preference for caesarean section. However, critical knowledge gaps were also observed among study obstetricians, particularly with regards to the indications for and timing of elective caesarean sections.ConclusionThere is a need to educate women about the advantages and disadvantages of different birthing modes to ensure their active participation in the decision making process. Strong policy regulations are needed to ensure legitimate decision making by obstetricians regarding mode of birthing.

They receive antenatal care in health facilities, yet do not deliver there: predictors of health facility delivery by women in rural Ghana

BackgroundResearch has shown that use of antenatal services by pregnant women and delivery in health facilities with skilled birth attendants contribute to better delivery outcomes. However, a gap exists in Ghana between the use of antenatal care provided by health facilities and delivery in health facilities with skilled birth attendants by pregnant women. This study sought to identify the predictors of health facility delivery by women in a rural district in Ghana.MethodsThis was a cross-sectional study conducted in June 2016. Women who delivered in the past 6 months preceding the study were interviewed. Data on socio-demographic characteristics, use of antenatal care, place of delivery and reasons for home delivery were collected from study participants. Chi-square test and multiple logistic regression analysis were used to assess an association between women’s socio-demographic and obstetric characteristics and place of delivery at 95% confidence interval.ResultsThe study found that 98.8% of women received antenatal care services at least once during their recent pregnancy, and 67.9% attended antenatal care at least four times before delivery. However, 61.9% of the women delivered in a health facility with a skilled attendant. The frequently mentioned reason for home delivery was “unaware of onset of labour and delivery”. The odds for delivery at a health facility were reduced among women with four living children [(AOR = 0.07, CI = 0.15–0.36, p = 0.001)], with no exposure to delivery care information [(AOR = 0.06, CI = 0.01–0.34, p = 0.002), who started their first ANC visit from the second trimester of pregnancy[(AOR = 0.003, CI = 0.01–0.15, p < 0.001)] and increased among women who made at least four ANC visits before delivery [(AOR = 17.53, CI = 6.89–44.61, p < 0.001)].ConclusionFindings from this study revealed a low rate of delivery at health facilities although visits to antenatal care sessions were high, an indication that there was the need to intensify health education on early initiation of antenatal care, signs of labour and delivery, and importance of health facility delivery.

Implementation research on community health workers' provision of maternal and child health services in rural Liberia.

ObjectiveTo assess changes in the use of essential maternal and child health services in Konobo, Liberia, after implementation of an enhanced community health worker (CHW) programme.MethodsThe Liberian Ministry of Health partnered with Last Mile Health, a nongovernmental organization, to implement a pilot CHW programme with enhanced recruitment, training, supervision and compensation. To assess changes in maternal and child health-care use, we conducted repeated cross-sectional cluster surveys before (2012) and after (2015) programme implementation.FindingsBetween 2012 and 2015, 54 CHWs, seven peer supervisors and three clinical supervisors were trained to serve a population of 12 127 people in 44 communities. The regression-adjusted percentage of children receiving care from formal care providers increased by 60.1 (95% confidence interval, CI: 51.6 to 68.7) percentage points for diarrhoea, by 30.6 (95% CI: 20.5 to 40.7) for fever and by 51.2 (95% CI: 37.9 to 64.5) for acute respiratory infection. Facility-based delivery increased by 28.2 points (95% CI: 20.3 to 36.1). Facility-based delivery and formal sector care for acute respiratory infection and diarrhoea increased more in agricultural than gold-mining communities. Receipt of one-or-more antenatal care sessions at a health facility and postnatal care within 24 hours of delivery did not change significantly.ConclusionWe identified significant increases in uptake of child and maternal health-care services from formal providers during the pilot CHW programme in remote rural Liberia. Clinic-based services, such as postnatal care, and services in specific settings, such as mining areas, require additional interventions to achieve optimal outcomes.

Impact of immediate vs delayed feedback in a midwifery teaching activity with a simulated patient

Background: Literature on evidence-based midwifery demonstrates a lack of simulation in antenatal consultation. Aims: This study aims to explore whether immediate individual feedback (IIFB) is more effective than delayed group feedback (DGFB) following a teaching activity for midwifery students, and evaluate students' satisfaction. Methods: A teaching activity with simulated patients was developed to improve midwifery students' competence in conducting a holistic antenatal session. Clinical and communication skills were evaluated using a validated grid adapted from the Calgary-Cambridge Referenced Observation Guide on communication. Students (n = 51) were randomly separated into two groups, IIFB or DGFB. Findings: Non-parametric tests showed that students who received IIFB significantly improved their competence in conducting history-taking in comparison to the students who received DGFB (P = 0.034), including higher satisfaction (P &lt; 0.001). Conclusions: Competence in leading holistic antenatal care sessions is essential for midwives. Students' clinical and communication skills, as well as satisfaction, improve with opportunities to work with simulated patients. Students who received IIFB showed a greater improvement of clinical skills and reported higher satisfaction with the timing of feedback than those who had DGFB.

Prevalence of herbal medicine use and associated factors among pregnant women attending antenatal care at public health facilities in Hossana Town, Southern Ethiopia: facility based cross sectional study.

BackgroundThe use of herbal medicine has been on increase in many developing and industrialized countries. More pregnant women use herbal remedies to treat pregnancy related problems due to cost-effectiveness of therapy and easy access of these products. We sought to assess the prevalence of herbal medicine use and associated factors among pregnant women attending antenatal clinics of public health facilities.MethodsFacility based cross sectional study was conducted among 363 pregnant women attending antenatal clinics from May to June 2015 at public health facilities in Hossana town, Hadiya zone, Southern Ethiopia. Pretested structured questionnaire was used to collect data from each study subject. Bivariate logistic regression analysis was used to see significance of association between the outcome and independent variables. Odds ratios at 95 % CI were computed to measure the strength of the association between the outcome and the independent variables. P-value <0.05 was considered as a statistically significant in multivariate analysis.ResultTwo hundred fifty eight (73.1 %) of pregnant women used herbal medicine during current pregnancy . The herbal medicines commonly taken during current pregnancy were ginger (55.8 %), garlic (69.8 %), eucalyptus (11.6 %), tenaadam (rutachalenssis) (26.4 %), damakesse (ocimumlamiifolium) (22.8 %), feto (3.5 %) and omore (3.1 %). Being students (AOR: (5.68, 95 % CI: (1.53, 21.13), second trimester of pregnancy (AOR: 0.22, 95 % CI: (0.08, 0.76), sufficient knowledge on herbal medicine (AOR: 0.37, 95 % CI: (0.19, 0.79), no formal education (AOR: 4.41, 95 % CI: (1.11, 17.56), primary education (AOR: 4.15, 95 % CI: (1.51, 11.45) and secondary education (AOR: 2.55, 95 % CI: (1.08,6.03) were significantly associated with herbal medicine use.ConclusionThe findings of this study showed that herbal medicine use during pregnancy is a common experience. Commonly used herbal medicines during current pregnancy were garlic, ginger, tenaadam, damakasse and eucalyptus. Educational status, occupation, knowledge on herbal medicine and second trimester of pregnancy were the major factors affecting use of herbal medicine. Health education about the effects of herbal medicine on pregnancy should be given during antenatal care sessions and through media. Health care providers, especially those that are involved in antenatal care should aware of evidence regarding potential benefits or harm of herbal medicinal agents when used by pregnant women.

Patient-physician relationship and ante-natal seeking behaviour in public hospitals

This study examines the roles of patient-physician relationship as the underpinning factor that may inhibit or motivate early booking of pregnancy among women in Ijebu Ogun State. The study utilizes a triangulation method of survey including in-depth interview. Ijebu-Ode carries 32.2 % (141) and Ijebu- Igbo 64.8 % (259) of the total sample representing the urban and rural populace. A structured questionnaire was administered to randomly select 400 consenting women attending ante-natal clinics session in equally randomly selected hospitals in Ijebu-Ode and Ijebu-Igbo. In addition ten percent of the women were selected through a stratified sampling method for in-depth interview. And ten in-depth interviews (IDIs) were conducted among gynaecologist nurses and other health workers. The study identifies a non-cordial relationship between physicians and ante-natal patients which in turn serves as a reason for late booking of pregnancy and irregular attendance of pregnant women at ante-natal care sessions. Qualitative data reveal that many of the pregnant women stay away from ante-natal care because of the uncooperative manner of the physician by not giving enough attention and the use of abusive vague and ambiguous words which are not discernable to barely literate patients. The study concludes that early booking of pregnancy by women is influenced by their closeness and mutual relationship with their physician. And therefore suggests that physicians should pay due diligence to the relationship that exists between them and patients and the appropriate organs of government agency and non-governmental organizations (NGOs) should encourage the dissemination of maternal health education.

Does knowledge of danger signs of pregnancy predict birth preparedness? A critique of the evidence from women admitted with pregnancy complications.

BackgroundImproved knowledge of obstetric danger signs, birth preparedness practices, and readiness for emergency complications are among the strategies aimed at both enhancing utilization of maternal health services and increasing access to skilled care during childbirth, particularly for women with obstetric complications. It is unclear whether knowledge of danger signs translates into improved birth preparedness and complication readiness. The objective was to assess the association between knowledge of danger signs and birth preparedness among women admitted with pregnancy complications.MethodsThe study included 810 women admitted in the antepartum period to Mulago hospital, Uganda. Data was collected on socio-demographic characteristics, reproductive history, pregnancy complications, knowledge of danger signs, and birth preparedness/complication readiness (BPCR). Logistic regression analyses were conducted to explore the relationship between knowledge of danger signs and birth preparedness.ResultsOnly about 1 in 3 women were able to mention at least three of the five basic components of BPCR, and could be regarded as ‘knowledgeable on BPCR’. One in every 4 women could not mention any of the five components. Women with history of obstetric problems during the previous pregnancy were more likely to be knowledgeable on danger signs when compared to those who had no complications in prior pregnancy. Women who were knowledgeable on danger signs were four times more likely to be knowledgeable on BPCR as compared to those who were not knowledgeable.ConclusionsThough awareness about danger signs was low, knowledge of danger signs was associated with knowledge of birth preparedness. More emphasis should be given to emergency/complication readiness during antenatal care sessions. There is a need to strengthen existing policy interventions to address birth preparedness and complication readiness for obstetric emergencies.

Evaluation of the use of herbal drugs by pregnant women in Nigeria

Women are increasingly recognized as the main users of alternative medicine, although data is limited on the extent of women's use of herbal medicine during pregnancy to help with the discomforts of pregnancy and labour. However, questions remain about the safety of many herbal drugs, especially within the first and second trimester. For this reason, this study aimed to ascertain patterns of use of herbal medicinal products by pregnant women in selected health care centers in Enugu South Local Government Area of Enugu State, Nigeria. The study utilized a descriptive survey/research design using a structured questionnaire for data collection. Data were collected from 60 respondents. The findings from the study showed that a greater percentage of the women (58.3%) (n = 35) used herbal drugs in pregnancy-free periods while 41.7% (n = 25) used them in the current pregnancy. The pattern of herbal drug use in pregnancy was irregular, although the first trimester showed the highest percentage (23.3%) (n = 14). When asked for their reasons for using the products, a good number of the pregnant women (n = 27; 45%) asserted it is safer and the majority (n = 33; 55%) said it works better than orthodox medicine. However, half of the women (n = 30; 50%) considered herbal products to be harmful to the baby during pregnancy, and yet 25 of the women (41.7%) were still taking it in their current pregnancy. From the findings of this study, it is recommended that a comprehensive coordinated health approach is needed to provide information about medication in pregnancy and this should be made available and translated into safe and effective use. Proper history taking on drug use (including herbal drugs) should be included in antenatal care sessions in order to exclude the possibility of drug interactions and consequent effects on pregnancy.