Antenatal Cards Research Articles

Predictor of anemia among pregnant women attending antenatal clinics at Hiwot Fana Comprehensive Specialized Hospital, Eastern Ethiopia: a case-control study.

Anemia during pregnancy is a public health problem and is related to negative birth outcomes, especially in developing countries. The main aim of this study was to assess predictors of anemia among pregnant women attending antenatal clinics at Hiwot Fana Comprehensive Specialized University Hospital, Eastern Ethiopia. Unmatched case-control study design was employed among 352 individuals. A face-to-face interview was used to gather data, and each pregnant woman's antenatal care follow-up record cards were reviewed in addition to the interview. EpiData version 3.1 and IBM SPSS version 26 was used for data entry and analysis, respectively. Bivariable and multivariable analyses were conducted to identify predictors of anemia, a p-value of <0.05 was considered a statistically significant association. The common determinants for anemia in pregnant mothers were: rural residency (AOR=2.25, 95% CI: 1.14-4.8), no formal education (AOR=4.4, 95% CI: 1.94-9.9), inter-pregnancy interval (AOR=2.7, 95% CI: 1.24-5.8), and mid-upper arm circumference (AOR=5.0, 95% CI: 2.0-12.7). In this study, the identified determinant factors for anemia were: rural residency, maternal educational status, inter-pregnancy-interval, and mid-upper arm circumference. Therefore, providing health education and promotion for pregnant women regarding anemia by focusing on rural residents and counseling to lengthen their birth spacing is an important task. Moreover, counseling on taking iron supplementation as suggested and consuming a diet rich in iron during antenatal care will be recommended.

Maternal and dietary behavior-related factors associated with preterm birth in Southeastern Terai, Nepal: A cross sectional study.

BackgroundPreterm birth (PTB) is a global issue although its burden is higher in low- and middle-income countries. This study examined the risk factors of PTB in Southeastern Terai, Nepal.MethodsIn this community-based cross-sectional study, a total of 305 mothers having children under the age of 6 months were selected using systematic random sampling. Data were collected by structured interviewer-administered questionnaires and maternal antenatal cards from study participants for some clinical information. Predictors of PTB were identified using multi-level logistic regression analysis at a P-value < 0.05.ResultsOf the total 305 mother-live-born baby pairs, 13.77% (42/305) had preterm childbirth. Maternal socio-demographic factors such as mothers from Dalit caste/ethnicity [adjusted odds ratio (AOR) = 12.16, 95% CI = 2.2–64.61] and Aadibasi/Janajati caste/ethnicity (AOR = 3.83, 95% CI = 1.01–14.65), family income in the first tercile (AOR = 6.82, 95% CI = 1.65–28.08), than their counterparts, were significantly positively associated with PTB. Likewise, other maternal and dietary factors, such as birth order first-second (AOR = 9.56, 95% CI = 1.74–52.53), and birth spacing ≤ 2 years (AOR = 5.16, 95% CI = 1.62–16.42), mothers who did not consume additional meal (AOR = 9.53, 95% CI = 2.13–42.55), milk and milk products (AOR = 6.44, 95% CI = 1.56–26.51) during pregnancy, having <4 antenatal (ANC) visits (AOR = 4.29, 95% CI = 1.25–14.67), did not have intake of recommended amount of iron and folic acid tablets (IFA) (<180 tablets) (AOR = 3.46, 95% CI = 1.03–11.58), and not having adequate rest and sleep (AOR = 4.83, 95% CI = 1.01–23.30) during pregnancy had higher odds of having PTB than their counterparts.ConclusionSome socio-demographic, maternal, and dietary behavior-related factors were independently associated with PTB. These factors should be considered while designing targeted health interventions in Nepal. In addition, we recommend specific measures such as promoting pregnant women to use available antenatal care and counseling services offered to them, as well as having an adequate diet to a level that meets their daily requirements.

Early pregnancy body mass index and gestational weight gain: A mediating or moderating factor for short stature and risk of gestational diabetes mellitus?

This study examined the association between height and the risk of Gestational Diabetes Mellitus (GDM), and whether this association was mediated or moderated by early pregnancy body mass index (BMI) and gestational weight gain (GWG) that are known independent risk factors for GDM. Data of a retrospective cohort of pregnant women (N = 1,945) were extracted from antenatal clinic cards. The cut-off values of height in relation to risk of GDM were identified using receiver operating characteristic analysis and four categories of height were derived: < 150 cm, 150–155 cm, 156–160 cm, and > 160cm. Mediation analysis was performed using the Preacher and Hayes bootstrapping method while the moderation effect was tested with multiple regression analysis with interaction terms. Although there was no mediation effect of BMI and GWG on the association between height and risk of GDM, both factors moderated this association with a significant association between shorter height and risk of GDM was observed in overweight / obese women (height < 150 cm: AOR = 1.41, 95% CI = 1.03–2.44; height 156–160 cm: AOR = 1.48, 95% CI = 1.03–2.14). Overweight / obese women with height < 150 cm and excessive GWG at the end of the second trimester (AOR = 2.25, 95% CI = 1.45–4.17) had significantly higher risk of GDM than those without these factors. Short stature (< 150 cm) was significantly associated with GDM risk among OW/OB women with excessive gestational weight gain at the end of second trimester. This finding underscores the importance of maintaining a healthy BMI during reproductive age and gaining weight in recommended range during pregnancy.

Early pregnancy hemoglobin is associated with the risk of gestational diabetes mellitus: a retrospective cohort study.

This study aimed to determine the association between hemoglobin (Hb) concentration and Hb change, during early to mid-pregnancy with the risk of gestational diabetes mellitus (GDM). This was a clinic-based retrospective cohort study of 1951 healthy pregnant women (18-45 years old) with a singleton gestation attending antenatal care at government health clinics. Hb concentration at first prenatal visit and each trimester was extracted from the antenatal cards. Hb changes from first prenatal visit to first and second trimester as well as from second to third trimester were calculated. Multivariate logistic regression was used with adjustment for covariates. Women with GDM had significantly higher Hb concentrations (Hb 1) at first prenatal visit (< 12 weeks) compared with non-GDM women (11·91 g/dl v.11·74 g/dl). Hb 1 and Hb changes (Hb change 2) from first prenatal visit to the second trimester (23-27th weeks) were significantly associated with GDM risk, with an adjusted OR of 1·14 (95 % CI 1·01, 1·29) and 1·25 (95 % CI 1·05, 1·49), respectively. The significant associations between Hb 1 and Hb change 2 with the risk of GDM were found among non-Malays, overweight/obese and women aged 35 years and above. Women with higher Hb concentrations in early pregnancy were at higher risk of GDM, and such association was significant among women aged 35 years and above, non-Malays and overweight/obese. This raises a potential concern for elevated Fe status in early pregnancy as a risk factor of GDM among Fe-replete women.

Determinants of low birth weight deliveries at five referral hospitals in Western Area Urban district, Sierra Leone

BackgroundLow birth weight (LBW) contributes significantly to infant and child mortality. Each year, about 20 1million deliveries are LBW with 96.5% occurring in developing countries. Whiles the incidence of LBW is reducing in other districts of Sierra Leone, it has been reported to be increasing in the Western Area Urban district. Determining the risk factors in a specific geographic area is important for identifying mothers at risk and thereby for planning and taking appropriate action. The current study sought to identify factors associated with LBW deliveries in the Western Area Urban district of Sierra Leone.MethodsA hospital-based unmatched 1:2 case-control study was conducted among mothers who delivered live singleton babies from November, 2019 to February, 2020 in five referral health facilities. Mothers were conveniently sampled and sequentially enrolled into the study after delivery. Their antenatal care cards were reviewed and a pre-tested questionnaire administered to the mothers. Data analysis was done using Stata 15.0 and association between maternal socio-demographic, socio-economic, obstetric and lifestyle factors and LBW assessed using bivariable and multivariable logistic regression analyses.ResultsA total of 438 mothers (146 cases and 292 controls), mean age: 24.2 (±5.8) and 26.1 (±5.5) years for cases and controls respectively participated in the study. Multivariable analysis revealed that being unemployed (AoR = 2.52, 95% CI 1.16–5.49, p = 0.020), having anaemia during pregnancy (AoR = 3.88, 95% CI 1.90–7.90, p < 0.001), having less than 2 years inter-pregnancy interval (AoR = 2.53, 95% CI 1.11–5.73, p = 0.026), and smoking cigarettes during pregnancy (AoR = 4.36, 95% CI 1.94–9.80, p < 0.001) were significantly associated with having LBW babies.ConclusionFactors associated with LBW identified were unemployment, anaemia during pregnancy, < 2 years inter-pregnancy interval and cigarette smoking during pregnancy. Health care providers should screen and sensitize mothers on the risk factors of LBW during antenatal sessions.

Symphysis-fundal height, gestational age and its value for identification of foetuses at risk in rural Tanzania: A qualitative follow-up study.

Preterm birth and abnormal foetal growth increase the risk of perinatal morbidity and mortality. Timely identification of foetuses at risk is critical to improving maternal and neonatal outcomes. The objective of this study was to increase understanding of the quality of foetal growth monitoring during antenatal care in Tanzania. Between 2015 and 2017, 13 women were followed throughout their pregnancy, childbirth and postpartum period. Participants were recruited using a staggered approach at selected health facilities. Data collection included direct observations of 25 of 48 antenatal care consultations, review of the women's antenatal cards, 88 in-depth interviews and participant observation at the health facilities. Six women had facility births and seven had home births. There was one stillbirth, one preterm birth and two term infants died between the age of 3-6 months. Of the 9 newborns with a known birthweight, 3 were possibly growth-restricted. During 12 ANC visits (25%) Symphysis-Fundal Height (SFH) was not recorded and during 22 visits (46%) the recorded Gestational Age (GA) was incorrect. Despite regular assessment of SFH, three possible growth-restricted infants remained undetected. There is a need to improve nurse-midwives ability to determine a reliable GA and improve critical reflection on SFH measurement.

Intermittent Preventive Treatment of Malaria in Pregnancy Coverage Estimates from Population-based Surveys: Reliability of Women's Recall Among Women with ANC Cards.

ABSTRACT.Large household surveys performed to estimate coverage rates for various health interventions, including intermittent preventive treatment, depend on recall. Many studies question the validity of recalled data. Regarding vaccine coverage rates, it is standard practice to validate responses using medical history cards. To validate the coverage rates of intermittent preventive treatment during pregnancy reported by large household surveys, recalled coverage rates were compared with antenatal care card data in Benin, Ghana, Malawi, and Tanzania. The results indicated that recall was comparable to the coverage rates provided indicated by the antenatal care cards. These findings suggest that intermittent preventive treatment coverage rates reported by large household surveys performed using recalled data are valid.

Effect of sulfadoxine-pyrimethamine doses for prevention of malaria during pregnancy in hypoendemic area in Tanzania

BackgroundMalaria in pregnancy increases the risk of deleterious maternal and birth outcomes. The use of ≥ 3 doses of sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria (IPTp-SP) is recommended for preventing the consequences of malaria during pregnancy. This study assessed the effect of IPTp-SP for prevention of malaria during pregnancy in low transmission settings.MethodsA cross-sectional study that involved consecutively selected 1161 pregnant women was conducted at Mwananyamala regional referral hospital in Dar es Salaam. Assessment of the uptake of IPTp-SP was done by extracting information from antenatal clinic cards. Maternal venous blood, cord blood, placental blood and placental biopsy were collected for assessment of anaemia and malaria. High performance liquid chromatography with ultraviolet detection (HPLC-UV) was used to detect and quantify sulfadoxine (SDX). Dried blood spots (DBS) of placental blood were collected for determination of sub-microscopic malaria using polymerase chain reaction (PCR).ResultsIn total, 397 (34.2%) pregnant women reported to have used sub-optimal doses (≤ 2) while 764 (65.8%) used optimal doses (≥ 3) of IPTp-SP at the time of delivery. The prevalence of placental malaria as determined by histology was 3.6%. Submicroscopic placental malaria was detected in 1.4% of the study participants. Women with peripheral malaria had six times risk of maternal anaemia than those who were malaria negative (aOR, 5.83; 95% CI 1.10–30.92; p = 0.04). The geometric mean plasma SDX concentration was 10.76 ± 2.51 μg/mL. Sub-optimal IPTp-SP dose was not associated with placental malaria, premature delivery and fetal anaemia. The use of ≤ 2 doses of IPTp-SP increased the risk of maternal anaemia by 1.36-fold compared to ≥ 3 doses (aOR, 1.36; 95% CI 1.04–1.79; p = 0.02).ConclusionThe use of < 2 doses of IPTp-SP increased the risk of maternal anaemia. However, sub-optimal doses (≤ 2 doses) were not associated with increased the risk of malaria parasitaemia, fetal anaemia and preterm delivery among pregnant women in low malaria transmission setting. The use of optimal doses (≥ 3 doses) of IPTp-SP and complementary interventions should continue even in areas with low malaria transmission.

The timing and quality of antenatal care received by women attending a primary care centre in Iquitos, Peru: A facility exit survey.

BackgroundMaternal mortality is high in Loreto, Peru, but can be reduced by high quality antenatal care. Indicators for the quality of antenatal care received include the timing (with respect to gestational age) and number of antenatal appointments attended, the delivery of antenatal services and health information, and women’s perceptions about their care. This study investigated these indicators amongst women receiving antenatal care in predominantly the San Juan Bautista district of Iquitos, Loreto. This was to identify areas for improvement through comparison with antenatal guidelines published by the Ministry of Health, Peru, and the World Health Organization.MethodsA total of 134 women were recruited at the Centro de Salud, San Juan—a primary care centre in Iquitos. Information about the delivery of antenatal services and the number of and gestational ages at appointments attended was collected from 121/134 women’s hand-held antenatal cards. The delivery of health information and women’s perceptions about their antenatal care were investigated through questionnaires (133/134 completed). Descriptive statistics, such as frequencies and valid percentages, were determined.ResultsHand-held antenatal cards revealed that 52.9% of participants began their antenatal care in the first trimester. Compared to national guidelines, 42.1% attended appointments at recommended gestational ages and no women received all recommended antenatal services. Most women received information about identifying complications in pregnancy and health and lifestyle topics. Over 85% of women reported satisfaction with their antenatal care.ConclusionsTimely antenatal attendance and delivery of services should be encouraged to meet national and global standards. Although all services were not delivered in a combined manner according to national guidelines, individual services were mostly delivered to a high standard and therefore a high proportion of women were satisfied with their antenatal care.

Uptake of Intermittent Preventive Therapy Among Pregnant Women Living in Dar es Salaam, Tanzania: a Descriptive Cross-sectional Study

Intermittent preventive therapy (IPTp) using sulphadoxine-pyrimethamine (SP) is a key component of malaria prevention strategy in pregnant women. A pregnant woman is required to receive at least 3 doses of SP during her pregnancy, with each dose being given at least 1 month apart, starting the first dose in the earliest second trimester of pregnancy. Therefore, a descriptive cross-sectional study was designed to assess the knowledge and uptake of IPTp-SP among pregnant women living in low malaria prevalent region. The questionnaires were used to collect data on sociodemographic characteristics, obstetric history, and knowledge scale while information about SP use was extracted from antenatal clinic cards. Overall, 389 pregnant women with a mean age (± standard deviation) of 29 years (5.3) participated in the study where majority of them (80.7%) were married. Majority of the study participants (77.1%) were in the third trimester of pregnancy and multigravida (42.9%). Of 389, 37 (9.5%), 288 (74%), and 64 (16.5%) were found to have low, moderate, and high level of knowledge about the use of IPTp-SP respectively. Of 300 pregnant women who were in the third trimester, 37 (12.3%) did not take SP at all while 109 (36.3%), 61 (20.3%), and 93 (31%) had taken a single, two doses, three, or more SP doses respectively. Although majority of pregnant women had moderate to high level of knowledge about the use of IPTp-SP, but only one third of pregnant women did take three or more IPTp-SP doses.

Agreement of antenatal care indicators from self-reported questionnaire and the antenatal care card of women in the 2015 Pelotas birth cohort, Rio Grande do Sul, Brazil

BackgroundStudies of healthcare service use during the pregnancy-postpartum cycle often rely on self-reported data. The reliability of self-reported information is often questioned as administrative data or medical records, such as antenatal care cards, are usually preferred. In this study, we measured the agreement of antenatal care indicators from self-reported information and antenatal care cards of pregnant women in the 2015 Pelotas Birth Cohort, Brazil.MethodsIn a sample of 3923 mothers, indicator agreement strengths were estimated from Kappa and prevalence-and-bias-adjusted Kappa (PABAK) coefficients. Maternal characteristics associated with indicator agreements were assessed with heterogeneity chi-squared tests.ResultsThe self-reported questionnaire and the antenatal care card showed a moderate to high agreement in 10 of 21 (48%) antenatal care indicators that assessed care service use, clinical examination and diseases during pregnancy. Counseling indicators performed poorly. Self-reported information presented a higher frequency data and a higher sensitivity but slightly lower specificity when compared to the antenatal card. Factors associated with higher agreement between both data sources included lower maternal age, higher level of education, primiparous status, and being a recipient of health care in the public sector.ConclusionsSelf-reported questionnaire and antenatal care cards provided substantially different information on indicator performance. Reliance on only one source of data to assess antenatal care quality may be questionable for some indicators. From a public health perspective, it is recommended that antenatal care programs use multiple data sources to estimate quality and effectiveness of health promotion and disease prevention in pregnant women and their offspring.

Adverse birth outcomes among mothers who received intermittent preventive treatment with Sulphadoxine-Pyrimethamine in the low malaria transmission region

BackgroundMalaria in pregnancy increases the risk of adverse birth outcomes such as low birth weight (LBW), maternal and foetal anemia. In Tanzania, some areas have attained low malaria transmission. However, data on the burden of preterm delivery, LBW, maternal and foetal anemia following substantial reduction of malaria transmission in recent years is still scarce in these settings.MethodsA study involving 631 pregnant women was conducted at Mwananyamala referral hospital in Dar es Salaam from April to August, 2018. Study enrollment was done prior to delivery. Structured interview and antenatal clinic cards were used to obtain data including the use of intermittent preventive therapy in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP). Infants birth weights were recorded, maternal venous and cord blood were taken for testing of malaria and determination of haemoglobin (Hb) levels. Chi-square test and regression analysis were done to identify risk factors for preterm delivery, LBW, maternal and foetal anemia.ResultsThe prevalence of malaria among mothers who used at least one dose of IPTp-SP was 0.6% (4/631). Fourteen mothers (2.2%) did not use IPTp-SP and had no malaria infection. The prevalence of maternal anemia, LBW, foetal anemia and preterm delivery was 40.6, 6.5, 5.9 and 9.2% respectively. Participants who were malaria positive had 11 times more risk of LBW compared to those who were negative (AOR, 11; 95%, CI 1.07–132.2; p = 0.04). The risk of delivering babies with LBW was 1.12 times high among mothers who were ≤ 36 weeks of gestation (AOR, 1.12; 95% CI, 0.06–0.25; p = < 0.001). The use of ≥3 doses of IPTp-SP was associated with 83% decrease in risk of LBW compared to those who did not use any dose of IPTp-SP (AOR, 0.17; 95% CI, 0.03–0.88; p = 0.05). Severe anaemia at delivery was associated with seven times increased risk of preterm delivery compared to non-anemic participants (AOR, 6.5; 95% CI, 1.49–28.16; p = 0.013).ConclusionDespite the reduced malaria transmission and use of IPTp-SP, prevalence of preterm delivery, maternal anemia, LBW and foetal anemia is still high in Tanzania. The recommended ≥3 doses of IPTp-SP should continue be provided even in areas with substantial reduction of malaria.

Audit of the patient-carried antenatal card, South Africa

Background: In South Africa, an antenatal care card is carried by all women to appointments. This cards allows health professionals to document medical and obstetric characteristics so that important medical information can be transferred. Aims: To audit completeness and management of the antenatal care cards against maternity guidelines. Methods: A retrospective study in which 300 cards were audited in September 2015. Information audited included clinical factors, education, ultrasound, results, referral, and treatment. A composite assessment with a score of between 0 and 100% of certain aspects was made. Findings: No cards were complete. Birthweight was often recorded as ‘big or ‘average’, rather than the exact weight. ‘Planned’ pregnancy was noted in 1 card, and obstetric history was complete in 60.5% cases. Overall, 14 (8.9%) of the 157 ultrasounds were in the first trimester. Education in pregnancy was poorly documented. Clinical examination was recorded in 95% of cards. Conclusions: The card was found to be incomplete in ways that may affect maternal and fetal outcomes

Epidemiological predictor variables in relation to the outcome of pregnancy in an urban setting

Background: Fetal weight at birth is the singular parameter resonant of maternal health and is measured with reasonable precision, while measuring preterm birth or IUGR requires a valid estimate of gestational age. Notwithstanding the relevance of mortality and morbidity as measures of adverse pregnancy outcome, proxy markers like low birth weight (LBW), preterm birth, intrauterine growth restriction (IUGR) and congenital anomalies have been used in the past. This exercise aims to study the epidemiological predictor variables in pregnant women attending ante-natal clinic and its association with birth outcome.Methods: This prospective study was carried out over a one-year period at a tertiary care teaching hospital. Data was collected using structured questionnaire, investigation reports and ante-natal cards. The outcome of delivery in all registered women was recorded by following them up till delivery.Results: The variables having a statistically significant association with an adverse pregnancy outcome were maternal and paternal education, family income, socioeconomic status (SES), gravidity, maternal complications, level of physical activity, rest during pregnancy, trimester of initiation of ANC visits, diet, iron supplementation, maternal weight gain, exposure to tobacco/environmental tobacco smoke and gestational age.Conclusions: Parental education, good antenatal care, early detection of high risk pregnancy, light physical activity and adequate rest, adequate nutrition with supplementation and exposure to ETS markedly influence the pregnancy outcome and intervention in these areas would result in an improved birth outcome. Factors having marginal scope of intervention include age of the pregnant women, adequate inter-pregnancy interval, maternal weight gain and socioeconomic status.

Internal migrants' experiences with and perceptions of frontline health workers: A nationwide study in 13 Indian cities.

The role of frontline health workers is crucial in strengthening primary health care in India. This paper reports on the extent of services provided by frontline health workers in migrants' experiences and perceptions of these services in 13 Indian cities. Cluster random sampling was used to sample 51055 households for a quantitative survey through interviewer-administered questionnaires. Information was sought on the receipt of health workers' services for general health care overall (from the head/other adult member of the household) and maternal and immunization services in particular (from mothers of children <2years old). Purposively, 240 key informants and 290 recently delivered mothers were selected for qualitative interviews. Only 31% of the total respondents were aware of the visits of frontline health workers, and 20% of households reported visits to their locality during past month. In 4 cities, approximately 90% of households never saw health workers in their locality. Only 20% of women and 22% of children received antenatal care and vaccination cards from frontline health workers. Qualitative data confirm that the frontline health workers' visits were not regular and that health workers limited their services to antenatal care and childhood immunization. It was further noted that health workers saw the migrants as"outsiders." These findings warrant developing migrant-specific health-care services that consider their vulnerability and living conditions. The present study has implications for India's National Urban Health Mission, which envisions addressing the health care needs of the urban population with a focus on the urban poor.

The Contribution of a Health Extension Programme in the Utilisation of Maternal Healthcare Services in the Mecha District of the Amhara Region, Ethiopia

The purpose of this study was to identify the contributions made by the Health Extension Programme (HEP) to influence the utilisation of maternal healthcare services at primary healthcare units in the Mecha district, Ethiopia. A non-experimental quantitative descriptive research design was conducted. This was structured into four phases. In phase one the continuum of care and quality of documentation was audited from 975 antenatal cards documented in three health centres from 1 July 2010 to 30 June 2013. In phase two 304 women were interviewed about their knowledge on the available services, the quality of maternal healthcare provision and factors that hinder the utilisation of maternal healthcare services. In phase three the opinions of all midwives and health extension workers (HEWs) were obtained with self-administered questionnaires from three health centres and 15 health posts respectively. In phase four the guidelines were developed.The findings revealed that the continuum care of maternal healthcare services was ineffective; the quality of documentation was poor. The majority of respondents were more knowledgeable about other HEP packages than maternal healthcare services. The advocacy and dissemination of information about the maternal healthcare services proved to be inadequate. The relations between the clients and the healthcare providers at the healthcentres were unsatisfactory.The study developed guidelines based on the findings. The study recommended that a strong antenatal care follow-up tracking mechanism be urgently provided, that providers be knowledgeable, that community midwives be trained and accredited to give skilled delivery at the health posts, and that the recording tools at the health post be reviewed and developed.

Correlation of Maternal Anthropometry with Intrauterine Growth Restricted Neonates’ Birth Weight

Objectives: To determine the correlation between weight, height and body mass index (BMI) of the mothers with their term intra-uterine growth restricted (IUGR) neonates’ birth weight. Material and methods: An observational, cross sectional study was conducted involving 322 term IUGR neonates and their mothers, and was compared with 336 term appropriate for gestational age (AGA) neonates matched for that gestational age, and their mothers over a period of one year. The anthropometric measurement was done on birth weight, length, head circumference, ponderal index of neonates, and height and BMI of mothers. The maternal weight was obtained from antenatal cards. Results: Majority (72.04%) of the mothers having IUGR neonates were primi-gravida, 63.04% were of poor economic status. Mean age, weight, height and BMI of the mothers of IUGR neonates were 20.2±0.8 years, 49.1±2.3 kg, 144.1±37.2 cm, and 17.6±2.1 kg/m 2 , respectively. These parameters for the mothers of AGA neonates were 22.3±2.5 years, 54.3±2.7 kg, 155.2±42.1 cm, and 19.2±2.3 kg/m 2 , respectively. Comparison of these maternal parameters between both the groups showed a significantly higher value in the second group (p< 0.01 in all cases). Maternal weight, height and BMI showed a strong negative correlation {Pearson’s correlation coefficient of -0.53, -0.76, and -0.42 respectively; adjusted odds ratio (95% CI) of 0.72 (0.54-0.91), 0.40 (0.28-0.52) and 0.76 (0.54-0.96), respectively with the neonates’ birth weight, but maternal age did not {Pearson’s correlation coefficient of -0.32, adjusted odds ratio (95% CI) of 0.89 (0.10-1.55)}. Conclusion: There are lesser chances of development of IUGR neonates with increase in maternal weight, height and BMI.

Prescription drug use during pregnancy in Southern Tigray region, North Ethiopia

BackgroundJudicious utilization of drugs rescues the fetus from the harmful effects while treating the health problems of the pregnant women. This study aimed at evaluating drug utilization pattern and its associated factors among pregnant women in Southern Tigray, Ethiopia.MethodInstitution based cross-sectional study was conducted among 647 pregnant women who had been attending obstetrics-gynecology and antenatal care units in different health facilities of Southern Tigray region. The study participants were selected using multistage sampling technique. Data collection was done using pre-tested semi-structured questionnaires and by reviewing antenatal follow-up cards. Descriptive and inferential statistics were analyzed, to assess drug utilization pattern and its associated factors among pregnant women, using SPSS version 20 software.ResultsOf 647 pregnant women, 87.5% were prescribed with at least one medication. As per the United States Food and Drug Administration (US-FDA) risk classification system, 87.7, 7.9, 3.9, and 0.5% of the prescribed drug were from category A, B, C and D, respectively. Prescription drug use was more likely among gynecology ward visitors [AOR = 8.97, 95% Cl (2.69–29.88)] and among those who visited health facilities for the first time during their first [AOR =2.65, 95% Cl (1.44–4.84)] and second [AOR = 2.50, 95% Cl (1.36–4.61)] trimesters.ConclusionMajority of the study population used safe and appropriate medications according to US-FDA risk classification system, with the exception of low proportion (0.5%) of medication with potential risk for the fetus. The average number of drug prescribed per pregnant women was in the recommended range of WHO drug use indicators guideline.

Diagnosis a posteriori? Assessing gestational diabetes screening and management in Morocco

BackgroundIn Morocco, gestational diabetes affects 1 in 10 pregnant women, but knowledge about screening and management practices outside university settings is limited.ObjectiveTo provide a comprehensive picture about the current situation of screening and management of gestational diabetes at different levels of care and to highlight existing challenges.DesignWe conducted a descriptive mixed methods study in the districts of Al Haouz and Marrakech by using both quantitative and qualitative methods, including document reviews of 369 antenatal cards and 299 hospital files, health facility inventories related to resource availability, 20 key informant interviews as well as focus group discussions with 32 pregnant women and exit interviews with 122 antenatal care (ANC) clients. Quantitative data were descriptively analyzed using STATA Version 13, whereas qualitative data were thematically analyzed using NVIVO Version 10.ResultsThe findings revealed that sensitization of women about gestational diabetes is low, and only 34.4% have ever heard about it before attending ANC. Fasting blood sugar is used for screening, and women are sent to external laboratories for testing. A fasting blood sugar of 0.92 g/l and above was documented in 12.3% of all antenatal cards examined. Women diagnosed with gestational diabetes are usually referred to a specialist despite general practitioners at health center level being responsible for the management of non-pregnant diabetic patients.ConclusionsDecentralization of screening for gestational diabetes and initial management of uncomplicated cases at the primary level of care could ease access to care and reduce the number of mothers who are diagnosed after a complication occurred.

Antenatal care visits’ absenteeism at a secondary care medical facility in Southwest Nigeria

abstractAntenatal care (ANC) is a specialised pattern of care organised for pregnant women with the goal of maintaining good health and promoting safe delivery of healthy infants. It is an indispensable part of effective maternity care services. This study identified the factors responsible for absenteeism from ANC follow-up visits. It was a hospital-based prospective cross-sectional descriptive study conducted at a faith based secondary healthcare facility in Ibadan, Nigeria. Relevant data were retrieved using interviewer-administered structured questionnaires and antenatal health record cards. The major reasons identified for absenteeism were delay in receiving hospital services due to long queues at service points and understaffing. The pregnant women aged 35 years and above were the most likely to miss the visits. Therefore, there is the need for hospital administrators and health care givers to make the services patient-friendly.