Care Attendance Research Articles

Women’s involvement in decision-making and association with reproductive health behaviors: findings from a cross-sectional survey in Niger

BackgroundThough women in Niger are largely responsible for the familial health and caretaking, prior research shows limited female autonomy in healthcare decisions. This study extends current understanding of women’s participation in decision-making and its influence on reproductive health behaviors.MethodsCross-sectional survey with married women (15–49 years, N = 2,672) in Maradi and Zinder Niger assessed women’s participation in household decision-making in health and non-health issues. Analyses examined [1] if participation in household decision-making was associated with modern contraceptive use, antenatal care (ANC) attendance, and skilled birth attendance at last delivery and [2] what individual, interpersonal, and community-level factors were associated with women’s participation in decision-making.ResultsOnly 16% of the respondents were involved—either autonomously or jointly with their spouse—in all three types of household decisions: (1) large purchase, (2) visiting family/parents, and (3) decisions about own healthcare. Involvement in decision making was significantly associated with increased odds of current modern contraceptive use [aOR:1.36 (95% CI: 1.06–1.75)] and four or more ANC visits during their recent pregnancy [aOR:1.34 (95% CI: 1.00-1.79)], when adjusting for socio-demographic characteristics. There was no significant association between involvement in decision-making and skilled birth attendance at recent delivery. Odds of involvement in decision-making was significantly associated with increasing age and household wealth status, listening to radio, and involvement in decision-making about their own marriage.ConclusionWomen’s engagement in decision-making positively influences their reproductive health. Social and behavior change strategies to shift social norms and increase opportunities for women’s involvement in household decision making are needed. For example, radio programs can be used to inform specific target groups on how women’s decision-making can positively influence reproductive health while also providing specific actions to achieve change. Opportunities exist to enhance women’s voice either before women enter marital partnerships or after (for instance, using health and social programming).

Risk of Hospitalization Associated with Use of Consumer-Directed Attendant Care

ABSTRACT Older people with disabilities living independently often use attendant care, also known as Personal Assistive Services (PAS). The aides providing care can come from a home health agency contracted by the state Medicaid authority, known as agency-directed PAS, or the Medicaid recipient can receive a monthly budget and arrange their own care, known as consumer-directed care. Consumer-directed care is hypothesized to have some possible benefits but could also potentially lead to health hazards. This study examined whether people receiving consumer-directed PAS versus people receiving agency-directed PAS faced a higher risk of hospitalization. The data for this study came from Pennsylvania Medicaid claims, enrollment files, standardized assessments, and hospitalization claims from Medicare and Medicaid. The analysis used two-stage least square regression, with the percentage of people in a county using consumer-directed care as an instrument for the type of PAS. People using consumer-directed care did not have a statistically significant difference in risk for hospitalization compared to people using agency-directed PAS (p = .976). Risk of hospitalization was not different for people using consumer-directed care compared to people using agency-directed care.

The use of antibiotics during pregnancy: A cross-sectional study of knowledge, attitude, and practices among antenatal care attendees in Northern Ghana.

The promotion of rational use of antibiotics among pregnant women is eminent not only for the risk of teratogenicity in the developing fetus but also the risk of drug resistance with its concomitant high cost of health care. Studies on antibiotic self-medication among pregnant women in Northern Ghana are rare. Improving the knowledge and awareness among the vulnerable groups about the appropriate use of antibiotics can help in limiting the antibiotic resistance menace. We, therefore, conducted this study to assess the knowledge, attitude, and practice (KAP) toward antibiotic use among pregnant women attending an antenatal clinic at a primary health care in Tolon, Northern Region, Ghana. We conducted a cross-sectional study using an interviewer-administered questionnaire to assess the KAP of 702 pregnant women on antibiotic use. This study was conducted in the Tolon Health Center (THC) from March 2021 and ended in October 2021. In this study, 55.6% of pregnant women had good knowledge and 45.3% of them had engaged in self-medication with antibiotics while pregnant. There were statistically significant associations between participants' background and obstetric characteristics and knowledge of antibiotic use and antibiotic resistance, except for age, marital status, and parity. Also, there was a significant association between pregnant women's knowledge and self-medication or over-the-counter purchase of antibiotics. We concluded that higher education level, monthly income, good practice, and good knowledge were significantly associated with a reduced likelihood of self-medication with antibiotics. A well-structured education that could be easily accepted and understood by pregnant women on the risks of antibiotic self-medication should be included in the routine education at the antenatal clinics.

Effect of HIV-Integrated Care on Uptake of Maternal Health and Routine Childhood Immunization Services at Primary Health Care Facility in Northern Nigeria: An Interrupted Time Series Analysis

Background: This study assessed the effect of HIV-integrated care delivered within routine primary health care (PHC) in Kano, Nigeria, on the uptake of maternal health and routine childhood immunization services. Methods: A retrospective cohort design was used to review and collect anonymized data from medical records of women and children who accessed health care from the PHC facility between January 2009 and December 2016. Data were analyzed using SPSS version 22. Interrupted time series analysis (ITS) was performed to estimate changes in maternal and childhood immunization service usage over time following the delivery of the integrated care. Results: Uptake of maternal health services increased over time: antenatal care attendance (effect/month [95% confidence interval (CI)]: 6.6 [44.55–8.65], P = 0.0001), family planning (effect/month [95% CI]: 1.3 [0.26–2.26], P = 0.014), and delivery (effect/month [95% CI]: 0.9 [0.39–1.45], P = 0.0009). Uptake of routine immunization also increased over time with the integrated care: Bacille Calmette Guerin (BCG) (Effect/month [95% CI]: 1.8 [0.64–2.88], P = 0.002), and diphtheria, tetanus, and pertussis 1 (DPT1)/Penta 1 vaccinations (Effect/month [95% CI]: 1.0 [0.20–1.73], P = 0.013) also showed a moderate increase over time, but DPT3/Penta 3 vaccination dropped gradually over time (Effect/month [95% CI]: −0.1 [−0.74–0.46], P = 0.649). Conclusion: The integrated care resulted in increased uptake of both maternal health and childhood routine immunization services. This suggests that the reorganization and restructuring of the HIV-integrated care in the Kumbotso Comprehensive Health Centre has had a positive impact on non-HIV services provided at the center. There are still opportunities for further research to refine and elaborate on the novel findings of this study.

Pregnancy outcomes before and during COVID-19 pandemic in Tamale Metropolis, Ghana: A retrospective cohort study.

The COVID-19 pandemic affected expectant mothers seeking maternal health services in most developing countries. Access and utilization of maternal health services including antenatal care (ANC) attendance and skilled delivery declined drastically resulting in adverse pregnancy outcomes. This study assessed pregnancy outcomes before and during COVID-19 pandemic in Tamale Metropolis, Ghana. A retrospective cohort study design was employed. A random sampling technique was used to select 450 women who delivered before or during the COVID-19 pandemic in Tamale Metropolis, Ghana. The respondents were interviewed using structured questionnaire at their homes. In this study, the data collected were socio-demographics characteristics, ANC attendance, before or during pandemic delivery, place of delivery and birth outcomes. Chi-square test and bivariate logistic regression analyses were performed under significant level of 0.05 to determine factors associated with the outcome variables. Of the 450 respondents, 51.8% were between 26 and 30 years of age. More than half (52.2%) of the respondents had no formal education and 93.3% were married. The majority (60.4%) of the respondents described their residence as urban setting. About 31.6% of the women delivered before the pandemic. The COVID-19 pandemic influenced place of delivery. The proportion of women who attended at least one ANC visit (84.5% before vs 70.5% during), and delivered at a hospital (76.8% before vs 72.4% during) were higher before the pandemic. More women were likely to deliver at home during COVID-19 (OR: 2.38, 95%CI: 1.52-3.74, p<0.001). Similarly, there was statistically significance difference between before and during COVID-19 delivery on at least one ANC attendance (OR: 2.72, 95%CI: 1.58-1.67, p<0.001). Women who delivered during COVID-19 were about twice more likely to develop complications (OR: 1.72, 95%CI: 1.03-2.87, p = 0.04). ANC attendance and health facility delivery decreased while pregnancy complications increased during COVID-19. During disease outbreaks, outreach engagement strategies should be devised to increase access and utilization of maternal health services for marginalized and underserved populations. The capacity of health workers should be strengthened through skills training to manage adverse birth outcomes.

Assessment of Attitude, Knowledge and Prevention of Anemia in Pregnancy among Women Attending Antenatal Care in Udi LGA in Enugu State, Nigeria

This study evaluated the knowledge, attitude and preventive practices towards anemia among women attending ANC in Udi LGA, Enugu State. Anemia is one of the most common nutritional deficiency disorders affecting pregnant women in developing countries, including Nigeria. Anemia during pregnancy is commonly associated with poor pregnancy outcomes and can result in complications that threaten the life of both the mother and fetus. Specific objectives of this study are; to determine the knowledge level of women attending ANC in selected clinics in Udi LGA on anemia, to determine the attitude towards anemia among women attending ANC clinic and to evaluate the knowledge level on preventive measures against anemia among women attending ANC in Udi LGA. A questionnaire-based study was implored to obtain direct information from the respondents and a total of three hundred and eighty-seven (387) respondents were captured. The mean age of the respondents is 32 years. Those between the ages of 26-30 and 31-35 are the highest in number with the frequency of 100 (25.83). Majority of the respondents 159 (46.08) had tertiary education. The results showed that most of the respondents (74.0%) had a good knowledge of anemia in pregnancy. About, 19.2% had an average level of knowledge while 6.8% had a poor knowledge of anemia in pregnancy. It also showed that (59.5%) had a right or excellent attitude towards anemia in pregnancy. About, 27.7% had an average or fair attitude. More so, (75.7%) had an excellent preventive measure towards anemia during pregnancy. Therefore, this study shows that the majority of the respondents have good knowledge, the right attitude and preventive measures towards anemia during pregnancy. Thus more effort is encouraged in sensitization of the public.

Health education to promote knowledge about sickle cell disease and newborn screening in pregnant women: a community-based pilot study using the healthy beginning initiative

BackgroundPregnancy presents a critical period for any maternal and child health intervention that may impact the health of the newborn. With low antenatal care attendance by pregnant women in health facilities in Nigeria, community-based programs could enable increased reach for health education about sickle cell disease (SCD) and newborn screening (NBS) among pregnant women. This pilot study aimed to assess the effect of education on the knowledge about SCD and NBS among pregnant women using the Healthy Beginning Initiative, a community-based framework.MethodsA pre-post study design was used to evaluate knowledge of SCD and NBS in a convenience sample of 89 consenting pregnant women from three communities. Participants were given surveys prior to and following completion of a health education session. McNemar’s test was used to compare the proportion of participants with correct responses. The level of significance was taken as p < 0.05.ResultsCompared to pre-test values, post-test values showed that participants understood that SCD is hereditary (93.3% vs. 69.7%), both parents must have at least one gene for someone to have SCD (98.9% vs. 77.5) and blood test is the right way to know if one has SCD (98.8% vs. 78.7%). Also, a large proportion of participants (post-test ~ 89.9%; compared to pre-test ~ 23.6%) understood that the chance of conceiving a child with SCD was 25% for a couple with the sickle cell trait (SCT). Knowledge of the possibility of diagnosing SCD shortly after birth was highly increased in the post test phase of the study when compared to the pre-test phase (93.3% vs. 43.9%, respectively). Concerning the overall knowledge scores, those with high level of knowledge significantly increase from 12.6% pretest to 87.4% posttest (p = 0.015).ConclusionThe health education intervention was associated with significant improvement on almost all measures of SCD knowledge. Focused health education for pregnant women using community structures can improve knowledge of SCD and NBS.

Efficacy of mobile phone intervention to increase male partner antenatal care attendance for HIV testing in Moshi municipal, Tanzania: a randomized controlled trial

BackgroundHIV partner counselling and testing in antenatal care (ANC) is a crucial strategy to raise the number of males who know their HIV status. However, in many settings like Tanzania, male involvement in antenatal care remains low, and there is a definite need for innovative strategies to increase male partner involvement. This study was designed to evaluate the efficacy of mobile phone intervention increase male partner ANC attendance for HIV testing in Moshi municipal, Tanzania.MethodsBetween April and July 2022, we enrolled pregnant women presenting to a first ANC visit at Majengo and St. Joseph reproductive health facilities without their male partners. Eligible pregnant women were randomly assigned to invitation of their male partners either via phone calls, text messages from clinic staff and verbal invites from pregnant partners (intervention arm) or verbal invites only from the pregnant partners (control arm). Neither healthcare provider nor participant were blinded. The primary outcome was the proportion of male partners who attended ANC with their pregnant partners during a follow-up period of two consecutive visits. The secondary outcome measure was HIV testing among male partners following the invitation. Participants were analyzed as originally assigned (intention to treat).ResultsA total of 350 pregnant women presenting to ANC for the first time were enrolled, with 175 women enrolled in each arm. The efficacy of male attendance with their pregnant women following the invitations was 83.4% (147/175) in the intervention arm and 46.3% (81/175) in the control arm. Overall, the results suggest a positive and statistically significant average treatment effect among men who received mobile phone intervention on ANC attendance. For the secondary outcome, the percent of male partners who accepted HIV counselling and testing was 99.3% (146/147) in the intervention arm and 93.8% (76/81) in the control arm. Married men were having higher odds of ANC attendance compared with single men (aOR:6.40(3.26–12.56), Males with multigravida women were having lower odds of ANC attendance compared with primigravida women (aOR:0.17(0.09–0.33).ConclusionThe study demonstrates that supplementing verbal invitations with mobile phone calls and text messages from clinic staff can significantly increase male partner ANC attendance and HIV testing. This combined approach is recommended in improving ANC attendance and HIV testing of male partners who do not accompany their pregnant partners to antenatal clinics in the first visits.Trial registrationPACTR202209769991162.

Factors Affecting Pregnancy Complications in Ghana

ABSTRACT Introduction The prevalence of maternal mortality continues to be a significant health concern across the world. In Ghana, pregnancy-related complications in the previous 5 years account for 12% of all deaths among women 15 to 49 years. More than half of these deaths were avoidable if early assessment had been done. However, assessment of the pooled prevalence of pregnancy-related complications among pregnant women to inform policy is limited. This study sought to determine the factors contributing to pregnancy complications in Ghana. Methods: Using a systematic sampling technique, a facility-based cross-sectional study was conducted among 415 pregnant women who attended antenatal care (ANC) services at Mamprobi Hospital. Bivariate and multiple logistics regression analyses were conducted to test significant factors determining pregnancy complications. The results of regression analysis are reported in odds ratio. Statistical significance was set at p &amp;lt; 0.05. Results: The mean age of the participants was 31.6 ± 6.6 years. The incidence of pregnancy complications among the pregnant women was 51.8% (95% CI, 0.47–0.56) The incidence of pregnancy complications among the women was significantly determined by age (adjusted odds ratio [AOR], 6.1; CI, 1.19–30.76), record of pregnancy complication (AOR, 2.5; CI, 1.35–4.49), ANC visit (AOR, 6.1; CI, 2.14–17.70), and family history of pregnancy complication (AOR, 3.6; CI, 1.25–10.40). Other significant factors included a record of abortion (AOR, 7.8; CI, 4.21–14.32), knowledge about obstetric danger signs (AOR, 2.4; CI, 1.21–4.88), and experiencing at least one obstetric danger sign during pregnancy (AOR, 6.6; CI, 3.30–13.29). Conclusion: The incidence of pregnancy complications was comparatively high among the women who used ANC services at Mamprobi Hospital. Early initiation of ANC services for pregnant women is an essential tool for addressing some of the challenges of early onset of some pregnancy complications, including anemia in pregnancy and preeclampsia. Midwives and other health workers who engage pregnant women should encourage their clients to initiate ANC visits at an early stage.

Nexus between postpartum depression and exclusive breastfeeding practices among lactating mothers in Assosa Town, West Ethiopia.

Across the globe, breastfeeding stands out as a highly effective strategy for reducing infant and child morbidity and mortality. Concurrently, postpartum depression (PPD) emerges as a notable public health issue, adversely affecting both exclusive breastfeeding (EBF) practices for infants and the fulfillment of parenting roles. Despite the lack of substantial evidence in Ethiopia and the specific study areas, indicating the association between PPD and EBF practices, this study endeavors to fill this gap. The primary objective is to examine the correlation between PPD and EBF practices, along with exploring other pertinent factors, in Assosa Town, West Ethiopia. A community-based cross-sectional study was carried out from 7 March to 5 April 2019. The study involved the recruitment of 462 participants through a systematic random sampling method. Data collection was facilitated by conducting a structured and pre-tested questionnaire. To screen for PPD, we used the Edinburgh Postnatal Depression Scale (EPDS) tool. This tool, EPDS, was used solely as a screening tool and not for diagnostic purposes. The collected data were entered into Epi-Data version 3.1 and subsequently exported to SPSS version 24 for comprehensive statistical analysis. Bivariate and multivariate logistic regression analyses were performed to assess the association between independent variables and dependent variables. Odds ratios, along with their 95% confidence intervals (CIs), were calculated to ascertain the presence and strength of any associations. Statistical significance was acknowledged at a p-value of <0.05. The overall prevalence of EBF practices was found to be 58.2% (95% CI: 51.4-65.7), while the prevalence of PPD was 18.7% (95% CI: 15.94-26.7). Among mothers without PPD, the prevalence of EBF practices was notably higher at 62.4% (95% CI: 55.9-65.2%) compared to mothers experiencing PPD, where the prevalence was 31.3% (95% CI: 24.7-32.5%). Mothers who experienced PPD exhibited 51% reduced odds of practicing EBF compared to their counterparts (AOR = 0.49. 95% CI: 0.25-0.8). Furthermore, factors such as having a higher family monthly income (AOR = 8.7, 95% CI: 4.2-17.2), being multiparous (AOR = 5.8, 95% CI 4.9-10.8), attending antenatal care (ANC) visits (AOR = 4.9, 95% CI: 3.4-14.1), opting for vaginal delivery (AOR = 9.8, 95% CI: 5.6-17.4), and receiving husband's support (AOR = 5.3, 95% CI: 4.6-12.7) demonstrated a statistically significant positive association with EBF practices. In this study, a substantial number of mothers demonstrated suboptimal EBF practices during the first 6 months of their infants' lives. Consequently, the findings underscore a clear association between PPD and EBF. Thus, it is imperative to intensify efforts in the early detection and treatment of PPD, enhance household income, advocate for ANC, and encourage active husband involvement to bolster EBF practices.

Partner-Based HIV Treatment for Seroconcordant Couples Attending Antenatal and Postnatal Care in Rural Mozambique: A Cluster Randomized Controlled Trial.

There is evidence that a supportive male partner facilitates maternal HIV testing during pregnancy, increases maternal antiretroviral therapy initiation and adherence, and increases HIV-free infant survival. Most male partner engagement clinical strategies have focused on increasing uptake of couple-based HIV testing and counseling. We delivered a couple-based care and treatment intervention to improve antiretroviral therapy adherence in expectant couples living with HIV. We implemented a cluster randomized controlled trial for seroconcordant couples living with HIV, comparing retention (using a patient's medication possession ratio) in HIV care for a couple-based care and treatment intervention vs. standard of care services in rural Mozambique. The intervention included couple-based treatment, couple-based education and skills building, and couple-peer educator support. We recruited 1080 couples to participate in the study. Using a linear mixed effect model with a random effect for clinic, the intervention had no impact on the medication possession ratio among women at 12 months. However, the intervention increased men's medication ratio by 8.77%. Our unadjusted logistic regression model found the odds of an infant seroconverting in the intervention group was 30% less than in the control group, but the results were not statistically significant. Our study found no difference in maternal outcomes by study arm, but our intervention resulted in an improved medication possession ratio among male partners. We provide a community/clinic-based treatment framework that can improve outcomes among male partners. Further work needs to be done to improve social support for pregnant women and to facilitate prevention of vertical transmission to infants among couples living with HIV.

Leveraging Community Health Workers as a Novel Approach to Reduce Maternal Mortality: A Discourse Analysis

Maternal mortality remains unacceptably high, particularly in low and middle-income countries (LMICs), representing a critical challenge requiring novel approaches to reach underserved populations. Community health worker (CHW) programs have demonstrated potential to promote maternal health by enhancing health literacy, service utilization, and access to care. This study aimed to critically synthesize evidence on leveraging CHWs as an innovative strategy for reducing maternal deaths across LMICs. A review of empirical literature from 2000-2023 was conducted across major databases (PubMed, CINAHL, Embase). Quantitative, qualitative, mixed-methods and review studies reporting primary data on CHW program impacts related to maternal health in LMICs were included. Thematic synthesis was used to explore CHW roles, implementation factors affecting effectiveness, and impacts on drivers of maternal mortality. CHWs increased antenatal care attendance, facility-based deliveries, obstetric complication recognition/referrals, and postnatal follow-up—contributing to reductions in maternal mortality across contexts like Nepal, Ethiopia, and Malawi. However, optimizing impact required comprehensive training, logistical support, functional integration of CHWs into health systems, community participation mechanisms, and tailored incentive packages fostering motivation. Persistent implementation challenges included poor supervision, lack of supplies/transportation, fragmented referral coordination, and inadequate sustainable financing. On implications, there is the need for context-adapted program models underpinned by health system readiness and multistakeholder commitment to overcoming long-standing implementation barriers.

Prevalence of Steinert's Myotonic Dystrophy and Utilization of Healthcare Services: A Population-Based Cross-Sectional Study.

Myotonic dystrophy type I (MDI) is the most common muscular dystrophy in adults. The main objectives of this study were to determine the prevalence of MDI in the Community of Madrid (CM) (Spain) and to analyze the use of public healthcare services; a population-based cross-sectional descriptive study was carried out on patients with MDI in CM and data were obtained from a population-based registry (2010-2017). A total of 1101 patients were studied (49.1% women) with average age of 47.8 years; the prevalence of MDI was 14.4/100,000 inhabitants. In the women lineal regression model for hospital admissions, being in the fourth quartile of the deprivation index, was a risk factor (regression coef (rc): 0.80; 95%CI 0.25-1.37). In the overall multiple lineal regression model for primary health care (PHC) attendance, being a woman increased the probability of having a higher number of consultations (rc: 3.99; 95%CI: 3.95-5.04), as did being in the fourth quartile of the deprivation index (rc: 2.10; 95%CI: 0.58-3.63); having received influenza vaccines was a protective factor (rc: -0.46; 95%CI: -0.66-(-0.25)). The prevalence of MDI in the CM is high compared to other settings. Moreover, having any level of risk stratification of becoming ill (high, medium or low) has a positive association with increased PHC consultations and hospital admissions.

Determinants of respectful maternity care among women who gave childbirth in Southern Ethiopia.

Having a good provision of respectful maternity care (RMC) to a woman who gives childbirth is a crucial component of maternal health care to result in positive maternal and neonatal outcomes. Disrespect and lack of women-centered care in birth discourage a woman from seeking healthcare during childbirth contributing to poor healthcare-seeking behaviour and dissatisfaction with the maternity service. The current study aimed to assess key determinants of RMC during childbirth at selected public health facilities of the Gofa zone, Southern Ethiopia. A cross-sectional study design was conducted from March to April 2021 among 390 women who gave birth in eight randomly selected public health facilities of Gofa zone, Southern Ethiopia. The level of RMC was measured using structured exit interview items. A structured-interviewer-administered questionnaire was used to collect data and then entered into Epi-data version 4.6 and exported to SPSS version 25 for further analysis. Bivariate and multivariate logistic regression analyses were used to identify determinants of RMC among women. A total of 390 women responded to the exit interview making a response rate of 100%. The mean (± SD) age of the 390 women was 27.9 (± 4.85) years. The overall prevalence of women who received RMC was 40.5%, 95% CI (36-45%). Two hundred and ninety-seven (76.2%; n = 297/390) women had antenatal care (ANC) attendance in the index pregnancy. A woman who had planned pregnancy (AOR = 1.72, CI: 1.04, 2.85), planned to deliver in a health facility (AOR = 1.68, CI: 1.00, 2.81), presence of familial support (AOR = 2.04, CI: 1.20, 3.48), and had information about service availability (AOR = 4.44, CI: 2.09, 9.42) were associated with RMC among women. The provision of respectful maternity care in the study area was low when compared with local studies. Planned pregnancy, plan to deliver in a health facility, family support, and presence of information about service availability were factors associated with RMC among women. More attention should be given to training and supportive supervision of health care professionals on respectful maternity care and its standards to increase service uptake and make service more women-centred.

Mental Health among Preschool Children Social Anxiety Disorder among Preschool Children in Baghdad / Iraq

Background: Social anxiety (SA) is an intense fear of performing in front of people or other social situations in which the child may feel embarrassed, humiliated or the focus of more attention than he or she wants(1). Children who suffer from social anxiety usually fear from looking foolish or stupid in front of other children or adults(2). Children with social anxiety (SA) avoid social situations or may enter these situations with extreme anxiety, nervousness and stress(3).Social anxiety (SA) is different from shyness. Shy children may be uneasy and quiet around others, but they do not necessarily avoid social or public situations (4). Also, after a short period, shy children usually feel more comfortable while social anxiety disrupts a child’s life by making it difficult to deal with school, social relationships and public situation (5). Few publishing on preschool SA in Iraq. This was the impetus to carry out this work.&#x0D; Objective: Enhancement the attendance care of mental health of preschool children.

Plasmodium Parasitaemia and Urine Alterations among Pregnant Women Attending Antenatal Care in Aba Metropolis, Abia State, Nigeria.

Malaria presents a huge threat to pregnant women, their foetus, and children below five years. This study is aimed at assessing malaria prevalence, associated clinical symptoms, and urine abnormalities among pregnant women in Aba metropolis, Abia State, Nigeria. A cross-sectional study involving 450 pregnant women purposively selected from nine health care centres was conducted. Data were analysed using SPSS version 26. The overall malaria prevalence rate was 68.4% (n = 308). Age group of 21-25 years had the highest prevalence rate of 20.4% (n = 92) while the least was recorded among the age group of 41-45 years (17 (3.8%)). Pregnant women in their first trimester had the greatest prevalence rate of 28.6% (n = 129), and the least prevalence was recorded among those in their third trimester (7 (15.6%)). The primigravidae were mostly infected at the rate of 27.7% (n = 125) whereas the multigravidae recorded the least prevalence of 85 (18.9%). Participants with secondary education were the most susceptible at the rate of 38.6% (n = 174). The infected participants exhibited significantly higher frequencies of reported fever (p > 0.001, OR 12.881, 95% CI 3.977-41.725) and headaches (p < 0.001, OR 4.688, 95% CI 1.819-12.083). However, cold, cough, body pains, poor appetite, and catarrh showed no significant association with malaria infection at p > 0.05. Participants using long-lasting insecticidal nets (LLINs) showed significantly lower prevalence rate of malaria infection (p < 0.001, OR 2.485, 95% CI 1.619-3.814). Malaria-infected participants showed statistically significant frequencies of proteinuria (p < 0.001, OR 274.14, 95% CI 16.91-4444.0), bilirubinuria (p < 0.001, OR 49.29, 95% CI 11.01-186.34), and urobilinogenuria (p < 0.001, OR 65.16, 95% CI 4.00-1062.40) than those not infected. Ascorbic acid, nitrate, and ketone showed no significant associations with malaria infection at p > 0.005. Infected participants had statistically significant amber and clear urine colour whereas there was no statistically significant difference between the pH levels of urine of the malaria-infected and malaria-noninfected pregnant women.

Determinant Factors of Antenatal Clinic on Female Sex Workers Attendance within Nairobi County, Kenya

Globally antenatal care (ANC) initiation is at 58.6% but varies in different continents. Sub-Sahara has the lowest level of ANC care where women attend at least four times during pregnancy. Recent survey in Nairobi County found out that majority of women attends only one antenatal visit during pregnancy. The aim of the study was to explore determinants of antenatal clinic attendance among female sex workers in Nairobi County. A quantitative cross-sectional descriptive study among FSWs (18-49years) was carried out. Simple random sampling and self-administered questionnaires were used for data collection. Data analysis was done using descriptive and inferential statistics. The results show that 132 (32.8%) FSWs were aged 30 to 34 years, 242 (60.0%) were not married. 346 (85.9%) had unplanned pregnancy. Late ANC initiation was due to 42.4% (171) attitude of HCWs, 67.6% (215) distance to the healthcare facility and 86.1% (347) longer waiting time. On inferential analysis, there was an association between occupation of respondent vs number of ANC attendance which was significant = 22.525, df 12, P = 0.032 at P &lt; 0.05. Marital of respondent vs number of ANC attendance was significant =29.058, df 15, P=0.016 at P&lt;0.05. The income level of respondents vs number of antenatal care visits was significant =17.557, df 6, P=0.007 at P&lt;0.05. Thus, pregnant FSWs face discrimination during ANC visits. These research findings will form a basis for future studies as well as guide the Ministry of Health and other stakeholders to develop policies that will guide ANC services among FSWs. Outreach programs on ANC among FSWs should be implemented and there should ANC services that only target FSWs.

Level of and factors associated with optimal uptake of intermittent preventive treatment for malaria in pregnancy at private-not-for-profit health facilities in Kasese district.

Malaria in pregnancy poses a high risk of poor maternal and neonatal outcomes and WHO recommends IPTp. However, its uptake has remained sub-optimal among mothers who attend antenatal care at private-not-for-profit health facilities. This study determined the level of and factors associated with uptake Intermittent preventive treatment of malaria for pregnant women (IPTp) at private-not-for-profit (PNFP) health facilities in Kasese District, Uganda. This was a cross-sectional study involving 396 postpartum mothers in the postnatal wards of 8 PNFP health facilities in Kasese district was conducted in September 2022. One hospital and 2 Health Centre IVs were purposively selected and 5 Health Centre IIIs selected randomly. Mothers were consecutively selected and interviewer administered semi-structured questionnaires were used to collect the data. Data were entered in epi-data version 3.1, cleaned and analyzed using STATA version 14. Data were adjusted for clustering & modified poison regression was used to determine associations of the factors and the outcome. From the analysis, level of optimal uptake of IPTp was 51.5% CI = (46.6-56.4). Being married (aPR = 1.35, 95% CI = 1.06-1.7, p = 0.014), attending ANC more than 4 Visits (aPR = 1.29, 95%CI = 1.09-1.54, p<0.001) positively influence optimal uptake while not taking IPTp at recommended time intervals (aPR = 0.49, 95%CI = 0.39-0.62 p<0.001) and mothers paying for IPTp drugs themselves (aPR = 0.74, 95%CI = 0.57-0.97, p = 0.031) negatively influence optimal uptake. This moderate uptake of IPTp among pregnant mothers suggests insufficient protection of pregnant mothers against malaria. Efforts to improve Antenatal care attendance, taking IPTp at recommended time intervals, not paying for ITPp drugs and encouraging marriages should be intensified.

Seroprevalence of Syphilis among Pregnant Women Attending Antenatal Care in Yaqshiid District, Mogadishu, Somalia

Background: The prevalence of syphilis among pregnant women in Somalia has been poorly studied, despite its significant impact on maternal and fetal health. In Somalia, the last syphilis study was conducted approximately 30 years ago, leaving a critical knowledge gap regarding the current epidemic of syphilis among pregnant women. Materials and methods: From January 2023 to April 2023, a hospital-based cross-sectional study was conducted on maternal and child health. A total of 300 pregnant women were included in the study, and the seroprevalence of syphilis was determined using the Venereal Disease Research Laboratory. This one-step quick diagnostic test cassette was used as the preliminary screening tool, and Positive results were confirmed using the full chemiluminescence immunoassay (CLIA) analyzer MAGLUMI. A structured questionnaire was used to collect demographic characteristics and knowledge regarding syphilis transmission and mother-to-child transmission. SPSS Version 27.0 was used to analyze the gathered data. Statistical significance was set at p &lt; 0.05. Results: Overall, 5.3% (16/300) of pregnant women had syphilis seroprevalence. Seroprevalence rates were higher in women aged 24-34 (50.0%). There were significant relationships between syphilis infection and education (p &lt; 0.000), occupation (p &lt; 0.000), and residence (p = 0.002). Furthermore, a significant majority of pregnant women (78%) were unaware of syphilis transmission routes and its correlation to HIV risk (81.7%). Stillbirths constituted 23.3% of pregnancy-related problems, whereas 17% of pregnant women had a prior record of blood transfusions. Conclusions: The study found an alarming syphilis seroprevalence in pregnant women, especially in certain demographic groups. The lack of knowledge of syphilis transmission and its effects highlights the necessity for targeted education. Improved prenatal care, health awareness, and effective prevention should lessen the effects of syphilis on mother and newborn health.

Evaluation of the feasibility, acceptability, and impact of Group Antenatal Care at the health post level on continuation in antenatal care and facility based delivery in Ethiopia using a cluster randomized stepped-wedge design: Study protocol

Background Adequate antenatal care (ANC) and facility-based delivery are linked to improved maternal and neonatal outcomes. Adequate antenatal care attendance and facility birth rates are increasing in Ethiopia but remain well below national goals and global recommendations. Group ANC (G-ANC), when implemented at higher level facilities, is associated with improved quality and experience of ANC, and increased ANC retention and facility-based delivery. The objectives of the study are to assess the feasibility, acceptability, and impact of G-ANC implemented at lower-level facilities (health posts) on ANC continuation and facility-based delivery. Methods G-ANC will first be piloted in five purposively selected health posts. The study will then use a stepped-wedge design in 36 health posts under six health centers, with randomization of the order of the start of the intervention done at the health center level (clusters). The design will include three time periods: first is a six-month control period with no G-ANC implementation, followed by another six months period where G-ANC will be introduced in half (n=18) of the study health posts, then final six months where G-ANC will be implemented in the remaining 18 health posts. Quantitative and qualitative data collection approaches will be used. The study has “pause and reflect” points designed to iterate on the intervention before rolling out to the next set of sites. Qualitative research will be conducted using in-depth interviews with pregnant women, health care workers, facility managers, and regional health managers. 770 women will be enrolled across all phases. Conclusions The study will inform decision makers locally and globally on whether G-ANC is a feasible service delivery model at the health post level. Effectiveness of G-ANC at increasing ANC retention and facility-based delivery will be reported, as well as its acceptability to pregnant women and Health Extension Workers. Registration NCT05054491, ClinicalTrials.gov (September 23rd 2021).