Antenatal Care Coverage Research Articles

Validation of maternal report of nutrition-related interventions and counselling during antenatal care in southern Nepal.

The delivery of nutrition‐related interventions and counselling during antenatal care is critical for a healthy pregnancy for both mother and child. However, the accuracy of maternal reports of many of these services during household surveys has not yet been examined. Our objectives were to assess the validity of the maternal reports of 10 antenatal nutrition interventions, including counselling, and examine associates between maternal characteristics and accuracy. Maternal report of services received collected during a post‐partum survey was compared to the gold standard, the direct observation of all women's antenatal care visits. Individual‐level validity was assessed by calculating indicator sensitivity, specificity and area under the operating curve (AUC). The inflation factor (IF) measured population‐level bias. For five indicators, the high true coverage limited our ability to assess the validity of the maternal reports. There were no indicators that had both high individual‐level validity (AUC > 0.70) and low population bias (0.75 < IF < 1.25). Indicators with greater true coverage estimates had higher sensitivity and lower specificity estimates compared to those indicators with lower true coverage. There were no maternal characteristics associated with the accuracy of the report. Maternal report of antenatal nutrition‐related interventions and counselling during household surveys was found to have variable validity across indicators. Additional research in settings with varying coverage levels should be considered to best inform antenatal care coverage measurement in household surveys.

Level of exclusive breastfeeding and its enabling factors among lactating women who delivered in health facilities of Asosa town, Ethiopia: a cross sectional study

BackgroundDespite the enormous benefit of exclusive breastfeeding (EBF) to mothers and infants, the practice of exclusive breastfeeding is globally low. In sub-Saharan Africa and Ethiopia, the prevalence of EBF stands at 35% and 59%, respectively. The low EBF practice in Ethiopia as well as in the studied region calls for further study and thus we studied the EBF practice in the study area since little is known about its current magnitude and factors influencing its practice for some programmatic improvements.MethodsA facility based cross-sectional study linked to a community was conducted from June-July 2019 among 412 mothers who had antenatal follow-up and delivered in health facilities of Asosa town over a period of one year prior to the study. Data on socio demographic characteristics and other important variables were collected through face to face interview while gestational age in weeks was recorded from their medical chart by trained health extension workers in accordance with relevant ethical guidelines and regulations. The collected data were then cleaned and entered into Epi-data software version 3.02. Analysis was done by SPSS version 20. Binary and multivariate logistic regression were performed to identify the contributing factors. P-value of less than 0.05 and 95% confidence interval was considered to determine statistical significance.ResultsOf the 412 respondents, the majority (88.1%) were multi-gravida and above. Slightly higher than a quarter (26.0%) and over half (55.4%) had neither received antenatal nor postnatal care. The proportion of mothers who exclusively breastfed their children was 76.0% and the overall aggregated good practice of EBF score was 64.1%. Mothers who completed primary school [AOR = 4.5; 95% CI = 1.1,18.2], had four or more ANC [AOR = 1.8;95CI = 0.79–0.98], and postnatal follow-up [AOR = 0.21;95% CI = 0.07–0.67], and had male infants [AOR = 2.3; 95% CI = 1.0–4.95] were among the factors influencing the exclusive breastfeeding practice score.ConclusionWhile three in four mothers exclusively breastfed their newborns and about two-thirds had good EBF score, the observed women’s retention on the continuum of the maternal care pathway is low with one in four had no antenatal and over half had no postnatal care which are important derivers for EBF practice. To improve the EBF score and narrow the observed maternal and child health disparities, it is essential to promote maternal education and increase the recomended coverage of antenatal and postnatal care for mothers.

Predictors of wealth-related inequality in institutional delivery: a decomposition analysis using Nepal multiple Indicator cluster survey (MICS) 2019

BackgroundInequality in maternal healthcare use is a major concern for low-and middle-income countries (LMICs). Maternal health indicators at the national level have markedly improved in the last couple of decades in Nepal. However, the progress is not uniform across different population sub-groups. This study aims to identify the determinants of institutional delivery, measure wealth-related inequality, and examine the key components that explain the inequality.MethodsMost recent nationally representative Multiple Indicator Cluster Survey (MICS) 2019 was used to extract data about married women (15-49 years) with a live birth within two years preceding the survey. Logistic regression models were employed to assess the association of independent variables with the institutional delivery. The concentration curve (CC) and concentration index (CIX) were used to analyze the inequality in institutional delivery. Wealth index scores were used as a socio-economic variable to rank households. Decomposition was performed to identify the determinants that explain socio-economic inequality.ResultsThe socio-economic status of households to which women belong was a significant predictor of institutional delivery, along with age, parity, four or more ANC visits, education status of women, area of residence, sex of household head, religious belief, and province. The concentration curve was below the line of equality and the relative concentration index (CIX) was 0.097 (p < 0.001), meaning the institutional delivery was disproportionately higher among women from wealthy groups. The decomposition analysis showed the following variables as the most significant contributor to the inequality: wealth status of women (53.20%), education of women (17.02%), residence (8.64%) and ANC visit (6.84%).ConclusionsTo reduce the existing socio-economic inequality in institutional delivery, health policies and strategies should focus more on poorest and poor quintiles of the population. The strategies should also focus on raising the education level of women especially from the rural and relatively backward province (Province 2). Increasing antenatal care (ANC) coverage through outreach campaigns is likely to increase facility-based delivery and decrease inequality. Monitoring of healthcare indicators at different sub-population levels (for example wealth, residence, province) is key to ensure equitable improvement in health status and achieve universal health coverage (UHC).

Factors associated with the timely initiation of antenatal care: findings from a cross-sectional study in Northern Bangladesh

ObjectiveThis paper explored the factors that influence the timely initiation of antenatal care (ANC) in Bangladesh.DesignThis was a cross-sectional survey.SettingThis study conducted in two rural subdistricts and one urban area...

Gaps in the implementation and uptake of maternal nutrition interventions in antenatal care services in Bangladesh, Burkina Faso, Ethiopia and India.

Antenatal care (ANC) is the largest health platform globally for delivering maternal nutrition interventions (MNIs) to pregnant women. Yet, large missed opportunities remain in nutrition service delivery. This paper examines how well evidence‐based MNIs were incorporated in national policies and programs in Bangladesh, Burkina Faso, Ethiopia and India. We compared the nutrition content of ANC protocols against global recommendations. We used survey data to elucidate the coverage of micronutrient supplementation, weight gain monitoring, dietary and breastfeeding counselling. We reviewed literature, formative research and program assessments to identify barriers and enabling factors of service provision and maternal nutrition practices. Nutrition information in national policies and protocols was often fragmented, incomplete and did not consistently follow global recommendations. Nationally representative data on MNIs in ANC was inadequate, except for iron and folic acid supplementation. Coverage data from subnational surveys showed similar patterns of strengths and weaknesses. MNI coverage was consistently lower than ANC coverage with the lowest coverage of weight gain monitoring and variable coverage of dietary and breastfeeding counselling. Key common factors associated with coverage were micronutrient supply disruptions; suboptimal counselling on maternal diet, weight gain, and breastfeeding; and limited or no record keeping. Adherence of women to micronutrient supplementation and dietary recommendations was low and associated with late and too few ANC contacts, poor maternal knowledge and self‐efficacy, and insufficient family and community support. Models of comprehensive nutrition protocols and health systems that deliver maternal nutrition services in ANC are urgently needed along with national data systems to track progress.

Beyond COVID-19: Prospect of telemedicine for obstetrics patients in Pakistan

ObjectiveTo explore obstetrics patients' experiences with telemedicine during COVID-19 and assess their intent for its future use. DesignAn exploratory design was applied considering that telemedicine was a new phenomenon in Pakistan particularly for antenatal care services during COVID-19. MethodPrimary data was collected through a telephonic survey of 132 respondents randomly selected from the pool of obstetrics patients who used telemedicine services of Shifa International Hospital (SIH) in Islamabad, Pakistan during the pandemic. We changed the survey tool of Medical Group Management Association to the study purpose. Required information included the respondents’ socioeconomic and antenatal characteristics and their telemedicine use experience on four parameters, namely, Appointment, Staff Attitude, Communication, and Telemedicine Services. Patients were inquired about their intent to use telemedicine beyond COVID-19 and the reasons supporting their answer. The data was analyzed descriptively and through t-test mean comparisons and binary logistic regression. ResultsMajority (54%) intend to use telemedicine in future. Average age of respondents was 30 years with gravidity 2.36, parity 1.40 and gestational amenorrhea 27.3 weeks. The respondents average schooling was 9.5 years, marriage duration was 4.5 years and monthly household income was PKR ∼83,000. However, the overall experience of those who were confident in future use of telemedicine was 0.677 points higher and significantly different than those who were not inclined to use it in future. Of those lacking interest in future use of telemedicine, nearly two-third felt in-person visit was more satisfying, 11% needed physical examination, ∼6% experienced long waiting time, 5% each had inadequate access to ICT and online payment facilities, and 6% faced other issues such as excess payments. The binary logistic regression analysis (R2 37.3%) held Medical Consultations and Communications as the most important determinants and could predict nearly two-fifth of variation in respondents’ intent for future use of telemedicine. ConclusionUptake of telemedicine for obstetrics patients is one of the positive externalities of COVID-19 and may appear as a cost-effective and culturally acceptable way to ensure universal coverage of antenatal care in Pakistan. However, telemedicine’s future beyond COVID-19 for obstetrics hinges upon improving users’ experience primarily through consultant and staff trainings and provision of effective communication e.g., in regional languages. Besides, offering physical examination facility and ability to use mobile wallet payment solutions may motivate future use of telemedicine in obstetrics.

Trends of maternal health service coverage in the Democratic Republic of the Congo: a pooled cross-sectional study of MICS 2010 to 2018

BackgroundMaternal health services are essential for reducing maternal and newborn mortality. However, maternal health service status in the Democratic Republic of the Congo (DRC) remains poorly understood. This study aims to explore the trends of antenatal care (ANC) and skilled birth attendance coverage in the past decade in the DRC.Methods The 13,361 participants were from two rounds of Multiple Indicators Cluster Survey (MICS) conducted by the National Institute of Statistics of the Ministry of Planning of the DRC, in collaboration with the United Nations Children’s Fund (UNICEF), in 2010 and 2017-2018. A regression-based method was adopted to calculate adjusted coverage of ANC and skilled birth attendance. Subgroup analysis based on different socioeconomic status (SES) was conducted to explore the impact of domestic conflicts.ResultsFrom 2010 to 2018, the overall weighted ANC coverage in the DRC declined from 87.3 % (95 % CI 86.1–88.0 %) to 82.4 % (95 % CI 81.1–84.0 %), while the overall weighted skilled birth attendance coverage increased from 74.2 % (95 % CI 72.5–76.0 %) to 85.2 % (95 % CI 84.1–86.0 %). Adjusted ANC coverage and adjusted skilled birth attendant coverage both declined in Kasai Oriental, but increased in Nord Kivu and Sud Kivu. In Kasai Occidental, ANC coverage declined, but skilled birth coverage increased. In the Kasai region, the largest decline in adjusted coverage of ANC was found among the poorest women. However, in the Kivu region, both the adjusted coverage of ANC and skilled birth attendance increased among the poorest women.ConclusionsDue to ongoing conflicts, there has been a systemic deterioration of maternal healthcare coverage in some regions of the DRC, particularly among people with low SES. However, in other regions, maternal healthcare services were not severely disrupted possibly due to substantial international health assistance.

Antenatal care access and concerns of pregnant women during pandemic: a population-based study

BackgroundThe COVID-19 pandemic continues to burden the health of vulnerable populations such as pregnant women. It has been estimated that antenatal care coverage has been decreased with workforce, supplies, demand, and access reductions during the outbreak in some countries. The study aimed to investigate the health care access and concerns of pregnant women during the pandemic.MethodsThis cross-sectional study was conducted among 331 pregnant women in one district of Istanbul (Üsküdar) and a random sampling method was applied. The data was collected between November 22nd and December 18th 2020 by telephone interview after verbal consents were taken from the participants. Chi-square and multiple logistic regression analyses were performed. The study was approved by the Bahcesehir University Institutional Ethics Board.ResultsThe median age of the participants was 30 years, the median gestational age was 24 weeks. Among the participants 9.6% were previously diagnosed with COVID-19, 15.8% had a chronic disease, 48.2% were nulliparous and 18.6% had a high-risk pregnancy. The frequency of having concern for their own health was 70.7%, for their children's health was 73,0%, for going to visits in healthcare facilities was 81.0% and for giving birth during the pandemic was 83.0%. Also, 17.1% did not go to antenatal visits because of the COVID-19 concerns. According to the logistic regression analysis, women who had chronic disease had higher concerns about their own health; women who had chosen to go to hospitals for antenatal care visits had higher concerns about children's health and giving birth, and women who had concerns about going to health facilities during the COVID-19 pandemic were less likely to go to family health centers.ConclusionsOur results suggest that the concerns related to the pandemic among pregnant women are at significant levels. Measures should be taken to ensure that antenatal care services are not interrupted throughout the current pandemic.Key messages Significant concern levels were detected among pregnant women in our sample.Measures should be taken to ensure to maintain uninterrupted antenatal care services.

Quality of antenatal care and its sociodemographic determinants: results of the 2015 Pelotas birth cohort, Brazil

BackgroundInadequate antenatal care (ANC) has been associated with adverse pregnancy outcomes. ANC quality is considered a key component of the right to health and a route to equity and dignity for women and their children. Although ANC coverage is relatively high in Brazil, there are revealed some health disparities when coverage is examined by socio-demographic determinants. In this study we evaluated ANC quality and its socio-demographic determinants using data from the 2015 Pelotas birth cohort, Rio Grande do Sul, Brazil.MethodsThis study is part of the 2015 Pelotas population-based birth cohort (n = 3923 pregnant women) conducted in southern Brazil. ANC quality was assessed through 19 content and service utilization indicators recommended by the Brazilian Ministry of Health. Descriptive analyses and associations of each of the ANC indicators and independent variables were performed using the chi-square and linear trend test. ANC indicators were analyzed individually and aggregated as a score. Associations between ANC score quality and socio-demographic variables were assessed with ordinal regressions. Mediation analysis with G-computation was performed to estimate direct and indirect effect of mother’s level of education on ANC quality mediated by the number of consultations and timing of ANC initiation. Base and post confounders were included.ResultsThe results showed that except for breast examination, height measurement, tetanus toxoid vaccination and ANC starting at the first trimester, all ANC indicators showed more than 80% coverage during ANC visits.In the adjusted analysis, inadequate quality ANC was associated with lower maternal education level, not having a partner, being multiparous, being attended by a private provider and by the same professional in all consultations. In the mediation analyses, 6.8% of the association between ANC quality and mother’s education was mediated by the trimester in which ANC started, while 12.8% was mediated by the number of ANC visits.ConclusionsANC quality is associated with pregnant women’s socio-demographic characteristics. Significant efforts are needed to improve the quality of facility-based maternity care.

Impact of antenatal care visits on childhood immunization: a propensity score-matched analysis using nationally representative survey.

Evidence has suggested a relationship between antenatal care (ANC) visits and childhood immunization coverage. However, evaluating its impact using observational data suffers from the problem of selection bias. Hence, we adopted propensity score-matched (PSM) analysis for studying the impact of ANC visits on childhood immunization. Data regarding ANC visits and childhood immunization were collected from a nationally representative survey, National Family Health Survey-4 (NFHS-4). We performed PSM analysis with logit model using the psmatch2 command package in STATA to find the average treatment effect on the population (ATE), treated (ATT), and untreated (ATU). In total, 5,430 participants were included in the analysis. Radius matching with caliper width of 0.01 was used to match the groups. The ATT values in the intervention and control groups were 0.71 and 0.47, respectively, indicating that the immunization coverage was increased by 24% because of ANC visits. The ATU values in the intervention and control groups were 0.40 and 0.65, respectively. This indicates that for the women who did not make the ANC visits, the chance of getting their children immunized would have increased by 25% if they had made four or more visits. The final ATE estimate was 0.25 among the study participants. Quality of matching was good with no significant difference in characteristics between the two groups. Findings from our study imply that policymakers in India should focus on further improving the ANC coverage as it has a significant impact on improving childhood immunization coverage.

Noncompliance with the WHO's Recommended Eight Antenatal Care Visits among Pregnant Women in Sub-Saharan Africa: A Multilevel Analysis.

Background In 2016, the World Health Organization (WHO) introduced a minimum of eight antenatal care (ANC) visits for positive pregnancy outcomes. This study examined the prevalence of noncompliance with 8+ ANCvisits and its associated factors in sub-Saharan Africa (SSA). Methods We used data from the Demographic and Health Surveys of eight countries in SSA. A pooled sample of 63,266 pregnant women aged 15-49 years who had given birth to children within 5 years prior to the surveys was included in this study. To examine the factors associated with noncompliance with ANC 8+ visits, multilevel binary logistic regression analysis was conducted, and the results were reported using odds radios at 95% confidence interval (CI). Results The pooled prevalence of noncompliance with ANC 8+ visits was 92.3% (95% CI: 91.1%-93.3%) with the highest and lowest prevalence in Zambia (98.7%, 95% CI: 98.3%-99.1%) and Libya (73.4%, 95% CI: 70.4%-76.2%), respectively. With the individual level factors, women's age (44-49 years-aOR = 0.33, 9% CI: 0.14-0.78), health insurance registration, (yes-aOR = 0.53, 95% CI: 0.29-0.98), and economic status (richest-aOR = 0.16, 95% CI: 0.05-0.49) were negatively associated with noncompliance with 8+ ANC visits, while parity (five or more children-aOR = 1.68, 95% CI: 1.12-2.52) was positively associated with noncompliance with 8+ ANC visit. With the community level factors, community level literacy was negatively associated with noncompliance with 8+ ANC visit (high-aOR = 0.56, 95% CI: 0.32-0.99). Conclusion About eight out of ten pregnant women did not comply with the WHO's recommended minimum of eight ANC visits for positive pregnancy outcomes in SSA. Empowering the economic status of women , enhancing health insurance and education coverage, and giving more attention to young pregnant women and those with more children are crucial for improving the coverage of ANC 8+ visits in the region.

Magnitude, trends and determinants of skilled delivery from Kilite-Awlaelo Health Demographic Surveillance System, Northern Ethiopia, 2009- 2017.

The fundamental approach to improve maternal and neonatal health is increasing skilled delivery rate. Women giving birth at health institutions can prevent maternal and neonatal deaths by getting skilled birth attendance. In Ethiopia, despite a significant decrease in maternal mortality over the past decade, still a significant number of women give birth at home. Moreover, evidence from population-based longitudinal studies on skilled delivery is limited. Therefore, this study aims to investigate the magnitude, trend, and determinants of skilled delivery in Kilite-Awlaelo Health Demographic Surveillance System (KA-HDSS), Northern Ethiopia. Population-based longitudinal study design was conducted by extracting data for nine consecutive years (2009-2017) from KA-HDSS database. In order to measure the trends of skilled delivery, KA-HDSS data sets were analyzed (2009-2017). Bivariate and multivariate analyses were performed using STATA version 16. A multivariable binary logistic regression model was fitted to assess determinants of skilled delivery and odds ratio with 95% CI was used to assess presence of associations at a 0.05 level of significance. The skilled delivery rate have continuously increased among reproductive age women from 15.12% (95% CI: 13.30% - 17.09%) in 2010 to 95.85% (95% CI: 94.58% - 96.895%) in 2017. The skilled delivery rate becomes high (> = 82) in the period of 2014-2017. Education, residence, marital status, occupation and antenatal care (ANC) visits were the most important determinants for skilled delivery among reproductive age women during the period of high skilled delivery rate (2014-2017). Women urban dwellers had about 28 times (AOR = 27.66; 95% CI: 3.86-196.97) higher odds to deliver by skilled birth attendants than rural dwellers. Unmarried women who gave birth were 2.18 (AOR: 2.18; 95% CI: 1.30-3.64) times more likely to have skilled delivery service compared to those married. Likewise, women with four or more ANC visits were 3.2 times more likely to undergo skilled delivery service than those having no ANC visits (AOR: 3.16; 95% CI: 2.33-4.28). Moreover, women having at least a secondary education were 2 times more likely to have skilled delivery service compared to those women with no formal education (AOR = 2.10, 95% CI: 1.18-3.74). Regardless of the importance of health facility delivery, a significant number of women still deliver at home attended by unskilled birth attendants. There has been a substantial increase in use of health facilities for delivery among women in the reproductive age. The factors affecting skilled delivery among reproductive age women were educational level, residence, marital status, occupation and use of ANC service. Maternal health related interventions are needed to change women's attitudes towards skilled delivery. Moreover, ANC coverage should be increased to improve skilled delivery service.

980Quantifying inadvertent data-duplication- findings from validation of antenatal-registration and HIV-testing data-sets from an Indian state

Abstract Background India plans elimination of HIV-Mother-to-Child-Transmission in 2020. Targets include &amp;gt;95% coverage of Antenatal-care (ANC) and HIV-testing. In 2015-16, while 43% of the estimated Indian pregnant-women (PW) received HIV-tests, one state reported &amp;gt;95% testing. Indian public-health-care is a three-tiered system from primary-level sub-centres (population-5000) to tertiary-level hospitals. ANC involves multiple-visits per pregnancy at different care-levels and data are aggregated in the Health-Management-Information-System (HMIS) at all levels. We validated (public and private-sector data from this state, for duplication in ANC registration and HIV-testing using mixed methods. Methods In the absence of guidelines for assessing aggregate-data duplication, we used mixed-methods, including surveys among 9845 PW and providers from 240 facilities in 10/36 representative districts; in-depth-interviews; case-studies and analysis of HMIS and HIV-program data (April 2015-Mar 2017). Interviews and case-studies highlighted inadvertent duplicate data-capture. Surveys quantified levels of duplication and adjustment factors (public and private-sector) were developed. Results Twenty-four% PW, visited multiple facilities for ANC, while 81% providers reported all the PW coming to their facilities as new ANC registrations (irrespective of lower-tier registration); identifying a minimum duplication of 19% (24%*81%) in ANC coverage. Twenty-nine% and 28% PW from public and private-facilities reported &amp;gt;1 HIV-test; while 75% and 36% reported visiting another public-facility where HIV test was likely to be reported again. Minimum duplication of 22% and 10% in HIV testing was noted in public and private-sectors respectively. Conclusions We report methods to quantify repeat HIV-testing and duplicate-reporting, due to inherent processes in ANC in public-healthcare in India. Modification of data-capture was recommended and adopted across India. Key messages Assessing duplication in aggregate health data is key to developing robust datasets for disease elimination

THE RELATIONSHIP BETWEEN MATERNAL AND CHILD HEALTH SERVICES WITH THE PREVALENCE OF STUNTING BASED ON THE BASIC HEALTH RESEARCH IN INDONESIA

ABSTRACTStunting is a linear growth disorder considered as a serious health problem in Indonesia, where its prevalence is related to maternal and child health (MCH) services. This study aimed to compare the coverage of maternal and child health services between two surveys and analyze how they relate to the prevalence of stunting. The study used aggregate data from the 2013 and 2018 Basic Health Research Reports using a cross-sectional approach. The research sample spanned to 34 provinces in Indonesia. Stunting prevalence was taken as aggregate data from individuals based on height-for-age z-scores (HAZ). The independent variable was the achievement of MCH service indicators. Data analysis used variance measures, correlations, simple linear regression, and paired T-tests. The results found variations in the prevalence of stunting, with 25.4% in 2013 and 25.1% in 2018. There was a 7.4% decrease in severe stunting prevalence between 2013 and 2018, but the decrease was not significant (p = 0.506). The analysis results of the 2013 Basic Health Research showed that MCH service indicators related to stunting prevalence were coverage of antenatal care, iron consumption, delivery by health personnel, delivery in health facilities, postpartum maternal health services, low birth weight (LBW) prevalence, neonatal examination, complete immunization, health card ownership, and growth monitoring. The analysis results of the 2018 Basic Health Research showed that MCH indicators were related to the prevalence of antenatal care coverage, delivery by health personnel, and delivery in health facilities, postpartum maternal health services, LBW prevalence, neonatal examination, and complete immunization. There was a significant increase in the coverage of MCH services from 2013 and 2018 (p &lt; 0.0001), except for the coverage of Fe tablet consumption, the prevalence of stunted birth babies, ownership of health cards, provision of vitamin A, and provision of colostrum. The better the coverage of MCH services, the lower the stunting prevalence. Efforts to improve the MCH service programs are required to reduce the prevalence of stunting for Indonesian children. Keywords: stunting, children under five years old, coverage of maternal and child health services

Mix Method Analysis of Factors Affecting Implementation of Antenatal Care (ANC) in Pregnant Women in the Work Area of the Medan Deli Health Center, Medan Deli District, Medan

workers which includes physical and mental health to get mothers and babies who are healthy during pregnancy, childbirth and postpartum. Data from the Medan Deli Health Center shows that in 2019 the K1 coverage is only (87%) and K4 only (66%), while the target of K1 and K4 coverage is 100% respectively. Many factors are thought to be the cause of not achieving coverage of antenatal care (ANC) implementation. The purpose of this study was to analyze the factors that influence the implementation of ANC in pregnant women. This type of research is a mix method with quantitative and qualitative approaches. The study population was 195 people, with the Slovin formula taken a sample of 66 people. Quantitative analysis was univariate, bivariate using chi-square and multivariate using multiple logistic regression at the 95% confidence level ( = 0.05). The qualitative analysis was analyzed by means of reduction, data display and verification. The results showed the variables that influenced the implementation of antenatal care (ANC) in pregnant women in the work area of ​​the Medan Deli Public Health Center in 2020, namely knowledge p = 0.032, attitude p = 0.018, parity p = 0.008, health services p = 0.016, husband support p = 0.026 and support for health workers p = 0.041. The unrelated variable was job status p = 0.269. The most dominant variable was the health service variable which had a value of Exp (B) = 12.048, meaning that respondents who received health services had 12 times the chance of implementing antenatal care compared to respondents who did not get health services. The conclusion of this research is that the implementation of antenatal care in pregnant women is influenced by knowledge, attitudes, parity, health services, husband support and support from health workers. It is hoped that health workers, especially midwives, will provide good IEC about the implementation of antenatal care to every pregnant woman and carry out more frequent home visit activities and provide advice to the puskesmas to re-attach the standby husband and cooperate with local regional leaders

Individual and context correlates of the oral pill and condom use among Brazilian female adolescents

BackgroundStudies have examined the impact of contextual factors on the use of contraceptives among adolescents and found that many measures of income and social inequality are associated with contraceptive use. However, few have focused on maternal and primary health indicators and its influence on adolescent contraceptive use. This paper assesses whether maternal mortality rates, antenatal care visits, and primary healthcare coverage are associated with pill and condom use among female adolescents in Brazil.MethodsWe used data from the Study of Cardiovascular Risks in Adolescents (ERICA), a national, school-based cross-sectional study conducted in Brazil. A subsample of all female adolescents who had ever had sexual intercourse and were living in one of the 26 State capitals and the Federal District was selected (n = 7415). Multilevel mixed effects logistic regression models were estimated to examine the effect of contextual variables on pill and condom use.ResultsSixty-five percent of female adolescents reported using pill while 21.9% reported using condom during the last sexual intercourse. Adolescents living in municipalities with low maternal mortality and high antenatal care coverage were significantly more likely to use pill during the last sexual intercourse compared to those from municipalities with high maternal mortality and low antenatal care coverage. Primary healthcare coverage (proportion of the population covered by primary healthcare teams) was not significantly associated with either condom or pill use during the last sexual intercourse.ConclusionOur findings suggest that promoting the use of pill among female adolescents may require approaches to strengthen healthcare systems rather than those focused solely on individual attributes.

Coverage of antenatal, intrapartum, and newborn care in 104 districts of Ethiopia: A before and after study four years after the launch of the national Community-Based Newborn Care programme.

Access to health services across the continuum of care improves maternal and newborn health outcomes. Ethiopia launched the Community-Based Newborn Care programme in 2013 to increase the coverage of antenatal care, institutional delivery, postnatal care and newborn care. The programme also introduced gentamicin and amoxicillin treatment by health extension workers for young infants with possible serious bacterial infection when referral was not possible. This study aimed to assess the extent to which the coverage of health services for mothers and their young infants increased after the initiation of the programme. A baseline survey was conducted in October-December 2013 and a follow-up survey four years later in November-December 2017. At baseline, 10,224 households and 1,016 women who had a live birth in the 3-15 months prior to the survey were included. In the follow-up survey, 10,270 households and 1,057 women with a recent live birth were included. Women were asked about their experience of care during pregnancy, delivery and postpartum periods, as well as the treatment provided for their child's illness in the first 59 days of life. Between baseline and follow-up surveys the proportion of women reporting at least one antenatal care visit increased by 15 percentage points (95% CI: 10,19), four or more antenatal care visits increased by 17 percentage points (95%CI: 13,22), and institutional delivery increased by 40 percentage points (95% CI: 35,44). In contrast, the proportion of newborns with a postnatal care visit within 48 hours of birth decreased by 6 percentage points (95% CI: -10, -3) for home deliveries and by 14 percentage points (95% CI: -21, -7) for facility deliveries. The proportion of mothers reporting that their young infant with possible serious bacterial infection received amoxicillin for seven days increased by 50 percentage points (95% CI: 37,62) and gentamicin for seven days increased by 15 percentage points (95% CI: 5,25). Concurrent use of both antibiotics increased by 12 percentage points (95% CI: 4,19). The Community-Based Newborn Care programme was an ambitious initiative to enhance the access to services for pregnant women and newborns. Major improvements were seen for the number of antenatal care visits and institutional delivery, while postnatal care remained alarmingly low. Antibiotic treatment for young infants with possible serious bacterial infection increased, although most treatment did not follow national guidelines. Improving postnatal care coverage and using a simplified antibiotic regimen following recent World Health Organization guidelines could address gaps in the care provided for sick young infants.

National Health Insurance Membership and Economic Status as Determinants of Accessibility of Antenatal Care Service

Background: According to WHO statistics, the maternal mortality rate (MMR) in developed countries is estimated at 12/100,000 live births, while in developing and low-income countries it is 239/100,000 live births. 99% of all maternal deaths are estimated to occur in developing countries, even though the causes of death can be prevented with the right policies considering that one of the goals of the Sustainable Develop­ment Goals is to reduce MMR. Antenatal Care (ANC) is the main technique to reduce maternal morbidity and mortality. This study evaluates JKN membership and economic status affecting ANC service coverage. Subjects and Method: This study is a cross-sectional study using data from the 2017 Indonesian Demographic and Health Survey (IDHS). This data is used to assess the propor­tion of economic status and national health insurance (JKN) membership and to measure the relationship between the two with ANC coverage. Analysis using Logistic Regression with R software version 3.6.3. and perform Pro­pensity Score Matching (PSM) to reduce self-selection bias by balancing the observed vari­ables between groups of respon­dents based on economic status with and without JKN. Results: Of the 5429 respondents, 20.2% were very poor, 20.9% poor, 19.9% middle class, 20.8% rich, and 18.2% very rich. Among these residents, 61.4% have JKN membership and 38.3% do not. The substantial gap in the utiliza­tion of maternal health services, especially in ANC4x services, is 30.7 points between the very poor (48.2%) and the very rich (86.9). Respon­dents who worked as employees were more likely to have JKN membership than those who did not have a job (AOR=2.34; 95% CI = 1.74 to 3.16). Respondents who were exposed to the internet at least once a week were more likely to have JKN membership than those who were not exposed to the internet (AOR=1.46; 95% CI= 1.09 to 1.97). Conclusion: JKN membership and economic status affect ANC 4x service coverage.

A multinomial regression analysis of factors associated with antenatal care attendance among women in Papua New Guinea

ObjectivesThis study sought to assess the prevalence and factors associated with antenatal care (ANC) uptake among women in Papua New Guinea. Study designThis is a secondary data analysis of a nationally representative population based cross-sectional survey of households in Papua New Guinea conducted from 2016 to 2018. MethodsDescriptive statistics in the form of frequencies and percentages and multinomial logistic regression analysis were done to assess the factors associated with ANC uptake and statistical significance was set at p<0.05. ResultsThe prevalence of 4 or more ANC visits was 51.4%. The multinomial logistic regression analysis showed that women aged 35–39 [ARRR = 1.630, 95% CI = 1.016,2.615], those in the richest wealth quintile [2.361, 95% CI = 1.595,3.496], women who had secondary/higher level of education [ARRR = 3.644, 95% CI = 2.614,5.079], and those whose partners had secondary/higher education [ARRR = 1.706, 95% CI = 1.310,2.223] were more likely to attain 4 or more ANC visits. The likelihood of 4 or more ANC visits increased among women in Momase region [ARRR = 3.574, 95% CI = 2.683,4.762], those with parity 1 [ARRR = 2.065, 95% CI = 1.513,2.816], women who did not have a big problem with permission to go to the hospital for care [ARRR = 1.331, 95% CI = 1.110,1.597] and distance to health facility [ARRR = 1.970, 95% CI = 1.578,2.458]. However, women who were not working [ARRR = 0.756, 95% CI = 0.630,0.906], those in rural areas [ARRR = 0.712, 95% CI = 0.517,0.980] and those who do not take healthcare decisions alone [ARRR = 0.824, 95% CI = 0.683,0.994] were less likely to attain 4 or more ANC visits. ConclusionIt was found that 51.4% of women have attained 4 or more ANC visits. Age, wealth status, employment, maternal and partner’s education, region and place of residence, parity, exposure to mass media, problem with distance and getting money needed for treatment and decision making on healthcare are associated with 4 or more ANC uptake among women in Papua New Guinea. To promote optimal number of ANC visits, there is the need for a multi-sectorial collaboration. For example, the various ministries such as the Ministry of Labour/Employment, Education, Development, Women affairs and Finance could collaborate with the Ministry of Health to achieve universal ANC coverage.

A qualitative study exploring barriers to adequate uptake of antenatal care in pre-conflict Syria: low cost interventions are needed to address disparities in antenatal care

BackgroundSyria has made progress in reducing maternal mortality and morbidity before the conflict in 2011. Despite the improvement in antenatal care (ANC) coverage and patterns of use, analyses of national surveys demonstrated wide regional variations in uptake, timing and number of visits even after controlling for women’s socio-demographic characteristics. This study compares two governorates: Latakia, where uptake of ANC was high and Aleppo, where uptake of ANC was low to highlight the barriers to women’s adequate uptake of ANC that existed in Syria pre-conflict.MethodsThis qualitative study carried out 30 semi-structured interviews with (18–45-year-old) pregnant women from Aleppo and Latakia (recruited purposively from different types of health facilities in rural and urban areas), and 15 observation sessions at health facilities. Transcripts and fieldnotes were analyzed using the Framework Method with attention to the dimensions of availability, accessibility and acceptability of services.ResultsInadequate uptake of ANC in Aleppo included not attending ANC, seeking care with providers who are not trained to provide ANC or discontinuing care. Three themes explained the regional disparities in the uptake of ANC in Aleppo and Latakia: women’s assessment of their health status and reasoning of causes of ill health in pregnancy; women’s evaluation of the risks of seeking ANC; and women’s appraisal of the value of different types of service providers. Poor experiences at public health facilities were reported by women in Aleppo but not by women in Latakia. Evaluations of ANC services were connected with the availability, accessibility (geographical and financial) and acceptability of ANC services, however, women’s views were shaped by the knowledge and prevailing opinions in their families and community.ConclusionsFindings are utilized to discuss low-cost interventions addressing the disparities in ANC uptake. Interventions should aim to enable vulnerable women to make informed decisions focusing on regions of low uptake. Women’s groups that foster education and empowerment, which have been effective in other low resource settings, could be of value in Syria. Increased use of mobile phones and social media platforms suggests mobile health technologies (mHealth) may present efficient platforms to deliver these interventions.