Antenatal Care Guidelines Research Articles

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

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

Antenatal Management Information System (Case Study: China-Uganda Friendship Hospital, Naguru)

To eradicate fetal deaths and stillbirths, the World Health Organization (WHO) set up antenatal care guidelines to help expectant mothers through this period. In Uganda today, it is estimated that at least 90% of the expectant mothers receive antenatal care, and with such a large number of people receiving this service, data is collected manually with pen, which makes it a long process and cumbersome to search specific records during emergencies and analysis of data for proper decision making. Therefore, there is a need for an antenatal management information system. The software is sectioned into registration, triage and consultation. The records officer handles registration of patients, patient visits, viewing and printing patient statistics. The senior clinical officer handles triaging the patient and capturing their vitals, viewing and printing patient statistics. The head midwife handles the monthly progress examination, and views and prints patient statistics. All these processes happen in real time. This system is designed to overcome the problems identified in the current antenatal management information system. The interfaces for the new system were implemented using JSP, Bootstrap and Javascript. PostgreSQL was also used for implementing the system database while Spring was used to create interactivity with the database. After the implementation, the new system was then tested and validated. When developing the system, the focus was on making the whole process of information management in the antenatal department faster, more convenient and efficient.

Factors associated with maternal tetanus vaccination in Myanmar: An analysis of demographic and health survey data

BackgroundTetanus toxoid vaccination is a life-saving maternal and child health intervention. Understanding gaps in maternal vaccination coverage is key to informing progress towards universal health coverage. We assessed the vaccination coverage in Myanmar and investigated factors associated with being unvaccinated. MethodIn this cross-sectional analysis of 2015–16 Demographic and Health Survey data including women aged 15–49 years with at least one childbirth in the last five years. The outcome maternal tetanus vaccination during her last pregnancy, defined as protected against neonatal tetanus based on the Myanmar National Guidelines for Antenatal Care. We also examined mothers who missed a second dose of tetanus toxoid containing vaccine (TTCV) by states and regions. We used logistic regression models to assess factors associated with being unvaccinated. ResultsOverall maternal tetanus vaccination coverage was 72%. At subnational level, the percent unvaccinated was highest in Shan State (42%), followed by Magway Region (33%), Kayin State (33%), and Sagaing Region (32%). The percentage of mothers who missed a second dose of TTCV was high predominantly in regions, rather than states. We found that the percentage of unvaccinated mothers was higher among younger mothers, and mothers with lower educational attainment. No antenatal care (ANC) or receiving ANC in non-public healthcare facilities were strongly associated with being unvaccinated. Differences in percent unvaccinated by maternal age were largely mediated through their healthcare access, particularly ANC services. InterpretationWe identified regional, structural, and individual differences in maternal tetanus vaccination coverage. Factors influencing mothers who missed a second dose of TTCV warrant further investigation. Achieving universal coverage of maternal tetanus vaccination will largely depend on the ability to provide accessible antenatal care to most women who do not currently receive it.

A review of current knowledge about the importance of iodine among women of child-bearing age and healthcare professionals.

Iodine is required for thyroid hormone synthesis and fetal neurogenesis. Recent population studies in the United Kingdom (UK) have found iodine deficiency among schoolgirls, women of child-bearing age and pregnant women. This review explores knowledge and awareness of iodine among women of child-bearing age and healthcare professionals (HCPs) in the UK, set within a global context. We aimed to identify gaps in iodine knowledge in the current UK setting of iodine deficiency without iodine fortification and where iodine is not included in antenatal guidelines. The search terms 'iodine knowledge' and 'iodine awareness' were used to identify relevant papers. Iodine knowledge is poor among women of child-bearing age in the UK according to four studies using questionnaires and qualitative methods. They were unsure of dietary sources of iodine and were not consistently provided with relevant information from HCPs during clinical care. Midwives have been recognised as the main providers of dietary information during pregnancy and, although they recognised the importance of their role in providing nutrition advice, they did not feel equipped to do so and lacked confidence in addressing nutritional concerns. Globally, there was a similar lack of knowledge, however, this was somewhat improved by the inclusion of iodine in antenatal care guidelines. Midwives' knowledge of iodine was poor, as was knowledge among women of child-bearing age. Improved HCP knowledge and effective communication of information to pregnant women and women planning to conceive may help to improve iodine status which is of particular concern in pregnancy.

Women’s Satisfaction with the Quality of Antenatal Care Services Being Offered in Bamenda Health District

<i>Background:</i> Antenatal care is the care women receive while pregnant. It is an important health service which detects and sometimes curbs the risk of complications among pregnant women (PW). The way women perceive the quality-of-care render during ANC influences utilization and consequently the outcome of pregnancy. This study investigated women’s satisfaction with the quality of antenatal care in the BHD. Women presenting for antenatal care for their second or subsequent visits at 14 health facilities in the Bamenda health district were interviewed in a cross-sectional designed study, using a semi-structured questionnaire. The questionnaire included sociodemographic and obstetric variables, and level of satisfaction with various aspects of antenatal care. Data analysis was done using EPI info. The p-value was set at P<0.05. 396 women participated in the study. 70% of the women were between 20 and 30yrs of age. 81.8% of them were married while. 49.2% had secondary education, 49.7% were self- employed while 10.4% were unemployed. Parity mean of 1.55 ± 1.357. 73.2% began ANC after the first trimester of pregnancy, mean number of ANC visits was 3.82 ±1.721. 84.6% of women were satisfied with elements of quality ANC services, 81.3% with the health education they received and only 41.0% were satisfied interventions for physiological problems of pregnancy. Women who attended faith-based health facilities (FBHF) were more satisfied with elements of quality ANC than those who attended public health facilities the reverse was true for health education messages received where women were more satisfied with public health facilities. There was no significant difference in the interventions during pregnancy for both faith-based and public health facilities (PHF). We concluded that apart from the physiological interventions during pregnancy, women were satisfied with the ANC services they receive in the BHD although there were gaps to be filled to improve on the quality of ANC. The use of antenatal care guidelines was recommended to enable a comprehensive delivery of antenatal care for an optimum satisfaction.

Effect of complete adherence to antenatal care guideline during first visit on maternal and neonatal complications during the intrapartum and postpartum periods: a prospective cohort study in Northwest Ethiopia

ObjectivesTo examine the relationship between complete of providers’ adherence to antenatal care (ANC) guideline during first visit and maternal and neonatal complications during intrapartum and postpartum periods.DesignProspective cohort study.SettingGondar town...

Antenatal care processes in rural Southern Nepal: gaps in and quality of service provision—a cohort study

ObjectivesThis study aimed to compare a standard quality of care definition to one that reflected focused antenatal care (FANC) guidelines and examine associations with receipt of good quality of care.DesignThis...

Household Socioeconomic Status and Antenatal Care Utilization Among Women in the Reproductive-Age.

The study examined the effect of household socioeconomic status and other socio-demographic characteristics on antenatal care (ANC) utilization among 819 women within the reproductive ages across eight rural communities in Delta State, Southern part of Nigeria. Characteristics of the women were described using simple proportion and frequency. The chi-square test was used to examine factors that were significantly associated with a minimum of four (≥4) and eight (≥8) antenatal care contacts, which were respectively in line with the focused ANC and WHO's new guideline. The multivariable logistic regression was used to examine the determinants of a minimum of four and eight ANC. Statistical analyses were set at 5%. The results showed that 31.4% (257/819) and 2.2% (18/819) of mothers, respectively, made ≥ 4 and ≥ 8 ANC contacts in the course of their last pregnancies. According to the results, the odds for reporting 4≥ and ≥ 8 ANC improved with both wealth and educational attainment. Distance to the health center and cost are barriers to maternal care utilization and they reduce the odds for undertaking ≥ 4 and ≥8 ANC contacts. Women on higher media exposure were more likely to undertake ≥ 4 and ≥8 ANC contacts, and those on the highest media exposure were more likely to undertake ≥8 ANC contacts. Financing maternal care through health insurance and free maternal care significantly improves the odds to undertake ≥ 4 and ≥ 8 ANC contacts. Intervention programs should be designed to improve access to maternal care services and should expand education opportunities for mothers, improve household socioeconomic conditions, and encourage enrolment in health insurance and free maternal care in the study area.

Provider-perceived benefits and constraints of complete adherence to antenatal care guideline among public health facilities, Ethiopia: A qualitative study.

BackgroundIn Ethiopia, health care providers’ level of adherence to the national Antenatal Care (ANC) guideline is relatively low. The reasons why they do not follow the guidelines are not well known. Therefore, this study aimed to explore the provider-perceived benefits and constraints associated with using the guideline for ANC in public health facilities in Gondar town.MethodsA qualitative study was conducted using a semi-structured interview guide. The interview was conducted among a purposive sample of nine health care providers working in four public health facilities in Gondar town. After the interviews were transcribed and coded, a content analysis was done using Atlas ti version 7.5 software packages.ResultDecreasing provider’s workload and maximizing performance, improving safe motherhood, and improving the process of service delivery were reported as the perceived benefits of following ANC guideline. Organizational problems, care providers’ existing knowledge, attitude, and skills and availability of training and mentorship were the three main identified groups of factors that hinder complete providers’ adherence to ANC guideline.ConclusionAlthough providers acknowledged the benefits of following ANC guideline, the guideline is not fully implemented. Refresher training should be given at the start of the updated eight-contact ANC guideline and continuing education and supervision throughout the implementation process. Health care providers call for profound and urgent revisions of the supply chain system for supplies and equipment.

Family influences on health and nutrition practices of pregnant adolescents in Bangladesh

Adolescent pregnancy can result in serious risks to the mother and her baby; yet, adolescents are among the least likely to access healthcare. Specific nutrition or antenatal care (ANC) guidelines for supporting pregnant adolescents are not available. To understand experiences and decision‐making of pregnant adolescents in Bangladesh related to ANC and nutrition practices, peer interviewers were trained to conduct qualitative interviews in Dhaka and Rangpur with pregnant adolescents (n = 48), adolescent mothers (n = 48), adolescents' family members (n = 64) and health service providers (n = 32). Key themes explored included perception and support of adolescent pregnancy, experiences in seeking ANC, dietary practices, sources of information and roles of male and female family members. Spheres of influence on adolescent pregnancy were identified through analytical framework informed by the socio‐ecological model. Respondents felt that adolescent pregnancy is risky and that adolescents require support and guidance through this experience. Families were highly influential on the care seeking, health and nutrition of pregnant adolescents, and mothers/mothers‐in‐law primarily took on the decision‐making roles, with husbands actively participating. Adolescents valued family support but felt a loss of autonomy and agency upon becoming pregnant. Financial constraints were the greatest perceived barrier to appropriate nutrition and healthcare; yet, both were valued. There is sometimes discord of health and nutrition beliefs between families and health service providers; more research is needed to understand this further. It is essential to engage family members and adolescents in initiatives to increase access to quality ANC for pregnant adolescents, improve dietary practices and support the ability to delay pregnancy.

P.114 Survey of current practices for stopping clear fluids before an elective caesarean birth

Introduction: Enhanced recovery is being increasingly used as a model of perioperative care for women having an elective caesarean birth. [1] Adshead D, Wrench I, Woolnough M. Enhanced recovery for elective caesarean section. BJA Educ 2020;20:354-7. Google Scholar Pre-operative hydration is essential and fasting times should be as short as possible, having a negative impact on patient experience if prolonged. The current recommendation is to drink clear fluids until two hours before surgery. [2] Wilson RD, Caughey AB, Wood SL et al. Guidelines for antenatal and preoperative care in cesarean delivery: Enhanced Recovery After Surgery Society Recommendations (Part 1). Am. J. Obstet. Gynecol. 2018;219:523-32. Google Scholar The survey aimed to establish if delivery suite practices are being more liberal in this approach.

The Development of an Electronic Clinical Decision and Support System to Improve the Quality of Antenatal Care in Rural Tanzania: Lessons Learned Using Intervention Mapping

It is widely recognised that high quality antenatal care is a key element in maternal healthcare. Tanzania has a very high maternal mortality ratio of 524 maternal deaths per 100,000 live births. Most maternal deaths are due to preventable causes that can be detected during pregnancy, and antenatal care therefore plays an important role in reducing maternal morbidity and mortality. Unfortunately, quality of antenatal care in Tanzania is low: Research has shown that healthcare workers show poor adherence to antenatal care guidelines, and the majority of pregnant women miss essential services. Digital health tools might improve the performance of healthcare workers and contribute to improving the quality of antenatal care. To this end, an electronic clinical decision and support system (the Nurse Assistant App) was developed and implemented in Tanzania in 2016 to provide digital assistance during antenatal care consultations to healthcare workers. The current study systematically evaluated the development and implementation process of the Nurse Assistant App in Magu District, Tanzania, with the aim of informing future programme planners about relevant steps in the development of a digital health intervention. Desk research was combined with semi-structured interviews to appraise the development process of the digital health tool. We employed the criteria stipulated by Godin et al., which are based on the six steps of Intervention Mapping [IM; Bartholomew Eldredge et al.]. Findings indicated that five of the six steps of IM were completed during the development and implementation of the Nurse Assistant App. Tasks related to community engagement, adjustment to local context, implementation in the practical context in collaboration with local partners, and rigorous evaluation were accomplished. However, tasks related to identifying theory-based behaviour change methods were not accomplished. Based on the lessons learned during the process of developing and implementing the Nurse Assistant App, we conclude that programme developers are recommended to (1) engage the community and listen to their insights, (2), focus on clear programme goals and the desired change, (3), consult or involve a behaviour change specialist, and (4), anticipate potential problems in unexpected circumstances.

Diagnosis, management and care of hypertensive disorders of pregnancy (HDP): An Indian Expert Opinion

Aim: To develop a guiding tool for the screening, diagnosis, management and care of hypertensive disorders of pregnancy (HDP) by Indian expert panel consensus. Materials and Methods: Databases such as PubMed, Medline, the Cochrane library and Google Scholar were searched for literature on HDP. Guidelines on HDP from Sri- Lanka, Bahrain, Singapore, Malaysia, Federation of Obstetric and Gynecological Societies of India (FOGSI), Japan, Canada, Australia, US, Europe, and others were studied and discussed as reference documents. A 14 member committee of Gynecology and Obstetrics experts was formed in scientific collaboration with Wockhardt Ltd., Mumbai (India) to prepare an expert opinion on HDP for India. The panel discussed hypertension (HTN) for a) classification b) techniques of monitoring BP c) when to start antihypertensive d) diagnostic tests e) important management and type of medical care needed in pre, during and post pregnancy. The panel also compared the guidelines of different countries to discuss the differences and similarities in management of HTN mainly focusing preeclampsia (PE). Results: The panel recommended NICE guidelines to classify HTN. The panel also advised to follow the antenatal care (ANC) guidelines and perform thorough clinical examination of the patient on first visit preferably in first trimester and then subsequent visits during the pregnancy. The panel emphasized on the measurement of BP with standard mercury sphygmomanometer in the sitting posture. Since PE has a higher incidence in India, a minimum of four antenatal care visits and initial screening (BP and proteinuria) at 8 to 12 weeks of gestation for early diagnosis of hypertension are advised. The panel suggested that the target BP should be 130-150 / 80-100 mm Hg on antihypertensive therapy. Either labetalol or methyldopa should be used as first line treatment during third trimester of pregnancy. However, during second trimester methyldopa should be used as the first line treatmen

Cost Benefit Analysis of Four and Eight Antenatal Care Visits in Bamenda Health District, Cameroon

Background: In 2016, the World Health Organization (WHO) published new antenatal care guidelines recommending an increase from four visits during pregnancy to eight contacts with skilled personnel, among other recommendations. Currently there are ongoing discussions in respect to the cost implications and potential outcomes countries can anticipate, if they make this move. Cameroon has adopted the new recommendation without analysis of the cost implication. Notwithstanding, it is imperative to investigate if pregnant women are willing to make this change, the cost implications of such changes, and if pregnant women will be willing to pay the extra cost. This study sets out to find out women’s preferred number of antenatal visits, their willingness to pay for antenatal visits and to perform a cost- benefit analysis of 4 and 8 visits in Bamenda Health District (BHD). Method: An exit interview was conducted using a semi structured interviewer administered questionnaire with women attending antenatal clinic in some 14 health facilities in BHD. The health facilities were chosen purposively. A total of 396 women were interviewed. Results: Our results revealed that 177 (44.7%) of the women preferred 4 antenatal care visits while 174 (43.9%) preferred 8 antenatal care visits and 45 (11.4%) preferred more than 8 antenatal visits. The extra cost for 4 and 8 visits was 10,390FCFA. The average willingness -to –pay (WTP) for 4 extra visits was calculated to be 2,209FCFA. Conclusion: Although women preferred a model of antenatal care (ANC) with 8 or more ANC contacts, they were not willing to pay for the contacts, thus it is recommended that the 4 visits model be implemented in the Bamenda Health District.

Country compliance with WHO-recommended antenatal care guidelines: equity analysis of the 2015–2016 Demography and Health Survey in Myanmar

IntroductionEarly access to adequate antenatal care (ANC) from skilled providers is crucial for detecting and preventing obstetric complications of pregnancy. We aimed to assess factors associated with the utilisation of...

Client Factors Affect Provider Adherence to Guidelines during First Antenatal Care in Public Health Facilities, Ethiopia: A Multi-Center Cross-Sectional Study.

Timely entry to an antenatal care with a healthcare provider who follows a set of national guidelines is assumed to ensure higher levels of client satisfaction. It is also expected to improve perinatal outcomes. Little is known about the level of adherence of Ethiopian providers to these guidelines. Therefore, this study aims to assess the proportion of clients who received complete (100%) provider adherence to antenatal care guidelines at the first visit and client associated factors in Gondar Town. A cross-sectional study of 834 study participants was conducted in public health facilities of Gondar Town in Ethiopia. An 18 point checklist was used to observe provider adherence to the first antenatal care visit guidelines. Descriptive statistics and multivariable binary logistic regression model were done by using STATA 14 software. The proportion of clients who received the complete provider's adherence to the first antenatal care guideline was 32.25% (95% CI: 29.1-35.5). The mean adherence score was 16.78%. Women who had prior history of pregnancy and/or birth-related complications (AOR = 1.58; 95%CI: 1.04-2.04) and late antenatal care booking at gestational week 16 or greater (AOR = 1.45; 95%CI: 1.03-2.03) were significantly associated with clients receiving complete providers' adherence to the first antenatal guideline. We found the level of adherence to national antenatal care guidelines during first visit as surprisingly low. When considering to upgrade the guidelines to the actual WHO guideline of eight visits, we recommend that refresher training be provided regularly to help staff understand the importance of following the guidelines as closely as possible. Perhaps, we need to learn more from the health care providers themselves about their reasons for not following the guidelines.

XML Data and Knowledge-Encoding Structure for a Web-Based and Mobile Antenatal Clinical Decision Support System: Development Study.

BackgroundDispleasure with the functionality of clinical decision support systems (CDSSs) is considered the primary challenge in CDSS development. A major difficulty in CDSS design is matching the functionality to the desired and actual clinical workflow. Computer-interpretable guidelines (CIGs) are used to formalize medical knowledge in clinical practice guidelines (CPGs) in a computable language. However, existing CIG frameworks require a specific interpreter for each CIG language, hindering the ease of implementation and interoperability.ObjectiveThis paper aims to describe a different approach to the representation of clinical knowledge and data. We intended to change the clinician’s perception of a CDSS with sufficient expressivity of the representation while maintaining a small communication and software footprint for both a web application and a mobile app. This approach was originally intended to create a readable and minimal syntax for a web CDSS and future mobile app for antenatal care guidelines with improved human-computer interaction and enhanced usability by aligning the system behavior with clinical workflow.MethodsWe designed and implemented an architecture design for our CDSS, which uses the model-view-controller (MVC) architecture and a knowledge engine in the MVC architecture based on XML. The knowledge engine design also integrated the requirement of matching clinical care workflow that was desired in the CDSS. For this component of the design task, we used a work ontology analysis of the CPGs for antenatal care in our particular target clinical settings.ResultsIn comparison to other common CIGs used for CDSSs, our XML approach can be used to take advantage of the flexible format of XML to facilitate the electronic sharing of structured data. More importantly, we can take advantage of its flexibility to standardize CIG structure design in a low-level specification language that is ubiquitous, universal, computationally efficient, integrable with web technologies, and human readable.ConclusionsOur knowledge representation framework incorporates fundamental elements of other CIGs used in CDSSs in medicine and proved adequate to encode a number of antenatal health care CPGs and their associated clinical workflows. The framework appears general enough to be used with other CPGs in medicine. XML proved to be a language expressive enough to describe planning problems in a computable form and restrictive and expressive enough to implement in a clinical system. It can also be effective for mobile apps, where intermittent communication requires a small footprint and an autonomous app. This approach can be used to incorporate overlapping capabilities of more specialized CIGs in medicine.

Building a Digital Tool for the Adoption of the World Health Organization's Antenatal Care Recommendations: Methodological Intersection of Evidence, Clinical Logic, and Digital Technology.

BackgroundOne of the key mandates of the World Health Organization (WHO) is to develop guidelines, defined as “a document containing recommendations for clinical practice or public health policy.” Guidelines represent the global standard for information sources shaping clinical practice and public health policies. Despite the rigorous development process and the value of guidelines for setting standards, implementing such standards within local contexts and at the point of care is a well-documented challenge. Digital technologies enable agile information management and may facilitate the adaptation of guidelines to diverse settings of health services delivery.ObjectiveThe objective of this paper is to detail the systematic and iterative process involved in transforming the WHO Antenatal Care (ANC) guidelines into a digital decision-support and patient-record application for routine use in primary health care settings, known as the WHO digital ANC module.MethodsThe WHO convened a team of clinical and digital health experts to develop the WHO digital ANC module as a tool to assist health care professionals in the implementation of WHO evidence-based recommendations for pregnant women. The WHO digital ANC module’s creation included the following steps: defining a minimum viable product (MVP), developing clinical workflows and algorithms, algorithm testing, developing a data dictionary, and the creation of a user interface or application development. The overall process of development took approximately 1 year to reach a stable prototype and to finalize the underlying content requirements of the data dictionary and decision support algorithms.ResultsThe first output is a reference software reflecting the generic WHO ANC guideline content, known as the WHO digital ANC module. Within it, all actionable ANC recommendations have related data fields and algorithms to confirm whether the associated task was performed. WHO recommendations that are not carried out by the health care worker are saved as pending tasks on a woman’s health record, and those that are adequately fulfilled trigger messages with positive reinforcement. The second output consists of the structured documentation of the different components which contributed to the development of the WHO digital ANC module, such as the data dictionary and clinical decision support workflows.ConclusionsThis is a novel approach to facilitate the adoption and adaptation of recommendations through digital systems at the health service delivery level. It is expected that the WHO digital ANC module will support the implementation of evidence-based practices and provide information for monitoring and surveillance; however, further evidence is needed to understand how the WHO digital ANC module impacts the implementation of WHO recommendations. Further, the module’s implementation will inform the WHO’s ongoing efforts to create a pathway to adaptive and integrated (Smart) Guidelines in Digital Systems to improve health system quality, coverage, and accountability.

“The nurse assistant app” to improve healthcare worker performance during antenatal care in Tanzania

Abstract Background The Nurse Assistant App (NAA) was developed to improve the quality of antenatal care in Magu District Tanzania by providing digital assistance to healthcare workers. The NAA guides healthcare workers step by step through all necessary antenatal care interventions and provides tailored advice and suggestions for follow-up actions. We used the Intervention Mapping framework to retrospectively evaluate the development of the NAA. Methods Desk research into the content, evidence base, and development of the NAA was performed combined with semi-structured interviews with two initial developers to fill in a planning tool consisting of 40 criteria for systematic evaluation of the data. Results Findings showed that the NAA was developed based on existing literature on antenatal care guidelines as well as the knowledge and experience of a broad variety of stakeholders and that five of the six steps of Intervention Mapping were performed. However, the development of the NAA lacked a theoretical foundation on behaviour change models. Future research will focus on the experiences of healthcare workers providing antenatal care using the NAA. Conclusions The NAA was developed in collaboration with relevant stakeholders and took practical matters as well as evidence from existing literature into account. However, we recommend that the responsibility and ownership of the NAA should be shared with the local government to increase the potential and sustainability of the NAA. Key messages The NAA was developed to improve the quality of antenatal care in rural Tanzania targeting healthcare workers. The current evaluation informs future digital health tool developers in sub-Saharan Africa about elements to take into account during the development phase such as systematic mapping of the process.

Facilitating factors and barriers to accessibility and utilization of kangaroo mother care service among parents of low birth weight infants in Mangochi District, Malawi: a qualitative study

BackgroundKangaroo Mother Care (KMC) is one of the interventions widely used in low-income countries to manage Low Birth Weight Infants (LBWIs), a global leading cause of neonatal and child mortality. LBWI largely contributes to neonatal mortality in Malawi despite the country strengthening and implementing KMC, nationwide, to enhance the survival of LBWIs. This qualitative study aimed to assess the facilitating factors and barriers to accessibility and utilization of KMC service by the parent of low birth weight infants (PLBWIs) in Mangochi District, Malawi.MethodsTwo focused group discussions assessed factors facilitating and hindering the accessibility and utilization of KMC service were conducted in April 2018 that reached out to (N = 12) participants; (n:6) PLBWI practicing KMC at Mangochi district hospital (MDH) referred from four health facilities and (n:6) high-risk pregnant mothers (HRPMs) visiting antenatal care (ANC) clinic at MDH. The availability of KMC at MDH was assessed using KMC availability checklist. The study used purposive, convenient and simple random sampling to identify eligible participants. Thematic analysis was used to analyze the findings.ResultsSixteen themes emerged on facilitating factors and barriers to accessibility and utilization of KMC service by the PLBWIs. The identified themes included; availability of KMC providers, social factor (social support and maternal love), timing of KMC information, knowledge on KMC, health linkage systems, recognition of LBWIs, safety on the use of KMC, preference of LBWI’s care practice, lived experience on KMC practice, KMC expert clients, perceived causes of LBWI births, cultural/traditional factors, religious beliefs, health-seeking behavior, women empowerment and quality of care.ConclusionsAlthough KMC was available in some of the health facilities, integration of KMC messages in ANC guidelines, community awareness and in sensitization of any health intervention may enhance KMC accessibility and utilization by the targeted population.