Antenatal Care In Health Facilities Research Articles

Assessing the quality of antenatal care provision by midwives: a mixed-method study of three levels of healthcare in southwestern Nigeria

Background Antenatal care allows healthcare providers to assess the wellbeing of pregnant women and their fetuses, leading to positive maternal and fetal outcomes. This study assessed the available facilities for antenatal care provided by midwives, and factors that influenced the quality of care provided. Methods This study used a mixed-method descriptive design based on the Donabedian model to explore the quality of care at 27 health facilities across the three levels of healthcare in Osun State. Qualitative data were collected from 11 purposively selected midwives using an in-depth interview guide, and a hospital checklist was used to collect quantitative data. Data were gathered over 12 weeks, then transcribed and analysed using content and thematic analysis. Results Some facilities (9.1%) did not offer all components of antenatal care. When examining the process and structure of care, 98.6% of healthcare facilities were found to have inadequate human resources. Although the equipment at the facilities was functional, it was reportedly inadequate in 27 (84.3%) facilities. Midwives reported that a lack of education, poor working conditions, interprofessional barriers and burnout hindered the provision of quality antenatal care, while community support and regular continuing education were motivating factors. Conclusions The quality of antenatal care was rated adequate, but there was a lack of resources, standard guidelines and retraining opportunities for midwives. Adequate manpower and resources are needed to enhance the quality of antenatal care in health facilities in Osun State.

Association between malaria and undernutrition among pregnant women at presentation for antenatal care in health facilities in the Mount Cameroon region.

In resource limited settings, malaria and undernutrition are major public health problems in pregnancy. Therefore, this study assessed the association between malaria infection and undernutrition among pregnant women in the Mount Cameroon area. This cross-sectional study enrolled 1,014 pregnant women consecutively over a year. A structured questionnaire was used to collect socio-demographic information and clinical data. Maternal nutrition was assessed using dietary diversity (DD). Peripheral blood samples collected were used for the diagnosis of malaria parasitaemia by microscopy whereas haemoglobin (Hb) levels were determined using an Hb meter. Logistic regression was used to determine factors associated with malaria and dietary diversity. The prevalence of malaria infection and undernutrition was 17.8% and 89.6% respectively. In addition, of those infected with malaria, geometric mean parasite density was 301/μL of blood (range: 40-9280) while mean DD score was 3.57±0.82 (range: 1-7). The odds of being infected with malaria parasitaemia was highest among women enrolled in the rainy season (OR = 1.58, P = 0.043), who were farmers (OR = 2.3, P = 0.030), had a household size of < 4 individuals (OR = 1.48, P = 0.026) and who were febrile (OR = 1.87, P < 0.001). Also, attending clinic visits in Mutengene Medical Centre (OR = 2.0, P = 0.012) or Buea Integrated Health Centre (OR = 2.9, P = < 0.001), being < 25 years (OR = 2.4, P = 0.002) and a farmer (OR = 10.6, P = 0.024) as well as < 4 clinic visits (OR = 1.62, P = 0.039) were identified as predictors of undernutrition. Furthermore, the association between malaria and DD was statistically significant (P = 0.015). In this study, undernutrition was highly frequent than malaria infection. Thus, there is an urgent need to improve maternal awareness through nutritional counselling and health campaigns on the benefits of consuming at least five food groups. Besides, improved maternal dietary nutrient intake is likely to have impact on the burden of malaria parasite infection.

Determinants of Alcohol Use among Pregnant Women at George Health Centre in Lusaka District, Zambia

Background: Alcohol is a recognized teratogen in utero because of its potential to cause damage to the brain resulting in developmental, cognitive and behavioral problems including Fetal alcohol spectrum disorders (FASDs) and mental health problems such as anxiety, depression, attention deficit hyperactivity disorders. Main objective: To explore the determinants of alcohol use among pregnant women at George Health Centre. Method: The study adopted a mixed convergent method approach. An analytical cross-sectional design recruited 255 pregnant women from which 24 participated in descriptive qualitative design collected through 4 focused group discussions from women who gave a history of drinking alcohol. Results: The study showed that 4 in every 10 pregnant women had a history of alcohol consumption prior to and during pregnancy. Significant factors associated with alcohol use included smoking which increased the odds of drinking alcohol 11.24 more times among smokers. Pregnant women’s likelihood to drink alcohol was 63% lower among those of high socioeconomic status (SES) compared to the lower classes. The results also found a behavioral gap between high levels of awareness on harmful effects of alcohol compared to the high prevalence rate recorded. Conclusion: The findings suggest a great need for assessment, identification and management of prenatal alcohol consumption among pregnant women attending antenatal care in health facilities.

Predictors of adherence to option B+ approach for the prevention of mother to child transmission of human immunodeficiency virus in Abuja, 2017.

Introductionoption B+ ART is a lifelong regimen of ART using a combination of 3 ARVs and adherence to this regimen can reduce risk of MTCT to 1-2% as against 15-40% without treatment. To achieve an undetectable viral load and prevent the development of drug resistance, a person on ARV drugs need to take at least 95% of prescribed doses on time. This study assessed the level of adherence to Option B+ PMTCT program and its predictors among HIV+ Pregnant women accessing antenatal care in health facilities Abuja.Methodswe enrolled 284 HIV positive pregnant women and lactating mothers in a hospital-based cross-sectional study. We sampled respondents using two-staged sampling technique. We collected data on socio-demographic characteristics, level of adherence, patients and healthcare related factors affecting adherence, knowledge of clients on HIV, ART and MTCT. Focused group discussion guide, data abstraction form and key informant interview guide were used for PMTCT focal persons. We conducted bivariate analysis and logistic regression using Epi-Info version 7 at 5% level of significance.Resultsthe mean age of respondents was 30.12 years (SD±4.86) with mean knowledge score of 16.7 and 75.5%% of them had good knowledge. The level of good adherence was 83.3%. Independent factors associated with non-adherence to ART included: Forgetfulness (OR 20.02; 95% CI 6.42-62.48), having side effects (OR 39.6; 95% C.I: 4.46-352.32), lack of food (OR 34.76; 95% C.I: 2.37-509.33), disclosure of HIV status (OR 2.51; 95% CI 1.22-5.15), being too busy (OR 13.96; 95% CI 3.89-49.98). Encountering challenge in ART initiation (OR 2.05; 95% CI 1.01-4.72) and level of Knowledge (OR 2.12; 95% CI 1.06-5.42).Conclusionthe level of adherence would improve study if the Public health department of Federal Ministry of Health (FMOH), Federal Capital Development Authority (FCDA) and National Agency for the Control of AIDS (NACA) sponsors public enlightenment on HIV/AIDS through the media which may help reduce stigma and encourage voluntary HIV status disclosure. Reminders should be used by patients to help them overcome forgetfulness.

EVALUATING SOCIO-CULTURAL BARRIERS TO ANTENATAL CARE UTILIZATION AMONG REPRODUCTIVE AGE WOMEN IN WUSHISHI AND ZUNGERU COMMUNITIES IN NIGER STATE, NIGERIA: A LOGISTIC REGRESSION APPROACH

More than 33% of Nigerian pregnant women do not use the Antenatal Care service during pregnancy. In 2015, for instance, World Health Organization (WHO) revealed that only 61% of Nigerian pregnant women had attended ANC at least once during their pregnancy period. Only 51% of these women met the WHO standard of a minimum of 4 visits. This ANC rate is, without doubt, lower than the WHO African region average of 77%. The situation in Wushishi and Zungeru communities of Niger State may not be different. Despite the number of health facilities available in these communities, some women of childbearing age do not access antenatal care. Most times, many of them lose their lives during delivery at home, some end up with complications or lose their babies at births. This situation raised concern why pregnant women do not attend antenatal care in health facilities around them? This paper examined the socio-cultural impediments to accessing antenatal care services among reproductive-aged women in Wushishi and Zungeru Communities of Niger State. We used a Multivariate Logistic Analysis. A total of 150 subjects were involved in this study comprising 83 from Zungeru and 67 from Wushishi. The questionnaire used for data collection was a structured consist of 17 items. The results indicated that ethnicity and preference for traditional birth attendant are major influences to accessing ANC in these communities

Dietary vitamin A intakes among pregnant women attending antenatal care in health facilities in Dessie Town, North East Ethiopia.

Vitamin A plays an important role in vision, cellular differentiation, embryonic development, reproduction, growth and the immune system. Women who live in developing countries face a risk of undernutrition during pregnancy as a result of poverty, poor diet quality and quantity, and a high fertility rate. This poor dietary problem could reflect the high risk of vitamin A deficiency in women. The present study aimed to determine the adequacy of vitamin A among pregnant women following antenatal care in health facilities of Dessie Town, Ethiopia, January 2017. Health facility-based cross-sectional study was conducted among 390 women who attended antenatal care in Dessie Town. Food groups from the Food and Agriculture Organization based on 24-h dietary recall were used to measure dietary intake of vitamin A and dietary diversity of women. Adequacy of vitamin A was determined from the nutrient adequacy ratio after obtaining reports of nutrient intake from food composition tables version III and IV in terms of B carotene and retinol equivalent, respectively, based on the estimated average requirement recommendation of vitamin A, 370retinol equivalent day-1 for pregnant women. Multivariable logistic regression analysis was performed to identify associated factors of vitamin A adequacy. Adequacy of vitamin A among pregnant women was 41.8%, with an average nutrient adequacy ratio of 0.9. The mean dietary intake of vitamin A was 290.1µgday-1 . The predictors for adequacy of vitamin A were high and medium women diversity scores (adjusted odds ratio=2.92; 95% confidence interval=1.50-5.70) and (adjusted odds ratio=1.87; 95% confidence interval=1.11-3.16). In the present study, adequacy of vitamin A was low and was affected by the dietary diversity score. A focus on food-based approaches, especially regarding educating pregnant women to diversify their diet, is crucial for reducing the risk of vitamin A deficiency. Vitamin A is crucial micronutrient for the health of women and fetus, being essential for morphological, ocular and functional developments, as well as fetal organ and skeletal growth. Its requirement is greater during pregnancy and its deficiencies lead to maternal and child mortality and development. The dietary intake of vitamin A among pregnant women remains below the current recommendation. Inadequate intake of vitamin A Pregnant women Heath facility Dessie, Ethiopia.

Factors associated with antenatal and health facility delivery care in selected areas of Subornochor upazila, Noakhali, Bangladesh

Improving maternal health and reducing maternal mortality rate (MMR) are major challenges for Bangladesh. Utilization of antenatal care (ANC) services from skilled professionals and deliveries in health facilities are therefore important to tackle MMR and socioeconomic differences play a major part for these service utilization. The purpose of the current study was to identify the level and determinants of ANC and health facility delivery care utilization in Subornochor upazila (a rural sub-district), Noakhali, Bangladesh. The study was a community based cross sectional study. A total of 360 women (15–49 years) who had a child in the last five years preceding the survey were interviewed and studied. The results of overall analysis showed that only 34.6% women received ANC from health professionals, whereas mere 5.3% deliveries were taken place at health facilities. Mother's education, partner's occupation, family income and area of residence were significant predictors of these services utilization. Place of receiving ANC was an influencing factor of health facility delivery. Women who didn't receive ANC in health facilities were almost three times (OR: 2.95, 95% CI: 1.06–7.9) less likely to deliver in health facilities compared to the women who received ANC. The study underscores the urgent need of addressing socioeconomic differences and targeted interventions might help the women who need to utilize these services more often. The study also pointed out huge differences of these services utilization with national average. Though further investigation is necessary but emphasis should be given more to address the barriers of maternal health service.

Risk factors of anemia among pregnant women attending antenatal care in health facilities of Eastern Zone of Tigray, Ethiopia, case-control study, 2017/18.

IntroductionWorldwide the average prevalence of anemia among pregnant women is 38.2% and in Ethiopia, the average prevalence of anemia among pregnant women is 22%. The aim of this research was to identify risk factors of anemia among pregnant women in Eastern Zone of Tigray, Ethiopia.MethodsA case-control study was conducted among 600 (150 cases and 450 controls) pregnant women in 2017/18. Pregnant women with a hemoglobin level below 11 g/dl were cases (anemic) and those with hemoglobin >11 g/dl were controls (non-anemic). Data were collected using structured questionnaire and SPSS version 20 was used for analysis. Bivariate and multivariate logistic regression model was used to identify the risk factors for anemia among pregnant women. P-value <0.05 and adjusted odds ratio with a 95% confidence interval were used to assess the association.ResultsIntestinal parasites (adjusted odds ratio (AOR)=3.4; 95% confidence interval (CI): 1.2, 17.9), farmer occupation (AOR=3, 95% CI: 1.4, 10.8), unprotected sources of drinking water (AOR=3; 95% CI: 1.7, 16.9), drinking coffee/tea with or immediately after meal daily (AOR=1.9; 95%CI: 1.04, 8.7) and diet diversity score (DDS) of less than 3 (AOR=3; 95% CI: 1.5, 5.5) were statistically significant for anemia among pregnant women.ConclusionIn this study, the risk factors for anemia among pregnant women were intestinal parasites, mother farmer occupation, unprotected source of drinking water, drinking coffee or tea with a meal or immediately after meal and low diet diversification score. Therefore, nutritional intervention should consider the above-identified risk factors.

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

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

Seroprevalence and risk factors of Hepatitis E virus infection among pregnant women attending antenatal care in health facilities of Tigray, Northern Ethiopia.

Existing literatures from developing countries show an increased mortality and morbidity related to hepatitis E virus during pregnancy as compared to the general population. Studies focusing on pregnant women are required for policy makers to improve maternal and child health. Therefore this study is aimed at determining the prevalence and associated risk factors of hepatitis E virus infection among pregnant women attending the health facilities of Tigray region, Northern Ethiopia. In this cross sectional study 846 pregnant women were included consecutively from April 2014 to February 2016. Clinical and sociodemographic were collected using structured questionnaire and blood was collected for laboratory analysis of Hepatitis E virus using IgG and IgM HEV ELISA. The data were analyzed using SPSS software version 21.0. Association with variables with the risk factors was determined using bivariate and multivariate analysis. The overall sero-prevalence of hepatitis E virus using anti-HEV IgG and anti-HEV IgM antibody among pregnant women were 367 (43.4%). From this 359 (42.4%) and 8 (0.9%) were tested positive for anti-HEV IgG and anti-HEV IgM antibody, respectively. Then finally age, rural residence, not washing after toilet use and lack of prevention aspects to minimize contamination were associated with HEV infection. This study shows the significant public health impact of HEV during pregnancy in low income countries.

Hepatitis B virus infection and associated risk factors among pregnant women attending antenatal care in health facilities of Tigray, Northern Ethiopia.

Hepatitis B virus infection is one of the leading causes of liver disease in the world. This study was conducted to determine the prevalence of HBV infection and associated risk factors among pregnant women in Northern Ethiopia using a cross-sectional study design. A total of 328 pregnant women were included in this study. Clinical and socio-demographic data of the pregnant women were collected using a structured questionnaire by nurses or midwives during their ANC visit. For the detection of HBsAg, 5 mL of venous blood was collected from the pregnant women; serum was separated in the health facilities from the whole blood and was transported to Tigray Public Health Research Institute for analysis using. The data were analyzed using SPSS software version 20.0. (IBM). Association of variables with HBV infection was determined with multivariate analysis and P < 0.05 was considered statistically significant. The mean age of the study participants was 25.45 ± 5.067. The overall prevalence rate of HBV infection among the pregnant women was 5.5%. A statistical association of HBV infection with risk factors was seen on participants, who were making unprotected sexual practices with multiple partners (AoR = 6.4, 95%CI, 2-21, P = 0.03), on those who had HBV-infected person in their family (AoR = 8, 95%CI, 1-58, P = 0.02), and on those who had undergone surgical procedures (AoR = 6.8, 95%CI, 1-32, P = 0.022).

Breast Feeding: knowledge and practice of pregnancy

Breastfeeding contributes positively to the growth and development of children and presents advantages immunological,psychological and nutritional. Additionally, it leads to considerable reduction in mortality from all causes and is alsoimportant for women’s health. Considering the information presented, there is the objective of this study was to identifythe knowledge and practice of breast-feeding of pregnant women attending health facilities in one district of ReconcavoBaiano. It is a cross-sectional study involving pregnant women attending antenatal care in health facilities in the municipalityReconcavo of Bahia, October/2010 to May/2011. The study excluded women with HIV / AIDS or who refused toparticipate. We used a structured questionnaire on breastfeeding and breastfeeding technique, containing 34 questions,19 aimed at multiparous on previous experience with breastfeeding. We interviewed 50 pregnant women, 68% primiparous.About 76% of women felt that children should breastfeed exclusively breastfed until 6 months, and 80% consideredstrong breast milk. Regarding the benefits of breastfeeding for the health of women, 88% recognized the importance ofthis practice and pointed as the main benefit to reducing breast cancer (68%). Although most mothers present knowledgeabout the importance of breastfeeding, it is not yet satisfactorily applied in the practice of breastfeeding. Must stress theimportance of education initiatives and support breastfeeding from antenatal and even the phase of introduction of newfoods for optimal breastfeeding.

Utilization of intermittent preventive treatment for malaria among pregnant women attending antenatal clinics in health facilities of Cross River State, Nigeria.

ObjectiveThis study assessed the utilization of intermittent preventive treatment with sulfadoxine–pyrimethamine for the prevention of malaria in pregnancy against the national treatment policy among women attending health care facilities in Cross River State, Nigeria.MethodsA clinical audit was carried out between January 2012 and March 2012 using case records of pregnant women who received antenatal care in health facilities in the state. Facilities were selected by simple random sampling. Information on the frequency of antenatal clinic (ANC) visits by the women, as well as parity, age, and adherence to intermittent preventive treatment (IPTp) doses was obtained using an audit checklist.ResultsA total of 322 pregnant women were assessed across 36 health care facilities. In addition, 246 (76%) of them attended the ANC in public health facilities. Age, parity, and gestational age at booking were recorded in more than 95% of the cases evaluated. The audit showed that 13.7% of the women did not utilize IPTp, 53.1% had one dose of IPTp (IPTp1), 24.2% had two doses of IPTp (IPTp2), while 3.1% had three doses of IPTp (IPTp3). The overall utilization of two doses or more of IPTp (IPTp2+) was 30.7%.ConclusionThere was good documentation of the basic obstetric information of pregnant women in the health care facilities examined in this study, but the overall utilization of IPTp was very low. Efforts at ensuring early ANC booking and regular visits may be a potential means of increasing IPTp utilization in health care facilities in the state.