Use Of Antenatal Care Research Articles

Access, perceived quality and uptake of antenatal services in urban communities of Osun state, Southwest Nigeria.

Quality antenatal care (ANC) is one of the key interventions to improve intrapartum care uptakes and to reduce the menace of maternal deaths globally. Yet, ANC coverage has remained low in many developing countries like Nigeria. It becomes imperative to contextually understand factors associated with ANC uptake in Nigeria. The study assessed level of utilization, perceived quality, level of satisfaction and determinants of ANC utilization among women of reproductive age-group in Oshogbo, South-west Nigeria. Cross-sectional study design was employed and cluster sampling method was used to recruit 420 consenting respondents. Data were collected using pretested interviewer-administered, semi-structured questionnaire. Both descriptive and inferential <0.05. The mean (±SD) age of the respondents was 30.84±6.0 years. Almost three-quarters (73.9%) of the respondents had at least 4 ANC visits. Main reasons for non-ANC usage were high cost of care, long waiting time at the clinic, long distance to the clinic and unsatisfactory service quality. Only 59.9% of respondents were satisfied with services received while 63.1% of them rated the service quality as excellent. Main determinants of ANC uptake were respondents' age (AOR=2.35;95%CI=1.34-5.89), level of education (AOR=0.56;95% CI= 0.42-0.71), socio-economic status (AOR=5.22; 95%CI=2.02-6.65) and monthly family income (AOR=0.89; 95%CI=0.02-0.90). Although the rate of ANC use was high in the study setting, the proportion of women who were satisfied with service quality was sub-optimal. There is need for implementation of multi-pronged intervention to make ANC services more available, accessible, affordable and acceptable to the Nigerian women.

Sub optimal HIV status ascertainment at antenatal clinics and the impact on HIV prevalence estimates: A cross sectional study.

While many countries including Kenya transitioned from sentinel surveillance to the use of routine antenatal care (ANC) data to estimate the burden of HIV, countries in Sub Saharan Africa reported several challenges of this transition, including low uptake of HIV testing and sub national / site-level differences in HIV prevalence estimates. In Kenya voluntary HIV testing is offered to all 1st ANC clients. However, some women may decline testing. We aim to predict the HIV positivity (as a proxy of prevalence) at ANC assuming 100% uptake of HIV testing and compare this to the observed positivity. Using a cross sectional study design, we examine routine data on HIV testing among all women attending ANC in Kwale County, Kenya, for the period January 2015 to December 2019.We used a generalized estimating equation with binomial distribution to model the observed HIV prevalence as explained by HIV status ascertainment. We then used marginal standardization to predict the HIV prevalence at 100% HIV status ascertainment and make recommendations to improve the utility of ANC routine data for HIV surveillance. HIV testing at ANC was at 91.3%, slightly above the global target of 90%. If there was 100% HIV status ascertainment at ANC, the HIV prevalence would be 2.7% (95% CI 2.3-3.2). This was 0.3% lower than the observed prevalence. Across the yearly predictions, there was no difference between the observed and predicted values except for 2018 where the HIV prevalence was underestimated with an absolute bias of -0.2 percent. This implies missed opportunities for identifying new HIV infections in the year 2018. Imperfect HIV status ascertainment at ANC overestimates HIV prevalence among women attending ANC in Kwale County. However, the use of ANC routine data may underestimate the true population prevalence. There is need to address both community level and health facility level barriers to the uptake of ANC services.

Determinants of facility-based childbirth among adolescents and young women in Guinea: A secondary analysis of the 2018 Demographic and Health Survey.

Maternal mortality remains very high in Sub-Saharan African countries and the risk is higher among adolescent girls. Maternal mortality occurs in these settings mainly around the time of childbirth and the first 24 hours after birth. Therefore, skilled attendance in an enabling environment is essential to reduce the occurrence of adverse outcomes for both women and their children. This study aims to analyze the determinants of facility childbirth among adolescents and young women in Guinea. We used the Guinea Demographic and Health Survey (DHS) conducted in 2018. All females who were adolescents (15-19) or young women (20-24 years) at the time of their most recent live birth in the five years before the survey were included. We examined the use of health facilities for childbirth and its determinants selected through the Andersen health-seeking model using descriptive analysis and multilevel multivariable logistic regression. All descriptive and analytical estimated were produced by adjusting for the survey sampling using the svy option, including adjustment for clustering, stratification and unequal probability of selection and non-response (individual sample weights). The subpopulation option was also used to account for the variance of estimations. Overall, 58% of adolescents and 57% of young women gave birth in a health facility. Young women were more likely to have used private sector facilities compared to adolescents (p<0.001). Factors significantly associated with a facility birth in multivariable regression included: secondary or higher educational level (aOR = 1.86; 95%CI:1.24-2.78) compared to no formal education; receipt of 1-3 antenatal visits (aOR = 9.33; 95%CI: 5.07-17.16) and 4+ visits (aOR = 16.67; 95%CI: 8.82-31.48) compared to none; living in urban (aOR = 2.50; 95%CI: 1.57-3,98) compared to rural areas. Women from poorest households had lower odds of facility-based childbirth. There was substantial variation in the likelihood of birth in a health facility by region, with highest odds in N'Zérékoré and lowest in Labé. The percentage of births in health facilities among adolescents and young women in Guinea was 58%. This remains suboptimal regarding the challenges associated maternal mortality and morbidity issues in Guinea. Socio-economic characteristics, region of residence and antenatal care use were the main determinants of its use. Efforts to improve maternal health among this group should target care discontinuation between antenatal care and childbirth (primarily by removing financial barriers) and increasing the demand for facility-based childbirth services in communities, while paying attention to the quality and respectful nature of healthcare services provided there.

Use of antenatal and delivery care services and their association with maternal and infant mortality in rural India

Optimum use of antenatal care (ANC) and delivery care services could reduce morbidity and mortality among prospective mothers and their children. However, the role of ANC and delivery services in prevention of both maternal and child mortality is poorly understood, primarily because of dearth of prospective cohort data. Using a ten-years population-based prospective cohort data, this study examined the use of ANC and delivery services and their association with maternal and infant mortality in rural India. Descriptive statistics were estimated, and multivariable logistic regression modelling was used to attain the study objective. Findings revealed that consumption of ≥ 100 iron-and-folic acid (IFA) tablet/equivalent syrup during pregnancy had a protective association with maternal and infant mortality. Lack of maternal blood group checks during pregnancy was associated with increased odds of the death of infants. Caesarean/forceps delivery and delivery conducted by untrained personnel were associated with increased odds of maternal mortality. Findings from this study reemphasizes on increasing coverage and consumption of IFA tablets/equivalent syrup. Improved ANC and delivery services and increased uptake of all types of ANC and delivery care services are equally important for improvement in maternal and child survival in rural India.

Risk Deciphering Pathways from Women's Autonomy to Perinatal Deaths in Bangladesh.

The level of perinatal mortality in Bangladesh is one of the highest in the world. Certain childbearing practices and low use of antenatal care make Bangladeshi women vulnerable to adverse birth outcomes. Women in Bangladesh also remain considerably subordinate to men in almost all aspects of their lives, from education and paid work to healthcare utilisation. Lack of these opportunities contributes to the low status of women within family and society, and to generally poor health outcomes for women and their children. This study investigates the risk factors of perinatal deaths in light of the low level of women's autonomy, and the relative role of childbearing practices and antenatal care in influencing the relationship between autonomy and perinatal deaths. The relevant data was extracted from the 2014 Bangladesh Demographic and Health Survey. Causal mediation analysis was undertaken to investigate the effects of mediators on the associations between women's autonomy and perinatal deaths. The risk of perinatal deaths was greater by about 44% and 39% respectively for high-risk maternal age and birth interval. Those who had received sufficient antenatal care had a much lower risk of perinatal deaths compared to those who had not received sufficient care. No significant direct relationship between women's autonomy and perinatal deaths was evident. However, the influence of women's autonomy was mediated through maternal age, birth interval and antenatal care, and the average amount of mediation was approximately 9.7%, 25.6% and 9.9% respectively. In Bangladesh, although women's autonomy did not exert any significant direct influence on perinatal deaths, the influence was transmitted through the pathways of childbearing practices and use of antenatal care.

Knowledge and Breastfeeding Experience are Associated with High Levels of Exclusive Breastfeeding Self-Efficacy in Pregnant Women from Dobo, Maluku

Background: The rate of exclusive breastfeeding in Indonesia, including Maluku Province, was still low. One of the factors associated with exclusive breastfeeding is maternal self-efficacy. This study aimed to determine factors associated with high levels of exclusive breastfeeding self-efficacy amongst pregnant women living in the catchment area of Dobo and Siwalima Health Centers in Dobo, Aru Islands District, Maluku Province. Methods: This study was conducted in October 2021 using a cross-sectional research design. Using total population sampling, 146 pregnant women living in Dobo and Siwalima Health Center’s catchment area were selected and interviewed. We examined the role of different factors: mothers' sociodemographic characteristics, number of children, breastfeeding knowledge, social support, antenatal care use, and mothers' history of breastfeeding. Logistic regression analysis was performed to determine factors associated with high levels of exclusive breastfeeding self-efficacy in pregnant women. Results: We found that 61.6% of pregnant women had high levels of exclusive breastfeeding self-efficacy. The odds of high levels of exclusive breastfeeding self-efficacy significantly increased in pregnant women with high levels of breastfeeding knowledge (aOR=4.73; 95%CI: 1.44-15.52, p=0.010). The odds also increased in mothers who had ever exclusively breastfed their previous child (aOR = 5.10; 95% CI: 2.02-12.86, p=0.001) or had any experience with breastfeeding (aOR=0.48; 95%CI: 1.88-12, p=0.001). Conclusions: The level of knowledge about exclusive breastfeeding and previous breastfeeding experience was associated with the level of exclusive breastfeeding self-efficacy amongst pregnant women. Health promotion efforts, including health education and provision of support from health workers and family members for pregnant women who did not have any breastfeeding experience, were beneficial to improving exclusive breastfeeding self-efficacy.

Effects of a mHealth voice messaging intervention on antenatal care utilisation at primary care level in Lagos, Nigeria: a cluster randomised trial.

BackgroundNigeria has one of the lowest antenatal care (ANC) utilization rates compared to other low- and middle-income nations. In order to ensure a positive pregnant experience, the World Health Organization recommends at least eight ANC visits during pregnancy. This study intends to examine the impact of a mobile phone-based voice message intervention on ANC use in Lagos, Nigeria.MethodsIn this cluster-randomized experiment, primary healthcare centres were divided into five intervention and five control groups using multistage simple random sampling. The intervention consisted of a weekly voice message transmitted through mobile phone from the time of recruitment in the first trimester until two weeks postpartum. Attending at least eight ANC visits before birth was the primary outcome. STATA v17.0 was used to conduct descriptive and bivariate analyses as well as multivariate linear models to calculate crude risk ratios.Results458 women participated. All intervention group women (269 women, or 58.7% of the sample) received the text message. These ladies were mostly married, Christian, had several children, and had completed high school. Women who received the intervention were more likely to attend eight ANC visits.ConclusionA voice message-based intervention can boost ANC utilization, according to the conclusion. This contributes to the existing body of information about the influence of mHealth treatments on maternal health outcomes and serves as a useful tool for ensuring that no woman is left behind.

The Magnitude of Optimal Antenatal Care Utilization and Its Associated Factors among Pregnant Women in South Gondar Zone, Northwest Ethiopia: A Cross-Sectional Study

Background Adequate antenatal care is essential for the health of the mother and the development of the fetus. The World Health Organization recommends at least four antenatal care (ANC) visits during pregnancy. In Ethiopia, only 32% of women of childbearing age attend four or more ANC visits. This figure is significantly lower than the average for least developed countries. This study is aimed at calculating the magnitude and identifying the factors associated with optimal antenatal care utilization in the South Gondar Zone, Northwest Ethiopia. Methods A community-based cross-sectional study was conducted in the South Gondar Zone of Northwest Ethiopia from September 2020 to May 2021. A total of 434 participants were selected using multistage cluster sampling. Data were gathered through face-to-face interviews using a structured questionnaire. A multivariate binary logistic regression model was used to determine the factors associated with the optimal use of antenatal care. Result The magnitude of optimal antenatal care utilization was 59% (95% CI; 54.20, 63.65). The study showed that mothers who completed their secondary school (AOR = 8.205; 95% CI: 3.406, 19.767), women who completed their tertiary school (AOR = 6.406; 95% CI: 2.229, 18.416), women whose husbands' level of education is secondary school (AOR = 5.967; 95% CI: 2.753, 12.936), those with a planned pregnancy (AOR = 1.912; 95% CI: 1.117, 3.271), those with a wanted pregnancy (AOR = 2.341; 95% CI: 1.366, 4.009), women whose husbands work in the government or nongovernment sector (AOR = 3.736; 95% CI: 2.093, 6.669), those not being exposed to the media (AOR = 0.520; 95% CI: 0.345, 0.783), and rural women (AOR = 0.267; 95% CI: 0.164, 0.435) were significantly associated with optimal ANC utilization. Conclusion The findings suggest that more emphasis should be placed on education-based programs for women and their husbands that highlight the benefits of a planned pregnancy, desired pregnancy, and maternal health care. Meanwhile, the government and other concerned bodies should focus on expanding road accessibility, health institutions, and ambulance distribution to improve optimal ANC utilization in the area.

Effectiveness of modular approach in ensuring data quality in large-scale surveys: Evidence from National Family Health Survey – 4 (2015–2016)

This study aims to examine the effect of administration of shorter and longer versions of questionnaires on key indicators such as age displacement, birth displacement, age heaping, and skipping questions on antenatal care (ANC) visits and use of contraceptive methods in India using National Family Health Survey (NFHS)-4 data. At the individual level, the effect of the adoption of the shorter and longer versions of the questionnaires on the age displacement of women and children and skipping of the key questions is insignificant. However, the results from the two-level logistic regression model reveal that at the primary sampling unit (PSU) level, work pressure, depending on the number of eligible women in a household, emerges as a confounder in skipping certain questions, namely ANC [1.18 (p < 0.09)] and contraceptive use [AOR = 1.17 (p < 0.05)]. To expand the coverage of NFHS in providing state- and district-level estimates since 2015, the overall sample size was increased from 88,562 households and 89,777 eligible women in 1992–93 to 6,01,509 households and 6,99,686 eligible women in 2015–16. As a strategy to reduce workload and non-sampling errors during the survey, a nested design and modular approach were adopted to provide estimates of maternal and child health indicators at the district/state level and sexual behaviour, HIV/AIDS, and women's empowerment at the state level. It was hypothesised that a longer version of the questionnaire canvassed in the state module may be detrimental to data quality issues. The findings of this study establish the effectiveness of adopting a modular approach in large-scale surveys, depending on the scale of investigation. However, the differential workload calls for expanding the duration of surveys in PSUs, where the number of eligible women is higher. State level variation in the key data quality indicators may be partially explained by differentials in the training of investigators by the agency and use of translators.

Maternal exposure to intimate partner violence and uptake of maternal healthcare services in Ethiopia: Evidence from a national survey.

BackgroundWomen exposed to Intimate Partner Violence (IPV) often do not utilize maternal health care optimally both because of stigma and other social problems. The current study aims to explore an association between maternal healthcare seeking and violence exposure among Ethiopian women and to assess if educational attainment and wealth status moderate this association.MethodsThe analyses included 2836 (weighted) currently married women with one live birth. We focus on the five years preceding the 2016 Ethiopian Demographic and Health Survey (EDHS) who participate, in the domestic violence sub-study. Exposure was determined by maternal reports of physical, emotional, sexual IPV or any form of IPV. The utilization of antenatal care (ANC) and place of delivery were used as proxy outcome variables for uptake of skilled maternal healthcare utilization. Women’s education attainment and wealth status were selected as potential moderators, as they can enable women with psychological and financial resources to counteract impact of IPV. Multilevel logistic regression analyses were used to explore the association between spousal IPV and maternal health outcomes. Moderation effects by education and wealth status were tested, and the data stratified. Using statistical software Stata MP 16.1, the restricted maximum likelihood method, we obtained the model estimates.ResultsAbout 27.5% of the women who reported exposure to any form of IPV had a health facility delivery. While 23.4% and 22.4% visited four or more antenatal care services among mothers exposed to emotional IPV and sexual IPV, respectively. After adjusting for potential confounding factors, only the association between maternal exposure to emotional IPV and adequate use of ANC was statistically significant (OR = 0.73, (95% CI:0.56–0.95)). But we found no significant association between IPV and utilization of health facility delivery. Some moderation effects of education and wealth in the association between IPV and maternal healthcare service utilization outcome were found.ConclusionExposure to emotional IPV was associated with poor uptake of maternal health care service utilization for married Ethiopian women. While developing interventions to improve women’s maternal healthcare service use, it is crucial to consider the effects of socio-economic variables that moderate the association especially with the intersection of IPV.

Factors Associated with Late use of Antenatal Care in the City of Mbandaka, Equateur Province, Democratic Republic of Congo (DRC)

Introduction: The present study was conducted to identify factors associated with late recourse to prenatal consultation in the city of Mbandaka. Method: This study was based on a case-control survey. A total of 650 pregnant women (325 cases and 325 controls) responded to a structured questionnaire. Cases were pregnant women seen late in the ANC service and each was paired with a control who came to the first antenatal visit in the first trimester. The data were analysed using SPSS 22 software where multivariate analyses based on the logistic regression model allowed the research objectives to be met. The risk of error considered was 0.05. Results: The factors associated with late recourse to ANC were: cost of ANC (p&lt;0.01); lack of financial means (p&lt;0.01); lack of motivation (p&lt;0.01); shame (p&lt;0.01); unavailability of the pregnant woman (p&lt;0.01); traditional practice before performing ANC (p&lt;0.01); parity (p&lt;0.05) and marital status (p&lt;0.05). Conclusion: The use of ANC remains late in Mbandaka. Any action aimed at encouraging pregnant women to start ANC in the first trimester of pregnancy should focus on improving the socio-familial environment, the service offer, socio-economic characteristics, socio-cultural characteristics and socio-demographic characteristics.

Food Supplement Use Differs from the Recommendations in Pregnant Women: A Multinational Survey.

The aim was to investigate, among pregnant women, (1) the use of food supplements and (2) the awareness of food supplement recommendations and beliefs about food supplement use in four European countries: Finland, Italy, Poland, and the United Kingdom. The participants (n = 1804) completed an online questionnaire with predefined statements. Daily intakes of vitamins and minerals were calculated using uploaded pictures or weblinks of the supplement packages. Country differences were assessed. Most participants (91%) used at least one food supplement during pregnancy. A prenatal multivitamin was the most commonly used supplement type (84% of the users), and 75% of the participants thought consumption of multivitamin is recommended. Of the participants, 81% knew that folic acid is recommended during pregnancy while 58% knew the recommendation for vitamin D. In 19% of the supplement users, the daily safe upper intake limit of at least one nutrient was exceeded. Nevertheless, most participants agreed that they knew which supplements (91%) and doses of supplements (87%) needed to be used during pregnancy. To conclude, the majority of the participants used food supplements, but lower proportions knew and adhered to the recommended intakes. Between-country differences were observed in the use and knowledge of and beliefs regarding supplements. The results suggest a need for assessment and monitoring of supplement use in antenatal care to ensure appropriate use.

Factors associated with utilization of quality antenatal care: a secondary data analysis of Rwandan Demographic Health Survey 2020

BackgroundOver the last decade, progress in reducing maternal mortality in Rwanda has been slow, from 210 deaths per 100,000 live births in 2015 to 203 deaths per 100,000 live births in 2020. Access to quality antenatal care (ANC) can substantially reduce maternal and newborn mortality. Several studies have investigated factors that influence the use of ANC, but information on its quality is limited. Therefore, this study aimed to identify the determinants of quality antenatal care among pregnant women in Rwanda using a nationally representative sample.MethodsWe analyzed secondary data of 6,302 women aged 15–49 years who had given birth five years prior the survey from the Rwanda Demographic and Health Survey (RDHS) of 2020 data. Multistage sampling was used to select RDHS participants. Good quality was considered as having utilized all the ANC components. Multivariable logistic regression was conducted to explore the associated factors using SPSS version 25.ResultsOut of the 6,302 women, 825 (13.1%, 95% CI: 12.4–14.1) utilized all the ANC indicators of good quality ANC); 3,696 (60%, 95% CI: 58.6–61.1) initiated ANC within the first trimester, 2,975 (47.2%, 95% CI: 46.1–48.6) had 4 or more ANC contacts, 16 (0.3%, 95% CI: 0.1–0.4) had 8 or more ANC contacts. Exposure to newspapers/magazines at least once a week (aOR 1.48, 95% CI: 1.09–2.02), lower parity (para1: aOR 6.04, 95% CI: 3.82–9.57) and having been visited by a field worker (aOR 1.47, 95% CI: 1.23–1.76) were associated with more odds of receiving all ANC components. In addition, belonging to smaller households (aOR 1.34, 95% CI: 1.10–1.63), initiating ANC in the first trimester (aOR 1.45, 95% CI: 1.18–1.79) and having had 4 or more ANC contacts (aOR 1.52, 95% CI: 1.25–1.85) were associated with more odds of receiving all ANC components. Working women had lower odds of receiving all ANC components (aOR 0.79, 95% CI: 0.66–0.95).ConclusionThe utilization of ANC components (13.1%) is low with components such as having at least two tetanus injections (33.6%) and receiving drugs for intestinal parasites (43%) being highly underutilized. Therefore, programs aimed at increasing utilization of ANC components need to prioritize high parity and working women residing in larger households. Promoting use of field health workers, timely initiation and increased frequency of ANC might enhance the quality of care.

Identifying the association of women’s empowerment with reproductive and maternal health practices using a cross-sectional study in the context of self-help groups in rural India

Background: Globally, women’s empowerment is captured through different combinations of indicators related to their collective and individual empowerment. In this paper, the association of diverse domains related to women’s collective and individual empowerment on their reproductive and maternal health practices were assessed. Collective empowerment referred to a cluster of indicators measuring mutual support, rights, and access to services women received, as a result of membership in self-help groups (SHGs) focused on micro-finance activities. Women’s individual empowerment was measured through their perception to make decisions on their own, be mobile, financially self-reliant, self-confident in expressing themselves, having self-esteem and being free from spousal violence. Methods: Cross-sectional data were collected in 2017 from 2,197 SHG members across 57 administrative blocks of Uttar Pradesh, India. Using exploratory and confirmatory factor analysis, the sub-domains of individual and collective empowerment were developed. The reproductive and maternal health indicators included antenatal care, delivery preparedness, postnatal care and current contraceptive use. Bivariate and multivariate analyses, using logistic regression, were carried out to measure the association of sub-domains of women’s empowerment with health practices. Results: Collective and individual empowerment were independently and jointly associated with correct health practices. Women with greater empowerment through independent mobility, high self-esteem, access to financial resources, and confidence in interacting with a frontline worker, were more likely to access antenatal care. Similarly, delivery preparedness—which entailed deciding on the place of delivery, arranging for transportation during labor, and managing expenses for the delivery—was positively influenced by collective support from fellow SHG members. Receiving postnatal care was positively associated with self-confidence and financial autonomy, and current family planning method use was positively associated with self-confidence, lower spousal violence and confidence in support from the group. Conclusions: Women’s collective and individual empowerment were independently and jointly positively associated with health outcomes among SHG members.

Psychometric properties of the Pregnancy-Related Anxiety Scale-Screener.

Pregnancy-related anxiety, a distinct anxiety characterized by pregnancy-specific concerns, has consistently been associated with adverse birth outcomes and obstetric and pediatric risk factors. Despite this, widespread screening for pregnancy-related anxiety has not been integrated into routine antenatal care likely due to the absence of a psychometrically sound screener. This study reports on the initial development of a brief screener derived from the 32-item pregnancy-related anxiety scale (PrAS). Three datasets (comprising pregnant women recruited online) were utilized in the development and evaluation of the PrAS screener (PrAS-Screener). Dataset one (N = 1,084) was used to derive two potential screeners from the PrAS using principal axis factoring (PAF). The factor structure of the models was evaluated using PAF and model fit assessed with confirmatory factor analysis (CFA) using datasets two (N = 638) and three (N = 581). The model comprised 15 items and five subscales was selected as the superior model. The selected model (i.e., PrAS-Screener) was evaluated for convergent and discriminant validity demonstrating higher correlations with similar measures and lower correlations with dissimilar measures and high internal consistency reliability (α = .93). The PrAS-Screener assesses the three core areas of pregnancy-related anxiety (childbirth, body image, baby concerns) but has the advantage of also assessing anxiety symptoms and medical staff concerns, an area integral to providing optimal antenatal care through trusted relationships with clinicians. Initial evidence indicates that the PrAS-Screener is promising as a brief and easy-to-administer screener suitable for use in routine antenatal care. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Country of birth as a potential determinant of inadequate antenatal care use among women giving birth in Brussels. A cross-sectional study.

One of the mechanisms explaining perinatal health inequalities could be inadequate antenatal care among some immigrant groups. Few European studies compared antenatal care use between different groups of immigrants taking into account individual characteristics. This research investigates the associations of three birth regions with the use of antenatal care, by also considering socioeconomic and migration-related determinants. We included 879 mothers born in Belgium, North Africa, and Sub-Saharan Africa, and interviewed them in four Brussels hospitals after they gave birth, using an adapted version of the Migrant-Friendly Maternity Care Questionnaire. We additionally collected clinical data from hospital records. We carried out descriptive analyses and ran univariate and multivariable logistic regression models to estimate the associations of socioeconomic and migration characteristics with a) late start of antenatal care and b) less than minimum recommended number of consultations. The vast majority of women in this study had adequate care in terms of timing (93.9%), frequency of consultations (82.2%), and self-reported access (95.9%). Region of birth was an independent risk factor for late initiation of care, but not for infrequent consultations. Women born in Sub-Saharan Africa were more prone to accessing care late (OR 3.3, 95%CI 1.5-7.7), but were not more at risk of infrequent consultations. Women born in North Africa, had similar adequacy of care compared to the Belgium-born population. The three groups also differed in terms of socioeconomic profiles and socioeconomic predictors of antenatal care use. Housing type, professional activity, and health insurance status were important predictors of both outcomes. This study showed that the region of birth was partly associated with adequacy of care, in terms of initiation, but not number of consultations. Further dimensions of adequacy of care (content, quality) should be studied in the future. Socioeconomic factors are also key determinants of antenatal care use.

Factors Associated with the Four-Visit ANC in Indonesia: A population-based study

Introduction: The number of maternal, neonatal and child mortality remains high in developing countries, including Indonesia. Antenatal care (ANC) coverage is an indicator of health-care use and access during pregnancy. Receiving at least four visits of ANC increases the chances of receiving appropriate maternal health interventions as one of the tracer indicators for universal health coverage in the Global Strategy for Women's, Children's, and Adolescents' Health Monitoring Framework (SDG indicator 3.8.1). The study aims to investigate the distribution and the factors associated with the four-visit ANC across urban and rural areas in Indonesia. Methods: We used data from the 2017 Indonesia Demographic and Health Survey, a large-scale nationally representative cross-sectional survey of women aged 15–49 years old (n=15,288). The use of ANC for the MNCH system is the dependent variable. The determinants are individual characteristics, family factors, and community factors. Results: Age, parity, household income, and distance from health facilities are significant factors associated with the four-visit ANC, as the first step in achieving continuum of care for MNCH. Urban women who had been pregnant 1–2 times or 3–4 times were 6.475 (95% Confidence Interval (95%CI) = 4.750–9.306) and 3.109 (95% CI = 2.268–4.262) times more likely to have at least four ANC visits than those who had been pregnant five times or more. Conclusion: Developing a health system, human resources, health facilities, and infrastructure are crucial for overcoming maternal and child health problems, especially in rural areas to make ANC universally affordable and accessible.

Predictors of health facility childbirth among unmarried and married youth in Uganda.

Uganda has a high maternal mortality rate combined with poor use of health facilities at childbirth among youth. Improved use of maternal health services by the youth would help reduce maternal deaths in the country. Predictors of use of health facilities at childbirth among unmarried compared to married youth aged 15-24 years in Uganda between 2006 and 2016 are examined. Binary logistic regression was conducted on the pooled data of the 2006, 2011 and 2016 Uganda Demographic and Health Surveys among youth who had given birth within five years before each survey. This analysis was among a sample of 764 unmarried, compared to 5,176 married youth aged 15-24 years. Overall, unmarried youth were more likely to have a childbirth within the health facilities (79.3%) compared to married youth (67.6%). Higher odds of use of health facilities at childbirth were observed among youth with at least secondary education (OR = 2.915, 95%CI = 1.747-4.865 for unmarried vs OR = 1.633, 95%CI = 1.348-1.979 for married) and frequent antenatal care of at least four visits (OR = 1.758, 95%CI = 1.153-2.681 for unmarried vs OR = 1.792, 95%CI = 1.573-2.042 for married). Results further showed that youth with parity two or more, those that resided in rural areas and those who were engaged in agriculture had reduced odds of the use of health facilities at childbirth. In addition, among married youth, the odds of using health facilities at childbirth were higher among those with at least middle wealth index, and those with frequent access to the newspapers (OR = 1.699, 95%CI = 1.162-2.486), radio (OR = 1.290, 95%CI = 1.091-1.525) and television (OR = 1.568, 95%CI = 1.149-2.138) compared to those with no access to each of the media, yet these were not significant among unmarried youth. Frequent use of antenatal care and higher education attainment were associated with increased chances of use of health facilities while higher parity, rural residence and being employed in the agriculture sector were negatively associated with use of health facilities at childbirth among both unmarried and married youth. To enhance use of health facilities among youth, there is a need to encourage frequent antenatal care use, especially for higher parity births and for rural residents, and design policies that will improve access to mass media, youth's education level and their economic status.

Factors Influencing Male Partner’s Knowledge on Their Role during Antenatal Care in Mangu, Nakuru Country

Male participation is key in the implementation and use of Antenatal Care (ANC) amenities. Over the years, there has been a slight increase in male participation in reproductive health. However, there is evidence that majority of those who participate do not understand their role in ANC. This study aimed to establish males' knowledge regarding their role in the ANC continuum. The study design was cross-sectional. The study population consisted of males with female partners aged 18-49 years who live in Mangu town, Nakuru County, Kenya, and have had a full-term delivery within the past 5 years. A sample of 73 respondents was recruited for the study. Structured questionnaires were used to collect data. The collected data were analyzed using descriptive statistics. Majority of the respondents (45.2%) were between ages 31-40 years. The main source of credible knowledge on ANC were health care providers, 71.2% of the respondents who escorted their female partners to ANC clinics waited outside the consultation room as their female partners sought medical attention hence, they either had little or completely no knowledge on ANC. Male's knowledge of ANC is influenced by age, type of family (monogamy or polygamy), level of education and caregiver’s attitude. Male partners should be provided with targeted education regarding their role in the ANC continuum.

Determinants of Intimate Partner Violence against Pregnant Women in Ethiopia: A Systematic Review and Meta-Analysis.

Background Intimate partner violence (IPV) against pregnant women is a recognized global public health problem affecting all spheres of women and unborn infants. In Ethiopia, although inconsistent, individual studies avail; there is a dearth of systematic reviews and meta-analysis about the prevalence and associated factors of intimate partner violence. Thus, the present study was aimed at determining the pooled prevalence of IPV and its determinant factors during pregnancy. Methods The report of meta-analysis follows the Preferred Reporting Items for Systematic Review and Meta-Analysis 20 guideline (PRISMA 20). Databases including PubMed/Medline, CINAHL, SCOPUS, HINARI (research4life), AJOL, IRIS, and AIM were searched. Heterogeneity test was assessed by the Cochrane chi-square (χ2) and quantified by I2 statistics test. Publication bias was tested by funnel plots and Egger's test. Sensitivity test and subgroup analysis were also performed. Effect size was calculated by random effects model. Results A total of 26 studies, including data from 13, 912 participants, were included in the analysis. The prevalence of IPV ranged from 7% to 81% with overall estimated pooled prevalence of 37% (30% -44%, I2 = 96.5%, p ≤ 0.001). Of this, the prevalence of physical, sexual, and psychological violence was 24% (95% CI; 19%-30%), 21% (95% CI; 16%-26%), and 27% (95% CI; 22%-32%), respectively. Factors such as lack of formal education, childhood violence, rural residency, low decision-making power, family history of violence, attitude, unplanned and unwanted pregnancy by women and partners, late initiation of antenatal care, partner alcohol, and khat use were associated with IPV. Conclusion More than one-third of pregnant women experienced IPV. The most prevalent form of IPV was psychological violence followed by physical and sexual violence. The identified risk for IPV including victim, pregnancy, and perpetrator-related factors indicated the need of a holistic approach in the promotion, prevention, and treatment of IPV. The finding of this study suggests the need of strengthening women empowerments (capacity building) against traditional beliefs, attitudes, and practices. This study also suggests the need of evaluation and strengthening the collaborative work among different sectors such as policy-makers, service providers, administrative personnel, and community leaders, including the engagement of men partners.