Antenatal Services Research Articles

Level of Autonomy and Antenatal Services Utilization among the Women of Reproductive age Group Residing in an Urban Municipality of Lalitpur

Introduction: Antenatal care is one of the pillars of a safe motherhood programme in improving maternal and child health. Women’s autonomy is seen as an important factor in utilization of maternal health services. Therefore, the objective of study was to find the level of autonomy and utilization of antenatal services among the women of reproductive age group. Methods: A descriptive cross-sectional study design was used. A total of 151 women of reproductive age group having at least one child in the age group of less than one year were selected using non probability purposive sampling technique from four randomly selected wards of Godawari Municipality. A validated and pretested Nepali version interview schedule was used to collect data from the respondents through door-to-door visit. Descriptive statistics such as frequency, percentage, mean, standard deviation and inferential statistics i.e. Fisher’s exact test was used to analyze data. Results: The study findings revealed that the majority (58.3%) of respondents had a lower level of overall autonomy. The highest autonomy was seen in decision making and lowest in financial related issues. Almost all (96%) of the respondents had fully utilized antenatal services. There was significant association between antenatal services utilization with women’s autonomy (p-value 0.041). Education of women and their husbands (p-value 0.009 and 0.013 respectively) as well as easy access to health facilities and availability of private transportation (p-value 0.005 and 0.039 respectively) were significantly associated with utilization of antenatal services. Conclusions: This study concludes that women’ autonomy tends to influence their antenatal services utilization. Likewise, education of women as well as their husbands tends to facilitate utilization of antenatal services. The study also concludes that easy access to health facilities and availability of private vehicles facilitates utilization of antenatal services.

The Effect of Service and Satisfaction of Pregnant Women on Antenatal Visits to Midwives

The utilization of antenatal services for pregnant women can be determined based on the achievements of K1 (first contact) and K4 (4 times contact) during pregnancy with competent and authorized health workers. The World Health Organization asserts that the attitude and performance of health workers are an essential elements of service quality as it affects the understanding and satisfaction of women, partners, and families in seeking ANC, delivery, and postnatal services. The objective of this research is to examine the effect of antenatal care by midwives and the satisfaction of pregnant women on antenatal visits. The type of this research is analytic observational with a cross-sectional design, performed from March - June in Kupang City. The research subjects were 120 pregnant women with a gestational age of 36 weeks. Data collection employed questionnaires and MCH Handbook. The analysis conducted was univariate and bivariate by employing the Chi-square test with Alpha = 0.05. The results of the study on 120 pregnant women demonstrated that most of the pregnant women received good service (98.3%) and most of whom (60%) were satisfied with the services they experienced. Seventy-one people (59.2%) possessed complete visits. The Chi-square test results revealed relationship between service and satisfaction of pregnant women with antenatal visits (p = 0.652, p = 0.324). The majority of pregnant women had thorough consultations, received adequate antenatal care, and were pleased with the services they received. In addition to satisfaction, health services and programs must be performed in accordance with local culture and language in order to be accepted by the community, encompassing a decision-making culture that can influence pregnant women's visits to health facilities. Distance, education, profession, parity, and the husband's support can all have an impact on the mother's adherence to antenatal visits.

Association between Services of Antenatal Care and Health Complications among Mother and Newborn in Ranya District

Background: globally maternal and neonatal mortality and morbidity identified as public health burden for this reason according to recommendation WHO 2016 guideline providing new model of antenatal care with adequate quality and number visits is responsible to decrease this risk among pregnant women and their neonates. Objectives: objective of this study was to identify association between of antenatal care services with pregnancy outcome health status. Methodology: this study employed quantitative design retrospective cohort study performed in Rania pediatric and maternal teaching hospital and 207 cases were collected. Questionnaire was consisted of demographic profile, antenatal care, maternal and neonatal health status information was constructed to collect data through interview technique face to face approach from 6 Jun to 7 July, a descriptive statistic used to assess frequency and percentage, inferential statistic chi square test applied to detect association between variables, the data analysis was done through statistical package for social science of software (SPSS V25). Results: Results revealed that 99% of samples attended to antenatal care clinics, 80.6% initiated first visit in the first trimester and 69.6% performed 4 - 8 visits, moreover 47.8 % samples identified as perceived adequate care during pregnancy, and 50.7% mostly adequate care. Furthermore results illustrate that There was statistically significant association between Services of antenatal care and newborn health status (P = 0.029), however there was no significant association with mother health (P = 0.191). Conclusion: pregnant woman’s awareness to attended antenatal clinics and services of ANC slightly high in this area so mothers with mostly adequate care had composed high proportion with no complication after delivery.

Drug use in pregnancy in Ireland’s capital city: A decade of trends and outcomes

ObjectiveThe aim of this study was to present contemporary trends in opiate use disorder (OUD) and substance use in pregnancy in Ireland, with associated obstetric outcomes, over the last ten years. Study designThis retrospective observational cohort study was conducted at an Irish tertiary maternity unit. All women with OUD or substance use in pregnancy delivered under this service between 2010 and 2019 were included. Drug-exposure was self-reported. Data was collected by combining electronic and hand-held patient records. Trends and outcomes were analysed by year of delivery. Approval for the study was granted by the institution’s clinical governance committee. ResultsOf the 82,669 women delivered, 525 had OUD or substance use in pregnancy (1 in every 160 women booking). 11.6% were homeless, 20.0% were in full-time employment and 91.0% smoked tobacco in pregnancy. 66.3% had a history of psychiatric disorders.Over the ten years, there was a significant reduction in women delivered with OUD or substance use in pregnancy (0.8 % to 0.4 %, RR 0.55, 95 % CI 0.36–0.85), significant reduction in the proportion of women on Opioid-Substitute-Treatment (OST, RR 0.66 95 % CI 0.51–0.87) and an increase in mean maternal age (30.7to32.0 years). Rates of cocaine and cannabis consumption increased (20.6 %, RR 3.8, 95 % CI 1.57–9.44: 24.0 %, RR 3.7, 95 % CI 1.58–8.86 respectively).The maternal mortality rate was 380.9:100,000 births. The perinatal mortality rate was 15.6:1000 births. The preterm birth rate was 17.9 %, with a mean birth weight of 2832 g. The rate of NICU admission was 52.0 % and the mean length of stay was 22.4 days. Amongst the smaller OUD population, the rate of NICU admission for Neonatal Abstinence Syndrome (NAS) and treatment for NAS increased over the study timeframe (36.0 %, RR 2.97, 95 % CI 1.86–4.75: 28.5 %, RR 2.92, 95 % CI 1.70–5.0 respectively). ConclusionsThe obstetric population attending an Irish antenatal service with opiate use disorder or substance exposure is reducing in size with older patients, less opioid substitute therapy and increasing cocaine and cannabis use. These women have high rates of maternal and perinatal morbidity and mortality. Specialist antenatal addiction services, coordinated by the drug-liaison midwife, are critical in adapting care to respond to this dynamic and vulnerable patient cohort.

Disruption to antenatal and postnatal services during the COVID-19 pandemic: Experience in a selected Medical Officer of Health area in Colombo District

The Sri Lanka Journal of Perinatal Medicine (SLJPM) was launched in 2019 as the official journal of the Perinatal Society of Sri Lanka. This journal is unique in the fact that it brings together three core specialties of perinatal medicine - obstetrics, neonatology and community medicine. It is an open access peer reviewed journal containing original research articles, expert reviews, current practices and other articles of interest to all involved in perinatal medicine.

Classifying caesarean section to understand rising rates among Palestinian refugees: results from 290,047 electronic medical records across five settings

BackgroundRising caesarean-section rates worldwide are driven by non-medically indicated caesarean-sections. A systematic review concluded that the ten-group classification system (Robson) is the most appropriate for assessing drivers of caesarean deliveries. Evidence on the drivers of caesarean-section rates from conflict-affected settings is scarce. This study examines caesareans-section rates among Palestinian refugees by seven-group classification, compares to WHO guidelines, and to rates in the host settings, and estimates the costs of high rates.MethodsElectronic medical records of 290,047 Palestinian refugee women using UNRWA’s (United Nations Relief and Works Agency for Palestine Refugees in the Near East) antenatal service from 2017–2020 in five settings (Jordan, Lebanon, Syria, West Bank, Gaza) were used. We modified Robson criteria to compare rates within each group with WHO guidelines. The host setting data were extracted from publicly available reports. Data on costs came from UNRWA’s accounts.FindingsPalestinian refugees in Gaza had the lowest caesarean-section rates (22%), followed by those residing in Jordan (28%), West Bank (30%), Lebanon (50%) and Syria (64%). The seven groups caesarean section classification showed women with previous caesarean-sections contributed the most to overall rates. Caesarean-section rates were substantially higher than the WHO guidelines, and excess caesarean-sections (2017–2020) were modelled to cost up to 6.8 million USD. We documented a steady increase in caesarean-section rates in all five settings for refugee and host communities; refugee rates paralleled or were below those in their host country.InterpretationCaesarean-section rates exceed recommended guidance within most groups. The high rates in the nulliparous groups will drive future increases as they become multiparous women with a previous caesarean-section and in turn, face high caesarean rates. Our analysis helps suggest targeted and tailored strategies to reduce caesarean-section rates in priority groups (among low-risk women) organized by those aimed at national governments, and UNRWA, and those aimed at health-care providers.

How valid are women’s reports of the antenatal health services they receive from Community Health Workers in Gombe State north-eastern Nigeria?

BackgroundCommunity health workers (CHWs) in low- and middle-income countries are key to increasing coverage of maternal and newborn interventions through home visits to counsel families about healthy behaviours. Household surveys enable tracking the progress of CHW programmes but recent evidence questions the accuracy of maternal reports. We measured the validity of women’s responses about the content of care they received during CHW home visits and examined whether the accuracy of women’s responses was affected by CHW counselling skills.MethodsWe conducted a criterion validity study in 2019, in Gombe State-Nigeria, and collected data from 362 pregnant women. During accompanied CHW home visits the content of CHW care and the presence or absence of 18 positive counselling skills were observed and documented by a researcher. In a follow-up interview three months later, the same women were asked about the care received during the CHW home visit. Women’s reports were compared with observation data and the sensitivity, specificity, and area under receiver curve (AUC) calculated. We performed a covariate validity analysis that adjusted for a counselling skill score to assess the variation in accuracy of women’s reports with CHW counselling skills.ResultsTen indicators were included in the validity analysis. Women consistently overestimated the content of care CHWs provided and no indicator met the condition for individual-level accuracy set at AUC ≥ 0.6. The CHW counselling skill score ranged from 9–18 points from a possible 18, with a mean of 14.3; checking on client history or concerns were the most frequently missed item. There was evidence that unmarried women and the relatively most poor women received less skilled counselling than other women (mean counselling scores of 13.2 and 13.7 respectively). There was no consistent evidence of an association between higher counselling skill scores and better accuracy of women's reports.ConclusionsThe validity of women's responses about CHW care content was poor and consistently overestimated coverage. We discuss several challenges in applying criterion validity study methods to examine measures of community-based care and make only cautious interpretation of the findings that may be relevant to other researchers interested in developing similar studies.

Implication des maris dans les soins anténatals: enquête sur les facilitateurs et les barrières: Cas des habitants de Bosomtwe au Ghana

RésuméContexteCet article a abordé les facilitateurs et les obstacles relatifs à l’implication des maris dans les soins prénatals dans le district de Bosomtwe au Ghana, du point de vue des maris, des femmes enceintes avec et sans expérience d'accouchement, des mères allaitantes, des sage-femmes et des accoucheuses traditionnelles.MéthodologieL’étude s’est basée sur une conception de recherche qualitative pour recueillir et analyser les données sur les facilitateurs et les obstacles relatifs à l’implication des maris dans les soins prénatals. Le champ d’analyse était constitué de 36 participants, dont 14 maris, 8 femmes enceintes ayant déjà accouché et mères allaitantes, 6 femmes enceintes n’ayant jamais accouché, 6 sage-femmes et 2 accoucheuses traditionnelles—sélectionnés délibérément. Les données de l’étude ont été recueillies par le biais d'entretiens approfondis et analysées par l’approche du contexte.RésultatsNombreux facteurs empêchent la participation active des maris aux soins prénatals. Ces facteurs sont d’ordre économique (contraintes de temps), culturels (l’association de la maternité et ses obligations aux femmes) et le système de santé (manque de Services prénatals destinés aux maris et le comportement des personnels de santé). Malgré cela, certains maris ont participé aux soins prénatals en raison de l'importance qu'ils accordent à la santé et à la sécurité de leurs femmes et du fœtus, de l'évolution des rôles de chacun des sexes et des traitements préférentiels reçus par leurs femmes dans les maternités (en raison de la participation de leurs maris aux soins prénatals).ConclusionLa mise en œuvre des stratégies alternatives, telles que le conseil aux couples, la prolongation des heures d’ouverture des centres de santé pour accueillir les hommes fonctionnaires, est recommandée afin d'offrir aux maris un moyen plus souple et plus attrayant de soutenir leurs femmes pendant la grossesse. Ces efforts doivent être renforcés par tous dans la société en modifiant l’opinion erronée selon laquelle la conception de la grossesse et l’éducation de l’enfant sont les devoirs de la femme seule.

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.

Exploring the Knowledge, Attitude, and Practices of Healthy Pregnant Women Towards Gestational Diabetes Mellitus in Nigeria.

Gestational Diabetes Mellitus (GDM) is a major public health issue and a threat to the well-being of a mother and her offspring. As a growing concern in sub-Saharan Africa, this paper explores the knowledge, attitude, and practices of healthy expectant mothers towards GDM, and the content of GDM information delivered by prenatal nurses during Antenatal Clinic (ANC) in Warri, Delta State, Nigeria. Semi-structured telephone interviews were employed with 22 participants comprising 20 pregnant women and 2 antenatal nurses. The results reveal that majority of the pregnant women were unaware of GDM as a particular health condition during pregnancy that poses a risk to both maternal and infant health and could lead to a long-term risk of developing the chronic condition of Type 2 Diabetes Mellitus (T2DM). This low level of awareness was attributed to a lack of adequate information during prenatal clinic sessions. The findings from this study emphasize the need to enhance the quality of public health education offered to pregnant women during pre and antenatal clinical services emphasizing GDM as part of the overall global agenda on promoting maternal and infant health.

Effect of community-level intervention on antenatal care attendance: a quasi-experimental study among postpartum women in Eastern Uganda

ABSTRACT Background Early Initiation of antenatal care (ANC) and at least four visits during pregnancy allow screening and support for a healthy lifestyle and self-care during pregnancy however, community-directed interventions to improve access to these services are rarely explored. Objective To assess the effect of community health worker (CHW) involvement on utilisation of antenatal services during pregnancy in resource-constrained rural settings in Uganda. Methods We conducted a quasi-experimental evaluation study among mothers from Eastern Uganda. We used Difference in Differences (DiD) analysis to assess the effect of CHW intervention on ANC attendance. Components of the intervention included community dialogues and empowering CHWs to educate pregnant women about using maternal health services. The primary endpoints were early initiation of ANC and completion of at least 4 ANC visits. Results Overall, the intervention significantly improved attendance of ≥ 4 ANC visits (DiD = 5.5%). The increase was significant in both intervention and comparison areas (46.2–64.4% vs. 54.1–66.8%, respectively), with slightly greater gains in the intervention area. Other elements that predicted ≥4 ANC attendance besides the intervention were post-primary education (PR1.14, 95%CI 1.02–1.30), higher wealth quintile (PR1.17, 95%CI 1.06–1.30), and early initiation of ANC (PR1.58, 95%CI 1.49–1.68). The intervention did not significantly improve early initiation of ANC (DiD =-1.3%). Instead, early initiation of ANC was associated with higher husband education (PR1.19,95%CI 1.02–1.39), larger household size (PR = 0.81, 95%CI 0.70–0.95), and higher wealth index (PR1.19,95%CI 1.03–1.37). Conclusions The CHW intervention improved attendance of at least 4 ANC visits but not early initiation of ANC. There is need to promote CHW-led health education to increase attendance at 4+ ANC visits, but other approaches to promote early initiation are urgently required.

Quality and Integrated Service Delivery: A Cross-Sectional Study of the Effects of Malaria and Antenatal Service Quality on Malaria Intervention Use in Sub-Saharan Africa.

Using regionally linked facility and household surveys, we measured the quality of integrated antenatal care and malaria in pregnancy services in Kenya, Namibia, Senegal, and Tanzania. We examined country heterogeneities for the association of integrated antenatal and malaria service quality scores with insecticide-treated bed net (ITN) use in pregnant women and children under-five and intermittent preventive treatment in pregnancy (IPTp-2) uptake. Malaria in pregnancy service quality was low overall. Our findings suggest modest, positive associations between malaria in pregnancy quality and ITN use and IPTp-2 uptake across pooled models and for most studied countries, with evidence of heterogeneity in the strength of associations and relevant confounding factors. Antenatal care quality generally was not associated with the study outcomes, although a positive interaction with malaria in pregnancy quality was present for pooled ITN use models. The improved quality of malaria services delivered during formal antenatal care can help address low coverage and usage rates of preventive malaria interventions in pregnancy and childhood. Study findings may be used to target quality improvement efforts at the sub-national level. Study methods may be adapted to identify low-performing facilities for intervention and adaption to other areas of care, such as HIV/AIDS, child immunizations, and postnatal care.

Pattern of Congenital Heart Diseases among Term and Preterm Neonates in a Tertiary Care Hospital of a Developing Country

Objective: To determine the frequency and pattern of various congenital heart diseases in a tertiary care hospital neonatal unit.&#x0D; Study Design: Prospective longitudinal study.&#x0D; Place and Duration of Study: Neonatal Unit of Pak Emirates Military Hospital, Rawalpindi Pakistan from Jul 2015 to Jun 2018.&#x0D; Methodology: All neonates admitted to the Neonatal Unit of Pak Emirates Military Hospital, Rawalpindi Pakistan, suspected of having congenital heart disease were included in the study. Suspicion for CHD was based on the presence of murmur, cyanosis with or without feeding difficulty, signs of congestive heart failure, and variation in pre and post-ductal SpO2 reading. Echocardiography was performed on all neonates by a Paediatric cardiologist to determine diagnosis and type of lesion.&#x0D; Results: One hundred and thirty-one neonates were found to have congenital heart disease with male predominance, with 79(60.3%) males and 52(39.7%) females. Ventricular Septal Defect (VSD) was the most common lesion occurring in 44(33.6%) neonates, followed by PDA in 28(21.37%) neonates. CHD occurred more frequently in term neonates (62.0%) than preterm neonates (38.0%).&#x0D; Conclusion: Congenital heart disease is the most common congenital malformation, with Asia having the highest prevalence worldwide. Lack of specialized antenatal and neonatal health services and paucity of diagnostic facilities lead to delays in diagnosis, increasing morbidity and mortality of CHD cases. Therefore, drastic measures are required to improve neonatal health and transport facilities in our country to mitigate the impact of this disease.

Examining socioeconomic status disparities in facility-based childbirth in Kenya: role of perceived need, accessibility, and quality of care

BackgroundGiving birth in health facilities with skilled birth attendants (SBAs) is one of the key efforts promoted to reduce preventable maternal deaths in sub-Saharan Africa. However, research has revealed large socioeconomic status (SES) disparities in facility-based childbirth. We seek to extend the literature on the factors underlying these SES disparities. Drawing on the Disparities in Skilled Birth Attendance (DiSBA) framework, we examined the contribution of three proximal factors—perceived need, accessibility, and quality of care—that influence the use of SBAs.MethodsWe used data from a survey conducted in Migori County, Kenya in 2016, among women aged 15–49 years who gave birth nine weeks before the survey (N = 1020). The primary outcome is facility-based childbirth. The primary predictors are wealth, measured in quintiles calculated from a wealth index based on principal component analysis of household assets, and highest education level attained. Proposed mediating variables include maternal perceptions of need, accessibility (physical and financial), and quality of care (antenatal services received and experience of care). Logistic regression with mediation analysis was used to investigate the mediating effects.ResultsOverall, 85% of women in the sample gave birth in a health facility. Women in the highest wealth quintile were more likely to give birth in a facility than women in the lowest quintile, controlling for demographic factors (adjusted odds ratio [aOR]: 2.97, 95% CI: 1.69–5.22). College-educated women were five times more likely than women with no formal education or primary education to give birth in a health facility (aOR: 4.96; 95% CI: 1.43–17.3). Women who gave birth in health facilities had higher perceived accessibility and quality of care than those who gave birth at home. The five mediators were estimated to account for between 15% and 48% of the differences in facility births between women in the lowest and higher wealth quintiles.ConclusionOur results confirm SES disparities in facility-based childbirth, with the proximal factors accounting for some of these differences. These proximal factors – particularly perceived accessibility and quality of care – warrant attention due to their relationship with facility-birth overall, and their impact on inequities in this care.

Antenatal care service utilization among women who gave birth amid COVID-19 pandemic in Wollega Zone, West Ethiopia: Community based cross-sectional study

Background: Starting from the day it was declared as an outbreak the novel coronavirus disease (COVID-19) has been observed in almost all countries and costing the lives of hundreds of thousands. The counter effect of preventive measurements is believed to affect the health of many vulnerable populations including pregnant mothers. Hence, this study was aimed to assess antenatal care service utilization and associated factors among women who gave birth amid the pandemic in West Ethiopia. Methods: A community-based cross-sectional study was carried out in selected districts of West Ethiopia. A systematic random sampling technique was used to select the study participants. Epi data version 3.1 and Statistical Package for the Social Sciences window (SPSS) version 25.0 were used for data entry and analysis respectively. Both bivariable and multivariable logistic regression was done. Results: A total of 827 participants were involved in the study with a response rate of 97.87 %. The prevalence of antenatal cares service utilization among mothers who gave birth during the pandemic was 54.4 % with 95% (51.0, 57.6). Age of mother, residence, occupation of mother, educational level of the mother, fear related to spreading of COVID-19 in the community, fear of being infected, following government guidelines, using a facemask, covering face and mouth when coughing, and level of practice towards covid-19 prevention measures had a statistically significant association with antenatal cares service utilization. Conclusion: The finding of the study revealed that there is a low antenatal care service utilization during the pandemic. Hence, health care providers should strengthen the integration of messages on COVID-19 prevention measures and health education with pregnancy risk, family planning and postnatal care. It is also advisable to start technology-based services to avert the transportation and related problems.

Veracity of universal health coverage of maternal and neonatal health care among slum dwellers in a metropolitan city of India – Factors aiding access to and cost of availing these services to the poorest household

BackgroundMaternal, newborn and child essential health services are used as tracer indicators for monitoring universal health coverage among countries. This study aims to measure accessibility, factors aiding access, its associated cost of maternal and neonatal health services (M&NHS) among slum dwellers of Chennai. MethodologyCross sectional study design with cluster sampling using Probability Proportion Sampling. The study participants were mothers with at least one child delivered alive in the preceding one year. ResultMost women availed antenatal and intranatal services (99% had ten antenatal visits, institutional delivery, immunization, 88.5% had two USG) while Postnatal services was low (34%). Women preferred combination of public and private facility for antenatal out-patient (80%), private for postnatal in-patient (66.7%) and public facilities for intranatal (90%) services. Influencing factor for public facility was free services and claiming cash benefit, for private it was perceived good care and physical proximity. Out of pocket expenditure was highest among users of private facility. Households with catastrophic expenditure were 54.2% (95% CI: 50.03%–58.37%). Use of exclusive private facility had highest risk (OR 60.7 and 73.8) of catastrophic expenditure. ConclusionAlthough every woman availed M&NHS, proportion of households facing catastrophic health expenditure was high especially among those using private health facilities. This gap in provision of financial risk protection may push households into eternal poverty and fails the effort to achieve Universal Health Coverage for the poorest.

Window of opportunity: screening for GCK monogenic diabetes in the antenatal diabetes clinic

Abstract Monogenic diabetes (MODY) is a rare, inherited form of diabetes, of which glucokinase (GCK) mutation is one of the most common forms. Correct diagnosis is important, particularly during pregnancy, as treatment should be tailored accordingly. In our antenatal diabetes clinic, we audited those eligible for genetic screening over a one‐year period as per European Best Practice guidelines (2008) and new NHS England criteria (2021), as well as those identified with the mutation. Our audit recorded a significant drop in the number of eligible women identified using new criteria (2.6% vs 5.2%), with a notable reduction in women of African ethnicity (15.2% vs 29.2%). The audit highlighted the need for increased health care professional awareness and the implementation of clear pathways within the antenatal diabetes service to facilitate identification of women for genetic screening and subsequent appropriate management. It also underlined the importance of ongoing assessment of the clinical performance of the new screening criteria. Copyright © 2022 John Wiley &amp; Sons.

Mother's Anxiety Level With Readiness Before Delivery at PMB Deli Serdang

Mother's readiness before delivery should be a priority for mothers and health workers in pregnancy services, because it can lead to excessive maternal worry in the face of childbirth. The purpose of this study was to analyze the relationship between the level of maternal anxiety before delivery which took place at the Independent Midwife Practice of Deli Serdang Regency. This study is an explanatory research. The population in this study were pregnant women in the third trimester with a sample of 60 respondents. The results obtained p value = 0.001 &lt;0.05, which means that there is a significant relationship between the level of maternal anxiety and readiness for delivery. Suggestions according to the results of the study are that it is considered necessary to provide education for pregnant women to reduce the level of maternal anxiety before childbirth. As well as motivating mothers to visit health services to get ante-natal services according to standards based on gestational age, especially before delivery, thereby reducing anxiety when facing childbirth.

Knowledge and Willingness toward Vaccination among Pregnant Women: Comparison between Pertussis and Influenza.

Our study sought to characterize the knowledge and willingness levels regarding vaccinations against pertussis and seasonal influenza (influenza) among pregnant women in Guizhou province, China, which have previously been unclear. In total, 11 hospitals that carried out obstetrics and antenatal examination services were randomly included in the target organizations, and 564 questionnaires completed by the pregnant women were collected and analyzed in Guizhou province. The questionnaires contained questions addressing awareness and knowledge of pertussis and influenza, willingness to be vaccinated at different life stages, and the basic statuses of subjects. A two-paired McNemar test was used to compare the knowledge levels on pertussis and influenza. A Friedman test was used to compare the willingness to be vaccinated at different life stages. To explore the factors influencing knowledge levels, a chi-square test and binary logistic regression were used with stepwise backward regression. In total, 11.9 percent of the pregnant women had received influenza vaccines in the year prior to their pregnancy in Guizhou province. The pregnant women had poorer knowledge of pertussis than of influenza. Given a vaccine was available, the willingness of pregnant women to partake in the following vaccination-related actions could be ranked, from highest to lowest: free vaccination of babies, recommend vaccination to family members, postpartum vaccination, vaccination of babies at mothers' expense, and vaccination during pregnancy. Knowledge levels played different roles in the women's willingness to receive vaccinations at different life stages. Common knowledge of pertussis and influenza played a limited role in the willingness to receive maternal vaccinations. Among the pregnant women, the factors influencing the low levels of pertussis knowledge were occupation as nonmedical-institution staff, lower educational level, pregnancy stage past the first trimester, and not bearing children; for influenza, the factors were occupation as nonmedical-institution staff, lower educational level, denial of pregnancy-induced disease, and lower monthly household income per capita. Pregnant women have poorer levels of knowledge on pertussis than influenza, whereas there was no significant difference in their willingness to be vaccinated against these conditions. Health education on pertussis should be strengthened and we called for vaccines given at birth.

Factors That Support The Completeness of Filling Out KIA Book (Mother and Child Health)

The KIA Handbook is a manual that contains information sheets and records of health services for mothers and children. However, the use of the KIA handbook has not achieved maximum results because the documentation system is still done conventionally. This study aims to analyze and describe the input, planning, and organizing factors that affect the completeness of filling out the KIA handbook. This study uses a literature review method. Journal searches were obtained from the Google Scholar database using keywords and inclusion criteria. The steps of data analysis are: data collection, data reduction, data presentation, and conclusions. The article search results obtained 34 articles published in national online journals using the Google Scholar search engine with keywords and inclusion criteria, namely: time period, language, subject, type of article, and theme of article content. The conclusions in this study are: (1) The input factors that affect the completeness of filling out the KIA book from the midwife's side are knowledge, attitudes, skills, while from the mother's side, namely in terms of knowledge, (2) Planning factors that affect the completeness of filling out the KIA book are service SOPs. Antenatal care at the Puskesmas is made by the Puskesmas based on the integrated antenatal service guidelines set by the District Health Office, and (3) Organizing factors that affect the completeness of filling out the KIA handbook, namely cooperation and joint commitment by each part involved such as: Health Office, Head of Puskesmas, Implementing Midwives, Local Government (Districts), Pregnant Women's Families, and Employers