Birth Attendants Research Articles

Armed violent conflict and healthcare-seeking behavior for maternal and child health in sub-Saharan Africa: A systematic review.

Over 630 million women and children worldwide have been displaced by conflict or live dangerously close to conflict zones. While the adverse effects of physical destruction on healthcare delivery are relatively well understood, the effects on healthcare-seeking behavior remain underexplored, particularly in sub-Saharan Africa. This study aims to better understand the interconnections and knowledge gaps between exposure to armed violent conflicts and healthcare-seeking behaviors for maternal and child health in sub-Saharan Africa. Five key electronic databases (PubMed, Scopus, Web of Science, PsycNET, and African Journals Online) were searched for peer-reviewed publications between 2000 and 2022. The review was designed according to PRISMA-P statement and the protocol was registered with PROSPERO database. The methodological quality and risks of bias were appraised using GRADE. A data extraction instrument was modelled along the Cochrane Handbook for Systematic Reviews and the Centre for Reviews and Dissemination of Systematic Reviews. The search results yielded 1,148 publications. Only twenty-one studies met the eligibility criteria, reporting healthcare-seeking behaviors for maternal and child health. Of the twenty-one studies, seventeen (81.0%) reported maternal health behaviors such as antenatal care, skilled birth attendance, postnatal care services, and family planning. Nine studies (42.8%) observed behaviors for child health such as vaccination uptake, case management for pneumonia, diarrhea, malnutrition, and cough. While conflict exposure is generally associated with less favorable healthcare-seeking behaviors, some of the studies found improved health outcomes. Marital status, male partner attitudes, education, income and poverty levels were associated with healthcare-seeking behavior. There is a need for multifaceted interventions to mitigate the impact of armed violent conflict on healthcare-seeking behavior, given its overall negative effects on child and maternal healthcare utilization. While armed violent conflict disproportionately affects children's health compared to maternal health, it is noteworthy that exposure to such conflicts may inadvertently also lead to positive outcomes. CRD42023484004.

Determinants of Traditional Birth Attendants Compliance to Existing Legal Frameworks against Female Genital Mutilation/ Cutting in Garissa County, Kenya

Determinants of Traditional Birth Attendants Compliance to Existing Legal Frameworks against Female Genital Mutilation/ Cutting in Garissa County, Kenya

Hubungan Tempat Bersalin, Penolong Persalinan dan Peran Tenaga Kesehatan terhadap Kelengkapan Imunisasi Dasar pada Masa Pandemi Covid-19

Immunization is the most effective primary prevention against infectious diseases. Immunization protects individuals from serious illnesses and prevents the spread of infectious diseases. In Indonesia, every baby is required to receive complete basic immunization according to the immunization schedule issued by the Indonesian Pediatrician Association (IDAI). The Ministry of Health noted a decrease in the number of complete basic immunization coverage in March-April 2020 and the same period in 2019. There was almost a 4.7% difference in the percentage of complete immunization coverage in 2019 and 2020. This figure experienced a decline after complete basic immunization coverage in January-2020. February 2020 was stated to have increased from the same period in the previous year (CNN Indonesia, 2020). This research was conducted using an analytical observational method with a cross sectional research design. The total research sample was 139 respondents and the sampling technique used a total sampling technique. Based on the Chi squere test, there is a relationship between place of delivery (p-Value 0.00 < 0.05) and completeness of basic immunization during the Covid-19 pandemic in the working area of the Parigi Health Center, there is a relationship between birth attendants (p-Value 0.00 < 0.05) and the role of health workers (p-value 0.026 < 0.05) with complete basic immunization. For the Parigi health center, it is recommended that health workers develop more promotive and preventive programs and provide assistance to traditional birth attendants so that all births are under the supervision of health workers.

Effects of Resuscitation and Simulation Team Training on the Outcome of Neonates with Hypoxic-Ischemic Encephalopathy in South Tyrol

Background/Objectives: Neonatal hypoxic-ischemic encephalopathy (HIE) due to perinatal complications remains an important pathology with a significant burden for neonates, families, and the healthcare system. Resuscitation and simulation team training are key elements in increasing patient safety. In this retrospective cohort study, we evaluated whether regular constant training of all personnel working in delivery rooms in South Tyrol improved the outcome of neonates with HIE. Methods: We retrospectively analyzed three groups of neonates with moderate to severe HIE who required therapeutic hypothermia. The first group included infants born before the systematic introduction of training and was compared to the second group, which included infants born after three years of regular training. A third group, which included infants born after the SARS-CoV-2 pandemic, was compared with the previous two to evaluate retention of skills and the long-term effect of our training program. Results: Over the three study periods, mortality decreased from 41.2% to 0% and 14.3%, respectively. There was also a significant reduction of patients with subclincal seizures detected only through EEG, from 47.1% in the first period to 43.7% and 14.3% in the second and third study periods, respectively. Clinical manifestations of seizures decreased significantly from 47.1% to 37.5% and 10.7%, respectively, as well as severe brain lesions in ultrasound (US) and MRI. Conclusions: In this study, constant and regular simulation training for all birth attendants significantly decreases mortality and improves the outcome in neonates with moderate to severe HIE. This positive effect seems to last even after a one-year period during which training sessions could not be performed due to the COVID-19 pandemic.

Obstetrical Catastrophe: Ruptured UterusIncidence, Risk Factors, Fetomaternal Outcome and Management in Ad-Din Women’s Medical College and Hospital, Dhaka, Bangladesh

Background: A ruptured uterus is a catastrophic condition. It is associated with a high incidence of fetal and maternal mortality and morbidity. Objective: To determine the incidence, risk factors, maternal and fetal outcome, and management of uterine rupture in Ad-din Women’s Medical College and Hospital, Dhaka, Bangladesh. Materials and Methods: This prospective observational study of patients with ruptured uterus from July 2022 to June 2023 admitted at Gynaecology and Obstetrics department of Ad-din Women’s Medical College and Hospital, Dhaka. All the cases of ruptured uterus who were either admitted with ruptured uterus or who developed it in hospital were included in the study. Patients were initially assessed in emergency and labor wards, and relevant sociodemographic data, obstetric history, and previous antenatal and surgical history were recorded. Ways of management, and maternal and fetal outcomes were taken for analysis. Results: There were 45 cases of ruptured uterus out of a total of 17,288 deliveries over one year with a prevalence of 0.26%. The most common age group was 30-35 years, and most of the patients 37(82.2%) had a history of previous cesarean section. A maximum of 24 (53.3%) rupture of the uterus was found >36-40 weeks. Subtotal hysterectomy was done in 4 (8.9%) patients, and Subtotal hysterectomy with the repair of the bladder was done in 2 (4.4%) patients, out of 45 patients, 4 (8.9%) patients developed acute renal failure and maternal death was found 4 (8.9%) patients. IUFD was found in 21 (46.7%) babies, 10 (22.2%) babies needed NICU and neonatal death was found in 4 (8.9%) babies. Conclusion: Uterine rupture is a preventable obstetric complication that carries severe risks both to the mother and to the baby. Proper antenatal care, appropriate counseling of patients with a history of previous caesarian section for hospital delivery, and training of skilled birth attendants can reduce maternal and perinatal mortality and morbidity due to ruptured uterus. The Journal of Ad-din Women's Medical College; Vol. 12 (2), July 2024; p 5-10

Postnatal experiences of teenage mothers in selected communities in Central Region, Ghana: a phenomenological study

BackgroundTeenage childbirth is an issue of social and public health concern in Ghana, with high prevalence in some regions, including the Central Region. There is a dire need to understand the experiences of teenagers beyond pregnancies to facilitate comprehensive sexual and reproductive health information and service provision. We explored the postnatal experiences of teenage mothers in five communities in the Central Region of Ghana.MethodsWe adopted a descriptive phenomenological design. Using in-depth interview guides and pictorial diaries/guides, 30 teenage mothers who had given birth less than two years before our study, were recruited. Data were analysed thematically using a systematic qualitative-oriented text analysis with QSR NVivo 12 Pro software.ResultsTeenage mothers experienced pregnancy and childbirth related complications such as postpartum haemorrhage, preterm births, and low birth weight of their babies. Socio-cultural, psychological, and economic-related experiences were also observed. Teenage mothers were inexperienced and lacked financial support after childbirth. They often depended on the microsystem consisting of the family, friends, and the children’s fathers as major source of support to enable them and their babies to survive, develop, and become healthy and happy in life.ConclusionsTeenage mothers are confronted with challenges that require the assistance of actors within the microsystem to address. We recommend that stakeholders including healthcare professionals, traditional birth attendants (TBAs), and parents be sensitive to the postnatal challenges faced by teenage mothers so that they can work at providing the necessary skills and support to enable them to cope better with motherhood.

Time to recovery of neonatal sepsis and its predictors in public hospitals of North Shoa Zone, Central Ethiopia

BackgroundNeonatal sepsis remains one of the most common causes of morbidity and mortality among neonates in developing countries. It can cause severe morbidities and sequelae, even though patients survive. Prolonged recovery time of neonatal sepsis leads to hospitalization, increased cost of treatments, antimicrobial resistance, disseminated intravascular coagulation, respiratory failure, septic shock, brain lesions, renal failure, and cardiovascular dysfunction, and eventually death. Thus, this study aimed to identify the time-to-recovery of neonatal sepsis and its predictors among newborns admitted to public hospitals in the North Shoa Zone, Central Ethiopia.MethodsA retrospective cohort study was conducted among 508 septic neonates admitted to selected public hospitals in the North Shoa Zone between March 1, 2021, and March 1, 2023. A systematic random sampling method was used to select eligible medical records. The data were collected through the open data kit (ODK) Collect Android app and consequently exported to STATA version 17 for analysis. The data were analyzed using both univariable and multivariable Cox regression models. The adjusted hazard ratio (AHR) with its corresponding 95% confidence interval (CI) was employed.ResultsOf all septic neonates, 441 were recovered. The predictors of time-to-recovery of neonatal sepsis were premature rupture of membrane (PROM) (AHR = 0.37; 95% CI: 0.21, 0.63), intrapartum fever (AHR = 0.49; 95% CI: 0.32, 0.75), chest-indrawing (AHR = 0.50; 95% CI: 0.36, 0.68), fifth-minute appearance, pulse, grimace, activity, and respiration (Apgar) score less than seven (AHR = 0.54; 95% CI: 0.38, 0.77), gestational age between 37 and 42 weeks (AHR = 1.35; 95% CI: 1.06, 1.70), septic shock (AHR = 0.52; 95% CI: 0.31, 0.85).ConclusionThe median time to recovery from neonatal sepsis in this study was comparable to the previous studies. Premature rupture of membranes, intrapartum fever, term gestational age, low fifth minute Apgar score, chest indrawing, and septic shock were the predictors of time-to recovery of neonatal sepsis. Therefore, birth attendants are advised to closely adhere to the obstetrics management protocols when providing care for women who have intrapartum fever and premature rupture of membranes, as this will help to minimize neonatal sepsis and the subsequent delay in recovery.

Spatial variation and determinants of skilled birth attendant delivery among women of reproductive age in Ethiopia: a spatial and multilevel analysis

BackgroundDelivery assisted by skilled birth attendants is essential for maternal and newborn health because most maternal and infant deaths occur during childbirth. Ethiopia continues to use skilled birth care services that are far below acceptable standards. There are also regional variations in skilled birth attendant delivery services in the country. Therefore, this study explored the spatial distribution and factors associated with the use of skilled birth attendants in Ethiopia based on nationally representative EMDHS 2019 data.MethodsThis study included a weighted sample of 5,527 women who had given birth within the 5 years prior to the survey year. ArcGIS version 10.7 was used to visualize the geographic variations, and Kulldorff’s SaTScan version 9.6 was used to identify significant purely spatial clusters. A multilevel mixed-effects logistic regression model was fitted to identify determinant factors of skilled birth attendant delivery using STATA 17.ResultsThe number of women who delivered with the assistance of skilled birth attendants was 2,740 (49.6%) and distributed non-randomly across the regions of the country. Low clustering of skilled birth attendant delivery was detected in the Afar, Amhara, Benshangul-Gumuz, Gambela, Oromia, and Somali regions, whereas high clustering was detected in the Addis Ababa, Dire Dawa, and Harari regions. Maternal education level, parity, wealth index, region, place of residence, and community poverty level were significant predictors of skilled birth attendant delivery.Conclusion and recommendationSkilled birth-assisted delivery remains below national and international acceptable standards and is associated with geographic variation across the country. If it continues at the current pace, it will be difficult to achieve national and international targets. Therefore, a geographic-specific intervention should be launched by the government and respective local administrators, supported by local research in regions with low-skilled birth attendant delivery, to tackle individual and aggregate community-level determinants.

Assessing longitudinal prenatal knowledge and skills retention among community birth attendants enrolled in a novel school.

Guatemala has one of the highest rates of maternal mortality in Central America. A total of 60% of births in Guatemala are attended by traditional Mayan birth attendants, or comadronas. Their prevalence in these communities makes them a valuable resource to bridge home births with safe prenatal care. The objective of this study was to evaluate a low-cost prenatal care training program for Guatemalan comadronas with the goal of improving maternal health outcomes in the region. In this retrospective longitudinal cohort study, we examined the knowledge retention of comadronas enrolled in a 12-month prenatal care training program known as the School of PowHER (SOP). Recruited from the Lake Atitlán region of Guatemala by Saving Mothers, 501(c)(3) and the Guatemalan Ministry of Health, comadronas participated in a four-month didactic curriculum followed by a nine-month clinical curriculum. Pre- and post-tests were administered to assess learning outcomes over the study's duration (2014-2022), and test results were evaluated to assess the effectiveness of the SOP. A total of 123 women were recruited and enrolled in all eight graduating classes of the SOP from 2014, 2016-2019, and 2021-2022. An average, statistically significant improvement in didactic and clinical pre- and post-test scores was found across all years analyzed. The SOP is a low-cost, culturally appropriate, community-based model that empowers comadronas through knowledge and skill acquisition to improve local maternal health outcomes. This program proves effective at not only teaching comadronas prenatal health information and clinical skills, but also at promoting long-term retention of these skills.

Overcoming Cultural Barriers to Managing Labor Pain Among Tanzanian Women Using Non-pharmacological Interventions.

Managing labor pain effectively is crucial for ensuring positive maternal health outcomes. In Tanzania, cultural barriers often hinder the acceptance and utilization of non-pharmacological pain management interventions. This clinical consultation explored strategies for overcoming these cultural barriers to improve labor pain management among Tanzanian women using non-pharmacological interventions. A comprehensive literature review of existing research on non-pharmacological pain management techniques and cultural influences on pain perception and management was conducted, and an observed case study regarding the need to utilize nonpharmacological pain management interventions was also added. Studies indicated that non-pharmacological interventions such as massage, breathing techniques, and relaxation methods are effective and can be culturally adapted to fit Tanzanian women's beliefs and practices. Key barriers to use using these interventions include lack of awareness, limited access to training for healthcare providers, and cultural stigmas associated with pain expression. Successful strategies to overcome these barriers involve community education, involvement of traditional birth attendants, training healthcare providers in cultural competence, and engaging community leaders and family members. Future research should further explore the cultural adaptation and effectiveness of these interventions to ensure their sustainable integration into maternal care practices in countries with limited resources.

Trends and factors associated with skilled birth attendance in a post-Ebola context: DHS Guinea 2018

Background: In Guinea, the 2013–2015 Ebola epidemic profoundly affected maternal health service use. The frequency of births attended by skilled health professionals in the post-Ebola context remains under-documented.Aim: The aim of this study was to analyze the trend and factors associated with skilled births among women aged 15-49 between 2016 and 2018 in Guinea.Setting: The Republic of Guinea was the setting for this study.Methods: Data from 3018 women aged 15–49 years who had at least one live birth over the period 2016–2018 were analysed. The simple binary logistic regression model was used to analyse factors associated with skilled births using Stata software version 16.1. The significance level was set at 5%.Results: Our study found that 57.3% of deliveries were skilled births. This proportion showed a remarkable variation with a trend in assisted deliveries from 61% in 2016 to 59% in 2017 and then to 50% (p = 0.003) in 2018. Factors associated with skilled birth attendance in post-Ebola were: having no level of education (odds ratio [OR] = 0.39; confidence interval [CI]: 0.31–0.77), performing four or more antenatal care (ANC) (OR = 12.10; CI: 8.24–17.77), residing in a rural area (OR = 0.25 [0.17–0.37]), having a spouse who was a trader or manual worker, belonging to a household with an intermediate or poor wealth index and residing in the Labé region.Conclusion: This study showed that the proportion of assisted births showed a downward trend between 2016–2018.Contribution: The interventions undertaken to strengthen the maternal health system in the aftermath of the Ebola epidemic should be reinforced and maintained, in particular the retention of health providers deployed in rural areas and capacity building (training, equipment) for community health workers would help to improve this indicator

Tadābīr-i-Navmawlūd (Child Health Care): A Holistic Framework in Unani System of Medicine for Child Well-Being

Infancy, the critical phase from birth to early childhood, holds immense importance, with each day contributing significantly to a child's development. Globally, approximately four million neonatal deaths occur annually, with 98% of these taking place in developing countries. In these regions, many newborns succumb to mortality at home, often under the care of mothers, family members, and traditional birth attendants. In Unani Medicine, this stage is associated with the temperament known as Mizāj Ḥārr Raṭb (hot and moist), highlighting a period of rapid growth and developmental milestones. Comprehensive neonatal and child care guidelines, referred to as Tadābīr-i-Navmawlūd, encompass various aspects, including newborn care, infant feeding, management of dentition, and therapeutic principles and treatments for children.Renowned Unani scholars such as Ibn Sīnā, Zakariyya Rāzī, Ali Ibn Abbas Majūsī, Ibn Rushd, and Ibn Hubal Baghdādī have extensively discussed these topics in classical Unani texts like Al-Qānūn fi’l Ṭibb, Kitāb al-Manṣūrī, Kāmil al-Ṣanāʻa, Kitāb al-Kulliyat, and Kitāb al-Mukhtārāt fi’l Ṭibb. Their writings outline regimens and medicinal practices aimed at promoting the health and well-being of newborns, infants, and children. Keywords: Unani medicine, Tadābīr-i-Navmawlūd, child health care, infancy, Amrāḍ-i-Aṭfāl.

Prenatal treatment with the antidepressant fluoxetine on maternal and neonatal behavior in sheep.

Fluoxetine is commonly prescribed to treat depression during pregnancy. We aimed to evaluate the effects of prenatal fluoxetine exposure on maternal-offspring behavior in a non-depressed sheep model. On day 119 ± 1 of a 151-day expected gestation, Hampshire ewes were randomly assigned to receive intravenous fluoxetine (10 mg/kg for the first 2 days and 5 mg/kg daily thereafter until parturition) or a control vehicle. Video was recorded of 8 fluoxetine-treated ewes and 10 control ewes for 2 h before and after parturition. Fluoxetine did not alter dam behavior during the peripartum period, including time spent lying before the first birth, lying bout duration, probability of needing birth assistance, duration of birth assistance when provided, and time spent touching her lambs. However, in utero exposure impaired neonatal vigor as lambs spent less time standing and tended to spend less time nursing compared to unexposed lambs. Neonatal behavioral impairments are consistent with those associated with fluoxetine exposure during human gestation. This effect appears to be independent of maternal behavior, which was unaffected by antidepressant use. Lambs exposed to SSRI in utero spent less time standing and tended to spend less time nursing than control lambs, consistent with neonatal behavioral outcomes encountered in clinical practice. The reduced neonatal vigor was likely unrelated to maternal behavior, which was not altered by SSRI treatment. Non-depressed sheep models can help to elucidate the behavioral effects of antidepressant use during pregnancy to enhance health outcomes and patient care.

Inequalities in utilization of maternal health services in Ethiopia: evidence from the PMA Ethiopia longitudinal survey.

Previous studies documented the existence of substantial inequalities in the utilization of maternal health services across different population subgroups in Ethiopia. Regularly monitoring the state of inequality could enhance efforts to address health inequality in the utilization of maternal health services. Therefore, this study aimed to measure the level of inequalities in the utilization of maternal health services in Ethiopia. The study used data from the Performance Monitoring for Action Ethiopia (PMA Ethiopia) dataset. Longitudinal data was collected from a weighted sample of 1966 postpartum women using multistage stratified cluster sampling techniques between November 2021 to October 2022. We assessed inequality in maternal health services using three indicators: antenatal care four (ANC), skilled birth attendants (SBA), and postnatal care (PNC). Age, economic status, education level, place of residence, and subnational regions were used as dimensions for measuring inequality. The analysis was conducted using Health Equity Assessment Toolkit Plus (HEAT Plus) software. We computed the summary measure of health inequality: Difference (D), Ratio (R), Population Attributable Risk (PAR), and Population Attributable Fraction (PAF). The simple summary measures of inequality difference (D) reported a high level of inequality in the utilization of maternal health services in ANC four, SBA, and PNC across economic, education, residence, and subnational regions. The difference (D) in maternal health service utilization between advantaged and disadvantaged population groups exceeded 20 percentage points in all four dimensions of inequality for the three maternal health indicators. Similarly, the complex summary measures of inequality (PAR and PAF) also showed high levels of inequality in the utilization of ANC four, SBA, and PNC across all four dimensions of inequality. However, there was no age-related inequality in the use of maternal health services. A high level of socioeconomic and geographic area related inequality was observed in the utilization of ANC four, SBA, and PNC services in Ethiopia. Women from socioeconomically disadvantaged subgroups and women from disadvantaged geographic areas significantly lagged behind in the utilization of maternal health services. Therefore, implementing targeted interventions for the most disadvantaged groups can help to reduce inequality in accessing maternal health services.

Practice, Experiences, and Facilitators of Simulation-Based Training During One Year of Implementation in 30 Hospitals in Tanzania.

Enhancing the proficiency of healthcare workers (HCWs) in handling birth-related complications is crucial for reducing maternal and newborn morbidity and mortality. To achieve this, the Safer Births Bundle of Care offers a comprehensive set of innovative, simulation-based training interventions designed to strengthen the skills and competencies of HCWs working as skilled birth attendants. To describe the use of in-situ low-dose, high-frequency simulation-based training, and the experiences of this usage among HCWs and stakeholders at facilities in Tanzania. This mixed-methods study included quantitative and qualitative data collected between July 2021 and July 2022 across 30 health facilities in five regions of Tanzania. NeoNatalie Live (NNL) simulators were installed for independent skills and scenario training, and in-situ facilitator-led team simulations were introduced. The training frequency was analyzed using descriptive and analytical statistics, and mentorship and supervision reports were analyzed using qualitative content analysis. A large and sustained number of in-situ NNL skill-training sessions (n = 35,101) and facilitator-led team simulations (n = 266) were conducted during the first year. Clinical burden per HCW did not affect the frequency of NNL skills training at the health facility level (r = -0.16, p = .40) nor facilitator-led team simulations. There was a positive but weak correlation between the frequency of facilitator-led team simulations and NNL skills training (r = 0.34, p = .05). Qualitative data showed a high degree of motivation and participation among all stakeholders, and active use of hospital data, both clinical indicators and training data, was perceived as a success factor. Facilitator-led in-situ simulation training was more likely to occur where individual skills-training sessions were recorded. Training sessions took place regardless of the increased workload.

Medicinal plant species used for contraception and reproductive health care in rural Uganda.

Medicinal plants form an integral part of traditional health care systems in Uganda and are known to possess a variety of bioactive compounds some of which are beneficial as contraceptives. This study documented indigenous traditional knowledge on medicinal plant species used in contraception and other reproductive health care-related issues in rural Uganda. An ethnobotanical study was conducted from December 2019 to August 2020 in four different regions of Uganda: Mpigi, Kamuli, Bushenyi and Arua. Data was obtained from 158 traditional medical practitioners using semi-structured questionnaires. Descriptive statistics were used to present the data while quantitative analysis of data was done using the informant consensus factor (FIC), Percentage Use Value (PUV) and Jaccard Index (JI). The study recorded 98 medicinal plant species with the potential to manage family planning and other reproductive health related conditions. The most represented family was Asteraceae with 18 species. Plant remedies were mainly prepared as decoctions (41%) and administered orally (36%). Most plant species (61%) were harvested from wild habitats. Herbs (50%) and leaves (50%) contributed the highest percentage of plant growth forms and parts used respectively. The FIC value of 0.6 demonstrated that the herbalists, traditional birth attendants and community elders tend to agree with each other regarding plant species used and administration. JI ranged from 13 % to 0.9 %, an indication of very low similarities between the plants used in family planning and traditional health care among the communities in the study areas. The most frequently cited plant species for family planning management were: Prunus africana (Hook.f.) Kalkman (14: with a PUV of 45.2 %): Sporobolus pyramidalis P.Beauv. (10: 19.6), Warburgia ugandensis Sprague (10: 23.1) and Dichrocephala integrifolia (L.f.) Kuntze (7 ': 26.9). There is a high diversity of the species and a wealth of indigenous traditional knowledge for contraceptives and reproductive health care. Species like Prunus africana, Warburgia ugandensis and Dichrocephala integrifolia with high percentage use values are trusted by the community and can be investigated further for contraceptive potential to confirm their efficacy.

Effects of Women's Participation in Household Decision Making on Skilled Birth Attendants Supervised Delivery in Bangladesh.

While the importance of women's participation in household decision making in enhancing access to healthcare services is widely acknowledged, limited evidence exists on the link between women's participation in household decision making and skilled birth attendants (SBA) supervised delivery. This study aims to fill this gap by examining the effects of women's participation in household decision making on SBA supervised delivery in Bangladesh. Data of 3607 mothers who had given birth within 2 years of the survey date were extracted from the 2022 Bangladesh Demographic and Health Survey (BDHS) and analyzed. The outcome variable considered was SBA supervised delivery, and the primary explanatory variable was a composite index of women's participation in household decision making generated from their responses regarding decision-making on own healthcare, large household purchases, and visits to their family or relatives. Multi-level mixed-effects logistic regression was used to explore the effects of women's participation in household decision making on SBA supervised delivery, adjusted for potential confounders. The reported prevalence of SBA supervised delivery was 70%. Women lacking participation power and moderately empowerment in household decision-making were 15% (aOR= 0.85, 95% CI: 0.66-1.08) and 20% less likely to had SBA supervised delivery (aOR = 0.80, 95% CI: 0.64-0.99) compared to those with high participation power, respectively. This association remained consistent across all 3 empowerment domains, with lower likelihoods of SBA supervised delivery among women lacking empowerment. The findings of this research affirm the positive effects of women's participation in household decision making on SBA supervised delivery in Bangladesh. Recommendations include increasing women's empowerment in household decision making and raising awareness and education about the importance of SBA supervised delivery.

Level of completion of maternity continuum of care among ever-married women: An analysis of Somalia's health and demographic survey 2020.

Somalia is continuing to recover from three decades of underdevelopment, political instability, civil unrest, and protracted humanitarian crises. However, Somalia has one of the lowest maternal health indicators in the world. For instance, the maternal mortality ratio is 621 per 100,000 live births. Extra efforts are needed to improve maternal health. In this study, we aim to investigate the level of completion and coverage along the maternity continuum of care in Somalia. The study used data from the Somalia Health and Demographic Survey 2020. We restricted our analysis to ever-married women who had a live birth in the five years preceding the survey (n = 2432). Completion of the continuum of maternity care was the outcome variable for this study. It was constructed into a binary variable with complete coded as one and incomplete coded as 0. We categorized it into three models: ANC4+ as the first model, ANC4+ & SBA as the second model, and ANC4+ & SBA & PNC as the third model. More than half of the women (53.1%) had their most recent births at ≤19 years old. Of all the mothers (n = 2432), only 235 (9.7%) had at least four or more of the recommended antenatal care (ANC4+), and 68 (2.8%) of them utilized skilled birth attendants. Only 14 (0.6%) women received all three maternal healthcare services (ANC4+, SBA, and PNC within 48 hours). About 78.1% of the mothers did not attend any of the three CoC services. Maternal health care utilization decreases as they progress from ANC4+ to PNC utilization. The government and partners should design and implement strategies to improve maternal healthcare utilization specific to rural and nomads, less educated, not working, low income, and have less power in decision-making.

Advancing Maternal and Child Health : A Comprehensive Analysis of United Nations’ Sustainable Development Goals

This study aligns with SDG 3: Good Health and Well-being, focusing on maternal and child health. It aims to address targets related to reducing maternal mortality, ensuring universal access to reproductive healthcare, and preventing avoidable deaths among newborns and children under five. The study analyzes the current status of maternal and child health, examining progress, challenges, and potential pathways for improvement. The research employs a rigorous methodology, including a comprehensive literature review, data analysis, and established frameworks. Diverse data sources are utilized to provide a nuanced understanding of regional variations in maternal and child health. The study highlights key insights into maternal and child health within the SDG framework, revealing both advancements and ongoing challenges. Sub-Saharan Africa, despite a decline from 400 to 250 per 100,000 live births, continues to have the highest rates. South Asia has shown steady progress, reducing its rate from 220 to 150. North America maintains low rates, with a decrease from 15 to 10. Other regions, including Latin America and the Caribbean, Eastern Europe and Central Asia, and the Middle East and North Africa, demonstrate varied progress, indicating the need for region-specific interventions. Sub-Saharan Africa lags in antenatal care coverage (70%), skilled birth attendance (60%), and access to family planning services (45%). North America exhibits high coverage (95% for antenatal care, 98% for skilled birth attendance) and access (92% for family planning services). South Asia shows moderate improvements but still faces challenges compared to North America. Sub-Saharan Africa has a high under-five mortality rate (50 per 1,000 live births), with pneumonia, malaria, and birth complications as leading causes. South Asia has reduced its rate to 30, with diarrheal diseases and malnutrition being major contributors. North America has a low mortality rate (4 per 1,000 live births), with congenital anomalies, accidents, and infections as primary causes. The study synthesizes insights on the interconnection between maternal and child health and broader SDGs, emphasizing the importance of socio-economic factors, equitable healthcare access, and global collaboration. The findings provide a foundation for actionable recommendations to advance the global agenda for improving maternal and child health.

Qualitative study midwives' experiences of Early Initiation Breastfeeding (EIBF) in Surabaya

Early initiation of breastfeeding(EIBF) is proven to be a very beneficial practice for both mother and baby. The EIBF should have been carried out for 1 hour, but the 2017 EIBF achievement in East Java, EIBF carried out in less than 1 hour was 84.90% and that carried out in 1 hour was 15.10%. This research is a qualitative phenomenological research, the sample was taken using purposive sampling using 5 participants. The aim of this research was to determine midwives' experiences regarding EIBF. Midwives' perceptions of EIBF practices have an impact on mothers and babies, as well as lactation success. Supporting factors for quality EIBF include the support of husband and family as well as health workers who are willing to provide opportunities and motivate EIBF. Factors inhibiting the implementation of early initiation of breastfeeding are maternal and family resistance, the mother's lack of knowledge about Early initiation of breastfeedingand the lack of experience of birth attendants in carrying out Early initiation of breastfeeding. EIBF practices are carried out according to procedures, but there are still obstacles that cause EIBF to not be implemented well. Providing education to staff and patients, as well as implementing total care ratios in implementing EIBF are identified as guaranteeing the success of EIBF.