Antenatal Care Delivery Research Articles

Healthcare provider’s perspective on the implementation & adoption of digitalized antenatal care services in Bangladesh

ABSTRACT The rise of mHealth has transformed maternal healthcare in low- and middle-income countries, enhancing care and women’s access to quality services. The “Kapasia Model,” launched in 2017 in Bangladesh, aims to connect beneficiaries with healthcare providers, improve antenatal care (ANC) and reduce maternal mortality. This study aimed to explore healthcare providers’ perspective on digitalized ANC services within the Kapasia model. Conducted from January to July 2022, it involved 30 in-depth interviews with community-level healthcare providers across 17 facilities in Kapasia Upazila, Gazipur. A thematic analysis was performed to analyze data. The findings revealed that healthcare providers emphasized the Kapasia Model’s role in raising awareness and knowledge of pregnancy care and increasing antenatal care attendance. They viewed digitalized service as means of improving connectivity and access to healthcare for pregnant women. However, providers also discussed challenges such as women’s limited access to mobile phones and the time-consuming nature of completing information forms. Overall, healthcare providers supported integration of digital tools and endorsed digitalization in their workflow. Addressing these challenges is essential for optimizing ANC delivery and improving quality of services. Insights from this study will inform evidence-based decisions for future scaling-up and replication by policymakers and stakeholders in similar settings.

Progress towards health equity in Vietnam: evidence from nationwide official health statistics, 2010-2020

IntroductionOne of the ultimate goals of strengthening the health system is to achieve health equity. Vietnam is considered one of the ‘fast-track countries’ to achieve the health-related Millennium Development Goals,...

Home delivery among women who receive antenatal care in Ethiopia, design-based logistic regression analysis

BackgroundIn Ethiopia, a significant proportion of women who receive antenatal care (ANC) deliver at home. This study aims to investigate home delivery among pregnant women who receive ANC during pregnancy...

A Meta-Analysis of the Global Stillbirth Rates during the COVID-19 Pandemic

COVID-19 has been shown to have variable adverse effects on pregnancy. Reported data on stillbirth rates during the pandemic have, however, been inconsistent—some reporting a rise and others no change. Knowing the precise impact of COVID-19 on stillbirths should help with the planning and delivery of antenatal care. Our aim was, therefore, to undertake a meta-analysis to determine the impact of COVID-19 on the stillbirth rate. Databases searched included PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and Web of Science, with no language restriction. Publications with stillbirth data on women with COVID-19, comparing stillbirth rates in COVID-19 and non-COVID-19 women, as well as comparisons before and during the pandemic, were included. Two independent reviewers extracted data separately and then compared them to ensure the accuracy of extraction and synthesis. Where data were incomplete, authors were contacted for additional information, which was included if provided. The main outcome measures were (1) stillbirth (SB) rate in pregnant women with COVID-19, (2) stillbirth rates in pregnant women with and without COVID-19 during the same period, and (3) population stillbirth rates in pre-pandemic and pandemic periods. A total of 29 studies were included in the meta-analysis; from 17 of these, the SB rate was 7 per 1000 in women with COVID-19. This rate was much higher (34/1000) in low- and middle-income countries. The odds ratio of stillbirth in COVID-19 compared to non-COVID-19 pregnant women was 1.89. However, there was no significant difference in population SB between the pre-pandemic and pandemic periods. Stillbirths are an ongoing global concern, and there is evidence that the rate has increased during the COVID-19 pandemic, but mostly in low- and middle-income countries. A major factor for this is possibly access to healthcare during the pandemic. Attention should be focused on education and the provision of high-quality maternity care, such as face-to-face consultation (taking all the preventative precautions) or remote appointments where appropriate.

"With group antenatal care, pregnant women know they are not alone": The process evaluation of a group antenatal care intervention in Ghana.

An essential component to improving maternal and newborn outcomes is antenatal care. A trial of group antenatal care was implemented in Ghana where 7 health care facilities were randomized to be intervention sites and 7 control sites continued traditional antenatal care. Group antenatal care, where 10-14 women with similar due dates meet together for visits, includes traditional components such as risk assessment with increased opportunity for education and peer support. The study aim was to assess and report the process evaluation of the implementation of a group antenatal care intervention. Process evaluation data were collected alongside intervention data and included both quantitative and qualitative data sources. Midwives at the health facilities which were randomized as intervention sites completed tracking logs to measure feasibility of the intervention. Research team members traveled to intervention sites where they conducted structured observations and completed fidelity and learning methods checklists to determine adherence to the model of group antenatal care delivery. In addition, midwives facilitating group antenatal care meetings were interviewed and focus groups were conducted with women participating in group antenatal care. In the majority of cases, midwives facilitating group antenatal care completed all components of the meetings with fidelity, following best practices such as sitting with the group rather than standing. Across 7 intervention sites, 7 groups (622 pregnant women) were documented in the tracking logs and of these participants, the majority (74%) attended more than half of the meetings, with 32% attending all 8 group meetings. Three themes were identified in both the midwife interviews and focus groups with pregnant women: 1) information sharing, 2) sense of community, and 3) time management challenges. An additional theme emerged from the focus groups with the women: women who had already given birth noticed a disconnect between what they learned and treatment received during labor and birth. This process evaluation determined that group antenatal care can be implemented with fidelity in low and middle-income countries. Time management was the biggest challenge, however both midwives and pregnant women found the model of care not only acceptable, but preferable to traditional care. The knowledge shared and sense of community built during the meetings was a valuable addition to the individual model of antenatal care.

Reproductive health of Syrian refugee women in Lebanon: a descriptive analysis of the Sijilli electronic health records database

BackgroundThe Syrian conflict has been responsible for the highest exodus of refugees, with Lebanon hosting the greatest number of refugees per capita, which placed a significant strain on an already overburdened healthcare system. Women are the most vulnerable group in times of conflict and displacement, with sexual and reproductive health and rights often neglected. This study focuses on the obstetric characteristics and pregnancy outcomes of Syrian Refugee (SR) women in Lebanon, in Comparison to their pre-displacement data.MethodsThis study is a secondary analysis of de-identified data from the Sijilli database. The data reported and analyzed were the refugees’ socio-demographics, obstetric history, pregnancy outcomes, experienced maternal and neonatal complications, breastfeeding history and duration, and contraception use and types. Data were reported in both frequencies and means/medians. Chi-square test, t-test, and ANOVA tests were used to compare pregnancies in Syria to those that happened in Lebanon.ResultsA total of 1065 female records were included in this study, with 634 ever-pregnant women and the total number of pregnancies being 3272. SR women were shown to get pregnant in Lebanon at a younger age compared to cases in Syria. The number of gravidities is equal in women who got pregnant in Syria and those who moved later to Lebanon. The mean spacing between pregnancies has decreased comparing SR women who got pregnant in Syria only versus those who got pregnant in Lebanon only. Among the mixed group, the mean spacing between pregnancies as well as the prevalence of spontaneous abortions significantly increased after displacing to Lebanon. C-section rate was higher among SR women after moving to Lebanon. Also, maternal complications and not breastfeeding have increased after moving to Lebanon. A prior pregnancy was significantly associated with higher contraception use rate. The most common methods of contraception were oral contraceptive pills and intra-uterine devices.ConclusionThe C-section deliveries, spontaneous abortions and maternal complications have all increased among SR women after being displaced to Lebanon. While the age at first pregnancy, mean spacing between their pregnancies and breastfeeding rates have decreased after moving to Lebanon. SR women are less likely to use contraceptives after their displacement. It is necessary to address access to reproductive healthcare and antenatal care delivery among displaced refugee women living in informal tented settlements.

Experiential Training Workshops for Group Antenatal Care in Malawi.

The positive effects of the CenteringPregnancy group antenatal care (ANC) model on perinatal outcomes in the United States has led to its adaptation and implementation in many low- and middle-income countries. Facilitative discussions are a core component of this group ANC model. Facilitator training lays a critical foundation for delivery of this paradigm-shifting model as practitioners learn to adapt their approach to health education from didactive to facilitative. However, there is little rigorous research focused on best practices for training group health care facilitators and none that is guided by a theoretical framework. Kolb's experiential learning theory offers a theoretical framework to guide the development of training workshops that allow trainees to experience, reflect on, and practice the facilitation skills needed to deliver this evidence-based intervention. This article describes an experiential learning-based training workshop that was implemented as part of an ongoing effectiveness-implementation trial of a Centering-based group ANC model in Blantyre District, Malawi. We provide a blueprint for conducting group ANC facilitator trainings that, in addition to imparting knowledge, effectively builds confidence and buy-in to this paradigm-changing approach to ANC delivery. This blueprint can be adapted for use in designing and implementing group health care across settings in the United States and globally.

Group Antenatal Care in Ghana: Protocol for a Cluster Randomized Controlled Trial.

BackgroundWhile group antenatal care (ANC) has been delivered and studied in high-income countries for over a decade, it has only recently been introduced as an alternative to individual care in sub-Saharan Africa. Although the experimental design of the studies from high-resource countries have been scientifically rigorous, findings cannot be generalized to low-resource countries with low literacy rates and high rates of maternal and newborn morbidity and mortality. The Group Antenatal Care Delivery Project (GRAND) is a collaboration between the University of Michigan in the United States and the Dodowa Health Research Centre in Ghana. GRAND is a 5-year, cluster randomized controlled trial (RCT). Our intervention—group ANC—consists of grouping women by similar gestational ages of pregnancy into small groups at the first ANC visit. They then meet with the same group and the same midwife at the recommended intervals for care.ObjectiveThis study aims to improve health literacy, increase birth preparedness and complication readiness, and optimize maternal and newborn outcomes among women attending ANC at seven rural health facilities in the Eastern Region of Ghana.MethodsQuantitative data will be collected at four time points using a secure web application for data collection and a database management tool. Data will be analyzed on an intention-to-treat basis to test the differences between the two arms: women randomized to group-based ANC and women randomized to routine individual ANC. We will conduct a process evaluation concurrently to identify and document patient, provider, and system barriers and facilitators to program implementation.ResultsThe study was funded in September 2018. Recruitment and enrollment of participants and data collection started in July 2019. In November 2021, we completed participant enrollment in the study (n=1761), and we completed data collection at the third trimester in May 2022 (n=1284). Data collection at the additional three time points is ongoing: 6 weeks postpartum, 6 months postpartum, and 1 year postpartum.ConclusionsThis study is significant and timely because it is among the first RCTs to be conducted to examine the effects of group ANC among low-literacy and nonliterate participants. Our findings have the potential to impact how clinical care is delivered to low-literacy populations, both globally and domestically, to improve maternal and newborn outcomes.Trial RegistrationClinicalTrials.gov NCT04033003; https://clinicaltrials.gov/ct2/show/NCT04033003International Registered Report Identifier (IRRID)DERR1-10.2196/40828

Awareness, attitude and practice on prevention of mother to child transmission of human-immunodeficiency virus among pregnant women in Taungoo Township, Myanmar

Background: Globally, about 1.3 million human-immunodeficiency virus (HIV)-positive women get pregnant once a year, and about 160,000 children are born with the HIV. This study was conducted to investigate pregnant women's awareness, attitude, and practice regarding the prevention of mother to child HIV transmission (PMTCT).Methods: This cross-sectional study collected qualitative data from 152 pregnant women registered in the health facilities in Taungoo township. Simple random sampling was applied to cull three out of total rural health centres and systematic random sampling was exercised to recruit the required pregnant women from all registered pregnancies. The semi-structured questionnaire and statistical package for the social sciences (SPSS) version 23 were used for data collection and analysis accordingly.Results: In overall, the pregnant women studied had good awareness (56.6%), favourable attitude (60.5%), and good practice (55.3%) on PMTCT services. 78.3% were aware of the PMTCT project and knew that a baby can be prevented from HIV transmission by an HIV mother, 57.8% agreed that counselling and testing for HIV during pregnancy are important and 85.5% were tested for HIV. The awareness was associated with the family type (p=0.049), the attitude was associated with age (p=0.048), residence (p=0.024), and frequency of antenatal visits during current pregnancy (p=0.021), and practice was associated with antenatal care delivery sites (p=0.038), husband's support for antenatal care (p=0.004) and taking antenatal services during a previous pregnancy (p=0.033).Conclusions: Many unsatisfactory findings regarding PMTCT services were noted. So, strategic interventions and effective approaches for getting the full coverage of PMTCT programs should be strengthened.

Millennium Development Goals and Status of Health Services in Morigaon District of Assam

The proposal of the Millennium Declaration in 2000 by all United Nations Member States marked an historic moment, as world leaders committed to tackle extreme poverty in its many dimensions and create a better life for everyone. The Millennium Development Goals (MDGs) translate this commitment into a framework of measurable goals and targets by which progress can be measured. The Millennium Development Goals (MDGs) are eight international development goals that all 193 United Nations member states and at least 23 international organizations have agreed to achieve by the year 2015. The goals are eradicating extreme poverty and hunger, achieving universal primary education, promoting gender equality and empowering women reducing child mortality rates, improving maternal health, combating HIV/AIDS, malaria, and other diseases, ensuring environmental sustainability, and developing a global partnership for development. Among these eight goals three goals are directly related to human health. As a first step in Assam’s Model District, Morigaon, the project has created a multi-sectoral team of health, nutrition, water, and education officials to focus activities on maternal and child health. The project also focused on improved training for Accredited Social Health Activists (ASHAs), the critical community based health workers that mobilize women and children for health services within the villages. The project will also focus on training nurses in better antenatal care delivery, which is vital for lowering the risk of maternal death, and will introduce mobile phone technologies so that data can be collected—and mothers and babies tracked-throughout rural areas that are difficult to access.

Widespread Implementation of a Low-Cost Telehealth Service in the Delivery of Antenatal Care During the COVID-19 Pandemic: An Interrupted Time-Series Analysis

(Abstracted from Lancet 2021;398:41–52) In response to the COVID-19 pandemic, health care systems around the world had to quickly adapt to protect patients and staff from exposure. In Australia, a government initiative was launched to temporarily change public health funding to support the use of telehealth.

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

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

Telehealth for the Delivery of Antenatal Care

There are few published data addressing the use of telehealth to provide routine antenatal care. In late March 2020, in response to the COVID-19

Widespread implementation of a low-cost telehealth service in the delivery of antenatal care during the COVID-19 pandemic: an interrupted time-series analysis

BackgroundLittle evidence is available on the use of telehealth for antenatal care. In response to the COVID-19 pandemic, we developed and implemented a new antenatal care schedule integrating telehealth across all models of pregnancy care. To inform this clinical initiative, we aimed to assess the effectiveness and safety of telehealth in antenatal care.MethodsWe analysed routinely collected health data on all women giving birth at Monash Health, a large health service in Victoria (Australia), using an interrupted time-series design. We assessed the impact of telehealth integration into antenatal care from March 23, 2020, across low-risk and high-risk care models. Allowing a 1-month implementation period from March 23, 2020, we compared the first 3 months of telehealth integrated care delivered between April 20 and July 26, 2020, with conventional care delivered between Jan 1, 2018, and March 22, 2020. The primary outcomes were detection and outcomes of fetal growth restriction, pre-eclampsia, and gestational diabetes. Secondary outcomes were stillbirth, neonatal intensive care unit admission, and preterm birth (birth before 37 weeks' gestation).FindingsBetween Jan 1, 2018, and March 22, 2020, 20 031 women gave birth at Monash Health during the conventional care period and 2292 women gave birth during the telehealth integrated care period. Of 20 154 antenatal consultations provided in the integrated care period, 10 731 (53%) were delivered via telehealth. Overall, compared with the conventional care period, no significant differences were identified in the integrated care period with regard to the number of babies with fetal growth restriction (birthweight below the 3rd percentile; 2% in the integrated care period vs 2% in the conventional care period, p=0·72, for low-risk care models; 5% in the integrated care period vs 5% in the conventional care period, p=0·50 for high-risk care models), number of stillbirths (1% vs 1%, p=0·79; 2% vs 2%, p=0·70), or pregnancies complicated by pre-eclampsia (3% vs 3%, p=0·70; 9% vs 7%, p=0·15), or gestational diabetes (22% vs 22%, p=0·89; 30% vs 26%, p=0·06). Interrupted time-series analysis showed a significant reduction in preterm birth among women in high-risk models (–0·68% change in incidence per week [95% CI −1·37 to −0·002]; p=0·049), but no significant differences were identified in other outcome measures for low-risk or high-risk care models after telehealth integration compared with conventional care.InterpretationTelehealth integrated antenatal care enabled the reduction of in-person consultations by 50% without compromising pregnancy outcomes. This care model can help to minimise in-person interactions during the COVID-19 pandemic, but should also be considered in post-pandemic health-care models.FundingNone.

Late registration for antenatal care by pregnant women with previous history of caesarean section.

BackgroundDespite good access to antenatal care (ANC) services for most women, and regular training of healthcare workers in obstetrics and gynaecology, many pregnant women with a previous history of caesarean section (C/S) still presented late for ANC services at Letsholathebe II Memorial Hospital (LIIMH) in Maun, Botswana. This may increase morbidity and mortality in women with previous C/S delivery and neonates. Knowing why women with previous C/S present late for ANC may help in the formulation of interventions that decrease morbidity and mortality amongst these women and neonates.AimThe aim of this study was to explore the reasons why pregnant women with a previous history of C/S registered late for ANC, at LIIMH.SettingThis study was performed at LIIMH, a district hospital situated in Maun, Botswana.MethodsThis was a descriptive qualitative study. Consenting pregnant women with previous C/S who presented at LIIMH after the 20 weeks of pregnancy were interviewed until data saturation. The data was analysed for themes.ResultsThe reasons for late registration at LIIMH include lack of information, misconception on the appropriate booking time and venue, dissatisfaction with the quality of ANC clinic services, use of alternative ANC providers, delayed referral, and pregnancy experience.ConclusionLack of knowledge of ANC delivery venue, using alternative ANC providers, and dissatisfaction with ANC clinic services, contributed to late registration. Pregnant women with previous history of C/S should be informed about ANC, delivery plans, and the assistance of alternative ANC providers should be explored.

Aboriginal women’s experiences of strengths and challenges of antenatal care in the Kimberley: A qualitative study

BackgroundHigh-quality, culturally safe antenatal care has an important role in improving health outcomes of Aboriginal and Torres Strait Islander people. We sought to describe Aboriginal women’s experiences of antenatal care in the Kimberley region of Western Australia, to better understand current systems and opportunities for enhancing antenatal care. MethodsThroughout the Kimberley, 124 Aboriginal women who had accessed antenatal care in 2015–2018 were recruited. They provided qualitative data during a health assessment or standalone interview. Transcripts were descriptively coded and thematically analysed. FindingsMost women expressed that overall they had a positive antenatal care experience. Key themes were the importance of positive relationships with antenatal care providers, the valuable role of family support during the antenatal period, challenges travelling for care and limitations of the Patient Assisted Travel Scheme, communication of pregnancy related information, and the provision of services. Almost all antenatal care providers described were non-Aboriginal. A few women spoke about involvement of Aboriginal Health Workers in their antenatal care, including recommending expansion of these roles. ConclusionsThe experiences shared by these Aboriginal women in the Kimberley contribute to broader evidence of a need to improve culturally safe antenatal care delivery for Aboriginal Australian women. Although excellent care was provided by a number of dedicated midwives, there were few Aboriginal antenatal staff and significant staff turnover. To improve the quality of care more local Aboriginal antenatal care providers, and additional support for the large number of women and their families required to travel, are required.

SARS-CoV-2 updates in a West African population and precautionary measures for sustaining quality antenatal care delivery.

SARS-CoV-2 updates in a West African population and precautionary measures for sustaining quality antenatal care delivery.

Descriptive epidemiology of anaemia among pregnant women initiating antenatal care in rural Northern Ghana.

BackgroundAnaemia in pregnancy is associated with adverse obstetric outcomes. When detected early in pregnancy, it can be treated; however, information on its prevalence and associated factors is limited in rural Ghana.AimThe aim of this study was to determine the prevalence and maternal factors associated with anaemia in pregnancy at first antenatal care (ANC) visits.SettingThe study was conducted in the Navrongo War Memorial Hospital, a secondary referral facility in the Kassena-Nankana district in rural northern Ghana.MethodsA retrospective analysis of antenatal clinic records of pregnant women collected from January to December 2014. All pregnant women initiating antenatal clinic, who had initial haemoglobin (Hb) levels measured, were included in the study. Logistic regression analyses were carried out to determine factors associated with anaemia at the initiation of ANC.ResultsWe analysed data from 506 women with median Hb of 11.1 g/dL (IQR 7.31–13.8). The median gestational age at booking was 14 weeks (5–36 weeks). The prevalence of anaemia was 42.7%, with 95% confidence interval (CI) [38.4–47.1], and was high among teenage mothers (52% [34.9–67.8]), mothers who booked in the third trimester (55% [33.6–74.7]) and grand multiparous women (58% [30.7–81.6]). Factors associated with anaemia included grand multiparity (odds ratio [OR] = 1.94 with 95% CI [1.58–2.46]), booking during the third trimester (OR = 2.06 [1.78–2.21]) and mother who were underweight compared to those with normal weight (OR = 3.17 [1.19–8.32]).ConclusionBurden of anaemia in pregnancy is still high in rural northern Ghana. We advocate further strengthening of the primary health care system to improve early access to ANC delivery.Keywordsanaemia in pregnancy; booking visit; maternal and child health; Navrongo; rural; Ghana.

Developing measures for WHO recommendations on antenatal care for a positive pregnancy experience: a conceptual framework and scoping review

ObjectivesIn response to the newest WHO recommendations on routine antenatal care (ANC) for pregnant women and adolescent girls, this paper identifies the literature on existing ANC measures, presents a conceptual...

Use of a Facilitated Group Process to Design and Implement a Group Antenatal and Postnatal Care Program in Rwanda.

IntroductionThe government of Rwanda is exploring strategies that may reduce the incidence of prematurity and low birth weight. Large‐scale implementation of group antenatal care (ANC) and postnatal care (PNC) within the context of the Rwanda national health care system is under consideration. To launch a cluster randomized controlled trial of group ANC and PNC in 5 districts in Rwanda, the implementation team needed a customized group care model for this context and trained health care workers to deliver the program.ProcessAdapting the group ANC and group PNC model for the Rwandan context was accomplished through a group process identical to that which is fundamental to group care. A technical working group composed of 10 Rwandan maternal‐child health stakeholders met 3 times over the course of 3 months, for 4 to 8 hours each time. Their objectives were to consider the evidence on group ANC, agree on the priorities and constraints of their ANC delivery system, and ultimately define the content and structure of a combined group ANC and PNC model for implementation in Rwanda. The same group process was employed to train health care workers to act as group ANC facilitators.OutcomesA customized group ANC and PNC model and guidelines for its introduction were developed in the context of a cluster randomized controlled trial in 36 health centers. Descriptions of this model and the implementation plan are included in this article.DiscussionOur experience suggests that the group process fundamental to successful group ANC and PNC is an effective method to customize and implement this innovative health services delivery model in a new context and is instrumental in achieving local ownership.