Early Booking For Antenatal Care Research Articles

Determinants of early antenatal care booking among pregnant mothers attending antenatal care at public health facilities in the Nole Kaba district, western Ethiopia: unmatched case–control study

BackgroundEarly initiation of antenatal care (ANC) is vital for the early detection and treatment of adverse pregnancy outcomes. Despite the widespread convenience of free ANC services, most women in Ethiopia...

Association between unintended pregnancy and maternal antenatal care services use in Ethiopia: analysis of Ethiopian demographic and health survey 2016.

Unintended pregnancy disproportionately affects women in low and middle-income countries including Ethiopia. Previous studies identified the magnitude and negative health outcomes of unintended pregnancy. However, studies that examined the relationship between antenatal care (ANC) utilization and unintended pregnancy are scarce. This study aimed to examine the relationship between unintended pregnancy and ANC utilization in Ethiopia. This is a cross-sectional study conducted using the fourth and most recent Ethiopian Demographic Health Survey (EDHS) data. The study comprised a weighted sample of 7,271 women with last alive birth and responded to questions on unintended pregnancy and ANC use. The association between unintended pregnancy and ANC uptake was determined using multilevel logistic regression models adjusted for possible confounders. Finally p < 5% was considered significant. Unintended pregnancy accounted for nearly a quarter of all pregnancies (26.5%). After adjusting for confounders, a 33% (AOR: 0.67; 95% CI, 0.57-0.79) lower odds of at least one ANC uptake and a 17% (AOR: 0.83; 95% CI, 0.70-0.99) lower odds of early ANC booking were found among women who had unintended pregnancy compared to women with intended pregnancy. However, this study founds no association (AOR: 0.88; 95% CI, 0.74, 1.04) between unintended pregnancy and four or more ANC visits. Our study found that having unintended pregnancy was associated with a 17 and 33% reduction in early initiation and use of ANC services, respectively. Policies and programs designed to intervene against barriers to early initiation and use of ANC should consider unintended pregnancy.

Obstetric outcomes of delayed initiation of antenatal care at a university teaching hospital in southwest Nigeria

Background: Antenatal care (ANC) is vital for the health of both mother and fetus. Generally, it has been observed that lack of prenatal care or inadequate utilization of antenatal care culminates in adverse maternal outcomes including maternal mortality.Objective: To compare the obstetric outcomes in pregnant women that commenced ANC in the third trimester with those that initiated ANC contacts early.Materials and Methods: This was a prospective cohort study conducted on antenatal attendees that booked and delivered at the Department of Obstetrics and Gynaecology of Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, southwest Nigeria from 1st of January, 2015 to 31st December, 2015. Data gathered were analyzed using Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics were used to examine the data, with results expressed as numbers and percentages. Associations between maternal factors, obstetric outcomes and delayed commencement of ANC were examined by Pearson Chi-square. The significance levels were set at p<0.05.Results: During the study period, 1633 women received antenatal care and delivered in our centre. Out of these 1633 women, 547(33.5%) had delayed initiation of antenatal care. Women with pre-existing medical illnesses were likely not to experience delayed initiation of ANC (X2 =8.31 p value=0.02). Women who initiated antenatal care in the third trimester were more likely to develop preeclampsia (X2 =7.86 p value=0.02) and prelabour rupture of the fetal membranes (X2 =11.59, p value=0.003).Conclusion: The proportion of women who delayed initiation of ANC was high and they may be predisposed to developing preeclampsia. There is, therefore, a pressing need to increase advocacy on the need for early booking for antenatal care.

Utilization of optimal antenatal care, institutional delivery, and associated factors in Northwest Ethiopia

Optimal antenatal care visits (ANC4+) and institutional delivery are essentials to save lives of the women and the baby during pregnancy and delivery. Though focused antenatal care visits and institutional delivery is recommended by World Health Organization, Ethiopia has sub-optimal antenatal care and lagged facility delivery. A community-based cross-sectional study was conducted among 811 lactating women in Northwest Ethiopia. Multivariable logistic regression analysis was performed using 95% confidence level and p < 0.05. The prevalence of optimal antenatal care visits and institutional delivery were 39.6% (95%CI: 36.2–43) and 62.6% (95%CI: 59.2–66), respectively. Maternal education (AOR = 2.05; 95%CI: 1.14, 3.69), home visiting by health extension workers (AOR = 1.57; 95%CI: 1.01, 2.29), and early antenatal care booking (AOR = 11.92; 95%CI: 8.22, 17.31) were significant predictors of optimal antenatal care. Exposure to mass media (AOR = 1.65; 95% CI: 1.02, 2.65); intended pregnancy(AOR = 1.68; 95%CI:1.12, 3.63); parity of one (AO = 3.46; 95% CI: 1.73, 6.89); 1–3 antenatal care visits (AOR = 2.17; 95% CI: 1.29, 3.63); and ANC4 + (AOR = 3.57; 95% CI: 2.07, 6.14); history of pregnancy-related complications(AOR = 1.63; 95%CI: 1.04, 2.57), and access to transportation to reach a health facility(AOR = 1.58; 95%CI: 1.00, 2.45) were significant predictors of institutional delivery. Addressing the modifiable factors identified in this study could improve optimal antenatal care visit and institutional delivery.

Molecular Survey of Plasmodium falciparum Drug Resistant Genes Among Pregnant Women Attending ANC at Maryam Abacha Women and Children Hospital (MAWCH) Sokoto, Nigeria

Research was conducted on the molecular survey of drug resistant Plasmodium falciparum malaria among pregnant women attending ante natal care (ANC) at Maryam Abacha Women and Children Hospital (MAWCH) Sokoto, Nigeria from February, 2020 to May, 2020. Blood samples of 200 pregnant women who came for ANC in the Hospital were collected and Questionnaire administered. Thin and thick blood film microscopy and Plasmodium falciparum mono clonal antibody specific RDT kit were used to detect Plasmodium falciparum. P. falciparum positive dried blood samples were investigated for the presence of Pfmdr1 and Pfcrt genes using PCR protocol. Results for the investigation of Pfcrt and Pfmdr1 genes revealed 26.30% and 89.50% prevalence respectively, while 4 samples were positive for both genes representing 21.05% prevalence. Prevalence of Pfcrt and Pfmdr1 genes do not associate (p&gt;0.05) with any of the parameters tested. Spread of the mutant genes observed in this study may be attributed to the continuous use of antimalarial drugs that the parasite developed resistant to. Pregnant women should be attending early ante-natal care booking and attend clinic regularly, malaria control programs should be carried out in the state.

Progression of anaemia during antenatal period among South African pregnant women.

Anaemia in pregnancy is a known public health problem in South Africa. Maternal, perinatal morbidity and mortality are known to be associated with anaemia in pregnancy. Very little is known from literature with regards to the progression of anaemia during the antenatal period of pregnancy. To estimate haemoglobin levels, the prevalence and determinants of anaemia at different gestational ages and to show the trend. A retrospective cohort (follow-up) study was conducted using the antenatal clinic register. Prevalence rates of anaemia (haemoglobin < 11 g/dl) at different gestational ages were measured. Factors associated with anaemia were assessed using chi-square test and stepwise multivariate logistic regression analysis. A total of 801 pregnant women were enrolled at the booking visit and followed-up during their antenatal period. The prevalence of anaemia at the booking visit was 37%. The prevalence of anaemia at 20, 26, 32 and 36 weeks of gestation were 36.6%, 39.6%, 39.8% and 29.2% respectively. Binary logistic regression at the booking visit showed that teenage women were 2.5 times more likely to have anaemia (OR=2.5, p=0.005) than older women. Women who booked during the first trimester were 60% less likely to have anaemia (OR= 0.40, P=0.005) at the booking visit and 62% less likely to be anaemic at 36 weeks of gestation (OR=0.38, p=0.013) compared to those who booked late for antenatal care. Prevalence of anaemia during pregnancy was high. Early booking for antenatal care was a predictor for lower rate of anaemia. Thus, health education strategy should be encouraged for early antenatal booking.

Characteristics and Predictors of Late Antenatal Booking Among Pregnant Women in Fiji.

Antenatal Care (ANC) plays a pivotal role in improving child and maternal health. Even though antenatal coverage in Fiji is more than 95%, the majority of pregnant women fail to initiate ANC within the first trimester. Thus, the research aimed to determine factors that are associated with late antenatal booking among pregnant women who delivered in Ba Mission Hospital (BMH) in Fiji in 2019. Secondary data analysis was done using SPSS version 24 on 340 pregnant women who had delivered in BMH from January 1 to December 31, 2019 and met the eligibility criteria. A data extraction sheet was used to collect information on socio-demographic, obstetric, and medical factors. The prevalence of late booking in BMH in 2019 was 79.7%. The results of the bivariate analysis showed that being from I-taukei ethnicity (AOR: 2.36; p = 0.003), an unmarried woman (AOR: 2.5; p = 0.004), and women with < eight ANC visits (AOR: 3.7; p < 0.001) during the pregnancy were significant predictors of late antenatal booking. Multivariate analysis showed that only < eight ANC visits were a significant determinant of late antenatal booking (COR: 3.6; p < 0.001). The burden of late antenatal booking in Ba is higher than those of some other developing nations. Efforts are needed to create community awareness on the importance of early ANC booking. The significant factor identified should inform policymakers on how to influence pregnant women to come for an early booking for ANC.

Adverse maternal outcomes of adolescent pregnancy in Northwest Ethiopia: A prospective cohort study.

BackgroundAdolescent pregnancy is considered a major contributor to maternal and child morbidity and mortality, the greatest concern of developing countries and an important public health issue globally. Adolescents are responsible for eleven percent of births worldwide and they face several pregnancy and childbirth related complications. However, in low-income countries like Ethiopia, there are limited researches conducted to investigate outcomes of adolescent pregnancy. Therefore, this study was conducted to assess the adverse maternal outcomes of adolescent pregnancy in Northwest Ethiopia.MethodsA prospective cohort study was conducted in 12 health facilities from seven districts in East Gojjam zone, Northwest Ethiopia. A total of 418 adolescents (15–19 years old) and 836 adult women (20–34 years old) who attended randomly selected health facilities in East Gojjam zone were included. Data were collected starting from admission to the maternity ward for labor and delivery, and postnatal depression was measured at six weeks’ postpartum period using the Edinburgh Postnatal Depression Scale. Generalized estimating equations (GEE) was used to account for the within subject correlation and assess the effect of different known factors that could influence the outcome of this study.ResultsA lower percentage of adolescent (58.4%) than adult (71.2%) women had their first antenatal care booking before 16 weeks of gestation. After adjusting for different confounding factors, the adverse outcome that was significantly associated with adolescent pregnancy was postpartum depression (AOR: 2.29; 95% CI, 1.42, 3.7, p-value = 0.001). Assisted vaginal delivery (AOR: 0.44; 95% CI, 0.23, 0.86, p-value 0.016) and cesarean section (AOR: 0.43; 95% CI, 0.19, 0.97, p-value = 0.042) were significantly lower among adolescent women.ConclusionsAdolescent pregnancy is associated with higher odds of postpartum depression, and lower odds to undergo cesarean section and assisted vaginal delivery than adult women. Perinatal care services should be more adolescent-friendly to ensure early diagnosis and treatment of postpartum depression. School and community-based awareness programs regarding use of contraception to prevent unwanted adolescent pregnancy, early antenatal care booking and adverse pregnancy outcomes of adolescent pregnancy and provision of psychosocial support are recommended.

Systematic review and meta-analysis of the effectiveness of pre-pregnancy care for women with diabetes for improving maternal and perinatal outcomes.

Pre-gestational diabetes mellitus is associated with increased risk of maternal and perinatal adverse outcomes. This systematic review was conducted to evaluate the effectiveness and safety of pre-conception care (PCC) in improving maternal and perinatal outcomes. Databases from MEDLINE, EMBASE, WEB OF SCIENCE, and Cochrane Library were searched, including the CENTRAL register of controlled trials, and CINHAL up until March 2019, without any language restrictions, for any pre-pregnancy care aiming at health promotion, glycemic control, and screening and treatment of diabetes complications in women with type I or type II pre-gestational diabetes. Trials and observational studies were included in the review. Newcastle-Ottawa scale and the Cochrane collaboration methodology for data synthesis and analysis were used, along with the GRADE tool to evaluate the body of evidence. The search identified 8500 potentially relevant citations of which 40 reports of 36 studies were included. The meta-analysis results show that PCC reduced congenital malformations risk by 71%, (Risk ratio (RR) 0.29; 95% CI: 0.21-0.40, 25 studies; 5903 women; high-certainty evidence). The results also show that PCC may lower HbA1c in the first trimester of pregnancy by an average of 1.27% (Mean difference (MD) 1.27; 95% CI: 1.33-1.22; 4927 women; 24 studies, moderate-certainty evidence). Furthermore, the results suggest that PCC may lead to a slight reduction in the risk of preterm delivery of 15%, (RR 0.85; 95% CI: 0.73-0.99; nine studies, 2414 women; moderate-certainty evidence). Moreover, PCC may result in risk reduction of perinatal mortality by 54%, (RR 0.46; 95% CI: 0.30-0.73; ten studies; 3071 women; moderate-certainty evidence). There is uncertainty about the effects of PCC on the early booking for antenatal care (MD 1.31; 95% CI: 1.40-1.23; five studies, 1081 women; very low-certainty evidence) and maternal hypoglycemia in the first trimester, (RR 1.38; 95% CI: 1.07-1.79; three studies; 686 women; very low- certainty evidence). In addition, results of the meta-analysis indicate that PCC may lead to 48% reduction in the risk of small for gestational age (SGA) (RR 0.52; 95% CI: 0.37-0.75; six studies, 2261 women; moderate-certainty evidence). PCC may reduce the risk of neonatal admission to intensive care unit (NICU) by 25% (RR 0.75; 95% CI: 0.67-0.84; four studies; 1322 women; moderate-certainty evidence). However, PCC may have little or no effect in reducing the cesarean section rate (RR 1.02; 95% CI: 0.96-1.07; 14 studies; 3641 women; low-certainty evidence); miscarriage rate (RR 0.86; 95% CI: 0.70-1.06; 11 studies; 2698 women; low-certainty evidence); macrosomia rate (RR 1.06; 95% CI: 0.97-1.15; nine studies; 2787 women, low-certainty evidence); neonatal hypoglycemia (RR 0.93; 95% CI: 0.74-1.18; five studies; 880 women; low-certainty evidence); respiratory distress syndrome (RR 0.78; 95% CI: 0.47-1.29; four studies; 466 women; very low-certainty evidence); or shoulder dystocia (RR 0.28; 95% CI: 0.07-1.12; 2 studies; 530 women; very low-certainty evidence). PCC for women with pre-gestational type 1 or type 2 diabetes mellitus is effective in improving rates of congenital malformations. In addition, it may improve the risk of preterm delivery and admission to NICU. PCC probably reduces maternal HbA1C in the first trimester of pregnancy, perinatal mortality and SGA. There is uncertainty regarding the effects of PCC on early booking for antenatal care or maternal hypoglycemia during the first trimester of pregnancy. PCC has little or no effect on other maternal and perinatal outcomes.

&lt;p&gt;Factors Associated with Timely Antenatal Care Booking Among Pregnant Women in Remote Area of Bule Hora District, Southern Ethiopia&lt;/p&gt;

BackgroundAntenatal care (ANC) is one of the most cost-effective and crucial components of maternal health care services. In developing countries where access to care, empowerment, and decision making power of women is low, ANC service is vital. The time at which first ANC visit was done has the utmost importance to ensure optimal health effects for both women and children. This study aimed to assess the proportion and factors associated with early antenatal care booking among pregnant women who were attending public health institutions in a remote area of Bule Hora district, Southern Ethiopia, from May to July, 2019.MethodsInstitutional-based cross-sectional study design was conducted at Bule Hora district public health facilities. Data were collected on systematically selected 377 pregnant women from 1st May to 30th July 2019. The sample size was determined by single population proportion formula and data were collected by using a standardized and pretested questionnaire and entered into Epidata 3.1 version, and then exported to Statistical Package for Social Science (SPSS) version 25 for analysis. The strength of association was measured by odds ratios with 95% confidence interval (CI) at a p-value of <0.05 and finally obtained results were presented by using simple frequency tables, bar graph, and texts.ResultsThe proportion of early antenatal care booking among pregnant women attending antenatal care in the study area was 57.8%. Factors contributing to early antenatal care booking were husband’s education (Adjusted odds ratio (AOR), 2.5; 95% CI: 1.2, 4.9), knowledge on antenatal care service (AOR,1.99; 95% CI:1.2,3.3), means of approving current pregnancy (AOR,1.8; 95% CI:1.1,2.8), and being advised before starting antenatal care visit (AOR,2.1; 95% CI:1.2,3.6).ConclusionGenerally, the timely initiation of ANC among pregnant mothers is not ideal. Modifiable factors like husband’s education, knowledge on antenatal care service, means of recognizing current pregnancy, and access to pre-ANC advice were found determinants for the timely initiation of ANC. Thus, it is advisable to provide proper information about antenatal care services by health care providers and enhancement of health extension program to increase community awareness before and during pregnancy at all levels of health care provision is very important.

\u201cIf we miss this chance, it\u2019s futile later on\u201d \u2013 late antenatal booking and its determinants in Bhutan: a mixed-methods study

BackgroundTo achieve the Sustainable Development Goal related to maternal and neonatal outcomes, the World Health Organization advocates for a first antenatal care (ANC) contact before 12 weeks of gestation. In order to guide interventions to achieve early ANC in the lower middle-income setting of Bhutan, we conducted an assessment of the magnitude and determinants of late ANC in this context.MethodsThis was a mixed-methods study with quantitative (cross-sectional study) and qualitative (in-depth interviews with pregnant women and ANC providers) component in a concurrent triangulation design. The quantitative component retrospectively analysed the socio-demographic and clinical characteristics, and the gestational age at booking of women who were provided care for delivery or miscarriages at the three tertiary hospitals in Bhutan from May–August 2018. The qualitative component involved thematic analysis of in-depth interviews with ten women attending ANC visits and four healthcare workers involved in ANC provision.ResultsAmong 868 women studied, 67% (n = 584) had a late booking (after 12 weeks), and 1% (n = 13) had no booking. Women with only primary education and those residing in rural areas were more likely to have a late first ANC booking. While many women achieved the recommended eight ANC visits, this did not necessarily reflect early booking. Late booking was common among multigravida women. The interviews illustrated a general understanding and recognition of the importance of early ANC. Support from peers, family and co-workers, and male participation in accessing ANC were seen as enablers. The outreach clinics (ORCs) at the primary healthcare level were an important means of reaching the ANC services to women in rural areas where geographical accessibility was a barrier. Specific barriers to early ANC were gender insensitivity in providing care through male health workers, cost/time in ANC visits, and the inability to produce the documents of the father for booking ANC.ConclusionLate ANC booking was common in Bhutan, and appeared to be associated with educational, geographic, socio-cultural and administrative characteristics. A comprehensive information package on ANC needs to be developed for pregnant mothers, and the quality of ANC coverage needs to be measured in terms of early ANC booking.

Prevalence and Factors Associated with Anemia among Pregnant Women Attending Antenatal Clinic at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.

Background In pregnancy, anemia is an important factor associated with an increased risk of maternal, fetal, and neonatal mortality, poor pregnancy outcomes, and impaired cognitive development, particularly in developing countries like Ethiopia. This study aimed to assess prevalence and factors associated with anemia among pregnant women attending antenatal clinic at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. Method A cross-sectional health facility based study was conducted on 284 pregnant women to assess prevalence and factors associated with anemia at St. Paul's Hospital Millennium Medical College from June to August 2014. Data on sociodemographic and clinical characteristics of the study participants were collected using a pretested structured questionnaire by interview and review of medical records. About 4 ml of venous blood was collected from each subject for peripheral blood film and complete blood counts (CBC). Binary Logistic regression analysis had been used to check for association between dependent and independent variables. In all cases, P value less than 0.05 was considered statistically significant. Result The prevalence of anemia was found to be 11.6% (95 % CI; 7.8%-14.8%). Pregnant women in the second [AOR (95% CI), 6.72 (1.17-38.45), and P=0.03] and third trimester [AOR (95% CI), 8.31 (1.24-55.45), and P=0.029] were more likely to be anemic when compared to pregnant women in their first trimester. Pregnant women who did not receive iron/folic acid supplementation [AOR (95%CI), 4.03(1.49-10.92), and P=0.01] were more likely to be anemic when compared to pregnant women who did take supplementations. Conclusion In this study the prevalence of anemia in pregnancy was low compared to the findings of others. Gestational age (trimester) and iron/folic acid supplementation were statistically associated with anemia. Therefore, iron supplementation and health education to create awareness about the importance of early booking for antenatal care are recommended to reduce anemia.

Antiretroviral initiation of pregnant women and antenatal care booking practices in eThekwini District, KwaZulu-Natal, South Africa.

BackgroundThe introduction of antiretroviral therapy (ART) in South Africa began as part of the prevention of mother-to-child transmission programme. For significant reduction of vertical transmission, early antenatal care booking and ART initiation are necessary.AimThis study aimed to evaluate ART initiation and booking practices of women attending antenatal care in eThekwini district during financial years (FY) 2010/2011 and 2013/2014.MethodsAn observational study used a retrospective chart review at four eThekwini district community health centres (CHC). From these CHCs, records of women that initiated ART in FY10/11 and FY13/14 were reviewed and compared for ART initiation delays and booking practices.ResultsA total of 2749 pregnant women who attended antenatal care (ANC) at the study sites were found eligible for ART; of these, 49% (n = 1334) attended ANC in FY10/11 while 51% (n = 1414) attended in FY13/14. In FY10/11, 46% (n = 610) and 60 % (n = 855) of the women were initiated on ART during pregnancy. The mean gestational age at booking for FY10/11 was 20.88 (standard deviation [s.d.] = 5.6) and 18.40 (s.d. = 6.2) in FY13/14. The mean gestational age at ART initiation for women who initiated ART in FY10/11 was 26.30 (s.d. = 6.02) and in FY13/14 it was 19.06 (s.d. = 6.86).ConclusionIn FY13/14 ART initiations occurred within 4 days after booking. ANC booking before 20 weeks was found to have improved between the two years from 39% to 58%; however, on average, in both years women booked during the second trimester.

Factors associated with late antenatal care booking among pregnant women in Ndola District, Zambia

Background: Many pregnant women book antenatal care (ANC) late and are at risk of poor pregnancy outcomes. Aims: This study aimed to determine the factors associated with late ANC booking among pregnant women attending antenatal clinics in Ndola District, Zambia. Methods: A quantitative cross-sectional design was used. A simple random sample of 305 pregnant women attending antenatal clinic at seven systematically selected clinics between May and July 2015 was selected. A pretested and structured interview schedule was used to collect data. Data were entered and analysed using Epidata (2008) and Stata 10.1, respectively. Multivariate logistic regression analysis was completed. Findings: The prevalence of late ANC booking was 86.6%. Mean age was 26.4 years (CI 25.7–27.1). Multivariate logistic regression analysis revealed that age, marital status and parity were associated with late ANC booking. Conclusions: Late booking remains high despite the free ANC services available to all pregnant women. Public awareness and health education could help to enhance the value of early ANC booking to pregnant women.

Distribution of Kell phenotype among pregnant women in Sokoto, North Western Nigeria.

IntroductionKell antigen is highly immunogenic and is the common cause of antibody production in mismatched blood transfusions, haemolytic transfusion reaction (HTR) and maternal alloimmunization, which causes severe anaemia in neonates. The aim of this study is to determine the prevalence and ethnic variation of the Kell phenotype among pregnant women in Sokoto, Nigeria.MethodsKell antigen status of 150 pregnant women aged 18-45 years and mean age 27.19 ±4.69 years attending antenatal clinic in UDUTH Sokoto Nigeria was determined using the conventional tube method and anti-Kell reagents (Lorne Laboratories, UK).ResultsAmong the 150 subjects studied, 3 (2.0%) of subjects were positive and 147 (98.0) were negative for K antigen. Of the 150 pregnant subjects; 32 (21.3%) were primigravidae while 118 (78.7%) were multigravidae. Kell phenotype was more prevalent among primigravidae (3.1%) compared to multigravidae (1.7%) women. The distribution of Kell phenotype among the pregnant subjects was compared based on ethnicity. The prevalence of Kell antigen was significantly higher among the Hausa ethnic group (3.2%) compared to other ethnic groups which indicated zero prevalence (p = 0.001). Kell negative phenotype was ≥ 96.8% among all the ethnic groups.ConclusionOur observed prevalence of Kell phenotype is consistent with previous studies among Blacks and Asians but significantly lower than values observed in previous studies among Caucasians. We recommend that all pregnant women should be screened for the presence clinically significant red cell antigens including Kell antigen on their first antenatal visit. Kell negative red cell should be routinely provided for all pregnant women and women with child bearing potential to reduce the risk of Kell-associated HDFN. There is need to introduce routine screening of pregnant women for clinically significant red cell antibodies to facilitate the effective management of HDFN as well as prevent HTR. There is also need for sustained health education of pregnant women in the area to encourage early booking for antenatal care.

Predictors of Early Antenatal Care Booking in Government Health Facilities of Hossana Town, Hadiya Zone, South Ethiopia: Unmatched Case Control Study

Background: Early entry to antenatal care is important for early detection and treatment of adverse pregnancy related outcomes. However, only 11% of Ethiopian women had an antenatal care visit before their fourth month of pregnancy, as recommended by world health organization. Hence, this study was aimed to assess predictors of early ante natal booking in government health facilities of Hossana town, Hadiya zone, South Ethiopia. Methods: Health facility based an unmatched case control study was conducted in government health facilities in Hossana town, from December, 1/2014-April, 30/2015 using interviewer guided questionnaire. Total sample size was 255 (85 cases and 170 controls) and taken from all government health facilities in case to control ratio 1:2 until the total sample of cases and controls obtained. Bivariate regression analysis was done and all explanatory variables associated with early ANC booking at p-value <0.25 were entered in to multivariable logistic regression analysis. Finally, p-value <0.05 was used to identify independent predictors of early antenatal booking. Results: Visiting antenatal care alone [Adjusted Odds Ratio (AOR)=3.43(95% confidence interval (CI: 1.06, 11.09)], being employed in non-governmental organizations [AOR=6.82(95%CI: 1.56, 29.77)], venders [AOR=6.25(95%CI: 2.16, 18.06)], housewife [AOR= 3.3(95%CI: 1.09, 9.97)], perceived time of antenatal care initiation at < 4 months of pregnancy [AOR= 5.51(95%CI: 1.28, 23.67)], recognition of pregnancy at 1-2 months [AOR= 7.21(95%CI: 2.47, 21.08)] and perceived number of 4 and more antenatal care visit per pregnancy [AOR=3.53(95%CI: 1.22, 10.21)] were independent predictors of early antenatal care booking among pregnant women attending antenatal care unit in government health facilities of Hossana town. Conclusions and recommendations: Health service managers, health care providers, Medias and community at large should give emphasis for the predictors of early antenatal booking like number of antenatal care visit per pregnancy, early recognition of pregnancy and time of antenatal care initiation to improve early antenatal care booking and to enable women benefit from the services in Hossana town.

Anaemia among pregnant women at the booking clinic of a teaching hospital in south-western Nigeria

Background : Anaemia in pregnancy is a global public health challenge. It is the commonest medical disorder of pregnancy and a major cause of morbidity and mortality in most developing countries. Aim : This study aimed at assessing the prevalence of anaemia in pregnancy and to identify the confounding socio-demographic factors. Methods : This is a cross-sectional descriptive study designed to determine the sociodemographic characteristics and prevalence of anaemia among pregnant women at their booking antenatal visit in a teaching hospital in Southwestern Nigeria. Pregnant women were enrolled for the study by consecutive sampling method at their first antenatal visit and the packed cell volume (PCV) was used to assess level of anaemia. Sociodemographic information was obtained from the case records of the enrolled women. Results : One hundred and thirty-eight (27.6%) of the 5000 enrolled women were found to be anaemic at the time of antenatal booking. Anaemia were more prevalent among primigravidae (33.9%) than the multigravidae (25.3%), although this difference was not statistically significant (P=0.079). Anaemia was higher among women with no formal education, those unemployed, single mothers and women with sickle cell traits. Conclusion : Anaemia in pregnancy remains a major health challenge in Nigeria with primigravidae identified as being those at most risk. So also are pregnant teenagers and women that book late for antenatal care (ANC). It is therefore important to educate women on early ANC booking and the need for compliance with prescribed medications in pregnancy. Key Words : Anaemia; pregnancy; prevalence; antenatal care; primigravidae; multigravidae; PCV

Assessment of the Content and Utilization of Antenatal Care Services in a Rural Community in Cameroon: A Cross-Sectional Study

Background: Pregnant women receive antenatal care (ANC) to ensure favorable pregnancy outcomes. Despite the high ANC coverage rate registered nationally in Cameroon; rural women, women with no formal education and those in the most deprived quintile still face difficulties in having access to quality ANC. The impact of the aforementioned factors on ANC use in the Muea Health Area (MHA) is unknown. The objective of this study was to determine the proportion of women attending ANC and the factors influencing ANC attendance in the MHA. Materials and Methods: This was a community based, analytical, cross sectional survey that involved pregnant women and women with children less than two years old who gave an informed consent or assent. Data were collected using a semi structured questionnaire. EPI info Version 7 and Stat Pac for Windows version 12? 1998-2011 (Stat Pac Inc, Bloomington, USA) were used for data analysis. Associations were considered statistically significant for p values less than 0.05. Results: Two hundred and twenty women were interviewed. The mean age was 25 years (SD 5.28). Ninety-nine percent of women had at least one ANC visit meanwhile 84.8% had at least four ANC visits. Only 27.2% of women booked for ANC in the first trimester. Rural (Maumu) residence was associated with inappropriate ANC attendance (attending less than four times) (χ2 = 18.5; p = 0.001). Semi urban women (87%; 95% C.I. = 85.10% - 89.0%) were more likely to attend four or more sessions than rural (Maumu) women (60.7%; 95% C.I. = 44.2% - 77.3%) (p = 0.001). Participant’s educational level was a significant predictor of early booking for ANC (χ2 = 26.8; p = 0.0002). Semi urban wom- en (79.1%; 95% C.I. = 76.0% - 82.2%) were significantly more likely to have a vaginal examination done than rural (Maumu) women (42.1%; 95% C.I. = 17.5% - 68.2%) (p = 0.0001). Women who met a doctor during ANC (84.0%; 95% C.I. = 80.8% - 87.0%) were more likely to have a vaginal examination done than women who only met a nurse or a midwife during ANC (65.0%; 95% C.I. = 57.7% - 71.4%) (p = 0.002). One third of women did not have a vaginal examination performed during ANC. 45.83% and 47.6% neither did a stool test nor received an insecticide treated net (ITN) respectively. Conclusion: Women in the MHA start their antenatal care late, so they should be encouraged to book early for antenatal surveillance. Furthermore, efforts should be made to increase the access of these women to quality ANC services and to adequately trained ANC providers.

Hospital-based incidence of maternal heart failure during pregnancy in Nigeria

PurposeTo determine the incidence of heart failure during pregnancy and incriminated cardiac lesions, as well as maternal and fetal outcomes in Ladoke Akintola University of Technology Teaching Hospital (LTH), Osogbo, Southwest Nigeria.MethodsThis study was a retrospective, descriptive review of all cases of heart failure during pregnancy based on data retrieved from the medical records of LTH over a 7-year period from January 2004 to December 2010. Analysis of these data was carried out using SPSS 17. Ethical clearance was obtained from the Ethical Committee of LTH.ResultsA total of 4523 patients delivered babies over the 7-year period, ten (2.2/1000) of which had cardiac decompensation. All patients were not registered at LTH for antenatal care (unbooked), with 70% of them aged 18–24 years. Fifty percent were primigravidae and the majority of them presented with symptoms in the second and third trimester. There were two cases of maternal deaths recorded and three cases of fetal/perinatal mortality. Only one case of congenital heart disease (pulmonary stenosis) and no cases of rheumatic heart disease were found.ConclusionThe data suggests that heart failure during pregnancy is uncommon in Southwest Nigeria. However, it occurs more often in young, unbooked primigravid women. Efforts should be aimed at encouraging early booking for antenatal care and a full cardiovascular evaluation to prevent associated maternal and fetal/perinatal morbidity and mortality.

Progression of pre-eclampsia to eclampsia under spinal anaesthesia

Eclampsia remains a problem in the developing countries despite improvements in antenatal care and emergency obstetric facilities. It is an important cause of maternal morbidity and mortality in Nigeria. A 26-year-old primipara, residing in an urban city in Nigeria with antenatal care facilities, booked for antenatal care at 36 weeks of gestation and was then diagnosed with severe pre-eclampsia. She initially refused therapy and was later booked for an emergency cesarean section. She had eclamptic fits during cesarean section under spinal anesthesia, and the seizure was aborted with intravenous diazepam. The postoperative period was uneventful. Progression of pre-eclampsia to eclampsia during cesarean section under spinal anesthesia is rare, but it can occur. Early booking for antenatal care to enable an early diagnosis and treatment are necessary to prevent the progression of pre-eclampsia to eclampsia. There is need to educate the populace on the importance of ante natal care so as to improve its utilization.