Frequency Of Antenatal Care Visits Research Articles

Determinants of normal haemoglobin concentration among under-five children in Sub-Saharan Africa: a Positive deviance inquiry using cross-sectional study design

BackgroundLow haemoglobin level in children is linked with short-term and long-term consequences including developmental delay. Globally, over half of the children under the age of five years had low haemoglobin...

Coverage and determinants of HIV testing and counseling services among mothers attending antenatal care in sub-Saharan African countries: a multilevel analysis

BackgroundHIV/AIDS is one of the top global public health threats that causes significant cases, deaths, and socioeconomic impact. Even though both HIV testing and counseling are identified as essential HIV interventions during pregnancy, large population-representative data shows that service coverage and determinants are limited. Therefore, this study aimed to assess the coverage and determinants of HIV testing and counseling services among pregnant mothers attending antenatal care services in sub-Saharan African countries using different nationwide data.MethodsThis study was conducted on large national-representative data from the Demographic Health Survey (DHS) using multilevel analysis. Data extraction, cleaning, coding, and statistical analysis were performed using STATA version 17. Weighting was used to ensure the representativeness of the sample and to obtain reliable estimates and standard errors. The multivariable multilevel logistic regression model was used to identify the determinants of HIV testing and counseling during the antenatal care visit. Adjusted odds ratios with 95% confidence intervals were used to measure statistical significance.ResultsA total of 83,584 women attending antenatal care were included in this study. HIV testing and counseling coverage in sub-Saharan Africa was found to be 62.87% with a 95% CI of 62.54–63.19%. The HIV testing and counseling determinants included being in the age group of 35–49 (AOR = 1.64; 95% CI: 1.46–1.83), secondary and above education levels (AOR = 1.50; 95% CI: 1.39–1.60), having at least four ANC visits (AOR = 1.85; 95% CI: 1.68–2.02), living in an urban area (AOR = 1.40; 95% CI: 1.30–1.52), and living in countries such as Rwanda (AOR = 6.19; 95% CI: 5.19–7.38) and Mauritania (AOR = 0.02; 95% CI: 0.01–0.03).ConclusionThis study revealed that HIV testing and counseling coverage was 62.87% in sub-Saharan Africa. Factors affecting the HIV testing and counseling coverage were age, education, frequency of antenatal care visits, residence area, and living in Rwanda and Mauritania. Therefore, to increase HIV testing and counseling coverage in sub-Saharan Africa, policymakers on maternal health and other stakeholders should work with an integrated approach with other sectors and give prior attention to modifiable factors such as promoting women’s education and the comprehensiveness of antenatal care follow-up services during the follow-up.

Obstetrics outcomes among women with incomplete antenatal care visits at Homa Bay Teaching and Referral Hospital, Kenya

Background : Perinatal morbidity and mortality present significant challenges in Kenya, particularly in regions with high rates of such adverse outcomes, including Homa Bay County. Universal health coverage and antenatal care (ANC) services play pivotal roles in improving obstetric outcomes, yet ANC uptake remains low in these areas. This study aimed to investigate the impact of incomplete ANC visits on obstetric outcomes among pregnant women at Homa Bay Teaching and Referral Hospital (HBTRH).
 Materials and Methods : From October 5 to November 13, 2020, we conducted an observational prospective study in the hospital's maternity unit. A random sample of 168 pregnant women in labour was selected. We closely monitored their deliveries, recording data on delivery mode, gestational age, birth weight, birth outcomes, APGAR scores, Neonatal Care Unit (NBU) admissions, and congenital defects. Additionally, we reviewed each mother's ANC visitation history.
 Results : There were positive correlations between the frequency of ANC visits and key obstetric indicators, including higher birth weight, longer gestational age, a greater likelihood of vaginal delivery, and improved APGAR scores. Furthermore, increased ANC visits were associated with a reduced incidence of congenital defects and NBU admissions. These findings align with existing research conducted in similar healthcare settings.
 Conclusion : A statistically significant positive correlation was noted between ANC visits and Apgar scores. The findings thus suggest other influential determinants of the obstetric outcome at HBTRH exist hence future studies should focus on determining key influencers of obstetric outcomes in the facility.

Utilization and determinants of adequate quality antenatal care services in India: evidence from the National Family Health Survey (NFHS-5) (2019-21)

BackgroundPregnancy-related complications and insufficiencies in antenatal care services are leading causes of maternal and infant morbidity and mortality in low-resource settings. However, there has been an undue focus on achieving a minimum number of Antenatal Care (ANC) visits without adequate focus on the factors affecting ANC service utilization. This secondary data analysis from the fifth round of the National Family Health Survey (NFHS-5, 2019-21) was conducted to estimate the coverage of adequate quality ANC service and its determinants in India.MethodsThe study sample included 176,877 women aged 15–49 years who had experienced a pregnancy in the last 5 years. The primary outcome variable was the utilization of ANC services by women during their last pregnancy assessed by the frequency of ANC visits and the quality of ANC services. Quality of ANC service utilisation was categorised as adequate quality, inadequate quality and ≥ 4 ANC visits and, inadequate quality and < 4 ANC visits. We performed multinomial logistic regression and reported relative risk ratio (RRR) along with 95% confidence intervals. We adjusted for sampling weight, clustering, and stratification in the sampling design.ResultsThe median (IQR) number of ANC visits attended by a woman during her previous pregnancy was 4 (IQR 3–7). A majority (59.25%) of the women reported availing of ≥ 4 antenatal care (ANC) visits during their previous pregnancy while 6.12% of women reported availing no ANC visits in their last pregnancy. Women aged ≥ 30 years were significantly less likely (aRRR 0.73 95% CI 0.66, 0.80) to receive ANC services of inadequate quality, and < 4 ANC visits. Additionally, any exposure to mass media (aRRR 0.69 95% CI 0.66, 0.73), and having health insurance (aRRR 0.71 95% CI 0.68, 0.75) decreased their risk of receiving inadequate quality ANC services and < 4 ANC visits. Women belonging to the richest wealth quintile (aRRR 0.52 95% CI 0.47,0.58) and those with an intended pregnancy (aRRR 0.62 95% CI 0.58 ,0.66) were at significantly lower risk of utilizing inadequate quality ANC services and < 4 ANC visits.ConclusionAlthough nearly 3 in 5 women in India utilized a minimum mandated ≥ 4 ANC visits during their last pregnancy, only one in five of those received adequate quality of ANC services indicating suboptimal content. However, only one in five women utilized the WHO-mandated ≥ 8 ANC visits for a positive pregnancy experience. Furthermore, 14.3% of the women received ANC services of inadequate quality despite attending ≥ 4 ANC visits in their previous pregnancy. Our study emphasized the importance of the quality of ANC services utilised irrespective of number of ANC visits availed. Efforts should be undertaken to enhance the utilization of antenatal care (ANC) services by implementing media initiatives that aim to raise awareness, particularly among women belonging to disadvantaged population groups.

DESCRIPTIVE STUDY OF LOW BIRTH WEIGHT INFANTS AT SEPASO HEALTH CENTER

Low birth weight (LBW) infants are a serious health issue in Indonesia. LBW is associated with high mortality rates, chronic diseases risks, and growth and developmental disorders in children. This study aims to provide an overview of LBW occurrence at Sepaso Health Center. This research employed a descriptive research design. According to Sumadi (2016), descriptive research aims to provide a description of a situation or event. A case study approach was used in this research design, where information was collected to understand a specific event or problem. The population of this study consisted of individuals with authority regarding the influence of LBW infants at Sepaso Health Center. Purposive sampling technique was utilized for sample selection. Based on the research conducted on 30 mothers with low birth weight (LBW) infants, the findings revealed that 60% of the mothers were at risk due to being below 20 years or above 35 years old, while 40% of the mothers were not at risk with ages between 20-35 years. Parity showed that 30% were nulliparous and 70% were multiparous. Maternal occupation indicated that 40% were employed and 60% were unemployed. Antenatal care (ANC) distribution showed that 40% had frequent ANC visits, while 60% had inadequate ANC visits. Maternal food consumption during pregnancy showed that 27% had good consumption, 67% had sufficient consumption, and 6% had inadequate consumption. These findings can serve as a basis for enhancing attention and care for low birth weight infants at the Sepaso Health Center. It is expected that this study can contribute to the efforts in improving the health of low birth weight infants in the region.

Disparities in Antenatal Care Visits between Urban and Rural Ethiopian Women.

Utilizing antenatal care is one of the best ways to identify issues that are already present or could arise throughout pregnancy. Despite increased efforts to expand health services and antenatal care utilization, less is known regarding antenatal care disparities across different population segments. Therefore, the purpose of this study was to assess the degree of discrepancies between urban and rural Ethiopian pregnant women's use of antenatal care. A total sample of 3927 women who gave birth to living children between 2014 and 2019 was included in the study from the 2019 Ethiopia Mini Demographic and Health Survey. Negative binomial Poisson's regression was adopted to analyze the data. The majority of pregnant women (73.8%) attend at least one antenatal care. Pregnant women in rural areas visited fewer number of antenatal care (68.36%) than those in urban areas (90.1%). Women with age range of 30-40 (IRR: 4.56, 95% CI: 1.07-19.34), women with attending incomplete primary education (IRR: 0.05, 95% CI: 0.02-0.12), women with attending complete primary education (IRR: 0.17, 95% CI: 0.07-0.42), women from middle-income households (IRR: 0.12, 95% CI: 0.06-0.24), women from richer household (IRR: 0.26, 95% CI: 0.14,0.5), women from the richest household (IRR: 0.45, 95% CI: 0.24-0.86), and pregnant women from rural areas (IRR: 0.615, 95%: 0.56-0.67) were observed to be linked with the frequency of antenatal care visits. In Ethiopia, three-fourths of pregnant women attend at least one antenatal care. Place of residence, educational attainment, age in five years' group, and wealth index for urban/rural were related to the frequency of antenatal care visits.

Key factors associated with quality of postnatal care: a pooled analysis of 23 countries

Progress in reducing maternal and neonatal mortality, particularly in low-income and middle-income countries (LMICs) and regions, is insufficient to achieve the Sustainable Developmental Goals by 2030. High-quality postnatal care (PNC) for mothers and neonates is crucial for mothers and babies, yet it remains the most neglected intervention on the continuum of maternal and child care. We aimed to estimate the associations between observable factors and high-quality maternal and neonatal PNC in pooled and country-specific analyses. In this cross-sectional study, we used the most recent (2015-2022) Demographic and Health Surveys from 23 countries across Africa (n=14), Southeast Asia (n=3), Eastern Mediterranean (n=2), Europe (n=2), Americas (n=1), and Western Pacific (n=1). Women who, within the last 5 years, were aged 15-49 years at their last live birth that had delivered a singleton child were included. We identified eleven PNC behaviours recommended by the World Health Organization (WHO) to measure PNC quality, and applied thresholds to create binary outcomes for quality maternal and neonatal PNC. 15 factors were included in our analysis to assess their association with high-quality PNC for mothers and neonates in a series of single-adjusted and mutually adjusted logistic regression models, both in pooled and country-specific analysis. We also conducted two sets of subgroup analyses for place of residence and maternal age at last birth, and two sets of supplementary analyses to test the robustness of the results. Among 172,526 women and their most recent child, 41.42% (40.93-41.91) received quality maternal PNC while 42.34% (41.86-42.83) received quality neonatal PNC. In the pooled analysis, we found that the factors showing the strongest associations with quality maternal PNC were delivery by skilled birth attendants (SBAs) (OR: 4.92; 95% CI: 4.32-5.59), four or more antenatal care (ANC) visits (OR: 1.69, 1.58-1.81), and institutional delivery (OR: 1.61; 1.46-1.78). Consistent results were found for all factors of quality newborn care (e.g., delivery by SBA: OR, 4.25; 3.75-4.81; four or more ANC visits: OR, 1.83; 1.70-1.96) except institutional delivery. The association between these leading factors and PNC quality were broadly consistent across countries. Subgroup analyses and sensitivity analyses showed generally consistent results. Our study demonstrated that institutional delivery and frequent ANC visits had the strongest positive associations with quality PNC for both mothers and neonates. Our findings highlight that improvements to the quality of maternal and neonatal PNC in the LMICs we assessed are urgently needed to achieve ambitious maternal, newborn, and child health goals. China National Natural Science Foundation.

Prevalence, knowledge, and attitudes toward herbal medicines among pregnant women attending antenatal clinic in Prince Mansour Military Hospital in Taif.

Using of herbs is very common among pregnant women to treat the symptoms related to pregnancy as most people believe that herbs are safer than the medical drugs. This study aims to explore the prevalence, knowledge, and attitudes toward herbal medicines among pregnant women attending the antenatal clinics. A cross-sectional study was applied at Prince Mansour Military Hospital in Taif city. It included a random sample of Saudi pregnant women who attended the antenatal clinic. Arabic language self-administered questionnaire was used for data collection. It included the personal data, herbal medicines use during pregnancy, and pregnant beliefs about use of herbal medicines and conventional medications. The study included 222 pregnant women. Their age ranged between 19 and 45 years with a mean of 30.15 and standard deviation of 5.51 years. About 15.3% of the participants never visited the antenatal clinics before while 56.8% of them visited them three times or more. The prevalence of using herbal medicines during pregnancy was 32.9%. The main source for obtaining herbal medicines was herbal shops (53.4%). Herbal medicines were self-used by majority of the pregnant women during pregnancy (82.2%). There was a statistically significant association between frequency of antenatal care visits and using of herbal medicines during pregnancy, P = 0.030. Majority of the women believed that most herbal medicines are natural (86%), most Western medicines are unsafe for them (74.8%) and their babies (75.2%) during pregnancy as well as herbals are beneficial if recommended by doctor (71.2%). Herbal medicines use during pregnancy is a common practice among women in Taif city, Saudi Arabia. Less frequent ANC visits was associated with high probability of herbal medicine use during pregnancy. Majority of pregnant women agreed that herbals are beneficial if recommended by doctor.

Receiving antenatal care components and associated factors in Northwestern Tanzania.

Tanzania had an estimated 5.400 maternal deaths in 2020. Suboptimal quality of antenatal care (ANC) presents a major challenge. It is not known what precisely the uptake of the various ANC components is, such as counseling on birth preparedness and complication readiness, preventive measures and screening tests. We assessed the level of receiving the various ANC components and associated factors in order to identify opportunities to improve ANC. A cross-sectional household survey using a structured questionnaire through face-to-face interviews, was conducted in April 2016 in Mara and Kagera regions, Tanzania, applying a two-stage, stratified-cluster sampling design. The analysis included 1,162 women aged 15-49 years who attended ANC during their last pregnancy and had given birth not longer than two years prior to the survey. To account for inter- and intra-cluster variations, we used mixed-effect logistic regression to examine factors associated with receiving essential ANC components: counseling around birth preparedness and complication readiness (with presumed effects on knowledge about danger signs) and preventive measures. About In 878 (76.1%) women preparedness for birth and its complications was observed to exist. Overall counseling was low where 902 (77.6%) women received adequate counseling. Overall knowledge of danger signs was low in 467 women (40.2%). Uptake of preventive measures was low, with presumptive malaria treatment in 828 (71.3%) and treatment of intestinal worms in 519 (44.7%) women. Screening test levels varied for HIV in 1,057 (91.2%), any blood pressure measurement in 803 (70.4%), syphilis in 367 (32.2%) and tuberculosis in 186 (16.3%) women. After adjusting for age, wealth and parity, the likelihood of receiving adequate counseling on essential topics was less in women without education versus primary education (aOR 0.64; 95% CI 0.42-0.96) and in women who had <4 ANC visits versus ≥4 visits (aOR 0.57; 95% CI 0.40-0.81). Receiving care in privacy or not (aOR 2.01; 95% CI 1.30-3.12) and having secondary education as compared to primary education (aOR 1.92; 95% CI 1.10-3.70) were associated with receiving adequate counseling. Odds of receiving adequate care in at least one ANC visit were lower in women with joint decision making on major purchases versus decision making by male partner or other family members alone (aOR 0.44; 95% CI 0.24-0.78), similar to being less knowledgeable on danger signs (aOR 0.70; 95% CI 0.51-0.96). Overall uptake of various essential ANC components was low. Frequent ANC visits and ensuring privacy are all essential to improve the uptake of ANC.

Factors associated with the willingness to receive COVID-19 vaccination among pregnant women

Pregnant women are a vulnerable group to be infected by COVID-19, and have a higher risk of serious illness, morbidity, and mortality than the general population. Willingness to receive COVID-19 vaccination has a decisive role in successfully controlling the COVID-19 pandemic. The objective of this study was to determine the factors related to the willingness to get COVID-19 vaccination in pregnant women at the Teluknaga Public Health Center. A total of 102 pregnant women with gestational ages of 13 to 33 weeks were selected by convenience sampling. Data were collected by filling out a questionnaire during November to December 2021. All respondents had a health status that meets the requirements for COVID-19 vaccination. Overall, 63% of pregnant women wanted to receive COVID-19 vaccination. There were significant relationships between education (p=0.029), frequency of antenatal care (p=0.019), husband's support (p&amp;lt;0.001) and willingness to receive vaccination. Religion, occupation, knowledge about COVID-19, parity, frequency of antenatal care visits, and sources of information did not show significant relationships with the willingness to receive COVID-19 vaccination among them. Education and awareness campaigns about the safety of the COVID-19 vaccine for pregnant women and the role of health workers are needed to raise awareness.

Risk of low birthweight associated with the timing and frequency of antenatal care visits in Lao PDR: a retrospective cohort study

BackgroundAntenatal care (ANC) plays an important role in preventing low birthweight (LBW). Whereas the government of Lao People’s Democratic Republic (Lao PDR) has committed to increasing the usage of ANC, little attention has been given to the early initiation of ANC. The present study assessed the influence of delayed and fewer ANC visits on LBW in the country.MethodsThis is a retrospective cohort study conducted at Salavan Provincial Hospital. Study participants were all pregnant women who gave birth at the hospital between 1 August 2016 and 31 July 31 2017. Data were collected from medical records. Logistic regression analyses were performed to quantify the relationship between ANC visits and LBW. We also investigated factors associated with inadequate ANC visits: first ANC visit after the first trimester or < 4 ANC visits.ResultsThe mean birth weight was 2808.7 g [standard deviation: SD 455.6]. Among 1804 participants, 350 (19.4%) had babies with LBW, and 147 (8.2%) had inadequate ANC visits. In multivariate analyses, compared to participants with adequate ANC visits, those with ≥ 4 ANC visits and the first ANC visit after the second trimester, those with < 4 ANC visits, and those with no ANC visits had higher odds ratios (ORs) of LBW: 3.77 (95% confidence interval: CI = 1.66–8.57), 2.39 (95% CI = 1.18–4.83) and 2.22 (95% CI = 1.08–4.56), respectively. Younger maternal age (OR 1.42; 95% CI = 1.07–1.89), government subsidisation (OR 2.69; 95% CI = 1.97–3.68) and ethnic minority (OR 1.88; 95% CI = 1.50–2.34) were associated with increased risk of insufficient number of ANC visits after adjusting for covariates.ConclusionsFrequent and early initiation of ANC was associated with a reduction in LBW in Lao PDR. Encouraging childbearing-aged women to receive sufficient ANC at proper timing may lead to a reduction in LBW and improvement in short- and long-term health outcomes of neonates. Special attention will be needed for ethnic minorities and women in lower socioeconomic classes.

Assessment of reproductive health service utilization in urban slums: Evidence from Western Rajasthan

Objective: To assess the utilization of reproductive health services in urban slum of Jodhpur city, India.Methods: A community based cross-sectional study was conducted in an urban slums of Jodhpur city amongst 300 married women of reproductive age between March and June 2021. Semi-structured questionnaire was used to gather demographic data and information about utilization of antenatal care (ANC) services, delivery and post-partum services.Results: The majority of females were aged less than 25 years (n=195; 65.0%), married after 18 years (n=240; 80%), living in extended families (n=265; 88.3%) and with monthly family income less than 10000 rupees (n=182; 60.7%). Statistically significant associations were found between ≥4 ANC visits and educational level of secondary and above (OR 2.47, 95% CI 1.03-6.28; P=0.04), older age (OR 15.70, 95% CI 14.87–16.54 for women aged 26–35 years, OR 16.14, 95% CI 12.12–20.01 for women aged ≥36 years; P<0.01), and backward and general castes (OR 15.91, 95% CI 13.57–17.85 for backward caste and OR 8.11, 95% CI 8.07–8.26 for general category of caste; P<0.01). Seven percent of females had undergone parturition. Older age was associated with higher risks of postpartum complications (OR 1.06, 95% CI 1.01–1.57 for women aged 26-35 years, OR 3.56, 95% CI 1.29–4.69 for women aged ≥36 years; P<0.01). In addition, risks of postpartum complications were associated with backward and general castes (OR 1.69, 95% CI 1.34–2.13 for backward classes and OR 5.01, 95% CI 4.29–5.31 for general category castes; P<0.01), and more than 4 ANC visits (OR 0.20, 95% CI 0.09-0.34; P<0.01).Conclusions: More frequent ANC visits are associated with a lower risk of postpartum complications. Furthermore, a high utilization of reproductive health services represents good implementation of reproductive and child health programme at the peripheral level resulting in a stark rise in maternal health indicators in the state of Rajasthan.

Knowledge on anaemia and benefit of iron–folic acid supplementation among pregnant mothers attending antenatal care in Woldia town, Northeastern Ethiopia: a facility-based cross-sectional study

BackgroundAnaemia in pregnancy is the leading cause of maternal morbidity and mortality and poor birth outcomes in low- and middle-income countries. The most common cause of anaemia during pregnancy is acute blood loss and iron deficiency due to physiological changes and increasing demand for iron on the mother and growing foetus. Iron and folic acid supplementation is the most widely employed strategy to alleviate iron deficiency anaemia during pregnancy. The mother’s knowledge of anaemia and the benefit of iron–folic acid is crucial in reducing the magnitude of anaemia due to iron deficiency. In Woldia town, despite the efforts made to reduce iron deficiency anaemia during pregnancy, information on pregnant mother knowledge on anaemia and the benefit of iron–folic acid and its associated factors are scarce.MethodsA facility-based cross-sectional study design was conducted, on 414 pregnant mothers attending antenatal care in Woldia town, Northern Ethiopia. Systematic random sampling methods were used to select study participants. The data were entered into Epi-data version 4.2 and analysed using SPSS version 24. Bivariable and multivariable analysis was done to see the association between the dependent variable and independent variables.ResultsThis study revealed that 54.1% and 57.7% of pregnant women had good knowledge of anaemia and the benefit of iron–folic acid, respectively. Maternal education status (AOR = 2.19, 95% CI 1.32–3.64), good knowledge of iron–folic acid (AOR = 5.85, 95% CI 3.60–9.50) and residence (AOR = 5.43, 95% CI 2.36–12.51) were statistically associated with pregnant mothers knowledge on anaemia. Obtained counselling on the benefit of iron–folic acid (AOR = 2.04, 95% CI 1.11–3.75), having four or more antenatal care visit (AOR = 3.12, 95% CI 1.38–7.07) and good knowledge of anaemia (AOR = 5.88, 95% CI 3.63–9.50) was statistically associated with pregnant mothers knowledge on the benefit of iron–folic acid.ConclusionsPromoting frequent antenatal care visits and giving counselling on the benefit of iron–folic acid and cause, prevention and treatment of anaemia were essential strategies to raise knowledge of pregnant mother on anaemia and the benefit of iron–folic acid.

Application of Count Regression Models for Factors of Antenatal Care (ANC) Utilization in Ethiopia

Adequate antenatal care is necessary to improve the health status of peoples in a country as it contributes the reduction of infant and maternal mortalities. The coverage and the quality of antenatal care plays significant role in maternal health. Ethiopia has witnessed an encouraging improvement in the ANC coverage (at least one visit) in the last decade from 62% in 2016 to 74% in 2019. But only 43% of women had at least four ANC visits during their last pregnancy. The purpose of this study is to identify factors that affect antenatal care visits based on 2019 Ethiopia Mini Demographic and Health Survey (EMDHS) dataset using count regression model. A total of 8,885 women aged 15-49 years were asked for the EMDHS-2019 out of which 3,927 women were illegible and asked for their ANC experiences for their last pregnancy. This empirical study aimed at investigating the impacts of the socioeconomic and demographic characteristics on the utilization of antenatal care. To investigate the impacts of the factors on the number of ANC visits, count models such as Poisson, Negative Binomial (NB), Zero Inflated Poisson (ZIP) and Zero-inflated negative binomial (ZINB) models were examined to select the best fitted model. The selection criterion Akaike information criterion (AIC), Bayesian information criterion (BIC) and Log Likelihood were applied to select the best model. The ZIP model was found to be the best fitted model for the data. Based on ZIP model, the explanatory variables region, age, place of residence, education, religion, wealth index and marital status were statistically significant factors on the frequency of ANC visits. Hence, efforts are still required to put on creating and expanding awareness on the utilization of ANC. The policy makers along with both private sectors and civil societies have to facilitate the increase of awareness and the experiences of the utilization of ANC in consideration of households within different groups of a society. Keywords: EMDHS-2019, antenatal care, Count Regression model DOI: 10.7176/JHMN/101-02 Publication date: June 30 th 2022

Socio-demographic factors associated with early antenatal care visits among pregnant women in Malawi: 2004-2016.

In 2016, the WHO published recommendations increasing the number of recommended antenatal care (ANC) visits per pregnancy from four to eight. Prior to the implementation of this policy, coverage of four ANC visits has been suboptimal in many low-income settings. In this study we explore socio-demographic factors associated with early initiation of first ANC contact and attending at least four ANC visits ("ANC4+") in Malawi using the Malawi Demographic and Health Survey (MDHS) data collected between 2004 and 2016, prior to the implementation of new recommendations. We combined data from the 2004-5, 2010 and 2015-16 MDHS using Stata version 16. Participants included all women surveyed between the ages of 15-49 who had given birth in the five years preceding the survey. We conducted weighted univariate, bivariate and multivariable logistic regression analysis of the effects of each of the predictor variables on the binary endpoint of the woman attending at least four ANC visits and having the first ANC attendance within or before the four months of pregnancy (ANC4+). To determine whether a factor was included in the model, the likelihood ratio test was used with a statistical significance of P< 0.05 as the threshold. We evaluated data collected in surveys in 2004/5, 2010 and 2015/6 from 26386 women who had given birth in the five years before being surveyed. The median gestational age, in months, at the time of presenting for the first ANC visit was 5 (inter quartile range: 4-6). The proportion of women initiating ANC4+ increased from 21.3% in 2004-5 to 38.8% in 2015-16. From multivariate analysis, there was increasing trend in ANC4+ from women aged 20-24 years (adjusted odds ratio (aOR) = 1.27, 95%CI:1.05-1.53, P = 0.01) to women aged 45-49 years (aOR = 1.91, 95%CI:1.18-3.09, P = 0.008) compared to those aged 15-19 years. Women from richest socio-economic position ((aOR = 1.32, 95%CI:1.12-1.58, P<0.001) were more likely to demonstrate ANC4+ than those from low socio-economic position. Additionally, women who had completed secondary (aOR = 1.24, 95%CI:1.02-1.51, P = 0.03) and tertiary (aOR = 2.64, 95%CI:1.65-4.22, P<0.001) education were more likely to report having ANC4+ than those with no formal education. Conversely increasing parity was associated with a reduction in likelihood of ANC4+ with women who had previously delivered 2-3 (aOR = 0.74, 95%CI:0.63-0.86, P<0.001), 4-5 (aOR = 0.65, 95%CI:0.53-0.80, P<0.001) or greater than 6 (aOR = 0.61, 95%CI: 0.47-0.79, <0.001) children being less likely to demonstrate ANC4+. The proportion of women reporting ANC4+ and of key ANC interventions in Malawi have increased significantly since 2004. However, we found that most women did not access the recommended number of ANC visits in Malawi, prior to the 2016 WHO policy change which may mean that women are less likely to undertake the 2016 WHO recommendation of 8 contacts per pregnancy. Additionally, our results highlighted significant variation in coverage according to key socio-demographic variables which should be considered when devising national strategies to ensure that all women access the appropriate frequency of ANC visits during their pregnancy.

The Usage of Antenatal Care Visit and Its Determinant Factors Using 2016 EDHS Data: Application of Count Regression Models

Antenatal care gives women and their families the information and advice they need to have a healthy pregnancy, have safe childbirth, and recover postpartum. ANC is an important intervention for lowering maternal and newborn mortality. There have been some studies done on determinants that affect the number of the minimum recommended antenatal care visits attendance, and it would be interesting to see the number of antenatal care visits and its determinant factor among pregnant women in Ethiopia from the 2016 Ethiopia Demographic Health Survey. The data was exported to STATASE 14 (64-bit) software was used for analysis and a weighted sample of 7575 women who gave birth in the last five years before the survey was included in the final analysis. A multivariable Negative Binomial regression analysis approach was carried out to identify the number of ANC visits and the determinants that affect the number of ANC visits, because the response variable was over dispersed. The aim of this study to assess the use of antenatal care visits and the factors affecting it using the 2016 EDHS Data through the application of count regression models. Finally, the IRR was used to report the relationship between the frequency of ANC and explanatory variables, along with its 95 percent confidence interval. According to the analysis (62.79%) of mothers had at least one antenatal care visit, (37.21%) had no antenatal care visit and only 31.88% attended four or more ANC visits during their pregnancy in Ethiopia. Maternal age, residence, maternal education, wealth quintile, place of ANC, ANC providers, and first ANC visit were significantly associated with level of antenatal care visits. Generally, frequency of antenatal care visits is low in Ethiopia. Its recommended to all concerned bodies should focus on their program on the number of ANC visits in all Ethiopia to improve both maternal and child health.

A Study on Role of Antenatal Care in Pregnancy Outcome in Tertiary Health Care Centre, Hyderabad

Background: Antenatal care (ANC) and regular antenatal visits are one of the interventions that have the potential to improve both maternal and child survival. The utilization of antenatal services remains less than 60% in India. The study aimed to find out the association between ANC visits and pregnancy outcome. Subjects and Method: Cross-sectional study was conducted on 200 antenatal women in a tertiary care centre over a period of 3 months. After taking informed consent data was collected by interviewer technique using a pretested semi-structured questionnaire. Questionnaire includes information related to socio-demographic variables, number of ANC visits, delivery outcome (normal/ LSCS) low birth weight, stillbirths, and abortions. Thus, collected data was entered in excel and analyzed using epi info 7.22.6. The bivariate analysis was the chi-square test. Binary logistic regression was used to study the association between delivery outcome and its covariates. Logistic regression was also done to see the association between ANC visits and Low birth weight and stillbirths. Results: Out of 59 women who had less than 4 ANC visits had more number of abortions (18.6%) (OR= 32.08; CI 95%= 4.03 to 255.07; p&lt;0.001), low birth weights (52.5%) (OR= 4.46; CI 95%= 2.31 to 8.62; p= 0.001), still births (8.5%) (OR= -1.00; CI 95%= -1 to -0.001 p=0.001), out of 22 illiterate mothers 16 of them had poor pregnancy outcomes (p= 0.002) and first ANC visit during first trimester had less complications (p &lt;0.001). Binary logistic regression revealed significant association between delivery outcome and Socio-economic status (OR= 2.14; CI 95%= -1.47 to 3.13; p&lt;0.001) as well as frequency of ANC visits (OR= 0.65; CI 95%= 0.55 to 0.77; p&lt;0.001). Significant association was also observed between ANC visits and Low birth weight (OR= 0.52; CI 95%= -0.43 to 0.62; p &lt;0.001). Logistic regression between ANC visits and stillbirths/abortion showed signi­fi­cant association (OR= 0.36 (CI 95%= -0.23 to 0.55; p&lt;0.001). Conclusion: The study shows that less than 4 ANC visits, illiteracy increases the risk of poor preg­nan­cy outcome. Women who had their first ANC visits during first trimester had less comp­li­ca­tions. Keywords: antenatal care, pregnancy outcomes, socio-demographic factors. Correspondence: K. Bhavani. Department of Community Medicine, Osmania Medical College, Hyderabad, Tela­nga­na. Email: bhavanikenche1969@gmail.com. Mobile: 9502710778. Journal of Maternal and Child Health (2022), 07(06): 653-661 https://doi.org/10.26911/thejmch.2022.07.06.04

Immediate Postnatal Care Satisfaction and Associated Factors Among Postnatal Women in Public Health Facilities at Debre Markos Town, Northwest Ethiopia, 2021.

BackgroundImmediate postnatal care (PNC) satisfaction is considered as the desired outcome of the health care system and determines the use of subsequent health care services. There is a paucity of evidence on the level of immediate PNC satisfaction in the study setting. Therefore, the aim of this study was to assess the level of immediate PNC satisfaction and associated factors among women who gave birth in Debre Markos town public health institutions, northwest Ethiopia.MethodsAn institution-based cross-sectional study was conducted from January 1 to February 28, 2021, and a systematic sampling technique was used to select the postnatal women. An interviewer-administered pretested structured tool was used. The level of immediate PNC satisfaction was measured by Jipi’s postnatal satisfaction with the nursing care questionnaire (JPSNQ). The collected data were entered into EpiData version 4.6.0 and exported to SPSS version 23 for management and analysis. Both bivariable and multivariable binary logistic regression analysis were applied. Adjusted odds ratios (AORs) with corresponding 95% confidence intervals (CIs) were calculated and statistical significance was declared at P-value <0.05.ResultsA total of 389 postnatal mothers participated in this study with a response rate of 98.73%. Immediate PNC satisfaction was 60.90% (95%CI: 56.50–65.60). Postnatal women having multiparity (AOR=7.31, 95%CI: 4.40–12.17), four and more antenatal care (ANC) visits (AOR=1.90, 95%CI: 1.08–3.36), satisfied by delivery care (AOR=2.05, 95%CI: 1.24–3.40), received friendly care (AOR=7.72, 95%CI: 2.42–13.52) and having companion (AOR=2.48, 95%CI: 1.37–4.50) had higher likelihood of immediate PNC satisfaction.ConclusionWomen’s satisfaction with immediate PNC was higher than the national achievements of targets for the client satisfaction. Therefore, health-care providers should encourage frequent ANC visits, friendly care, and companionship to increase the level of immediate PNC satisfaction.

Factors Associated with the Timing and Number of Antenatal Care Visits among Unmarried Compared to Married Youth in Uganda between 2006 and 2016

Antenatal care is an important determinant of pregnancy and childbirth outcomes. Although the youth disproportionately experience adverse maternal complications and poor pregnancy outcomes, including maternal mortality, timely and frequent use of antenatal care services among unmarried youth in Uganda remains low. This study examines the factors that are important predictors of the use of antenatal health care services among unmarried and married youth. Binary logistic regression was conducted on the pooled data of the 2006, 2011 and 2016 Uganda Demographic and Health Surveys among youth who had given birth within five years before each survey to examine the predictors of ANC use. This analysis was among a sample of 764 unmarried, compared to 5176 married youth aged 15–24 years. Overall, married youth were more likely to have more frequent antenatal care visits (56% versus 53%) and start antenatal care early (27% versus 23%) than unmarried youth. Factors significantly associated with use of antenatal care in the first trimester were education and occupation among unmarried youth, and place of residence and access to the radio among married youth. Key predictors of ANC frequency among unmarried youth were parity, education level, pregnancy desire, age group, sex of head of household and region of residence. Among married youth, significant predictors of ANC frequency were parity, pregnancy desire, occupation, access to the radio and region of residence. These findings will help inform health-care programmers and policy makers in initiating appropriate policies and programs for ensuring optimal ANC use for all that could guarantee universal maternal health-care coverage to enable Uganda to achieve the SDG3.

Determinant factors of low birth weight in Indonesia: Findings from the 2017 Indonesian demographic and health survey

BackgroundLow birth weight (LBW) is still a significant problem in Indonesia because it affects the growth and development of infants. It is also one of the factors that increase the risk of developing chronic disease later in life. PurposeThe study aimed to analyse the determinants of LBW in Indonesia. MethodsThis cross-sectional analytic study used secondary data from the 2017 Indonesian Demographic and Health Survey (IDHS). Data on the maternal factors (maternal age, frequency of antenatal care (ANC) visits, education, and maternal smoking status), children's birth order, and socio-demographic factors of the 14,239 respondents were examined. The association between LBW and the independent variables was analysed using bivariate analysis with a chi-square test (X2), followed by multivariate analysis in the form of binary logistic regression. ResultsLBW was identified in 960 infants (6.74%). Fewer than four ANC visits [AOR = 1.86; 95% CI = 1.44–2.42], uneducated mothers [AOR = 2.09; 95% CI = 1.00–4.37], and mothers who finished only primary school [AOR = 1.45; 95% CI = 1.05–2.00] were significantly associated with the incidence of LBW. ConclusionsThis study revealed that the frequency of ANC visits was a dominant factor in the incidence of LBW. Practice implicationTo reduce LBW in Indonesia, the government must increase ANC visits through health promotion programmes and maintain ANC facilities and quality.