High-quality Antenatal Care Research Articles

Trends in the quality of antenatal care in India: Patterns of change across 36 states and union territories, 1999-2021.

Antenatal care (ANC) quality is important to maternal and neonatal mortality. However, trends in the quality of ANC received by pregnant women in India have been understudied. This paper seeks to fill this gap by examining the long-term patterns nationwide and the state-specific prevalence of inadequate ANC quality received by pregnant women in India. We utilised data from four National Family Health Surveys (NFHS) conducted in 1999 (NFHS-2), 2006 (NFHS-3), 2016 (NFHS-4), and 2021 (NFHS-5) across India's 36 states/union territories (UTs). The sample includes mothers who had given birth within three years (NFHS-2) and five years (NFHS-3, NHFS-4, and NFHS-5) before each survey. We define inadequate ANC quality as not completing seven essential ANC services (weight measurement, blood pressure measurement, urine sampling, blood sampling, provision of iron supplements, provision of tetanus vaccination, and ultrasound scans) during pregnancy. We calculated the standardised absolute change to quantify the change in the share of women receiving inadequate quality ANC nationally and by each state/UT. Additionally, we estimated the population headcount of mothers who received inadequate-quality ANC in 2021 and identified the socioeconomic correlates associated with inadequate ANC quality. The prevalence of inadequate ANC quality substantially declined between 1999-2021, from 84.8% (95% confidence interval (CI) = 84.1-85.5) to 28.8% (95% CI = 28.5-29.2). However, between-state inequality in ANC quality has increased over this time. We identified a weak correlation between prevalence and population headcounts in 2021. Socioeconomically disadvantaged groups exhibited a higher prevalence of inadequate quality of ANC than less disadvantaged groups. The proportion of pregnant women receiving inadequate ANC quality has decreased over time throughout India. However, multi-faceted efforts at national and state levels are necessary to enhance the effectiveness of existing policies. Additionally, innovative and targeted approaches are required to ensure the timely and equitable provision of high-quality ANC.

Association between quality of antenatal care service utilisation and adverse birth outcomes among adolescent women in 22 Sub-Saharan African countries. A mixed-effects multilevel analysis

ObjectivesThis study aimed to assess the association between the quality of antenatal care (ANC) service utilisation and adverse birth outcomes among adolescent women in Sub-Saharan Africa (SSA). MethodsA two-level mixed-effects model was employed using the recent Demographic Health Survey (DHS) data from 22 SSA countries. Both bivariable and multivariable multilevel analyses were conducted to assess the association between individual and community level factors with adverse birth outcomes. The results of the fixed effects model were interpreted in the form of adjusted odds ratios (AORs) with 95% confidence intervals (95% CIs). ResultsIn SSA, 23.5 % of adolescent mothers experienced adverse birth outcomes. This study found that receiving high quality ANC was associated with a 28 % reduction in the likelihood of adverse birth outcomes (AOR = 0.72, 95 % CI: 0.63, 0.83). Among the individual-level factors, middle-aged adolescence (AOR = 1.23, 95 % CI: 1.11, 1.36), being a female newborn (AOR = 1.15, 95 % CI: 1.05, 1.26), single marital status (AOR = 0.87, 95 % CI: 0.78, 0.96) and higher educational status (AOR = 0.83, 95 % CI: 0.74, 0.93) were significantly associated with adverse birth outcomes. From the community-level variables, women from Eastern Africa had positive significant association with adverse birth outcomes (AOR = 1.30, 95 % CI: 1.15, 1.46). ConclusionsNearly one-fourth of adolescent women in SSA experienced at least one type of adverse birth outcome. Low quality of ANC was significantly associated with adverse birth outcomes. Policymakers need to consider a comprehensive, essential, and minimal package of ANC to enhance the quality of ANC, which is crucial for better adolescent birth outcomes.

Quality of antenatal care services received by women of reproductive age prior to delivery in selected public health facilities in the northern zone of Ghana

BackgroundOver the past two decades, antenatal care (ANC) coverage has increased in most settings across low- and middle-income countries, including Ghana. However, evidence shows that there is a need to focus on both access and quality to improve maternal and newborn health outcomes. We investigated ANC quality among public healthcare facilities in the northern region of Ghana.MethodsWe conducted a facility-based study involving 420 postpartum women, selected randomly from five public health facilities. We collected information on a set of prenatal services that respondents self-reported to have received during their most recent pregnancy. Women who received all the interventions assessed were considered to have received quality ANC. Using multilevel (mixed-effects) regression analysis, we identified the independent factors associated with ANC quality, with healthcare facility as the cluster variable.ResultsOf the 420 women, 31.2% (95% CI: 26.9, 35.8) received ANC services of high quality. ANC quality differed significantly by women’s background characteristics and ANC use. However, gestational age at first ANC and the number of follow-up visits before delivery were significantly associated with ANC quality: booking the first visit in the second or third trimester reduced the odds of receiving high-quality ANC compared to booking in the first trimester (aOR = 0.15, 95% CI: 0.07, 0.31, and aOR = 0.09, 95% CI: 0.01, 0.83, respectively). In contrast, achieving a minimum of eight ANC follow-ups before delivery increased the odds of receiving high-quality ANC compared to attaining fewer than eight visits (aOR = 4.82, 95% CI: 2.33, 9.99).ConclusionsA significant proportion of pregnant women in the study setting received suboptimal quality ANC during their most recent pregnancy. ANC quality was primarily associated with the timing of the first visit and the number of follow-up visits before delivery. Timely initiation of ANC and frequent follow-up visits will be crucial in the study’s setting for pregnant women to benefit from comprehensive ANC services.

Decomposition of the wealth gradient in maternal healthcare quality in low- and middle-income countries

Although access to health services by poor populations has improved in most low- and middle-income countries, wealth remains associated with better quality of care that in turn leads to better health outcomes. Understanding the patterns of such inequities can inform the design of policies to improve services received by poor populations. We employ regression and inequality decomposition analyses using household survey data from 58 low- and middle-income countries between 2010 and 2021 to characterize inequity in quality of antenatal care, to test at which levels inequity exists, and to assess at which levels inequities are most pronounced. We find that in most countries and in both rural and urban areas, wealthier women are more likely to receive high-quality antenatal care than their poorer peers who reside in the same locality (village or neighborhood), even when attending similar types of health facilities (public vs. private, and primary care facilities vs. hospitals). However, although inequity exists at such a local level, most of the wealth gradient in quality of antenatal care is explained by variation in quality of care between wealthier and poorer localities.

A mixed-method analysis of provider adherence to integrated antenatal care guideline in BEmONC and Non BEmONC primary health center: An Indonesian case.

Provider adherence to the integrated antenatal care (ANC) procedure is an important indicator of high-quality ANC. The procedure is intended to avoid missed opportunities to detect the risk of abnormalities in pregnancy. This study aims to assess the provider's adherence to integrated ANC in Basic Emergency Obstetric and Newborn Care (BEmONC) and non-BEmONC Primary Health Center (PHC). This study employed an explanatory sequential mixed-method design. The quantitative phase reviewed 149 medical records of pregnant women in the four PHCs in Semarang from January until February 2020. The findings were used to describe the provider's adherence to the integrated ANC and lead to the contributing factors which should be explored in the qualitative phase. The study involved four in-depth interviews with midwife coordinators in four PHCs. The Mann-Whitney and Chi-square test was employed to analyse the quantitative data, while the thematic analysis was undertaken on the qualitative data. The provider's adherence to the guideline did not differ between BEmONC and non-BEmONC PHC. The general physical examination of the patients (18.81%) and dentist visits (84.6%) were not done in either BEmONC or non-BEmONC PHC. Incomplete laboratory tests were haemoglobin (28.2%) and urine protein (38.9%). The barriers to adherence to the integrated ANC guideline were related to an imbalance of resources, role and responsibility issues among doctors and midwives, and policy issues. This study found low BEmONC nor non-BEmONC PHC adherence to the integrated ANC guideline. A Periodic evaluation of the implementation of integrated ANC to ensure its high-quality implementation in Indonesia is needed.

Adverse Birth Outcomes associated with Antenatal Care among Mothers at Madhesh Province, Nepal: A Cross Sectional Study

Background & Objectives: High-quality antenatal care (ANC) plays a vital role in reducing maternal and neonatal mortality rates and enhancing health results, especially in low-income nations. Although various factors play a role in adverse birth outcomes, antenatal care (ANC) emerges as a crucial preventive measure. Therefore, this study was conducted to investigate factors that influence participation in antenatal care services and their association with adverse birth outcomes in Madhesh Province of Nepal. Materials and Methods: A quantitative cross-sectional study was conducted among mothers who delivered their baby at health care facilities of Madhesh Pradesh from July 2020 to January 2021. A total of 104 participants selected for the study. Structured questionnaire was used and face to face interview was carried out to obtain information from participants. SPSS software was used for the data analysis and multiple logistic regression analysis was performed. A p value of less than 0.05 is considered statistically significant. Results: Among 104 mother, 11 had an adverse birth outcome. Majority of pregnancy related characteristics and antenatal care during pregnancy were significantly associated with adverse birth outcomes. In terms of socioeconomic status, education (p=0.021) and occupation (p<0.0001) showed the significant association with adverse outcome in bivariate analysis. However, in multivariate analysis socio demographic factors such as mothers’ occupation (p=0.004) and antenatal care practice such as rest during pregnancy (p=0.023) remained statistically significant. Conclusion: Finding suggests that mothers’ occupation and rest during pregnancy were associated with adverse birth outcomes. Therefore, raising awareness through prenatal care educational programs may reduce the likelihood of adverse delivery outcomes.

A Community-Based Reproductive Health Care Model Effectively Enhances Reproductive Health Among Lahu Women in Northern Thailand.

Inadequate and delayed access to sexual and reproductive health services among the Hill Tribe population can be attributed to the intersection of socioeconomic challenges and distinct cultural practices. To address this limitation and create a tailored model capable of addressing it, this study assesses the effectiveness of the Community-Based Reproductive Health Care Model (CRHC) in enhancing reproductive health knowledge, attitudes, and practices among Lahu women, a prominent hill tribe population in Northern Thailand. Implementing the CRHC model includes training programs for community influencers and subsequent education for Lahu women using culturally adapted courses. The effectiveness of the model is assessed through pre-test and post-test comparisons of knowledge, attitudes, and practices related to reproductive health care and analyzed using paired t-tests and repeated ANOVA. The scores for knowledge, attitudes, and practices among Lahu women changed from 8.92 ± 2.02, 52.99 ± 5.54, and 27.76 ± 6.67 to 10.47 ± 2.32 (p < 0.001), 56.61 ± 5.54 (p < 0.001), and 29.47 ± 6.76 (p = 0.030), respectively. Significant improvements are observed in these areas, particularly in maternal health practices among pregnant Lahu women (n = 11). This study additionally evaluates the model's impact on the healthcare system by analyzing changes in government performance indexes, showing increased access to high-quality antenatal care and contraceptive usage. This study highlights the challenges faced by hill tribe populations in accessing healthcare, emphasizing the need for tailored reproductive health education and the importance of addressing health insurance barriers. The CRHC model's success illustrates the potential of community-based, culturally sensitive interventions in improving reproductive health outcomes, providing valuable insights for similar interventions in other indigenous or marginalized communities.

Determinants of early neonatal mortality: secondary analysis of the 2012 and 2017 Indonesia Demographic and Health Survey.

Most neonatal deaths occur during the first week of life (i.e., early neonatal deaths). In this analysis, we aimed to investigate the determinants of early neonatal deaths in a nationally representative sample of births in Indonesia over the five years before each survey. Data were obtained from the 2012 and 2017 Indonesia Demographic and Health Survey (IDHS), including information from 58,902 mothers of children aged <5 years of age. The outcome variable was early neonatal death (death of a newborn within the first six days of life). Explanatory variables were categorized into environmental, household, maternal, pregnancy, childbirth, and child characteristics. Multivariate regression methods were employed for analysis. Increased odds of early neonatal deaths were associated with mothers who lacked formal education or had incomplete primary schooling (adjusted odd ratio [OR] = 2.43, 95% confidence interval [CI]: 1.18-5.01), worked outside the house in agricultural (aOR = 5.94, 95% CI: 3.09-11.45) or non-agricultural field (aOR = 2.98, 95% CI: 1.88-4.72), and were required to make a joint decision about health care with their partner or another household member (aOR = 1.79, 95% CI: 1.12-2.84). Increased odds were also observed in smaller-than-average infants, particularly those who received low-quality antenatal care services (aOR = 9.10, 95% CI: 5.04-16.41) and those whose mothers had delivery complications (aOR = 1.72, 95% CI: 1.10-2.68) or who were delivered by cesarean section (aOR = 1.74, 95% CI: 1.07-2.82). Furthermore, male infants showed higher odds than female infants (aOR = 1.85, 95% CI: 1.23-2.76). A multifaceted approach is essential for curtailing early neonatal mortality in Indonesia. Enabling workplace policies, promoting women's empowerment, strengthening the health system, and improving the uptake of high-quality antenatal care services are among the critical steps toward preventing early neonatal deaths in Indonesia.

Reduced Compared With Traditional Schedules for Routine Antenatal Visits: A Systematic Review

(Abstracted from Obstet Gynecol 2023;142:8–18) Preventive care during pregnancy generally involves screening and monitoring of both mother and fetus to minimize negative outcomes for both during pregnancy and childbirth. Previous research has demonstrated improved outcomes associated with high-quality antenatal care but has not established optimal timing or frequency of visits for routine care.

Inequality in Afghanistan in the use of prenatal healthcare services according to the sex of newborns.

The association between the sex of newborns and the utilization of prenatal healthcare services during pregnancy and childbirth has not been thoroughly studied. This study investigated the association between the sex of newborns and the extent to which women used prenatal healthcare services in Afghanistan. This study used data obtained from a nationally representative demographic and health survey. The participants in this analysis were women who had given birth in the last five years (n=19,126). Four indicators related to prenatal healthcare utilization were used: (1) number of antenatal care (ANC) visits, (2) number of ANC services provided by skilled professionals, (3) quality of ANC services, and (4) institutional delivery. Multivariate linear and logistic regression models were employed to examine the association between the sex of newborns and the use of prenatal healthcare services after adjusting for sociodemographic and decision-making autonomy variables. There was a significant association between the sex of newborns and use of prenatal healthcare services. Women with female newborns used ANC services fewer times (β =-0.10, 95% CI: -0.17, -0.03), used ANC services provided by skilled professionals fewer times (β=-0.11, 95% CI: -0.18, -0.04), were less likely to receive high-quality ANC (adjusted odds ratio (AOR)=0.78, 95% confidence interval (CI): 0.67, 0.90), and were less likely to deliver their babies at health institutions (AOR=0.83, 95% CI: 0.77, 0.91) than those with male newborns, after adjusting for other variables. The findings revealed a negative association between female newborns and the utilization of prenatal healthcare services among women of reproductive age in Afghanistan. It is important to pay attention to this issue and ensure that all women have equal access to healthcare services regardless of their newborn's sex.

A secondary analysis of the factors associated with women´s adequate utilization of antenatal care services during their last pregnancy in Uganda

BackgroundAdequate antenatal care services (ANC) use is critical to identifying and reducing pregnancy risks. Despite the importance placed on adequate antenatal care service utilization, women in Uganda continue to underutilize antenatal care services. The primary goal of this study is to identify the factors associated with women’s adequate utilization of antenatal care services in Uganda.MethodsSecondary data from the 2016 Uganda Demographic and Health Survey were used in this study. The study sample consists of 9,416 women aged 15 to 49 who reported giving birth in the five years preceding the survey. The adequate use of antenatal care services is the dependent variable. A woman who used antenatal care services at least four times is considered to have adequately used antenatal care services. We used univariate, bivariate, and multilevel logistic regression modelling to identify the factors associated with adequate utilization of antenatal care services. STATA version 14.2 was used to analyze the data.ResultsThe prevalence of adequate utilization of antenatal care services in Uganda was found to be 61.4%. Women with secondary or higher education were 32.0% (AOR = 1.32, 95% CI;1.07–1.63), employed women were 26.0% (AOR = 1.26, 95% CI;1.10–1.44), women who received high-quality antenatal care content were 78.0% (AOR = 1.78, 95% CI;1.58–2.02), and women who belong to the rich category of the wealth index bracket were 27.0% (AOR = 1.27, 95% CI;1.09–1.49), more likely to use antenatal care services adequately. Finally, the study discovered that women from less diverse ethnic communities were 15.0% (AOR, 0.85, 95%CI; 0.73–0.99) less likely to use antenatal care services adequately.ConclusionWomen’s adequate utilization of antenatal care was influenced by both community and individual-level characteristics. Policymakers must use a multi-sectoral approach to develop policies that address both individual and community-level characteristics.

Women's Expectations of and Satisfaction with Antenatal Care Services in a Semi-Urban Setting in Tanzania and Associated Factors: A Cross-Sectional Survey.

Women's satisfaction has been found to be a good indicator of quality of care and is associated with the utilization of healthcare services. Women's needs and satisfaction could be improved through the provision of high-quality antenatal care services. This study assessed women's expectations of and satisfaction with antenatal care and their associated factors in a semiurban setting in Tanzania. A cross-sectional survey using the Expectations and Satisfaction with the Prenatal Care Questionnaire (PESPC) was used to measure pregnant women's expectations of and satisfaction with antenatal care in the two districts of Kibaha and Bagamoyo, involving 338 pregnant women. The data were analyzed using SPSS version 26. In the expectation subscale, women had high expectations for personalized care (78.4%), other services (from a social worker and nutritionist) (68.8%), and complete care (being taken care of on time, receiving excellent care, and receiving information without prompting) (60.9%), while expectations for continuity of care were the lowest (38.9%). In the satisfaction subscale, women were highly satisfied with providers' care (being cared for with respect, healthcare provision, the way they were made to feel, and the ability to ask questions) (88.9%), while the least satisfying aspect was system characteristics (e.g., waiting times, scheduling, parking, tests and examinations, and facilities) (63.4%). Distance from a health facility was a significant predictor of both women's expectations of and satisfaction with antenatal care services, while age and number of pregnancies were also significant predictors of antenatal care expectations. To meet expectations for quality antenatal care services and improve satisfaction with antenatal care, policymakers should improve system characteristics, including the availability of human resources and medical supplies, increased consultation time, flexible schedules, and reduced waiting time. Additionally, ensuring the accessibility of evidence-based health information is important for increasing health literacy among pregnant women.

More is not enough: High quantity and high quality antenatal care are both needed to prevent low birthweight in South Asia

Antenatal care (ANC) is an opportunity to receive interventions that can prevent low birth weight (LBW). We sought to 1) estimate LBW prevalence and burden in South Asia, 2) describe the number of ANC visits (quantity) and interventions received (quality), and 3) explore associations between ANC quantity, quality and LBW. We used Demographic and Health Survey (DHS) data from Afghanistan (2015), Bangladesh (2018), India (2016), Nepal (2016), Pakistan (2018) and Sri Lanka (2016) (n = 146,284 children &lt;5y). Women were categorized as follows: 1) low quantity (&lt;4 ANC visits) and low quality (&lt;5 of 10 interventions received during ANC), 2) low quantity and high quality (≥5 of 10 interventions), 3) high quantity (≥4 visits) and low quality, 4) high quantity and high quality. We used fixed effect logistic regressions to examine associations between ANC quality/quantity and LBW (&lt;2500 grams). LBW prevalence was highest in Pakistan (23%) and India (18%), with India accounting for two-thirds of the regional burden. Only 8% of women in Afghanistan received high quantity and high quality ANC, compared to 42–46% in Bangladesh, India, and Pakistan, 65% in Nepal and 92% in Sri Lanka. Compared to the low quantity/quality reference group, children of women with high quantity/quality ANC had lower odds of LBW in India (Adjusted Odds Ratio 0.84, 95% CI 0.78–0.89), Nepal (0.57, 0.35–0.94), Pakistan (0.45, 0.23–0.86), and Sri Lanka (0.73, 0.57–0.92). Low quantity but high quality ANC was protective in India (0.90, 0.84–0.96), Afghanistan (0.53, 0.27–1.05) and Pakistan (0.49, 0.23–1.05). High quantity but low quality ANC was protective in Sri Lanka (0.76, 0.61–0.93). Neither frequent ANC without appropriate interventions nor infrequent ANC with appropriate interventions are sufficient to prevent LBW in most South Asian countries, though quality may be more important than quantity. Consistent measurement of interventions during ANC is needed.

Association between quality antenatal care and low birth weight in Rwanda: a cross-sectional study design using the Rwanda demographic and health surveys data

BackgroundLow birth weight (LBW) is an important factor influencing infant morbidity and mortality. Pregnant women should receive a variety of interventions during antenatal care (ANC) that are crucial in improving birth weight. ANC visits alone do not promise that women have received all recommended antenatal services. However, there are limited evidence of the relationship between ANC quality and LBW in Rwanda. Therefore, the purpose of this study was to assess the association between quality ANC and LBW along with the factors influencing LBW and how quality ANC affects LBW in Rwandan pregnant women.MethodsThe Demographic and Health Surveys (DHS) are cross-sectional, nationally representative household surveys that collect population, health, and nutrition. In this Study we used three waves of Rwanda Demographic and Health Surveys 2010,2014-5 and 2019-20. A total of 16,144 women aged 15 to 49 years who had live births in the five years preceding each survey were included in this study. A stratified two-stage sampling methods was used to select the participants. The first stage involves selecting clusters (villages) from a list of all clusters in the country. The second stage involves selecting households within each cluster. A survey adjusted for clusters at multiple level and a bivariate and multivariable logistic regression was used to estimate adjusted odds ratios(aOR) and 95% confidence intervals to assess the association between the outcome and independent variables.ResultsThe utilization of a high-quality ANC increased slightly over the three survey years and LBW had a slow decline. Out of 5813 women;201(3.45%) had high-quality ANC in the 2010 survey, and out of 5813 newborns,180(3.10%) were LBW. Out of 5404 women;492(9.11%) had high-quality ANC in 2015, and out of 5404 newborns,151(2.79% were LBW). Out of 5203 women,776(14.92%) had high-quality ANC in the 2020 survey year, and out of the 5206 newborns,139(2.67%) were LBW. In multivariable analysis, at a borderline limit high quality ANC was negatively associated with LBW(aOR:0.67;95%CI:0.43,1.05) compared to low-quality ANC. Higher birth orders of the newborn were negatively associated with LBW (aOR:0.63;95%CI:0.49,0.82 and aOR:0.44;95%CI:0.32,0.61 for 2nd -3rd and 4th and above respectively) compared to 1st orders newborn. Newborns from rich households were less likely to experience LBW than those from poor households (aOR:0.71;95%CI:0.55,0.91). Female newborns were associated with an increase of LBW (aOR:1.43;95% CI:1.18,1.73) than male newborns.ConclusionThe findings confirm the fundamental importance of a high-quality ANC on LBW. The findings could be utilized to develop monitoring strategies and assess pregnancy health assistance programs with a focus on LBW reduction.

Improving the readiness and clinical quality of antenatal care – findings from a quasi-experimental evaluation of a performance-based financing scheme in Burkina Faso

BackgroundWhile maternal mortality has declined globally, it remains highest in low-income countries. High-quality antenatal care (ANC) can prevent or decrease pregnancy-related complications for mothers and newborns. The implementation of performance-based financing (PBF) schemes in Sub-Saharan Africa to improve primary healthcare provision commonly includes financial indicators linked to ANC service quality indicators. In this study, we examine changes in ANC provision produced by the introduction of a PBF scheme in rural Burkina Faso.MethodsThis study followed a quasi-experimental design with two data collection points comparing effects on ANC service quality between primary health facilities across intervention and control districts based on difference-in-differences estimates. Performance scores were defined using data on structural and process quality of care reflecting key clinical aspects of ANC provision related to screening and prevention pertaining to first and follow-up ANC visits.ResultsWe found a statistically significant increase in performance scores by 10 percent-points in facilities’ readiness to provide ANC services. The clinical care provided to different ANC client groups scored generally low, especially with respect to preventive care measures, we failed to observe any substantial changes in the clinical provision of ANC care attributable to the PBF.ConclusionThe observed effect pattern reflects the incentive structure implemented by the scheme, with a stronger focus on structural elements compared with clinical aspects of care. This limited the scheme’s overall potential to improve ANC provision at the client level after the observed three-year implementation period. To improve both facility readiness and health worker performance, stronger incentives are needed to increase adherence to clinical standards and patient care outcomes.

Preeclampsia: Prevalence, Risk Factors, and Impact on Mother and Fetus

Objectives: Preeclampsia is one of the most common hypertensive disorders in pregnancy accounting for &gt;50,000 maternal deaths, and over 500,000 fetal deaths worldwide. The incidence of preeclampsia is estimated to be 7 times higher in developing countries like India. Women with preeclampsia are several folds more likely to contract cardiovascular diseases such as ischemic heart disease, stroke, and thromboembolism later in life. This study aims to record the prevalence of preeclampsia, examine the incidence of various associated risk factors and document, and analyze the effects preeclampsia has on the mother and fetus. Materials and Methods: A cross-sectional study was conducted. Five hundred pregnant women were randomly selected based on availability of medical records. Prevalence of preeclampsia was identified in them and the preeclamptic population was further studied for various risk factors and epidemiological factors. The impact on mother and fetus was also studied. The data obtained from the medical records were entered into MS excel and variables were expressed as frequency and proportions. Analysis was done on SPSS 26.0 and major data were subjected to Chi-square test for determining significance. Results: Out of a total of 500 pregnant women, 31 developed preeclampsia; hence, the prevalence of preeclampsia was found to be 6.2%. Of the 31 preeclamptic women, majority belonged to the 20–29 age group (51.6%), 19 (61.2%) had a pre-pregnancy body mass index &gt;23, thus being classified as overweight or obese. Thirteen of these 19 (41.9%) were obese class 1, while 5 (16.1%) were obese class 2. Only two patients were multiparous, while nulliparous and primiparous women accounted for 48.38 and 45.16% of preeclamptic women. Twenty of the 31 women had preeclampsia with severe features and this was found to be significantly associated with delivering a baby having lower birth weight (P &lt; 0.05). A significant 45.1% (14 of the 31 women) had to undergo preterm delivery and 48.38% of the preeclamptic women terminated pregnancy by a lower segment cesarean section. Two of the women were also diagnosed with elevated liver enzymes and low platelets syndrome. With respect to the fetal outcomes, 48.4% of infants had low birth weight. Intrauterine fetal death, fetal growth restriction, and cleft lip and palate were also documented in few neonates. Conclusion: Preeclampsia has a high morbidity and mortality rate as well as an increased risk for future cardiovascular diseases. Hence, risk factors which are in an individual’s self-control such as weight must be modified to prevent unfavorable complications. Pregnant women at risk of preeclampsia should be identified and high-quality antenatal care should be given to minimize the complications of preeclampsia both for the mother and the fetus. More research avenues must be explored on this subject so that enhanced treatment and management options can emerge.

Levels and determinants of quality antenatal care in Bangladesh: Evidence from the Bangladesh Demographic and Health Survey.

Assessing the quality of antenatal care (ANC) is imperative for improving care provisions during pregnancy to ensure the health of mother and baby. In Bangladesh, there is a dearth of research on ANC quality using nationally representative data to understand its levels and determinants. Thus, the current study aimed to assess ANC quality and identify the sociodemographic factors associated with the usage of quality ANC services in Bangladesh. Secondary data analysis was conducted using the last two Bangladesh Demographic and Health Surveys (BDHSs) from 2014 and 2017-18. A total of 8,277 ever-married women were included in the analysis (3,631 from 2014 and 4,646 from 2017-18). The quality ANC index was constructed using a principal component analysis on the following ANC components: weight and blood pressure measurements, blood and urine test results, counselling about pregnancy complications and completion of a minimum of four ANC visits, one of which was performed by a medically trained provider. Multinomial logistic regression was used to determine the strength of the association. The percentage of mothers who received all components of quality ANC increased from about 13% in 2014 to 18% in 2017-18 (p < 0.001). Women from the poorest group, those in rural areas, with no education, a high birth order and no media exposure were less likely to receive high-quality ANC than those from the richest group, those from urban areas, with a higher level of education, a low birth order and media exposure, respectively. Although the quality of ANC improved from 2014 to 2017-18, it remains poor in Bangladesh. Therefore, there is a need to develop targeted interventions for different socio-demographic groups to improve the overall quality of ANC. Future interventions should address both the demand and supply-side perspectives.

Understanding antenatal care use in pastoralist communities: a focused ethnographic study in Kenya

Background/Aims The provision of high-quality antenatal care improves maternal and child health outcomes. Pastoralist communities face unique challenges in accessing healthcare associated with a nomadic, marginalised lifestyle, and have high rates of maternal morbidity and mortality. There is minimal evidence on antenatal care use globally among this group. To develop optimal services for pastoralist communities, there is an urgent need to understand pastoralist women's use of antenatal care services. This study's aim was to explore experiences of antenatal care among pastoralist communities in Kenya, to identify key barriers and facilitators of uptake. Methods This focused ethnographic qualitative study was underpinned by a philosophy of critical realism. A total of 58 participants (women, husbands, traditional birth attendants and nurses) were included. Data were collected using interviews, focus group discussions and observation. Data were collected for 6 months in six villages and five health facilities in a pastoralist region of northern Kenya. Inductive thematic analysis and retroduction were used to identify concepts, structures and mechanisms that influenced antenatal care use. Results Pastoralist women's antenatal care experiences and use were linked to two main themes. The first was government policies that incentivised antenatal care use by linking the provision of the baby's health and citizenship records to antenatal care uptake and encouraging traditional birth attendants to adopt defined referral roles. The second highlighted multiple structural barriers that impeded consistent antenatal care uptake, including the pastoralist lifestyle, cultural barriers, health system constraints and a gap in information sharing. The dissonance between these led to partial, sub-optimal use patterns of antenatal care. Conclusions Government policy created an impetus for the pastoralist community to use contemporary healthcare services. At the same time, multiple barriers impeded access to services. This explains the partial use of antenatal care services among pastoralist communities. The findings throw doubt on the feasibility of antenatal care guidelines that recommend eight contacts during pregnancy. There is a need to work collaboratively with communities to develop context-specific models of care.

Predictors of surgical site infection among women following cesarean delivery in eastern Ethiopia: a prospective cohort study.

The authors conducted a prospective cohort study in eastern Ethiopia. The women were serially enrolled until the desired sample size was reached. A structured questionnaire was used to collect data. Women were followed at the hospital during their weekly visits. Culture-based microbiological methods were used to identify causal agents. A binary logistic regression model was used to identify the predictors of SSI after CS. Among serially enrolled women, 336 were followed for 30 days. The incidence of SSI was 7.74% (95% CI: 7.68-7.80). Rupture of the membrane before operation [adjusted odds ratio (AOR)=3.75, 95% CI: 1.85-16.6], labor duration greater than 24h (AOR=4.04, 95% CI: 1.52-10.79), and postoperative hemoglobin less than 11g/dl (AOR=3.42, 95% CI: 1.32-8.87) were all significantly associated with SSI. The most common isolated pathogen was Staphylococcus aureus, followed by Escherichia coli. Nearly one-tenth of the women developed SSIs. Factors such as rupture of the membrane before the operation, absence of antenatal care, labor duration greater than 24h, a midline skin incision, and postoperative hemoglobin less than 11g/dl were the predictors of SSI. To reduce the incidence of SSI, policymakers should consider the importance of high-quality antenatal care, shorten the duration of labor, and maintain women's hemodynamics in future SSI prevention bundles.

Risk factors associated with intrauterine growth restriction: A scoping review

Background: Intrauterine growth restriction (IUGR) is said to be present in those babies whose birth weight is below the 10th percentile of the average for gestational age. Those fetuses are prone to perinatal morbidity and mortality. IUGR remains prevalent in developing countries even after advancements in obstetric care. Aim: The current scoping analysis is conducted to review observational studies reporting on various sociodemographic, medical and obstetrics, and placental risk factors associated with IUGR. Methods: We performed a systematic meta-analysis of relevant studies obtained by electronic databases PubMed and Google Scholar from 2010 to 2022. Relevant research articles were searched forward and backward. Citation searches were also undertaken and all relevant literature were included. Of the 68 studies reviewed, 10 studies were included. Results: Pooled results after investigating 10 articles show that younger maternal age, low-socioeconomic status, primiparity, hypertensive disorders in pregnancy, and anemia are significantly associated with the risk of developing IUGR. Conclusion: By studying the risk factors, we will be able to identify the high-risk group. Focus on early detection and high-quality antenatal care will help to overcome the problem of IUGR in the community.