Initiation Of Antenatal Care Research Articles

EFFECT OF ANTENATAL CARE ON MATERNAL AND NEONATAL OUTCOMES IN WOMEN'S HEALTH HOSPITAL

Introduction: Good antenatal care (ANC) reduces maternal and neonatal mortality and improves health outcomes, particularly in low-income countries. World Health Organization recommendation of initiation of antenatal care within the first four months of pregnancy and at least four antenatal care visits during the course of an uncomplicated pregnancy. Inadequate care during this time breaks a critical link in the continuum of care and affects both women and her neonate. Objectives: The aim of the study was to identify effects of antenatal care on maternal and neonatal outcomes in Women Health Hospital Subjects & Method: Three hundred parous women and their neonates conducted a comparative study. They were divided into two groups' according to parity the first group (primipara =150), and the second group (high parity=150) and divided every group into two groups the first was poor antenatal care and other was adequate antenatal care during the period from February 2017 to August 2017 using a stratified sampling. Results: Most of the primipara women had poor antenatal care (88%) but high parity (67.3%). There was the highly significant relationship between two groups. More than half were had poor antenatal care (60.3%) but less than half were adequate antenatal care. The most common complication in primipara group was eclampsia (36.4%) while in high parity group was anemia (14.3%) in poor antenatal care. The most common complication in labor was premature rupture of membrane (19.0% & 14.3%) respectively, in poor antenatal care of two groups. In primipara group, the proportion of low birth weight was 16.0% in poor antenatal care, while stillbirth was (11.0%) inadequate antenatal care also neonatal weight in Kg related to poor antenatal care and adequate antenatal care were (2.636 ± 0.659 & 3.050 ± 0.503) respectively. In high parity group, the proportion of Special Care Baby Units admission was 12.2% in poor antenatal care, while Special Care Baby Unit admission was 11.9% inadequate antenatal care also neonatal weight related to poor antenatal care and adequate antenatal care were (2.973 ± .709 & 3.081 ± 0.643) respectively. Conclusion: Good quality antenatal care promote the health of the mother and decreases the percentage of iron deficiency anemia, gestational hypertension and before term labor and promote maternal outcomes, including a reduced risk of under birth weight, preterm neonates and Special Care Baby Unit admission. Recommendations: the women should have access to good quality antenatal care. Both the woman and the neonatal are at a greater risk during pregnancy and labor. This risk can be reduced with good antenatal care and delivery by trained personnel. And awareness of the adverse impact of high parity on obstetric

EFFECT OF ANTENATAL CARE ON MATERNAL AND NEONATAL OUTCOMES IN WOMEN'S HEALTH HOSPITAL

Introduction: Good antenatal care (ANC) reduces maternal and neonatal mortality and improves health outcomes, particularly in low-income countries. World Health Organization recommendation of initiation of antenatal care within the first four months of pregnancy and at least four antenatal care visits during the course of an uncomplicated pregnancy. Inadequate care during this time breaks a critical link in the continuum of care and affects both women and her neonate. Objectives: The aim of the study was to identify effects of antenatal care on maternal and neonatal outcomes in Women Health Hospital Subjects & Method: Three hundred parous women and their neonates conducted a comparative study. They were divided into two groups' according to parity the first group (primipara =150), and the second group (high parity=150) and divided every group into two groups the first was poor antenatal care and other was adequate antenatal care during the period from February 2017 to August 2017 using a stratified sampling. Results: Most of the primiparous women had poor antenatal care (88%) but high parity (67.3%). There was the highly significant relationship between two groups. More than half were had poor antenatal care (60.3%) but less than half were adequate antenatal care. The most common complication in primipara group was eclampsia (36.4%) while in high parity group was anemia (14.3%) in poor antenatal care. The most common complication in labor was premature rupture of membrane (19.0% & 14.3%) respectively, in poor antenatal care of two groups. In primipara group, the proportion of low birth weight was 16.0% in poor antenatal care, while stillbirth was (11.0%) inadequate antenatal care also neonatal weight in Kg related to poor antenatal care and adequate antenatal care were (2.636 ± 0.659 & 3.050 ± 0.503) respectively. In high parity group, the proportion of Special Care Baby Units admission was 12.2% in poor antenatal care, while Special Care Baby Unit admission was 11.9% inadequate antenatal care also neonatal weight related to poor antenatal care and adequate antenatal care were (2.973 ± .709 & 3.081 ± 0.643) respectively. Conclusion: Good quality antenatal care promote the health of the mother and decreases the percentage of iron deficiency anemia, gestational hypertension and before term labor and promote maternal outcomes, including a reduced risk of under birth weight, preterm neonates and Special Care Baby Unit admission. Recommendations: the women should have access to good quality antenatal care. Both the woman and the neonatal are at a greater risk during pregnancy and labor. This risk can be reduced with good antenatal care and delivery by trained personnel. And awareness of the adverse impact of high parity on obstetric

Regional disparities of late entry to antenatal care and associated sociodemographic barriers in Burkina Faso

Introduction Early initiation of antenatal care (ANC) can reduce maternal and neonatal mortality and improve maternal- and newborn health [1] . Understanding the geographic and the sociodemographic barriers to an appropriate utilization of ANC services is needful to identify where greatest scaling-up efforts should be concentrated [2] . Aim The aim of this study was to identify the geographic and the sociodemographic factors associated with a late entry to antenatal care services in Burkina Faso. Methods The nationwide representative cross-sectional data from the 2010 Burkina Faso Demographic and Health Survey were used to estimate the proportion of women who entered late to antenatal care in the 13 regions of Burkina Faso. A late entry was defined as timing of first antenatal > 3 months, according to WHO guidelines [3] . Logistic regression taking into consideration the complex sample design was used to identify the determinants of late entry to ANC. Adjusted prevalence estimates of late entry to ANC were derived from the fitted logistic models. Results Overall, among the 9788 women who visited the ANC services, 5644 women (57%, 95% CI: 55% > 59%) entered after 12 weeks of gestational age. The prevalence of women who had a delayed first visit differed substantially across geographic areas ranging from 43% (95% CI: 35% > 50%) in the Centre-Est to 72% (95% CI: 67% > 78%) in the Sahel region. After adjusting for sociodemographic factors, lowest wealth quintiles (OR = 1.66, 95% CI: 1.35–2.06) and lowest education level (OR = 1.88; 95% CI: 1.48–2.39) were significantly associated with a delayed first visit. By contrast, a high media exposure (OR = 1.18; 95% CI: 1.05–1.31) and knowledge about pregnancy complications were significantly associated with a non-delayed first visit. Conclusion We observed a regional difference and several potential barriers to early use of ANC services. Prenatal care program should take into account the specificity of each region while focusing on women education. Improving access to the media could reduce the late entry to ANC services in Burkina Faso.

The role of timely initiation of antenatal care on protective dose tetanus toxoid immunization: the case of northern Ethiopia post natal mothers

BackgroundGlobally, tetanus toxoid protective dose immunization of the mothers is one of the strategies of maternal and neonatal tetanus prevention. Ethiopia has planned the national tetanus protection at birth coverage to reach 86% by the year 2015. However, there is still low coverage with less identified associated factors. Therefore; the purpose of this study was to assess tetanus toxoid protective dose immunization at last birth and associated factors among mothers who gave birth within one year prior to the study in Debretabor town, Northwest Ethiopia, 2016.MethodsA community based cross sectional study was conducted from May 1 to June 10 / 2016. A total of 511 mothers were included in the study. Structured questionnaire and checklists were used to collect the data. Face to face interview with cross checking documented record were employed. A systematic random sampling technique was used. The data were entered in to Epinfo version 7.0 and then exported to SPSS version 20.0 for analysis. Both bivariate and multivariable logistic regression model were fitted and crude and Adjusted Odds ratio with 95% confidence interval were computed. Finally, statistically significant association of variables was determined based on Adjusted Odds ratio with its 95% confidence interval and p-value ≤0.05.ResultThe proportion of tetanus toxoid protective dose immunization among mothers was 56.2% (95% CI: 52–60%). In the multivariable analysis; formal education (AOR = 2.09; 95%CI: 1.12, 3.90), planned last pregnancy (AOR = 6.63; 95%CI: 2.36, 18.63), four or more antenatal care visits (AOR = 5.16; 95%CI: 2.93, 11.14), timely antenatal care visit (AOR = 4.29; 95%CI: 1.94, 9.49), and perceived good quality of service (AOR = 2.20; 95% CI: 1.26, 3.84) were positively associated with tetanus toxoid protective dose immunization.ConclusionIn this study, protective dose tetanus toxoid immunization is lower than the national target. Strengthening information education communication regarding tetanus and its prevention and encouraging timely initiation of and complete attendance of antenatal care is recommended.

Why do rural women in the most remote and poorest areas of Zambia predominantly attend only one antenatal care visit with a skilled provider? A qualitative inquiry

BackgroundWhile focused antenatal care (ANC) has served as an entry point in the continuum of care for both mothers and children, fewer than a third of pregnant women in the most remote and poorest communities of Zambia achieve the four ANC visits recommended by the World Health Organization. Current evidence suggests that attending ANC provided by a skilled healthcare worker at least once is common and associated with skilled birth attendance. The aim of this study was to explain why one ANC visit with a skilled provider seemed more common than four ANC visits among women in the remote and poorest districts of Zambia.MethodsA qualitative case study design was conducted in 2012 among 84 participants in the selected remote and poorest districts of Zambia. Focus group discussions were conducted with mothers and community health volunteers, while key informant interviews were conducted with healthcare providers. Thematic analysis was conducted.ResultsMost women delayed starting antenatal care visits due to uncertainties about the timing for initiation of ANC and due to waiting for confirmation of the pregnancy by an elderly woman. Attendance of ANC once with a skilled provider was due to the need to assess their health status and that of their baby. In some facilities, attendance of ANC at least once was enforced by financial charges imposed on women for late ANC initiation, and/or incentives provided by nongovernmental organisations. Unavailability of services at health posts closest to these remote communities led to failure to return for subsequent ANC visits. Women’s livelihoods such as nomadic lifestyles made it harder for them to initiate and make additional ANC visits.ConclusionThe popularity of ANC attendance once by a skilled provider among the remote and poorest women of Zambia was explained through perceived unavoidable social and economic barriers to care, and the punitive and incentive procedures implemented by health services. Maximising comprehensive care by skilled healthcare workers in the one visit a woman makes at the health facility, may lead to optimal utilisation of quality focused ANC. Enhancing community-based interventions may increase the potential to reach the vulnerable populations.

Understanding Predictors of Early Antenatal Care Initiation in Relationship to Timing of HIV Diagnosis in South Africa.

Effective prevention of mother-to-child transmission benefits from early presentation to antenatal care (ANC). It is, however, unclear whether a previous HIV diagnosis results in earlier initiation of ANC. We estimated the probability of early ANC initiation among women with a previous HIV-positive diagnosis compared to those who first tested for HIV during ANC and explored determinants of early ANC among HIV-positive women. We conducted an analysis of a cross-sectional survey among 411 HIV-positive adult (>18 years) women who gave birth at midwife obstetrics units in Gauteng between October 2016 and May 2017. Predictors of early ANC (defined as initiating ANC before or at 14 weeks of gestation) were assessed by multivariate log-binomial regression model. Overall, 51% (210) were diagnosed during pregnancy with 89% (188) initiating antiretroviral therapy on the same day of diagnosis. There was no meaningful difference in the timing of ANC initiation between women with previous HIV diagnosis [adjusted risk ratio (aRR) = 1.2; 95% confidence interval (95% CI): 0.9-1.7] compared with those diagnosed during pregnancy. Early ANC was predicted by planned pregnancy [aRR = 1.3; 95% CI: 1.1-1.7], parity (>2 children) [aRR = 0.6; 95% CI: 0.2-0.9] compared to not having a child, and tuberculosis diagnosis [aRR = 2.9; 95% CI: 1.4-6.1]. Our results suggest the need for a targeted intervention among HIV-positive women by improving the quality, content and outreach of ANC services to enhance early ANC uptake, and minimize mother-to-child transmission risk.

Association between timing and number of antenatal care visits on uptake of intermittent preventive treatment for malaria during pregnancy among Malawian women

BackgroundMalaria in pregnancy is a critical public health challenge, and intermittent preventive treatment for malaria during pregnancy (IPTp) has proven to be an effective intervention. However, access to and use of malaria interventions, including IPTp, remains a considerable problem among African women. This cross-sectional study investigated factors, including antenatal care (ANC) attendance (both numbers of visits and timing of the first visit) and socio-demographics, associated with the uptake of the recommended IPTp dose among Malawian women.MethodsA nationally representative sample of women with a live birth in the 2 years preceding the survey from the Malawi Demographic Health Survey 2015–2016 dataset was analysed. Self-reported data on socio-demographics, ANC attendance and IPTp uptake were collected using a questionnaire and analysed using logistic models.ResultsOf the 6549 included women, 1981 (30.2%) took the recommended three or more IPTp doses. Despite inadequate ANC visits, early ANC initiation increased the likelihood of these women taking the recommended IPTp dose; women who initiated ANC in the first [adjusted odds ratio (aOR) = 2.24; 95% confidence interval (CI) = 1.44–3.49] and second (aOR = 2.19; 95% CI = 1.56–3.08) trimesters were more likely to take the recommended IPTp dose compared to late initiators. The effect of the number of ANC visits on IPTp uptake was significant in married women (aOR = 1.68, 95% CI = 1.42–1.98), and the timing of first ANC visit was associated with IPTp uptake only among rural women (aOR = 2.13, 95% CI = 1.54–2.95).ConclusionANC attendance is vital in IPTp uptake. The results highlight the need for health care providers to encourage women, particularly those in high-risk groups, to make frequent ANC visits and receive early ANC initiation to ensure high coverage of the recommended IPTp dose.

Inequity in the utilization of antenatal and delivery care in Yangon region, Myanmar: a cross-sectional study

BackgroundEquity of access to and utilization of healthcare across socio-economic groups is important to achieve universal health coverage. Although the utilization of antenatal and delivery care has been increasing in low- and middle-income countries, inequities in the utilization of antenatal and delivery care have been reported in many countries, but have not yet been studied in Myanmar. This study aimed to determine whether inequities in the utilization of antenatal and delivery care existed in Yangon region, Myanmar.MethodsA community-based cross-sectional survey using multistage sampling was conducted from October to November 2016. A wealth index was selected as the main socioeconomic parameter for measuring inequities with respect to early initiation of antenatal care (ANC), number of antenatal care visits, delivery by a skilled birth attendant (SBA) and delivery by cesarean section (CS). Inequities were evaluated using concentration curves and concentration indexes.ResultsOf the 762 women who gave birth within the 12-month survey period, there was no evidence of inequity in utilization of ANC; however, inequity of at least one antenatal visit among women aged less than 20 years was found with a concentration index of 0.04. The concentration indexes for delivery by SBA and CS were 0.05 and 0.14, respectively. Delivery by CS was disproportionately higher in adolescents and women with higher education than middle school.ConclusionThere was no overall inequity in the utilization of ANC but substantial inequities in delivery by CS and SBA were shown. Social determinants of health, particularly age and education, were associated with inequities in the utilization of delivery care. Adolescent pregnant women were found to be particularly vulnerable, and thus should be a target group for strategic plans to reduce inequities in utilization of delivery care.

DELAY on first antenatal care visit and its associated factors among pregnant women in public health facilities of Debre Markos town, North West Ethiopia

BackgroundDelay on timely initiation of antenatal care has a great impact on adverse pregnancy out comes. However, evidences in Ethiopia revealed that majority of pregnant mothers did not start their first visit as recommrnded by WHO. The aim of this study was to assess delay and associated factors of first antenatal care visit among pregnant mothers at public health facilities of Debremarkos town, North West Ethiopia.MethodsAn institutional based crosss-sectional study was conducted from February to March, 2014 in public health facilities of Debremarkos town North west Ethiopia. A total of 320 pregnant mothers who were sure of their last menstrual periods were interviewed with a structured questionnaire. Data entry was done using Epi data 3.1 and analysis was done using SPSS version 20. Descriptive statistics, binary and multivariable logistic regression analyses were employed to identify the magnitude and factors associated with delay on timely initiation of the first antenatal care visit.ResultsThe proportion of respondents who made their first antenatal care visit after 16 weeks of gestation was found to be 33.4%. Mothers residing in rural settings (AOR = 2.8 [95% CI:1.54–5.44]), not attained formal education(AOR = 2.2 [95% CI:1.10–4.68]),with unintended pregnancy (AOR = 3.6 [95% CI:2.00–6.80]) and who perceived that the right initiation time of the first antenatal care visit is beyond 16 weeks of gestation (AOR = 3.9 [95% CI:1.61–9.76]) were more likely delayed on their first antenatal care visit .ConclusionResidence, educational status, intention of pregnancy and perception on the right time of first antenatal care visit initiation were found to be predictors of delay on timely initiatin of first antenatal care visit. Therefore, the Zonal health department should strengthen awareness creation about timely initiation of first antenatal care visit and family planning to prevent unintended pregnancy in the community especially in the rural settings.

They receive antenatal care in health facilities, yet do not deliver there: predictors of health facility delivery by women in rural Ghana

BackgroundResearch has shown that use of antenatal services by pregnant women and delivery in health facilities with skilled birth attendants contribute to better delivery outcomes. However, a gap exists in Ghana between the use of antenatal care provided by health facilities and delivery in health facilities with skilled birth attendants by pregnant women. This study sought to identify the predictors of health facility delivery by women in a rural district in Ghana.MethodsThis was a cross-sectional study conducted in June 2016. Women who delivered in the past 6 months preceding the study were interviewed. Data on socio-demographic characteristics, use of antenatal care, place of delivery and reasons for home delivery were collected from study participants. Chi-square test and multiple logistic regression analysis were used to assess an association between women’s socio-demographic and obstetric characteristics and place of delivery at 95% confidence interval.ResultsThe study found that 98.8% of women received antenatal care services at least once during their recent pregnancy, and 67.9% attended antenatal care at least four times before delivery. However, 61.9% of the women delivered in a health facility with a skilled attendant. The frequently mentioned reason for home delivery was “unaware of onset of labour and delivery”. The odds for delivery at a health facility were reduced among women with four living children [(AOR = 0.07, CI = 0.15–0.36, p = 0.001)], with no exposure to delivery care information [(AOR = 0.06, CI = 0.01–0.34, p = 0.002), who started their first ANC visit from the second trimester of pregnancy[(AOR = 0.003, CI = 0.01–0.15, p < 0.001)] and increased among women who made at least four ANC visits before delivery [(AOR = 17.53, CI = 6.89–44.61, p < 0.001)].ConclusionFindings from this study revealed a low rate of delivery at health facilities although visits to antenatal care sessions were high, an indication that there was the need to intensify health education on early initiation of antenatal care, signs of labour and delivery, and importance of health facility delivery.

4.4-O2A retrospective analysis of variations in antenatal care initiation in an ethnically diverse maternal population in the UK with high levels of area deprivation

4.4-O2A retrospective analysis of variations in antenatal care initiation in an ethnically diverse maternal population in the UK with high levels of area deprivation

PROPORTION OF EARLY ANTENATAL CARE BOOKING AND ASSOCIATED FACTORS IN MEKELLE CITY, PUBLIC HEALTH INSTITUTIONS, NORTHERN ETHIOPIA, 2015

Objective: The objective of this study was to assess the proportion and associated factors for early initiation of antenatal care visit in Mekelle City, Tigray, Northern Ethiopia, 2015.Method: An institution-based cross-sectional study was employed among 391 pregnant women’s in Mekelle special zone. A systematic sampling technique was used to select study participants. Pretested structured questionnaire was used to collect the data through interview. Data were entered into EPI info version 7 and analyzed using SPSS version 20, respectively. Bivariate and multivariate logistic regression was done to see significant variables with p&lt;0.05 at 95% confidence interval (CI).Result: The proportion of pregnant women who initiate early antenatal care (ANC) visit was found to be 41.1%. Perceived correct time of initiation before 4 months (adjusted odds ratio [AOR]=3.261, 95% CI 1.391–7.645) and correct time told by others before 4 months with (AOR=6.617, 95% CI 2.580, 16.971) were found to have statistically significant positive outcomes association with early initiation of antenatal care visit.Conclusion: The proportion of early ANC initiation in Mekelle is lower than the World Health Organization recommendation which is &lt;16 weeks gestation. Therefore, providing information to the community, initiation counseling, and providing health education on the benefits early ANC is crucial to improving maternal, neonatal, and child health outcomes.

Obstetric outcomes and antenatal access among adolescent pregnancies in Kwazulu-Natal, South Africa

Background: Pregnancy among adolescents in South Africa is a growing concern as it may be associated with adverse socioeconomic and health impacts. Timeous initiation and optimal utilisation of antenatal care (ANC) services is imperative to ensure positive pregnancy outcomes. However, this is not always possible owing to various challenges.&#x0D; &#x0D; Methods: A multi-method study design using both retrospective record review and qualitative interviews was undertaken at a district hospital on the North Coast of KwaZulu-Natal, South Africa. Data on ANC attendance trends and obstetric/perinatal outcomes for all recorded adolescent pregnancies (13–16 years) at the district hospital under study was collected over 3 years (2011–2013) (n = 314). Qualitative interviews with randomly selected pregnant adolescents were conducted to assess experiences of ANC access and utilisation.&#x0D; &#x0D; Results: Late ANC booking and reduced ANC visits were common for adolescent pregnancies. Under-utilisation of ANC (i.e. less than 4 visits) was significantly associated with lower gestational age (&lt; 37 weeks) (OR = 2.64; 95% CI = 1.04; 6.74; p &lt; 0.05). Low birthweight, low Apgar scores as well as the incidence of maternal anaemia and pregnancy-induced hypertension (PIH) were found to be related to late ANC booking. In-depth interviews suggested that teenagers suffered emotional vulnerability linked to family, partner and financial support. They discussed various barriers linked with accessing ANC while acknowledging perceived benefits.&#x0D; &#x0D; Conclusion: Adolescent pregnancy was associated with late booking and reduced ANC visits, which was a risk for adverse maternal health outcomes. In-depth interviews suggested numerous challenges associated with ANC access including; financial barriers, attitude of healthcare workers (HCWs), long queues, distance travelled to access ANC services, human immunodeficiency virus (HIV) status and a lack of knowledge.&#x0D; &#x0D; (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp)&#x0D; &#x0D; S Afr Fam Pract 2017; DOI: 10.1080/20786190.2017.133378

Evaluation of community-level interventions to increase early initiation of antenatal care in pregnancy: protocol for the Community REACH study, a cluster randomised controlled trial with integrated process and economic evaluations

BackgroundThe provision of high-quality maternity services is a priority for reducing inequalities in health outcomes for mothers and infants. Best practice includes women having their initial antenatal appointment within the first trimester of pregnancy in order to provide screening and support for healthy lifestyles, well-being and self-care in pregnancy. Previous research has identified inequalities in access to antenatal care, yet there is little evidence on interventions to improve early initiation of antenatal care. The Community REACH trial will assess the effectiveness and cost-effectiveness of engaging communities in the co-production and delivery of an intervention that addresses this issue.Methods/designThe study design is a matched cluster randomised controlled trial with integrated process and economic evaluations. The unit of randomisation is electoral ward. The intervention will be delivered in 10 wards; 10 comparator wards will have normal practice. The primary outcome is the proportion of pregnant women attending their antenatal booking appointment by the 12th completed week of pregnancy. This and a number of secondary outcomes will be assessed for cohorts of women (n = approximately 1450 per arm) who give birth 2–7 and 8–13 months after intervention delivery completion in the included wards, using routinely collected maternity data. Eight hospitals commissioned to provide maternity services in six NHS trusts in north and east London and Essex have been recruited to the study. These trusts will provide anonymised routine data for randomisation and outcomes analysis. The process evaluation will examine intervention implementation, acceptability, reach and possible causal pathways. The economic evaluation will use a cost-consequences analysis and decision model to evaluate the intervention. Targeted community engagement in the research process was a priority.DiscussionCommunity REACH aims to increase early initiation of antenatal care using an intervention that is co-produced and delivered by local communities. This pragmatic cluster randomised controlled trial, with integrated process and economic evaluation, aims to rigorously assess the effectiveness of this public health intervention, which is particularly complex due to the required combination of standardisation with local flexibility. It will also answer questions about scalability and generalisability.Trial registrationISRCTN registry: registration number 63066975. Registered on 18 August 2015.

Improvement of Early Antenatal Care Initiation: The Effects of Training Local Health Volunteers in the Community.

Background:Although antenatal care (ANC) coverage has been increasing in low- and middle-income countries, the adherence to the ANC initiation standards at gestational age <12 weeks was inadequate including Thailand. The study aimed to improve the rate of early ANC initiation by training the existing local health volunteers (LHVs) in 3 southernmost provinces of Thailand.Methods:A clustered nonrandomized intervention study was conducted from November 2012 to February 2014. One district of each province was selected to be the study intervention districts for that province. A total of 124 LHVs in the intervention districts participated in the knowledge–counseling intervention. It was organized as half-day workshop using 2 training modules each comprising a 30-minute lecture followed by counseling practice in pairs for 1 hour. Outcome was the rate of early ANC initiation among women giving birth, and its association with intervention, meeting an LHV, and months after training was analyzed.Results:Of 6677 women, 3178 and 3499 women were in the control and intervention groups, respectively. Rates of early ANC were significantly improved after the intervention (adjusted odds ratio [OR]: 1.29, 95% confidence interval [CI]: 1.17-1.43, P < .001) and meeting an LHV (adjusted OR: 2.06, 95% CI: 1.86-2.29, P < .001), but lower at 6 months after training (adjusted OR: 0.76, 95% CI: 0.60-0.96, P = .002). Almost all women (99.7%) in the intervention group who met an LHV reported that they were encouraged to attend early ANC.Conclusion:Training LHVs in communities by knowledge–counseling intervention significantly improved early ANC initiation, but the magnitude of change was still limited.

A tale of two pregnancies: A Critical Interpretive Synthesis of women's perceptions about delayed initiation of antenatal care.

Delayed access to antenatal care in high income countries is associated with poor maternal, fetal and neonatal outcomes. The aim was to synthesise the diverse body of evidence around women's views of early antenatal care and barriers to attendance in such countries. Critical Interpretive Synthesis integrates the process of systematic review with the qualitative methods of meta-ethnography and grounded theory, with a focus on theory generation to inform policy, practice and future research. Database searches were conducted, supplemented with reference and citation tracking and website searching between February 2014 and April 2016. Qualitative data analysis methods were used to extract and summarise the key themes from each study. A taxonomy of constructs was created, with the synthesis developed to thread these together. Fifty-four papers were synthesised, including qualitative, quantitative, mixed method and systematic review, published between 1987 and 2016. Seventeen constructs around the core concept of 'acceptance of personal and public pregnancies' were produced. Acceptance of the 'personal' pregnancy considers the contribution of mindset in the recognition and acceptance of pregnancy, influenced by knowledge of pregnancy symptoms, pregnancy planning and desire. Acceptance of the 'public' pregnancy considers women's assessment of the social consequences of pregnancy, and the relevance and priority of antenatal care. Critical Interpretive Synthesis offers a systematic yet creative approach to the synthesis of diverse evidence. The findings offer new perspectives on women's perceptions of early pregnancy and attendance for care, which may be used to facilitate timely antenatal provision for all pregnant women.

Factors associated with late ANC initiation among pregnant women in select public health centers of Addis Ababa, Ethiopia: unmatched case-control study design.

BackgroundAlthough Ethiopia has shown remarkable achievements in reducing maternal mortality in the last 10 years, the prevalence of late antenatal care (ANC) initiation is still high in the country.ObjectiveThe primary purpose of this study was to identify the factors related to late ANC initiation among pregnant women in selected public health centers in Addis Ababa, Ethiopia.Subjects and methodsA total of 402 pregnant women (cases=134, controls=268) were recruited using multistage sampling. The design selected for the study was unmatched case–control. EpiData version 3.02 and SPSS version 20.0 were used for data entry and statistical analysis, respectively. Binary logistic regression model was used to model the odds of late ANC initiation.ResultsThe odds of attending ANC late were significantly higher for mothers with a monthly household income of <US$45.5 (AOR=6.67; 95% CI: 2.40, 18.60), who were educated up to eighth grade or below (AOR=2.17; 95% CI: 1.03, 4.60), who had unplanned pregnancy (AOR=2.73; 95% CI: 1.03, 7.23), who did not receive advice from health extension workers or TV/radio (AOR=5.21; 95% CI: 2.49, 10.88), who stayed for <5 years in Addis Ababa (AOR=3.93; 95% CI: 1.89, 8.12), and who was charged >$8.50 to start the ANC service (AOR=3.04; 95% CI: 1.98, 4.67).ConclusionLow educational level, low income of the household, unplanned pregnancy, stay for <5 years in Addis Ababa, not getting advice from health extension workers or local TV/radio and higher cost associated with initiation of the first ANC service were the main predictors of late ANC initiation. Therefore, any intervention which would need to improve early ANC initiation should focus on economic empowerment of women, and tailored health education for migrant women should be strengthened.

Timing of First Antenatal Care (ANC) and Inequalities in Early Initiation of ANC in Nepal

The provision and uptake of quality and timely antenatal care (ANC) is an essential element of efforts to improve health outcomes for women and newborn babies. Antenatal consultations assist in early identification and treatment of complications during pregnancy. This study aimed to provide an information on distribution and inequalities in early initiation of ANC in Nepal. The distribution and inequalities in the early initiation of ANC were examined using Nepal Demographic and Health Surveys 2011. Bivariate and multivariate logistic regression was used to assess inequalities. Overall, 70% of the women had started their first ANC at 4 month or earlier. Among participants who had never attended school, just more than half (52%) received first ANC at 4 months or earlier, while majority of participants (97%) who had received higher education received first ANC at recommended time. Similarly, 89% of those from richest quintile and 48% of those from poorest quintile received first ANC at recommended time. In adjusted analysis, women from richest wealth quintile were significantly more likely to initiate ANC early (AOR: 3.74, 95% CI: 2.31-6.05) compared to the poorest. Similarly, women with higher level education were significantly more likely (AOR: 11.40, 95% CI: 5.05-25.73) to initiate ANC early compared to women who had never attended school. A significantly lower odds of early ANC take up was observed among madhesi other caste (AOR: 0.56, 95% CI: 0.35-0.90) compared to brahmin/chhetri women. Women whose pregnancy was unwanted were significantly less likely to attend first ANC at 4 months or early (AOR: 0.73, 95% CI: 0.58-0.93) in comparison to women whose pregnancy was wanted. The differences in the recommended timing of initiation of ANC were evident among women with different educational, economic levels, and caste/ethnic groups. Rural women were less likely to have checkups as per guidelines. The findings suggest to a need of interventions to raise female education and improve economic status of households. Targeted interventions suitable to local context and culture are equally important. Increasing access to family planning methods and reduction of unwanted pregnancy can promote early ANC take up.

Barriers to Antenatal Care Services Seeking in Africa

This review article has been conducted in order to evaluate the barriers to antenatal care seeking in African women. Six articles were reviewed in terms of the results and the relevance of recommendation made, thereafter further recommendations were made by the reviewers. According to a qualitative study about barriers and facilitators to antenatal delivery care carried out in western Kenya, study results showed some barriers to fully utilize ANC and delivery services by women included the fear of being tested positive with HIV/AIDS, attitudes of health care providers, long clinic waiting time and costs of both service cost and transport, access to health facility, the argument was that if government increases health facilities especially targeting areas in need, this can reduce both transport and TBAs seeking by the women and through VCT women’s awareness of living with HIV infection, avoiding self blaming it is normally achieved and ensures confidentiality thus promoting antenatal care seeking behaviors. A qualitative study titled as “Barriers and solutions for timely initiation of antenatal care in Kigali, Rwanda: Health facility professionals’ perspective” according to the reported barriers to timely antenatal care initiation by women in Kigali, Rwanda, health professionals highlighted lack of knowledge, experience with previous births, issues with male partners not willing/able to attend the clinic, poverty or problems with health insurance and antenatal care culture, encouraging to swear to practice legal marriage as laws suggest which can reduce irresponsible behaviors of men. The government should create opportunities for unemployed young adolescents where possible vocational trainings should be introduced, to avoid both young boys and girls getting in illegal marry due to lack of something to do. A study called they would never receive you without husband paradoxical barriers to antenatal scale up in Rwanda, highlighted that “come with your partner” for the first visit was a great barriers to attend ANC visits on fully and timely, and poor quality of care, limited men’s involvement throughout the pregnancy period, the argue was to men’s awareness of ANC role need to be increased not to be understood as HIV test. The study Awareness and barriers to utilization of maternal health care services among reproductive women” in Amassoma community, Bayelsa State Nigeria almost similar barriers were highlighted, the argument was the need for community based education to all women reproductive age and men. a study examining factors influencing the utilization of late antenatal care services in rural areas: a case study of kisoro district indicated barriers like female literacy; poverty, age of women, cultural beliefs, quality of care, availability of ANC alternatives and myths and misconceptions influenced the timing and utilization of ANC services, reviewers argued that there is also a need to establish laws against people marrying young adolescents where available then followed. The last article reviewed was barriers to antenatal use in Nigeria; evidences from non users and implication for maternal health programming, showed similar barriers to the first article except that getting permission from partners was highlighted . We argued that men should be educated alongside their wives to induce men feel responsible of mothers’ and infants’ safety.

Intimate partner violence as a predictor of antenatal care service utilization in Honduras

ABSTRACTObjectiveTo describe the relationship between exposure to physical and/or sexual intimate partner violence (IPV) and indicators of antenatal care (ANC) service utilization among Honduran women of reproductive age.MethodsData from the 2011-2012 Honduras Demographic and Health Survey were analyzed to describe the relationship between self-reported exposure to IPV and two ANC outcomes: (1) sufficient ANC visits (defined by the Honduran Ministry of Health as five or more visits) and (2) early ANC initiation (within the first trimester). Multiple logistic regression was used to estimate effects of physical and sexual IPV on the outcomes, controlling for women’s age, education, literacy, residence, household size, religion, parity, wealth, husband’s age, and husband’s education.ResultsOf women who were married, had at least one living child 5 years or younger, and completed the IPV module (N = 6 629), 13.5% of them reported any physical IPV, and 4.1% reported both physical and sexual IPV. There was no significant association between IPV and early ANC; however, a significant relationship between IPV and sufficient ANC was found. Women who experienced any physical IPV (adjusted odds ratios (aOR) = 1.25; 95% confidence interval (CI): 1.00-1.56) or sexual IPV (aOR = 1.53; 95% CI: 1.08-2.16) were, respectively, 25% and 53% more likely to receive insufficient ANC.ConclusionsHonduras has one of highest rates of interpersonal violence of any nation in the world. In Honduras, IPV is a contributor to this broader category of interpersonal violence as well as a risk factor for insufficient ANC. Our findings suggest that universal IPV screening during ANC as well as future initiatives aimed at reducing IPV might improve ANC utilization in the country.