Provision Of Maternal Services Research Articles

Effects of COVID-19 pandemic on provision and use of maternal health services in Allada, southern Benin: a local health system perspective.

To assess the effects of the COVID-19 pandemic on the provision and use of maternal health services in southern Benin from a local health system perspective. We conducted a qualitative study from April to December 2021 in a health district in southern Benin. We interviewed health workers involved in antenatal, delivery, postnatal and family planning care provision, alternative and spiritual care providers, administrative staff of the district hospital, community health workers, adolescents and women who had given birth in the past six weeks in public health centers were interviewed. The World Health Organization health systems building blocks framework was used to guide the thematic analysis from a local health system perspective. The COVID-19 pandemic changed the lines of command and the institutional arrangements in the local health systems leadership; it put the interpersonal relationships in the health care provision team under stress and reduced the overall revenues of the district hospital. The motivation of allopathic health workers was undermined. Communities underutilized maternal health services in the COVID-19 period. Plausible causes included negative patient perceptions of COVID-19 measures taken at the public health facility level as well as well as fear of being forcibly vaccinated against COVID-19 in the health facilities. In times of health crises, appropriate local health system governance that integrates providers' concerns into effective guidelines is critical to reach and maintain a sufficient level of work motivation to ensure quality maternal health services.

Provision and utilization of maternal health services during the COVID-19 pandemic in 16 hospitals in sub-Saharan Africa.

Maintaining provision and utilization of maternal healthcare services is susceptible to external influences. This study describes how maternity care was provided during the COVID-19 pandemic and assesses patterns of service utilization and perinatal health outcomes in 16 referral hospitals (four each) in Benin, Malawi, Tanzania and Uganda. We used an embedded case-study design and two data sources. Responses to open-ended questions in a health-facility assessment survey were analyzed with content analysis. We described categories of adaptations and care provision modalities during the pandemic at the hospital and maternity ward levels. Aggregate monthly service statistics on antenatal care, delivery, caesarean section, maternal deaths, and stillbirths covering 24 months (2019 and 2020; pre-COVID-19 and COVID-19) were examined. Declines in the number of antenatal care consultations were documented in Tanzania, Malawi, and Uganda in 2020 compared to 2019. Deliveries declined in 2020 compared to 2019 in Tanzania and Uganda. Caesarean section rates decreased in Benin and increased in Tanzania in 2020 compared to 2019. Increases in maternal mortality ratio and stillbirth rate were noted in some months of 2020 in Benin and Uganda, with variability noted between hospitals. At the hospital level, teams were assigned to respond to the COVID-19 pandemic, routine meetings were cancelled, and maternal death reviews and quality improvement initiatives were interrupted. In maternity wards, staff shortages were reported during lockdowns in Uganda. Clinical guidelines and protocols were not updated formally; the number of allowed companions and visitors was reduced. Varying approaches within and between countries demonstrate the importance of a contextualized response to the COVID-19 pandemic. Maternal care utilization and the ability to provide quality care fluctuated with lockdowns and travel bans. Women's and maternal health workers' needs should be prioritized to avoid interruptions in the continuum of care and prevent the deterioration of perinatal health outcomes.

“It is not by choice that I gave birth at home”: the social determinants of home births during COVID-19 in peri-urban and urban Kenya, a qualitative study

BackgroundThe COVID-19 pandemic significantly impacted the provision of global maternal health services, with an increase in home births. However, there are little data on women’s decision-making and experiences leading up to home births during the pandemic. The objective of this study is to examine the economic, social, and health system factors associated with home births in Kenya.MethodsCommunity health volunteers (CHVs) and village leaders helped identify potential participants for an in-depth, one-on-one, qualitative telephone interview in Nairobi and Kiambu County in Kenya. In total, the study interviewed 28 mothers who had home births.ResultsThis study identified a number of economic, social, neighborhood, and health system factors that were associated with birthing at home during the COVID-19 pandemic. Only one woman had planned on birthing at home, while all other participants described various reasons they had to birth at home. Themes related to home births during the pandemic included: (1) unmet preferences related to location of birth; (2) burdens and fear of contracting COVID-19 leading to delayed or missed care; (3) lack of perceived community safety and fear of encounters with law enforcement; and (4) healthcare system changes and uncertainty that led to home births.ConclusionAddressing and recognizing women’s social determinants of health is critical to ensuring that preferences on location of birth are met.

Strategies to Reduce Maternal Death Rate and Improve the Provision of Quality Healthcare Services in Selected Hospitals of Vhembe District Limpopo Province.

The maternal death rate remains high in South Africa despite the availability of many existing strategies to improve the quality of service. A 30% increase in the maternal mortality rate was reported between 2020 and 2021, with Limpopo ranking fourth highest out of nine provinces. The Vhembe district maintained its position as the third-ranked area with a notably elevated maternal mortality rate. This study aimed to explore the strategies used to reduce the maternal death rate and improve the provision of quality maternal healthcare services based on participant experiences in selected hospitals of the Vhembe district, Limpopo Province. One hospital was purposively sampled from every four municipalities. A qualitative approach using a phenomenological design was employed. Twenty-eight participants were sampled using a convenience sampling method. The semi-structured interview guide was used to collect data, complemented by the use of an audio recorder, continuing until data saturation was reached. Data saturation was reached at the 20th participant; however, the researcher continued until 28 sampled participants were interviewed. An interpretative phenomenological analysis was used following the analytical stages of interpretative data analysis. The study proposal was ethically cleared by the University of Venda Ethics Committee (FHS/22/PH/08/3108). The results indicate that, despite implementing strategies to improve maternal healthcare services and reduce the maternal death rate, several factors, such as the lack of material resources, shortage of staff, incompetent staff and poor infection control, affect the quality of maternal health services in the Vhembe district. The Limpopo Department of Health and hospital management should ensure that hospitals have all the necessary resources and support healthcare professionals through in-service training to ensure the functionality of existing strategies.

Obstetric referrals, complications and health outcomes in maternity wards of large hospitals during the COVID-19 pandemic: a mixed methods study of six hospitals in Guinea, Nigeria, Uganda and Tanzania

ObjectivesThe COVID-19 pandemic affected provision and use of maternal health services. This study describes changes in obstetric complications, referrals, stillbirths and maternal deaths during the first year of the pandemic...

The Cost of Maternal Complications and Its Associated Factors Among Mothers Attending Public Hospitals in Harari Region and Dire Dawa City Administration, Eastern Ethiopia: An Institution-Based Cross-Sectional Study.

Pregnant women face high costs for health-care services despite being advertised as free. These costs include non-medical expenses, lost productivity, difficulties caring for family members, and long-term financial impact from complications. Limited research has been done on the cost burden of maternal services and complications, despite numerous studies on maternal health service provision. This is notable considering the government's claim of providing free maternal health-care services. A cross-sectional study was conducted in July (1-30) 2022 among 425 randomly selected mothers in Harari and Dire Dawa City, Eastern Ethiopia. Data were collected through structured questionnaires and medical record reviews. The collected data was entered into Epi-Data version 3.02 and analyzed using STATA version 14.0 after data cleaning. Descriptive statistics and linear regression analysis were used to examine the data, ensuring assumptions of linearity, independence, homoscedasticity, and normality were met. The correlation coefficient was used to assess the strength of the association. The median cost of maternal complications was around 4250 ETB (81.3 USD; IQR = 2900-5833.3), factors that predicted cost were monthly family income of ≥3001 birr (β=1.13; 95% CI: 1.00, 1.26), distance from hospital (β=0.73; 95% CI = 0.64-0.83), being admitted for less than 4 days (β=0.60; 95% CI = 0.53-0.69), accompanied by relatives besides their husbands (β=1.93; 95% CI = 1.52-2.46), caesarian sections delivery (β=1.17; 95% CI = 1.04-1.31), and giving birth to a normal baby (β=0.86; 95% CI = 0.77-0.97). Maternal complications incur significant costs, with factors such as family income, travel time, hospital stay, caregiver presence, mode of delivery, and neonatal outcome predicting these costs. The Ethiopian health system should address the additional expenses faced by mothers with complications and their caregivers.

In uncharted territory "together each achieves more": a United Nations interagency collaboration for continuity of maternal and newborn health services during the coronavirus pandemic in the Eastern and Southern Africa region.

The frangible collaboration between three United Nations agencies (UNICEF, UNFPA and WHO) in the Eastern and Southern Africa Region was strengthened by the outbreak of the coronavirus pandemic. The aim was to combine existing resources and expertise to support countries to respond to the pandemic more effectively and efficiently regarding the provision of maternal and newborn health services. Three kinds of activities were conducted: 15 webinars on a variety of topics and issues impacted by the pandemic; virtual training on maternal and perinatal death surveillance and response as well as on quality improvement; and the development of online e-learning modules for continuous professional development. Key dimensions of the collaboration included: a common vision; commitment to the process; dialogue; building relationships and trust; communication and information sharing; sharing of technical and financial resources and expertise; mobilization of additional resources; celebration of intermediate outcomes; facilitative leadership; and institutional design. Start-up lessons revolved around shared risk taking, while retaining agency autonomy. Collaboration lessons included forming a "united front", harnessing technology to accelerate results, and mitigating adverse structural and contextual factors. There are widespread perceptions that collaborative initiatives tend to yield minimum results in terms of increased efficiency or effectiveness. This particular collaborative effort demonstrated elements of feasibility, value addition, synergy, cost effectiveness and demonstrable results where UN agencies delivered as one. The emergency in healthcare as a ripple effect of the coronavirus pandemic has caused a rethink of collaboration models and levels of engagement.

Effects of Communicable Diseases on Maternity services in selected MNCH priority counties’ Public Health facilities in Kenya: A Case of COVID-19.

Covid-19 is a rapidly evolving pandemic which has affected both developed and developing countries. Maternity services in low resource countries are adapting to provide antenatal and postnatal care midst a rapidly shifting health system environment due to the COVID-19 pandemic. Over the years there has been progress in reducing maternal and new-born mortality and stillbirths in Kenya and the globe. However, in the wake of covid-19 pandemic, perinatal women and their frontline health services providers especially nurses and midwives have been cited to bear the brunt of the pandemic. This has largely been linked to the limited access to Personal Protective Equipment (PPE) requirements and the fear of contracting the disease within health services delivery points. There have been adverse effects of maternal and new-born care outcomes due to coronavirus disease. The objective of this study was to determine the effect of coronavirus disease (COVID 19) to maternity services in selected levels III and IV public health facilities within five (5) Counties in Kenya. The five MNCH priority counties selected included Nairobi, Migori, Kilifi, Isiolo and Garissa. A two-stage sampling approach was used to select health facilities in the 5 MNCH priority counties with the sampling frame comprising all MNCH priority counties in Kenya. The study employed cross-sectional and observational retrospective approaches. Data was collected from the midwifery managers and maternity registers in a total of 28 levels III and IV facilities. Open Data Kit (ODK) formatted tools were used to collect data from maternity services facility managers and maternity registers in the selected facilities. Data collected from maternity registers covered the period of four months before covid-19 pandemic and four months during the covid-19 pandemic. A two-days training programme comprising of introduction to study objectives and instruments as well as review of the instruments, practice interviews and data collection was conducted. Data was analysed using STATA Version 15. Descriptive statistics and measures of central tendencies were used to analyse the demographic details of the respondents and health related variables of interests. Chi-square test and fishers exact test were used to find association between facilities that had diagnosed COVID-19 cases and their demographic characteristics. For all tests, a p-value < 0.05 was taken as statistically significant. A total of 31 midwifery managers were interviewed and a total of 801 maternity records (400 before COVID and 401 during COVID-19 pandemic) were obtained from levels 3 III (66%) and IV (34%) facilities across 5 MNCH priority counties in Kenya [Nairobi (27%), Garissa (10%), Isiolo (20%), Kilifi (23%) and Migori (20%)]. On Overall representation, Level III facilities were slightly over half (51.6%) and level IV facilities had 48.4% representation. Most of the maternity services managers interviewed (48.4%) had worked for less than 3 years in their respective stations and the majority (67.7%) had a diploma in either Nursing or midwifery as their highest level of professional education. Overall, the managers indicated that ANC visits had reduced (67.9%), referrals of mothers with complications got delayed (29%), mothers feared delivering in hospitals (64.5%) and possibly some mothers were delivering with the assistance of TBAs (45.2%). The managers reported that New-born care services were the most affected by the pandemic (54.8%) followed by ANC services (45.2%). Immunization services were the least affected (35.5%). The managers (41.9%) reported reduced uptake of FP commodities and a reduction in exclusive breastfeeding (12.9%). Majority (51.6%) of the managers confirmed there was an increase of unplanned pregnancies (90.4) during the pandemic period with limited opportunity to educate ANC clients (74.2%). It was observed that 48% of the facilities surveyed had diagnosed a covid-19 case yet only 61.3% and 54.8% of the facilities had access to masks and hand sanitizers respectively. Facility records indicated a 19% higher ANC attendance before COVID than during COVID-19 pandemic period. Neonatal deaths increased significantly during Covid-19 period ((P=0.010) by 38%. Live births significantly increased by 15% during the pandemic (p<0.0001). Other significant increases were observed in mothers with labour complications (p=0.0003) and number of mothers that underwent caesarean sections(p<0.001) during the pandemic period. There was no sufficient statistical evidence on whether the uptake of FP commodities, post-partum complications, immunizations and maternal mortalities were affected by the covid-19 pandemic. The Covid-19 pandemic caught maternity service providers and the local health systems unaware. The fear of the pandemic had a cross-cutting effect on utilisation of maternity services. Continuous training of health services providers on emergency response to pandemics and health system preparedness is vital in order to have resilient service delivery points.

The impact of donor transition on continuity of maternal and newborn health service delivery in Rwenzori sub-region of Uganda: a qualitative country case study analysis

BackgroundThe transition of donor-supported health programmes to country ownership is gaining increasing attention due to reduced development assistance for health globally. It is further accelerated by the ineligibility of previously Low-Income Countries’ elevation into Middle-income status. Despite the increased attention, little is known about the long-term impact of this transition on the continuity of maternal and child health service provision. Hence, we conducted this study to explore the impact of donor transition on the continuity of maternal and newborn health service provision at the sub-national level in Uganda between 2012 and 2021.MethodsWe conducted a qualitative case study of the Rwenzori sub-region in mid-western Uganda which benefited from a USAID project to reduce maternal and newborn deaths between 2012 and 2016. We purposively sampled three districts. Data were collected between January and May 2022 among subnational key informants (n = 26), national level key informants at the Ministry of Health [3], national level donor representatives [3] and subnational level donor representatives [4] giving a total of 36 respondents. Thematic analysis was deductively conducted with findings structured along the WHO’s health systems building blocks (Governance, Human resources for health, Health financing, Health information systems, medical products, Vaccines and Technologies and service delivery) framework.ResultsOverall, continuity of maternal and newborn health service provision was to a greater extent maintained post-donor support. The process was characterised by a phased implementation approach. The embedded learning offered the opportunity to plough back lessons into intervention modification which reflected contextual adaptation. The availability of successor grants from other donors (such as Belgian ENABEL), counterpart funding from the government to bridge the gaps left behind, absorption of USAID-project salaried workforce (such as midwives) onto the public sector payroll, harmonisation of salary structures, the continued use of infrastructure (such as newborn intensive care units), and support for MCH services under PEPFAR support post-transition contributed to the maintenance of coverage. The demand creation for MCH services pre-transition ensured patient demand post-transition. Challenges to the maintenance of coverage were drug stockouts and sustainability of the private sector component among others.ConclusionA general perception of the continuity of maternal and newborn health service provision post-donor transition was observed with internal (government counterpart funding) and external enablers (successor donor funding) contributing to this performance. Opportunities for the continuity of maternal and newborn service delivery performance post-transition exist when harnessed well within the prevailing context. The ability to learn and adapt, the presence of government counterpart funding and commitment to carry on with implementation were major ingredients signalling a crucial role of government in the continuity of service provision post-transition.

Influence of participatory monitoring and evaluation on decision-making in maternal and newborn health programs in Mombasa County, Kenya

The study assessed the utilization of participatory monitoring and evaluation approaches (PM&E) and their influence on decision-making in maternal and newborn health programs (MNH) in Mombasa County, Kenya. We conducted a cross-sectional study with a sample of 390 participants and used a structured questionnaire, modified Quality of Decision-Making Orientation Scheme, and an interview guide to collect data. We analyzed quantitative responses using descriptive statistics and binary logistic regression (at significance level of 0.05) and qualitative responses using content analysis. The study established that quality decision-making was more likely to occur in MNH programs in Mombasa County that used PM&E approaches at the initiation (OR 1.728, p < 0.05), design and planning (OR 2.977, p < 0.05), and implementation (OR 5.665, p < 0.05) phases of MNH programs than in those that did not use the PM&E approaches. This study shapes a persuasive case for improving the provision of maternal and newborn health services.

Reflective, pragmatic, and reactive decision-making by maternity service providers during the SARS-CoV-2 pandemic health system shock: a qualitative, grounded theory analysis

BackgroundPregnant and postpartum women were identified as having particular vulnerability to severe symptomatology of SARS-CoV-2 infection, so maternity services significantly reconfigured their care provision. We examined the experiences and perceptions of maternity care staff who provided care during the pandemic in South London, United Kingdom – a region of high ethnic diversity with varied levels of social complexity.MethodsWe conducted a qualitative interview study, as part of a service evaluation between August and November 2020, using in-depth, semi-structured interviews with a range of staff (N = 29) working in maternity services. Data were analysed using Grounded Theory analysis appropriate to cross-disciplinary health research.Analysis & findingsMaternity healthcare professionals provided their views, experiences, and perceptions of delivering care during the pandemic. Analysis rendered three emergent themes regarding decision-making during reconfigured maternity service provision, organised into pathways: 1) ‘Reflective decision-making’; 2) ‘Pragmatic decision-making’; and 3) ‘Reactive decision-making’. Whilst pragmatic decision-making was found to disrupt care, reactive-decision-making was perceived to devalue the care offered and provided. Alternatively, reflective decision-making, despite the difficult working conditions of the pandemic, was seen to benefit services, with regards to care of high-quality, sustainability of staff, and innovation within the service.ConclusionsDecision-making within maternity care was found to take three forms – where at best changes to services could be innovative, at worst they could cause devaluation in care being delivered, and more often than not, these changes were disruptive. With regard to positive changes, healthcare providers identified staff empowerment, flexible working patterns (both for themselves and collectively as teams), personalised care delivery, and change-making in general, as key areas to capitalise on current and ongoing innovations borne out of the pandemic. Key learnings included a focus on care-related, meaningful listening and engagement of staff at all levels, in order to drive forward high-quality care and avoid care disruption and devaluation.

Barriers and facilitators to the provision of maternal health services at community health centers during the COVID-19 pandemic: Experiences of midwives in Indonesia

ObjectiveTo explore the experiences of midwives in Indonesia on the provision of maternal health services during the COVID-19 pandemic. Design and methodsA qualitative descriptive study using focus group discussions was undertaken. A conventional content analysis was used to analyze the data. Coding categories were generated from the transcripts. Setting and participantsTwenty-two midwives from five community health centers of three regions in the Province of Jambi, Indonesia were included. FindingsThe interviewees shared similar barriers and facilitators in delivering the services, including the unavailability of adequate protective equipment, the limitation of the number of services, and dealing with the new public health measures related to the COVID-19. Overall, midwives demonstrated a continued commitment to provide maternal health services during the pandemic. Key conclusions and implications for practiceSignificant changes in service delivery have been made to comply with pandemic related restrictions. Despite the unprecedentedly difficult working environment, the midwives continue to provide adequate services to the community by implementing a strict health protocol. Findings from this study contribute to a better understanding of how the quality of the services changed, as well as how new challenges can be addressed and positive changes can be reinforced.

Maternal near miss at Kathmandu Medical College: An analysis of severe maternal morbidity at a Nepalese tertiary care facility.

The World Health Organization (WHO) 'near miss' tool has been extensively used to audit maternal morbidity in low- and middle-income countries. Analysis of the cases of 'near miss' enables a better understanding of the associated factors, identifies deficiencies in the provision of maternity services and lays a foundation for better preventive measures in the future. To understand the epidemiology, aetiology and determine the aspects of preventability of maternal 'near miss' (MNM) at Kathmandu Medical College. A prospective audit of MNM and maternal deaths (MD) was undertaken at Kathmandu Medical College over a period of 12 months. The cases were identified using WHO 'near miss' criteria and areas of preventability in the provision of care determined using the modified Geller's criteria. The total number of deliveries and live births in the study period were 2747 and 2698 respectively. A total of 34 'near misses' and two MDs were identified. The common direct aetiologies of MNM and MDs identified were obstetric haemorrhage followed by hypertensive disorders with one-third of cases being of indirect aetiology. Fifty-five percent of cases had some aspects of provider- or system-related preventability with the leading delays being lack of diagnosis and recognition of high-risk status among patients and lack of interdepartmental communication. The WHO near miss rate at Kathmandu Medical College was 12.5/100 live births. Significant aspects of preventability, especially at the level of the provider, were noted among cases of MNM and MDs.

Early effects of COVID-19 on maternal and child health service disruption in Mozambique.

After the World Health Organization declared COVID-19 a pandemic, more than 184 million cases and 4 million deaths had been recorded worldwide by July 2021. These are likely to be underestimates and do not distinguish between direct and indirect deaths resulting from disruptions in health care services. The purpose of our research was to assess the early impact of COVID-19 in 2020 and early 2021 on maternal and child healthcare service delivery at the district level in Mozambique using routine health information system data, and estimate associated excess maternal and child deaths. Using data from Mozambique's routine health information system (SISMA, Sistema de Informação em Saúde para Monitoria e Avaliação), we conducted a time-series analysis to assess changes in nine selected indicators representing the continuum of maternal and child health care service provision in 159 districts in Mozambique. The dataset was extracted as counts of services provided from January 2017 to March 2021. Descriptive statistics were used for district comparisons, and district-specific time-series plots were produced. We used absolute differences or ratios for comparisons between observed data and modeled predictions as a measure of the magnitude of loss in service provision. Mortality estimates were performed using the Lives Saved Tool (LiST). All maternal and child health care service indicators that we assessed demonstrated service delivery disruptions (below 10% of the expected counts), with the number of new users of family planing and malaria treatment with Coartem (number of children under five treated) experiencing the largest disruptions. Immediate losses were observed in April 2020 for all indicators, with the exception of treatment of malaria with Coartem. The number of excess deaths estimated in 2020 due to loss of health service delivery were 11,337 (12.8%) children under five, 5,705 (11.3%) neonates, and 387 (7.6%) mothers. Findings from our study support existing research showing the negative impact of COVID-19 on maternal and child health services utilization in sub-Saharan Africa. This study offers subnational and granular estimates of service loss that can be useful for health system recovery planning. To our knowledge, it is the first study on the early impacts of COVID-19 on maternal and child health care service utilization conducted in an African Portuguese-speaking country.

Accessibility and utilization of antenatal care services in sub-Saharan Africa during the COVID-19 pandemic: A rapid review.

Control measures for the COVID-19 pandemic brought unprecedented challenges to health care delivery. Some countries in sub-Saharan Africa (SSA) stopped the provision of essential health care except for those services that were deemed emergencies or life-threatening. A rapid review was conducted on March 18, 2022, on the accessibility and utilization of antenatal care services in sub-Saharan Africa during the COVID-19 pandemic. PubMed, Google Scholar, SCOPUS, and the World Health Organization library databases were searched for relevant studies. A modified Population, Intervention, Control, and Outcomes (PICO) framework informed the development of the search strategy. The review included studies conducted within Africa that described the availability, access, and utilization of antenatal services during the COVID-19 pandemic. Eighteen studies met the inclusion criteria. This review revealed a reduction in access to ANC services, an increase in the number of home deliveries, and a reduction in the number of women attending ANC visits during the COVID-19 pandemic. A decrease in ANC service utilization was reported in some studies in the review. Barriers to ANC access and utilization during the COVID-19 pandemic included movement restrictions, limited transport access, fear of contracting COVID-19 at the health facilities, and facility barriers. The use of telemedicine needs to be improved in African countries to allow for the continued provision of health services during pandemics. In addition, there should strengthening of community involvement in the provision of maternal health services post-COVID-19 so that services may be able to better withstand future public health emergencies.

A STUDY TO ASSESS THE ATTITUDE TOWARDS DIFFICULTIES FACED DURING ANTENATAL VISITS IN PANDEMIC SITUATION AMONG ANTENATAL MOTHERS AT SMVMCH, PUDUCHERRY.

The COVID-19 pandemic is posing considerable challenges for countries to maintain the provision of high quality, essential maternal and newborn health services. Pregnant women and mothers with newborns may experience difculties accessing services due to transport disruptions and lockdown measures or be reluctant to come to health facilities due to fear of infection. Thus, a modest decline of 10% in coverage of pregnancy related and newborn health-care services were reported due to pandemics. This would result in 28,000 maternal deaths Anxiety and stress are prevalent psychiatric disorders that can result in negative health outcomes in the long run. The risk factors of anxiety and stress are numerous among which personal factors and genetic susceptibility are the main important ones; furthermore, the inappropriate coping with the changing environment has been identied as an important source of stress that causes anxiety as well. Pregnancy is one of the life periods with a high frequency of stress and anxiety disorders, supposed to be triggered by hormonal and physical changes, the fear of the neonate's health, giving birth, and other pregnancy-related factors. Majority of the antenatal mothers 45 (90%) had moderately favourable level of attitude, 4(8%) had unfavourable level of attitude and 1(2%) had favourable level of attitude s and the mean and standard deviation of level of attitude towards difculties faced during antenatal visits in pandemic situation among antenatal mothers is (36.92+6.074) respectively. Therefore the study should be conducted to test the level of attitude about the difculties faced by the antenatal mothers during the pandemic situation in SMVMCH

Involvement of community pharmacy professionals in maternal health service provision in Ethiopia: a multi-centre cross-sectional survey

Abstract Objectives In countries with high maternal mortality and a shortage of healthcare professionals, community pharmacy professionals can provide important maternal healthcare services within their scope of practice. Evidence of community pharmacy professionals’ level of involvement in maternal health service provision in Ethiopia is limited. This study aimed to assess the level of involvement of community pharmacy professionals in providing maternal health services in Ethiopia. Methods A multi-centre cross-sectional survey of 238 community pharmacy professionals was conducted from March to July 2020 in 6 cities of Amhara regional state in Ethiopia. Independent samples t-test and one-way analysis of variance (ANOVA) were used to test the mean difference. Key findings Most community pharmacy professionals were either ‘involved’ in advising about vitamins (53.4%), provision of contraceptives (52.9%), advising about lifestyle changes (46.2%), responding to minor symptoms (47.5%), nutritional advice during pregnancy (45.0%) and breastfeeding guidance or ‘very involved’ in advising about screening for chronic disease (41.6%). However, the level of involvement of community pharmacy professionals differed according to study participants’ educational qualification/s, years of experience, licensure level, setting type, responsibility in the facility and previous training exposure about maternal health services. Conclusions Community pharmacy professionals in Ethiopia are involved in providing various maternal health services highlighting the importance that pharmacists can play in improving access and care within this context. However, government attention is needed to enhance their role through policy support and capacity building to improve the quality of service provided which could contribute to the reduction of maternal mortality.

Impact of COVID-19 pandemic on utilization of essential maternal healthcare services in Ethiopia: A systematic review and meta-analysis.

The COVID-19 pandemic has a significant challenge for countries to maintain the provision of essential maternity services. Many women could experience difficulties in accessing maternal healthcare due to transport problems, anxiety, and fear of infection. A reduction in the utilization of maternity services has been suggested as a possible cause of worsened maternal health outcomes. Thus, this study aimed to determine the impact of the COVID-19 pandemic on the utilization of maternal healthcare services in Ethiopia. Searching of articles was conducted from PubMed, Science Direct, Cochrane Library, Web of Science, Scopus, and Google scholar. The quality of studies was evaluated using the Newcastle-Ottawa scale. Inspection of the Funnel plot and Egger's test were used to evaluate the evidence of publication bias. Heterogeneity was evaluated using Cochran's Q statistic and quantified by I2. A random-effects model was used to determine pooled estimates using STATA 14. After reviewing 41,188 articles, 21 studies were included in this systematic review and meta-analysis. The pooled reduction was 26.62% (95% CI: 13.86, 39.37) for family planning, 19.30% (95% CI: 15.85, 22.76) for antenatal care, 12.82% (95% CI: 7.29, 18.34) for institutional delivery, 17.82% (95% CI: 8.32, 27.32) for postnatal care, and 19.39% (95% CI: 11.29, 27.49) for abortion care. This study also demonstrated that maternal perception of poor quality of care and fear of infection, lack of transport, cultural events, diversion of resources, lack of essential drugs, and lack of personal protective equipment and sanitizer were identified as the main challenges faced during the pandemic. This study revealed that the utilization of maternal healthcare services in Ethiopia significantly decreased during the COVID-19 pandemic. Government measures, health facility-related barriers, and maternal-related factors were identified as challenges faced during the pandemic. Thus, service providers, policy-makers, and other relevant stakeholders should prioritize maternity care as an essential core healthcare service. Besides, increasing awareness of women through mass media, and making maternity services more accessible and equitable would likely increase the utilization of maternal healthcare services. PROSPERO CRD42021293681.

Implementation gaps in culturally responsive care for refugee and migrant maternal health in New South Wales, Australia

BackgroundRefugee and migrant women are at higher risk of childbirth complications and generally poorer pregnancy outcomes. They also report lower satisfaction with pregnancy care because of language barriers, perceived negative attitudes among service providers, and a lack of understanding of refugee and migrant women’s needs. This study juxtaposes health policy expectations in New South Wales (NSW), Australia on pregnancy and maternity care and cultural responsiveness and the experiences of maternal healthcare providers in their day-to-day work with refugee and migrant women from non-English speaking backgrounds.MethodsThis study used a qualitative framework method to allow for a comparison of providers’ experiences with the policy expectations. Sixteen maternal health service providers who work with refugee and migrant women were recruited from two local health districts in New South Wales, Australia and interviewed (November 2019 to August 2020) about their experiences and the challenges they faced. In addition, a systematic search was conducted for policy documents related to the provision of maternal health care to refugee and migrant women on a state and federal level and five policies were included in the analysis.ResultsFramework analysis revealed structural barriers to culturally responsive service provision and the differential impacts of implementation gaps that impede appropriate care resulting in moral distress. Rather than being the programmatic outcome of well-resourced policies, the enactment of cultural responsiveness in the settings studied relied primarily on the intuitions and personal responses of individual service providers such as nurses and social workers.ConclusionAuthentic culturally responsive care requires healthcare organisations to do more than provide staff training. To better promote service user and staff satisfaction and wellbeing, organisations need to embed structures to respond to the needs of refugee and migrant communities in the maternal health sector and beyond.

Impact of Nutrition Education Intervention Programme On Nutritional Awareness Among Pregnant Women in Ningi Local Government Area of Bauchi State. Nigeria

This study assessed the impact of nutrition education intervention programme on nutritional awareness among pregnant women in Ningi Local Government Area of Bauchi State. Nigeria. The population for this study comprised of thirty-three thousand and thirty-five (33,035) pregnant women in Ningi LGA, Bauchi State. Multi-stage sampling techniques of clustered, simple random sampling, proportionate sampling and systematic sampling technique were used to select one hundred (100) participants as a sample size of the study. Quasi-experimental research design was adopted for this study. The research instrument for the collection of relevant data for this study is a researcher-developed closed-ended questionnaire which is divided into four (4) sections (A, B, C and D) on the adapted General Nutritional Awareness Questionnaire (AGNAQ) developed by Kliemann, Wardle, Jonhson, and Croker (2016). The instrument was validated by five (5) experts in the field of Human Kinetics and Health Education, Public Health and Nursing Science. Reliability index of 0.71 was obtained using split-half method of thirty (30) pregnant women who were attending ANC at the general hospital in the Birnin Kudu Local Government Area of Jigawa State and data collected was subjected to statistical test using Spearman Brown’s Prophecy Formula. Frequency count and percentage were used to describe the described the socio-demographic information of the respondents. Paired sample t-test and independent t-test was used to test formulated null-hypotheses at 0.05 level of significant. The result of the study indicated that there is significant impact of nutrition education intervention programme on nutritional awareness among pregnant women in Ningi LGA, Bauchi State (t-52.723, df: 99; P&lt;0.05); and there is significant difference between the experimental and the control groups after nutrition education intervention programme (t=-39.2, df: 98; P&lt;0.05). It was recommended that Seminar and workshop should be organized periodically to the primary health workers on nutritional education intervention programme during ANC to improves nutritional awareness of pregnant women by optimising collaboration between primary health care agency, government, non-governmental organizations, and maternal and child health service providers.