Maternal Care Programs Research Articles

Determinants of utilization of antenatal and delivery care at the community level in rural Bangladesh.

Timely utilization of antenatal care and delivery services supports the health of mothers and babies. Few studies exist on the utilization and determinants of timely ANC and use of different types of health facilities at the community level in Bangladesh. This study aims to assess the utilization, timeliness of, and socio-demographic determinants of antenatal and delivery care services in two sub-districts in Bangladesh. This cross-sectional study used data collected through a structured questionnaire in the eRegMat cluster-randomized controlled trial, which enrolled pregnant women between October 2018-June 2020. We undertook univariate and multivariate logistic regression analysis to determine the associations of socio-demographic variables with timely first ANC, four timely ANC visits, and facility delivery. We considered the associations in the multivariate logistic regression as statistically significant if the p-value was found to be <0.05. Results are presented as adjusted odds ratios (AOR) with 95% confidence intervals (CI). Data were available on 3293 pregnant women. Attendance at a timely first antenatal care visit was 59%. Uptake of four timely antenatal care visits was 4.2%. About three-fourths of the women delivered in a health facility. Women from all socio-economic groups gradually shifted from using public health facilities to private hospitals as the pregnancy advanced. Timely first antenatal care visit was associated with: women over 30 years of age (AOR: 1.52, 95% CI: 1.05-2.19); nulliparity (AOR: 1.30, 95% CI: 1.04-1.62); husbands with >10 years of education (AOR: 1.40, 95% CI: 1.09-1.81) and being in the highest wealth quintile (AOR: 1.49, 95% CI: 1.18-1.89). Facility deliveries were associated with woman's age; parity; education; the husband's education, and wealth index. None of the available socio-demographic factors were associated with four timely antenatal care visits. The study observed socio-demographic inequalities associated with increased utilization of timely first antenatal care visit and facility delivery. The pregnant women, irrespective of wealth shifted from public to private facilities for their antenatal care visits and delivery. To increase the health service utilization and promote good health, maternal health care programs should pay particular attention to young, multiparous women, of low socio-economic status, or with poorly educated husbands. ISRCTN69491836; https://www.isrctn.com/. Registered on December 06, 2018. Retrospectively registered.

Teenage Mothers in Yaoundé, Cameroon-Risk Factors and Prevalence of Perinatal Depression Symptoms.

Background: Perinatal depression is defined as a non-psychotic depressive episode occurring during pregnancy or during the first year following childbirth. This depressive disorder is highly prevalent among teenage women but there is a lack of data in low- and middle-income countries. The objective of this study was to provide baseline data on the sociodemographic characteristics of pregnant teenagers or teenage mothers in an urban zone in Yaoundé, Cameroon. Risk factors were assessed, and prevalence of depressive disorders was determined. Methods: Women aged 20 years old or less in the perinatal period were invited to participate in the study. A total of 1344 women participated in the four-stage data collection process involving a questionnaire including questions on sociodemographic background, an assessment of their risk of perinatal depression using the EPDS questionnaire (Edinburgh Postnatal Depression Scale), a clinical interview based on the DSM 5 (Diagnostic and Statistical Manual of Mental Disorders), and a final section focusing on risk factors of perinatal depression. Results: The EPDS score was obtained for 1307 women. The prevalence of depressive disorder symptoms among teenage or young pregnant women is estimated to be 70.0%. This risk is significantly increased by different factors including unintended or unplanned pregnancy (aOR: 1.33, 1.14–1.56 CI95%), being separated or single (aOR: 1.34, 1.12–1.60 CI95%), experiencing depression and anxiety before childbirth (aOR: 1.50, 1.02–2.27 CI95%), abortion experience (aOR: 2.60, 1.03–7.14 CI95%) and domestic violence (aOR: 1.76, 1.12–2.83 CI95%). Conclusion: The results of this study reveal a high prevalence of depressive disorder symptoms within the study population. These findings highlight the need to develop maternal care programs to support both mothers and their infants.

HEALTH CARE PROVIDERS’ VIEWS CONCERNING KNOWLEDGE AND PRACTICES OF TRADITIONAL BIRTH ATTENDANTS IN TAJIKISTAN: A QUALITATIVE STUDY

Introduction: This study seeks to explore health care providers’ perspectives of the traditional birth attendants’ knowledge and practices. Methods: This qualitative study was conducted in 2018 with 16 health care professionals working at various levels of maternal health care system in two purposefully selected research settings, Khorog town and Dushanbe, which have different social, economic and ethnic backgrounds. Semi-structured face-to-face interviews were conducted to gather the data. Duration of interviews ranged from 30-60 min. NVivo software for qualitative research was used to analyse the results. Results: This study has shown that health care workers have extremely negative views of the knowledge and practices of traditional birth attendants. They highlight the lack of adequate knowledge of traditional birth attendants on biomedical aspects of birth, poor skills in infections control and lack of use of clean delivery practices. They also claim that the traditional birth attendants’ practices also lead to different complications while they are woefully unprepared to recognize obstetric complications during birth. Conclusion: The study recommends providing a skilled birth attendant in every area. It also recommends avoiding a homogeneous approach to address maternal health issues in diverse countries of the Global South and reviewing maternal health care policies and programs to provide the most marginalized groups of women with skilled birth services to improve their maternal health and further decrease maternal mortality in Tajikistan.

Effect of Preconception Care Intervention on Maternal Nutritional Status and Birth Outcome in a Low-Resource Setting: Proposal for a Nonrandomized Controlled Trial.

BackgroundThe provision of preconception care approaches such as maternal assessments and education on healthy lifestyle (including physical activity, nutrition, and dietary supplements such as folic acid), general and sexual health, avoidance of high-risk behavior, and immunizations has been shown to identify and reduce the risk of adverse birth outcomes through appropriate management and preventive measures.ObjectiveThe goal of the study is to determine the effect of an integrated preconception care intervention on delivery outcomes, which is a novel challenge for lowering unfavorable birth outcomes in India’s low-resource setting. The main objectives are to investigate the relationship of birth outcomes to both maternal and paternal preconception health and determine the effect of preconception care intervention on improvement of maternal nutritional status and reduction of the risk of adverse birth outcomes such as prematurity, low birth weight, and maternal and neonatal complications.MethodsA nonrandomized controlled trial design will be used for comparing 2 groups: preconception care with a standard maternal health care (MHC) program and an integrated MHC program (without preconception care). Two rural field areas of Khordha district, Odisha, will be selected for conducting the study. The study will enroll 782 married women between the ages of 18 and 35 years with their spouses, with 391 women in each group. The couples will receive preconception care based on their health circumstances, and they will be followed up at 3-month intervals before pregnancy. Following pregnancy, they will be followed up for 8 prenatal monitoring and care visits as well as 6 weeks after delivery as part of the standard MCH program. The preconception care intervention package includes couples counseling, contraceptive education and distribution, sex education, lifestyle modification, and nutritional supplementation of iron and folic acid, along with multivitamins if needed.ResultsThe proposal was approved by the institutional ethical committee for conducting the study in June 2020 (Ref No: T/EMF/Nursing/20/6). Participants were enrolled in phase 1 in April 2021, phase 2 of offering preconception services will begin in August 2021, and study outcomes will be measured from 2023 to 2024.ConclusionsThrough preconception care and counseling, the eligible couples will recognize, embrace, and implement the actions to improve their preconception health. Finally, it is expected that maternal and paternal health will have a significant impact on enhancing maternal nutritional status and birth outcomes.Trial RegistrationClinical Trials Registry–India CTRI/2021/04/032836; http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=48239&EncHid=&userName=CTRI/2021/04/032836International Registered Report Identifier (IRRID)PRR1-10.2196/28148

Stakeholders perceptions regarding implementing maternal and newborn health care programs in Rwanda

BackgroundWhile maternal and newborn deaths has been decreasing since 2008 in Rwanda, there is room for improvement to meet its sustainable development goals. The maternal and newborn health care program needs to be monitored to ensure its effective implementation. This study therefore aimed to explore stakeholder’s perceptions of the Rwandan maternal and newborn health care program to identify areas for improvement.MethodsThe convergent, parallel, mixed method study used quantitative and qualitative data in a single phase. The quantitative data was obtained from 79 health care workers, ranging from maternal community health care workers to program supervisors. The 10 areas of the Project Implementation Profile (PIP) instrument checklist with a five-point Likert scale were used to indicate their perceptions (strongly disagree to strongly agree). The qualitative interviews of five nurse managers used a manifest inductive content analysis, directed approach that entailed using existing theory and prior research to develop the initial coding scheme before starting data analyse.ResultsThere was disagreement about the level of top management support, human resources was regarded as an area of concern, with 18.7% (n = 14/79) indicating that they did not agree that this was adequately provided for; urgent solutions for unexpected problems was regarded as an areas of concern by 46.8% (n = 36/79). Top management support weakness were inadequate support training, materials, money for home visits, supervision and leaderships, and training of newly recruited maternity health care workers. For human resources, there were insufficient trained staff to take care of mothers and newborns due to the shortages of health providers. The management of unexpected problems was also an area of concerns and related to getting patients to health facilities during pregnancy emergencies and the lack of qualified birth attendants at health facilities.ConclusionThe study identified three areas for improvement: top management support, human resources and urgent solutions for unexpected problems, as they may be affecting the provision of maternal and newborn health care program services. Using the PIP enable managers to improve the country’s maternal and newborn health care program, and to provide ongoing monitoring and evaluation of with respect to the desired outcomes of reducing maternal and neonatal mortality.

Incidence of Stillbirth in Relation to Period of Delivery, Socioeconomic Status and Period of Gestation in a Rural Tertiary Care Hospital-MGIMS, Sewagram Within Study Period of Three Years (2013-2016).

Stillbirth remains one of the most common adverse outcomes of pregnancy, yet is among the least studied. Occurrence of stillbirth is a tragic event faced by mother as well as obstetrician. It has implications on couple, their family and the health care providers. It reflects a failure or lapse in implementation of maternal and child health care programs. Worldwide 3.2 million stillbirth occur in world, 20-66 per 1000 total births in India in different states. Stillbirth in India is largely underreported. Stillbirths contribute to more than half of perinatal death. More than 2/3rd Stillbirth take place during pregnancy and remaining during course of labour. Registration of all live births and stillbirths, together with evaluation of cause of stillbirths are important initial steps for developing countries. A standard classification system would be important to document aetiology of stillbirth in developing countries. All cases who delivered a stillborn baby in the hospital were studied in details. The records were maintained date-wise. Initially, the basic demographic information was taken giving special attention to age, education, occupation, socioeconomic status, rural or urban residence etc. The two controls of live births were also asked the same details and the data were entered in Microsoft word excel sheet and analyzed by Chi-square test. Incidence of stillbirth in MGIMS Sewagram which is Tertiary care centre placed in rural area was 30.57%. Incidence in relation to place (rural) 62.42%, more in antepartum 94.9% (149/157), in low socioeconomic status 48%. It was found more in 30-32 weeks of period of gestation as in this period most of medical disorders of pregnancy precipitate. The online version of this article (10.1007/s13224-021-01453-6) contains supplementary material, which is available to authorized users.

Exclusive Breast feeding in the 21st Century: a Roadmap to success in South Asia

Background: Exclusive breast feeding is a simple, cost-effective and life-saving intervention for the health of an infant. Despite its undisputable benefits, in past two decades, exclusive breast feeding rates have not improved much globally. Among the South Asian countries, some are raising the bars and some are still struggling to meet the target for reaching sustainable development goal. So this review was planned to understand their situation and how to improve further for establishment of successful exclusive breast feeding.&#x0D; Main Body: On simple review of different literatures on exclusive breast feeding in South Asia, it was observed that the rate widely varies among the countries due to cultural and societal differences, women empowerment, illiteracy, maternal care practices, policy and program implementation and many other modifiable factors. Given the compelling evidence on the positive impacts of breast feeding, some integrated approaches are required involving policy makers, ensuring community participation and family centered counseling, providing health education for mothers and establishment of the Baby Friendly Hospital Initiatives.&#x0D; Conclusion: Experiences from successful neighboring countries can guide the other countries of South Asia to plan their roadmap. Moreover, further dissemination and scaling up of existing programs on exclusive breast feeding can help to achieve the desired target for Sustainable Development Goal.&#x0D; Bangladesh Journal of Medical Science Vol.20(4) 2021 p.725-731

Postnatal Care in Rural Egypt: Perspectives of Women and Health Care Providers

Objectives: Postnatal care (PNC) is an essential component of maternal care program. However, gap exists between high coverage with antenatal and natal care and low coverage with PNC in Egypt. Consequently, the current study was conducted to explore pattern of early PNC (after first day following delivery) among rural mothers. Methods: An exploratory cross-sectional study was done in four Primary Health Care (PHC) centers related to one district in rural Egypt. Mothers who had delivered in the previous year were invited to a structured exit interview. Focus group discussions and in-depth interviews were done with mothers and health care providers (HCPs). Results: Out of the total mothers (n=600), 34.2% received PNC. Multivariate analysis showed that low family income was a significant negative predictor for receiving PNC (P=0.000), while utilization of ANC (P=0.00), delivery at public (P=0.004) or private health facility (P=0.00) were significant positive predictors for receiving PNC. Qualitative data identified barriers for seeking PNC as shortage in HCPs, especially nurses, poor communication by HCPs, mothers perceived HCPs as incompetent in PNC service delivery. Lack of knowledge among women about the importance of PNC and unavailability of female physicians formed social barriers. Conclusion: Inadequate knowledge about the importance and components of PNC among service providers and served community reduces the demand for PNC.

The Norwegian experience with nationwide implementation of fetal RHD genotyping and targeted routine antenatal anti-D prophylaxis.

To reduce the risk of RhD alloimmunization during the last trimester of pregnancy, a targeted routine antenatal anti-D prophylaxis (RAADP) programme was implemented in Norway in 2016. Here, we present and discuss our experience with the nationwide implementation of the programme, and report sample uptake and preliminary data of de novo anti-D in pregnancy. The targeted RAADP was advised by the academic community and evaluated by the health authorities. A National Working Group has conducted the implementation in the transfusion services and contributed to organise the administration of the antenatal anti-D prophylaxis. Fetal RhD type is determined by non-invasive prenatal testing at gestational week 24, and anti-D prophylaxis is administrated at gestational week 28 only to women with RhD positive fetuses. We describe the implementation process of targeted RAADP in Norway. The sample uptake is calculated by comparing the number of fetal RHD screens with the expected number of samples. The sample uptake shows regional variations: 88%-100% after 3 years. Promising decrease in de novo anti-D detected during pregnancy is observed. Nationwide targeted RAADP is implemented and included in the Norwegian maternity care programme. Compliance to sample uptake should further improve in some regions. A remaining issue to fulfil is the documentation of the accuracy of the fetal RHD-typing at all sites. Post-natal prophylaxis will then be guided by the fetal RHD result. Dedicated registries will ensure data to evaluate the expected reduction in pregnancy-related RhD immunisations, which is the final success criterion of the programme.

What Is the Next Focus of Collaborative Care?

Back to table of contents Previous article Next article Psychiatry & Integrated CareFull AccessWhat Is the Next Focus of Collaborative Care?Jürgen Unützer, M.D., M.P.H., M.A.Jürgen UnützerSearch for more papers by this author, M.D., M.P.H., M.A.Published Online:9 Feb 2021https://doi.org/10.1176/appi.pn.2021.2.34AbstractAdoption of the Collaborative Care Model has come a long way in a relatively short time span, and this column has provided in-depth information about how it works. Now the column will look at ways in which psychiatrists can leverage their expertise by creating partnerships with key stakeholders.Seven years ago, I was invited to write a column in Psychiatric News on integrated care to “educate members about integrated care and raise their interest in the topic and in this practice model.” When I first started presenting about integrated care at APA meetings 20 years ago, I was speaking to mostly empty lecture halls, so a monthly column on the topic in APA’s preeminent news publication for members was a welcome and exciting opportunity. At the time, integrated care was slowly gaining traction but was still somewhat in the shadows of our profession.Fast forward to today when nearly 4,000 psychiatrists have completed APA’s training in the Collaborative Care Model, new billing codes have been approved for collaborative care by Medicare and an increasing number of state Medicaid and commercial insurance plans, and integrated care is finding its way into psychiatry residency programs. Collaborative care is now widely regarded as an evidence-based model of care for depression, anxiety, and a number of other common psychiatric disorders in patients with and without comorbid medical disorders such as heart disease, diabetes, and cancer.Research and real-world implementation studies of collaborative care have been carried out in a wide variety of clinical settings including primary care clinics, community health clinics, school-based clinics, and specialty care settings such as maternal and infant care programs and cancer care programs. Collaborative care has also been shown to be effective for individuals from a wide age spectrum ranging from adolescents to older adults. Collaborative care programs that are adapted for specific settings or populations continue to evolve and adapt, and some of the most recent research is applying core principles of collaborative care in the treatment of individuals with opioid use and other substance use disorders. In short, collaborative care has come a long way!With the increasing knowledge and acceptance of collaborative care, our initial goal for this column has been met. Over the last seven years, we have had the privilege of sharing people’s experiences with integrated care in different settings and populations; profiling psychiatrists and other health care professionals who work in such programs; and sharing challenges, opportunities, and insights into this maturing field. Psychiatric News has compiled an archive of many of those columns that is a wonderful body of stories and a testament to the outstanding work that has been done.Looking ahead, we plan to continue this column every other month but with a broader interpretation of “collaborative care.” We know that more than half of counties in the United States do not have a single practicing psychiatrist or psychologist, and the simple truth is that we will never have enough psychiatrists to meet all of the needs of our population. So we will take a good look at ways in which psychiatrists can partner with others in the health care or social services sectors to leverage our clinical expertise. What new intersections and partnerships can we step into? How can we “think outside the box” to better meet the needs of the large populations of patients who need care for a mental health or substance use problem?I look forward to hearing about the intersections of psychiatry with the criminal justice system, juvenile justice system, schools, faith-based organizations, community-based organizations, family members of those living with mental illness, and more. Please reach out if you would like a platform to share your experience in this broader context of collaborative care.I am grateful to the editors of Psychiatric News for being such supportive partners in this journey, and I look forward to what we can accomplish in the expanded iteration of this column on integrated and collaborative care. ■Jürgen Unützer, M.D., M.P.H., M.A., is a professor and chair of psychiatry and behavioral sciences at the University of Washington and founder of the AIMS Center, dedicated to “advancing integrated mental health solutions.” ISSUES NewArchived

Determinants of Maternal Health Care Utilization in the Era of Free Maternity Services in Busia County, Kenya

Purpose. The main objective was to establish determinants of maternal health care utilization and specifically to assess the trends of maternal health care utilization and determine the predictors of maternal health care service utilization in the era of free maternity policy in Busia County.&#x0D; Methodology. It was a cross-sectional study design. The study was conducted between February and April 2019. The research targeted mothers within childbearing age of 15-49 years and a sample size of 634 mothers was used. Quantitative data were analyzed using SPSS version 22.0. Descriptive statistics was used to describe results on socio-demographic characteristics while inferential statistics employed bivariate and multivariate logistic regressions to investigate determinants of maternal health care utilization. Odds ratio was used to test the strength of association, and a p-value of ≤ 0.05 considered as statistically significant.&#x0D; Results. In 2010, FANC increased by 5.6% from 2010 (pre-free maternity period) to 2017 (post-free maternity era). There was also an increase of 2.2% cases of health facility deliveries during pre-free maternity period (2010) and post-free maternity period (2017). Eleven predictors of maternal health care utilization were identified. Among them were respondent being a farmer (OR = 2.6; 95% CI: 1.4-4.8; p = 0.002), the status of the infrastructure of the nearest health facility maternity being good (OR = 3.2; 95% CI: 1.1-9.6; p = 0.03), fare for the public vehicle being USD 0.2 (OR = 3.4; 95% CI: 1.6-7.1; p = 0.001), all maternal health services being available in the nearest health facility (OR = 3.1; 95% CI: 1.8-5.4; p&lt;0.0001), difficulty to attend MCH services due to non-suitability of working days (OR = 2.7; 95% CI: 1.5-4.7; p=0.0008), there being some services that clients pay for (OR = 3.3; 95% CI: 1.5-7.4; p=0.004), services being provided by nurses (midwives) (OR = 2.3; 95% CI: 1.0-4.9; p=0.04) , baby checkup being done within 24 hours by nurses (OR = 18.8; 95% CI: 8.0-44.0; p&lt;0.0001. In conclusion, free maternity care program has led to increased utilization of facility ANC visits and deliveries in the study area. Barriers related to utilization of maternal health care services included unreliable transport especially at night, limited infrastructure and low socio-economic status of the women in the study area. National and county governments need to put in place strategies which will help them to jointly assess, map and plan investments to improve utilization of maternal health care services through prioritizing investments in human resource, infrastructure and commodities based on the anticipated demand for such services.&#x0D; A unique contribution to theory, practice, and policy: The study findings identified key factors that are unique to the mothers in Busia County on predisposing factors, enabling factors and the need characteristics that determine utilization of maternal health care in the era of Free Maternity services in the study area. These results contribute to both maternal health care utilization and policy change that could directly meet the social setting, geographical location and cultural needs of the people of Busia County.

Coverage of completion of four ANC visits based on recommended time schedule in Northern Ethiopia: A community-based cross-sectional study design.

Despite decades of implementation of maternal health care programs, the uptake of antenatal care services based on the recommended gestational age continues to be below the national and regional targets. Thus, this study aimed to assess the prevalence and factors related to the completion of four antenatal care visits among mothers who gave birth 6 months preceding the study. We conducted a community-based cross-sectional study using both quantitative and qualitative approaches. The quantitative component included administering a pre-tested structured questionnaire to 466 mothers who gave birth 6 months preceding the study using a simple random sampling technique from respective Tabias. The quantitative result was analyzed using SPSS version 22. Bivariate and multivariate analysis was done to determine the association between independent and dependent variables. Variables were declared as statistically significant at P ≤ 0.05 in multivariable logistic regression model. The qualitative interview data were collected from eight mothers and four key informants recruited through purposive sampling method. The overall prevalence of completion of four ANC visits based on the recommended time schedule was 9.9% (95% CI, 7.1-12.4). However, 63.9% of the participants attended four visits or more regardless of the recommended time schedule. Being member of community health insurance (AOR 2.140, 95% CI, 1.032-4.436), walking on foot less than or equal one hour to reach the health facility (AOR 3.921, 95% CI, 1.915-8.031), having workload at home (AOR 0.369, 95% CI, 0.182-0.751), and husband supported during antenatal care (AOR 2.561, 95% CI, 1.252-5.240) were independently associated with the completion of four ANC visits based on the recommended time schedule in multivariable analysis. The completion of four ANC contacts based on the recommended time schedule remains low in rural areas of Northern Ethiopia. Being a member of community health insurance, distance to the health facility, workload, and male involvement were associated with the completion of four ANC visits based on the recommended time schedule. The existing health system should consider improving the recommended ANC visits by integrating Community based interventions.

The Rajarata Pregnancy Cohort (RaPCo): study protocol

BackgroundEnding preventable maternal deaths remains a global priority and in the later stages of obstetric transition, identifying the social determinants of maternal health outcomes is essential to address stagnating maternal mortality rates. Countries would hardly achieve the Sustainable Development Goal (SGD) targets on maternal health, unless the complex and context-specific socio-economic aetiologies associated with maternal mental health and suicide are identified. The Rajarata Pregnancy Cohort (RaPCo) is a prospective cohort study, designed to explore the interactions between social determinants and maternal mental health in determining pregnancy and new-born outcomes.MethodsThe study will recruit all eligible pregnant women in the maternal care programme of Anuradhapura district, Sri Lanka from July to September 2019. The estimated sample size is 2400. We will assess the socio-demographic and economic status, social capital, gender-based violence and mental health, including a clinical examination and biochemical investigations during the first trimester. Participants will undergo four follow-ups at 2nd and 3rd trimesters, at delivery and in early postpartum. The new-borns will be followed up at birth, neonatal period, at 6 six months and at 1 year. Pregnancy and child outcome data will be collected using direct contact. Qualitative studies will be carried out to understand the complex social factors and behavioural dimensions related to abortion, antenatal depression, maternal deaths and near misses.DiscussionThis is the first reported maternal cohort in Sri Lanka focusing on social determinants and mental health. As a country in stage four of obstetric transition, these findings will provide generalizable evidence on achieving SGD targets in low- and middle-income countries. The study will be conducted in a district with multi-cultural, multi-ethnic and diverse community characteristics; thus, will enable the evidence generated to be applied in many different contexts. The study also possesses the strength of using direct participant contact, data collection, measurement, examination and biochemical testing to minimise errors in routinely collected data. The RaPCo study will be able to generate evidence to strengthen policies to further reduce maternal deaths in the local, regional and global contexts particularly focusing on social factors and mental health, which are not optimally addressed in the global agenda.

Effect of Antenatal Exercise Teaching Program on Neonatal Outcomes During Delivery in Erbil, Iraq

Background:Antenatal exercises are safe and beneficial for the fetus, and neonatal health, wellbeing, were positive effect on neonatal outcomes during delivery, such as prevent fetal distress, remained the Apgar score and birth weight in normal range level. The aim of this study was to determine the effect of antenatal exercise classes on the neonatal outcomes during delivery. Methods: prospective -Interventional study was conducted in Maternal – Child Health Department in Najdi Heydari Health Care Center, Maternity and Razgary Teaching Hospitals / Erbil City / Kurdistan region / Iraq. One hundred and twelve healthy pregnant women. One half of the pregnant women were included in the intervention group (n = 56) and the other half in the control group (n= 56). The intervention group was educated about antenatal exercises. While the control group remained on standard maternal health care program (without exercise classes). Neonatal outcomes evaluated from documents of birth registry and mothers interview in the postpartum ward using a special check list prepared for that purposed.Results: In the original data, there was a statistically significant difference between both groups. Regarding the fetal heart rate (P<0.01), Apgar score (P<0.004), neonatal complications (P<0.039), admission neonatal intensive care unit (P<0.003) through the progress of delivery. in other hand, not a statistically significant difference between intervention and control groups concerning neonatal weight. Conclusion: Antenatal exercise is recommended for healthy pregnant women as a safe and effective strategy, enhance the neonatal outcomes during the delivery process.

If dukun receive support from village funds, are they more likely to have motivation to find ways to prevent maternal and infant mortality?

Objective: This paper explores traditional healers role in developing an indigenous health approach in the context of making pregnancy safer in remote areas, where cultural resources are more accessible as compared to those of professionals. Content: In some remote areas, the half-hearted participation of traditional birth attendants in partnership maternal care programs signifies a lack of government trust in indigenous midwives. Even though the government assumes responsibility to increase access to trained health workers for women who choose traditional midwives to give birth, it is unlikely that the dukuns have the same response. Therefore, local actors need to bring this into their policy agenda. In the presence of the local government's engagement with the indigenous health approach, the bottom-up proposed usage of village funds for birth assistance, cultural ceremony, and referral transport costs help dukuns work confidently with village leaders to assure the child and mother's safety. Under local village leaders cultural support, the traditional birth attendants are more likely to accept the support as credit for their cultural practice and prepare for potential complications of pregnant women who need hospital referral. Not only that, local birth practitioners will use their autonomy to build their indigenous systems as a parallel approach to achieve the common goal both from the government and the local indigenous community. As the Pencerah Nusantara Program alumni working in remote areas in Central Kalimantan, we reexamine the nature of an indigenous health entity, growing from the cultural traditions in responding to reproductive health and maternal care.

Effect of maternal health programme on rural women agricultural activities in Owerri Agricultural Zone of Imo State, Nigeria

The study analyzed the effects of maternal health programme on rural women agricultural activities in Owerri agricultural zone of Imo state, Nigeria. Specifically, the study described the socio-economic characteristic of rural women; identified the various agricultural activities rural women are involved-in; ascertained the perceived effect of maternal health programme on agricultural activities and identified the barriers of women in participating in maternal health programme in the area. Multistage sampling procedure was used in the selection of 120 women. Data was collected with structured questionnaire and analyzed with descriptive and inferential statistical tools. Mean age was 37 years. Majority (92.50%) of the women were married with an average household size of 5 persons. Also, majority (75%) had primary education while a greater proportion (92.50%) were members of social organizations. Average farming experience and farm income were 17 years and ₦47,853 respectively. Majority (82.50%) had access to maternal and health care services. Planting (96.67%), transplanting (83.33%) and weeding (79.17%) were identified as the major agricultural activities they were involved-in. Result also showed that there were positive and significant effects of maternal health care programme on women agricultural activities in the area. There were significant increase in farm produce (mean = 3.90) and women involvement in agricultural activities (mean = 3.63) among other positive effects in the area. Estimated regression result showed that the socio-economic characteristic of the women influence their perceived effectiveness of maternal health programme in the area. The F-ratio was (6.591), indicating the overall significant of the regressor at 1% level of probability. The maternal health care programme has been invaluable to women in the area as well as enhancing their engagement in agricultural and entrepreneurship activities in the area. However, exorbitant charges (99.17%) and long distance between house and health care centre (95.83%) were barriers to participating in maternal health programmes. It was therefore recommended that high fees should be reduced and health centres be established closer to the women community as these would increase their access to maternal health programme and engagement in agricultural entrepreneurship activities in the area.Keywords: Maternal Health Programme, Rural women, Agricultural activities

Effects of Devolution on Maternal Health Care: The Case of Level Four Hospitals in Nairobi City County, Kenya

Maternal healthcare is an integral part of the Millennium development goals. However, most developing countries have been experimenting with different types of interventions to increase access and utilization of maternal care services. Health care devolution was greeted with great anticipation in Kenya as a means of bringing services closer to the people. However, since the implementation of the recent devolution reforms, criticism has mounted, with evidence of corruption, poor management, late payment of county staff and considerable disaffection among service providers, especially health professionals. Thus, this study assessed the effects of devolution on maternal health care in Nairobi City County in Kenya. Particularly, the study examined the situation of maternal healthcare before and after devolution and how devolution as affected provision of maternal healthcare in Nairobi City County. The study also assessed how devolution affected maternal health care programs implementation and the challenges facing the devolved maternal health care in Nairobi City County. The study adopted the systems approach and the decentralization theorem. This study employed a descriptive research design and the population of the study was made up of the 4 level four hospitals in Nairobi County and all the 189 selected medical health workers in the hospitals. A sample of 57 respondents was selected through simple random sampling. Additionally, the study used questionnaires and an interviews guide to collect data. The questionnaires were administered to the sampled medical workers and the interviews schedules were administered to the key informants who comprised of the medical superintendent from every hospital. Quantitative data was collected through the use of the questionnaires was analyzed using descriptive statistics with the aid of the Statistical Package for Social Sciences. Qualitative data was analyzed using content analysis. The study found that the status of maternal healthcare infrastructure under devolution of health services in Nairobi was good. The findings also established that most health workers preferred that the national government should manage maternal health care infrastructure as opposed to county governments. The study further revealed that county governments had not instituted and implemented effective maternal healthcare programs formulated by the national government. Finally, the study concludes the major challenges influencing the implementation of maternal healthcare services include attitude and perception of health professionals, resistance of devolution by health workers, strikes by health workers, shortage of healthcare workers corruption and tribalism, increased pressure on hospital equipment and infrastructure and stock outs of essential commodities in the facilities affect devolved maternal health care. The study recommended that both the county and national government should work together and combine their efforts to enhance the devolved systems of healthcare so that they can enhance maternal healthcare.&#x0D; This is an open-access article published and distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License of United States unless otherwise stated. Access, citation and distribution of this article is allowed with full recognition of the authors and the source.

Measuring the quality of maternal and care processes at the time of delivery in sub-Saharan Africa: development and validation of a short index

BackgroundThere is a growing recognition that quality of care must improve in facility-based deliveries to achieve further global reductions in maternal and newborn mortality and morbidity. Better measurement of care quality is needed, but the unpredictable length of labor and delivery hinders the feasibility of observation, the gold standard in quality assessment. This study evaluated whether a measure restricted to actions at or immediately following delivery could provide a valid assessment of the quality of the process of intrapartum and immediate postpartum care (QoPIIPC), including essential newborn care.MethodsThe study used a comprehensive QoPIIPC index developed through a modified Delphi process and validated by delivery observation data as a starting point. A subset of items from this index assessed at or immediately following delivery was identified to create a “delivery-only” index. This delivery-only index was evaluated across content and criterion validation domains using delivery observation data from Kenya, Madagascar, and Tanzania, including Zanzibar.ResultsThe delivery-only index included 13 items and performed well on most validation criteria, including correct classification of poorly and well-performed deliveries. Relative to the comprehensive QoPIIPC index, the delivery-only index had reduced content validity, representing fewer dimensions of QoPIIPC. The delivery-only index was also less strongly associated with overall quality performance in observed deliveries than the comprehensive QoPIIPC index.ConclusionsWhere supervision resources are limited, a measure of the quality of labor and delivery care targeting the time of delivery may mitigate challenges in observation-based assessment. The delivery-only index may enable increased use of observation-based quality assessment within maternal and newborn care programs in low-resource settings.

PENGELOMPOKAN KABUPATEN/KOTA DI JAWA TIMUR BERDASARKAN PROGRAM PELAYANAN KESEHATAN IBU

Maternal health services are one of the basic health efforts that must be carried out by the local government. Good maternal health services affect the degree of maternal health. Maternal health degrees are measured by the Maternal Mortality Rate (MMR). One of the cases is the increasing return of MMR in East Java Province in 2016. The main causes of high MMR in East Java are bleeding and preeclampsia. Local governments try to reduce MMR by optimizing maternal health care efforts in various work areas. &#x0D; The purpose of this study is to apply the analysis of cluster complete linkage to describe the distribution of areas of achievement of maternal health care programs in East Java Province in 2016. The data used in the analysis of cluster complete linkage is the scale of data ratios. This type of research is non-reactive using secondary data. The data used in this study is the maternal health service profile data obtained from the program planning and budget sub-section of the East Java Provincial Health Office in 2016. &#x0D; The results of cluster analysis research were conducted to produce 2 optimum districts clusters, with the highest statistical pseudo-f value of 92,420. Cluster 1 produced 4 district members, while Cluster 2 produced 34 members. &#x0D; The conclusion of this study shows that between cluster 1 and cluster 2 has different characteristics. The naming of each cluster is based on the characteristics of the average value of the achievement of the maternal health care program. Cluster 1 is a group of districts whose program achievement status is below the target, while Cluster 2 is a group of districts whose program achievement status is above the target.

Advice on healthy pregnancy, delivery, motherhood and information on non-communicable diseases in the maternal care programme in Myanmar: a cross-sectional study

ObjectivePregnancy and delivery periods offer an opportunity for counselling women to improve behavioural risk and prevent complications, including non-communicable diseases (NCDs). However, little evidence is available on counselling offered during...