Number Of Antenatal Care Visits Research Articles

Inequalities in reproductive health care use in five West-African countries: A decomposition analysis of the wealth-based gaps

BackgroundFamily planning and maternal care services have become increasingly available in West Africa but the level of non-use remains high. This unfavorable outcome may be partly due to the unaffordability of reproductive health care services.MethodsUsing the Demographic Health Survey data from Burkina Faso, Niger, Nigeria, Ghana, and Senegal, we perform a decomposition analysis to quantify the contribution of socio-demographic characteristics to disparities in exposure to mass media information on family planning, use of modern contraceptives, adequate antenatal care visits, facility-based childbirth and C-section between low-wealth and high-wealth women.ResultsOur study shows that differences in maternal characteristics between the wealth groups explain at least 40% of the gap in exposure to mass media family planning information, 30% in modern contraceptive use, 24% of adequate antenatal care visits, 47% of the difference in facility-based childbirths, and 62% in C-section. Lack of information on pregnancy complications, living in rural residence, religion, lack of autonomy in health facility seeking decision, need to pay, and distance explains the disparity in reproductive health care use across all countries. In countries with complete fee exemption policies for specific groups in the population, Ghana, Niger, and Senegal, the inequality gaps between wealth groups in having an adequate number of antenatal care visits and facility-based childbirth are smaller than in countries with partial or no exemption policies. But this is not the case for C-section.ConclusionsThere is evidence that current policies addressing the cost of maternal care services may increase the wealth-based inequality in maternal care use if socio-demographic differences are not addressed. Public health interventions are needed to target socio-demographic disparities and health facility seeking problems that disadvantage women in poor households.

Uptake of intermittent preventive treatment for malaria during pregnancy with Sulphadoxine-Pyrimethamine in Malawi after adoption of updated World Health Organization policy: an analysis of demographic and health survey 2015\u20132016

BackgroundMalawi adopted the 2012 updated Word Health Organization (WHO) Intermittent preventive treatment of malaria during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) policy in 2013. This study aimed to estimate the proportion of and identify factors associated with the uptake of at least three doses of IPTp with SP among pregnant women in Malawi after the adoption and operationalisation of updated WHO IPTp-SP policy.MethodsThe 2015–16 Malawi Demographic and Health Survey dataset was analysed. Of 1219 women aged 15–49 years who had live births and the children were born after the date of July 2015, 1069 women were included in the analysis. Bivariate and multiple logistic regression were used in data analysis. The statistical analysis took into account a complex survey sample design.ResultsOf the 1069 women, 447 (42, 95% CI: 38.1–45.6) received three (optimal) or more doses of IPTp-SP. Less than half (47%) managed to attend at least four antenatal care (ANC) clinics. Only 52% received optimal SP doses among those who made at least four ANC visits. Only the number of ANC visits was associated with the optimal uptake of SP. Women who attended ANC three times only and those who visited ANC once or twice only were less likely to receive at least three doses of SP than those who managed to attend ANC at least four times during pregnancy (AOR = 0.71, 95% CI 0.49–1.02) and (AOR = 0.12, 95% CI 0.06–0.21) respectively.ConclusionsTo achieve effective malaria prevention in pregnancy, IPTP-SP is used alongside other interventions. However, there is low uptake of optimal SP doses in Malawi, and this seems to be associated with the number of ANC visits. Moreover, there is limited effectiveness of an increased number of ANC visits on the uptake of optimal SP doses. Further research should be done to explore health systems factors affecting uptake of optimal IPTp with SP doses during pregnancy.

Level of Knowledge About Prevention of Mother-to-Child Transmission of HIV Option B+ and Associated Factors Among ANC Clients in Kombolcha Town, South Wollo Amhara Regional State, Ethiopia, 2017.

PurposeThe purpose of this study was to assess the level of knowledge about prevention of mother-to-child transmission option B+ and associated factors among antenatal care clients in Kombolcha town; 2017.MethodsAn institutional-based cross-sectional study design was conducted from May 1 to 30, 2017. Simple random sampling techniques were used to select 129 study subjects from May 1 to 30, 2017. A chi-square test was done by using SPSS 20 to assess the association between the dependent and independent variables. Frequency tables, pie chart, and graphs were used to present the findings of the study.ResultsAmong the total study participants, 61% had adequate knowledge about prevention of mother-to-child transmission Option B+. This study found a strong positive association between knowledge of prevention of mother-to-child transmission B+ option and age, educational status, occupational status, number of ANC follow-up visits for the current pregnancy and number of parity.ConclusionThis study showed more than half of these study participants had adequate knowledge about the prevention of mother-to-child transmission B+ option. Age, educational status, employment, parity and number of antenatal care visits had a statistically significant association with pregnant womens' knowledge of prevention of mother-to-child transmission B+ option. Therefore, it is better to design to give health education on prevention of mother-to-child transmission B+ option particularly for older age, uneducated, unemployed, partiy of one pregnant women.

A cross sectional study on out born neonate referral pattern and factors influencing the neonatal outcomes among the out born neonates admitted to sick newborn care units of a government teaching hospital

Background: Neonatal mortality rate (NMR) is one of the major contributors to infant mortality rate. The neonatal mortality depends on many factors birth weight, gestational age, post-natal care; it also depends on maternal social and environmental conditions which contribute to the social determinants of maternal health. This study was taken up to identify maternal social determinants contributing to outcome among outborn neonates in order to reduce neonatal deaths. The present was conducted to assess the outcome among the outborn neonates and assess the maternal social determinants of health affecting the outcome.Methods: A cross sectional study conducted in sick newborn care units (SNCU), Hassan Institute of Medical Sciences, Hassan among all out born neonates. After taking prior written consent, all mothers/bystanders of outborn neonates were interviewed using predesigned, pretested semi-structured proforma. Social factors, environmental conditions and antenatal care affecting the maternal health were collected. Neonatal outcome data was collected from SNCU register. The mothers/bystanders of outborn neonates not willing to give consent and re-admitted neonates were excluded from the study. Data analysis was done using SPSS V20.0.Results: Of 353 outborn neonates admitted, 16.1% was mortality rate. Number of antenatal care visits, consumption of iron tablets, gestational age, high risk mother, staff attending delivery, birth weight, referral time (at p≤0.5) and distance from hospital, passive smoking exposure, maternal services utilization (at p-value <0.1) were significantly associated with poor outcome among outborn neonates.Conclusions: There is need for establishment of SNCUs at sub-divisional levels.

Modelling the number of antenatal care visits in Bangladesh to determine the risk factors for reduced antenatal care attendance.

The existence of excess zeros in the distribution of antenatal care (ANC) visits in Bangladesh raises the research question of whether there are two separate generating processes in taking ANC and the frequency of ANC. Thus the main objective of this study is to identify a proper count regression model for the number of ANC visits by pregnant women in Bangladesh covering the issues of overdispersion, zero-inflation, and intra-cluster correlation with an additional objective of determining risk factors for ANC use and its frequency. The data have been extracted from the nationally representative 2014 Bangladesh Demographic and Health Survey, where 22% of the total 4493 women did not take any ANC during pregnancy. Since these zero ANC visits can be either structural or sampling zeros, two-part zero-inflated and hurdle regression models are investigated along with the standard one-part count regression models. Correlation among response values has been accounted for by incorporating cluster-specific random effects in the models. The hurdle negative binomial regression model with cluster-specific random intercepts in both the zero and the count part is found to be the best model according to various diagnostic tools including likelihood ratio and uniformity tests. The results show that women who have poor education, live in poor households, have less access to mass media, or belong to the Sylhet and Chittagong regions are less likely to use ANC and also have fewer ANC visits. Additionally, women who live in rural areas, depend on family members' decisions to take health care, and have unintended pregnancies had fewer ANC visits. The findings recommend taking both cluster-specific random effects and overdispersion and zero-inflation into account in modelling the ANC data of Bangladesh. Moreover, safe motherhood programmes still need to pay particular attention to disadvantaged and vulnerable subgroups of women.

Magnitude of disrespectful and abusive care among women during facility-based childbirth in Shambu town, Horro Guduru Wollega zone, Ethiopia

BackgroundDisrespectful care during childbirth causes suffering and discourages women from seeking facility-based care. It is one of the silent causes of maternal mortality and morbidity worldwide, but not yet well recorded especially in developing countries. The aim of this study was to measure the magnitude of disrespect and abusive behaviors of health professionals during childbirth and associated factors. MethodCommunity based cross-sectional study design was employed among 321 women who gave birth in public health facilities of Shambu town, Ethiopia, between January 01 and December 31, 2018. Simple random sampling was used to select the study participants. Data were collected using a semi-structured interviewer administered questionnaire. Prevalence of disrespect and abuse was measured by using seven categories of disrespect and abuse with their respective verification criteria. The data were entered into Epi-data 3.1 and then transported to SPSS version 23.0. Logistic regression models were fitted to determine the presence of statistically significant associations between the dependent and independent variables at p-value <0.05 and AOR values with 95% confidence interval. ResultsOut of 321 sampled respondents, 316 participated in this study with response rate of 98.4%. The overall prevalence of disrespect and abuse was 78.2% (95% CI: 73.5–83.2). The most common forms disrespect and abuse encountered by the mothers were: unconsented care (86.1%), non-dignified care (37.3%), lack of privacy (33.9%), physical abuse (21.5%) and neglectful care (13.3%). Mother's occupational status, increasing number of antenatal care visits and giving birth in a hospital setting were significantly associated with disrespect and abuse during facility-based childbirth. ConclusionThough government interventions are in place, excessive levels of disrespect and abusive practices during facility-based childbirth persisted to be important problems in the study area. To address the unnecessary suffering, health policy makers and program designers should develop strategies to enhance respectful maternity care approaches. Health managers and health professionals should do their best to provide high quality, client-centered care in health facilities so that women are not discouraged from using them. We also recommend knowledge exchange with development partners to determine which practices will be adaptable and helpful to address the problem of mistreatment of women in health care facilities.

Attendance and Utilization of Antenatal Care (ANC) in Bangladesh: Examining individual-and division-level factors using a Multilevel Analysis

The present study examines the individual and division-level factors associated with the utilization of antenatal care, following the adoption of the antenatal care visits in Bangladesh. In this study, two mixed effect models (Poisson regression model with random effect and negative binomial regression model with random effect) are applied to a real data set to obtain the potential determinants of number of antenatal care (ANC) visits of women during pregnancy in Bangladesh, where data are extracted from Bangladesh Demographic and Health Survey (BDHS), 2014. These mixed effect models are termed as the multilevel model with two level variations. The individual or within variation in each division is lower level (level-1) and between variation among the division is higher level (level-2). Multilevel model with two levels, where individual nested under division are fitted to address the hierarchical effect and also to find out the true estimate of the model parameter. Among the significant covariates, the place of residence, respondent's education, wealth index, respondent's husband's education, decision maker on respondent's health care and access to mass media are notable factors that are found highly associated with the number of antenatal care visits of women during their pregnancy period in Bangladesh. It is found that the educated women who live in urban area, whose husband is higher educated, socio-economic status is standard as well as who have access to mass media and to take decision about own health care, visit more for antenatal care. Although both individual-and division-level characteristics have an influence on the inadequate and non-use of ANC, division-level factors have a stronger influence in the rural areas. The results suggest that much sensitization has to be done specifically in these rural areas to empower pregnant women and their husbands as to improve ANC attendance and utilization. Furthermore, health promotion programs need to increase consciousness about the importance of ANC visits during pregnancy in rural area to ensure the ANC visits among the rural women, and consequently, maternal and child mortality and morbidity can be reduced to great extent and disparities of number of ANC visits between urban and rural areas will decrease.

Compliance to Iron-Folic Acid Supplementation and Its Association with the Number of ANC Visits in Ethiopia: Systematic Review and Meta-Analysis.

Background The World Health Organization recommended that 80% of communities in all countries should receive the standard dose of iron folic acid. But, in Ethiopia, this target was not yet achieved. The compliance of iron folic acid was also variable across each district. Therefore, the aim of this study was to assess women compliance with iron-folic acid supplementation and its association with a number of antenatal care visits in Ethiopia using systematic review and meta-analysis, 2018. Methods In the current meta-analysis, the target variables were searched from different electronic database system like PubMed, Google Scholar, Science Direct, and Cochrane Library. To predict the pooled prevalence of compliance with iron-folic acid supplementation in Ethiopia, all original studies were considered. All necessary data were extracted by using a standardized data extraction format. The data were analyzed by using STATA 14 statistical software. Heterogeneity between the studies was assessed by Cochrane Q and I2 tests. A random effect model was computed to estimate the pooled compliance with iron-folic acid supplementation. Results Twelve full-text studies were included in the meta-analysis. The findings of this meta-analysis revealed that the pooled prevalence of compliance with iron-folic acid supplementation in Ethiopia was 43.63% (CI: 28.00, 59.25%). The women from the city administration had a high rate of compliance as compared with other regions of Ethiopia. The odds of having four or more antenatal care visit were the independent pooled predictor of compliance with iron-folic acid supplementation. Conclusion Current compliance with iron-folic supplementation was lower than the World health organization recommendation. Mothers from the city administration who utilized the antenatal care four and above times, had high level compliance with iron-folic acid supplementation. Therefore, we recommended that women should visit the antenatal clinic four times to compliance with the iron folic acid supplementation.

Neonatal mortality and its determinates in public hospitals of Gamo and Gofa zones, southern Ethiopia: prospective follow up study

BackgroundThe neonatal period is the most vulnerable time for child survival. The declines in the neonatal mortality rate have been slower than the post-neonatal under-five mortality rate in the majority of countries. This trend is also similar in Ethiopia, that neonatal mortality was high as compared to the post-neonatal mortality rate. A large proportion of neonatal deaths occur during the 48 h after delivery. Different studies were conducted in assessing determinates for neonatal mortality but there is a need to assess the immediate postnatal (within 2 days following delivery) cause of neonatal mortality that the majority of deaths occurred at that time. So, this study is to fill those gaps of the aforementioned studies, in assessing the determinate factors affecting neonatal mortality in public hospitals of Gamo and Gofa Zones, Southern Ethiopia.MethodsA prospective follow up study was conducted among 6769 study participants from April 5, 2018, to March 5, 2019. All live births at the hospitals during the study period were included in this study. A structured verbal autopsy questionnaire was used to collect the data on the causes of neonatal death. Data were entered into Epi data version 3.1 and exported to Stata version 15 for analysis. Crude and adjusted estimate β with 95%CI was calculated in the binary logistic regression model. A log-likelihood ratio (LR) was tested for goodness of fit. In this study P-value < 0.05 was considered to declare a result as a statistically significant association.ResultsIn this study, neonatal mortality incidence ratio was 9.6 (95%CI: 7.5, 12.2) per 1000 live births. Age of the mother, number of antenatal care visits, sex of the neonate, presentation, and gestational age were identified as the significant determinates for neonatal mortality cases. Prematurity, infection, and birth asphyxia were the most common causes of neonatal mortality cases.ConclusionsThis study indicated that a significant number of neonates died during the neonatal period. Both maternal and neonatal factors were identified. Therefore, early identification of obstetric complications and immediate interventions, strengthening the provision of quality antenatal and postnatal care services are recommended.

Seroprevalence of anti-tetanus antibodies in mothers and cord blood and associated factors in health-care settings in Lao People’s Democratic Republic

BackgroundMaternal neonatal tetanus (MNT) was eliminated from Lao People’s Democratic Republic (PDR) in 2014. WHO recommends 80% coverage of 2 or more tetanus vaccinations (TT2+) in pregnancy to maintain MNT control. Vaccination coverage in Lao PDR varies among regions although the reasons are not clear. Methods185 pregnant women giving birth in three district hospitals in Savannakhet province, Lao PDR were recruited. A questionnaire was administered to determine factors associated with seroprotection and blood was taken from mother and cord blood to be tested for anti-tetanus antibodies by ELISA. Results77% of mothers and 79% of newborns had sufficiently protective antibody titres (>0.5 IU/ml) against tetanus. Only 70% of the mothers received one dose of TT vaccination during antenatal care (ANC) consultation and 45% received the recommended two injections. Although most of the vaccination took place during ANC 1 and 2, many were missed at these time-points. Anti-tetanus seroprotection in the mothers was associated with maternal age, number of ANC visits, number of TT vaccinations during and before pregnancy and gestational age. ConclusionSeroprevalence of anti-tetanus antibodies in mothers and newborns was intermediate but TT2+ coverage was low in healthcare settings in Lao PDR. TT2+ coverage during ANC is likely to be significantly lower in settings with less robust ANC practices. Missed opportunities to vaccinate in ANC 1 and 2 suggest a need to promote vaccine awareness and vaccination at first ANC visit. A booster dose of TT containing vaccine should be considered for children aged between 4 and 7 years old.

Geographic differences in maternal and child health care utilization in four Ethiopian regions; a cross-sectional study

BackgroundMaternal and child health (MCH) care utilization often vary with geographic location. We analyzed the geographic distribution and determinants of utilization of four or more antenatal care visits, health facility delivery, child immunization, and care utilization for common childhood illnesses across four Ethiopian regions.MethodsA cross-sectional community-based study was employed with two-staged stratified cluster sampling in 46 districts of Ethiopia. A total of 6321 women (13–49 years) and 3110 children below the age of 5 years residing in 5714 households were included. We performed a cluster analysis of the selected MCH care utilization using spatial autocorrelation. We identified district-specific relationships between care coverage and selected factors using geocoded district-level data and ordinary least squares and hotspot analysis using Getis Ord Gi*.ResultsOf the 6321women included in the study, 714 had a live birth in the 12 months before the survey. One-third of the women (30, 95% CI 26–34) had made four or more antenatal visits and almost half of the women (47, 95% CI 43–51) had delivered their most recent child at a health facility. Nearly half of the children (48, 95% CI 40–57) with common childhood illnesses (suspected pneumonia, diarrhoea, or fever) sought care at the health facilities. The proportion of fully immunized children was 41% (95%, CI 37–45). Institutional delivery was clustered at district level (spatial autocorrelation, Moron’s I = 0.217, P < 0.01). Full immunization coverage was also spatially clustered (Moron’s I = 0.156, P-value < 0.1). Four or more antenatal visits were associated with women’s age and parity, while the clustering of institutional delivery was associated with the number of antenatal care visits. Clustering of full immunization was associated with household members owning a mobile phone.ConclusionsThis study showed evidence for geographic clustering in coverage of health facility deliveries and immunization at the district level, but not in the utilization of antenatal care and utilization of health services for common childhood illnesses. Identifying and improving district-level factors that influenced these outcomes may inform efforts to achieve geographical equitability and universal health coverage.

Factors associated with the preference of institutional delivery after antenatal care attendance in Northwest Ethiopia

BackgroundEven though maternal mortality during the time of delivery can be prevented with proper medical care in the health facilities with skilled healthcare professionals, unexpectedly death is still high and is a persistent challenge for low-income countries. Therefore identifying factors affecting the preference of institutional delivery after antenatal care service attendance is a key intervention to reduce maternal morbidity and mortality.MethodA community-based cross-sectional study was conducted using face to face using interviewer-administered questionnaire from a total of 528 women who gave their last birth within 12 months prior to the study period who attended antenatal care (ANC) services. Descriptive statistics, bivariable and multivariable logistic regressions analysis were performed. Statistical significance was considered at p < 0.05 and odds ratio with 95% CI were calculated to examine factors associated with institutional delivery.ResultsOf the 528 pregnant women attending ANC services, 250 (47.3%) gave birth in health facilities (95% CI: 43.2, 51.7%). Urban residence [AOR = 7.8, 95% CI: 4.1, 15.6], four or more ANC visits [AOR = 4.5, 95% CI: 1.6, 12.3], those who got health education on ANC [AOR = 2.9, 95% CI: 1.5, 5.6] and decision on place of delivery with her partner agreement [AOR = 3.3, 95% CI: 1.3, 8.7] were found to be contributing factors for the preference of institutional delivery.ConclusionInstitutional delivery was not adequate. Residence, number of antenatal care visits, health education, decisions making on a place of delivery and having awareness of the difference of place of delivery were contributing factors for the preference of institutional delivery.

PMTCT Service Utilization and Associated Factors among Pregnant Women Attending Public Health Facilities in Hawassa City, Southern Ethiopia

BACKGROUND: Among various interventions to control HIV transmission, prevention of mother-to-childtransmission program have been implemented to offer a range of related services to the women and their infants.In Ethiopia, although the overall trend of the program coverage has shown improvements over time, studying itsutilization and identifying factors that influence the utilization among pregnant women could have paramountimportance for improving the service by addressing important bottlenecks. The aim of this study was to determinethe utilization of prevention of mother-to-child transmission service and its associated factors among pregnantwomen attending public health facilities in Hawassa City, Southern Ethiopia.METHOD: Institution based cross-sectional study was conducted among pregnant women who visited six publichealth facilities for Antenatal Care service. A sample of 588 pregnant women having at least two Antenatal Carevisits were included in the study using a systematic sampling technique. Trained nurses collected the data using theAmharic version structured questionnaire that was pretested before the actual data collection. The collected datawere entered and analyzed using Epi info version 7.0 and Statistical Package of Social Science version 20 statisticalsoftware respectively. Bivariable and multivariable logistic regression analysis was conducted and we reported bothcrude and adjusted odds ratios with 95% confidence intervals.RESULT: Among the study subjects, 531 (90.3%) utilized prevention of mother-to-child transmission service fortheir current pregnancy. Pregnant women having only two antenatal care visits were 76% less likely to utilize theservice as compared to pregnant women having three or more antenatal care visits [AOR= 024, 95% CI=0.11,0.53].Pregnant women who do not support the idea that every pregnant woman should be tested for HIV/AIDS were 91%less likely to utilize prevention of mother-to-child transmission service as compared to those who support the idea[AOR= 0.09, 95% CI= 0.03, 0.29]. Finally, pregnant women who don’t know the view of her partner regarding HIVtesting were 96% less likely to utilize the service as compared to pregnant women having a partner who supportscouple counseling [AOR=0.04, 95% CI= 01, 12].CONCLUSION AND RECOMMENDATION: Nearly all of the study subjects utilized preventionof mother-to-child transmission service for their current pregnancy. The number of antenatal care visits, the view ofthe women on supporting the idea that every pregnant should be tested for HIV and the view of husband regardingHIV screening were found to be the major predictive factors. Encouraging partner involvement on the importanceof HIV testing could have an important contribution to further improve the utilization of prevention of motherto-child transmission service. Further studies to document the best practice of the prevention of mother-to-childtransmission service should be undertaken.KEY WORDS: PMTCT, Utilization, Public Health Facilities, Hawassa, Southern Ethiopia

Assessment of Need of Antenatal Education by Assessing the Existing Knowledge of Pregnant Women

OBJECTIVE: To assess the antenatal knowledge and preferred information seeking behavior of pregnant women attending antenatal care clinics of Allied Hospitals of Rawalpindi Medical University, Rawalpindi.METHODOLOY: This was a multi-centered based cross-sectional design study. This study was conducted in the antenatal care clinics of three allied hospitals of Rawalpindi medical University, Rawalpindi. A total of 400 pregnant women in third trimester of pregnancy, attending antenatal care clinics were included in the study through consecutive sampling. Antenatal knowledge was assessed by a valid (scale-content validity index=1.00) and reliable (Cronbach’s alpha=0.90) questionnaire developed for this purpose. SPSS 22 was used for data analysis. RESULTS: Out of 400 pregnant women, majority 148 (37%) were in the age group of 23-27 years. Mean age was 26.5±4.8 years. Mean antenatal knowledge score was 28±6.2. Two hundred and sixty-eight (67%) women had poor (˂70% score), ninety-six (24%) had adequate (70%-80% score) and thirty-six (9%) had good (˃80% score) level of antenatal knowledge. Three hundred and sixty (90%) women had poor nutritional and gestational weight gain knowledge. Antenatal knowledge scores were significantly associated with education, number of antenatal care visits, locality and monthly household income. One to one education was preferred format by most (53%) of women. Doctors were the preferred source of information by 80% of the participants.CONCLUSION: The findings of the study indicate that most of the pregnant women lack the adequate antenatal knowledge while one to one education given by doctors was the preferred mode of health education by the majority of the participants. KEYWORDS: Pregnant women, Antenatal education, Antenatal knowledge

Timing of first antenatal care attendance and associated factors among pregnant women in public health institutions of Axum town, Tigray, Ethiopia, 2017: a mixed design study

BackgroundTimely initiation of antenatal care can avoid pregnancy related problems and save lives of mothers and babies. In developing nations, however, only half of the pregnant mothers receive the recommended number of antenatal care visits, and start late in their pregnancy. Thus, the study was conducted to assess the magnitude of timely initiation of antenatal care and factors associated with the timing of antenatal care attendance in Axum in which studies regarding this issue are lacking.MethodsAn institution based cross-sectional study mixed with qualitative approach was conducted. A total of 386 pregnant women were selected using systematic sampling technique for the quantitative study. In addition, 18 participants were selected purposively for the qualitative part. The quantitative data were collected using structured interviewer administered questionnaire while the qualitative data were collected using an open-ended interview guide. Quantitative data were analyzed using SPSS version 22 and the qualitative data were analyzed using Atlas software. Multi-variable logistic regression was used to control the effect of confounders.ResultsThe magnitude of timely attendance of antenatal care was 27.5% (95% CI: 23–32%). Unintended pregnancy (AOR = 2.87; CI 95%: 1.23–6.70), maternal knowledge (AOR = 2.75; CI 95%: 1.07–7.03), educational status of the women (AOR = 2.62; CI 95%: 1.21–5.64), perceived timing of antenatal care (AOR = 3.45; CI 95%: 1.61–7.36), problem in current pregnancy (AOR = 3.56; CI 95%: 1.52–8.48) and advice from significant others (AOR =2.33; CI 95%: 1.10–4.94) were found significantly associated with timely booking of antenatal care.ConclusionThe magnitude of timely attendance of antenatal care is low. Educational status, maternal knowledge, unintended pregnancy, problem in current pregnancy, perceived timing of antenatal care, and advise from significant others were the significant factors for timing of antenatal care. Therefore more effort should be done to increase the knowledge of mothers about importance of antenatal care and timely ante natal care booking.

Understanding Myths in Pregnancy and Childbirth and the Potential Adverse Consequences: A Systematic Review.

The trend of choosing natural birth at home without proper supervision is gaining more attention and popularity in Malaysia. This is partly due to wrong beliefs of modern medical care. It prompts the need to explore further into other myths and wrong beliefs present in communities around the world surrounding pregnancy and childbirth that may lead to harmful consequences. A total of 25 literatures were selected and reviewed. The most reported wrong belief is the eating behaviour such as avoiding certain nutritious fruits besides eating saffron to produce fairer skinned babies which in fact contains high doses of saffron that may lead to miscarriage. The most worrying myth however, is that unregulated birth attendants such as doulas have the necessary knowledge and skills to manage complications in labour which may well end up in perinatal or even maternal death. Other myths suggested that modern medical care such as vaginal examinations and baby’s heart monitoring in labour as unnecessary. A well-enforced health education programme by well-trained healthcare personnel besides sufficient number of antenatal care visits are needed to overcome these myths, wrong beliefs and practices. In conclusion, potential harmful beliefs and practices in pregnancy and childbirth are still abound in today’s communities, not just in least developed and developing countries but also in developed countries. Women and children are two very vulnerable groups, therefore debunking myths and eliminating harmful practices should be one of a healthcare provider priority especially those in the primary care settings as they are the closest to the community.

Temporal and regional variations in use, equity and quality of antenatal care in Egypt: a repeat cross-sectional analysis using Demographic and Health Surveys

BackgroundEgypt has seen substantial decreases in maternal mortality and reached near universal coverage for antenatal care (ANC). The objective of this paper is to describe the changes over time (1991–2014) in the use of ANC in Egypt, focusing on sector of provision (public versus private), and the content and equity of this care, to inform future policies for improving maternal and newborn health.MethodsWe used Demographic and Health surveys (DHS) conducted in Egypt in 1995, 2000, 2005, 2008 and 2014 to explore national and regional trends in ANC. To assess content of care, we calculated the percentage of ANC users who reported receiving seven ANC components measured in DHS in 2014.ResultsDuring the period under consideration, the percentage of women in need of ANC who received facility-based ANC increased from 42 to 90%, the majority of which was private-sector ANC. The mean number of ANC visits among ANC users increased over time from 7.5 (95% confidence interval [CI] = 7.1–7.9) in 1991–1995 to 9.7 (95%CI 9.6–9.9) in 2010–2014. In 2010–2014, 44% of women using public ANC reported eight or more visits compared to 71% in private ANC. In the same period, 24% of ANC users received all seven care components. This percentage ranged from 10% of women reporting fewer than four ANC visits to 29% of women reporting eight or more. The poorest ANC users received all seven measured components of care less often than the wealthiest (20% versus 28%, p-value< 0.001).ConclusionsEgypt’s improvements in ANC coverage were characterized by decreasing reliance on public services and a rising number of ANC visits. However, despite rising ANC coverage, less than a third of women received the seven essential ANC components measured at least once during pregnancy, with differences between poorer and wealthier women. Policymakers need to ensure that high ANC coverage translates into equity-focused interventions targeting ANC quality. Further research needs to support this effort by assessing the determinants behind poor quality of ANC and evaluating potential interventions.

Role of receipt of antenatal care in subsequent contraceptive use at primary health care centres serving slum areas of Cairo, Egypt

Objectives: Information on family planning and use of antenatal care services is vital for understanding the main influences on fertility and evaluating the success of national family planning programmes. This study aimed to explore contraceptive use and its relation to use of antenatal care services in Egypt.Methods: A cross-sectional survey was conducted among women attending three primary health care centres serving different slum areas of Cairo.Results: Most of women who used antenatal care services obtained contraception from the state sector. Although the number of antenatal care visits was not significantly associated with contraceptive use, it was a significant determining factor for the type of method used. Reasons given for non-use of contraception were related to reproductive health concerns or disapproval of contraceptive use.Conclusion: Contraceptive use is widespread in Egypt, regardless of age and level of education. Antenatal care is no longer viewed with suspicion. Antenatal care visits are an opportunity for health care providers (HCPs) to encourage the use of contraception. Repeated antenatal care visits help to engender a relationship of trust between women and HCPs. Incorporation of family planning programmes into antenatal care programmes would be an opportunity to promote modern contraceptive use.

Assessment of the impact of availability and readiness of malaria services on uptake of intermittent preventive treatment in pregnancy (IPTp) provided during ANC visits in Tanzania

BackgroundIntermittent preventive treatment during pregnancy (IPTp) is a highly-recommended intervention to prevent maternal and neonatal complications associated with malaria infection. Despite fairly high antenatal care (ANC) coverage in Tanzania, low IPTp uptake rates represent a gap in efforts to decrease complications attributed to malaria in pregnancy. The objective of this study was to examine if availability, readiness and managing authority are associated with uptake of IPTp during ANC.MethodsData for this analysis come from a cross-sectional survey, the Tanzania Service Provision Assessment conducted between 2014 and 2015. Principal component analysis was used to create scores for availability of malaria services and readiness for the provision of services. Generalized estimating equation models with logit link and the binomial distribution assessed factors that impact the uptake of IPTp by pregnant women attending ANC.ResultsHigher fraction of women in their third trimester than second (68% versus 49%, OR = 2.6; 95% CI (2.1–3.3)), had received at least one dose of IPTp. There was a wide variation in the availability and readiness of malaria services provision and diagnostic tools by managing authorities. Public facilities were more likely than private to offer malaria rapid diagnostic test, and more providers at public facilities than private diagnosed and/or treated malaria. Women who attended facilities where direct observation therapy was practiced were more likely to have received at least one dose of IPTp (64% versus 46% who received none; p < 0.001). Women who attended ANC at a facility with a high readiness score were more likely to take IPTp than those attending facilities with low readiness scores (OR = 2.1; 95% CI (1.4–3.3)). Reported stock out on the day of interview was negatively associated with IPTp uptake (OR 0.09; 95% CI 0.07–0.1).ConclusionReadiness of health facilities to provide malaria related services, the number of ANC visits and gestational age were associated with uptake of IPTp among women attending ANC. There are disparities in malaria service availability and readiness across geographical location and managing authorities. These findings could be used to assist the malaria programme and policymakers to appropriately decide when planning for malaria service deliveries and interventions.

Enhancing the Knowledge and Behaviors of Fieldworkers to Promote Family Planning and Maternal, Newborn, and Child Health in Bangladesh Through a Digital Health Training Package: Results From a Pilot Study.

Community health workers, also known as fieldworkers (FWs), are frontline health-care providers in Bangladesh, where unmet need in family planning outcomes related to maternal and child health are high. A digital health intervention provided netbook computers to Bangladeshi FWs with eLearning courses and an eToolkit, which included material on family planning, maternal, newborn, and child health topics to enhance FWs’ knowledge and skills. To understand how the intervention affected FW’s knowledge and counseling behavior, this pre-poststudy measured FWs’ knowledge related to family planning, maternal, newborn, child health, and counseling on family topics before and after the pilot. Bivariate analyses were used to determine changes in FW knowledge, and multivariate analyses were conducted to determine changes in behavior, comparing knowledge and behaviors prepilot to postpilot. Comparing mean knowledge scores after and before the pilot, the difference in mean scores was significant ( p &lt; .05) related to knowledge of benefits of birth spacing (1.26) and benefits of a small family (1.3) and related to maternal health, anemia prevention (0.95), and recommended number of antenatal care visits (0.13). Regarding newborn and child health, the difference in mean scores was significantly ( p &lt; .05) related to knowledge of proper attachment for breastfeeding (3.56) and signs of adequate breast milk supply (1.08). Postintervention, FWs were significantly more likely to counsel couples on all available contraceptive options (adjusted odds ratio: 4.64; 95% CI [3.16, 6.83]) and birth spacing benefits (adjusted odds ratio: 4.54; 95% CI [3.17, 6.50]). Digital health training approaches can improve FWs’ knowledge and counseling skills within an international context, specifically in low-resource settings.