Number Of Antenatal Care Research Articles

Hubungan Usia, Paritas DAppN Jarak Kehamilan dengan Kejadian Anemia pada Ibu Hamil Multipara di Praktek Mandiri Bidan Kelurahan Sukajadi Kabupaten Banyuasin 2020

Anemia in pregnant women is one of the most common health problems experienced by pregnant women. Causes of anemia in pregnant women include maternal compliance in consuming FE tablets, parity, age of pregnant women, number of Antenatal Care (ANC) visits and gestational spacing. This study aims to determine the relationship between age, parity and pregnancy distance with the incidence of anemia in pregnant women. The study used an analytical survey with a cross sectional approach. The population of all multiparous pregnant women was 186 respondents. The sampling technique used systematic random sampling with a sample of 65 respondents. Collecting data on the variables of anemia, age, parity and pregnancy interval using a checklist. The research was conducted at the Independent Midwife Practice of Sukajadi Village, Banyuasin Regency in July-August 2021. Data were analyzed using the Chi-Square test. More than half of pregnant women with anemia (66.2%), more than half of pregnant women with high risk age (55.4%), more than half of pregnant women with low priority (52.3%), and most pregnant women with low-risk pregnancies (75.4%). There is no relationship between age and the incidence of anemia, p value 0.052 and odds ratio 3.267, there is a parity relationship with the incidence of anemia, p value is 0.004 and odds ratio is 5.200, there is a relationship between pregnancy distance and the incidence of anemia, p value is 0.007 and odd ratio is 11.250. In this study is that the age of pregnant women has no relationship with the incidence of anemia, parity and distance between pregnancies has a relationship with the incidence of anemia in multiparous pregnant women.

Comprehensive Anaemia Programme and Personalized Therapies (CAPPT): protocol for a cluster-randomised controlled trial testing the effect women\u2019s groups, home counselling and iron supplementation on haemoglobin in pregnancy in southern Nepal

BackgroundAnaemia in pregnancy remains prevalent in Nepal and causes severe adverse health outcomes.MethodsThis non-blinded cluster-randomised controlled trial in the plains of Nepal has two study arms: (1) Control: routine antenatal care (ANC); (2) Home visiting, iron supplementation, Participatory Learning and Action (PLA) groups, plus routine ANC. Participants, including women in 54 non-contiguous clusters (mean 2582; range 1299–4865 population) in Southern Kapilbastu district, are eligible if they consent to menstrual monitoring, are resident, married, aged 13–49 years and able to respond to questions. After 1–2 missed menses and a positive pregnancy test, consenting women < 20 weeks’ gestation, who plan to reside locally for most of the pregnancy, enrol into trial follow-up. Interventions comprise two home-counselling visits (at 12–21 and 22–26 weeks’ gestation) with iron folic acid (IFA) supplement dosage tailored to women’s haemoglobin concentration, plus monthly PLA women’s group meetings using a dialogical problem-solving approach to engage pregnant women and their families. Home visits and PLA meetings will be facilitated by auxiliary nurse midwives. The hypothesis is as follows: Haemoglobin of women at 30 ± 2 weeks’ gestation is ≥ 0.4 g/dL higher in the intervention arm than in the control. A sample of 842 women (421 per arm, average 15.6 per cluster) will provide 88% power, assuming SD 1.2, ICC 0.09 and CV of cluster size 0.27.Outcomes are captured at 30 ± 2 weeks gestation. Primary outcome is haemoglobin concentration (g/dL). Secondary outcomes are as follows: anaemia prevalence (%), mid-upper arm circumference (cm), mean probability of micronutrient adequacy (MPA) and number of ANC visits at a health facility. Indicators to assess pathways to impact include number of IFA tablets consumed during pregnancy, intake of energy (kcal/day) and dietary iron (mg/day), a score of bioavailability-enhancing behaviours and recall of one nutrition knowledge indicator. Costs and cost-effectiveness of the intervention will be estimated from a provider perspective. Using constrained randomisation, we allocated clusters to study arms, ensuring similarity with respect to cluster size, ethnicity, religion and distance to a health facility. Analysis is by intention-to-treat at the individual level, using mixed-effects regression.DiscussionFindings will inform Nepal government policy on approaches to increase adherence to IFA, improve diets and reduce anaemia in pregnancy.Trial registrationISRCTN 12272130.

Number of antenatal care utilization and associated factors among pregnant women in Ethiopia: zero-inflated Poisson regression of 2019 intermediate Ethiopian Demography Health Survey

BackgroundThe frequency of antenatal care utilization enhances the effectiveness of the maternal health programs to maternal and child health. The aim of the study was to determine the number of antenatal care and associated factors in Ethiopia by using 2019 intermediate EDHS.MethodsSecondary data analysis was done on 2019 intermediate EDHS. A total of 3916.6 weighted pregnant women were included in the analysis. Zero-inflated Poisson regression analysis was done by Stata version 14.0. Incident rate ratio and odds ratio with a 95% confidence interval were used to show the strength and direction of the association.ResultAbout one thousand six hundred eighty eight (43.11%) women were attending four and more antenatal care during current pregnancy. Attending primary education (IRR = 1.115, 95% CI: 1.061, 1.172), secondary education (IRR = 1.211, 95% CI: 1.131, 1.297) and higher education (IRR = 1.274, 95% CI: 1.177, 1.378), reside in poorer household wealth index (IRR = 1.074, 95% CI: 1.01, 1.152), middle household wealth index (IRR = 1.095, 95% CI: 1.018, 1.178), rich household wealth index (IRR = 1.129, 95% CI: 1.05, 1.212) and richer household wealth index (IRR = 1.186, 95% CI: 1.089, 1.29) increases the number of antenatal care utilization. The frequency of antenatal care was less likely become zero among women attending primary (AOR = 0.434, 95% CI: 0.346, 0.545), secondary (AOR = 0.113, 95% CI: 0.053, 0.24), higher educational level (AOR = 0.052, 95% CI: 0.007, 0.367) in the inflated part.ConclusionThe number of antenatal care utilization is low in Ethiopia. Being rural, poorest household index, uneducated and single were factors associated with low number of antenatal care and not attending antenatal care at all. Improving educational coverage and wealth status of women is important to increase the coverage and frequency of antenatal care.

Determinants of Early Initiation of Breastfeeding in West Belessa District, Northwest Ethiopia.

Background:The world is now suffering from malnutrition and remains one of the leading causes of death for under 5 children. Children from developing countries, including Ethiopia also suffer from undernutrition due to suboptimal breastfeeding practice. Therefore, the aim of this study was to assess the EIBF practices and determinants among children aged less than 24 months in West Belessa district, Northwest Ethiopia, 2019.Methods:A community-based cross-sectional study was conducted from January 2 to February 28, 2019 in the West Belessa district. A total of 569 mother-children pairs were participated in the study. Study particnapants were selected by using simple random sampling technique. The data were collected by an interviewer-administered structured questionnaire. Data were entered and analyzed by using Epi-Info version 7 and SPPS version 20, respectively. Bi-variable and Multivariable logistic regression analysis were done. Odds ratio with 95% confidence was done to determine the level of significance value less than .05 considered as significant with the outcome variable.Result:The prevalence of early initiation of breastfeeding (EIBF) was found to be 77.7 % (95%CI, 74.3-81.0). Age of the mother (AOR = 2.76, 95%CI [1.21, 6.27]), antenatal care (ANC) (AOR = 3.79, 95%CI [2.58, 9.94]), and number of antenatal care visit (AOR = 1.85, 95%CI [1.03, 3.85]) were significantly associated with early initiation of breastfeeding.Conclusion and Recommendation:In this study, more than three fourth of children were received early initiation of breastfeeding within 1 hour after delivery. Age of the mother, antenatal, and number of antenatal care were associated with EIBF. Therefore, during this contact period, improve antenatal services by increasing accessibility and providing counseling is important to improve EIBF utilization.

Risk factors for surgical site infection after cesarean delivery in a rural area in China: A case–controlled study

BackgroundWe aimed to determine the prevalence and risk factors of surgical site infection (SSI) after cesarean delivery (CD) in a rural area in China. MethodsWe identified 155 patients with incisional and organ/space SSIs by International Classification of Disease codes and matched them with 465 patients (controls) in a time-matched retrospective quality assurance analysis. Multiple logistic regression analyses were performed to examine the risk factors for SSI: the work-years of providers, the number of antenatal care (ANC) visits, CD after labor, positive discharge culture, postoperative C-reactive protein (CRP) levels and fever. Resultsand discussion: During the study, 155 women with SSI were identified among the 8640 patients who delivered by CD. The incidence of SSIs was 179 per 10 000patients (95%CI: 151–207 per 10 000 patients). The total duration of hospitalization in patients with SSI was 14.49 ± 8.68 days compared with 7.96 ± 2.35 days in patients with no SSI (P < 0.01). Multiple logistic regression analysis showed that the work-years of providers (odds ratio [OR] = 3.729, 95% confidence interval [CI]: 1.463–9.501, p = 0.006), irregular ANC visits (OR = 3.245, 95% CI: 1.264–8.329, p = 0.028), CD after labor (OR = 2.545, 95% CI: 0.935–6.926, p = 0.020), postoperative CRP level (OR = 2.545, 95% CI: 0.935–6.926, p = 0.016) and a positive discharge culture (OR = 2.954, 95% CI: 0.305–28.643, p = 0.019) were positively associated with SSI. However, the rates of maternal request (OR = 0.186, 95% CI: 0.065–0.535, p = 0.002) and postoperative fever (OR = 0.208, 95% CI: 0.087–0.494, p = 0.001) were negatively related to SSI. ConclusionsSpecial attentions should be paid to CD patients who had irregular ANC visits, attempted labor, a positive discharge culture, higher CRP levels and fever after surgery, who had a greater risk of SSI.

Quality of antenatal care and its sociodemographic determinants: results of the 2015 Pelotas birth cohort, Brazil

BackgroundInadequate antenatal care (ANC) has been associated with adverse pregnancy outcomes. ANC quality is considered a key component of the right to health and a route to equity and dignity for women and their children. Although ANC coverage is relatively high in Brazil, there are revealed some health disparities when coverage is examined by socio-demographic determinants. In this study we evaluated ANC quality and its socio-demographic determinants using data from the 2015 Pelotas birth cohort, Rio Grande do Sul, Brazil.MethodsThis study is part of the 2015 Pelotas population-based birth cohort (n = 3923 pregnant women) conducted in southern Brazil. ANC quality was assessed through 19 content and service utilization indicators recommended by the Brazilian Ministry of Health. Descriptive analyses and associations of each of the ANC indicators and independent variables were performed using the chi-square and linear trend test. ANC indicators were analyzed individually and aggregated as a score. Associations between ANC score quality and socio-demographic variables were assessed with ordinal regressions. Mediation analysis with G-computation was performed to estimate direct and indirect effect of mother’s level of education on ANC quality mediated by the number of consultations and timing of ANC initiation. Base and post confounders were included.ResultsThe results showed that except for breast examination, height measurement, tetanus toxoid vaccination and ANC starting at the first trimester, all ANC indicators showed more than 80% coverage during ANC visits.In the adjusted analysis, inadequate quality ANC was associated with lower maternal education level, not having a partner, being multiparous, being attended by a private provider and by the same professional in all consultations. In the mediation analyses, 6.8% of the association between ANC quality and mother’s education was mediated by the trimester in which ANC started, while 12.8% was mediated by the number of ANC visits.ConclusionsANC quality is associated with pregnant women’s socio-demographic characteristics. Significant efforts are needed to improve the quality of facility-based maternity care.

Investigation of some factors associated with utilization of maternal health care services by adolescent mothers in Tanzania

This study examined some factors associated with the utilization of maternal health care servicesby adolescent mothers (15-19 years) in Tanzania in order to provide advice accordingly. The studyused cross-sectional study of adolescent mothers aged 15-19 years using Demographic HealthSurvey and Malaria indicator Survey 2015/16 data. The dependent variables were number ofantenatal care visits, the place where an adolescent mother delivered and post-natal checkup(adolescent mother’s health checking after being discharged or after a home delivery). Theindependent variables were birth order, education level of a mother, marital status of a mother,media exposure, wealth index, distance to health facility. Multiple binary logistic regression wasused to examine an association between each dependent variable and their respective independentvariables. Data was analyzed using IBM SPSS statistics and STATA. This study used 550adolescent mothers in the analysis. Majority of the adolescent mothers had less than four AntenatalCare (ANC) visits (53.5%), while 68.5% of adolescent mothers delivered at a health facility.Adolescent mothers with two or more children had less odds of having at least four ANCscompared to those with one child, whereas adolescent mothers with at least secondary educationhad greater odds of delivering at a health facility compared to those who had no education.Adolescent mothers who had at least four antenatal care visits and those who are married hadgreater odds of checking their health after being discharged compared to adolescent mothers whohad less than 4 ANCs and single adolescent mothers. It was advised that provision of maternaleducation to young girls on the importance of safe delivery and health checking after delivery isvery important to reduce adolescent maternal morbidity and mortality in the country.&#x0D; Keywords: Adolescent; Maternal Health; Logistic regression; Chi-square

Assessment of Common Maternal Risk Factors in Fetal Malnutrition

Introduction: Nutritional assessment of the newborn gives the reflection of the growth process in the intrauterine period. The Clinical Assessment of Fetal Nutritional Status score (CAN score) method is only the method to assess the fetal malnutrition which includes the clinical observation for the presence of the sign of malnutrition in newborns. Since the fetal growth is related to availability of intrauterine nutrition and placental function, there may be several maternal factors associated with the fetal malnutrition.&#x0D; Objectives: The main objective of the study was to determine the prevalance of Fetal Malnutrition in term newborns and the role of maternal factors in the etiology of fetal malnutrition (FM) in the Neonatal and Maternity Units of B.P Koirala Institute of Health Sciences, Dharan.&#x0D; Methodology: This was a hospital based observational cross sectional study of consecutive, singleton, term live babies delivered between September 2019 to March 2020. Fetal malnutrition was diagnosed using Clinical Assessment of Fetal Nutritional Status score (CAN score) developed by Metcoff. The maternal history was obtained from the mother which included age, parity, socioeconomic class, pre pregnancy weight, number of antenatal care during pregnancy, history of maternal illness and drugs taken during pregnancy. Nutritional status of the mother was determined using weight, height, mid arm circumference (MAC) and the body mass index (BMI). Collected data was entered in Microsoft excel 2010 and converted it into SPSS 23 version software, for statistical analysis.&#x0D; Results: Of the 400 studied newborns, 73 [18%] had FM. The prevalence of teenage pregnancy, primiparity, lower maternal mid arm circumference and vegetarian diets were higher in the mothers of the babies who had suffered fetal malnutrition than the mothers of the babies without FM (p value &lt;0.05).The adverse maternal condition like Pregnancy induced hypertension (PIH), Antepartum hemorrahge (APH), Urinary tract infection (UTI), fever during pregnancy had significant impact in the fetal malnutrition(p value &lt;0.05).&#x0D; Conclusion: Improvement in the socioeconomic condition of women and good antenatal care could reduce most of the maternal factors associated with fetal malnutrition. There should be implementation of more accessible programs which address the issues of the maternal nutrition and the maternal health care in Nepal.

Maternal healthcare utilsation and complete childhood vaccination in sub-Saharan Africa: a cross-sectional study of 29 nationally representative surveys

ObjectiveThe objective of the study was to examine the association between maternal healthcare utilisation and complete childhood vaccination in sub-Saharan Africa.DesignOur study was a cross-sectional study that used pooled data...

Adherence to iron and folic acid supplementation during pregnancy among postnatal mothers seeking maternal and child healthcare at Kakamega level 5 hospital in Kenya: a cross-sectional study.

Background: Maternal anaemia is a public health problem worldwide, and its aetiology is linked to iron deficiency. The high nutrient demand during pregnancy exacerbates the condition. To meet the increased nutritional demand, supplementation of iron and folic acid (IFA) is key. The supplements are provided freely to pregnant women during antenatal visits at public health facilities, however, their uptake and adherence in Kenya remain unacceptably low. Methods: A hospital-based cross-sectional study involving 241 postnatal mothers seeking maternal and child healthcare (MCH) care at Kakamega level 5 hospital was conducted. Both quantitative and qualitative data were collected. Quantitative data were collected from 241 eligible postnatal mothers, while qualitative data were obtained through key informant interviews with community health volunteers and healthcare providers. Results: There was a moderate adherence to IFA supplementation (60.6%) during pregnancy among postnatal mothers seeking MCH care at Kakamega level 5 hospital. Some of the reasons for non-adherence stated by the respondents included; IFA related side effects (41.3%), forgetfulness (37.3%) and bad smell of the IFA supplements (10.3%). Higher IFA adherence was noted among the primigravida participants (OR=2.704; 95% CI: 1.262, 5.793; p=0.010) compared to multigravida participants, and those with a higher knowledge level of anaemia (OR=3.215; 95% CI: 1.346, 7.68; p=0.009) compared to their counterparts with low anaemia knowledge. Other factors that showed correlation with IFA adherence were: IFA education, pregnancy counselling before conception and the number of antenatal care visits attained. Conclusion: There is a moderate adherence to IFA supplementation during pregnancy among mothers seeking MCH at Kakamega level 5 hospital. The greatest impediments of IFA compliance during pregnancy are IFA side effects, forgetfulness and the bad smell of the IFA tablets. Therefore, providing IFA education to pregnant mothers incorporated with probable ways of managing the IFA side effects would contribute to IFA supplementation adherence.

Healthcare without borders: A cross-sectional study of immigrant and nonimmigrant children admitted to a large public sector hospital in the Gauteng Province of South Africa.

BackgroundHuman migration is a worldwide phenomenon that receives considerable attention from the media and healthcare authorities alike. A significant proportion of children seen at public sector health facilities in South Africa (SA) are immigrants, and gaps have previously been noted in their healthcare provision.The objective of the study was to describe the characteristics and differences between the immigrant and SA children admitted to Kalafong Provincial Tertiary Hospital (KPTH), a large public sector hospital in the urban Gauteng Province of SA.Methods and findingsA cross-sectional study was conducted over a 4-month period during 2016 to 2017. Information was obtained through a structured questionnaire and health record review. The enrolled study participants included 508 children divided into 2 groups, namely 271 general paediatric patients and 237 neonates. Twenty-five percent of children in the neonatal group and 22.5% in the general paediatric group were immigrants. The parents/caregivers of the immigrant group had a lower educational level (p < 0.0001 neonatal and paediatric), lower income (neonatal p < 0.001; paediatric p = 0.024), difficulty communicating in English (p < 0.001 neonatal and paediatric), and were more likely residing in informal settlements (neonatal p = 0.001; paediatric p = 0.007) compared to the SA group. In the neonatal group, there was no difference in the number of antenatal care (ANC) visits, type of delivery, gestational age, and birth weight. In the general paediatric group, there was no difference in immunisation and vitamin A supplementation coverage, but when comparing growth, the immigrant group had more malnutrition compared to the SA group (p = 0.029 for wasting). There was no difference in the prevalence of maternal human immunodeficiency virus (HIV) infection, with equally good prevention of mother-to-child transmission (PMTCT) coverage. There was also no difference in reported difficulties by immigrants in terms of access to healthcare (neonatal p = 0.379; paediatric p = 0.246), although a large proportion (10%) of the neonates of immigrant mothers were born outside a medical facility.ConclusionsAlthough there were health-related differences between immigrant and SA children accessing in-hospital care, these were fewer than expected. Differences were found in parental educational level and socioeconomic factors, but these did not significantly affect ANC attendance, delivery outcomes, immunisation coverage, HIV prevalence, or PMTCT coverage. The immigrant population should be viewed as a high-risk group, with potential problems including suboptimal child growth. Health workers should advocate for all children in the community they are serving and promote tolerance, respect, and equal healthcare access.

The impact of antenatal care on under\u2010five mortality in Ethiopia: a difference\u2010in\u2010differences analysis

BackgroundSub-Saharan Africa, as opposed to other regions, has the highest under-five mortality rates yet makes the least improvement in reducing under-five mortality. Despite the decline, Ethiopia is among the top ten countries contributing the most to global under-five mortalities. This article examines the impact of the number of antenatal care and the timing of first antenatal care on child health outcomes. We specifically investigated if the utilization of antenatal care services positively affects the reduction of under-five mortality.MethodsWe employ a difference-in-differences design with propensity score matching to identify direct causal effects of antenatal care on under-five mortality based on the Ethiopian Demographic Health Survey data of 2011 and 2016. Our sample includes 22 295 women between the ages of 14–49 who had antenatal care visits at different times before delivery.ResultsThe study revealed 1 481 cases of reported under-five mortality. 99.0% of that under-five mortality cases are women who had less than eight antenatal care visits, while only 1% of that is by women who had eight or more antenatal care visits. Antenatal care visit decreases the likelihood of under-five mortality in Ethiopia by 45.2% (CI = 19.2–71.3%, P-value < 0.001) while the timing of first antenatal care within the first trimester decreases the likelihood of under-five mortality by 10% (CI = 5.7–15.6%, P-value < 0.001).ConclusionsTo achieve a significant reduction in the under-five mortality rate, Intervention programs that encourages more antenatal care visits should be considered. This will improve child survival and help in attaining Sustainable Development Goal targets.

Factors Associated with Low Coverage of Intermittent Preventive Treatment with Sulfadoxyne-Pyrimethamine in Pregnancy in Dassa-Glazoué

Introduction: Malaria during pregnancy is a major public health concern in most endemic areas, including Benin. To overcome this, the World Health Organization (WHO) recommends several prevention strategies, including the administration of sulfadoxine-pyrimethamine (SP) during pregnancy. Objective: To study the factors associated with low coverage of Intermittent Preventive Treatment with sulfadoxine-pyrimethamine (IPT-SP) against Malaria in pregnant women at Dassa-Glazoué area hospital in 2020. Study Method: This was a descriptive, analytical study with retrospective data collection that took place from May 25 to September 25, 2020. Results: During our study, three hundred and forty (340) pregnant women were investigated. The mean age was 27.67±6.12 years. The pregnant women included in the study were traders/dealers (35%) with a primary level of education (35%) and living in a common-law relationship (77.65%). The prevalence of IPT-SP coverage in antenatal care (ANC) was 35.00%. The number of ANC (less than 4) attended by the pregnant women (p=0.00), the age of more than 3 months from pregnancy to the first ANC (p=0.00) and non-compliance with ANC (p=0.00) were the factors associated with this low coverage. Conclusion: ANC is a special time for the administration of SP. New strategies must be put into place for the correct use of this service by pregnant women.

Compliance to iron and folic acid supplements among the pregnant women of the rural field practice area of a medical college in Central Karnataka

Background: According to the World Health Organization anemia in pregnant women is defined as blood hemoglobin 40% of pregnant women all over the world are anemic, South Asia constituting 49.8% and 50.1% by India. About 20% of maternal deaths are caused by complications secondary to anemia worldwide and Iron deficiency anemia accounts for 85%. Additional iron and folic acid (IFA) are needed for pregnant women to meet their own nutritional needs and that of the developing fetus. Deficiencies in IFA during pregnancy can negatively influence the health of the mother as well as fetal development. The use of IFA supplements is associated with a reduced risk of iron deficiency and anemia. Therefore, Reproductive Child Health Program is supplementing 100–200 IFA supplements to all pregnant women who are registered. Objectives: To determine the compliance for IFA tablets and factors influencing it among the pregnant women (2nd and 3rd trimester) residing at Rural Health Training Centre (RHTC) of Shyamanur Shivashankarappa Institute of Medical Sciences and Research Centre (SSIMS and RC), Davangere. Materials and Methods: A cross-sectional study was conducted from June 2017 to December 2017 at RHTC of SSIMS and RC, Davangere. All the pregnant women who gave consent were interviewed on their antenatal visits and data was collected using pre-designed, pre-structured questionnaire and other necessary information were taken from their recent medical reports. Analysis was done by using SPSS v10, Chi-square test was applied to find the association among the variables. Results: In the present study the compliance to IFA tablets was found to be 85.7% among the total participants. Education, type of family, number of antenatal care (ANC) visits are significantly related to the compliance of IFA tablets. Conclusion: Compliance to IFA is higher than the national average which may be attributed to the good awareness and health service provided during the ANC check-ups.

Spatial pattern of perinatal mortality and its determinants in Ethiopia: Data from Ethiopian Demographic and Health Survey 2016.

The perinatal mortality rate in Ethiopia is among the highest in Sub Saharan Africa. The aim of this study was to identify the spatial patterns and determinants of perinatal mortality in the country using a national representative 2016 Ethiopia Demographic and Health Survey (EDHS) data. The analysis was completed utilizing data from 2016 Ethiopian Demographic and Health Survey. This data captured the information of 5 years preceding the survey period. A total of 7230 women who at delivered at seven or more months gestational age nested within 622 enumeration areas (EAs) were used. Statistical analysis was performed by using STATA version 14.1, by considering the hierarchical nature of the data. Multilevel logistic regression models were fitted to identify community and individual-level factors associated with perinatal mortality. ArcGIS version 10.1 was used for spatial analysis. Moran's, I statistics fitted to identify global autocorrelation and local autocorrelation was identified using SatSCan version 9.6. The spatial distribution of perinatal mortality in Ethiopia revealed a clustering pattern. The global Moran's I value was 0.047 with p-value <0.001. Perinatal mortality was positively associated with the maternal age, being from rural residence, history of terminating a pregnancy, and place of delivery, while negatively associated with partners' educational level, higher wealth index, longer birth interval, female being head of household and the number of antenatal care (ANC) follow up. In Ethiopia, the perinatal mortality is high and had spatial variations across the country. Strengthening partner's education, family planning for longer birth interval, ANC, and delivery services are essential to reduce perinatal mortality and achieve sustainable development goals in Ethiopia. Disparities in perinatal mortality rates should be addressed alongside efforts to address inequities in maternal and neonatal healthcare services all over the country.

＜Editors' Choice＞ Factors influencing utilization of postnatal care visits in Afghanistan.

ABSTRACTThe World Health Organization (WHO) defines the postnatal period as the first six weeks (42 days) after delivery and recommends four postnatal care (PNC) visits for women giving birth to a child to enable early detection and treatment of complications. However, a low utilization of PNC visits by Afghan women has contributed to a relatively high maternal mortality in Afghanistan. This study aimed to identify factors influencing the utilization of PNC visits among Afghan women by sampling nationally representative data from Afghanistan Demographic and Health Survey (AfDHS), 2015. The logistic model was used to measure the adjusted odds of utilizing PNC services among women, with a 95% confidence interval (95% CI) and a p-value of <0.05 for statistical significance. The study found that the utilization of PNC visits in Afghanistan is low; among 8,581 women (44%) who utilized PNC visits and 10,924 women (56%) who didn’t, the women’s age, place of residence, parity, education, occupation, number of antenatal care (ANC) visits, place of delivery, exposure to public media, the woman’s role in decision making and needing a permission to seek healthcare were found to be associated with the level of utilization of PNC visits. Based on the study results, health promotion interventions are recommended to increase the utilization of PNC visits.

FACTORS THAT INFLUENCE CESAREAN SECTION DELIVERIES IN INDONESIA

Background: The percentage of cesarean deliveries in Indonesia increased from 12% in 2012 to 17% in 2017. Purpose: The aim of this study was to determine the factors that influenced the rate of cesarean deliveries in Indonesia in 2017. Method: The study used a cross-sectional design, gathering secondary data from the Indonesian Health Demographic Survey (IDHS) in 2017. The sample included mothers who gave birth to their last child in Indonesia in the last five years; a survey was conducted after respondents with missing data were excluded. The selection of samples was based on the availability of data in the IDHS 2017 dataset (8,683 respondents). A stratified two-stage sampling method was used. Data were gathered through a household questionnaire and a women of childbearing age questionnaire. Univariate, bivariate, and multivariate analyses were conducted using the chi-squared test and a simple logistic regression. Results: The factors that influenced the rate of cesarean section deliveries in Indonesia in 2017 were birth attendants (p value = 0.01; PR = 3.12; 95% CI = 2.88–3.38), number of Antenatal Care (ANC) visits (p=0.02; PR=1.23; 95%CI=1.03–1.47), low wealth index (p=0.02; PR=0.89; 95%CI=0.81–0.98), place of delivery (p=0.01; PR=0.87; 95%CI=0.81–0.94), and ANC provider (p=0.01; PR=0.57; 95%CI=0.53–0.62). The results of the analyses also obtained confounding factors; namely, parity and birth interval. Conclusion: Factors that influenced cesarean delivery in Indonesia in 2017 were a low wealth index, number of ANC visits, ANC provider, place of delivery, and birth attendants.

Impact of Antenatal Care (ANC) on Perinatal Asphyxia.

Antenatal care (ANC) is very important for all women for their own health and their neonates. This study was done to observe the impact of antenatal care on perinatal asphyxia. This case-control study was conducted at Neonatology Department of Dhaka Medical College Hospital, Dhaka from July 2014 to December 2014. Fifty neonates with perinatal asphyxia (Group I) and fifty neonates without perinatal asphyxia (Group II) were selected as study subjects. After selection, informed written consent was taken. Then data were collected by face to face interview of the mother. The mean age of neonates was 49.0±72.1 hours in group I and 55.8±63.9 hours in group II. Majority (80.0%) of the neonates had birth weight 2.5- 4.0 kg in group I and only 22(44.0%) neonates had birth weight 2.5-4.0 kg in group II. Almost half (48.7%) of the mothers received antenatal check-up at UHC/FWC/MCWC in group I and 20(41.7%) in group II. It was observed that 19(38.0%) mothers received antenatal care from untrained Dai in group I and 42(84.0%) in group II. Only 30.0% of the mothers received adequate antenatal check-up in group I and 68.0% in group II. Mothers having baby with perinatal asphyxia received significantly less number of ANC. Faridpur Med. Coll. J. Jan 2019;14(1): 34-36

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.

Postnatal care services and factors affecting its utilization in slum areas of Dhaka city

Background and objectives: Maternal as well as infant mortality is high in Bangladesh. Utilization of post natal care (PNC) services is important to reduce maternal and infant mortality. Considering this matter, this study attempted to find out the level of PNC utilization by women living in slum areas of Dhaka city as well as to identify the factors associated with the utilization of PNC services.&#x0D; Methods: This study was conducted in Khilgaon and Rampura slums of Dhaka city. In each slum, women aged between 15-49 years who had given birth to at least one child were enrolled in the study by random sampling technique. Participants were interviewed with a semi-structured questionnaire which included information on socio-economic, demographic, cultural status as well as information on PNC service utilization.&#x0D; Results: Out of total 360 enrolled women in both slums, 58.6% utilized PNC services. The rate of utilization of PNC services was 55% and 62.2% in Khilgaon and Rampura slum respectively. Compared to 40-49 years age group, significantly (p&lt;0.01) higher percentage of women aged &lt;20, 20-29 and 30-39 years utilized PNC services (69.6%, 67.0% and 56.4% respectively). The significant associates of receiver of PNC were respondent’s education, number of antenatal care (ANC) received, level of tetanus vaccination, place of delivery, distance between home and clinic, mass media exposure, male participation and autonomy.&#x0D; Conclusion: Local socioeconomic and cultural aspects should be considered while planning intervention program to improve the utilization of PNC service.&#x0D; Ibrahim Med. Coll. J. 2019; 13(2): 53-58