Quality Of Antenatal Services Research Articles

Unveiling challenges of maternal health in India’s tribal mothers: Insights from a case series of maternal deaths

ABSTRACT Maternal mortality remains a significant public health concern globally, with disparities often evident among marginalized populations, including tribal communities. This case series delves into the complexities surrounding maternal mortality among tribal populations in India, shedding light on the multifaceted factors contributing to this persistent public health issue. Through verbal autopsy and retrospective review of medical records, a series of maternal deaths among tribal mothers were examined. Maternal deaths have been broadly divided into two categories Bottlenecks in quality antenatal services and missed opportunities.

Maternal and Child Health Handbook Utilization, Quantity and Quality of Antenatal Services, and Maternal Emergency Rates in Padang City in 2022

This study analyzed the relationship between the utilization of the Indonesian Ministry of Health’s Maternal and Child Health Handbook and the quantity and quality of antenatal care to maternal emergency levels. This study applied mixed methods with a consecutive sampling technique and included 108 mothers undergoing maternal emergencies at a central general hospital (quantitative) and eight mothers, seven midwives, and five cadres at primary health cares (qualitative) as informants. The result showed a relationship between the utilization of the Maternal and Child Health Care Handbook (p-value = 0.043), the quantity of antenatal care (p-value<0.001), the quality of antenatal care (p-value = 0.044) and the maternal emergency level. Not all mothers understood the benefits of the Maternal and Child Health Handbook. Most did not read it, and some mothers perceived that it could prevent emergency cases for them. The mothers were satisfied with the quality of the antenatal care services received. Maternal emergency cases are still quite high; hence, it is necessary to increase the use of Maternal and Child Health Handbook and the quantity and quality of antenatal care.

Quality and Integrated Service Delivery: A Cross-Sectional Study of the Effects of Malaria and Antenatal Service Quality on Malaria Intervention Use in Sub-Saharan Africa.

Using regionally linked facility and household surveys, we measured the quality of integrated antenatal care and malaria in pregnancy services in Kenya, Namibia, Senegal, and Tanzania. We examined country heterogeneities for the association of integrated antenatal and malaria service quality scores with insecticide-treated bed net (ITN) use in pregnant women and children under-five and intermittent preventive treatment in pregnancy (IPTp-2) uptake. Malaria in pregnancy service quality was low overall. Our findings suggest modest, positive associations between malaria in pregnancy quality and ITN use and IPTp-2 uptake across pooled models and for most studied countries, with evidence of heterogeneity in the strength of associations and relevant confounding factors. Antenatal care quality generally was not associated with the study outcomes, although a positive interaction with malaria in pregnancy quality was present for pooled ITN use models. The improved quality of malaria services delivered during formal antenatal care can help address low coverage and usage rates of preventive malaria interventions in pregnancy and childhood. Study findings may be used to target quality improvement efforts at the sub-national level. Study methods may be adapted to identify low-performing facilities for intervention and adaption to other areas of care, such as HIV/AIDS, child immunizations, and postnatal care.

Literature Review: Analysis to Reduce Maternal Mortality

The maternal mortality rate in Indonesia is still high. Hard efforts are needed so that the Sustainable Development Goals target of 70 per 100,000 live births in 2030 can be achieved. The purpose of the study was to identify aspects related to the trend issue of maternal mortality, the determinants of causes, strategic efforts and the role of family planning in reducing maternal mortality. This literature review describes sixteen peer-reviewed journals based on inclusion criteria. The results of the analysis of the literature review found that aspects of findings related to maternal mortality were as follows: trends issue maternal mortality (Maternal mortality is more common in developing countries), causative factors (Status health (nutrition, comorbidities and maternal complications), reproductive status (age, parity, gestational distance), access to health services and policies/regulations, health behavior (contraception use, socioeconomic)), strategic efforts (maternal and neonatal health management, Quality antenatal services, safe delivery and family planning) and family plans (Support system (women's status, family and community status)). The review analysis provides directions and patterns of strategic work steps, collaboration of various support systems ranging from the role of individuals, families, communities, health services and the government in ensuring maternal and child health.

Investigation of technical quality of antenatal and perinatal services in a nationally representative sample of health facilities in Nepal

BackgroundAccess to routine antenatal and perinatal services is improved in the last two decades in Nepal. However, gaps remain in coverage and quality of care delivered from the health facilities. This study investigated the delivery of technical quality antenatal and perinatal services from health facilities and their associated determinants in Nepal.MethodsData for this study were derived from the Nepal Health Facility Survey 2015. The World Health Organization's Service Availability and Readiness Assessment framework was adopted to assess the technical quality of antenatal and perinatal services of health facilities. Outcome variables included technical quality scores of i) 269 facilities providing antenatal services and ii) 109 facilities providing childbirth and postnatal care services (perinatal care). Technical quality scores of health facilities were estimated adapting recommended antenatal and perinatal interventions. Independent variables included locations and types of health facilities and their management functions (e.g., supervision). We conducted a linear regression analysis to identify the determinants of better technical quality of health services in health facilities. Beta coefficients were exponentiated into odds ratios (ORs) and reported with 95% confidence intervals (CIs). The significance level was set at p-value < 0.05.ResultsThe mean score of the technical quality of health facilities for each outcome variable (antenatal and perinatal services) was 0.55 (out of 1.00). Compared to province one, facilities of Madhesh province had 4% lower odds (adjusted OR = 0.96; 95%CI: 0.92, 0.99) of providing better quality antenatal services, while health facilities of Gandaki province had higher odds of providing better quality antenatal services (aOR = 1.05; 95% CI: 1.01, 1.10). Private facilities had higher odds (aOR = 1.13; 95% CI: 1.03, 1.23) of providing better quality perinatal services compared to public facilities.ConclusionsPrivate facilities provide better quality antenatal and perinatal health services than public facilities, while health facilities of Madhesh province provide poor quality perinatal services. Health system needs to implement tailored strategies, including recruiting health workers, supervision and onsite coaching and access to necessary equipment and medicine in the facilities of Madhesh province. Health system inputs (trained human resources, equipment and supplies) are needed in the public facilities. Extending the safe delivery incentive programme to the privately managed facilities could also improve access to better quality health services in Nepal.

Effectiveness of Health Insurance Project; Women Satisfaction Regarding Quality of Ante-natal Services

Objective: This study aimed to evaluate the effectiveness of the universal health insurance project regarding the quality of health care with antenatal care services. Materials and methods: A descriptive comparative study carried out at ten Primary Health Care (PCH) centers affiliated to Port-said and Damietta governorates. Multi-stage sampling probability technique used for selecting these centers, simple random sample of 460 women chosen. Data was collected through two tools; women's satisfaction questionnaire, and Support Tool for Improving Quality of Antenatal Care. Results: the study results revealed that 69.1% of women were unsatisfied with the antenatal care services and available resources provided by the traditional insurance. On the other hand, 79.1% of women receiving universal health insurance were satisfied with the services provided. Conclusion: level of satisfaction was higher among women using universal health insurance regarding the recent health care services, cleanness, arrangement of medical facilities, availability of resources and criteria of service. Keywords: Antenatal care, Satisfaction, Quality measures, Universal Health Insurance System.

Pregnant Women's Perception of the Effectiveness, Safety and Timeliness of Antenatal Services Provided by Midwives in Government-Owned Healthcare Facilities in South-South Nigeria

Background: Both non- and under-utilization of antenatal services can lead to poor materno-fetal outcomes. Perception of the effectiveness, safety and timeliness of the services by pregnant women may substantially affect the utilization. Objectives: The objectives of this study were to determine pregnant women’s perception of the effectiveness, safety and timeliness of the antenatal services provided by midwives, and the relationships between effectiveness, safety and timeliness of antenatal services at government-owned healthcare facilities in South-South Nigeria. Method: A cross-sectional research design was adopted for the study. Multistage sampling technique was used to select 30 primary, secondary and tertiary government-owned health facilities across the six States in South-South Nigeria from which 50 respondents were selected from each of the selected facilities. A total of 1,500 pregnant women were selected for the study. The instrument used for data collection was a self-developed Questionnaire on Pregnant Women’s Perception of the Effectiveness, Safety and Timeliness of Antenatal Services Provided by Midwives. The reliability of the instrument was established through the test-retest method using Cronbach’s alpha which yielded co-efficient of 0.715. Data collected were analyzed using frequencies, percentages, mean and Spearman Rank order correlation. Results: The result showed means of 4.27+0.68, 3.72+1.03, 3.23+1.17 respectively for pregnant women’s perceived effectiveness, safety and timeliness of antenatal services provided by midwives. Significant relationships also existed between safety and effectiveness (rho = 0.33, p &lt; 0.001), as well as between timeliness and effectiveness (rho = 0.10, p &lt; 0.001) of the antenatal services. Conclusion: Pregnant women in South-South Nigeria had a positive perception of effectiveness, safety and timeliness of the antenatal services provided by midwives. Midwives in government-owned healthcare facilities should conduct regular evaluations to get feedback from pregnant women regarding the quality of antenatal services they provide.

A mixed reception: perceptions of pregnant adolescents\u2019 experiences with health care workers in Cape Town, South Africa

BackgroundMaternal mortality among adolescent mothers in South Africa is higher than many middle-income countries. This is largely attributable to conditions that can be prevented or managed by high quality antenatal care. The way in which pregnant adolescents are treated at antenatal clinics influences their timely utilization of antenatal services. This qualitative study reports on the experiences of pregnant adolescents with health care workers when accessing antenatal care.MethodsPregnant girls aged 13–19 (n = 19) who attended public health care facilities that provide Basic Antenatal Care (BANC) services in Cape Town, South Africa were recruited. Four face to face in-depth interviews and four mini focus group discussions were undertaken, facilitated by a topic guide. Thematic analyses were used to analyse the data.ResultsExperiences that reinforce antenatal attendance, such as respectful and supportive treatment, were outweighed by negative experiences, such as victimization; discrimination against being pregnant at a young age; experiencing disregard and exclusion; inadequate provision of information about pregnancy, health and childbirth; clinic attendance discouragement; and mental health turmoil.ConclusionsThere is evidence of a discordant relationship between the health care workers and the pregnant adolescents. Adolescents feel mistreated and discriminated against by the health care workers, which in turn discourages their attendance at antenatal clinics. Maternal health care workers need to receive support and regular training on the provision of youth friendly antenatal care and be regularly evaluated, to promote the provision of fair and high quality antenatal services for adolescent girls.

THE QUALITY OF ANTENATAL CARE BASED ON INDEX SATISFACTION OF PREGNANT WOMEN

AbstractBackground: Quality antenatal care in the MCH program is considered to be one of the effective efforts to reduce maternal and child morbidity and mortality. An indicator of the success of ANC services can be seen from the output produced, namely in the form of K4 coverage. According to Kotler there are 5 (five) determinants of service quality that can be used as a basis for assessing the level of customer satisfaction with the quality of service received including Tangibles, Reliability, Responsiveness, Assurance and Empathy. Method: This research method is quantitative descriptive with survey approach. The total sample of 149 pregnant women with total sampling techniques. The instrument used was a questionnaire. Data analysis uses univariate analysis. Results: The most valued statements both from each dimension namely; tangible: Midwife performance reliability: recording in the MCH handbook, responsiveness: responses to complaints, assurance: the nature of the Midwife, empathy of communication between midwives and patients. The most valued statements are enough from each dimension namely; tangible: examination room, reliability: service procedures, responsieness: midwife response to patients waiting for long queues, assurance: guarantee to service, empathy: suitability of waiting time and duration of service. Conclusion: The data shows that the majority of respondents considered the quality of antenatal services at the Tambakrejo Public Health Center to be good but still needed to be improved so that the assessment was sufficiently good.

Determinants of focused antenatal care service satisfaction in public health facilities in Ethiopia 2018: A mixed study design

Ethiopia has been implementing focused antenatal care package to reduce maternal and child deaths. The quality of antenatal care service has not being resolved widely due to unstandardized measurement. Hence, this study assessed determinants of focused antenatal care service satisfaction in Public Health Facilities of West Guji Zone, Ethiopia, 2018. A facility based cross-sectional triangulated with qualitative study design was conducted and multistage sampling techniques was used to select 810 pregnant women in West Guji Zone, from February 5th to 28th, 2018. Key informants were selected purposively for in-depth interview. Internal reliability test checked and Crobach‘s alpha became 86.5%. Data was cleaned, coded, entered to EPI INFO software, and then exported to SPSS version 21 for analysis. Predictors in multivariate logistic regression analysis determined where p value is less than 0.05. Qualitative data were thematically analyzed and triangulated for final conclusion. The overall prevalence of satisfaction was 66%. The predictors of overall satisfaction level were urban resident (AOR=1.91, 95%CI: 1.07-3.35), males’ sex service provider (AOR=0.42, 95%CI: 0.31-0.70), housewife in occupation (AOR=5.81, 95%CI :1.06-31.35), living alone (AOR= 0.16, 95%CI: 0.04-0.71), waiting time 30-60 minutes (AOR= 0.62, 95%CI :0.40-0.99), frequency ANC (AOR= 0.35, 95%CI: 0.16-0.76), care giving approach (AOR= 5.10, 95%CI: 2.10-12.51), and service provider respect (AOR= 2.41, 95%CI: 1.31-4.50). Three-in-ten study women were dissatisfied with the service they received and predicators were rural residence, male service providers, government employees, living alone, 30-60’ waiting time duration, frequency of antenatal care visit, care giving and respectful approach of service provider. Therefore, a multidimensional intervention is crucial to alleviate multifaceted negative outcomes in maternal health. Key words: Antenatal care, child, maternal satisfaction.

Penerapan Aplikasi Sahabat Ibu Hamil (ASIH) terhadap Peningkatan Kualitas Pelayanan Antenatal di Pedesaan

Quality of antenatal care is important to reduce the maternal mortality rate. It associated with providing antenatal care according to standards and meet the expectations or satisfaction of pregnant women. However, today’s midwifery practise still show low compliance with standards, especially related to health education and pregnant women empowerment through the use of Maternal and Child Health media books. This research aimed to analyze the effect of “ Aplikasi Sahabat Ibu Hamil ” implementation to antenatal care quality improvement in rural areas. This study using quasi-experimental pre-post test design with control groups conducted in West Bandung regency with sample of 61 midwive and pregnant women, using checklists and questionnaires. Univariable analysis was done through Rash modeling, bivariable analysis using numeric categorical comparative test. The results indicated that the quality of antenatal services between control and treatment groups showed significant difference with p<0,01. Aplikasi Sahabat Ibu Hamil (ASIH) implementation served to increase midwive adherence to antenatal care standards by 47.2% and satisfaction of pregnant women by 43.8%. The proportion of good quality antenatal care were 84% in treatment groups and 37% in control group. Antenatal care without using ASIH will increase midwives’ risk of noncompliance in antenatal care standards 3.93 times, pregnant women dissatisfaction 4.4 times and poor quality of antenatal care 3.93 times compared with antenatal care using ASIH.

Correction: Analysis of socioeconomic differences in the quality of antenatal services in low and middle-income countries (LMICs).

[This corrects the article DOI: 10.1371/journal.pone.0192513.].

Analysis of socioeconomic differences in the quality of antenatal services in low and middle-income countries (LMICs).

The desired results of increasing access and availability of antenatal care (ANC) services may not be realized if the quality of care offered is not adequate. We analyzed the content/quality of antenatal care to determine whether there are socioeconomic (education and wealth) inequalities in the services provided in 59 low and middle income countries in six WHO regions–Africa, East Asia and Pacific, Europe and Central Asia, Latin America and Caribbean, Middle East and South Asia. We aggregated the most recent (2005–2015) Demographic and Health Survey for each country. The quality of content was measured on eight recommended ANC services–(1) monitoring of blood pressure; (2) tetanus injection; (3) urine analysis for protein; (4) blood test; (5) information about danger signs (6); weight (7); height measurements and (8) provision of iron-folate supplement. Descriptive and Poisson regression techniques were applied to analyse the data. We found considerable wealth and educational differences prior to controlling for known covariates. Between wealth and education, however, the disparities in the latter are larger than the former. Whereas the socioeconomic differences remained at post adjusting for residence, place and number of antenatal care, parity and region, the magnitude of change was minimal. Higher number of ANC content was provided in “other” forms of private facilities; the Latin America and Caribbean region recorded the highest number of content compared to the other regions. The hypothesized socioeconomic status on content/number of ANC services was generally supported, although the associations are substantially constrained to other variables. Efforts are made to increase the number and timing of ANC services; due recognition is needed for the content offered.

‘They would never receive you without a husband’: Paradoxical barriers to antenatal care scale-up in Rwanda

Objectiveto explore perspectives and experiences of antenatal care and partner involvement among women who nearly died during pregnancy (‘near-miss’). Designa study guided by naturalistic inquiry was conducted, and included extended in-community participant observation, semi-structured interviews, and focus group discussions. Qualitative data were collected between March 2013 and April 2014 in Kigali, Rwanda. Findingsall informants were aware of the recommendations of male involvement for HIV-testing at the first antenatal care visit. However, this recommendation was seen as a clear link in the chain of delays and led to severe consequences, especially for women without engaged partners. The overall quality of antenatal services was experienced as suboptimal, potentially missing the opportunity to provide preventive measures and essential health education intended for both parents. This seemed to contribute to women’s disincentive to complete all four recommended visits and men’s interest in attending to ensure their partners’ reception of care. However, the participants experienced a restriction of men’s access during subsequent antenatal visits, which made men feel denied to their increased involvement during pregnancy. Conclusions‘near-miss’ women and their partners face paradoxical barriers to actualise the recommended antenatal care visits. The well-intended initiative of male partner involvement counterproductively causes delays or excludes women whereas supportive men are turned away from further health consultations. Currently, the suboptimal quality of antenatal care misses the opportunity to provide health education for the expectant couple or to identify and address early signs of complications Implications for practicethese findings suggest a need for increased flexibility in the antenatal care recommendations to encourage women to attend care with or without their partner, and to create open health communication about women’s and men’s real needs within the context of their social situations. Supportive partners should not be denied involvement at any stage of pregnancy, but should be received only upon consent of the expectant mother.

English

INTRODUCTION: Birth weight is an indicator of both neonatal morbidity and mortality, maternal health, nutrition and quality of antenatal services. OBJECTIVE: To find out important anthropometric parameter(s) in the newborn as related to birth weight so that newborns with low birth weight can be identified. MATERIAL AND METHODS: A prospective cross sectional, analytical, hospital based study was conducted at Amritsar on 200 term low birth weight newborn babies(<2.5 kg) born during a period of 10 months and their various anthropometric measurements (HC, CC, MAC, TC, CFC) were taken according to standard techniques. RESULTS: The study showed a strong correlation (p <0.001) between mid-arm circumference (r=0.834) and birth weight, followed by head circumference (r=0.816) and birth weight. Other parameters were also strongly correlated (p < 0.001). A value of <9.2 cm and <7.6 cm for mid-arm circumference showed highest validity for picking up newborns weighing <2500 gm and <2000 gm respectively. CONCLUSION: Measurement of arm circumference is easier, convenient and statistically superior to other anthropometrical parameters in detection of low birth weight newborn babies. The researchers recommend designing of a simple 'Tri-colored tape' for early detection of 'At Risk' LBW newborns in rural communities for their timely management.

How twins differ: multiple pregnancy and the use of health care in the 2008 Nigeria Demographic and Health Survey

To (i) document the incidence of multiplicity in Nigeria, (ii) compare healthcare utilization during pregnancy and at delivery for singleton and multiple pregnancies (iii)and investigate whether antenatal care modifies the relationship between multiplicity and likelihood of having skilled attendance. This observational study was a secondary analysis of the 2008 Nigeria Demographic and Health Survey and included 17,635 women who gave birth to a live infant between 2003 and 2008. Multivariate logistic regression with adjustment for weighting, clustering and confounding was used to investigate associations and look for effect modification. There were 18.5 multiple pregnancies per 1000 maternities. Multiple births had nearly six times the chance of neonatal mortality (AOR 5.74). Mothers with multiple births had more skilled attendance (AOR 1.75), but similar antenatal care utilization (AOR 0.95) as women with a singleton pregnancy. Women with multiple pregnancies attending antenatal care had more visits (mean 9.0 vs. 8.2), blood pressure checks (OR 1.52) and urine tests (OR 1.51). Although antenatal care was strongly associated with skilled attendance, there was no evidence that this was more so for twins than singletons. Multiplicity in Nigeria is not just a common occurrence, but an indicator of a high-risk pregnancy. The fact that the use of antenatal care by women with a multiple pregnancy is not associated with a disproportionately greater use of skilled delivery care raises questions about the quality of antenatal services. Services should encourage and link all women and especially high-risk women to skilled attendance at delivery.

Pattern of Deliveries in Rural Areas of a District in Haryana, India.

Introduction: Home deliveries contribute considerably to unacceptably high maternal and perinatal mortality especially in Rural India. Several socio-cultural and economic factors interplay in the decision for place of delivery. Objective: To know the pattern of deliveries and related factors for appropriate advocacy and interventions. Material and Methods: Community based crosssectional study was conducted in 2007-08 in a Rural Block of District Jhajjar, Haryana. Assuming 50% institutional deliveries, at 95% confidence level with 10% allowable error; the calculated sample size was 400 deliveries. Sampling frames of all eligible women, who delivered within last 12 months, were prepared separately for all five sectors in the study block. 80 mothers were selected randomly from each sector. Absentees after three visits were replaced by next mothers in the frame. Required data were collected on pretested semi-structured schedules from study mothers by house-to-house visits and analyzed using SPSS (version10.0). Results: 227(56.7%) mothers had institutional deliveries. Among home deliveries 173(43.3%), attending personnel were: 30(17%) untrained dais, 103(59%) trained dais; 19% health personnel and 5% others. Illiteracy, poverty, no accompanying person, lower castes, inadequate antenatal check-ups, previous home delivery etc. were significantly associated with home deliveries. 50% mothers considered that institutional deliveries were not necessary. Discussion: Addressing socioeconomic constraints, creating awareness regarding importance of institutional deliveries, identifying and motivating mothers, who are likely to have home deliveries, for institutional deliveries through quality antenatal services appeared vital for ensuring deliveries in institutions.

Quality of antenatal services at the primary care level in southwest Nigeria.

A survey of 452 pregnant women accessing care at first level public health facilities in a local government area in southwest Nigeria was conducted to assess their perspectives on the quality of antenatal care received. Majority of the women expressed satisfaction with the level of expertise and basic technical competence of their careproviders. Less than 30% were pleased with the existing patients' referral mechanisms. At least two-thirds received as much information as desired in salient aspects of antenatal health information needs. Frequency of antenatal visits was "about the same as expected" for 93.6% of the women. The mean reported waiting time before antenatal consultation was 131.1 minutes although 106 (43.3 %) women expected to be attended within 30 minutes of arrival. Approximately two-thirds of women were unhappy about their involvement in decision-making with respect to birth planning and postpartum contraception. Compared to other elements of quality, women were least pleased with constellation of services especially sanitary facilities and number of skilled healthcare providers. On the whole, respondents expressed a high level of overall satisfaction (81.4%) with the care received. The survey indicates that antenatal women may generally express satisfaction with the quality of services despite some inconsistencies between received care and their expectations of the facilities.