Quality Of Antenatal Care Services Research Articles

Perceptions and Expectations of Midwives and Women Regarding Prenatal Care within the Scope of Primary Health Care Services in Türkiye.

One of the Sustainable Development Goals is to reduce the global maternal mortality rate. Antenatal care is a crucial component in achieving this goal. The aim of our study is to reveal the perceptions and expectations of midwives and women regarding antenatal care. In this qualitative study, Husserl's philosophy of phenomenology was adopted to emphasize the knowledge of experiences. One-to-one in-depth interviews were conducted with 31 participants - 15 midwives and 16 women - who received antenatal care in Türkiye. Each interview was recorded and transcribed verbatim. The data obtained from the research were analyzed using traditional content analysis, resulting in five main themes and ten sub-themes. The main themes were "Lack of knowledge/awareness," "Midwifery in Antenatal Care Services," "Practices within the Scope of Antenatal Care," "Factors Hindering Receiving Antenatal Care," and "Expectations from Antenatal Care." The women participating in the research could not define the concept of "Antenatal care" and did not consider the service they received during pregnancy as antenatal care. It was determined that midwives could not provide quality antenatal care services to women for various reasons. Midwives should raise women's awareness about antenatal care, which includes examination, treatment, education, and counselling. In addition, the areas of need of primary health care services should be determined, and necessary improvements should be made.

Prevalence and Factors Associated with the Fourth Standard Antenatal Care Utilization among Pregnant Women Attending Ruli District Hospital, Rwanda

Purpose: The purpose of this research is to identify the prevalence of adherence to the recommended four antenatal care (ANC) visits and to analyze factors associated with achieving the fourth ANC visit among pregnant women attending Ruli District Hospital in Gakenke District, Rwanda. The study aims to address gaps in ANC attendance, focusing on improving maternal and fetal health. Methodology: A cross-sectional study design was used, with a sample size of 421 women, determined through Fisher et al.'s (1998) formula. Systematic sampling was employed to select participants between November 20, 2023, and January 20, 2023. Data collection included informing participants about the study and obtaining consent. Confidentiality was maintained by anonymizing participant data. Analysis was conducted using SPSS version 25, applying descriptive statistics such as percentages, means, and frequencies. Bivariate and multivariate regression analyses were used to identify relationships between independent and dependent variables, with significance assessed at p < 0.05. Findings: The study found that 57.5% of respondents adhered to the four recommended ANC visits, while 42.5% attended fewer than four. Factors significantly associated with increased ANC attendance included higher educational attainment, abstinence from alcohol by both the mother (AOR=1.953, CI: 1.202-3.174, P<0.007) and husband (AOR=2.041, CI: 1.112-3.747, P<0.002), planned pregnancies (AOR=4.159, CI: 1.975-10.326, P<0.001), and absence of mistreatment toward women (AOR=3.040, CI: 1.367-6.762, P=0.006). Unique Contribution to Theory, Practice and Policy: The study recommends enhanced supportive supervision and mentorship of Community Health Workers for home visits to pregnant women. Additionally, improving customer care and the quality of ANC services is advised. These insights are expected to guide policymakers in Rwanda, including the Ministry of Health, Ruli District Hospital, and other stakeholders, in enhancing ANC adherence and improving maternal health outcomes.

Evaluation of focused antenatal care services quality at University of Gondar Comprehensive Specialized Hospital, Central Gondar zone, Northwest Ethiopia.

Antenatal care is the care that women receive during their pregnancy to ensure the health of the mother and her baby. The provision of information on birth preparedness in Ethiopia is still low, which implies identification of pre-existing health conditions that may affect the outcome of pregnancies was not provided. Even if the Focused Antenatal Care service was provided in our setup, maternal death was still high. In addition, as far as our search, the quality of antenatal care service in this facility has not yet been evaluated. As a result, the purpose of this study was to assess the quality of focused antenatal care services at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. A mixed method case study evaluation design was employed at the University of Gondar Comprehensive Specialized Hospital from February 29 to March 29, 2020. Quantitative data was collected through exit interviews of 411 mothers who attended antenatal care follow-up and review of 422 clients' cards 2 months prior to the study period. Similarly, 35 items of resources inventory, 10 direct observations, and 12 key informant interviews were conducted. The data were entered into Epi-Data version 4.6 and exported to SPSS version 25 and it was analysed with the Evaluation judgment matrix analysis method. Qualitative data were transcribed, translated and analysed by using thematic analysis. The evaluation focused on availability, compliance, and satisfaction dimensions with 25 indicators to judge the quality of antenatal care services. The overall quality of focused antenatal care services was judged as good, based on pre-set judgment criteria (76.7%), to which availability of resources, healthcare provider's compliance with the national guideline, and maternal satisfaction contributed, 73.3, 77.75, and 78.8%, respectively. Auditory and visual privacy were practiced which enhances patient confidentiality and personal dignity. The waiting area was perceived to be satisfactory by the majority (89%) of ANC clients, but there is no separate waiting area for ANC clients. Ten (10) client/provider interactions were observed, demonstrating that all clients were counseled about pregnancy danger signs. The overall focused antenatal care services quality was relatively good, although the availability of resources was fair. Some essential drugs and medical equipment were out of stock. Therefore, the hospital had better fulfill crucial medicines and equipment for better service quality.

Overview of Integrated Antenatal Care (ANC) Implementation in the Regional Technical Implementation Unit West Selemadeg Health Center Tabanan Regency

Providing comprehensive and quality ANC services to pregnant women is called Integrated ANC services. The indicator used to describe pregnant women's access to antenatal care is K1 coverage while the indicator to describe service quality is K4-K6 coverage with 10T service quality including physical examination, laboratory examination, provision of fe table, immunization and counseling. The purpose of the study was to determine the description of the application of integrated antenatal care (ANC) in the Regional Technical Implementation Unit of the West Selemadeg Health Center. This type of research is descriptive quantitative. Implementation of research in March - April 2024 with purposive sampling technique. The sample using the slovin formula amounted to 40 people. Data collection in the form of integrated ANC indicator data collection sheets. Data analysis using univariate in the form of frequency distribution. The results showed that pure K1, K4 and K6 visits from pure K1 were 62.5% of respondents while a small proportion of respondents according to the standards of K1 access visits, K4 and K6 from K1 access were (37.5%) respondents. The results of pure K1, K4 and K6 services from pure K1 were 62.5% of respondents while a small proportion of respondents met the standards of K1 access visits, K4 and K6 from K1 access as many as (37.5%) respondents. Suggestions for UPTD Puseksmas Selemadeg Barat to increase education to pre-conception couples and pregnant women about the purpose of visits and appropriate ANC examinations.

Quality of antenatal care services received by women of reproductive age prior to delivery in selected public health facilities in the northern zone of Ghana

BackgroundOver the past two decades, antenatal care (ANC) coverage has increased in most settings across low- and middle-income countries, including Ghana. However, evidence shows that there is a need to focus on both access and quality to improve maternal and newborn health outcomes. We investigated ANC quality among public healthcare facilities in the northern region of Ghana.MethodsWe conducted a facility-based study involving 420 postpartum women, selected randomly from five public health facilities. We collected information on a set of prenatal services that respondents self-reported to have received during their most recent pregnancy. Women who received all the interventions assessed were considered to have received quality ANC. Using multilevel (mixed-effects) regression analysis, we identified the independent factors associated with ANC quality, with healthcare facility as the cluster variable.ResultsOf the 420 women, 31.2% (95% CI: 26.9, 35.8) received ANC services of high quality. ANC quality differed significantly by women’s background characteristics and ANC use. However, gestational age at first ANC and the number of follow-up visits before delivery were significantly associated with ANC quality: booking the first visit in the second or third trimester reduced the odds of receiving high-quality ANC compared to booking in the first trimester (aOR = 0.15, 95% CI: 0.07, 0.31, and aOR = 0.09, 95% CI: 0.01, 0.83, respectively). In contrast, achieving a minimum of eight ANC follow-ups before delivery increased the odds of receiving high-quality ANC compared to attaining fewer than eight visits (aOR = 4.82, 95% CI: 2.33, 9.99).ConclusionsA significant proportion of pregnant women in the study setting received suboptimal quality ANC during their most recent pregnancy. ANC quality was primarily associated with the timing of the first visit and the number of follow-up visits before delivery. Timely initiation of ANC and frequent follow-up visits will be crucial in the study’s setting for pregnant women to benefit from comprehensive ANC services.

Prevalence and determinants of readiness of health facilities for quality antenatal care services in Bangladesh.

This study investigates the prevalence and determinants of readiness for quality antenatal care (ANC) services in Bangladesh using data from the 2017 Bangladesh Health Facility Survey (BHFS). We assessed the association between selected factors and the readiness index using multinomial logistic regression. We identified a significant gap in the availability and quality of ANC services, only 4.26% of health facilities provide quality ANC services, with rural facilities showing lower readiness compared to urban facilities (RRR:0.13; 95% CI: 0.06-0.31; p < 0.001). Community clinics and private hospitals have a lower likelihood of medium or high readiness compared to public hospitals or clinics. Health facilities with specialized care are more likely to demonstrate readiness for quality ANC services. Policy recommendations include increased healthcare funding, implementation of ANC guidelines, strengthened monitoring and evaluation of health facilities, and heightened community awareness. These measures should improve ANC, overall health outcomes, and public health policies.

Inequity in antenatal care quality in Zimbabwe: The role of women’s empowerment

ABSTRACT The health systems fail to provide quality antenatal health services to vulnerable and marginalised pregnant women regardless of their effectiveness in reducing maternal and neonatal mortality. Despite the importance of antenatal care quality during pregnancy, less is known regarding its inequality in developing countries. This paper aims to determine the inequality in antenatal care quality in Zimbabwe and the contribution of women’s empowerment. The paper used the 2010/11 and the 2015 Demographic Health Survey data and concentration index and Shapley decomposition. We found that antenatal care quality was pro-rich for blood sample tests, urine sample tests, blood pressure tests, and iron tablets except for tetanus injections, thus the affluent benefit more from better antenatal care quality than the poor. Women’s empowerment had a major contribution to inequality in antenatal care quality. Given the paramount importance of antenatal care in improving maternal, birth, and child outcomes, policymakers should consider policies that enhance the women’s empowerment and quality of antenatal care services in Zimbabwe, which in turn enhance the attainment of Sustainable Development Goals.

Factors affecting antenatal care attendance in Soweto, Johannesburg: The three-delay model.

Antenatal care remains critical for identifying and managing complications contributing to maternal and infant mortality, yet attendance among women in South Africa persists as a challenge. This study aimed to understand the challenges faced by women attending antenatal care in Soweto, Johannesburg, using the three-delay model. This study was conducted in Soweto, Johannesburg. An exploratory, descriptive and qualitative research design was used, and in-depth interviews were conducted with 10 pregnant women and four women who had recently given birth. Findings indicate delays in seeking care due to factors such as pregnancy unawareness, waiting for visible signs, and fear of human immunodeficiency virus (HIV) testing. Challenges such as transportation difficulties, distance to clinics, and facility conditions further impeded the initiation of antenatal care. Late initiation often occurred to avoid long waits, inadequate facilities, language barriers and nurse mistreatment. From this study, we learn that challenges such as unawareness of pregnancy, cultural notions of keeping pregnancy a secret, fear of HIV testing, long waiting lines, high cost of transportation fees, clinic demarcation, shortage of essential medicines, broken toilets and verbal abuse from nurses have delayed women from initiating antenatal care early in Soweto, Johannesburg.Contribution:Challenges of women with antenatal care attendance in South Africa must be addressed by implementing community-based health education interventions, institutionalising HIV psycho-social support services and improving quality of antenatal care services in public health facilities.

Assessment of quality of antenatal care services and associated factors in Malawi: Insights from a nationwide household survey.

Provision of quality antenatal care (ANC) to pregnant women is essential for reducing maternal and newborn mortality. ANC provides an opportunity for early identification of conditions that increase the risk of adverse pregnancy outcomes. However, there is limited evidence regarding the quality of ANC received by women in Malawi. This study aimed to assess the quality of ANC and associated factors in Malawi. National representative data from the 2019-2020 Malawi Multiple Indicator Cluster Survey was used for this cross-sectional study. A total of 6,287 weighted sample of women aged 15 to 49 years who had a live birth and received ANC at least once within two years preceding the survey were included in the analysis. Descriptive statistics were used to estimate the magnitude of quality ANC and multivariable logistic regression was computed to identify associated factors. Of the 6,287 women, only 12.6% (95% CI: 11.4-13.9) received quality ANC. The likelihood of receiving quality ANC was significantly higher among women who had four to seven ANC contacts (AOR = 2.10; 95% CI: 1.79-2.49), made at least eight ANC contacts (AOR = 3.40; 95% CI: 1.90-6.09) and started ANC within the first trimester (AOR = 1.30; 95% CI: 1.10-1.53). On the other hand, women who had only primary education (AOR = 0.62; 95% CI:0.48-0.82) and had five or more births (AOR = 0.56; 95% CI: 0.40-0.78) were less likely to receive quality ANC. The findings reveal that quality of ANC in Malawi is low. These findings suggest the need for targeted interventions aimed at improving access to and utilization of ANC services among women with lower education and higher parity. Strengthening efforts to promote early ANC initiation and increasing the number of ANC contacts could significantly enhance the quality of ANC received by women in Malawi.

Prevalence of neural tube defect and its identification during antenatal period: a cross-sectional study in eastern Indian state

ObjectiveTo estimate the prevalence of neural tube defects among all birth outcomes in Odisha during 2016–2022. Additionally, to estimate the identification rate of neural tube defects during Pradhan Mantri Surakshit...

Assessment of modern maternal health care usage in Ethiopia

Ethiopia, like many developing nations, has struggled with the problem of low utilization of maternal healthcare services. The main objective of this study is to investigate the awareness and application of modern maternal healthcare usage and to identify the determinant factors that affect the usage of modern maternal healthcare services in Ethiopia. A quantitative approach to the survey questionnaire was employed. A simple random sampling technique was used to select 240 respondents from a sample of women aged between 18 and 49. Using statistical software, the collected data were analyzed using categorical variable tests and binary logistic regression. The findings showed that, from the total of 240 respondents, some of the respondents had not attended Antenatal care, delivery care, and postnatal care. Therefore, from the findings of the study, the researchers have concluded that to increase health care utilization, the concerned bodies should be expanding access to health services, improving the quality of antenatal care services, conducting awareness-raising promotions, and providing training for health workers to increase their skills and professional ethics. Keywords: Health care; maternity; modern health care service; women.

The Influence of Health Education on Knowledge of Antenatal Care in Pregnant Women in Rural Areas

Background: Maternal health problems are closely related to pregnant women, which contribute a lot to the current maternal mortality rate, maternal mortality can be prevented if pregnant women get good quality antenatal care services. Lack of knowledge of pregnant women about antenatal care results in a lack of care for pregnant women about their own health and the baby in their womb. One of the efforts that can be done is by conducting antenatal care so that it can monitor pregnancy and ensure the health of the mother and fetus. Objective: This study aims to analyze the effect of health education on knowledge of antenatal care for pregnant women in Karangpring Village, Jember Regency. Methods: This type of research is a quasi-experimental design with the one group pre and post-test design. This study was conducted on pregnant women as many as 17 respondents. Results: Shows the value of knowledge before being given health education in the less category of 10 people (58.8%) and the sufficient category of 5 people (29.4%) and after being given health education knowledge in the sufficient category 10 people (58.8%) and good category amounted to 7 people (41.2%). The results of the paired t-test statistic obtained a significant value less than 0.05 (p = 0.000 &lt;0.05). Conclusion: There is an effect of health education on knowledge of antenatal care for pregnant women in Karangpring Village, Jember Regency.

Understanding Antenatal Care Service Quality for Malaria in Pregnancy through Supportive Supervision Data in Tanzania.

Malaria in pregnancy (MiP) is associated with maternal anemia, spontaneous abortion, and infant and maternal death. In Tanzania, MiP service data are collected through routine Malaria Services and Data Quality Improvement (MSDQI) supportive supervision rounds at antenatal care (ANC) facilities. Using structured assessment tools, the U.S. President's Malaria Initiative Impact Malaria Project reviewed two annual rounds of MSDQI data (492 facilities in 2021 and 522 facilities in 2022), including ANC records and client satisfaction interviews. We assessed coverage of key MiP care components, used logistic regression to analyze uptake of the recommended three or more doses of intermittent preventive treatment in pregnancy (IPTp3+), and assessed client satisfaction. Coverage of most MiP care components exceeded 80%; however, only 38% of women received all components. Odds of receiving IPTp3+ were much lower among late ANC initiators than among those who initiated ANC during their first trimester (odds ratio [OR], 0.46; 95% CI, 0.38-0.57). Uptake of IPTp3+ increased almost exponentially by number of ANC visits. Women with seven visits were 30 times more likely than those with three visits to receive IPTp3+ (OR, 30.71; 95% CI, 11.33-83.22). Just 54% of clients had anemia screening and only 46% received IPTp3+. Client satisfaction with services and provider communication was high (98% and 97%, respectively); only 8% of client visits exceeded 3 hours. Increased ANC visits could boost IPTp3+ coverage. Routine MSDQI supportive supervision data are useful to assess quality of care, identify service delivery gaps, and guide policies to improve quality of MiP services.

A study on utilization of ANC services and Psychological status of mothers during Covid–19 pandemic in five adopted villages of KSRDPR University, Gadag, Karnataka

Antenatal care is also known as prenatal care is a type of preventive and primitive health care during the period of whole pregnancy to ensure a better birthing outcome for mother and baby. Improving the utilization of maternal health care services is a global challenge for the health system in low and middle-income countries. The goal set by the United Nations, Millennium Developmental goals to reduce the maternal mortality ratio by three quarters during the period 1990-2015. WHO's new SMART guidelines approach, which includes the ANC Digital Adaptation Kit and WHO digital ANC module to support countries through the process of adapting and applying. With the emergence of the COVID - 19 outbreak, it is not impossible that access to quality antenatal care services in the region will be further compromised due to competition for limited health care services. COVID -19 pandemic affects routine service delivery, which may have an impact on antenatal care (ANC) utilization among pregnant women.To assess the utilization of Antenatal Check-ups before to and during the Covid -19 Pandemic period.After obtaining permission from the District Health Office and the appropriate officer in the health force, a community-based cross-sectional study was conducted. To select study participants who are both convenient and cooperative, the purposive sampling technique was used. A semi-structured questionnaire was used to collect data, information about mothers' socio-demographic details, Antenatal service utilization before and during the Covid - 19 pandemic, An interview schedule was developed in order to identify the Antenatal Care utilization Gap in the eyes of prospective pregnant mothers and the challenges faced by health workers in providing Antenatal services. The data was entered into an excel sheet, and the results were expressed as frequency, percentage.The study included 360 pregnant and delivered mothers aged 18 to 45 years. The majority of mothers (68.33 percent) are between the ages of 18 and 25. Half of the mothers are Primi (51.94%), a quarter of the mothers are Para 1 (33.61%), and more than one-fourth of the mothers are mildly anemic (38.06%). Few mothers have high blood pressure (8.89 percent), the majority of spouses supported their wives' Antenatal natal services visits (93.89 percent), and the majority of mothers received ANC services at no cost (99.44 percent).The current study discovered that due to the COVID - 19 pandemics, antenatal care utilization was lower than before the pandemic period.

Magnitude, disparity, and predictors of poor-quality antenatal care service: A systematic review and meta-analysis.

Antenatal care is directed toward ensuring healthy pregnancy outcomes. Quality antenatal care increases the likelihood of receiving an effective intervention to maintain maternal, fetal, and neonatal well-being, while poor quality is linked to poor pregnancy outcomes. However, owing to the complex nature of quality, researchers have followed several approaches to systematically measure it. The evidence from these variable approaches appears inconsistence and poses challenges to programmers and policymakers. Hence, it is imperative to obtain a pooled estimate of the quality of antenatal care. Therefore, considering the scarcity of evidence on the quality of antenatal care, this study aimed to review, synthesize, and bring pooled estimates of accessible evidence. This study aimed to estimate the pooled magnitude and predictors of quality of antenatal care services and compare regional disparity. We conducted a comprehensive systematic three-step approach search of published and unpublished sources from 2002 to 2022. The methodological quality of eligible studies was checked using Joanna Briggs Institute critical appraisal tool for cross-sectional studies. Meta-analysis was carried out using STATA version 16. Statistical heterogeneity was assessed using Cochran's Q test. In the presence of moderate heterogeneity (I2 more than 50%), sensitivity and subgroup analyses were conducted and presented in a forest plot. Effect size was reported using standardized mean difference and its 95% confidence interval. Funnel plots and Egger's regression test were used to measure publication bias at the 5% significance level. A trim-and-fill analysis was conducted to adjust for publication bias. Pooled estimates were computed using random-effects models and weighted using the inverse variance method in the presence of high heterogeneity among studies. A 95% CI and 5% significance level were considered to declare significance variables. The global pooled poor-quality antenatal care was 64.28% (95% CI: 59.58%-68.98%) (I2 = 99.97%, p = 0.001). The identified pooled predictors of good-quality antenatal care service were: number of antenatal care visits (fourth and above antenatal care visit) (Adjusted odds ratio (AOR) = 2.6, 95% CI: 1.37-3.84), family wealth index (AOR = 2.72, 95% CI: 1.89-3.55), maternal education attainment (AOR = 3.03, 95% CI: 2.24-3.82), residence (urban dwellers) (AOR = 4.06, 95% CI: 0.95-7.17), and confidentiality antenatal care (AOR = 2.23, 95% CI: -0.36 to -4.82). The study found regional and country-level disparities in the quality of antenatal care services for pregnant women, where poor-quality antenatal care services were provided for more than two-thirds to three-fourths of antenatal care attendants. Therefore, policymakers and health planners should put a great deal of emphasis on addressing the quality of antenatal care services.

Mapping the Role of Digital Health Interventions to Enhance Effective Coverage of Antenatal Care: A Scoping Review.

Antenatal care (ANC) is a core component of maternal health services. However, only half of the pregnant women in LMICs obtain WHO recommended minimum of four antenatal contacts. In addition, ANC 4+ is a commonly used indicator in monitoring ANC utilization. However, contact coverage alone provides no indications of service quality. In recent years, digital health interventions bring opportunities to provide quality maternal health care. Yet, there are few reviews on how digital health interventions contribute to improving effective coverage of antenatal care. A rigorous review that examines the role of digital health interventions in improving effective coverage of antenatal care is needed to examine how digital health solutions were rapidly deployed to support quality antenatal care service delivery. This review aimed to map evidence on the role of digital health solutions on quality of antenatal care service to enhance effective ANC coverage. A scoping review approach was used and four Databases (PubMed, Cochrane Library, Scopus and Embase) as well as search engines like Advanced Google Search and Google Scholar were searched from September 1 to 8, 2022. Thematic content analysis was used to present the findings. A total of 1701 articles were searched. A total of 27 full-text studies were included in the final analysis. The most reported use of digital health was for client education and behavior change communication. Most studies showed that digital health interventions have proven effective in improving antenatal care. However, most of the studies did not address to assess the quality of ANC services. In this review, we found out that digital health solutions targeted at pregnant women can improve antenatal care services. There is body of evidence showing the effectiveness of digital health interventions on a range of maternal health outcomes. Few pieces of literature exist on the use of digital health interventions on the quality of antenatal care services. There is a need for more trial and program evaluation studies that examine the role of digital health interventions on the quality of ANC.

Inequality in Afghanistan in the use of prenatal healthcare services according to the sex of newborns.

The association between the sex of newborns and the utilization of prenatal healthcare services during pregnancy and childbirth has not been thoroughly studied. This study investigated the association between the sex of newborns and the extent to which women used prenatal healthcare services in Afghanistan. This study used data obtained from a nationally representative demographic and health survey. The participants in this analysis were women who had given birth in the last five years (n=19,126). Four indicators related to prenatal healthcare utilization were used: (1) number of antenatal care (ANC) visits, (2) number of ANC services provided by skilled professionals, (3) quality of ANC services, and (4) institutional delivery. Multivariate linear and logistic regression models were employed to examine the association between the sex of newborns and the use of prenatal healthcare services after adjusting for sociodemographic and decision-making autonomy variables. There was a significant association between the sex of newborns and use of prenatal healthcare services. Women with female newborns used ANC services fewer times (β =-0.10, 95% CI: -0.17, -0.03), used ANC services provided by skilled professionals fewer times (β=-0.11, 95% CI: -0.18, -0.04), were less likely to receive high-quality ANC (adjusted odds ratio (AOR)=0.78, 95% confidence interval (CI): 0.67, 0.90), and were less likely to deliver their babies at health institutions (AOR=0.83, 95% CI: 0.77, 0.91) than those with male newborns, after adjusting for other variables. The findings revealed a negative association between female newborns and the utilization of prenatal healthcare services among women of reproductive age in Afghanistan. It is important to pay attention to this issue and ensure that all women have equal access to healthcare services regardless of their newborn's sex.

Antenatal Care Services in Sudan Before and During the 2023 War: A Review Article.

Antenatal care (ANC) is provided by skilled healthcare professionals to pregnant women to ensure the best health conditions for both mother and baby during pregnancy. It includes risk identification, prevention, management of pregnancy-related diseases, health education, and health promotion. Antenatal care has a great effect on vital health indicators such as maternal and neonatal mortality by identifying and treating pregnancy-related complications. Political instability and armed conflict have seriously affected the health system, which has catastrophic implications for pregnant women's health. This review aimed to summarize the literature on ANC in Sudan before and during political instability and war by highlighting its effect on maternal mortality, coverage, care providers, quality of care, accessibility, and utilization. Other aspects of this review are the ANC components and service provision during the war. In addition, the author tried to identify the gaps and point out the future research needs in Sudan. A total of 58 articles about ANC in Sudan have been reviewed through PubMed, Google Scholar, ResearchGate databases, and other search tools. The keywords used were "antenatal care", "coverage", "service providers", "service quality", "accessibility and utilization", "components", and "ANC during the war". All the keywords were followed by "Sudan" to confine the search. According to the reviewed data, ANC services in Sudan, even during normal political situations, were not sufficient and of poor quality in most of the reviewed regions. The political instability and armed conflicts worsened the situation, and it became catastrophic. To improve the accessibility and quality of ANC services, we will need the collaboration of all stakeholders to address the health needs of vulnerable groups, people in remote rural areas, and nomadic communities towards providing the required health services in general and ANC in particular. On the other hand, an important aspect of this development is the availability of skilled healthcare providers and the adoption, revision, and updating of working procedure guidelines to match the needs of the local communities. The main shareholders are the local communities; they must be empowered and involved by raising their awareness. Then, effective, punctual, and applicable contingency plans should be ready for any unfortunate crises.

Poor coverage of quality-adjusted antenatal care services: a population-level assessment by visit and source of antenatal care services in Bihar state of India

Despite the evidence on the poor quality of antenatal care (ANC) services, significant gap remains in the understanding of quality-adjusted coverage at the population-level for each ANC visit and by the source of ANC services, and in equity in this coverage. All births between July 2020 and June 2021 were listed from 261,124 households (91.5% participation) representative of the Bihar state. Mothers of all stillbirths and neonatal deaths, and of 25% random sample of livebirths who survived the neonatal period provided data on each ANC visit up to a maximum of first 4 ANC visits, including the source of ANC services and the services received (weight measurement, blood pressure checked, abdomen checked, urine sample taken, and blood sample taken). An ANC visit was deemed of quality if all of these services were received in that visit. We report the coverage of quality-adjusted ANC services (Q-ANC) for ANC visits 1-4 disaggregated by source of ANC services and wealth index (WI). Weighted proportions are reported to take into account the sampling design. A total of 30,412 births were reported by 29,517 women, and 7270 (82.1%) of the 8853 eligible women participated. Overall, 19,950 unique ANC visits from 6929 women were available for analysis, of which 41.7%, 13.8% and 44.5% were at Village Health and Nutrition Day (VNHD), public facility, and with a private provider, respectively. A total of 4409 (65.3%) of the 1st ANC visits were undertaken at VHND, with the proportion of private provider ANC visits increasing significantly from ANC visit 1 to ANC visit 4 (p<0.001). Q-ANC coverage considering all ANC visits was 20.9% (95% CI 20.7-21.2); and was 0.9% (95% CI 0.8-1.0), 29.9% (95% CI 29.2-30.7) and 36.9% (95% CI 36.5-37.4) for ANC visits in VHND, public facilities, and with private provider, respectively. Q-ANC coverage in the public facility was significantly lower in the 4th ANC visit (25.1%; 95% CI 23.4-26.9) as compared with visits 1 to 3, whereas it was the highest for 1st ANC visit with private provider (50.2%; 95% CI 49.2-51.1) and then dropped for visits 2 to 4. Irrespective of the source of ANC services, Q-ANC coverage increased significantly with increasing WI quartile for ANC visits 1 and 2, with WI quartile 3 women having significantly less coverage for ANC visit 3 compared to the rest, and no significant difference seen in the coverage of ANC 4 visit. Varied pattern of Q-ANC coverage by WI for each ANC visit was seen for public facility and private provider visits. With only 2 of 10 ANC visits deemed of adequate quality, sustainable delivery of quality ANC services are needed for every pregnant woman through-out the pregnancy irrespective of gestation period, number of ANC visit, and source of ANC services. The funding was provided by the India office of the Bill & Melinda Gates Foundation, USA.

Utilization and determinants of adequate quality antenatal care services in India: evidence from the National Family Health Survey (NFHS-5) (2019-21)

BackgroundPregnancy-related complications and insufficiencies in antenatal care services are leading causes of maternal and infant morbidity and mortality in low-resource settings. However, there has been an undue focus on achieving a minimum number of Antenatal Care (ANC) visits without adequate focus on the factors affecting ANC service utilization. This secondary data analysis from the fifth round of the National Family Health Survey (NFHS-5, 2019-21) was conducted to estimate the coverage of adequate quality ANC service and its determinants in India.MethodsThe study sample included 176,877 women aged 15–49 years who had experienced a pregnancy in the last 5 years. The primary outcome variable was the utilization of ANC services by women during their last pregnancy assessed by the frequency of ANC visits and the quality of ANC services. Quality of ANC service utilisation was categorised as adequate quality, inadequate quality and ≥ 4 ANC visits and, inadequate quality and < 4 ANC visits. We performed multinomial logistic regression and reported relative risk ratio (RRR) along with 95% confidence intervals. We adjusted for sampling weight, clustering, and stratification in the sampling design.ResultsThe median (IQR) number of ANC visits attended by a woman during her previous pregnancy was 4 (IQR 3–7). A majority (59.25%) of the women reported availing of ≥ 4 antenatal care (ANC) visits during their previous pregnancy while 6.12% of women reported availing no ANC visits in their last pregnancy. Women aged ≥ 30 years were significantly less likely (aRRR 0.73 95% CI 0.66, 0.80) to receive ANC services of inadequate quality, and < 4 ANC visits. Additionally, any exposure to mass media (aRRR 0.69 95% CI 0.66, 0.73), and having health insurance (aRRR 0.71 95% CI 0.68, 0.75) decreased their risk of receiving inadequate quality ANC services and < 4 ANC visits. Women belonging to the richest wealth quintile (aRRR 0.52 95% CI 0.47,0.58) and those with an intended pregnancy (aRRR 0.62 95% CI 0.58 ,0.66) were at significantly lower risk of utilizing inadequate quality ANC services and < 4 ANC visits.ConclusionAlthough nearly 3 in 5 women in India utilized a minimum mandated ≥ 4 ANC visits during their last pregnancy, only one in five of those received adequate quality of ANC services indicating suboptimal content. However, only one in five women utilized the WHO-mandated ≥ 8 ANC visits for a positive pregnancy experience. Furthermore, 14.3% of the women received ANC services of inadequate quality despite attending ≥ 4 ANC visits in their previous pregnancy. Our study emphasized the importance of the quality of ANC services utilised irrespective of number of ANC visits availed. Efforts should be undertaken to enhance the utilization of antenatal care (ANC) services by implementing media initiatives that aim to raise awareness, particularly among women belonging to disadvantaged population groups.