Quality Of Antenatal Care Services Research Articles

Does health insurance matter in antenatal care experience? A study among expectant mothers at a federal medical centre in Nigeria

One of the viable ways of improving accessibility to maternal health services and Antenatal Care (ANC) is through health insurance. The National Health Insurance Scheme (NHIS) in Nigeria has the objective of promoting access to quality healthcare, which includes maternity care amongst other services. A descriptive cross-sectional study was done between August and September 2017 to evaluate the perception and satisfaction of insured (NHIS) and uninsured (Out-of-Pocket paying) pregnant women with the quality of antenatal care services at the Federal Medical Centre- Keffi, Nasarawa state, Nigeria, and to also identify if health insurance has any influence on the antenatal care experience. Data were collected from 85 respondents from each group through interviewer-administered questionnaires, containing socio-demographic and obstetric characteristics, knowledge on ANC, satisfaction with antenatal care services and perception about the NHIS and out-of-pocket payment. Data analysis was done using IBM SPSS Statistics 20.0. The mean gestational age at booking for insured enrollees (16.5 ± 4.3 weeks) was significantly lower than that of uninsured patients (20.3 ± 5.8 weeks), p-value = 0.001. There were some significant differences in the specific aspects of services accessed, however, the overall mean satisfaction for the uninsured group was 80.4 ± 7.5 while that of the insured group was 82.1 ± 5.9, with the difference not statistically significant, p-value: 0.057. Majority of the insured 69(81.2%) and uninsured 60(70.6%) patients indicated preference for the insurance system. This study found that overall, insured and uninsured pregnant women generally expressed comparable levels of satisfaction, and it also indicated the need for service improvement and expansion. Efforts and advocacy should be strengthened therefore, towards increasing health insurance coverage and improving its services.Keywords: Antenatal care, Perception, Satisfaction, Quality of care, Health insurance, NigeriaSavannah Journal of Medical Research and Practice 2018; 7(1):07-16

High Prevalence of Syphilis and Inadequate Prenatal Care in Brazilian Pregnant Women: A Cross-Sectional Study.

In Brazil, the reported number of syphilis cases among pregnant women has markedly increased. We conducted a cross-sectional study to determine the prevalence of Treponema pallidum infection and associated factors in pregnant women in Dourados, Mato Grosso do Sul, Brazil. Participants voluntarily completed a risk-factor questionnaire and provided blood specimens for unlinked anonymous testing for the presence of antibodies against T. pallidum, the causative agent of syphilis. Data of newborns were obtained from medical records. We performed univariate and multivariate regression analyses to assess associations with syphilis. The seroprevalence of syphilis in pregnant women was 4.4% (n = 29/661). Twenty-five newborns were seropositive for T. pallidum, and complications due to syphilis were observed in 28% (n = 7/25). Although 96.5% (n = 28/29) of women with syphilis received antenatal care, Venereal Disease Research Laboratory tests were performed in the first trimester for 47.6% (n = 10/21) of women. Women who received treatment in the third trimester (28.6%; n = 6/21) were considered successfully treated at the time of delivery. The use of illicit drugs during pregnancy (odds ratio [OR]: 13.3, 95% CI: 1.9-91.2) and a history of abortion (OR: 3.7, 95% CI: 1.7-8) were associated with syphilis. Our findings highlight that the poor quality of antenatal care services contributes to the high prevalence of syphilis. In addition, there are social and behavioral risk factors associated with syphilis in pregnant women. Future studies are needed to determine limitations of clinical management and control services available to pregnant women with syphilis.

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.

Assessing the impact of antenatal care utilization on low birthweight in India: Analysis of the 2015–2016 National Family Health Survey

Low birthweight (LBW) is a serious public health problem in lower-middle income countries. Despite several efforts have been made to improve the utilization of maternal health care, universalization of antenatal care (ANC) remains a major challenge in India. This paper aims to examine the association between the use of ANC services and LBW in India. A cross-sectional observational study was carried out using the data from the 2015 to 2016 National Family Health Survey (n = 147,762). We have carried out bivariate and multivariate analyses to fulfil the objective of this study. About 18% of the sample children were born with LBW. Only ¼th last birth women received full ANC services in 2015–2016. The results of binary logistic regression indicate that the likelihood of LBW was significantly lower among those children whose mother have adequate ANC services compared to those mother who did not receive those services even after accounting for important socioeconomic and demographic factors. The findings of this study suggest that providing affordable and quality ANC services could be an effective strategy to reduce the incidence of LBW. Furthermore, targeted invention is needed among socioeconomically vulnerable women to improve the utilization of ANC services, which could combat the incidence of LBW.

Understanding client and provider perspectives of antenatal care service quality: a qualitative multi-method study from Tanzania

Understanding client and provider perspectives of antenatal care service quality: a qualitative multi-method study from Tanzania

English

Antenatal care (ANC) has been recommended as a service that can reduce both maternal and newborn mortalities. However, even in areas recording high ANC attendance, there are unevenly high levels of maternal and new born mortalities. Evidence of a weak relationship between ANC use and maternal and newborn survival has motivated recent calls to focus on content and quality of care provided rather than mere ANC attendance. This was a descriptive cross sectional study which was designed to evaluate the quality of antenatal care services in two health facilities in Lusaka and two in Mumbwa districts of Zambia. The health facilities were selected purposively based on poor maternal outcomes such as high maternal mortality ratio. Women attending antenatal clinics were selected using simple random sampling. Data was collected using a client exist interview schedule designed by World Health Organization for assessing quality of antenatal care. Data was analyzed using Statistical Package for Social Scientist (SPSS) version 24.0. The study revealed a lot of variations in the care provided at the four sites. None of the women had all the blood tests for haemoglobin, grouping and X-match, HIV and syphilis conducted from three out of the four health facilities, while at the fourth, only 30% of women had all the blood tests conducted. Furthermore, less than 20% of women had a full head to toe examination. While less than 10% of women from each of the facility reported that the health providers met the requirements for provision of privacy. Despite not meeting the minimum standards of care, only less than 5% of women categorized the care as poor. All the four health facilities recorded low quality of care on all domains of antenatal care. Therefore, if antenatal care has to achieve its intended purpose of reducing adverse maternal and new born outcomes, then quality of care delivered during pregnancy should be the focus as opposed mere attendance. Key words: Quality, antenatal care services, evaluation.

Examining the impact of WHO\u2019s Focused Antenatal Care policy on early access, underutilisation and quality of antenatal care services in Malawi: a retrospective study

BackgroundA variety of antenatal care models have been implemented in low and middle-income countries over the past decades, as proposed by the World Health Organisation (WHO). One such model is the 2001 Focused Antenatal Care (FANC) programme. FANC recommended a minimum of four visits for women with uncomplicated pregnancies and emphasised quality of care to improve both maternal and neonatal outcomes. Malawi adopted FANC in 2003, however, up to now no study has been done to analyse the model’s performance with regards to antenatal care service quality and utilisation patterns.MethodsThe paper is based on data pooled from three comparable nationally representative Malawi Demographic and Health Survey (MDHS) datasets (2000, 2004 and 2010). The DHS collects data on demographics, socio-economic indicators, antenatal care, and the fertility history of reproductive women aged between 15 and 49. We pooled a sample of 8545 women who had a live birth in the last 5 years prior to each survey. We measure the impact of FANC on early access to care, underutilisation of care and quality of care with interrupted time series analysis. This method enables us to track changes in both levels and the trends of our outcome variables.ResultsWe find that FANC is associated with earlier access to care. However, it has also been associated with unintended increases in underutilisation. We see no change in the quality of ANC services.ConclusionIn light of the WHO 2016 ANC guidelines, which recommend an increase of visits to eight, these results are important. Given that we find underutilisation when the benchmark is set at four visits, eight visits are unlikely to be feasible in low-resource settings.

The relationship between perceived service quality of antenatal care and use among rural women in Ghana

PurposeThe purpose of this paper was to examine rural women’s perceived quality of antenatal care (ANC) and its influence on the extent of ANC in the Amansie Central District in the Ashanti Region of Ghana.Design/methodology/approachA quantitative cross-sectional study was conducted with 120 women attending postnatal care at selected public health facilities. Structured interviews were used to obtain data. Crude odds ratio with 95% confidence interval (CI) was generated to determine the odds of women’s utilisation of ANC with their perceived service quality. The association between women’s background characteristics and ANC use was determined and assessed using Pearson’s χ2 (2) test.FindingsMajority of the women (58.3 percent) utilised ANC for at least four times during pregnancy. Women’s education (p=0.027), religious affiliation (p=0.006), source of income (p=0.012) and insurance status (p=0.023) all had a positive relationship with ANC use. Women who perceived ANC quality as good were three times more likely to have four or more ANC visits than those who perceived quality as poor (OR= 3.042, 95% CI=0.181–0.647, p=0.001).Originality/valueGhana has had numerous policy interventions that address the accessibility and quality of ANC service. However, little is known about the extent to which they are observed and about the quality of service from users’ perspective. Most existing literature on ANC use in Ghana focusses on socio-economic factors that influence utilisation. This paper will be the first to examine the perceived quality of ANC provided, and its influence on the extent of ANC visits among rural women in Ghana.

Quality of antenatal care services in Rwanda: assessing practices of health care providers

BackgroundAlthough most pregnant women in Rwanda visit antenatal care (ANC) clinics, little has been studied about the quality of services being provided. We investigated the ANC providers’ (HCPs) current practices in relation to prevention, management and referral of maternal conditions as well as the information provided to pregnant women attending ANC services in Rwanda.MethodsThis facility-based, cross-sectional study included 312 ANC providers as participants and a review of 605 ANC medical records from 121 health centers. Data collection was performed using an interviewer-administered questionnaire and a structured observation checklist. For the analyses, descriptive statistics and bi-and multivariable logistic regression were used.ResultsNurses and midwives in ANC services failed to report a number of pregnancy-related conditions that would need urgent referral to a higher level of health care. Midwives did somewhat better than nurses in reporting these conditions. There was no statistically significant difference in how nurses and midwives informed pregnant women about pregnancy-related issues. Ever been trained in how to manage a pregnant woman exposed to violence was reported by 14% of the participants. In 12, 13 and 15% of the medical records there was no report on tetanus immunization, anthelmintic treatment and syphilis testing, respectively.ConclusionThe providers in ANC clinics reported suboptimal practices on conditions of pregnancy that needed urgent referral for adequate management. Information to pregnant women on danger signs of pregnancy, recommended medicines and tests do not seem to be consistently provided. Midwifery training in Rwanda should be expanded so that most of staff at ANC clinics are trained as midwives to help lower maternal and child mortality and morbidity.

Demand Side Factors Associated With Quality Antenatal Care Services: A Case Study of Lusaka District, Zambia.

Background: The quality of antenatal care (ANC) a woman receives during pregnancy is crucial to both the child and the mother's life. It has been established that providing high-quality ANC can save lives and has a positive impact on postnatal health care services. However, the quality of ANC in Zambia requires attention as maternal and neonatal mortality rates are still unacceptably high with Lusaka district not being left out of the problem.Methods: Using a cross-sectional study design, the main aim of this study was to determine the demand side factors associated with high-quality antenatal care among pregnant women in Lusaka. It also estimated the proportion of women who received high-quality ANC during their last antenatal visit. Multifactorial logistic regression model was fitted in STATA version 13 to predict the demographic, socio and economic factors that influence the quality of ANC.Results: It was established that only 47.1% of pregnant women received high-quality ANC while 52.9% received low quality. Six key ANC interventions were considered, among which urine (36.7%) and blood (46.8%) testing were the least received basic components of ANC. After adjusting for the effect of other factors, women with secondary education had higher odds of receiving high-quality ANC than women with primary level of education (OR = 1.98; 95% CI: 1.24–3.14). Women staying with their husband/partners had lesser odds of receiving high quality ANC compared to those that were not staying with their partners (OR = 0.47; 95% CI: 0.28–0.79).Conclusion: The quality of antenatal care received by pregnant women in Lusaka is low. Continued efforts to improve the delivery of basic ANC services such as blood and urine testing is required to improve the quality of healthcare services provided by medical personnel at all levels.

Providers adherence to essential contents of antenatal care services increases birth weight in Bahir Dar City Administration, north West Ethiopia: a prospective follow up study

BackgroundLow birth weight (LBW) is one of the most important factors affecting child morbidity and mortality worldwide. Antenatal care (ANC) is an opportunity for reaching pregnant women with a number of interventions that may be vital to their health and well-being of their infants. However, data on the link between ANC quality and LBW remain limited especially in developing countries. Therefore, this study was aimed at investigating the effect of ANC service quality on birth weight among pregnant women attending ANC at public health facilities of Bahir Dar City Administration, Bahir Dar, Ethiopia using provision of essential services by providers as proxy for quality of care.MethodsNine hundred seventy pregnant women with gestational age ≤ 16 weeks who came for their first ANC visit and selected by systematic sampling were enrolled and followed until delivery. Longitudinal data was collected during consultation with ANC providers using structured observation checklist. Women who gave birth at home and those who deliver a premature or still birth baby were excluded as data on birth weight could not be obtained for home deliveries and as the birth weight of the baby might be affected due to prematurity and still birth. Completed data were obtained from 718 women (since the rest women gave birth at home, we could not obtain birth weight data and we exclude them from analysis). The overall ANC service was considered as acceptable quality if women received ≥75th percentile of the essential ANC services. Generalized Estimating Equation was carried out to identify predictors of birth weight by controlling the cluster effect among women who received ANC services in the same facility.ResultsThe prevalence of low birth weight (< 2500 g) was 7.8% (95%CI = 6.0%, 9.7%) with 1.4% versus 10.5% among those who received acceptable and not acceptable quality ANC services respectively, P-value< 0.001. Maternal nutritional advice, iron-folic acid supplementation, tetanus toxoid vaccination, maternal educational status, parity and age were determinants for birth weight.Conclusion and recommendationThe study showed that access to quality ANC services led to good birth weight outcome. Strengthening adherence of providers to essential components of antenatal care through regular monitoring and need based capacity building is very important for reducing the risk of low birth weight.

Determinants of frequency and contents of antenatal care visits in Bangladesh: Assessing the extent of compliance with the WHO recommendations.

BackgroundIn addition to the number of antenatal care (ANC) visits, the items of ANC services covered by ANC visits greatly influence the effectiveness of the ANC services. Recently the World Health Organization (WHO) recommended not only to achieve a minimum of eight ANC visits, but also to use a core set of items of ANC services for safe motherhood. This study examined the levels and determinants of frequency and contents of ANC visits in Bangladesh and thus assessed the level of compliance with the WHO recommended number and the content of ANC services during pregnancy in Bangladesh.MethodsThe data for the study come from the 2014 Bangladesh Demographic and Health Survey (BDHS), which covereda nationally representative sample of 17,863 ever-married women aged 15–49 years. Data derived from 4,627 mothers who gave birth in the three years preceding the survey constituted the study subjects. Descriptive, inferential and multivariate statistical techniques were used for data analysis.ResultsOn average, mothers received less than three (2.7 visits) ANC visits and only 6% receive the recommended eight or more ANC visits. About 22% of the mothers received all the prescribed basic items of ANC services. About one-fifth (21%) of the mothers never received ANC visits and thus no items of ANC services. Measurement of blood pressure was the most common item received during ANC visit as reported by 69% mothers. Blood test was the least received item (43%). Significant positive association was found between frequency of ANC visits and receiving the increased number of items of ANC services. High socio-economic status, low parity, living in urban areas and certain administrative regions, planned pregnancies, having media exposure, visiting skilled providers for ANC services and visit to public or NGO health facilities are associated with frequent ANC visits and receiving higher number of items of ANC contents.ConclusionAn unsatisfactory level of coverage of and content of ANC visits have been observed in Bangladesh. Further investigation is needed to identify the causes of under-utilization of ANC services in Bangladesh. A greater understanding of the identified risk factors and incorporating them into short and long term strategies would help improve the coverage and contents and thus quality of ANC services in Bangladesh.

Does antenatal care service quality influence essential newborn care (ENC) practices? In Bahir Dar City Administration, North West Ethiopia: a prospective follow up study

BackgroundThe neonatal period is only 1/60th of the first 5 years of life but it accounts for 63% of all infant deaths and 44% of all under-five deaths in Ethiopia. Most causes of neonatal death are preventable with clean cord care, temperature control by delaying first bath and initiation of early breastfeeding which has additional benefit of controlling hypothermia. Poor positive pressure ventilation (PPV) with ambubag is also another essential neborn care practice to reduce neonatal death even though it was not the focus of this study with the assumption that it cannot be measured only by exit interview (needs direct observation about the procedure).This study was aimed to assess the link between quality of ANC service and implementation of essential newborn care practices among pregnant women attending ANC at public health facilities of BDR City Administration.MethodsA facility based prospective follow up study was conducted and 970 pregnant women with gestational age ≤ 16 weeks who came for their first ANC visit were enrolled. Women were followed from their first ANC visit until 6 weeks after delivery. Longitudinal data was collected during consultation with ANC providers using structured observation checklist and exit interview was also carried out at 6 weeks after birth when they came to immunize their child to assess the essential newborn care practices that their babies received. ANC service was considered as acceptable quality if women received ≥75th percentile of the essential ANC services. Generalized Estimating Equation (GEE) was carried out to control cluster effect among women who received ANC in the same facility.ResultsThe composite essential newborn care practice indices were 13.7%, with 95% CI (11.3%, 16.2%) and 86.3%, with 95% CI (83.8%, 88.7%) for good and poor essential new born care practices respectively. Of those who received acceptable ANC quality and un acceptable ANC quality 24.7% and 9.6% had good essential newborn care practice respectively (X2 = 31.668, p < 0.000).ConclusionsMost neonatal interventions are not reaching newborns, indicating a “policy-to practice gap”. It is crucial that maternal knowledge about essential newborn care need to start before the baby’s birth with an effective educational plan.Quality ANC service is a facilitator for essential newborn care practice. To improve newborn survival, newborn care should be integrated into the current maternal and child health interventions, and should be promoted both at community and health facility level as part of a universal coverage strategy.

A study on obstetric care in a primary health center of South Assam district, India

Background: Maternal and child health are critically important in a country that is experiencing high infant mortality and maternal mortality. Research all over the world has suggested that one of the major solutions to this problem is availability of Emergency Obstetric Care services within the reach of people. Objectives of the study were to examine profile of mothers who have delivered in health facility during a year and the interplay of various factors in child birth and newborn outcome.Methods: Retrospective cross sectional study conducted by collecting information in predesigned format from medical records. Appropriate statistical methods and test of significance performed for qualitative and quantitative variables.Results: Out of 539 women, the majority of 42.9% were in the age group 20-25 years, the mean age (SD) of mother was 24.1 years (±4.09). Out of total 539 vaginal deliveries, 56.6% cases episiotomy was performed. 41.6% deliveries occurred from 8 AM to 4 PM. The mean birth weight was 2.830 kg SD 0.439 and low birth prevalence 16.0%. Parity with time to delivery after admission in different age groups revealed significant association (X2=66.456, p=0.000). Women aged less than 20 years are 12 times more at risk of episiotomy performed. The multivariate logistic regression analysis shows 60.67% specificity and 85.59% sensitivity in predicting episiotomy.Conclusions: From study it is evident that women report to hospital late in labor hence there is urgent need to provide quality antenatal care services at village and PHC level and augment awareness among the community for promotion of safe motherhood.

The Correlation of Maternal Factors and The Quality of Antenatal Care Services With Low Birth Weight Babies In Health Facilities Level I

Infant Mortality Rate in West Sumatra still increased from 96 cases in 2015 becomes 111 cases in 2016. One of the contributors to this was the case of Low Birth Weight Babies (LBWB), wich is birth weight &lt; 2500 grams. Causative factors of LBWB are derived from maternal factors because it is related to fetal growth, starting from the moment of conception until the baby is born. Maternal health is very influential towards the growth and development of the fetus. In addition, Antenatal Care is also require to monitor maternal health. Antenatal service care quality can detect the occurrence of risk in pregnancy. This study aims to determine the relationship of maternal factors based on maternal age, parity, distance of pregnancy, complications of pregnancy, economic status, nutritional status, anemia status, antenatal care implementation and the quality of antenatal care services with LBWB incidence on health facilities level 1 in Padang City.This study used a comparative cross-sectional design totalling 72 respondents consisting of a group of mothers who gave birth to babies with birth weight &lt; 2500 grams and ≥ 2500 grams using consecutive sampling technique. Then conducted interviews and observations by using questionnaires as well as data processing were carried out using SPSS. The results showed there was a correlation between pregnancy complications (p = 0.033), anemia status (p = 0.016) and the implementation of antenatal care (p = 0.000) with the incidence of LBWB, while the unrelated were maternal age (p = 0.405), parity (p = 1,000), pregnancy distance (p = 1,000), economic status (p = 0.637), nutritional status (p = 0.326), and quality of antenatal care services (p = 0.812).The conclusion of this study is that there is no correlation between the quality of antenatal care services and the incidence of LBWB, and the implementation of antenatal care is the dominant factor related with the incidence of LBWB in Padang City.

Quality of antenatal care services in selected health facilities of Kaski district, Nepal

Background: Antenatal care service is an evidence based interventions given to the pregnant women. Objective of the study was to assess quality of antenatal care services in selected health facilities of Kaski district, Nepal.Methods: A cross sectional study was conducted in selected health institutions in Kaski district of Nepal during June to November 2017. Two hundred seven participants were selected from health facilities of Kaski district. Structured questionnaires were employed as tool for data collection.Results: This study showed that 50.7 percent respondents waited less than 35 minutes for receiving service. More than half of the total respondents (63.3%) reported that the consultation time provided for them was less than 20 minutes. All respondents reported that weight and blood pressure measurement was undertaken while none of them reported that height was measured. It was found that maximum number of participants (99.0%) were received iron/folate tablets and tetanus vaccination. Similarly, 97.6% of participants reported that they were counselled on nutrition and 96.6% of reported they get counselling on danger signs. In overall, 48.3% of the respondents were satisfied with the services they received and 43% of the respondents received good quality ANC service from different health institutions.Conclusions: In overall satisfaction of antenatal care services was found to be low and more than half of respondent does not received good quality ANC services.

Quality of care in six sub-Saharan Africa countries: a provider-based study on adherence to WHO's antenatal care guideline.

Quality of care may help explain the high burden of disease in maternal, newborn and child health in low- and middle-income countries even as access to care is improved. We explored the determinants of quality of antenatal care (ANC) in sub-Saharan Africa (SSA). Cross-sectional study. Multilevel Generalized Linear Latent Mixed-Effect models with logit link function were employed to obtain the adjusted odds ratios (AORs) and 95% confidence interval (CI). We used Service Provision Assessment data from six countries in SSA, including Kenya, Malawi, Namibia, Rwanda, Tanzania and Uganda. Seven thousand, five hundred and seventy seven observed antenatal clients across the six countries. Quality of ANC services, measured using indexes of quality of clinical care and quality of information provided. Providers in facilities that had ANC guideline (AOR = 1.26; 95% CI, 1.08-1.48), were well-equipped (AOR = 1.65; 95% CI, 1.41-1.92), were classified as upper level facility (AOR = 1.32; 95% CI, 1.05-1.66), had central electricity supply (AOR = 2.19; 95% CI, 1.81-2.65), and piped water (AOR = 1.30; 95% CI, 1.09-1.55) were more likely to provide optimal quality of clinical care. Moreover, those having ANC guideline (AOR = 1.81; 95% CI, 1.43-2.28) and central electricity supply (AOR = 2.67; 95% CI, 2.01-3.44) were more likely to provide optimal information as well. Provider's qualification and experience were also important in information provision and clinical care independently. The lack of some very basic facility equipment and amenities compromised quality of care in sub-Saharan countries. Policy actions and investment on facility and providers will enable provision of quality services necessary to improve maternal, newborn and child health in SSA.

Antenatal care service quality increases the odds of utilizing institutional delivery in Bahir Dar city administration, North Western Ethiopia: A prospective follow up study.

BackgroundIn Ethiopia, more than 62% of pregnant women attend antenatal care at least once, yet only about one in four women give birth at health facility. This gap has fueled the need to investigate on the quality of ANC services at public health facilities and its link with the use of institutional delivery.ObjectiveTo assess the linkage between ANC quality and the use of institutional delivery among pregnant women attending ANC at public health facilities of BDR City AdministrationMethodsA facility based prospective follow up study was conducted. and nine hundred seventy pregnant women with gestational age ≤ 16 weeks who came for their first ANC visit were enrolled.Women were followed from their first ANC visit until delivery. Longitudinal data was collected during consultation with ANC providers using structured observation checklist. ANC service was considered as acceptable quality if women received ≥75th percentile of the essential ANC services. Generalized Estimating Equation (GEE) was carried out to control cluster effect among women who received ANC in the same facility.ResultsAmong 823 pregnant women who completed follow up, only about one third (27.6%) received acceptable quality of ANC services. In one health facility syphilis test was not done at all for the last two years. The odds of giving birth at health institution among pregnant women who received acceptable ANC quality service was about 3.38 times higher than among pregnant women who received unacceptable ANC quality service (AOR = 3.38, 95% CI: 1.67, 6.83).Conclusion and recommendationIn this study the quality of ANC service provision in public health facilities was compromised/low. Provision of quality ANC service had a great role in promoting institutional delivery. Therefore the local authorities at each level of health sector or the nongovernmental organizations working to improve maternal health need to provide training on focused antenatal care protocol for ANC providers.

Quality of Antenatal Care Service at Debre Berhan Referral Hospital

Quality of Antenatal Care Service at Debre Berhan Referral Hospital

Barriers and enablers for iron folic acid (IFA) supplementation in pregnant women.

In order to inform large scale supplementation programme design, we review and summarize the barriers and enablers for improved coverage and utilization of iron and folic acid (IFA) supplements by pregnant women in 7 countries in Africa and Asia. Mixed methods were used to analyse IFA supplementation programmes in Afghanistan, Bangladesh, Indonesia, Ethiopia, Kenya, Nigeria, and Senegal based on formative research conducted in 2012–2013. Qualitative data from focus‐group discussions and interviews with women and service providers were used for content analysis to elicit common themes on barriers and enablers at internal, external, and relational levels. Anaemia symptoms in pregnancy are well known among women and health care providers in all countries, yet many women do not feel personally at risk. Broad awareness and increased coverage of facility‐based antenatal care (ANC) make it an efficient delivery channel for IFA; however, first trimester access to IFA is hindered by beliefs about when to first attend ANC and preferences for disclosing pregnancy status. Variable access and poor quality ANC services, including insufficient IFA supplies and inadequate counselling to encourage consumption, are barriers to both coverage and adherence. Community‐based delivery of IFA and referral to ANC provides earlier and more frequent access and opportunities for follow‐up. Improving ANC access and quality is needed to facilitate IFA supplementation during pregnancy. Community‐based delivery and counselling can address problems of timely and continuous access to supplements. Renewed investment in training for service providers and effective behaviour change designs are urgently needed to achieve the desired impact.