Skilled Maternal Care Research Articles

Unequal uptake of skilled maternal health care services in Ethiopia: cross-sectional data analyses informed by the intersectionality theory

ObjectiveTo investigate intersectional inequality encompassing socioeconomic, geographical and demographic variables in the use of competent birth and postnatal care services in Ethiopia.DesignData for the study came from a series of...

Community-based integrated intervention for skilled maternal health care utilization in riverine remote areas, Bangladesh

IntroductionDespite the decrease in maternal mortality ratio, many women in Bangladesh are still at high-risk of death due to pregnancy-related morbidities. Increasing the rate of skilled maternal healthcare service utilization is effective to reduce maternal mortality rate. This paper examines the intervention effect of an integrated community-based maternal healthcare project implemented by a non-government organization, Friendship, aiming to provide maternal health services to women living in the remote riverine regions of Bangladesh. MethodsWe examined the skilled maternal healthcare service utilization before and after project implementation of the mothers with birth experience of 0–6 months from the intervention (N = 1,304) and comparison areas (N = 1,304). A difference-in-differences logistic model measured the effect of the intervention. ResultsAfter the intervention, mothers were three times more likely to receive ≥ 4 ANC visits from skilled providers (AOR: 2.9; 95 % CI: 2.1–4.2), 1.5 times more likely to have skilled birth attendants during deliveries (AOR: 1.5; 95 % CI: 1.1–2.1) and 1.5 times more likely to seek at least one PNC within 42 days after delivery (AOR: 1.5; 95 % CI: 1.1–2.2) as compared to the comparison group. ConclusionThe intervention showed positive effect on improving the ANC coverage, skilled delivery, and PNC among the mothers residing the remote riverine areas. Therefore, it opens up the opportunity for adaptation of such integrated community and facility-based interventions by other LMICs.

Scaling up the “24/7 BHU” strategy to provide round-the-clock maternity care in Punjab, Pakistan: a theory-driven, coproduced implementation study

BackgroundPakistan’s maternal mortality rate remains persistently high at 186/100,000 live births. The country’s government-run first-level healthcare facilities, the basic health units (BHUs), are an important source of maternity care for rural women. However,BHUsonly operate on working days from 8:00 am to 2:00 pm. Recognizing that this severely constrains access to maternity services, the government is implementing the “24/7 BHU” initiative to upgrade BHUs to provide round-the-clock care. Although based on a successful pilot project, initial reports reveal challenges in scaling up the initiative. This implementation research project aims to address a key concern of the Government of Punjab: How can the 24/7 BHU initiative be successfully implemented at scale to provide high-quality, round-the-clock skilled maternity care in rural Punjab?MethodsThe project consists of two overlapping work packages (WP). WP1 includes three modules generating data at the directorate, district and BHU levels. Module 1 uses document analysis and policy-maker interviews to explicateprogrammetheory and begin to build a system model. Module 2 compares government-collected data with data generated from a survey of 1500 births to assess BHU performance. Module 3 uses institutional ethnographies in 4–5 BHUs in three districts to provide a detailed system for understanding and identifying processes that influence scale-up. WP2 includes two modules. First, two workshops and regular meetings with stakeholders integrate WP1 findings, identify feasible changes and establish priorities. Next, “change ideas” are selected for testing in one district and 2–3 BHUs through carefully documented pilots using the PDSA (plan–do–study–act) improvement approach. An integrated knowledge translation approach will engage key policy and practice stakeholders throughout the project.DiscussionThis theory-driven implementation research project willcoproducesignificant new understandings of the wider system in which the 24/7 BHU initiative is being implemented, and actionable knowledge that will highlight ways the implementation processes might be modified to enable BHUs to meet service provision goals. This study will also produce insights that will be relevant for other South Asian and low- and middle-income countries (LMICs) that experience similar challenges of programme scale-up and delivery of maternal health services to remote and marginalized communities.

Determining factors associated with the prevalence of knowledge, attitude, and practice in seeking skilled maternal healthcare services among women in a remote area of Gesha district

BackgroundSkilled health care is essential for the mother's and newborn's health and well-being during pregnancy, labor, and the postpartum period. This study aimed to analyze women's knowledge, attitudes, and practices while requesting competent assistance for maternity healthcare in Gesha District, Southwest Region of Ethiopia.MethodsA community-based cross-sectional study design was conducted from September 20, 2021 to October 19, 2021. A total of 424 mothers participated in this study and a systematic sampling technique was used to select the respondents. The data were collected using a pretested and structured questionnaire. Statistical software SPSS-20 and R-4.1.2 were used to enter and analyze the data respectively. The factors associated with the prevalence of Knowledge, Attitude, and Practice in seeking Skilled Maternal Healthcare Services were identified using descriptive analysis and a binary logistic regression model.ResultsThis study result revealed that the overall proportions of good knowledge, positive attitude, and good practice in seeking skilled maternal health care services were 39.15%, 37.5%, and 34.67% respectively. Estimated odds of having knowledge, attitude, and practice were as follows: for having age between 20–24 years at first pregnancy 1.859, 1.86, and 1.799; having a plan for pregnancy 2.74,2.315 and 2.579; mothers attended elementary education 2.337, 2.565 and 3.312; having maternal age 20–24 years 4.336,4.989 and 5.870; maternal age 25–29 years 2.917, 3.794 and 4.017; maternal age 35–49 years 2.837, 2.991 and 3.412; having husbands who had attended elementary education level 2.736, 2.542 and 2.134; secondary and above education 3.464, 3.360 and 2.508; rich mothers 2.261, 1.995 and 2.452; having antenatal care 4 times and above 2.606, 2.570, 2.682; having transportation access 1.921, 1.956 and 2.404; having media access 1.979, 2.171 and 2.715 respectively. The odds of having attitude and practice respectively were as follows: married 1.762, and 2.208; having medium wealth index 1.933 and 2.424. The odds of having previous pregnancy complications was 2.147 which significantly affect the practice of seeking skilled maternal care assistance.ConclusionsThis study discovered that the study participants' knowledge, attitude, and practice of skilled maternal health care are low. Associated factors included age at first pregnancy, planned pregnancy, maternal education level, husband’s education level, maternal age, antenatal care service visits, transport access, and access to media were found to significantly affect the knowledge, attitude, and practice of the respondents in seeking skilled maternal care assistance in common. The household wealth index was also associated with attitude. Pregnancy complications, current marital status, and household wealth index also significantly affect the practice of seeking skilled maternal care assistance. As a result of the findings, initiatives to increase women's knowledge, attitudes, and use of expert maternal health services in the research area are needed for women residing in rural areas.

P39 - Women’s experiences of obstetric fistula risk factors and the need for skilled birth attendance in North-central Nigeria: An Interpretive Description

An obstetric fistula is an abnormal opening between the vagina, bladder, or rectum that causes uncontrolled and abnormal leaking of urine or feces. A prolonged obstructed labor and ischemic necrosis of the women’s bladder, vagina, or rectum is the major cause of obstetric fistula. Recently, it has been proposed that obstetric fistula survivors the women, should suggest interventions to mitigate or resolve the incidence of VVF which would enable the identification of gaps in maternity care provision, and would be of interest to community and health service leaders as well as policymakers. This study explores birthing women's experiences of obstetric fistula risk factors and the need for skilled birth attendance in Northern-central Nigeria. The design was an interpretive qualitative study involving face-to-face semi-structured interviews with 15 women with an obstetric fistula at a repair Centre in North-central Nigeria. A thematic approach to data analysis was employed to generate findings. Three core themes emerged from this study: • Delayed or suboptimal skilled maternal health care services • Absence or inadequately skilled birth attendance • Lack of women’s empowerment impeding access to maternal health The collective expression of women’s views through the interaction between the midwife and women with obstetric fistula is a call for quality health care for birthing women specially trained and skillful midwives to shape service development and delivery for improved maternity care and fistula prevention in Nigeria.

Exploring underutilization of skilled maternal healthcare in rural Edo, Nigeria: A qualitative study.

IntroductionExisting studies have acknowledged the underutilization of skilled maternal healthcare services among women in rural Nigeria. Consequently, women in rural areas face a disproportionate risk of poor health outcomes including maternal morbidity and mortality. Addressing the challenge of non-use of skilled maternal healthcare in rural areas necessitates the involvement of multi-stakeholders across different sectors who have vital roles to play in improving maternal health. This study explores the factors contributing to the non-use of maternal healthcare services in rural areas of Edo, Nigeria from the perspectives of community elders and policymakers.MethodsIn this qualitative study, data were collected through 10 community conversations (group discussions) with community elders each consisting of 12 to 21 participants, and six key informant interviews with policymakers in rural areas of Edo State, Nigeria. Participants were purposefully selected. Conversations and interviews occurred in English, Pidgin English and the local language; lasted for an average of 9 minutes; were audio-recorded and transcribed to English. Data were manually coded, and data analysis followed the analytical strategies for qualitative description including an iterative process of inductive and deductive approaches.ResultsPolicymakers and community elders attributed the non-use of maternal health services to poor quality of care. Notions of poor quality of care included shortages in skilled healthcare workers, apathy and abusive behaviours from healthcare providers, lack of life-saving equipment, and lack of safe skilled pregnancy care. Non-use was also attributed to women’s complex utilization patterns which involved a combination of different types of healthcare services, including traditional care. Participants also identified affordability and accessibility factors as deterrents to women’s use of skilled maternal healthcare.ConclusionThe emerging findings on pregnant women’s combined use of different types of care highlight the need to improve the quality, availability, accessibility, and affordability of skilled maternal care for rural women in Nigeria.

Assess the effectiveness of structured teaching program on knowledge and attitude of birth preparedness among primigravida mothers

Background: Birth preparedness is a safe motherhood initiative with the objective of planning for normal birth and anticipating actions needed in the case of emergency. The pregnant mother and their families are encouraged to effectively plan for births and deal with anticipated complication, if they occur it ensures that the readiness and timely utilization of skilled maternal and unit health care services. Aim: To assess the effectiveness of structured teaching program on knowledge and attitude of birth preparedness among Primigravida mothers. Design: Quasi Experimental one group pretest and posttest design was used.Setting: The study was conducted in Government Medical College and Hospital, Thiruvallur, Tamilnadu in Maternal and Child Health Center. Sample: Primigravida mothers in their third trimester who visited the antenatal OPD at Thiruvallur GH served as study participants.Tools: Demographic Variables, Self-structured knowledge questionnaire, self-structured 5 point Likert Scale to assess the attitude. Results: The study results showed that knowledge level in the pretest was 42(42%) of Primigravida mothers had moderately adequate knowledge, 41(41%) had inadequate knowledge and 17(17%) had adequate knowledge on birth preparedness whereas in the post test, 79(79%) had adequate knowledge and 21(21%) had moderate adequate knowledge on birth preparedness among Primigravida mothers. The attitude level in the pretest was 79(79%) of Primigravida mothers had moderately favourable attitude, 17(17%) had favourable attitude and 4(4%) had unfavourable attitude on birth preparedness whereas in the post test, 78(78%) had favourable attitude and 22(22%) had moderate favourable attitude on birth preparedness among Primigravida mothers. There was a significant ix difference between the pretest and post test score of knowledge and attitude which clearly infers that structured teaching programme on birth preparedness administered to the Primigravida mothers was found to be effective in improving their level of knowledge and attitude in the post test.

Awareness and Practice of Birth Preparedness and Complications Readiness among Pregnant Women in the COVID-19 era in Fako Division, Cameroon

Background: Birth Preparedness and Complication Readiness is a strategy to enhance the timely use of skilled maternal and neonatal care, especially during childbirth, based on the theory that preparing for childbirth and readiness for complications reduces delays in obtaining this care and reducing possible pregnancy risk. Sustainable Development Goal 3 has as one of its targets to reduce the global maternal mortality ratio to less than 70 per 100,000 births, with no country having a maternal mortality rate of more than twice the global average.
 Following the intensity of the problem, it is necessary to investigate ways to curb marternal mortality which is an essential component which should begin with awareness, and practice of birth preparedness readiness and complications and inturn vital in the management and development of intervention measures.
 Objective: of this study was to investigate the awareness and practice of birth preparedness and complication readiness among pregnant women in Fako Division.
 Methods: This was a community -based cross sectional study carried out in the Fako division of the South West Region, Cameroon. 163 pregnant women of ≥28 weeks gestational ages seen at the antenatal consultation units were selected using convenient sampling method. Data collected was analysed with SPSS version 25.0 and Microsoft excel 2010.
 Results: Of the 163 pregnant women included in this study, 129 (79.1%) were aware of birth preparedness and complication readiness. 136 (83.4%) had knowledge in recognising danger signs in pregnancy and Vaginal bleeding was the most frequent mentioned danger sign (72.4%). 80(49.1%) had excellent knowledge on danger signs, 59(36.2%) had good knowledge while 24(14.7%) had poor knowledge on key danger sign in pregnancy. The practice of birth preparedness and complication readiness, 47.9% had optimal practice, 37.4% had standard practice while 14.7% had poor practice.
 Conclusion: The findings of this study revealed that the awareness of birth preparedness and complication readiness was high. Few pregnant women lacked adequate preparations as required by the BPCR plan. The findings also indicated that the knowledge on danger signs in pregnancy among pregnant women in the BHD are high. Women’s knowledge of danger signs during pregnancy positively influenced their decisions regarding when to seek medical care and when to take appropriate action.

Birth Preparedness and Complication Readiness (BPACR) among brick kiln workers in Indore, India

Abstract Background Birth preparedness and complication readiness (BPACR), promotes utilization of skilled maternal and neonatal care. Preparing for childbirth reduces delays in seeking care. Brick-kiln workers constitute a vulnerable social group who contribute to city infrastructure by laboring at low wages. 37% of the sample were Scheduled Castes, 49% Scheduled Tribes. Methods 139 mothers of children < 2 years, residing temporarily in brick kilns of Indore were asked about preparedness for birth of youngest child. Birth preparedness was assessed by enquiring about saving money, arranging transport, identifying health facility for delivery, identified family member to accompany for labor/emergency. Findings 10% did >3 BPACR practices implying good level of preparedness; 50% did 1-2 BPACR practices; 40% did no birth preparedness. Access to maternity benefit scheme was twice as likely to result in reasonable birth preparedness as compared to no access. Those with primary to class XII were twice as likely to practice birth preparedness as compared to those with no formal education. >3 ANC was associated with 8 percentage points greater practice of reasonable BPACR as compared to < 2 or no ANC. Mothers with knowledge of one danger sign each of pregnancy and delivery were 3 times more likely to practice BPACR than those without this knowledge. FGDs revealed challenges in access to bank account, obtaining required documents to apply for and access state maternity benefit. Lack of family support led to low BPCAR and low institutional delivery. Conclusions Brick-kiln women face risk of low utilization of government healthcare services. The health systems should conduct outreach antenatal care sessions in brick-kilns on knowledge of key danger signs and BPACR during health education and ANC counselling can help promote BPACR and hospital delivery. Information on requisite steps to apply for maternity benefit schemes should be shared among brick-kiln workers. Key messages It is crucial to promote BPACR among urban vulnerable sections, through NUHM’s outreach sessions by ANMs/ASHAs in brick-kiln, construction workers and similar groups. Access to maternity benefit cash transfer scheme should be enhanced particularly among excluded temporary urban groups such as brick-kiln workers as it is a motivation to avail hospital care.

Changes in health worker knowledge and motivation in the context of a quality improvement programme in Ethiopia.

A knowledgeable and motivated workforce is critical for health systems to provide high-quality services. Many low- and middle-income countries face shortages in human resources and low health worker motivation but are also home to a burgeoning number of quality improvement (QI) programmes. This study evaluates whether and how motivation and clinical knowledge in three cadres of health workers changed in the context of a QI programme for maternal and newborn health in Ethiopia. This mixed-methods study used a pre–post comparison group design with matched comparison areas. We interviewed 395 health workers at baseline in April 2018 and 404 at endline in June 2019 from seven districts (woredas) with QI and seven comparison woredas. Three cadres were interviewed: health extension workers, facility-based skilled midlevel maternal and newborn care providers, and non-patient-facing staff. A qualitative component sought to triangulate and further elucidate quantitative findings using in-depth interviews with 22 health workers. Motivation was assessed quantitatively, exploratory factor analysis was used to categorize motivation dimensions, and regression-based difference-in-difference analyses were conducted. Knowledge was assessed through a clinical vignette. Qualitative data were analysed in a deductive process based on a framework derived from quantitative results. Although knowledge of the QI programme was high (79%) among participants from QI woreda at endline, participation in QI teams was lower (56%). There was strong evidence that health worker knowledge increased more in areas with QI than comparison areas. Three motivation dimensions emerged from the data: (1) ‘helping others’, (2) ‘pride and satisfaction’ and (3) ‘external recognition and support’. We found strong evidence that motivation across these factors improved in both QI and comparison areas, with weak evidence of greater increases in comparison areas. Qualitative data suggested the QI programme may have improved motivation by allowing staff to provide better care. This study suggests that although QI programmes can increase health worker knowledge, there may be little effect on motivation. Programme evaluations should measure a wide range of outcomes to fully understand their impact.

Birth preparedness and complication readiness practice and associated factors among pregnant women in Northwest Ethiopia: 2018.

BackgroundBirth-preparedness and complication readiness is a comprehensive strategy aimed at promoting the timely utilization of skilled maternal and neonatal health care. Pregnancy-related complications both on the mother and the newborn could be largely alleviated if there is a well-consolidated birth preparedness and complication readiness plan developed during pregnancy and implemented at the time of delivery.ObjectiveTo determine the prevalence of birth preparedness and complication readiness practice (BPCR) and associated factors among pregnant women in North Gondar Zone, Northwest Ethiopia, 2018.MethodsA community based cross-sectional study was conducted among pregnant women in North Gondar Zone from March 2017 to February 2018. A multistage clustered sampling technique was used to enroll a total of 1620 participants. The data were collected by face to face interviews using pretested and semi-structured questionnaires at baseline and following delivery. The data were entered using EPI-data version 3.1 and analyzed using STATA version 14 software. Bivariate and multivariable logistic regression model was fitted to assess factors with BPCR practice. Adjusted odds ratio (AOR) with 95% confidence interval was used to determine the association between covariates and the outcome variable.ResultsFrom a total of 1620 pregnant women only 1523 (94.0%) mothers were followed at the end line. The prevalence of BPCR plan during pregnancy was 66.1% [95% CI: 63.8, 68.5] and the practice at the time of delivery was 73.5% [95% CI 71.3, 75.7]. Of the total respondents who mentioned having a BPCR plan, 76.4% practiced at the time of delivery. Frequency of ANC visits [AOR = 1.97; 95% CI: 1.67, 2.32], larger number of family in the household [AOR = 1.14; 95%CI: 1.00, 1.30], highest wealth asset [AOR = 1.87; 95%CI: 1.16, 3.01], Multigravidity [AOR = 0.30; 95% CI: 0.15, 0.62], husband involvement in decision making [AOR = 2.2; 95% CI: 1.25, 3.82], counseled on BPCR [AOR = 2.35; 95% CI: 1.51, 3.68], were found to be significantly associated with BPCR practice.ConclusionBPCR practice at the time of delivery was higher than previous studies conducted in the country. However, BPCR practice was found to be lower than the standard that every woman should practice the plan at the time of delivery. Intersectoral collaborative interventions required to improve the economic status and living standard of families in the community as well as various awareness creation strategies should be implemented to support women to attend ANC follow-up visits.

Identifying barriers to accessing skilled maternal health care in rural Morocco.

Over the past 30 years, the Moroccan government has made enormous strides towards improving maternal health care for Moroccan women, but outcomes for rural women remain much worse than those of their urban counterparts. This study aimed to understand the experiences of women giving birth in rural Morocco, and to identify the barriers they face when accessing facility-based maternity care. Fifty-five participants were recruited from villages in Morocco's rural south to participate in focus group discussions (FGDs), using appreciative inquiry as the guiding framework. Several themes emerged from the analysis of the focus group data. Women felt well-cared for and safe giving birth both at home and in the large, tertiary care hospitals, but not in the small, primary care hospitals. Women who gave birth at the primary care hospitals reported a shortage of some equipment and supplies and poor treatment at the hands of hospital staff. Locating and paying for transportation was identified as the biggest hurdle in accessing maternity care at any hospital. The findings of this study indicate the need for change within primary care health facilities.

Influence of women's empowerment indices on the utilization of skilled maternity care: evidence from rural Nigeria.

There is increasing evidence that women with the ability to exercise control over their sexual and reproductive lives have greater access to prompt prevention and treatment of maternal health disorders, resulting in a concomitant reduction in maternal morbidity and mortality. This study assessed the association between indices of women's empowerment and utilization of skilled antenatal, intrapartum and postnatal maternity care in two rural Local Government Areas in Edo State, Nigeria. Data were taken from a household survey conducted in July and August 2017, and the study sample comprised 1245 ever-married women currently in a union who had given birth in the 5 years preceding the survey. A Gender Roles Framework guided the selection of independent women's empowerment variables. Using hierarchical logistic regression, the likelihood of receiving all three levels of skilled maternal health care service (antenatal, intrapartum and postnatal) by women's empowerment variables, grouped into resource, decision-making and influencer domains following the model of Anderson and Neuman, was assessed. Of the resource domain variables, respondent's education and respondent's participation in payment for their own health care positively predicted their use of all three levels of skilled maternal care, whereas their ownership of land negatively predicted this. Two decision-making domain variables were significantly associated with respondent's use of all three levels of service: those who made decisions alone about major household purchases were twice as likely to use all three levels of services than when decisions were made by their partners or others, while respondent making decisions alone about what food to cook each day was a negative predictor. Of the influencer variables, religion and a large spousal education gap were strong positive factors, whereas living in a consensual union rather than being legally married was a negative factor. Although health system factors are important, interventions geared towards changing gender norms that constrain women's empowerment are critical to achieving maternal health-related development goals in Nigeria. A composite strategy that targets all women's empowerment indices is recommended, as Nigeria strives towards achieving SDG-3.

Magnitude and Determinants of Perinatal Mortality in Southwest Ethiopia.

Despite several efforts globally, the problem of perinatal mortality remained an unsolved agenda. As a result, it continued to be an essential part of the third sustainable development goals to end preventable child deaths by 2030. With a rate of 33 per 1000 births, Ethiopia has the highest level of perinatal mortality in the world. Thus, determining the magnitude and identifying the determinants are very crucial for evidence-based interventions. A community-based longitudinal study was conducted in Southwest Ethiopia among 3474 pregnant women to estimate the magnitude of perinatal mortality. Then, a case-control study among 120 cases and 360 controls was conducted to identify the determinants of perinatal mortality. Data were collected by using an interviewer-administered questionnaire and analyzed by using SPSS version 20. Multivariate logistic regression analysis was used to identify variables having a significant association with perinatal mortality at p < 0.05. The perinatal mortality rate was 34.5 (95% CI: 28.9, 41.1) deaths per 1000 births. Attending ≥4 ANC visits (AOR = 0.46; 95% CI: 0.23, 0.91), having good knowledge on key danger signs (AOR = 0.27; 95% CI: 0.10, 0.75), and having a skilled attendant at birth (AOR = 0.34; 95% CI: 0.19, 0.61) were significantly associated with a reduction of perinatal mortality. Being a primipara (AOR = 3.38; 95% CI: 1.90, 6.00), twin births (AOR = 5.29; 95% CI: 1.46, 19.21), previous history of perinatal mortality (AOR = 3.33; 95% CI: 1.27, 8.72), and obstetric complication during labor (AOR = 4.27; 95% CI: 2.40, 7.59) significantly increased perinatal mortality. In conclusion, the magnitude of perinatal mortality in the study area was high as compared to the national target for 2020. Care during pregnancy and childbirth and conditions of pregnancy and labor were identified as determinants of perinatal mortality. Hence, interventions need to focus on increasing knowledge of danger signs and utilization of skilled maternity care. Special emphasis needs to be given to mothers with a previous history of perinatal mortality, twin pregnancies, and having obstetric complications.

Birth Preparedness and Complication Readiness among Women with Pregnancy and Childbirth related Complications at Kenyatta National Teaching and Referral Hospital, Kenya.

Background:In developing countries, particularly those in Sub-Saharan Africa, women and newborns continue to face increased risks of mortality and morbidity during the time of pregnancy, birth and postpartum. Preparing for childbirth and being ready for complications is a key strategy in reducing maternal mortality and morbidity as this would reduce delay in obtaining skilled maternal care especially during childbirth. This survey was evaluating birth preparedness and complication readiness (BPCR) among women seeking services at Kenyatta National Teaching and Referral Hospital.Methods:A cross-sectional hospital-based study was conducted among women admitted in the antenatal and postnatal ward. Data was collected using a standardised questionnaire. A respondent was considered to have satisfactory BPCR if she reported that she had identified the place of delivery, made prior financial arrangements and organised for means of transport to place of childbirth and/or for the time of obstetric emergencies ahead of childbirth.Results:The survey recruited 353 women aged between 15 and 44 years. Majority were married (n=288, 81.6%) and unemployed (n=232, 65.7%). Additionally, most of the participants were multiparous (n=345,97.7%) and had made at least 1 visit at the Antenatal Clinic during their current pregnancy (n=331, 93.8%). The proportion of women whose BPCR was rated as satisfactory was 56.7% (95% confidence interval, (CI) 49.7% - 63.6%). Factors associated with satisfactory BPCR included: being married (OR10.66, 95%CI5.21-21.83), having post-secondary education (OR 11.52, 95% CI 6.62-20.05), being in formal employment (OR 4.14, 95%CI2.51-6.82), gestation >28 weeks (OR=1.83,95%CI1.08-3.09), multiparity (OR=1.87,95%CI1.21-2.88), visiting Ante-natal Care Clinic (OR=9.31, 95% CI 2.70-32.09)and particularly visiting the clinic more than 2 times (OR=4.43, 95% CI 2.75-7.13).Conclusions:The study documented sub-optimal BPCR. This highlights the need to review the current strategies and approaches being utilised to promote BPCR.

Effectiveness of Health Intervention on Birth Preparedness on Knowledge and Outcome of Pregnancy among Primi Antenatal Mother in Selected Hospital of Pune

Background of the Study: Birth preparedness and complication readiness is a strategy to promote the timely use of skilled maternal and neonatal care, especially during child birth based on the theory that preparing for childbirth and being ready for complication and reduce delay in obtaining care Annual global estimate of 287,000 maternal deaths were recorded in 2010 as a result of complication of pregnancy and childbirth. Methodology: In the present study Quantitative research approach is applied approach is applied and quasi experimental pre –test post-test design is used sample all primi mother sample size 60 primi mother sampling technique non- probability convenience sampling setting the selection of study setting is on the basis of the feasibility of conducting study and availability of sample. Study will be conducted in Talera and Bhosri hospital, PCMC,Pune Results:Birth preparedness and complication since all the p-values are large (greater than 0.05), none of the demographic variables was found to have significant association with the mode of delivery Maternal complication during labor.In the present study pretest, 20% of the primi antenatal mothers had poor knowledge (Score 0-3), 66.7% of them had average knowledge (score 4-6) and 13.3% of them had good knowledge (score 7-10) regarding birth preparedness. In post-test, 5% of them had average knowledge (score 4-6) and 95% of them had good knowledge (score 7-10) regarding birth preparedness. Conclusion: In this study indicates that the knowledge of the women regarding birth preparedness improved remarkably after health intervention Researcher applied paired t-test for the effectiveness of health intervention on Knowledge of woman regarding birth preparedness among antenatal mother

Knowledge about birth preparedness and complication readiness and associated factors among primigravida women in Addis Ababa governmental health facilities, Addis Ababa, Ethiopia, 2015

BackgroundGlobally, every minute, at least one woman dies from complications related to pregnancy or childbirth. The situation is more serious for women in Sub-Saharan Africa which also include Ethiopia. Birth preparedness is a strategy to promote the timely use of skilled maternal and neonatal care, especially during childbirth. Based on the theory, preparing for childbirth reduces delays in obtaining this care. In adequate preparation for rapid action in the event of obstetric complications are well documented factors contributing to delay in receiving skilled obstetric care. Hence, the aim of this study was to assess the knowledge of birth preparedness and complication readiness and its associated factors among primigravida in Addis Ababa Governmental Health Facilities.MethodsA quantitative facility based cross-sectional study design and client exit interview questionnaire were used. Simple random and census sampling was used to select the health care facilities and study participants, accordingly. The data were entered using Epidata version3.1 and analysed by window statistical package for social science version 20 software. Logistic regression model was used to assess the knowledge by predictor’s variables.ResultFrom 442 respondents the response rate was 422 (95.5%). Based on finding, the respondents were knowledgeable on danger signs in pregnancy, labour, postnatal and new born neonate 113(26.8%), 47(11.1%), 60(14.2%) and 46(10.9%), respectively. According to birth preparedness, 64 (15.2%) of primigravida women were knowledgeable. In this study, factors associated with knowledge of birth preparedness and complication readiness were found to be being married [AOR = 0.110, 95%CI (0.026, 0.461);], house hold monthly income of 1000–3000 [AOR = 3.362(1.203,9.393);], knowledgeable for key danger signs of labour with [AOR = 3.685, 95%CI (1.157, 11.737);] and knowledgeable for key danger signs of post-partum period with [AOR =5.117, 95%CI (1.388, 18.863);].ConclusionThe knowledge of primigravida women for birth preparedness and its complication readiness was low. Information given about danger sign and birth preparedness during ANC follow up was not comprehensive. Therefore, family health care providers, health facility, other partners, program level managers and policy makers take their responsibility and work together to improve the health education service and increase knowledge on birth preparedness and complication readiness through easily accessible health education strategies.

Effect of Attending Pregnant Mothers Conference on Birth Preparedness and Complication Readiness Practice among Recently Delivered Women in Rural Libo Kemkem District, North West, Ethiopia: A Community-Based Comparative Cross-Sectional Study

Background. Birth preparedness and complication readiness strategies aimed to promote the timely utilization of skilled maternal health care. Pregnant mother conference is viewed as one of the needed interventions to reduce delays, by promoting obstetric danger sign awareness, family support, and decision-making power on a choice of place of delivery and the use of maternal health service. Objective. To compare the effect of attending a pregnant mother conference on birth preparedness and complication readiness practice among recently delivered women. Method. A community-based comparative cross-sectional study was conducted from February 15 to March 26, 2017, among mothers who gave birth in the past 12 months. Multistage simple random sampling method was implemented and 896 participants were contacted through a face-to-face interview. Descriptive, binary, and multiple logistic regression analysis was done. Results. Well-preparedness for birth and its complication among women who attended and did not attend the pregnant mother conference were 38.9% and 25.7%, respectively. Among the mothers who did not attend the conference, those who had four or more antenatal care visits (AOR=6.8, 95%CI 1.6, 29.8) and knew two or more danger signs of pregnancy (AOR=4.7, 95%CI:1.4, 15.6) were more likely being well-prepared for birth and its complication readiness, whereas among mothers who attended the conference, those who knew two or more danger signs of pregnancy (AOR=2.1, 95%CI:1.1, 4.3), those who had discussion with partners/families about place of delivery (AOR=11.4, 95%CI:3.1, 42.2), those who had previous delivery at health facility (AOR=2.4, 95%CI:1.2, 4.8), women who lived within one-hour walk to the nearest health facility (AOR=3.6, 95%CI:1.9, 6.9), and age of women within 19-34 years (AOR=6.8, 95%CI:1.7, 26.6) were significantly associated with birth preparedness and its complication readiness. Conclusion. Birth preparedness and complication readiness practice were higher among pregnant mother conference attendant women as compared to nonattendants. The health facility has to ensure encouraging women to participate in pregnant mother conference, promoting the utilization of antenatal care service, and counselling on obstetric danger sign. Moreover, the concerned bodies should promote interventions targeting the predisposing and reinforcing behavioral factors affecting the practice of birth preparedness and its complication readiness.

The quality of skilled birth attendants in Nepal: High aspirations and ground realities.

BackgroundWhile Nepal’s maternal mortality ratio (MMR) has improved overall, the proportion of maternal deaths occurring in health facilities and attended to by skilled birth attendants (SBAs), has nearly doubled over 12 years. Although there are numerous socioeconomic, environmental and other factors at play, one possible explanation for this discrepancy between utilization of skilled maternal care services and birth outcomes lies in the quality of care being provided by SBAs. The objective of this study is to determine how competent SBAs are after training, across multiple settings and facility types in Nepal.MethodsWe used a quantitative cross-sectional analysis to evaluate a sample of 511 SBAs, all female, from 276 sub-health posts (SHP), health posts (HP), primary healthcare centers (PHC), and district and regional hospitals in the mountain, hill, and terai districts of Nepal. Any SBA actively employed by one of these health facilities was included. SBAs who had received less than three months of training were excluded. Outcomes were measured using SBAs’ scores on a standardized knowledge assessment, clinical skills assessment, and monthly delivery volume, particularly as it compared with the WHO’s recommendation for minimum monthly volume to maintain competence.ResultsSBAs on average exhibit a deficiency of both knowledge and clinical skills, failing to meet even the 80-percent standard that is required to pass training (knowledge: 75%, standard deviation 12%; clinical skills: 48%, standard deviation 15%). Moreover, SBAs are conducting very few deliveries, with only 7 percent (38/511) meeting the minimal volume recommended to maintain competence by the WHO, and a substantial fraction (70/511, 14%) performing an average of no monthly deliveries at all.ConclusionsTaken together, our findings suggest that while countries like Nepal have made important investments in SBA programs, these healthcare workers are failing to receive either effective training or sufficient practice to stay clinically competent and knowledgeable in the field. This could in part explain why institutional deliveries have generally failed to deliver better outcomes for pregnant women and their babies.

A Mobile Health Wallet for Pregnancy-Related Health Care in Madagascar: Mixed-Methods Study on Opportunities and Challenges.

BackgroundMobile savings and payment systems have been widely adopted to store money and pay for a variety of services, including health care. However, the possible implications of these technologies on financing and payment for maternal health care services—which commonly require large 1-time out-of-pocket payments—have not yet been systematically assessed in low-resource settings.ObjectiveThe aim of this study was to determine the structural, contextual, and experiential characteristics of a mobile phone–based savings and payment platform, the Mobile Health Wallet (MHW), for skilled health care during pregnancy among women in Madagascar.MethodsWe used a 2-stage cluster random sampling scheme to select a representative sample of women utilizing either routine antenatal (ANC) or routine postnatal care (PNC) in public sector health facilities in 2 of 8 urban and peri-urban districts of Antananarivo, Madagascar (Atsimondrano and Renivohitra districts). In a quantitative structured survey among 412 randomly selected women attending ANC or PNC, we identified saving habits, mobile phone use, media consumptions, and perception of an MHW with both savings and payment functions. To confirm and explain the quantitative results, we used qualitative data from 6 semistructured focus group discussions (24 participants in total) in the same population.Results59.3% (243/410, 95% CI 54.5-64.1) saved toward the expected costs of delivery and, out of those, 64.4% (159/247, 95% CI 58.6-70.2) used household cash savings for this purpose. A total of 80.3% (331/412, 95% CI 76.5-84.1) had access to a personal or family phone and 35.7% (147/412, 95% CI 31.1-40.3) previously used Mobile Money services. Access to skilled health care during pregnancy was primarily limited because of financial obstacles such as saving difficulties or unpredictability of costs. Another key barrier was the lack of information about health benefits or availability of services. The general concept of an MHW for saving toward and payment of pregnancy-related care, including the restriction of payments, was perceived as beneficial and practicable by the majority of participants. In the discussions, several themes pointed to opportunities for ensuring the success of an MHW through design features: (1) intuitive technical ease of use, (2) clear communication and information about benefits and restrictions, and (3) availability of personal customer support.ConclusionsFinancial obstacles are a major cause of limited access to skilled maternal health care in Madagascar. An MHW for skilled health care during pregnancy was perceived as a useful and desirable tool to reduce financial barriers among women in urban Madagascar. The design of this tool and the communication strategy will likely be the key to success. Particularly important dimensions of design include technical user friendliness and accessible and personal customer service.