Antenatal Care For Women Research Articles

Pregnancy-Induced Hypertensive Disorders predictors among pregnant and delivery mothers receiving care in public health institutions in Sidama, Ethiopia: a multicenter case control study

BackgroundPregnancy-Induced Hypertensive Disorders (PIHD) include conditions like Pre-Eclampsia, Eclampsia, and Gestational Hypertension, impacting 5–10% of pregnancies globally. These disorders are responsible for 16% of maternal deaths in Sub-Saharan Africa and account for 16.9% of maternal mortality in Ethiopia, representing 10% of the country's total maternal deaths.ObjectiveTo identify predictors of PIHD among pregnant and delivery women in public hospitals and primary health care units (health centers) in Sidama, Ethiopia.MethodsA multi-center unmatched case–control study was conducted on women in antenatal care and obstetrics/gynecology departments at 12 randomly selected public health institutions, including one specialized teaching hospital, two general hospitals, three primary hospitals, and six health centers. The study involved 920 women (230 cases and 690 controls) selected from December 2023 to February 2024. Cases included pregnant or delivery women at 20 + weeks gestation with PIHD such as pre-eclampsia, eclampsia, gestational hypertension, and chronic hypertension with superimposed preeclampsia. Controls were normotensive pregnant women or delivering mothers without PIHD after 20 weeks gestation. Data was manually verified, entered, and validated using Epidata software, followed by analysis with SPSS 22. Univariate analysis assessed predictors of PIHD, while binary logistic regression evaluated the relationships between factors. Model fitness was checked using collinearity assessments and the Hosmer–Lemeshow test, with variables having a P value < 0.05 deemed independent predictors.ResultsOut of 920 planned participants, 686 were included, resulting in a response rate of 94.35%. Factors associated with PIHD in women included age at first conception (AOR = 1.26), mid (AOR = 6.05) and high (AOR = 5.01) wealth index levels, multigravidity (AOR = 4.34), pregnancy age ≥ 42 weeks (AOR = 3.65), maternal mid-upper arm circumference (MUAC) (AOR = 1.29), hemoglobin levels of 6.5–10.9 g/dL (AOR = 5.59), pre-pregnancy Body Mass Index (BMI) ≥ 25 kg/M2 (AOR = 0.81), preexisting hypertension (AOR = 8.97), family history of diabetes mellitus (AOR = 20.02), former alcohol consumption (AOR = 0.27), and total physical activity during pregnancy (AOR = 0.54).ConclusionsThe study identifies key predictors of PIHD in women, including age at conception, wealth index, multigravidity, gestational age, and pre-pregnancy BMI. It underscores the link between socioeconomic status and maternal health, highlighting that financial resources alone don’t ensure better outcomes without educational access. The research advocates for a health intervention strategy focusing on socioeconomic factors and public health initiatives to reduce maternal health disparities while exploring the role of partner stability and psychosocial aspects.

Anesthesia Management in Antenatal Care for Women With Chronic Kidney Disease: A Comprehensive Review.

Chronic kidney disease (CKD) presents significant challenges in the management of pregnant women due to its impact on renal function and cardiovascular stability. This review examines the crucial role of anesthesia management in antenatal care for women with CKD, focusing on the complexities introduced by renal dysfunction and the implications for maternal and fetal health outcomes. The review discusses the physiological changes in CKD during pregnancy, highlighting the increased risks of hypertension, proteinuria, and adverse fetal outcomes. Anesthesia considerations, including the choice of anesthesia techniques (general anesthesia, regional anesthesia), perioperative monitoring, and management of fluid and electrolyte balance, are analyzed in the context of CKD-specific challenges. Clinical outcomes and current evidence regarding anesthesia efficacy and safety in CKD patients are reviewed, emphasizing the need for tailored anesthesia protocols to ensure optimal maternal comfort and fetal safety. The review concludes by identifying research gaps and proposing future directions to enhance anesthesia practices and improve outcomes for pregnant women with CKD undergoing surgical interventions or labor management.

Community case management to accelerate access to healthcare in Mali: a realist process evaluation nested within a cluster randomized trial.

The Proactive Community Case Management (ProCCM) trial in Mali reinforced the health system across both arms with user fee removal, professional community health workers (CHWs) and upgraded primary health centres (PHCs)-and randomized village-clusters to receive proactive home visits by CHWs (intervention) or fixed site-based services by passive CHWs (control). Across both arms, sick children's 24-hour treatment and pregnant women's four or more antenatal visits doubled, and under-5 mortality halved, over 3 years compared with baseline. In the intervention arm, proactive CHW home visits had modest effects on children's curative and women's antenatal care utilization, but no effect on under-5 mortality, compared with the control arm. We aimed to explain these results by examining implementation, mechanisms and context in both arms We conducted a process evaluation with a mixed method convergent design that included 79 in-depth interviews with providers and participants over two time-points, surveys with 195 providers and secondary analyses of clinical data. We embedded realist approaches in novel ways to test, refine and consolidate theories about how ProCCM worked, generating three context-intervention-actor-mechanism-outcome nodes that unfolded in a cascade. First, removing user fees and deploying professional CHWs in every cluster enabled participants to seek health sector care promptly and created a context of facilitated access. Second, health systems support to all CHWs and PHCs enabled equitable, respectful, quality healthcare, which motivated increased, rapid utilization. Third, proactive CHW home visits facilitated CHWs and participants to deliver and seek care, and build relationships, trust and expectations, but these mechanisms were also activated in both arms. Addressing multiple structural barriers to care, user fee removal, professional CHWs and upgraded clinics interacted with providers' and patients' agency to achieve rapid care and child survival in both arms. Proactive home visits expedited or compounded mechanisms that were activated and changed the context across arms.

The best healthcare (commodity) available (for purchase): provider-induced demand for obstetric ultrasonography among ethnic minority women in rural northern Vietnam

Despite Vietnam's overall progress on maternal health indicators, marginalized ethnic minorities in remote areas face lower access to antenatal care and higher maternal mortality rates relative to the Kinh (majority ethnic group). Last year, we conducted fieldwork for 2 qualitative research projects that aimed to address maternal health inequities among pregnant ethnic minority women in rural Northern Vietnam. Although not the focus of our research, the use of ultrasonography services at for-profit private clinics was ubiquitous in participants' healthcare-seeking accounts. Ultrasound scans from for-profit clinics were a major component of ethnic minority women's antenatal care: many purchased 8 to 10 scans during pregnancy at $6.15 US dollars per scan, despite their limited agricultural income of $120 to $205 per month. Women were unaware of how many scans were recommended and their medically indicated scheduling, but purchased frequent scans to assuage pregnancy anxieties and access what they experienced as the highest-quality antenatal service. In tandem, for-profit ultrasonography providers offered broader opening hours, immediate results, and rich technological scans, which seemed to deliver poor families the most tangible "value" for their hard-earned money. Previous literature documented the concerning overuse of ultrasonography among Kinh women in urban Vietnam: What are the implications of this trend extending to affect rural-dwelling ethnic minority women who face lower education, economic marginalization, and a 4-fold higher maternal mortality rate? Our findings raise concerns related to safety, financial vulnerability and provider-induced demand, and broader health policy questions regarding healthcare commodities in low-resource settings. Critically, there is no evidence of the effect of obstetrical ultrasound on reducing maternal mortality in low- and middle-income countries, and its excess use could burden available resources and detract from evidence-based services. Our findings suggest that health system gaps are driving poor women toward frequent purchases of a single insufficient maternal health commodity: this will not improve their pregnancy outcomes or health equity for marginalized ethnic minorities. We argue that addressing this overuse of ultrasonography due to provider-induced demand requires a multipronged response that meets women's growing expectations. Our findings highlight the need for investment in health education, health promotion, and reliable high-quality public maternal healthcare for ethnic minority communities in Vietnam.

Time to initiation of antenatal care and its predictors among pregnant women who delivered in Arba Minch town public health facilities, Gamo Zone, southern Ethiopia, 2023: a retrospective follow-up study

BackgroundEarly antenatal care visit is important for optimal care and health outcomes for women and children. In the study area, there is a lack of information about the time to initiation of antenatal care. So, this study aimed to determine the time to initiation of antenatal care visits and its predictors among pregnant women who delivered in Arba Minch town public health facilities.MethodsAn institution-based retrospective follow-up study was performed among 432 women. A systematic random sampling technique was employed to select the study participants. The Kaplan-Meier survival curve was used to estimate the survival time. A Multivariable Cox proportional hazard regression model was fitted to identify predictors of the time to initiation of antenatal care. An adjusted hazard ratio with a 95% confidence interval was used to assess statistical significance.ResultsThe median survival time to antenatal care initiation was 18 weeks (95% CI = (17, 19)). Urban residence (AHR = 2.67; 95% CI = 1.52, 4.71), Tertiary and above level of education of the women (AHR = 1.90; 95% CI = 1.28, 2.81), having pregnancy-related complications in a previous pregnancy (AHR = 1.53; 95% CI = 1.08, 2.16), not having antenatal care for previous pregnancy (AHR = 0.39; 95% CI = 0.21, 0.71) and unplanned pregnancy (AHR = 0.66; 95% CI = 0.48, 0.91) were statistically significant predictors.ConclusionHalf of the women initiate their antenatal care visit after 18 weeks of their pregnancy which is not in line with the recommendation of the World Health Organization. Urban residence, tertiary and above level of education of the women, having pregnancy-related complications in a previous pregnancy, not having previous antenatal care visits and unplanned pregnancy were predictors of the time to initiation of antenatal care. Therefore, targeted community outreach programs including educational campaigns regarding antenatal care for women who live in rural areas, who are less educated, and who have no previous antenatal care experience should be provided, and comprehensive family planning services to prevent unplanned pregnancy are needed.

Feasibility and acceptability of sexually transmitted infection screening during antenatal care of women in Dhaka, Bangladesh.

Sexually transmitted infections (STIs) are a major public health concern worldwide. Untreated STIs may have serious sequelae, particularly in pregnant women. The objective of this study was to assess the feasibility and acceptability of screening and treating common STIs in women during pregnancy in Bangladesh. Women were enrolled from four maternity clinics/hospitals serving the lower-middle class population in Dhaka, Bangladesh. The participants were interviewed, and vaginal swab samples were collected by clinical staff. Specimens were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and high-risk Human Papilloma Viruses (HPVs) using GeneXpert (Cepheid, Sunnyvale, California). Women were informed of their test results and were provided treatment for curable infections. A test of cure was performed. Out of 1157 pregnant women approached, 1000 (86.4%) participated. Ninety-one percent women learned of their test results on the same day of testing. Out of the 996 valid results, 7 (0.7%) tested positive for Chlamydia trachomatis and 1 (0.1%) for Trichomonas vaginalis. There were no gonorrhoea cases. Out of the 971 women with valid results for high-risk HPVs, 46 (4.7%) tested positive. Screening women for STIs during antenatal care was highly feasible and well-accepted in Bangladesh. While the prevalence of common curable STIs was very low, hrHPV infection prevalence was moderately high. Our findings support period monitoring of STIs and continued prevention efforts for cervical cancer in Bangladesh.

Factor Analysis of Antenatal Care in Women of Fertilizing Age in Nepal

&lt;div&gt;&lt;table cellspacing="0" cellpadding="0" align="left"&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" valign="top"&gt;&lt;p&gt;&lt;em&gt;The high maternal and infant mortality rate in Nepal is a global problem. Antenatal Care (ANC) services are an effort to reduce maternal and infant mortality rates. This study aims to analyze factors in the utilization of antenatal care among women of childbearing age in Nepal. This research method The Nepal Demographic and Health Survey (NDHS) was carried out in the new era with official approval from the Ministry of Health and Population (MoHP), and the data collection period lasted from January 5 to June 22, 2022. The study population was women aged 15 to 49 years. who have given birth or experienced a stillbirth in the previous two years and have attended at least one antenatal care (ANC) visit. Data collection using questionnaires interviewed after they were discharged from the facility that provides delivery services. Data analysis using the JASP version 18 application to see the influence of the independent variable on the dependent variable. Bivariate data will be analyzed using chi-square analysis, and multivariate data will be analyzed using the logistic regression test. The research results showed that there was a relationship between age (p&amp;lt;0.001), place of residence (p&amp;lt;0.001), zone of residence (p&amp;lt;0.001), economy (p&amp;lt;0.001), education (p&amp;lt;0.001), number of children (p&amp;lt;0.001) women of childbearing age in Nepal with ANC visits. These factors greatly influence women of childbearing age in utilizing ANC services. Therefore, it is necessary to strengthen ANC service policies and remind women of childbearing age to make at least 4 ANC visits during pregnancy so that examinations and visits for pregnant women can be carried out completely.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt; &lt;/em&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt;&lt;/div&gt;&lt;strong&gt;&lt;em&gt;Keywords : Antenatal Care, Women of childbearing age, Nepal&lt;/em&gt;&lt;/strong&gt;

Adolescent girls' and young mothers' knowledge and use of antenatal care in the Ahafo Region, Ghana: A cross-sectional study.

Antenatal care (ANC) is crucial to reducing maternal and neonatal deaths, but few studies examined adolescent girls' and young women's ANC utilisation and knowledge in Ghana. To assess adolescents' and young mothers' knowledge of ANC, utilisation and factors influencing its use in Ghana. Tano North Municipality, Ahafo Region. This community-based, cross-sectional study involved 440 adolescent and young mothers (between 10 and 24 years). A structured questionnaire was employed to collect data face-to-face. Descriptive and statistical analyses were performed, andp 0.05 was considered statistically significant. Of the 440 respondents, most were aged 20-24 years (61.2%), married (30.0%), Christians (78.2%), completed junior high school (JHS) (47.8%) and traders (38.9%). Postnatal mothers were 71.6% (315), and all had utilised ANC services. Antenatal care knowledge was good among 75% (330) respondents, with no significant variation by age. Religion influenced knowledge, with Muslims having lower knowledge. Antenatal care utilisation was high ( 50%) among those aged 15-19 years, married, Christians, JHS graduates and traders. Age, marital status and employment type significantly influenced ANC utilisation. Individuals in the age group 15-19 years and married women demonstrated higher odds of utilising ANC services. Casual workers and unemployed respondents were found to have lower odds of utilising ANC services compared to traders. Age, marital status, and employment type influenced ANC utilisation in the Ahafo Region. Adolescent mothers under 15 years had lower rates, requiring targeted interventions to improve pregnancy outcomes.Contribution:This study highlights the knowledge and factors influencing ANC use in Ahafo Region and adds to the existing research evidence on ANC.

Reassuring pregnancy outcomes in women with mild COL4A3-5–related disease (Alport syndrome) and genetic type of disease can aid personalized counseling

Individualized pre-pregnancy counseling and antenatal care for women with chronic kidney disease (CKD) require disease-specific data. Here, we investigated pregnancy outcomes and long-term kidney function in women with COL4A3-5 related disease (Alport Syndrome, (AS)) in a large multicenter cohort. The ALPART-network (mAternaL and fetal PregnAncy outcomes of women with AlpoRT syndrome), an international collaboration of 17 centers, retrospectively investigated COL4A3-5 related disease pregnancies after the 20th week. Outcomes were stratified per inheritance pattern (X-Linked AS (XLAS)), Autosomal Dominant AS (ADAS), or Autosomal Recessive AS (ARAS)). The influence of pregnancy on estimated glomerular filtration rate (eGFR)-slope was assessed in 192 pregnancies encompassing 116 women (121 with XLAS, 47 with ADAS, and 12 with ARAS). Median eGFR pre-pregnancy was over 90ml/min/1.73m2. Neonatal outcomes were favorable: 100% live births, median gestational age 39.0 weeks and mean birth weight 3135 grams. Gestational hypertension occurred during 23% of pregnancies (reference: 'general' CKD G1-G2 pregnancies incidence is 4-20%) and preeclampsia in 20%. The mean eGFR declined after pregnancy but remained within normal range (over 90ml/min/1.73m2). Pregnancy did not significantly affect eGFR-slope (pre-pregnancy β=-1.030, post-pregnancy β=-1.349). ARAS-pregnancies demonstrated less favorable outcomes (early preterm birth incidence 3/11 (27%)). ARAS was a significant independent predictor for lower birth weight and shorter duration of pregnancy, next to the classic predictors (pre-pregnancy kidney function, proteinuria, and chronic hypertension) though missing proteinuria values and the small ARAS-sample hindered analysis. This is the largest study to date on AS and pregnancy with reassuring results for mild AS, though inheritance patterns could be considered in counseling next to classic risk factors. Thus, our findings support personalized reproductive care and highlight the importance of investigating kidney disease-specific pregnancy outcomes.

Prevalence, antimicrobial susceptibility profile, and associated risk factors of uropathogenic Escherichia coli among pregnant women attending Dr. Sumait Hospital Mogadishu, Somalia.

Uropathogenic Escherichia coli (UPEC) is a strain of E. coli commonly associated with urinary tract infections. In addition, antibiotic resistance in UPEC is one of the most significant health problems. This study was conducted to determine the prevalence, antimicrobial resistance, and factors linked to uropathogenic Escherichia coli (UPEC) in pregnant women. This cross-sectional study was conducted within a hospital setting between August 2022 and December 2022. Using consecutive convenient sampling, the research enrolled 220 pregnant women. The urine samples obtained from these women were cultured on MacConkey and blood agar and incubated at 37°C overnight, followed by sub-culturing on Mueller Hinton media. Bacterial identification involved Gram staining and biochemical characterization (TSI, indole, citrate, methyl red, urea agar, and motility tests). Conversely, susceptibility tests were performed using the Kirby-Bauer disk diffusion method. A binary logistic regression model and analysis of odds ratios (ORs) were employed to evaluate the risk factors associated with E. coli infection, and statistical significance was attributed to p-values of ≤0.05. Out of the 220 urine samples examined, 42 (19%) exhibited a positive culture, indicating an E. coli infection in pregnant women. Our analysis revealed that income, gestational age, and history of UTIs were identified as risk factors associated with E. coli infection. Most E. coli isolates demonstrated sensitivity to amikacin (100%), nitrofurantoin (85.7%), amoxicillin/clavulanic acid, and meropenem (83.3%). The prevalence of E. coli was remarkable. It could be recommended that pregnant women in antenatal care have routine culture and antimicrobial susceptibility tests to prevent transmission of resistant pathogens and complications in both pregnant mothers and the unborn baby.

Antenatal care of women who use opioids: a qualitative study of practitioners’ perceptions of strengths and challenges of current service provision in Scotland

BackgroundThe increasing rise of women using opioids during pregnancy across the world has warranted concern over the access and quality of antenatal care received by this group. Scotland has particularly high levels of opioid use, and correspondingly, pregnancies involving women who use opioids. The purpose of this study was to investigate the different models of antenatal care for women using opioids during pregnancy in three Scottish Health Board Areas, and to explore multi-disciplinary practitioners’ perceptions of the strengths and challenges of working with women who use opioids through these specialist services.MethodsThirteen semi-structured interviews were conducted with health and social care workers who had experience of providing antenatal and postnatal care to women who use drugs across three Scottish Health Board Areas: NHS Greater Glasgow and Clyde, NHS Lothian, and NHS Tayside. Framework Analysis was used to analyse interview data. The five stages of framework analysis were undertaken: familiarisation, identifying the thematic framework, indexing, charting, and mapping and interpretation.ResultsEach area had a specialist antenatal pathway for women who used substances. Pathways varied, with some consisting of specialist midwives, and others comprising a multidisciplinary team (e.g. midwife, mental health nurse, social workers, and an obstetrician). Referral criteria for the specialist service differed between health board areas. These specialised pathways presented several key strengths: continuity of care with one midwife and a strong patient-practitioner relationship; increased number of appointments, support and scans; and highly specialised healthcare professionals with experience of working with substance use. In spite of this, there were a number of limitations to these pathways: a lack of additional psychological support for the mother; some staff not having the skills to engage with the complexity of patients who use substances; and problems with patient engagement.ConclusionsAcross the three areas, there appears to be high-quality multi-disciplinary antenatal services for women who use opioids during pregnancy. However, referral criteria vary and some services appear more comprehensive than others. Further research is needed into the perceptions of women who use opioids on facilitators and barriers to antenatal care, and provision in rural regions of Scotland.

HUBUNGAN DUKUNGAN SUAMI DENGAN KEPATUHAN KUNJUNGAN ANC

The maternal mortality rate in 2020 has increased partly due to pregnant women's non-compliance with ANC check-ups. According to data from the Ministry of Health of the Republic of Indonesia, Indonesia did not reach the target of 93.3 percent of ANC visits. This study aims to determine the relationship between compliance of pregnant women in conducting antenatal care (ANC) in the working area of the Wongsorejo Health Center with husband support. Retrospective design was used in this research methodology, using a purposive sampling, the total population was 139 people and the sample size was 58 respondents. Visit data from the MCH book from June to August at 2022 was used as a research instrument. Wilcoxon statistical test was used for data analysis to obtain data on differences between the two groups. The results showed that out of 58 respondents, or 32 people (55.2%), reported that they had strong husband support. Of these pregnant women, 27 people (46.6%) made compliant ANC visits. In the working area of Puskesmas Wongsorejo, there is a significant relationship between husband support and adherence to ANC visits, as indicated by a significance value of 0.025 obtained from the Wilcoxon statistical test. It is suggested that it can provide information and add insight into the importance of support and involvement of husbands to pregnant women in antenatal care (ANC) checks.

Health insurance coverage and access to maternal healthcare services by women of reproductive age in Nigeria: a cross-sectional study

BackgroundInequitable financial access to maternal healthcare services (MHS) has contributed to maternal deaths, especially in low and middle-income countries. Evidence in the literature on women’s health insurance status and access...

Behavior of Pregnant Women In Pregnancy Examinations In Manisa Village, Baranti District

The occurrence of maternal deaths is related to direct causal factors and indirect causes. The direct causes of maternal death in Indonesia are still dominated by factors. by bleeding, eclampsia, and infection, while the indirect factors causing maternal death are because there are still many cases, 3 too late and 4 too late, which are related to access, socio-cultural, educational and economic factors. This research uses a combination method with a sequential explanatory design. The first uses quantitative methods, and the second uses qualitative methods. A quantitative approach is used to identify and explain variables that influence behavior such as knowledge, attitudes, facilities and encouragement of officers. A qualitative approach is used to support and complement quantitative research results. The chi-square test shows that there is a significant relationship between knowledge, facilities and encouragement of health workers on the behavior of pregnant women in pregnancy checks. P value = 0.001. If the significance value is &lt;0.05, it is recognized that there is a statistically significant correlation. Meanwhile, attitudes show no statistical correlation. The logistic regression test shows that there is an influence between knowledge and facilities on the behavior of pregnant women. There are two substantial findings, namely regarding knowledge about antenatal care and the availability of facilities which influence the behavior of pregnant women in antenatal care.

Determinants of Pre-Eclampsia Incidence among Pregnant Women in Antenatal Care at Fortportal Regional Referral Hospital

Pre-eclampsia stands as a major contributor to maternal mortality, perinatal complications, preterm births, and restricted fetal growth. Globally, it ranks among the top three causes of maternal mortality and affects 6-8% of pregnancies, contributing to approximately nine percent of maternal deaths in Africa. This study aimed to identify factors linked to preeclampsia prevalence among pregnant women receiving antenatal care at Fortportal Regional Referral Hospital. Conducting a hospital-based cross-sectional study involving 60 pregnant women, data collection employed a structured questionnaire. Statistical analysis with SPSS version 25 determined Odds Ratios with 95% confidence intervals, marking significance at p values &lt;0.05. Findings revealed several significant associations. Sociodemographic factors like lower maternal age, limited education, and reduced income were linked to pre-eclampsia, alongside obstetric factors including lower parity (≤ 4), overweight status, a history of gestational diabetes mellitus, shorter interpregnancy intervals (≤ 2 years), and previous diagnoses of gestational hypertension. The study underscores the critical need for urgent interventions in the district to address these identified risk factors and prevent and manage pre-eclampsia effectively among pregnant women attending Fortportal Regional Referral Hospital. Both socio-economic and obstetric factors significantly contribute to the occurrence of pre-eclampsia, necessitating targeted interventions for improved maternal and fetal health outcomes. Keywords: prevalence, pre-eclampsia, pregnant women, antenatal care

ВЕРОЯТНОСТЬ ИЗМЕНЕНИЯ ПОКАЗАТЕЛЕЙ ФУНКЦИИ ВНЕШНЕГО ДЫХАНИЯ ПРИ РАЗВИТИИ ХОБЛ В ЗАВИСИМОСТИ ОТ КОЛИЧЕСТВА ВЫКУРИВАЕМЫХ СИГАРЕТ НА ФОНЕ ГОРМОНАЛЬНЫХ ИЗМЕНЕНИЙ ПРИ БЕРЕМЕННОСТИ

Introduction. This is a study of possible changes in the respiration function indicators in the development of chronic obstructive pulmonary disease (COPD), depending on the number of cigarettes smoked and associated with pregnancy-related hormone fluctuations. Aim. Our study aimed to determine the dependence of changes in first- second forced expiratory volume upon the level of anti-inflammatory hormones cortisol and progesterone in female smokers with different number of cigarettes smoked. Materials and Methods. The study is based on the findings of the analysis of changes in the level of hormones cortisol and progesterone in 243 pregnant women in antenatal care and on how such changes affect the first-second forced exhalation volume. The control group consisted of healthy non-smoking female patients. 4 groups were formed. For each group, the expected values of the first-second forced exhalation volume were calculated, in parallel with changes in the cortisol and progesterone profile and with forming the relevant statistical data matrices. Results and Discussion. With an increase in cortisol and progesterone levels, there is an increase in the first-second of forced exhalation volume, which indicates an increase in the lung tissue elasticity and in the air flow rate in the first second under the influence of hormones that have a pronounced anti-inflammatory effect. Conclusion. Pregnancy progress in smokers consuming different amounts of cigarettes is accompanied by an increase in the cortisol and progesterone levels. Hormone fluctuations improve the functional state of external respiration in pregnant smokers with COPD, creating the illusion of preserving the physiological capabilities of lungs regardless of the number of cigarettes smoked. With this variant of the COPD developing during pregnancy, a temporary physiological increase in the anti-inflammatory hormonal profile masks the extent, to which the number of cigarettes smoked affects the COPD severity.

Factors associated with knowledge of mother-to-child transmission (MTCT) of HIV/AIDS among young adults in Indonesia: Analysis of IYARHS

Background: The prevalence of mother-to-child transmission (MTCT) of HIV/AIDS is increasing, particularly in low- and middle-income countries. Most previous studies focused on pregnant women in antenatal care, but this study examined the early phases of non-married women, which are young adults. Objective: This study aimed to examine the factors associated with knowledge MTCT of HIV/AIDS among young adults in Indonesia. Methods: This study used secondary data from the Special Indonesia Demographic Health Survey (IDHS), also known as the Indonesia Young Adult Reproductive Health Survey (IYARHS). The unit of analysis in this study is a non-married young adult aged 14 to 24 from 34 provinces in Indonesia. The final samples brought into the analysis were 9,600 women. The univariate analysis, bivariate analysis using the Chi-Square test, and multivariate analysis using binary logistic regression were done using the STATA 17 version licensed by the Institute for Population and Social Research, Mahidol University. Results: This study revealed that 33.75% of the respondents had poor knowledge of the MTCT of HIV/AIDS. Moreover, the factors found to be significantly associated with knowledge of MTCT of HIV/AIDS were age (19 to 24 years old), residence in an urban area, graduation from junior high school, senior high school, academy, and university, and also those who talked about sexual matters with friends. Conclusion: This study suggests supporting and encouraging related stakeholders in order to provide education about MTCT in the early years of adulthood so the prevention program can be applied more easily.

A Complex mHealth Coaching Intervention to Prevent Overweight, Obesity, and Diabetes in High-Risk Women in Antenatal Care: Protocol for a Hybrid Type 2 Effectiveness-Implementation Study.

Women with overweight and obesity are at higher risk of developing complications in pregnancy such as gestational diabetes and longer-term chronic conditions. Research concerning health behavior change interventions during pregnancy and postpartum shows promising effects, but implementation into routine services is sparsely investigated. Most interventions focus on the antenatal or postpartum life stages, failing to meet the needs of women. IMPACT DIABETES Bump2Baby is a multicenter project across 4 high-income countries developed to test the implementation of an antenatal and postpartum evidence-based mobile health (mHealth) coaching intervention called Bump2Baby and Me (B2B&Me) designed to sit alongside usual care in the perinatal period. We aim to explore the feasibility and implementation of the B2B&Me intervention and investigate the effectiveness of this intervention in women at risk of gestational diabetes. IMPACT DIABETES Bump2Baby is a hybrid type 2 effectiveness-implementation study, which integrates an evidence-based mHealth coaching app that includes personalized health behavior change coaching provided by health care professionals alongside antenatal care from the first antenatal visit to 12 months postpartum. The mHealth app offers the possibility of synchronous calls, asynchronous contact (including coach-participant text and video messaging exchanges tailored to the participant's needs), and ongoing access to an extensive library of bespoke intervention materials. Participants will interact asynchronously with their health coach throughout the intervention via the app. This randomized controlled trial across 4 clinical sites within Ireland, the United Kingdom, Spain, and Australia will recruit 800 women in early pregnancy to evaluate the effectiveness on postpartum weight. The Exploration, Preparation, Implementation, and Sustainment implementation framework is the theoretical underpinning of the study. The implementation evaluation will be assessed at the individual, hospital staff, and broader community levels using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Data sources for the RE-AIM evaluation will include app and platform analytics, screening and training records, participant medical records, key informant interviews, participant and partner exit interviews, cost data, study questionnaires, staff surveys, and blood sample analyses. The study was approved and registered with the Australian New Zealand Clinical Trials Registry on November 19, 2020. Recruitment commenced on February 9, 2021, and data collection is ongoing. Publication of the results is expected in 2024. This is the first hybrid effectiveness-implementation study of an 18-month mHealth coaching intervention in at-risk women that we are aware of. As research aims to move toward real-world implementable solutions, it is critical that hybrid studies are conducted. The data from this large multicenter study will be useful in planning the potential implementation and scale-up of evidence-based perinatal health behavior change interventions. Australian New Zealand Clinical Trials Registry ACTRN12620001240932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380020&isReview=true. DERR1-10.2196/51431.

PENGARUH E-KIE TERHADAP TINGKAT PENGETAHUAN DAN KEPUASAN IBU HAMIL DALAM ANTENATAL CARE DI MASA PANDEMI COVID-19

Background: The Covid-19 pandemic that has occurred throughout the world affects all aspects, including health aspects. The Covid-19 pandemic is certainly an obstacle for the government to overcome the Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) in Indonesia. Optimal Antenatal Care is one of the efforts to suppress MMR and IMR. The government recommends using online counseling to support antenatal care during the Covid-19 pandemic. Research objective: to determine the impact of e-KIE on the knowledge level and satisfaction of pregnant women in antenatal care during the Covid-19 pandemic. Research Methods: The design used was pre-experimental, namely one group pre-post test design to see the effect between the independent variables of the e-KIE method and the dependent variable, namely level of knowledge and satisfaction of pregnant women which were analyzed by marginal homogeneity. The research sample was selected by purposive sampling taken from the registration book (K1) with a population range of pregnant women from September to October 2021 totaling 37 respondents. Research results: there is a significant increase in the level of knowledge of pregnant women before and after e-KIE with a p value of 0.035 and an insignificant effect due to the compatibility between the expected value and the reality of pregnant women with a p value of 0.059. Conclusion: E-KIE significantly affects the level of knowledge of pregnant women and the e-KIE provided does not significantly affect the satisfaction of pregnant women in supporting dialogue/counseling in antenatal care during the Covid-19 pandemic.

Economic analysis of a new four-panel rapid screening test in antenatal care in Kenya, Rwanda, and Uganda

BackgroundWe performed an economic analysis of a new technology used in antenatal care (ANC) clinics, the ANC panel. Introduced in 2019–2020 in five Rwandan districts, the ANC panel screens for four infections [hepatitis B virus (HBV), human immunodeficiency virus (HIV), malaria, and syphilis] using blood from a single fingerstick. It increases the scope and sensitivity of screening over conventional testing.MethodsWe developed and applied an Excel-based economic and epidemiologic model to perform cost-effectiveness and cost-benefit analyses of this technology in Kenya, Rwanda, and Uganda. Costs include the ANC panel itself, its administration, and follow-up treatment. Effectiveness models predicted impacts on maternal and infant mortality and other outcomes. Key parameters are the baseline prevalence of each infection and the effectiveness of early treatment using observations from the Rwanda pilot, national and international literature, and expert opinion. For each parameter, we found the best estimate (with 95% confidence bound).ResultsThe ANC panel averted 92 (69–115) disability-adjusted life years (DALYs) per 1,000 pregnant women in ANC in Kenya, 54 (52–57) in Rwanda, and 258 (156–360) in Uganda. Net healthcare costs per woman ranged from $0.53 ($0.02-$4.21) in Kenya, $1.77 ($1.23-$5.60) in Rwanda, and negative $5.01 (-$6.45 to $0.48) in Uganda. Incremental cost-effectiveness ratios (ICERs) in dollars per DALY averted were $5.76 (-$3.50-$11.13) in Kenya, $32.62 ($17.54-$46.70) in Rwanda, and negative $19.40 (-$24.18 to -$15.42) in Uganda. Benefit-cost ratios were $17.48 ($15.90-$23.71) in Kenya, $6.20 ($5.91-$6.45) in Rwanda, and $25.36 ($16.88-$33.14) in Uganda. All results appear very favorable and cost-saving in Uganda.ConclusionThough subject to uncertainty, even our lowest estimates were still favorable. By combining field data and literature, the ANC model could be applied to other countries.