Malaria among pregnant women in Abeokuta, Nigeria

Pregnant women were enrolled from two hospitals and a Traditional Birth Home (TBH) in Abeokuta, Nigeria and monitored monthly for malaria parasites from the first antenatal visit until delivery. A total of 466 pregnant women were recruited for the study. The prevalence of malaria was 57.4%, and was higher among women in the TBH. The prevalence of malaria in the first, second and third trimesters of pregnancy were 37.5%, 47.3% and 47.5% respectively. At the time of the first antenatal visit 35.6% of the women were already parasitaemic, with a high frequency observed among primigravids. The prevalence recorded in the ninth month of pregnancy (35.7%) was not statistically different from that recorded at first antenatal visit (P > 0.05). The need to improve the quality of care, malaria prevention and treatment given to pregnant women especially receiving antenatal care outside the hospital is recommended.     

Influence of women's knowledge on maternal health care utilization in southern Laos

This study aims to clarify women's knowledge on obstetric care and to analyse the situation of maternal health care (MHC) utilization in southern Laos. Face to face structured questionnaire and focus group discussions were carried out for 205 mothers aged 29.6 +/- 6.7 who had children under the age of five. Three measurements of MHC utilization comprised: 1) antenatal care (ANC), 2) tetanus toxoid (TT) inoculation, and 3) attendance delivery by health professional. Women's knowledge on obstetric care was scored. Women's knowledge was positively correlated with ANC and TT inoculation. It was found that the women with strong superstitious belief were less likely to utilize all three types of MHC than the others. Accessibility to health care facilities strongly affected ANC and attendance delivery. Enhancing women's knowledge on obstetric care and reducing barriers related with sociocultural beliefs are essential to improving maternal health in southern Laos.     

Barriers to and attitudes towards promoting husbands' involvement in maternal health in Katmandu, Nepal

Couple-friendly reproductive health services and male partner involvement in women's reproductive health have recently garnered considerable attention. Given the sensitive nature of gender roles and relations in many cultures, understanding the context of a particular setting, potential barriers, and attitudes towards a new intervention are necessary first steps in designing services that include men. In preparation for a male involvement in antenatal care intervention, this qualitative study specifically aims to: (a) understand the barriers to male involvement in maternal health and (b) explore men's, women's, and providers' attitudes towards the promotion of male involvement in antenatal care and maternal health. In-depth interviews were conducted with fourteen couples and eight maternal health care providers at a public maternity hospital in Katmandu, Nepal. Additionally, seventeen couples participated in focus group discussions. The most prominent barriers to male involvement in maternal health included low levels of knowledge, social stigma, shyness/embarrassment and job responsibilities. Though providers also foresaw some obstacles, primarily in the forms of hospital policy, manpower and space problems, providers unanimously felt the option of couples-friendly maternal health services would enhance the quality of care and understanding of health information given to pregnant women, echoing attitudes expressed by most pregnant women and their husbands. Accordingly, a major shift in hospital policy was seen as an important first step in introducing couple-friendly antenatal or delivery services. The predominantly favorable attitudes of pregnant women, husbands, and providers towards encouraging greater male involvement in maternal health in this study imply that the introduction of an option for such services would be both feasible and well accepted.     

Does antenatal care make a difference to safe delivery? A study in urban Uttar Pradesh, India.

Evidence to support that antenatal screenings and interventions are effective in reducing maternal mortality has been scanty and studies have presented contradictory findings. In addition, antenatal care utilization is poorly characterized in studies. As an exposure under investigation, antenatal care should be well defined. However, measures typically only account for the frequency and timing of visits and not for care content. We introduce a new measure for antenatal care utilization, comprised of 20 input components covering care content and visit frequency. Weights for each component reflect its relative importance to better maternal and child health, and were derived from a survey of international researchers. This composite measure for antenatal care utilization was studied in a probability sample of 300 low to middle income women who had given birth within the last three years in Varanasi, Uttar Pradesh, India. Results showed that demarcating women's antenatal care status based on a simple indicator--two or more visits versus less--masked a large amount of variation in care received. Logistic regression analyses were conducted to examine the effect of antenatal care utilization on the likelihood of using safe delivery care, a factor known to decrease maternal mortality. After controlling for relevant socio-demographic and maternity history factors, women with a relatively high level of care (at the 75th percentile of the score) had an estimated odds of using trained assistance at delivery that was almost four times higher than women with a low level of care (at the 25th percentile of the score) (OR = 3.97, 95% CI = 1.96, 8.10). Similar results were obtained for women delivering in a health facility versus at home. This strong positive association between level of care obtained during pregnancy and the use of safe delivery care may help explain why antenatal care could also be associated with reduced maternal mortality.     

“They Told Me to Come Back”: Women’s Antenatal Care Booking Experience in Inner-City Johannesburg

To assess women’s experience of public antenatal care (ANC) services and reasons for late antenatal care attendance in inner-city Johannesburg, South Africa. This cross-sectional study was conducted at three public labour wards in Johannesburg. Interviews were conducted with 208 women who had a live-birth in October 2009. Women were interviewed in the labour wards post-delivery about their ANC experience. Gestational age at first clinic visit was compared to gestational age at booking (ANC service provided). ANC attendance was high (97.0 %) with 46.0 % seeking care before 20 weeks gestation (early). Among the 198 women who sought care, 19.2 % were asked to return more than a month later, resulting in a 3-month delay in being booked into the clinic for these women. Additionally 49.0 % of women reported no antenatal screening being conducted when they first sought care at the clinic. Delay in recognizing pregnancy (21.7 %) and lack of time (20.8 %) were among the reasons women gave for late attendance. Clinic booking procedures and delays in diagnosing pregnancy are important factors causing women to access antenatal care late. In a country where a third of pregnant women are HIV infected, early ANC is vital in order to optimise ART initiation and thereby reduce maternal mortality and paediatric HIV infection. It is therefore imperative that existing antenatal care policies are implemented and reinforced and that women are empowered to demand better services.     

From research to practice: the example of antenatal care in Thailand

The rationale for providing antenatal care is to screen predominantly healthy pregnant women to detect early signs of, or risk factors for, abnormal conditions or diseases and to follow this detection with effective and timely intervention. The recommended antenatal care programme in most developing countries is often the same as the programmes used in developed countries. However, in developing countries there is wide variation in the proportion of women who receive antenatal care. The WHO randomized trial of antenatal care and the WHO systematic review indicated that a model of care that provided fewer antenatal visits could be introduced into clinical practice without causing adverse consequences to the woman or the fetus. This new model of antenatal care is being implemented in Thailand. Action has been required at all levels of the health-care system, from consumers through to health professionals, the Ministry of Public Health and international organizations. The Thai experience is a good example of moving research findings into practice, and it should be replicated elsewhere to effectively manage other health problems.     

Impact of the French system of statutory visits on antenatal care.

A survey of a representative sample of births in France in 1976 showed that the great majority of women receive at least the minimum antenatal care laid down by law: 4% of women missed one of the three statutory visits linked to payment of the antenatal allowance and 6% missed the fourth visit that should take place in the ninth month. A smaller study conducted in two hospitals, one in the Paris region and the other in Nord-Pas-de-Calais, showed that the date of the first visit did not depend on a knowledge of the regulations. In one of the hospitals, where about 95% of women made more than the four statutory visits, the actual number of visits made was independent of a knowledge of the statutory number, In contrast, in the other hospital, where the mean number of visits was nearer to the statutory minimum, about half the women who said that four visits were required made exactly that number of visits and about half of those who gave three as the number made three visits.     

农村贫困地区产前保健实施情况分析

目的:了解被调查农村贫困地区孕产妇产前检查的情况。方法:采用分层抽样与典型调查的方法,对22所乡镇卫生院2004年1月~2006年7月的孕产妇系统保健卡(册)进行研究。结果:孕妇产前检查的平均次数为(5·01±1·65)次,孕12周内进行首次产前检查的比例为62·63%。在检查的具体内容中,进行血压测量的孕产妇比例达90%以上,进行体重、宫高、胎位和胎心测量比例为50%以上,进行实验室项目检查的孕产妇比例为20%~30%。至少有一次高危评分人数比例为34·83%,有3次高危评分的人数比例为20·79%。在东中部、西北和西南地区的比较中,东中部地区孕妇产前检查的质量较好。结论:应提高产前检查的内容与质量,在有限的产前检查次数中保障孕产妇与胎儿的健康。     

Evaluating antenatal care in Liberia: evidence from the demographic and health survey

Liberia has one of the highest maternal mortality ratios worldwide. Using quality antenatal care (ANC) can prevent maternal mortality. Indicators of quality ANC include: (1) timing of care initiation; (2) number of ANC visits (4+); and (3) ANC with recommended components. The purpose of this study was to examine factors associated with quality ANC in Liberia. Data from the 2013 Liberia Demographic and Health Survey were used (n = 5,348). Factors associated with quality ANC were assessed using multiple logistic regression. The majority of women attended at least four ANC visits (76.13%) and initiated care in the first trimester (66.5%); however, only 30% received care with all recommended components. Intended pregnancy, contraceptive use, and receiving ANC at a health facility with skilled providers were significantly associated with quality care. The lack of quality ANC may contribute to the high maternal mortality in Liberia. Facilitating access to health facilities and skilled ANC providers could improve the quality of care and potentially improve maternal outcomes over time. Additionally, focusing on empowering women with respect to access to birth control and control over pregnancies may increase the use of quality care.     

Measuring the adequacy of antenatal health care: a national cross-sectional study in Mexico

ObjectiveTo propose an antenatal care classification for measuring the continuum of health care based on the concept of adequacy: timeliness of entry into antenatal care, number of antenatal care visits and key processes of care.MethodsIn a cross-sectional, retrospective study we used data from the Mexican National Health and Nutrition Survey (ENSANUT) in 2012. This contained self-reported information about antenatal care use by 6494 women during their last pregnancy ending in live birth. Antenatal care was considered to be adequate if a woman attended her first visit during the first trimester of pregnancy, made a minimum of four antenatal care visits and underwent at least seven of the eight recommended procedures during visits. We used multivariate ordinal logistic regression to identify correlates of adequate antenatal care and predicted coverage.FindingsBased on a population-weighted sample of 9 052 044, 98.4% of women received antenatal care during their last pregnancy, but only 71.5% (95% confidence interval, CI: 69.7 to 73.2) received maternal health care classified as adequate. Significant geographic differences in coverage of care were identified among states. The probability of receiving adequate antenatal care was higher among women of higher socioeconomic status, with more years of schooling and with health insurance.ConclusionWhile basic antenatal care coverage is high in Mexico, adequate care remains low. Efforts by health systems, governments and researchers to measure and improve antenatal care should adopt a more rigorous definition of care to include important elements of quality such as continuity and processes of care.     

Implementing antenatal care recommendations,South Africa

Despite progress in reduction in maternal deaths in South Africa, deaths due to complications of hypertension in pregnancy remain high at 26 deaths per 100 000 live births in 2016. The South African health ministry modified its existing four-visit antenatal care model to align with the World Health Organization’s (WHO) 2016 recommendations for the number and content of antenatal care contacts. Implementation of the eight-contact antenatal care recommendations began in April 2017, after adaptation to the national context and nationwide trainings. In this article, we describe the stages of implementation and the monitoring of key indicators. We share lessons, particularly from the important early stages of nationwide scale-up and an analysis of the early results. We analysed samples of maternity case records in four catchment areas in the first year of the updated care model. The mean number of antenatal care contacts among five monthly samples of 200 women increased steadily from 4.76 (standard deviation, SD: 2.0) in March 2017 to 5.90 (SD: 2.3) in February 2018. The proportion of women with hypertension detected who received appropriate action (provision of medical treatment or referral) also increased from 83.3% (20/24) to 100.0% (35/35) over the same period. South Africa’s experiences with implementation of the updated antenatal care package shows that commitment from all stakeholders is essential for success. Training and readiness are key to identifying and managing women with complications and developing an efficient antenatal care system accessible to all women.     

A new measurement for optimal antenatal care: determinants and outcomes in Cameroon

A combined measure of optimal antenatal care can provide more information on the role it plays in maternal health. Our objectives were to investigate the determinants of a measure of optimal antenatal care and the associated pregnancy outcomes. Data on 7,557 women taken from the 2004 Demographic and Health Survey in Cameroon were used to develop a new measurement of optimal antenatal care based on four indicators: at least four visits, first visit in first trimester, last visit in third trimester and a professional provider of antenatal care. We studied the relationship of this new variable with other related variables in a multivariate analysis, taking into account the complex study design. Almost sixty six percent of the women had optimal antenatal care. Secondary or higher education (OR 1.74; 95% CI 1.28–2.36), greater wealth (OR 2.31; 95% CI 1.73–3.1), urban residence (OR 1.42; 95% CI 1.12–1.82) and parity of 3–4 (OR 0.79; 95% CI 0.62–0.99) were independently associated with optimal antenatal care. Women with optimal antenatal care were more likely to deliver in a health unit (OR 2.91; 95% CI 2.42–3.49), to be assisted by a skilled health worker during delivery (OR 1.88; 95% CI 1.49–2.37) and to have a baby with a normal birthweight (OR 1.62; 95% CI 1.11–2.38). Obtaining and using a new measure for ANC is feasible. The association of optimal antenatal care to education, wealth and residence in this study, consistent with others, highlights the role of the country’s development in maternal health.     

Factors associated with reproductive health care utilization among Ghanaian women

Background

This study investigates factors determining the timing of antenatal care (ANC) visit and the type of delivery assistant present during delivery among a national representative sample of Ghanaian women.

Method

Data for the study was drawn from the women questionnaire (N=4,916) of the 2008 Ghana Demographic and Health Survey among 15–49-years-old women. Multivariate logistic regression analysis was used to explore factors determining the type of delivery assistance and timing of ANC visit for live births within five years prior to the survey.

Results

Majority of Ghanaian women attended ANC visit (96.5%) but many (42.7%) did so late (after the first trimester), while 36.5% had delivery without the assistance of a trained personnel (30.6%) or anyone (5.9%). Age (OR=1.5, CI=1.1-1.9, OR for 25-34-year-olds compared to 15-24-year-olds), religion (OR=1.8, CI=1.2-2.8, OR for Christians versus Traditional believers) wealth index (OR=2.6, CI=1.7-3.8, OR for the richest compared to the poorest) were independently associated with early ANC visit. Likewise, age, place of residence, education and partner’s education were associated with having a delivery assisted by a trained assistant. Also, Christians (OR=1.8, CI=1.1-3.0) and Moslems (OR=1.9, CI=1.1-3.3) were more likely to have trained delivery assistants compared to their counterparts who practised traditional belief. Furthermore, the richer a woman the more likely that she would have delivery assisted by a trained personnel (OR=8.2, CI= 4.2-16.0, OR for the richest in comparison to the poorest).

Conclusions

Despite the relatively high antenatal care utilisation among Ghanaian women, significant variations exist across the socio-demographic spectrum. Furthermore, a large number of women failed to meet the WHO recommendation to attend antenatal care within the first trimester of pregnancy. These findings have important implications for reducing maternal mortality ratio by three-quarters by the year 2015.

     

Factors influencing antenatal care service utilization in hadiya zone

Background

In Ethiopia, the levels of maternal and infant morbidity and mortality are among the highest in the world. This is attributed to, among other factors, none use of modern health care services by women in Ethiopia. According to the 2005 Ethiopian Demographic Health Survey, more than seven in ten mothers did not receive antenatal care at all. Therefore, the objective of this study was to explore factors influencing antenatal care services utilization in Southern Ethiopia.

Methods

A community-based cross sectional study was conducted in Hadiya Zone of Southern Ethiopia from January to February 2009. A multi stage sampling technique was used to select the study population in one urban and five rural kebeles. Analysis was done using SPSS for windows version 16.

Result

This study revealed that antenatal care service utilization in the study area was 86.3%. However, from those who attended antenatal care service 406 (68.2%) started antenatal care visit during the second trimester of pregnancy and significant proportion 250 (42%) had less than four visits. Maternal age, husband attitude, family size, maternal education, and perceived morbidity were major predictors of antenatal care service utilization.

Conclusion

Though the antenatal care service utilization is high in the study population, four in ten of the mothers did not have the minimum number of visits recommended by World Health Organization. Promoting information, education and communication in the community is recommended to favorably affect the major predictors of antenatal care service utilization.     

Differences in Timely Antenatal Care Between First and Second-Generation Migrants in the Netherlands

To assess whether there are differences in the timing of first antenatal care visit between 1st and 2nd-generation migrants, and if so, how such differences could be explained. The study has been conducted in the framework of Generation R Study, a multi-ethnic population-based study conducted in Rotterdam, the Netherlands. The study population consists of 845 women of the six largest ethnic groups. Data were derived from the electronic antenatal charts of the participating midwives and from written questionnaires. Logistic regression analyses have been carried out to investigate whether difference could be explained by need, predisposing and enabling factors. More first than second generation women enter antenatal care after 14 weeks of pregnancy (28.1 vs. 18.7 %). Women who were not likely to adopt healthy behaviour regarding pregnancy—such as timely taking folic acid—equally were not inclined to enter antenatal care early in pregnancy. The role of Dutch language mastery was limited. Given our results, first generation women are less likely to receive timely health educational advice or to benefit from screening opportunities than second generation women. Future studies should pay more attention to adequate assessment of proficiency of the host language.     

佛山市某区1岁以下流动儿童保健服务利用与其母亲孕产期保健服务的相关性研究

目的 探讨1岁以下流动儿童保健服务利用与其母亲孕产期保健服务的相关性,为进一步提高流动儿童保健服务利用提出建议。方法 采用横断面调查,选取佛山市某区1岁以下流动儿童母亲579名为对象,对其进行面对面的问卷调查,利用二分类Logistic分析儿童系统管理与其母亲孕产期保健服务利用的相关性。结果 流动儿童保健服务利用现状为:儿童体检率89.1%,儿童系统管理率49.2%;流动儿童母亲孕产期保健服务利用现状为:产前检查率96.0%,孕早期检查率87.5%,≥5次产前检查率61.5%,住院分娩率99.7%,产后访视率37.3%,孕产妇系统管理率22.2%;多因素分析结果显示母亲产后访视、孕产期系统管理分别与儿童系统管理呈正相关(OR=2.017,95%CI=1.339~3.038;OR=1.941,95%CI=1.208~3.119)。结论 流动人口妇幼保健服务全程利用水平相对较低;母亲产后访视和孕产期系统管理是儿童系统管理的促进因素,提示母亲孕产期保健服务利用的改善可能有助于进一步提高儿童保健服务的利用。     

农村贫困地区孕产妇保健服务状况分析及对策

目的为了解农村贫困地区孕产妇保健服务状况,改善其服务提供参考依据。方法采取分层定额随机抽样的方法,获取样本。由统一培训的调查员进行调查。调查表用EPI Info3.3.2软件进行数据录入,用SPSS11.5软件进行统计分析。结果建立孕产妇保健手册率为62.8%,有89人(37.2%)没有建册,孕早期建册率为55.2%;产前检查率为92.9%,产前检查次数达标的比例为55.7%,还有17人(7.1%)没有做过产前检查,产前检查医院以区级及以下医院为主,其比例为93.3%;分娩方式,自然分娩率为72.4%,剖宫产率为27.6%;参加孕期保健保偿的比例为41.4%;产后访视次数达标率64%;对产前检查及产后访视需求的很好满足度,分别为24.7%、28.5%。结论孕早期建册率及产前检查次数达标比例较低,参加孕期保健保偿的比例有待提高。建议有针对性的对孕产妇进行健康教育,增强她们对孕产期保健服务的主动需求意识。     

Prenatal screening in rural Bangladesh: from prediction to care

The role of antenatal care is being increasingly questioned,particularly in resource poor environments. The low predictabilityof antenatal markers for adverse maternal outcomes has led someto reject antenatal care as an efficient strategy in the fightagainst maternal and perinatal mortality. Few studies, however,have assessed the predictability of adverse outcomes other thandystocia or perinatal death, and most studies have been hospitalbased. This population-based cohort study was undertaken toassess whether prenatal screening can identify women at riskof severe labour or delivery complications in a rural area inBangladesh. Antenatal risk markers, signs and symptoms wereassessed for their association with severe maternal complicationsincluding dystocia, malpresentation, haemorrhage, hypertensivediseases, twin delivery and death. The results of the studysuggest that antenatal screening by trained midwives fails toadequately distinguish women who will need special care duringlabour and delivery from those who will not need such care.The large majority of the women with dystocia or haemorrhagehad no warning signs during pregnancy. A single blood pressuremeasurement and the assessment of fundal height, on the otherhand, may detect a substantial number of women with hypertensivediseases and twin pregnancies. In addition, women who had anantenatal visit were four times more likely to deliver witha midwife than women who had no antenatal visit. Antenatal caremay not be an efficient strategy to identify those most in needfor obstetric service delivery, but if promoted in concurrencewith effective emergency obstetric care, and delivered in skilledhands, it may become an effective instrument to facilitate betteruse of emergency obstetric care services.