scholarly journals Pica Is Associated With Smoking and Self-Reported Stress Among Palestinian Pregnant Women: Cross-Sectional Study

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 702-702
Author(s):  
Souzan Zidan ◽  
Manal Badrasawi ◽  
May Hamdan
Keyword(s):  
Pregnant Women ◽  
Psychological Stress ◽  
Health Care Professionals ◽  
Dietary Habits ◽  
First Trimester ◽  
Cross Sectional Study ◽  
Lifestyle Factors ◽  
Sectional Study ◽  
Chi Square ◽  
Cross Sectional

Abstract Objectives 1. To determine the prevalence of pica among Palestinian pregnant women. 2. To identify substance most commonly ingested by Palestinian pregnant women. 3. To explore whether dietary habits and lifestyle factors are associated with pica practice among Palestinian pregnant women. Methods A cross-sectional study was conducted among 170 pregnant women. Interview pre-tested structured questionnaire was administrated to pregnant women who were attending private gynecological clinics in Hebron district. Cronbach Alpha was used to determine the reliability of the questionnaire. The statistical analysis was done using descriptive statistics. Independent t-test and Chi-square test were also used to see whether pica practice is related to sociodemographic characteristics, dietary habits, and lifestyle factors. Results Eight (4.7%) participants reported experiencing pica during pregnancy. Pica prevalence categorized by substances ingested as follows: ice cube (62.5%); dirt (12.5%); cigarette ash residue (12.5%); toothpaste (12.5%). Minority of women who practiced pica reported experiencing pica in previous pregnancy, and health problems-related to pica. Most women who practiced pica reported ingestion of pica item during the first trimester. Pica practice was significantly associated with smoking and psychological stress during pregnancy. Moreover, pica practice was related to the dietary intake of milk and fat. Conclusions Pica practice is not common in the current sample. It was found that pica practice was associated with smoking and psychological stress. Health care professionals need to be conscious of the presence of this behavior. A nation-wide research of pica prevalence among pregnant women is highly needed. The phenomenon obviously needs further research. Funding Sources The authors declare that no external financial support was received for this study.

Several Components of the Lebanese Mediterranean Diet and Particular Sociodemographic, Medical and Lifestyle Factors may be Associated with Gastroesophageal Reflux Disease in Adults: A Cross-sectional Study in a Middle Eastern Setting

2020 ◽  
Vol 17 (1) ◽  
pp. 82-93
Author(s):  
Mary-Joe Youssef ◽  
Antoine Aoun ◽  
Aline Issa ◽  
Lana El-Osta ◽  
Nada El-Osta ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Gastroesophageal Reflux Disease ◽  
Perceived Stress ◽  
Dietary Habits ◽  
Cross Sectional Study ◽  
Lifestyle Factors ◽  
P Value ◽  
Sectional Study ◽  
Cross Sectional ◽  
Gerd Symptoms

Background: The prevalence of gastroesophageal reflux disease (GERD) is increasing worldwide and the related chronic symptoms can be associated with morbidity and poor quality of life. Objective: The objective of this study was to identify foods and beverages consumed by the Lebanese population, dietary habits, socio-demographic and lifestyle factors, health parameters and perceived stress, implicated in increasing GERD symptoms. Methods: This observational cross-sectional study was carried among Lebanese adults in 2016. A convenient sample of 264 participants was equally divided into a GERD group and a control group. Data on socio-demographic characteristics, lifestyle, health status and dietary habits including Lebanese traditional dishes were collected. The perceived stress scale (PSS) was also used to assess the participants’ perception of stress. Logistic regression analyses were conducted with GERD symptoms (presence or absence) being the dependent variable. Results: The GERD symptoms were significantly associated with age (-p-value=0.017), family history of GERD symptoms (-p-value<0.001), smoking (-p-value=0.003) and chronic medical conditions (-p-value<.001). Regarding the dietary factors, participants who ate three meals or less/day, between meals and outside homes were 2.5, 2.9 and 2.4 times at a higher risk of experiencing GERD symptoms than others, respectively. Moreover, the logistic regression model showed that the GERD symptoms were significantly associated with the consumption of coffee (-p-value=0.037), Lebanese sweets (-p-value=0.027), fried foods (-p-value=0.031), ‘Labneh’ with garlic (-p-value<0.001), pomegranate molasses (-p-value=0.011), and tomatoes (-p-value=0.007). Conclusion: Some specific lifestyle factors and components of the Lebanese Mediterranean diet could be associated with GERD symptoms.

scholarly journals Cross-sectional study to assess etiology and associated factors for anaemia during first trimester of pregnancy in Anuradhapura District, Sri Lanka: a protocol

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 223
Author(s):  
Gayani Amarasinghe ◽  
Vasana Mendis ◽  
Thilini Agampodi
Keyword(s):  
Sri Lanka ◽  
Data Collection ◽  
Pregnant Women ◽  
Associated Factors ◽  
First Trimester ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Anaemia In Pregnancy ◽  
In Pregnancy

Background: Anaemia in pregnancy, which can lead to adverse maternal and fetal outcomes, is a significant global health problem. Despite Sri Lanka’s strong public health system and commitment towards prevention, maternal anaemia remains a major problem in the country. While prevention is focused on iron deficiency, detailed etiological studies on this topic are scarce. Moreover, estimates of socio demographic and economic factors associated with anaemia in pregnancy, which can provide important clues for anaemia control, are also lacking. This study aims to evaluate the hemoglobin distribution, spatial distribution, etiology and associated factors for anaemia in pregnant women in Anuradhapura, Sri Lanka. Methods: This is a cross sectional study of pregnant women in their first trimester registered for antenatal care from July to September 2019 in the Anuradhapura district. The minimal sample size was calculated to be 1866. Initial data collection has already been carried out in special field clinics for pregnant women between June to October 2019. An interviewer-administered questionnaire, a self-completed dietary questionnaire and an examination checklist were used for data collection. In addition, all participants underwent complete blood count testing. Further investigations are being conducted for predicting the etiology of anaemia based on a developed algorithm (such as high-performance liquid chromatography [HPLC] and peripheral blood film analysis). Discussion: Being the largest study on anaemia during pregnancy in a single geographical area in Sri Lanka, this study will provide important clues about geographical clustering of anaemia cases with similar etiology, associated factors and etiologies which would help to develop interventions to improve the health of pregnant women in the area. The possibility of selection bias is a potential limitation associated with the study design.

scholarly journals Faktor Berhubungan dengan Rendahnya Kunjungan Antenatal pada Kontak Pertama Pemeriksaan Ibu Hamil (K-1)

2019 ◽  
Vol 2 (2) ◽  
pp. 162
Author(s):  
Moh. Rivandi Dengo ◽  
Idjrak Mohamad
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Family Support ◽  
Community Health Center ◽  
Cross Sectional Study ◽  
P Value ◽  
Sectional Study ◽  
Chi Square ◽  
Cross Sectional ◽  
Antenatal Visits

The coverage of Antenatal Care (ANC) visits in Gorontalo District during the last three years is as follows: the first visit of the pregnant women in 2015 reached 90%, the visit in the following year in 2016 decreased to 76%, and the visit in 2017 reached 89,86%. This research aims to find out the factors related to the decrease of Antenatal Care in accordance with the decrease in the Antenatal Care visits in the first contact of pregnant women checking K-1 in the working area of Community Health Center Bongomeme Gorontalo District in 2018. The population of the current research was all pregnant women listed in Kohort pregnant women book in the Community Health Center Bogomeme in 2018 there were 163 pregnant women participated. The research design used was a cross sectional study approach. The obtained data were subsequently examined using chi-square test by referring to p value < 0,005. The research results shown that the parity variable of the pregnancy has p value of 0,038, pregnant women knowledge has p value of 0,012, and pregnant women job has p value of 0,000. Thus, this variable has a parity of pregnancy, knowledge of pregnant women and occupation of pregnant women has a relationship with antenatal visits (K-1), while family support variables with p value of 0.478 means that this variable has no relationship with antenatal visits (K-1). The conclusion was the parity, pregnant women knowledge, and pregnant women occupation have the significant relationship with the antenatal care visits (K-1), while the family support has no significant relationship with antenatal visits (K-1). The pregnant women should maintain the pregnancy spacing, maintain the pregnancy health, and increase their knowledge.Cakupan kunjungan Antenatal Care (ANC) di Kabupaten Gorontalo selama tiga tahun terakhir adalah cakupan kunjungan pertama ibu hamil (K-1) tahun 2015 mencapai 90%, pada tahun berikutnya tahun 2016 terjadi penurunan yaitu 76% dan pada tahun 2017 mencapai 89,86%. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan rendahnya kunjungan Antenatal Care pada kontak pertama pemeriksaan ibu hamil K-1 pada Wilayah Kerja Puskesmas Bongomeme Kabupaten Gorontalo tahun 2018. Adapun populasi pada penelitian ini adalah seluruh ibu hamil tercatat di buku kohort ibu hamil Puskesmas Bongomeme tahun 2018 yaitu sebanyak 163 orang ibu hamil. Desain penelitian yang digunakan adalah pendekatan cross sectional study. Data yang diperoleh kemudian dilakukan uji statistic chi square dengan melihat nilai p value < 0,005. Hasil penelitian menunjukkan bahwa variable paritas kehamilan dengan nilai p value 0,038, pengetahuan ibu hamil nilai p value 0,012, dan pekerjaan ibu hamil nilai p value 0,000. Artinya variabel paritas kehamilan, pengetahuan ibu hamil dan pekerjaan ibu hamil memiliki hubungan dengan kunjungan antenatal (K-1). Sedangkan variabel dukungan keluarga nilai p value 0,478 ini berarti variabel dukungan keluarga tidak memiliki hubungan dengan kunjungan antenatal (K-1). Disimpulkan bahwa paritas, pengetahuan ibu, pekerjaan ibu ada hubungan yang signifikan dengan kunjungan antenatal K-I, sedangkan dukungan keluarga tidak memiliki hubungan yang signifikan dengan kunjungan antenatal (K-I). Ibu hamil agar lebih menjaga jarak kehamilan, menjaga kesehatan kehamilan, meningkatkan pengetahuan ibu hamil.

scholarly journals HUBUNGAN LAMANYA PEMBERIAN MAGNESIUM SULFATE PADA PASIEN PEB DAN EKLAMPSIA DENGAN KEJADIAN HIPERMAGNESIUM DI RSUP DR. M. DJAMIL PADANG

2018 ◽  
Vol 2 (1) ◽  
pp. 21-25
Author(s):  
Mayuliani Mayuliani ◽  
Dovy Djanas
Keyword(s):  
Pregnant Women ◽  
Magnesium Sulfate ◽  
Cross Sectional Study ◽  
Research Data ◽  
Severe Preeclampsia ◽  
Sectional Study ◽  
Inclusion Criteria ◽  
Chi Square ◽  
Cross Sectional ◽  
The Relationship

Objective :To find out the relationship between the duration of MgS04 administration in severe preeclampsia patients and eclampsia with the incidence of hypermagnesium.Method :This study is a comparative observational study using a cross sectional study design. The study was conducted in the medical record of Dr.M.Djamil Padang Hospital during the period January 1, 2016 to August 31, 2017 of pregnant women with severe preeclampsia and eclampsia, found 30 study subjects who met the inclusion criteria. Furthermore, data is recorded in a research form that has been provided, then carried out research data processing. Statistical analysis to assess significance using the chi-square test.Results : Magnesium levels increased in pregnant women with severe preeclampsia and eclampsia by 21 correspondents. Increased Magnesium levels in patients with severe preeclampsia and eclampsia who received MgS04 treatment for 48 hours by 16 correspondents (84.2%) and 5 correspondents with MgS04 administration for 24 hours.Conclusion : There is a significant relationship between the duration of Magnesium Sulfate with the incidence of hyperpermagnesium in patients with severe preeclampsia and eclampsia. Keywords: severe preeclampsia, eclampsia, magnesium sulfate, magnesium levels

scholarly journals A cross sectional study of nutritional status among a group of school children in relation with gingivitis and dental caries severity

2016 ◽  
Vol 1 (3) ◽  
pp. 150
Author(s):  
Harun Achmad ◽  
Andi M. Adam ◽  
Anni Satria
Keyword(s):  
Dental Caries ◽  
Nutritional Status ◽  
School Children ◽  
Dietary Habits ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Ideal Weight ◽  
Chi Square ◽  
Cross Sectional ◽  
Chi Square Test

To determine nutritional status among a school children of Barru Regency, South Sulawesi, Indonesia, in relation with gingivitis and dental caries severity. Cross-sectional study. A total of 127 school children in the age range of 9-12 years from Barru Regency were included in this study as a sample of simple random sampling. Nutritional status of children (BMI index), degree of gingival inflammation (using chi-square test statistic), and missing teeth (DMF-T index) were recorded. Additional information was collected using a questionnaire survey regarding knowledge about dental health, dietary habits, and oral health behaviors. The data were processed using the program Statistical Package for the Social Sciences (SPSS). A group of who severe underweight (102 children), had higher odds for mild gingivitis (GI 79.4%) than others group of who has an ideal weight (16 children), had mild gingivitis (GI 62.5%). Children, who severe underweight, had higher odds for moderate caries (38.2%) than others group of who has an ideal weight, had moderate caries (18.8%). Based on chi-square test, there are correlation of nutritional status and dental caries severity (p=0.000<p=0.05). There is a relationship of nutritional status with gingivitis and dental caries severity among a school children.

scholarly journals Serum Magnesium Levels among Pregnant Women with and without Complications: A Cross-sectional Study

2020 ◽  
Author(s):  
Santhini Gopalakrishnan Sethulekshmi ◽  
S Sumathy ◽  
Banani Dutta
Keyword(s):  
Pregnant Women ◽  
Magnesium Deficiency ◽  
Serum Magnesium ◽  
First Trimester ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Significant Difference ◽  
History Of ◽  
Student’S T

Introduction: Pregnancy is a period that is characterised by remarkable physiological changes which are needed to support the growing fetus. Micronutrients play a crucial role in the maintenance of pregnancy. Among the micronutrients, magnesium has got ample amount of clinical relevance to pregnancy. Magnesium deficiency has been associated with reproductive risk during pregnancy such as anaemia, pre-eclampsia, eclampsia, fetal growth retardation, preterm labour, low intrauterine growth rate and leg cramps. Aim: To find out whether there was significant difference in the magnesium levels among pregnant women with and without pregnancy related complications and also to find out whether the magnesium levels differed significantly among the three trimesters. Materials and Methods: This was a cross-sectional study done among 240 pregnant patients from different trimesters attending the Obstetrics and Gynaecology Outpatient Department. Out of them 164 women had complications like pre-eclampsia, Gestational Diabetes Mellitus, leg cramps and history of abortions. Demographic details were obtained from all the women. BMI was calculated for each subject using the formula BMI=weight(kg)/height(m2). Haemoglobin was assessed in all samples using cyanmethaemoglobin method. Magnesium levels were analysed in the all samples using automated analyser in the Biochemistry laboratory. Student’s t-test was used to compare the levels of magnesium among the groups with and without complications. ANOVA test was used to compare the three trimesters. Results: The pregnant women were divided into three groups based on the different trimesters in which the samples were taken. Magnesium levels among the women in the first trimester were (2.96±0.83) second trimester (2.99±1.48) and third trimester (3.05±1.48) respectively. Women with previous abortions were found to have less magnesium levels (2.71) compared to women without a history of abortion (3.11) and value was found to be statistically significant (p<0.007) and magnesium levels among vegetarians (2.45) were lower than non vegetarians (3.08) and it was found to be statistical significant (p<0.013). There was no significant difference in the magnesium levels among pregnant women with complications and those without complications. Conclusion: The study shows the importance of maintaining the magnesium levels among pregnant women. There was no difference in the magnesium levels among the three trimesters. Study also points out the influence of parity, diet and occupation of pregnant women on the levels of magnesium.

scholarly journals A Cross-Sectional Study to Assess Nutritional Profile of Pregnant Women Diagnosed with Hypothyroidism

2021 ◽  
Vol 11 (8) ◽  
pp. 173-179
Author(s):  
Soujanya Devarmani ◽  
Harpreet Kour ◽  
Mubashir B A
Keyword(s):  
Pregnant Women ◽  
First Trimester ◽  
Cross Sectional Study ◽  
Endocrine Gland ◽  
Sectional Study ◽  
Demographic Information ◽  
Eligibility Criteria ◽  
Cross Sectional ◽  
Dietary Recall ◽  
Nutritional Profile

Thyroid is an important endocrine gland, during first trimester enlargement of gland occurs and also increases the requirements of iodine. During this period insufficient intake of iodine results in hypothyroidism. As per recent research, prevalence of hypothyroidism has been increased in pregnant women. So, the cross-sectional study was conducted to assess nutritional profile of pregnant women diagnosed with hypothyroidism. Women were enrolled in the study as per eligibility criteria. Demographic information, biochemical parameters, dietary questions, 24-hour dietary recall and food frequency of pregnant women were evaluated. Our study resulted that pregnant woman were micronutrient deficient due to inadequate of nutrients in their diet. Also, this study supported that iron deficiency is associated with iodine deficiency which causes hypothyroidism. Key words: Pregnant women, Nutritional status, Dietary intake, Hypothyroidism, Anemia.

scholarly journals 3rd TRIMESTER OF PREGNANCY;

2014 ◽  
Vol 21 (06) ◽  
pp. 1113-1116
Author(s):  
Nasira Naseem ◽  
Ijaz-Ul-Haque Taseer ◽  
Sohail Safdar
Keyword(s):  
Blood Transfusion ◽  
Pregnant Women ◽  
Low Income ◽  
Dietary Habits ◽  
Multiple Pregnancy ◽  
Well Being ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
History Of

Objective: To see the frequency of anemia in pregnant ladies and its possible outcomes. Study design: Descriptive cross sectional study. Setting: Fatima Jinnah Women Hospital, Multan. Duration of study: Six months. Material and method: This prospective cross sectional study was conducted at Gynae and Obst. OPD at Fatima Jinnah Women Hospital, Multan. Non probability convenient sampling technique was used. All the pregnant women between 20-35 years irrespective of gestational age or any concurrent illness having parity upto 5 were registered for the study after getting written consent for participation. The pregnant ladies were evaluated by asking history of blood loss, parity, multiple pregnancy, worm infestation, use of NSAIDS and blood transfusion. They were especially asked about dietary habits which were rated as good, average and poor. Their socio economic status was assessed and was placed into high, middle and low income groups. Blood samples were drawn for blood counts and hemoglobin estimation in all the women presenting at hospital. Reflotron photometer, Roche Diagnostic was used for the blood testing. A cut off value of< 11 g/dl irrespective of duration of pregnancy was used for anemia. Peripheral blood film was examined for RBC morphology. Mean corpuscular volume (MCV) was used to categorize into micorcytic (< 76fl), macrocytic (>98fl) and normocytic (78-98fl). Fetal well being was evaluated by serial abdominal ultrasounds. Results: Three hundred pregnant women attending Gyne and Obst. OPD, Fatima Jinnah Women Hospital, Multan, were registered according to the study protocol. The duration of the study was 6 months. Maternal age was between 25-35 years. 86 % women were multiparous, 79% women presented during 3rd trimester, 15% during the 2nd trimester and 6% during 1st trimester. Thirty eight percent women had hemoglobin 8-9.9 g/dl, 48% had from 7-7.9 g/dl and 10%were falling between 5-7 g/dl. Eighty eight percent had microcytic hypochromic anemia, 12% with dimorphic picture and 4% were having low MCV and MCH but normal MCHC and these were referred for hemoglobin electrophoresis. Fifty eight percent had monthly income 2-4 thousands rupees and only 10% were earning 4-10 thousands per month. Seventy eight percent had poor diet and 22% had an average and no women were fit into the criteria for good diet. History of breast feeding was positive in 92% of the women. History of use of iron supplement was also asked, 28% had used various preparations of iron and folate for a variable period from 1-4 months, 72% never used hematinic supplements. History of previous blood transfusion during pregnancy and labour was present in 16% of the women. Three percent had fetal growth retardation. Conclusions: Prevalence of anemia during 3rd trimester of pregnancy in is high our society. It can have significant effects on maternal and fetal out come. It is a preventable cause which can be treated easily. Poverty and lack of education are the most important causes of anemia during pregnancy.

scholarly journals The Association between Maternal Age and Gravidity and the Event of Gravidarum Emesis in Kupang, East Nusa Tenggara

2020 ◽  
Author(s):  
Dina Melanieka Sintikhe Henukh ◽  
◽  
Siti Nur Asyah ◽  
Jamillah Ahmad ◽  
◽  
...  
Keyword(s):  
Pregnant Women ◽  
Maternal Age ◽  
Community Health Center ◽  
First Trimester ◽  
Cross Sectional Study ◽  
Hormonal Changes ◽  
Chi Square ◽  
Study Program ◽  
Cross Sectional ◽  
Independent Variables

Background: Emesis gravidarum or better known as morning sickness is a symptom of nausea which is usually accompanied by vomiting which generally occurs in early pregnancy, usually in the first trimester. This condition is generally experienced by more than half of pregnant women due to hormonal changes. This study aimed to analyze the association between maternal age and gravidity and the event of gravidarum emesis in Kupang, East Nusa Tenggara. Subjects and Method: This was a cross-sectional study conducted at the Tenau Auxiliary Community Health Center, Kupang City, East Nusa Tenggara, from February to June 2019. Total of 60 pregnant women were enrolled in this study. The independent variables were maternal age and gravidity. The dependent variable was emesis gravidarum. The data were collected using a questionnaire and analyzed using the Chi-Square. Results: Total of 68.3% of pregnant women were experienced emesis. 92.7% aged 20-35 years and 7.3% aged <20 years. 84.2% of pregnant women did not experience emesis aged 20-35 years and aged> 35 years were 15.8%. Most of the pregnant women who experienced emesis were primigravida (51.2%) and multigravidas (48.8%). 84.2% of mothers did not experience multigravida emesis and did not experience primigravidas emesis (15.8%), and they were statistically significant. Conclusion: Maternal age and gravidity are positively relate to the incidence of emesis gravidarum among pregnant women. Keywords: age, gravidity, emesis gravidarum Correspondence: Dina Melanieka Sintikhe Henukh. Study Program of Midwifery, Universitas Citra Bangsa, Kupang, East Nusa Tenggara. Jl. Bhakti Warga 34, East Nusa Tenggara. Email: [email protected]. Mobile +6285238629495 DOI: https://doi.org/10.26911/the7thicph.03.01

scholarly journals Dukungan Suami Meningkatkan Kunjungan Pemeriksaan K4 Ibu Hamil

2020 ◽  
Vol 5 (2) ◽  
pp. 104-116
Author(s):  
Eva Nurhidayati ◽  
Emdat Suprayitno
Keyword(s):  
Pregnant Women ◽  
Health Workers ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Third Trimester ◽  
Chi Square ◽  
Cross Sectional ◽  
Study Approach ◽  
Chi Square Test ◽  
The Relationship

Background: K4 is the fourth prenatal check-up visit for health workers to obtain antenatal care according to standards and to detect complications as early as possible during pregnancy. The K4 coverage in Batang-Batang Daya village, the working area of ​​the Batang-Batang Puskesmas is still below the target in 2018. The purpose of this study was to determine the relationship between husband's support and the decision of pregnant women in carrying out K4 examinations. Methods: The design of this study is analytic correlational with a cross-sectional study approach, the population of pregnant women in the third trimester of pregnancy in Batang-Batang Daya Village in 2019 was 27 respondents, using total sampling techniques, husband's support data was collected using a valid and reliable questionnaire. K4 examination data used a checklist in the KIA book, and the statistical test used was Chi-Square with an expected value of less than 5. Result: The results showed that most of the pregnant women received support from their husbands as many as 20 people (74.1). Most of the pregnant women underwent a K4 examination (4th pregnancy visit), as many as 20 people (74.1%). The analysis result from the Chi-Square test shows the value (ρ) = 0.000. Conclusion: It can be concluded that the husband's support is related to the decision by pregnant women to carry out K4 examinations. Husbands should always provide support to their wives to carry out routine checks so that pregnant women are motivated to carry out K4 examinations, and are more confident about carrying out their pregnancy.

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