Community-Based Improvements to Increase Identification of Pregnant Women and Promote Linkages to Antenatal and HIV Care in Mozambique

A Community Health System Strengthening model, which mobilizes communities by applying quality improvement, was used in 39 communities around 3 health centers in Gaza Province, Mozambique, to increase identification of pregnant women and support them to attend antenatal care (ANC). This article describes the process and results. Community group representatives formed a community improvement team to spread messages about the importance of ANC, identify pregnant women, link them to the facility, and follow up. Between March 2014 and February 2015, teams identified 2020 pregnant women. Antenatal care attendance increased at all 3 centers. One health center did an additional chart review and found that postintervention, women were enrolling in care earlier in pregnancy. There were no changes in HIV testing or treatment initiation for HIV-positive women. Community-led improvement initiatives play an important role in connecting pregnant women with services to receive testing and treatment to promote optimal health and prevent HIV transmission.

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Challenges in Assessing Outcomes among Infants of Pregnant HIV-Positive Women Receiving ART in Uganda

AIDS Research and Treatment ◽

10.1155/2017/3202737 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4

Author(s):

Barbara Castelnuovo ◽

Frank Mubiru ◽

Ivan Kalule ◽

Shadia Nakalema ◽

Agnes Kiragga

Keyword(s):

Clinical Trials ◽

Pregnant Women ◽

Median Time ◽

Hiv Transmission ◽

Cd4 Count ◽

Hiv Positive ◽

Hiv Positive Women

Since 2012, the WHO recommends lifelong ART with TDF+FTC/3TC+EFV for all HIV-positive pregnant and breastfeeding women (Option B-plus). In this analysis we describe the proportion of early and late transmission in mothers with high retention in Kampala, Uganda. We included 700 pregnant women from January 2012 to August 2014 with a follow-up extended to August 2016; the median age was 31 years (IQR: 26–35), 36.3% in WHO stage 3/4; median CD4 count was 447 cells/μL (IQR: 301–651) and 73.3% were already on ART for a median time of 28 (IQR: 10–57) months; 52% infants were male and median weight was 3.2 Kg (IQR: 2.5–3.5). Five hundred and sixty-five (80.7%) infants had at least one test for HIV; 22 (3.1%) infants died, all with unknown serostatus; 3 tested positive at week 6 and one additional at months 12 and 18. Two of the mothers of the 4 HIV-positive infants were ART-naïve at the time of pregnancy. We report very low documented HIV transmission comparable with those reported in clinical trials settings; however, demonstrating the efficacy of Option B-plus in terms of averted transmission in routine settings is challenging since high proportion of infants do not have documented HIV tests.

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The effects of ANC follow up on essential newborn care practices in east Africa: a systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-021-91821-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Erkihun Tadesse Amsalu ◽

Bereket Kefale ◽

Amare Muche ◽

Zinabu Fentaw ◽

Reta Dewau ◽

...

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

East Africa ◽

Meta Analysis ◽

Newborn Care ◽

Cochrane Library ◽

Care Practice ◽

Essential Newborn Care ◽

Newborn Care Practice

AbstractIn the situation of high maternal morbidity and mortality in Sub-Saharan Africa, less than 80% of pregnant women receive antenatal care services. To date, the overall effect of antenatal care (ANC) follow up on essential newborn practice have not been estimated in East Africa. Therefore, this study aims to identify the effect of ANC follow up on essential newborn care practice in East Africa. We reported this review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). We searched articles using PubMed, Cochrane library, African journal online (AJOL), and HINARI electronic databases as well as Google/Google scholar search engines. Heterogeneity and publication bias between studies were assessed using I2 test statistics and Egger’s significance test. Forest plots were used to present the findings. In this review, 27 studies containing 34,440 study participants were included. The pooled estimate of essential newborn care practice was 38% (95% CI 30.10–45.89) in the study area. Women who had one or more antenatal care follow up were about 3.71 times more likely practiced essential newborn care compared to women who had no ANC follow up [OR 3.71, 95% CI 2.35, 5.88]. Similarly, women who had four or more ANC follow up were 2.11 times more likely practiced essential newborn care compared to women who had less than four ANC follow up (OR 2.11, 95% CI 1.33, 3.35). Our study showed that the practice of ENBC was low in East Africa. Accordingly, those women who had more antenatal follow up were more likely practiced Essential newborn care. Thus, to improve the practice of essential newborn care more emphasis should be given on increasing antenatal care follow up of pregnant women in East Africa.

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Describing Point of Entry into Care and Being Lost to Program in a Cohort of HIV Positive Pregnant Women in a Large Urban Centre in Uganda

AIDS Research and Treatment ◽

10.1155/2017/3527563 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Rachel Musomba ◽

Frank Mubiru ◽

Shadia Nakalema ◽

Hope Mackline ◽

Ivan Kalule ◽

...

Keyword(s):

Pregnant Women ◽

Older Women ◽

First Trimester ◽

Hiv Positive ◽

Urban Centre ◽

Factors Associated ◽

Point Of Entry ◽

Art Initiation ◽

Hiv Positive Women

Introduction. We aim to describe the time of entry into care and factors associated with being lost to program (LTP) in pregnant women on Option B Plus in an integrated HIV and antenatal care (ANC) clinic in Uganda. Methods. We included all pregnant women enrolled into the integrated HIV-ANC clinic from January 2012 to 31st July 2014, while the follow up period extended up to October 30th 2015. LTP was defined as being out of care for ≥3 months. Results. Overall 856 women were included. Only 36.4% (86/236) of the women were enrolled in the first trimester. Overall 69 (8.1%) were LTP. In the multivariate analysis older women (HR: 0.80 per five-year increase, CI: 0.64–1.0, and P=0.060) and women on ART at the time of pregnancy (0.58, CI: 0.34–0.98, and P=0.040) were more likely not to be LTP. Among women already on ART at the time of pregnancy no factor was associated with LTP. Conclusion. Our results suggest the need for interventions to enhance prompt linkage of HIV positive women to HIV services for ART initiation and for increased retention particularly in young and ART naive women.

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Prevalence and Associated Factors of Self-Medication among Pregnant Women on Antenatal Care Follow-Up at University of Gondar Comprehensive Specialized Hospital in Gondar, Northwest Ethiopia: A Cross-Sectional Study

International Journal of Reproductive Medicine ◽

10.1155/2020/2936862 ◽

2020 ◽

Vol 2020 ◽

pp. 1-12

Author(s):

Faisel Dula Sema ◽

Deres Gezahegn Addis ◽

Eshetie Azezew Melese ◽

Demeke Dana Nassa ◽

Zemene Demelash Kifle

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

Previous History ◽

Cross Sectional Study ◽

Monthly Income ◽

Self Medication ◽

Cross Sectional ◽

Specialized Hospital ◽

History Of

Background. Self-medication is being prevalent throughout the globe. Although pregnant women are among the most vulnerable group of the population for drug-induced adverse effects on their fetus and themselves, many pregnant women use self-medication without adequate safety precautions. Objective. This study was aimed at assessing the prevalence and associated factors of self-medication among pregnant women on antenatal care follow-up at University of Gondar Comprehensive Specialized Hospital. Methods. A cross-sectional study was employed among 400 pregnant women attending antenatal care clinic at the University of Gondar Comprehensive Specialized Hospital between February 01 and May 30, 2019. A structured interviewer-administered questionnaire was used for data collection. Data were analyzed using SPSS® (IBM Corporation) version 22. Descriptive statistics were presented using frequency and proportion. Binary logistic regression was used to identify factors associated with self-medication with a 95% confidence level and p value of 0.05. Results. Among 400 respondents, the prevalence of self-medication during the current pregnancy was 44.8% (95% CI=40.5-50). Among all respondents (400), 38.0% (95% CI=33.3-42.8) and 12.5% (95% CI=9.5-15) used herbal and conventional medicine, respectively. Self-medication showed a significant association with a previous history of self-medication and monthly income. Conclusions. The prevalence of self-medication among pregnant women is considerably high. The previous history of self-medication and monthly income showed a significant association with self-medication. Awareness creation should be done for reproductive-age women on the potential risks of self-medication.

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1319. Events of Disengagement from HIV care and Subsequent Reengagement in a Kenyan Pastoralist Community: Frequency, Determinants, and Patient Views

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1182 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S476-S477

Author(s):

Paul Otieno Yonga ◽

Stephen Kiplimo Kalya ◽

Lutgarde Lynen ◽

Tom Decroo

Keyword(s):

Antiretroviral Therapy ◽

Hiv Transmission ◽

Hospital Admissions ◽

Hiv Care ◽

Engagement In Care ◽

Work Related ◽

Medication Side ◽

Competing Priorities ◽

Lost To Follow Up

Abstract Background Regular follow-up HIV-infected patients on antiretroviral therapy (ART) is vital to ensure viral suppression, thus reducing HIV transmission, and HIV-related morbidity and mortality. However, some patients have been reported to have events of disengagement from care with subsequent re-engagement in care, though knowledge on the magnitude and determinants of this phenomenon, particularly in pastoralist communities is scarce. Methods A mixed-methods study was carried out among HIV-infected patients on antiretroviral therapy (ART) follow-up between January 2014 and June 2017 at the Baringo County Referral Hospital, Kabarnet, Kenya. Records on their clinic attendance and laboratory follow-up were extracted, and those noted to have a recent event of disengagement from care who later re-engaged in care, were then purposively sampled for in-depth interviews. Results 342 patient records were analyzed, of which 48% (166/342) of the patients were noted to be active at the end of the study period, with 63.3% (105/166) of them noted to have one or more events of disengagement from care. Female patients, patients with baseline CD4 counts ≥200 cells/mm3, and patients with a low WHO stage category (I and II) were more likely to return to care after an experience of disengagement from HIV care (P < 0.05). Eight interviewee transcripts showed the following reported reasons for disengagement in care: long distances, stigma, work-related problems, medication side effects, competing priorities, perceived recovery of the health status, medication fatigue, and not being informed of their clinic return dates. Motivators for re-engagement in care included hospital admissions, fear of getting sick like their spouse, and phone reminders. Conclusion A vast majority of patients currently active in care experienced multiple events of disengagement from care. Thus, early identification of those who disengage from care is recommended, before they become lost to follow-up. Disclosures All authors: No reported disclosures.

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Association between Helicobacter pylori Infection and Occurrence of Anemia among Pregnant Women Attending Antenatal Care in Kulito Health Center, Halaba Zone, South Ethiopia, 2018

Anemia ◽

10.1155/2020/6574358 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Bahredin Abdella ◽

Mohammed Ibrahim ◽

Iyasu Tadesse ◽

Kalkidan Hassen ◽

Mekonnin Tesfa

Keyword(s):

Developing Countries ◽

Helicobacter Pylori ◽

Antenatal Care ◽

Pregnant Women ◽

Health Center ◽

Experimental Studies ◽

Third Trimester ◽

South Ethiopia ◽

The Third

Background. Anemia in pregnancy is defined as a hemoglobin (Hb) concentration of less than 11 grams (gm)/deciliter (dl) in venous blood. Globally, it affects 1.62 billion people. In developing countries, anemia is a major cause of maternal and child morbidity and mortality. Globally, anemia contributes to 20% of all maternal deaths. Nearly 50% of the world’s population is estimated to be infected with Helicobacter pylori (HP). High prevalence of HP among pregnant women was also reported in developing countries than developed ones. The association between HP infection and occurrence of anemia is not well known in Ethiopia. Therefore, the aim of this study was to determine the association between anemia and Helicobacter pylori infection among pregnant women attending antenatal care follow-up in Kulito Health Center, Halaba Zone, South Ethiopia. Methods. Institution-based cross-sectional study was employed. Systematic random sampling procedure was employed to select 236 pregnant women who attended antenatal care at Kulito Health Center. An interviewer-administered questionnaire supplemented by laboratory tests was used to obtain the data. The collected data were analyzed by using SPSS version 20.0. Results. The prevalence of anemia among antenatal care attendant pregnant women of Kulito Health Center was 27.5% with 36 (15.2%) of mild, 29 (12.3%) of moderate, and no severe cases of anemia. The overall prevalence of HP infection among study participants was found to be 129 (54.7%) (95% CI: 47.9–61.4). Factors significantly associated with anemia were presence of HP infection (AOR = 3.064, 95% CI: 1.336 7.027), low interpregnancy gap (AOR = 2.863, 95% CI: 1.245–6.582), being on the third trimester (AOR = 6.457; 95% CI: 1.276–32.729), and mid-upper arm circumference (MUAC) level <21 cm (AOR = 2.595, 95% CI: 1.044–6.450). Conclusion. This study revealed that anemia and HP infection were highly prevalent among pregnant women attending the antenatal follow-up clinic in Kulito Health Center. HP infection, low interpregnancy gap, being on the third trimester, and MUAC less than 21 cm were the independent factors associated with anemia. Recommendation. Pregnant women should be aware that anemia is a problem that can be prevented by early prevention and treatment of HP infection and undernutrition, using family planning to widen the interpregnancy gap. Further experimental studies are warranted to determine the cause and effect of the association between anemia and HP infection.

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Pregnant and Postpartum Women’s Experiences and Perspectives on the Acceptability and Feasibility of Copackaged Medicine for Antenatal Care and PMTCT in Lesotho

AIDS Research and Treatment ◽

10.1155/2015/435868 ◽

2015 ◽

Vol 2015 ◽

pp. 1-10

Author(s):

Michelle M. Gill ◽

Heather J. Hoffman ◽

Appolinaire Tiam ◽

Florence M. Mohai ◽

Majoalane Mokone ◽

...

Keyword(s):

Drug Delivery ◽

Antenatal Care ◽

Pregnant Women ◽

Cross Sectional Study ◽

Hiv Positive ◽

Structured Interviews ◽

Cross Sectional ◽

Hiv Positive Women ◽

Related Service ◽

Improved Design

Objective.To improve PMTCT and antenatal care-related service delivery, a pack with centrally prepackaged medicine was rolled out to all pregnant women in Lesotho in 2011. This study assessed acceptability and feasibility of this copackaging mechanism for drug delivery among pregnant and postpartum women.Methods.Acceptability and feasibility were assessed in a mixed method, cross-sectional study through structured interviews (SI) and semistructured interviews (SSI) conducted in 2012 and 2013.Results.290 HIV-negative women and 437 HIV-positive women (n=727) participated. Nearly all SI participants found prepackaged medicines acceptable, though modifications such as size reduction of the pack were suggested. Positive experiences included that the pack helped women take pills as instructed and contents promoted healthy pregnancies. Negative experiences included inadvertent pregnancy disclosure and discomfort carrying the pack in communities. Implementation was also feasible; 85.2% of SI participants reported adequate counseling time, though 37.8% felt pack use caused clinic delays. SSI participants reported improvement in service quality following pack introduction, due to more comprehensive counseling.Conclusions.A prepackaged drug delivery mechanism for ANC/PMTCT medicines was acceptable and feasible. Findings support continued use of this approach in Lesotho with improved design modifications to reflect the current PMTCT program of lifelong treatment for all HIV-positive pregnant women.

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Birth Preparedness and Complication Readiness Practice and Associated factors among Women Attending Antenatal care Follow up in Yirgalem General Hospital, Sidama Zone, Southern Ethiopia, 2019

10.21203/rs.3.rs-55574/v1 ◽

2020 ◽

Author(s):

Molalegn Mesele Gesese ◽

Walellign Anmut Tirfe

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

General Hospital ◽

Associated Factors ◽

Southern Ethiopia ◽

Birth Preparedness ◽

Complication Readiness ◽

Factors Associated ◽

History Of

Abstract Background: Birth preparedness and complication readiness is an approach that inspires pregnant women, their families and individuals to successfully design strategy for childbirths and deal with emergencies. In developing countries, world health organization estimates that more than 300 million women suffer from short-term and long-term complications related to pregnancy and child birth. In Ethiopia only 32% women have birth preparedness. The aim of this study is to assess practice and Associated factors of birth preparedness and complication readiness among Women Yirgalem General Hospital, Sidama Zone, Southern Ethiopia, 2019Methods: Facility based cross-sectional study was conducted from September 1st to 30th, 2019. A total of 422 pregnant women were randomly selected and interviewed by using pretested structured questionnaire. Data was entered by Epi-data version 3.1 and the analysis was done by SPSS version 21. Bivariate and multivariable logistic regression was performed to identify factors associated with birth preparedness and complication readiness.Result: From 422 study participants, 356(48.6%) (95% CI: 46.9%, 49.8%) have birth preparedness and complication readiness practice. Age of respondent ≥ 37 years (AOR =4.2, 95% C.I =1.23, 14.24) and between 25 to 30 (AOR=2.35, 95% C.I =1.1, 5.1); level of education College and above(AOR=5.59, 95% C.I 2.8, 11.2)and secondary school (AOR=9.5, 95% C.I 3.99-22); previous history of ANC follow up (AOR=4.33, 95% C.I = 2.46, 7.61) and history of birth at health facility (AOR=3.09, 95% C.I= 1.72, 5.56) where factors associated with birth preparedness and complication readiness practice. Conclusion: Relatively higher birth preparedness and complication readiness practice was observed in this study when compared with previous studies. Health extension workers and health care provider should encouraged women to actively utilize the health services and the governments with other stakeholders should works on antenatal care and institutional delivery by focusing on women those has no formal education.

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Anaemia and Associated Factors Among Pregnant Women Attending Antenatal Care Follow-Up at Yabello General Hospital Living in Pastoralist Borena Zone, Oromia, Ethiopia From From July to August, 2019

10.21203/rs.3.rs-33531/v1 ◽

2020 ◽

Author(s):

Godana Arero ◽

Kinde Asssefa

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

General Hospital ◽

Random Sampling ◽

Associated Factors ◽

Blood Film ◽

Stool Examination ◽

Excessive Bleeding ◽

Cross Sectional

Abstract Objective: The purpose of the study is to assess magnitude of anemia and associated factors among pregnant women attending antennal care follow-up at Yabello General Hospital in Pastoralist Borena Zone from July-August, 2019.Method: A hospital based cross-sectional study design was employed among 265 pregnant women attending antenatal care at Yabello General Hospital from June 17-August 16 2019. A systematic random sampling technique was used to select two hundreds sixty five study subjects. The first study subject was chosen randomly by simple random sampling method blindly picking one of two using pieces of papers named for the first two visitors. The sampling interval (K) calculated to be 2, and then, every second pregnant woman who attending antenatal care was recruited.Socio-demographic, maternal nutrition, information and obstetric and medical characteristics were assessed. Hemoglobin value, stool examination, HIV and syphilis test results were collected from their regular laboratory tests. Blood film was conducted for pregnant women who had signs and symptoms and whose hemoglobin value less than the established cut of values and data were analyzed using SPSS version 20.0 softwareResults: Magnitude of anemia with median hemoglobin value were (11.10g/dl ± 1.66); majority 46(63.9%) had mildly anemia, 24(33.3%) moderate and 2(2.8%) were severe anemia. Urban dwellers women (AOR, 95% CI: .18(.05-.64)), for those who had abortion before current pregnancy (AOR, 95% CI: 3.08(1.17-8.13)); coffee/tea drinking immediately after meal (AOR, 95% CI: 4.39(1.82-10.59), & who had excessive menstrual bleeding before current pregnancy were (AOR, 95% CI: 3.39(1.47-7.84)) & mid-upper arm circumference less than 23cm (AOR, 95% CI: 6.27(1.15-14.30)) were found to be independent predictors of anemia among pregnant women.Conclusion: Anemia in study area among pregnant women in Ethiopia was higher as compare with similar study elsewhere. Malnutrition, abortion, excessive bleeding & nutrition interaction with other inhibitors like coca cola, tea and coffee immediately after meals were independent predictors for anemia.

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Adherence to Combination Antiretroviral Therapy among Pregnant Women Enrolled in a HIV Prevention Program in Rural North-central Nigeria

International Journal of MCH and AIDS (IJMA) ◽

10.21106/ijma.327 ◽

2020 ◽

Vol 9 (1) ◽

pp. 81-92

Author(s):

Cedrina L. Calder ◽

Heather O ◽

Mohammad Tabatabai ◽

Celia J. Maxwell ◽

Salisha Marryshow ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Pregnant Women ◽

Hiv Transmission ◽

Secondary Analysis ◽

Self Report ◽

Hiv Positive ◽

Combination Antiretroviral Therapy ◽

North Central ◽

Hiv Positive Women ◽

Mother To Child

Objective: Adherence to combination antiretroviral therapy (ART) among pregnant women is essential to attaining the goal of eliminating mother-to-child HIV transmission. The objective of this study was to determine which factors affect adherence to ART among HIV-positive women enrolled in a large prevention of mother-to-child HIV transmission (PMTCT) trial in rural north-central Nigeria. Methods: The parent study included 372 HIV-positive pregnant women enrolled in a cluster-randomized control trial conducted at 12 health facilities in Nigeria between 2013 and 2015. This secondary analysis included HIV-positive women (and their infants) from the original trial with documented adherence data (n=210, 56.5%). The primary outcome was maternal adherence to ART, determined by self-report and based on the visual analogue scale (VAS) of a validated medication adherence tool. Participants with a VAS score of ? 95% were classified as adherent. We employed multivariate logistic regression to evaluate the predictors of maternal ART adherence in the study sample. Results: Approximately 61.0% of study participants (128/210) were adherent to ART. The majority of adherent participants (62.5%, 80/128) were enrolled in the trial intervention arm. The most common cited response for non-adherence was fear of status disclosure. Adherence to ART was associated with study arm (intervention arm vs. control arm, adjusted Odds Ratio (aOR) [95% CI]: 16.95 [5.30-54.23]), maternal ethnicity (Gwari vs. Other, aOR = 0.13 [0.05-0.38]), and partner HIV status (HIV-positive vs. unknown, aOR = 3.14 [1.22-8.07]). Conclusion and Global Health Implications: Adherence to ART among a cohort of pregnant women enrolled in a PMTCT trial in rural North-Central Nigeria was associated with trial arm, maternal self- reported ethnicity, and partner

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