Antenatal care packages with reduced visits and perinatal mortality: a secondary analysis of the WHO antenatal care trial

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.

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Predictors of Anemia Among Pregnant Women of Under-privileged Ethnic Groups Attending Antenatal Care at Provincial Level Hospital of Province 2, Nepal

10.21203/rs.3.rs-57411/v1 ◽

2020 ◽

Author(s):

Umesh Kumar Yadav ◽

Prabesh Ghimire ◽

Archana Amatya ◽

Ashish Lamichhane

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

Ethnic Groups ◽

Dietary Diversity ◽

Secondary Level ◽

Provincial Level ◽

Lower Education ◽

Level Hospital ◽

Antenatal Visits ◽

Prevalence Of Anemia

Abstract Background: This study aims to determine the predictors of anemia among pregnant women of underprivileged ethnic groups attending antenatal care at provincial level hospital of Province 2.Methods: A hospital based cross-sectional study was carried out in Janakpur Provincial Hospital of Province 2, Southern Nepal. 287 pregnant women from underprivileged ethnic groups attending antenatal care were selected and interviewed. Face to face interviews using structured questionnaire was undertaken. Anemia status was assessed based on hemoglobin levels determined at the hospital’s laboratory. Bivariate and multiple logistic regression analyses were used to identify the predictors of anemia. Analyses were performed using IBM SPSS version 23 software.Results: The overall anemia prevalence in the study population was 66.9% (95% CI 61.1-72.3). The women from most under-privileged ethnic groups (Terai Dalit, Terai Janajati and Muslims) were twice more likely to be anemic than Madhesi women. Similarly, women having education lower than secondary level were about 3 times more likely to be anemic compared to those with secondary level or higher education. Women who had not completed four antenatal visits were twice more likely to be anemic than those completing all four visits. The odds of anemia were three times higher among pregnant women who had not taken deworming medication compared to their counterparts. Furthermore, women with inadequate dietary diversity were four times more likely to be anemic compared to women having adequate dietary diversity.Conclusions: The prevalence of anemia is a severe public health problem among the pregnant women of under-privileged ethnic groups in Province 2. Being Dalit, Janajati and Muslim, having lower education, less frequent antenatal visits, not receiving deworming medication and having inadequate dietary diversity are found to be the significant predictors. The present study highlights the need of improving the frequency of antenatal visits and coverage of deworming program in ethnic populations. Furthermore, promoting a dietary diversity at the household level would help lower the prevalence of anemia. The study findings also imply that the nutrition interventions to control anemia must target and reach pregnant women from most-marginalized ethnic groups and those with lower education.

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Effects of Electronic Technology Antenatal Care (E-ANC) on Midwives and Pregnant Women during the COVID-19 Period

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.4923 ◽

2020 ◽

Vol 8 (T1) ◽

pp. 115-121

Author(s):

Rosmala Nur ◽

St. Radiah ◽

Ulfa Aulia ◽

Rahma Rahma Dwilarasati ◽

Nurhaya S. Patui ◽

...

Keyword(s):

High Risk ◽

Reproductive Health ◽

Early Detection ◽

Antenatal Care ◽

Pregnant Women ◽

Sampling Technique ◽

Health Problems ◽

Electronic Technology ◽

The Impact ◽

Antenatal Visits

BACKGROUND: Pregnant women are considered as a risk group for exposure to COVID-19. Changes in their hormones and immune systems possibly influence their rate of infection by several viruses, including the coronavirus. This stresses the need to observe necessary precautions, by maintaining social distancing, avoiding crowds, and staying at home. Furthermore, the condition also influences the scope of pregnant women’s antenatal visits. AIM: The study aims to determine the effect of COVID-19 on antenatal visits by pregnant women. Furthermore, it seeks to ascertain the effect of electronic technology antenatal care (e-ANC) on the enhanced participation of midwives and pregnant women in antenatal care (ANC) (i.e., counseling, high-risk early detection on pregnancy, and monitoring of Hb and Fe tablets). Therefore, the impact COVID-19 on women’s reproductive health during the pandemic is also evaluated. METHODS: This research involved pre- and post-test experiments on 30 pregnant women and 20 midwives at areas around the Public Health Centers in Tinggiede and Marawola. A purposive sampling technique was adopted, and the results were analyzed using a paired t-test. RESULTS: The study showed discrepancies in the ANC visits of pregnant women before and after the COVID-19 lockdown period, with p < 0.00. Furthermore, there were also differences in midwife participation in counseling by p < 0.00, high-risk early detection on pregnancy by p < 0.001, Hb monitoring by p < 0.002, and provision of Fe tablets by p < 0.003 during the pandemic. Moreover, the pregnant women showed variations in the frequency of counseling by p < 0.00, high-risk early detection on pregnancy by p < 0.00, Hb monitoring by p < 0.002, and the provision of Fe tablets by p < 0.003. The e-ANC instigated a decline in reproductive health problems before (73.4%) and after (10.0%) the intervention. CONCLUSION: The lockdown period influences the low antenatal visits of pregnant women. However, e-ANC for midwives and pregnant women is developed as an alternative solution to improve ANC (i.e., counseling, high-risk early detection, and monitoring Hb and Fe tablets). This consequently has an effect on the reduced reproductive health problems of pregnant women during the pandemic.

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Reinventing the Pregnancy Wheel to Improve Pregnancy Dating and Antenatal Care Visits: A Pilot Randomized Trial in Malawi

International Journal of MCH and AIDS (IJMA) ◽

10.21106/ijma.474 ◽

2021 ◽

Vol 10 (1) ◽

pp. 139-145

Author(s):

Mary Stokes ◽

Amber Olson ◽

Mtisunge Chan'gombe ◽

Bakari Rajab ◽

Isabel Janmey ◽

...

Keyword(s):

Global Health ◽

Antenatal Care ◽

Pregnant Women ◽

Randomized Trial ◽

Gestational Age ◽

Age Dating ◽

World Health ◽

Secondary Outcome ◽

Time Of Presentation ◽

Antenatal Visits

Background and Objectives: The purpose of this study was to evaluate the feasibility of a customized, culturally sensitive pregnancy wheel given to pregnant women to improve gestational age dating accuracy at the time of delivery and to improve antenatal care attendance. Methods: This was a pilot randomized trial involving pregnant women presenting to a regional hospital in Lilongwe, Malawi. The primary outcome was accuracy of gestational age at the time of presentation to the hospital in labor. The secondary outcome was the number of antenatal visits. Results: At final analysis, 14 subjects were included in the pregnancy wheel (intervention) arm and 11 in the standard care arm. Fifty percent (n=7) of women in the intervention arm were accurately dated at the time of presentation for delivery, compared to only 9% (n=1) in the standard antenatal care arm (p=0.04). There was not a significant difference in the number of antenatal visits between the two study arms. No patients met the World Health Organization’s recommended eight antenatal care visits for prenatal care. Conclusion and Global Health Implications: The customized pregnancy wheel given to patients could improve gestational age dating accuracy, and as a result, clinical decision making. However, the barriers to greater antenatal care access are more complex and likely require a more complex solution. Significant attrition in this pilot trial limited statistical power, suggesting the need for future larger interventions. Accurate gestational dating requires access to ultrasonography and early antenatal care initiation, both of which are inadequate in Malawi. Although the customized pregnancy wheel did not improve antenatal care attendance, it improved gestational age dating accuracy in a pilot study at a central hospital in Lilongwe, Malawi. Copyright © 2021 Stokes et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

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Use of mobile phone for improvement in maternal health: a randomized control trial

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175260 ◽

2017 ◽

Vol 6 (12) ◽

pp. 5458 ◽

Cited By ~ 6

Author(s):

Vidyadhar B. Bangal ◽

Sai K. Borawake ◽

Satyajit P. Gavhane ◽

Kunal H. Aher

Keyword(s):

Maternal Health ◽

Antenatal Care ◽

Mobile Phone ◽

Pregnant Women ◽

Tetanus Toxoid ◽

Postnatal Care ◽

Intervention Group ◽

Randomized Control ◽

Antenatal Visits ◽

Tetanus Toxoid Immunization

Background: The rapid escalation of cellular network coverage and expansion of mobile phone usage has opened up a new way of deploying health services. The mobile app with message facilities help in imparting health education regarding nutrition, iron and folic acid prophylaxis, tetanus toxoid immunization, danger symptoms and signs during pregnancy etc. Present study aimed to improve maternal health and pregnancy outcome by optimum utilization of antenatal, natal and postnatal care services, with the use of mobile phone as a medium of communication between health care provider and community in rural area.Methods: The prospective randomized control study, with two hundred pregnant women each, coming for antenatal visit and having personal mobile phone facility, were randomly allocated to control and intervention group. Control group women received routine antenatal care and advice as per hospital protocol. In addition to routine care and advice, intervention group received mobile phone calls, as reminders about next visit and text messages (SMS) on important aspects of antenatal care at regular intervals. The primary outcome indicators of the study were percentage of pregnant women coming for at least four antenatal visits, percentage of institutional delivery and postnatal check-ups.Results: Women in the intervention group had significantly higher number of antenatal visits, consumption of iron tablets, tetanus toxoid immunization, institutional deliveries and postnatal check-ups as compared to the control group.Conclusions: In the present study, the mobile phone intervention, significantly increased the percentage of women receiving the recommended four antenatal visits and showed a trend towards more women receiving preventive health services. Study gathered good evidence that m-Health tools present an opportunity to influence behaviour change and ensure that women access prevention services, including antenatal, natal and postnatal care. Mobile technology, specifically SMS can be successfully used to extend health information services to pregnant women.

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Reproductive Health ◽

10.1186/1742-4755-10-19 ◽

2013 ◽

Vol 10 (1) ◽

Cited By ~ 56

Author(s):

Joshua P Vogel ◽

Ndema Abu Habib ◽

João Paulo Souza ◽

A Metin Gülmezoglu ◽

Therese Dowswell ◽

...

Keyword(s):

Antenatal Care ◽

Perinatal Mortality ◽

Secondary Analysis

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Factors Associated with Anemia among Pregnant Women of Underprivileged Ethnic Groups Attending Antenatal Care at Provincial Level Hospital of Province 2, Nepal

Anemia ◽

10.1155/2021/8847472 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Umesh Kumar Yadav ◽

Prabesh Ghimire ◽

Archana Amatya ◽

Ashish Lamichhane

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

Ethnic Groups ◽

Dietary Diversity ◽

Secondary Level ◽

Factors Associated ◽

Lower Education ◽

Level Hospital ◽

Antenatal Visits ◽

Prevalence Of Anemia

Background. This study aims at determining the factors associated with anemia among pregnant women of underprivileged ethnic groups attending antenatal care at the provincial level hospital of Province 2. Methods. A hospital-based cross-sectional study was carried out in Janakpur Provincial Hospital of Province 2, Southern Nepal. 287 pregnant women from underprivileged ethnic groups attending antenatal care were selected and interviewed. Face-to-face interviews using a structured questionnaire were undertaken. Anemia status was assessed based on hemoglobin levels determined at the hospital’s laboratory. Bivariate and multiple logistic regression analyses were used to identify the factors associated with anemia. Analyses were performed using IBM SPSS version 23 software. Results. The overall anemia prevalence in the study population was 66.9% (95% CI, 61.1–72.3). The women from most underprivileged ethnic groups (Terai Dalit, Terai Janajati, and Muslims) were twice more likely to be anemic than Madhesi women. Similarly, women having education lower than secondary level were about 3 times more likely to be anemic compared to those with secondary level or higher education. Women who had not completed four antenatal visits were twice more likely to be anemic than those completing all four visits. The odds of anemia were three times higher among pregnant women who had not taken deworming medication compared to their counterparts. Furthermore, women with inadequate dietary diversity were four times more likely to be anemic compared to women having adequate dietary diversity. Conclusions. The prevalence of anemia is a severe public health problem among pregnant women of underprivileged ethnic groups in Province 2. Being Dalit, Janajati, and Muslim, having lower education, less frequent antenatal visits, not receiving deworming medication, and having inadequate dietary diversity are found to be the significant factors. The present study highlights the need of improving the frequency of antenatal visits and coverage of deworming program in ethnic populations. Furthermore, promoting a dietary diversity at the household level would help lower the prevalence of anemia. The study findings also imply that the nutrition interventions to control anemia must target and reach pregnant women from the most-marginalized ethnic groups and those with lower education.

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The Costs of Alternative Types of Routine Antenatal Care for Low-Risk Women: Shared Care Vs Care by General Practitioners and Community Midwives

Journal of Health Services Research & Policy ◽

10.1177/135581969600100304 ◽

1996 ◽

Vol 1 (3) ◽

pp. 135-140 ◽

Cited By ~ 22

Author(s):

Julie Ratcliffe ◽

Mandy Ryan ◽

Janet Tucker

Keyword(s):

Health Service ◽

Antenatal Care ◽

Pregnant Women ◽

Controlled Trial ◽

Shared Care ◽

Low Risk ◽

Maternity Hospitals ◽

Routine Antenatal Care ◽

Antenatal Visits ◽

Health Service Costs

Objectives: To compare the costs to the health service, women and their families of routine antenatal care provided by either traditional obstetrician-led shared care or general practitioner (GP)/community midwife care. Method: A multicentre randomized controlled trial in 51 general practices linked to nine maternity hospitals in Scotland: 1667 low-risk pregnant women provided information on costs to the health service. 704 of these women provided information on non-health service costs. Results: GP/midwife antenatal care was found to cost statistically significantly less than shared care. This was the case for investigations carried out at routine antenatal visits (GP/midwife = £87.25, shared care = £91.15, P = 0.05), staffing costs at routine antenatal visits (GP/midwife = £127.76, shared care = £131.09, P = 0.001), and non-health service costs incurred by women and their companions (GP/midwife = £118.53, shared care = £133.49, P = 0.001). While non-routine care in the GP/midwife arm of the trial costs less than in the shared care arm, the difference was not statistically significant (GP/midwife = £83.74, shared care = £94.43, P = 0.46). The total societal cost of antenatal care was £417.28 per woman in the GP/midwife arm of the trial and £450.19 in the shared care arm of the trial. This difference was statistically significant ( P < 0.001). The application of sensitivity analysis did not change these results. Conclusions: GP/midwife antenatal care is a satisfactory option for low-risk pregnant women in Scotland provided that clinical outcomes and women's satisfaction are at least the same as those of women with shared care.

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Quantifying Pregnant Women’s Knowledge of Educational Components of Antenatal Care in Lesotho

Africa Journal of Nursing and Midwifery ◽

10.25159/2520-5293/4317 ◽

2019 ◽

Vol 21 (1) ◽

Author(s):

Tabeta Seeiso ◽

Mamutle M. Todd-Maja

Keyword(s):

Antenatal Care ◽

Maternal Mortality ◽

Pregnant Women ◽

Rural Areas ◽

Geographic Location ◽

Sub Saharan Africa ◽

World Health ◽

Cross Sectional ◽

Danger Signs ◽

In Pregnancy

Antenatal care (ANC) literacy is particularly important for pregnant women who need to make appropriate decisions for care during their pregnancy and childbirth. The link between inadequate health literacy on the educational components of ANC and maternal mortality in sub-Saharan Africa (SSA) is undisputable. Yet, little is known about the ANC literacy of pregnant women in SSA, with most studies inadequately assessing the four critical components of ANC literacy recommended by the World Health Organization, namely danger signs in pregnancy; true signs of labour; nutrition; and preparedness for childbirth. Lesotho, a country with one of the highest maternal mortality rates in SSA, is also underexplored in this research area. This cross-sectional study explored the levels of ANC literacy and the associated factors in 451 purposively sampled women in two districts in Lesotho using a structured questionnaire, making recourse to statistical principles. Overall, 16.4 per cent of the participants had grossly inadequate ANC literacy, while 79.8 per cent had marginal levels of such knowledge. The geographic location and level of education were the most significant predictors of ANC literacy, with the latter variable further subjected to post hoc margins test with the Bonferroni correction. The participants had the lowest scores on knowledge of danger signs in pregnancy and true signs of labour. Adequate ANC literacy is critical to reducing maternal mortality in Lesotho. Improving access to ANC education, particularly in rural areas, is recommended. This study also provides important recommendations critical to informing the national midwifery curriculum.

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EFFECTIVENESS OF USING MCH BOOKS AND MONSCA APPLICATIONS IN THE IMPLEMENTATION OF 14 T ANTENATAL SERVICE STANDARDS

Jurnal Riset Kesehatan Poltekkes Depkes Bandung ◽

10.34011/juriskesbdg.v12i1.870 ◽

2020 ◽

Vol 12 (1) ◽

pp. 68-73

Author(s):

Rahmawati Rahmawati ◽

Syarif Syafruddin ◽

Nontji Wena

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

Continuity Of Care ◽

Control Design ◽

Sampling Technique ◽

Limited Time ◽

Control Groups ◽

Post Test ◽

Service Standards

The component of antenatal care received by pregnant women is classified as incomplete because the implementation of standard pregnancy services is still using conventional methods. There are obstacles faced by midwives, such as the limited time in a recording, which has an impact on the declining quality of antenatal care standards. This research aims to compare the effectiveness of the use of KIA books and MONSCA applications in midwives in the application of the standard Antenatal service 14 T. This research was conducted in Puskesmas Tanete and Puskesmas Bontobangun Bulukumba District. The method used in the study is experimental quasi (pre-test post-test nonequivalent control design). Using a sample of midwives in this study, as many as 36 people were divided into two groups (18 intervention groups and 18 control groups). The sampling technique in this study used purposive sampling. Data were analyzed using the Mann-Whitney Test. The results showed that there was a difference in the effectiveness of using KIA books with MONSCA applications, MOSCA's applications were easier to use, faster, safer, and more accurate than KIA books. It can be concluded that the MONSCA application is more effective than KIA books. Key words: Effectiveness, Android-based Smart Continuity of Care application, KIA book, Antenatal service 14 T

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