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

2021 ◽  
Vol 10 (1) ◽  
pp. 139-145
Author(s):  
Mary Stokes ◽  
Amber Olson ◽  
Mtisunge Chan'gombe ◽  
Bakari Rajab ◽  
Isabel Janmey ◽  
...  

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.

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4675-4675
Author(s):  
Nikil V Moodabagil ◽  
Sarah Scheiderich Osmundson ◽  
Christian Cepeda ◽  
Colleen Morton

Background/Objective: The World Health Organization, Centers for Disease Control, and the American College of Obstetricians and Gynecologists recommend screening for anemia in pregnancy. While screening is commonly performed in the second half of pregnancy to prevent anemia at delivery, few guidelines specify a gestational age when screening should occur. Our primary study objective was to examine whether gestational age (GA) at anemia diagnosis is associated with anemia at delivery. Secondarily, as Tennessee is one of 17 states with statues requiring third trimester HIV screening, we also assessed whether bundling of common screening labs, especially state-mandated third trimester HIV screening, is associated with later anemia screening in pregnancy. Study Design: We performed a retrospective cohort study of all outpatient pregnant women who had a CBC done at >=24 weeks, delivered at >= 32 weeks, and had a CBC within 7 days of delivery between 1/1/19 and 1/31/19. Anemia was defined as a hemoglobin (hg) <10.5g/dL between 24-27 weeks and <11g/dL at >=28 weeks. The primary exposure was gestational age when anemia was first diagnosed. Relevant covariates included maternal age, race/ethnicity, and comorbidities associated with anemia such as hemoglobinopathies and malabsorptive disorders. The primary outcome was anemia at delivery and secondary outcome was mean Hg at delivery. Anemia screening was defined as the first CBC performed >=24 weeks and anemia diagnosis was defined by the earliest GA at >= 24 weeks when anemia was diagnosed. Bundling of screening tests was defined as performing HIV and/or glucose tolerance testing (GTT) on the same day as the CBC versus testing on different days. We constructed logistic and linear regression models to examine the association between both anemia at delivery and hg at delivery, and gestational age of anemia diagnosis, adjusted for covariates. Results: Of 208 women meeting inclusion criteria, 53 (26%) women were anemic at delivery with a mean Hg of 10.0+1.0 g/dL. Later anemia diagnosis (in weeks) was associated both an increased odds for anemia at delivery (aOR 1.06, 95% CI 1.04-1.09) and a decreased Hg level at delivery. Specifically, each week later that anemia was diagnosed resulted in a 0.04 decrease in Hg at delivery (-0.04, 95% CI -0.06 to -0.03). These findings were unchanged after adjusting for maternal age, race, and comorbidities. The timing of anemia screening and frequencies of anemia are displayed in Figure 1. The majority (58%) of anemia screening occurred between 28-31 weeks and anemia screening was frequently done either in conjunction with HIV (73%), GTT (36%), or both (29%). Anemia screening was more likely to occur in conjunction with HIV screening at 28-31 weeks (OR 3.47, 95% CI 1.39-8.63) compared to 24-28 weeks. Conclusions: One quarter of pregnant women are anemic at delivery, which is associated with later diagnosis of anemia in pregnancy. Bundling of screening labs, particularly state-mandated HIV testing, may impact timing of anemia screening in Tennessee, which suggests unintended consequences of well-intended health policies. Figure 1 Disclosures No relevant conflicts of interest to declare.


2019 ◽  
Vol 21 (1) ◽  
Author(s):  
Tabeta Seeiso ◽  
Mamutle M. Todd-Maja

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.


2020 ◽  
Vol 4 (3) ◽  
pp. 01-12
Author(s):  
Martin Malick

Background: Anemia in pregnancy is a major public health problem especially in Low and Middle-income countries (LMIC) including Ghana and is defined by the World Health Organization (WHO) as being present when the hemoglobin concentration in the peripheral blood is 11g/dl or less. In most African countries anemia in pregnancy occurs if the hemoglobin concentration falls below 10g/dl. Pregnant women are at a higher risk of developing anemia due to several factors such as hemodilution, nutritional factors, multiple gestation, socio-economic status and malaria infestation. Anemia in pregnancy is an important cause of maternal mortality and affects half of pregnant women worldwide; with 56% of West African pregnant women being anemic. The objective of this study is to assess the prevalence and identify the risk factors associated with anemia among pregnant women receiving antenatal care at the West Gonja Hospital (WGH) Methods: A cross-sectional was conducted with 136 pregnant women receiving antenatal care at the WGH between January 2017 to February 2018. Random sampling was used to select participants and data was collected using a structured questionnaire. Data was analyzed using the SPSS Version 24.0. Results: A total 71(52.2%) of the study population were anemic, while 65 (47.8%) were not anemic. 20(74.1%) of the 27 pregnant housewives were anemic, while 11(64.7%) of the pregnant farmers were anemic. 27 (96.4%) of the 28 pregnant women who took their iron/folate supplement only some few days were anemic. 12 (100%) of the 12 participants who took their iron/folate supplement a few times a week were anemic. 4 (80%) of the 5 participants who never took their iron/folate supplement were anemic. 21 (70%) of those who did not sleep under ITN were anemic. 33 (84.6%) of the 39 patients who were diagnosed with malaria were also anemic. 28 (87.5%) of the 32 participants who took only 2 meals a day were anemic. 27 (79.4%) of the 34 patients who took liver, beef, chicken and fish only twice weekly were anemic. 15 (88.2%) of the 17 patients who drank tea some days in a week were anemic. Conclusion: Although most of the pregnant women were adequately educated on the most relevant aspects of anemia in pregnancy, more than half of them were still anemic. Anemia was more prevalent among pregnant uneducated housewives with poor nutritional habits. All the pregnant sickle cell disease patients as well as those diagnosed with malaria were also anemic.


2021 ◽  
Vol 15 (1) ◽  
pp. 1-11
Author(s):  
Paul Mkandawire ◽  
Joseph Kangmennaang ◽  
Chad Walker ◽  
Roger Antabe ◽  
Kilian Atuoye ◽  
...  

Background/aims With coverage of antenatal care in sub-Saharan Africa approaching a universal level, attention is now turning to maximising the life-saving potential of antenatal care. This study assessed the gestational age at which pregnant mothers make their first antenatal visit in the context of high antenatal coverage in Lesotho. Methods For the purposes of this study, secondary data from the Demographic and Health Survey of 2014 was analysed. These data were collected in 2014, via an interviewer administered questionnaire. Survival analysis was applied to the data, using Stata SE 15 to compute time ratios that estimate time to first antenatal visit in Lesotho. Results Despite near universal coverage, only 24% of mothers start antenatal care before 12 weeks of gestation, as recommended by the World Health Organization. In addition, mothers with unwanted pregnancies are most likely to delay antenatal care until later in gestation, followed by mothers with mistimed pregnancies. Education, but not wealth, correlates with the start of antenatal care. Conclusions Having achieved near universal coverage, emphasising a prompt start and adherence to recommended visits could optimise the life-saving potential of antenatal care in Lesotho.


2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Saidi Mgata ◽  
Stephen Oswald Maluka

Abstract Background Antenatal care (ANC) provided by a trained health care provider is important for monitoring pregnancy thereby reducing potential risks for the mother and child during pregnancy and delivery. The World Health Organization (WHO) recommends at least four ANC visits to all pregnant women. While the proportion of women who attend at least one ANC in low-income countries is high, most pregnant women start their first ANC attendance very late. In Tanzania only 24% of pregnant women start their first ANC attendance before the fourth month of pregnancy. While factors for the utilization of antenatal care in general have been widely studied, there is paucity of studies on the factors affecting timing of the first ANC attendance. This study aimed to understand individual, community, and health system factors that lead to the delay in seeking ANC services among pregnant women in Ilala Municipal in Dar es Salaam region, Tanzania. Methods A qualitative exploratory study, using in-depth interviews with 20 pregnant women and five health care workers was conducted in three different health facilities in Dar es Salaam Tanzania. Thematic analysis approach was used to analyse the data. Results Individual perceptions of antenatal care, past experience with pregnancy, fear of pregnancy disclosure, and socio-cultural beliefs were the key individual and social factors for late ANC attendance. Shortage of trained health care workers, lack of spouse’s escort and health providers’ disrespect to pregnant women were the main health system barriers to early ANC attendance. Conclusions This study concludes that community members should be sensitized about the importance of early ANC attendance. Additionally, while spouse’s escort policy is important for promoting PMTCT, the interpretation of the policy should not solely be left to the health providers. District and regional health officials should provide correct interpretation of this policy.


Author(s):  
Kariman Ghazal ◽  
Janoub Khazaal ◽  
Janoub Khazaal ◽  
Rabih Chahine ◽  
Rabih Chahine ◽  
...  

Background: The primary aim of this study was to measure the prevalence of pregnant women who fast during Ramadan. The secondary outcome was their beliefs and motivations regarding fasting during Ramadan in addition to the consequences of fasting on maternal and neonatal outcome.Methods: A retrospective review of pregnant patients aged between 18-45 years who presented for antenatal care in the private clinic in Beirut, Lebanon during or after the month of Ramadan between 2010 and 2019 was performed.Results: A total of 502 pregnant patients were included in the study, of which 426 (84.9%) fasted during Ramadan and 76 (15.1%) did not fast at all. Of those who fasted, 148 (34.7%) fasted between 1 and 15 days while 278 (65.3%) fasted more than 15 days. Multiparous and non-Lebanese women had significantly higher rate of fasting compared to primiparous and Lebanese women. Adherence to fasting was associated with the spiritual environment that accompanies the month of Ramadan while non-adherence was mainly related to the fear from adverse effects on the mother and fetus. Fasting was not significantly associated with maternal complications or decreased neonatal birth weight.Conclusions: The present study showed that Ramadan fasting is important to pregnant Muslim women. This was manifested by the relatively high rate of fasting even in summer and spring seasons. Understanding the beliefs and motivations of pregnant women would provide valuable insight to physicians to appropriately advise these women without compromising the maternal or fetal well-being.


Author(s):  
Belarmina Reis-Muleva ◽  
Luciane Simões Duarte ◽  
Carla Marins Silva ◽  
Luciana Magnoni Reberte Gouveia ◽  
Ana Luiza Vilela Borges

Objective: 1)to assess the gestational age at the beginning of antenatal care and its covariates; 2)to assess the number of antenatal visits and its covariates; and 3)to identify the reasons for the late initiation of antenatal care and for attending less than four visits among postpartum women living in Nampula, Mozambique. Method: cross-sectional study conducted with 393 mothers who answered a structured instrument in face-to-face interviews. Logistic regression was used to analyze the covariates of having initiated antenatal care up to the 16thgestational week, having attended four or more antenatal visits, and reporting both situations simultaneously. Results: all postpartum women underwent antenatal care, but only 39.9% started it until the 16thgestational week, 49.1% attended four or more visits, and 34.1% reported both events. Having concluded high school (ORadj=1.99; 95%CI=1.19-3.31) or college (ORadj=3.87; 95%CI=1.47-10.18) were aspects associated with reporting both situations. The reasons for the late initiation of antenatal care and attending less than four visits were as follows: not finding it important to attend several visits, not having easy access to the health facility, not being aware about pregnancy, and not having a companion for the visits. Conclusion: the gestational age at the beginning of antenatal care and the number of antenatal visits are lower than the current recommendations in the country.


2019 ◽  
Vol 2 (2) ◽  
pp. 162
Author(s):  
Moh. Rivandi Dengo ◽  
Idjrak Mohamad

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.


2019 ◽  
Vol 3 (3S) ◽  
pp. 84-89
Author(s):  
Dian Furqani ◽  
Nuraerni Semagga

This study aims to see the factors that influence the quality of Antenatal Care in the City of Palopo; the type of design used is analytical descriptive with the Cross-Sectional Study approach. Samples from this study were all pregnant women based on 1, 2 and 3th-trimester pregnancy age, and 3 who were lived at the research location as many as 154 people who conducted inspection visits from January to March 2018. The results showed that the average age of the mother was 20 years. In the research statisticallly interconnected variables are maternal knowledge showed p-value (0.000). There are several variables have statistical significance, but there are differences in the percentage between the classification of each variabels as for the quality of Antenatal care associated with parity, maternal characteristics (age, education and occupation), antenatal care in each of the 1.2 trimester, and 3. Service access and economic welfare status, where each variable has a p-value> 0.005. The study expects that a health program should not look the quantity of maternal pregnancy visits, but pay attention to the examination checks received at each gestational age. We hope to encourage mothers to be more active in paying attention to the examinations that will be accepted based on their gestational age so that good health services and of recipients of services occur.


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