scholarly journals “Taking Care of Your Pregnancy”: A mixed-methods study of group antenatal care in Kakamega County, Kenya

2021 ◽  
Author(s):  
Aleefia Somji ◽  
Kate Ramsey ◽  
Sean Dryer ◽  
Fredrick Makokha ◽  
Constance Ambasa ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Antenatal Care ◽  
Health Workers ◽  
Wait Times ◽  
Health Providers ◽  
Healthy Behaviors ◽  
Danger Signs ◽  
Intention To Treat ◽  
Experience Of Care ◽  
Time Diaries

Abstract Background Traditional antenatal care (ANC) models often do not meet women’s needs for information, counseling, and support, resulting in gaps in quality and coverage. Group ANC (GANC) provides an alternative, person-centered approach where pregnant women of similar gestational age meet with the same health provider for facilitated discussion. There are few studies that show associations between GANC and various outcomes. Methods We used mixed methods to evaluate a contextualized GANC model (Lea Mimba Pregnancy Clubs) and to understand implementation experiences at six health facilities in Kakamega County, Kenya. Between April 2018 and January 2019, we tracked 1,652 women who were assigned to 162 GANC cohorts to assess ANC retention. Using an intention-to-treat approach, we conducted baseline (N = 112) and endline surveys (N = 360) with women attending immunization visits to assess outcomes and used time diaries to assess wait times. At endline, we conducted 29 in-depth interviews (IDIs) and three focus group discussions with women who were currently and previously participating in GANC, and 15 IDIs with stakeholders. Results GANC was associated with enhanced social support, with some evidence for improved knowledge, adoption of healthy behaviors, enhanced self-efficacy, and improved experience of care. Quantitatively, we found strong associations between GANC and knowledge of danger signs, women who shared their feelings with other women, knowledge and competence of health workers, respect shown by ANC providers, overall quality of care, and birth preparations; as well as an improvement in ANC retention. No changes were seen in knowledge of positive behaviors, empowerment, several aspects related to women’s experience of care, ANC retention, early initiation of ANC, and other healthy behaviors. Qualitatively, women and stakeholders noted improved interactions between health providers and women, improved counseling, increased feelings of empowerment to ask questions and speak freely, and strengthened social networks and enhanced social cohesion among women. Both wait times and counseling times increased in GANC compared to traditional ANC. Conclusions This is one of the few mixed-methods studies evaluating GANC and offers new measures for experience of care, empowerment, and adoption of healthy behaviors. While more research is required, GANC holds promise for enhancing women’s experiences during pregnancy. Modifications are needed for sustainability and scalability.

scholarly journals “Taking Care of Your Pregnancy”: A Mixed-Methods Study of Group Antenatal Care in Kakamega County, Kenya

2020 ◽  
Author(s):  
Aleefia Somji ◽  
Kate Ramsey ◽  
Sean Dryer ◽  
Fredrick Makokha ◽  
Constance Ambasa ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Antenatal Care ◽  
Health Workers ◽  
Wait Times ◽  
Health Providers ◽  
Healthy Behaviors ◽  
Danger Signs ◽  
Intention To Treat ◽  
Experience Of Care ◽  
Time Diaries

Abstract Background: Traditional antenatal care (ANC) models often do not meet women’s needs for information, counseling, and support, resulting in gaps in quality and coverage. Group ANC (GANC) provides an alternative, person-centered approach where pregnant women of similar gestational age meet with the same health provider for facilitated discussion. There are few studies that show associations between GANC and various outcomes. Methods: We used mixed methods to evaluate a contextualized GANC model (Lea Mimba Pregnancy Clubs) and to understand implementation experiences at six health facilities in Kakamega County, Kenya. Between April 2018 and January 2019, we tracked 1,652 women who were assigned to 162 GANC cohorts to assess ANC retention. Using an intention-to-treat approach, we conducted baseline (N = 112) and endline surveys (N = 360) with women attending immunization visits to assess outcomes and used time diaries to assess wait times. At endline, we conducted 29 in-depth interviews (IDIs) and three focus group discussions with women who were currently and previously participating in GANC, and 15 IDIs with stakeholders.Results: GANC was associated with enhanced social support, with some evidence for improved knowledge, adoption of healthy behaviors, enhanced self-efficacy, and improved experience of care. Quantitatively, we found strong associations with knowledge of danger signs, women who shared their feelings with other women, knowledge and competence of health workers, respect shown by ANC providers, overall quality of care, and birth preparations. No changes were seen in knowledge of positive behaviors, empowerment, several aspects of the experience of care, ANC retention, early ANC, and other healthy behaviors. Qualitatively, women and stakeholders noted improvements in interactions between health providers and women, improved counseling, increased feelings of empowerment to ask questions and speak freely, and strengthened social networks and enhanced social cohesion among women. Both wait times and counseling times increased in GANC compared to traditional ANC.Conclusions: This is one of the few mixed-methods studies evaluating GANC and offers new measures for experience of care, empowerment, and adoption of healthy behaviors. While more research is required, GANC holds promise for enhancing women’s experiences during pregnancy. Modifications are needed for sustainability and scalability.

The Effect of Counselling Intervention during Antenatal Care on the Knowledge and Attitude about Danger Signs in Pregnancy: A Cross-Sectional Study in Takalar Regency -

2020 ◽  
Vol 10 (2) ◽  
pp. 51-55
Author(s):  
Nurhikmah ◽  
Tahir Abdullah ◽  
Stang ◽  
Suriah ◽  
Andi Imam Arundhana ◽  
...  
Keyword(s):  
Health Service ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Community Health ◽  
Health Workers ◽  
Community Health Service ◽  
Cross Sectional ◽  
Danger Signs ◽  
Knowledge And Attitude ◽  
In Pregnancy

Objective: This study was to examine the effects of counselling delivered during antenatal care on the knowledge and attitudes of pregnant women about danger signs in pregnancy.Methods: This was a pre-experimental design using one group pre- and post-test only. This study was conducted in Takalar, specifically within Sanrobone Community Health Service working area. Takalar is located in South Sulawesi Province Indonesia and this area is coastal with the majority of people working as a fisherman. Participants of this study were pregnant women living in the villages which are included in the working area of Sanrobone Community Health Service.Results: The study shows that counselling improved knowledge and attitude of pregnant women about danger signs in pregnancy (p=0.011 and p=0.025, respectively). The number of pregnant women with good knowledge and positive attitude increased after the intervention (43.8% vs 93.8%, 62.5% vs 93.8%, respectively).Conclusions: In can be concluded that intervention by means of counselling can improve the knowledge and attitude of pregnant women about danger signs in pregnancy. Therefore, it is important to implement the counselling program delivered by health workers in Community Health Service in order to mitigate the risk of maternal mortality.

scholarly journals Men perspectives on attending antenatal care visits together with their pregnant partners in Misungwi district, rural Tanzania: a qualitative study

2020 ◽  
Author(s):  
Maendeleo Boniphace ◽  
Dismas Matovelo ◽  
Rose Laisser ◽  
Hadija Swai ◽  
Victoria Yohana ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Health Workers ◽  
Cultural Norms ◽  
Health Providers ◽  
Group Discussions ◽  
Individual Interviews ◽  
Men 2 ◽  
Rural Tanzania ◽  
Expectant Fathers ◽  
And Gender

Abstract Background: Mens’attendance with their pregnant partners at facility-based antenatal care (ANC) visits is important for maternal and child health and gender equality yet remains uncommon in parts of rural Tanzania. This study examined men’s perspectives on attending ANC with their pregnant partners in Misungwi District, Tanzania.Methods: Twelve individual interviews and five focus group discussions were conducted using semi-structured questionnaires with fathers, expectant fathers, and in-depth interviews were done to health providers, volunteer community health workers, and village leaders. Interviews were recorded and transcribed in Swahili and later translated to English. The research team conducted thematic analysis to identify common themes among interviews. Results: We identified two broad themes on the barriers to male attendance at facility-based ANC visits: (1) Perceived exclusion during ANC visits among men (2) Traditional gender norms resulting to low attendance among men.Conclusion: Attendance at health facility for ANC visits by men with their pregnant partners in the study areas were challenged by structural and local cultural norms. At the facility men were uncomfortable to sit with women due to lack of specific waiting area for men and that they perceived to be neglected. Local cultural norms demanded women to have secrecy in pregnancy while men perceived not to have a role of being with their partners during ANC visits.

scholarly journals Men perspectives on attending antenatal care visits with their pregnant partners in Misungwi district, rural Tanzania: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maendeleo Boniphace ◽  
Dismas Matovelo ◽  
Rose Laisser ◽  
Hadija Swai ◽  
Victoria Yohani ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Health Workers ◽  
Cultural Norms ◽  
Health Providers ◽  
Group Discussions ◽  
Individual Interviews ◽  
Men 2 ◽  
Rural Tanzania ◽  
Expectant Fathers ◽  
And Gender

Abstract Background Mens’attendance with their pregnant partners at facility-based antenatal care (ANC) visits is important for maternal and child health and gender equality yet remains uncommon in parts of rural Tanzania. This study examined men’s perspectives on attending ANC with their pregnant partners in Misungwi District, Tanzania. Methods Twelve individual interviews and five focus group discussions were conducted using semi-structured questionnaires with fathers, expectant fathers, and in-depth interviews were done to health providers, volunteer community health workers, and village leaders. Interviews were recorded and transcribed in Swahili and later translated to English. The research team conducted thematic analysis to identify common themes among interviews. Results We identified two broad themes on the barriers to male attendance at facility-based ANC visits: (1) Perceived exclusion during ANC visits among men (2) Traditional gender norms resulting to low attendance among men. Conclusion Attendance at health facility for ANC visits by men with their pregnant partners in the study areas were challenged by structural and local cultural norms. At the facility men were uncomfortable to sit with women due to lack of specific waiting area for men and that they perceived to be neglected. Local cultural norms demanded women to have secrecy in pregnancy while men perceived not to have a role of being with their partners during ANC visits.

scholarly journals Knowledge, attitude and practices for antenatal care, danger signs of pregnancy and family planning among pregnant women in a rural area of Kerala, India

2020 ◽  
Vol 8 (1) ◽  
pp. 201
Author(s):  
Nimmy N. John ◽  
Amrutha George
Keyword(s):  
Family Planning ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Rural Area ◽  
Health Workers ◽  
Critical Role ◽  
Danger Sign ◽  
Danger Signs ◽  
Planning Methods ◽  
Family Planning Methods

Background: Maternal health services have a potentially critical role in the improvement of reproductive health. The use of health service related to availability, quality and cost of services as well as the social structures, health beliefs and personal characteristics of the users. Objective was to determine the level of knowledge, attitude, and practice related to antenatal care (ANC), danger signs and family planning among the pregnant women.Methods: This cross-sectional study was carried out in May 2020 to August 2020 in a rural area of Thrissur district of Kerala, India. 150 pregnant women (aged 18‑35 years) attending the antenatal clinics were interviewed using a predesigned, pretested questionnaire.Results: The knowledge and attitude of the participants towards antenatal care, danger signs of pregnancy and adopting family planning methods was adequate in the study population. The total score of knowledge was 80%, positive attitude was 91% and practice was 77%. The participants also had knowledge regarding pregnancy danger signs. Nearly 92% were aware of bleeding per vagina being a danger sign, 85% stated weak or no movement of baby as a danger sign, 75% knew that pain in abdomen was a danger, 68% knew excessive vomiting as a danger sign while a mere 41% reported that convulsions were a danger sign.Conclusions: The role of health workers in increasing awareness among mothers about the importance of ANC, the danger signs of pregnancy and adopting family planning methods are of paramount concern.

scholarly journals Men perspectives on attending antenatal care visits together with their pregnant partners in Misungwi district, rural Tanzania: a qualitative study

2021 ◽  
Author(s):  
Maendeleo Boniphace ◽  
Dismas Matovelo ◽  
Rose Laisser ◽  
Hadija Swai ◽  
Victoria Yohana ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Health Workers ◽  
Cultural Norms ◽  
Health Providers ◽  
Group Discussions ◽  
Individual Interviews ◽  
Men 2 ◽  
Rural Tanzania ◽  
Expectant Fathers ◽  
And Gender

Abstract Background: Mens’attendance with their pregnant partners at facility-based antenatal care (ANC) visits is important for maternal and child health and gender equality yet remains uncommon in parts of rural Tanzania. This study examined men’s perspectives on attending ANC with their pregnant partners in Misungwi District, Tanzania.Methods: Twelve individual interviews and five focus group discussions were conducted using semi-structured questionnaires with fathers, expectant fathers, and in-depth interviews were done to health providers, volunteer community health workers, and village leaders. Interviews were recorded and transcribed in Swahili and later translated to English. The research team conducted thematic analysis to identify common themes among interviews. Results: We identified two broad themes on the barriers to male attendance at facility-based ANC visits: (1) Perceived exclusion during ANC visits among men (2) Traditional gender norms resulting to low attendance among men.Conclusion: Attendance at health facility for ANC visits by men with their pregnant partners in the study areas were challenged by structural and local cultural norms. At the facility men were uncomfortable to sit with women due to lack of specific waiting area for men and that they perceived to be neglected. Local cultural norms demanded women to have secrecy in pregnancy while men perceived not to have a role of being with their partners during ANC visits.

scholarly journals The power of peers: an effectiveness evaluation of a cluster-controlled trial of group antenatal care in rural Nepal

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Poshan Thapa ◽  
Alex Harsha Bangura ◽  
Isha Nirola ◽  
David Citrin ◽  
Bishal Belbase ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Maternal Mortality ◽  
Community Health ◽  
Home Visit ◽  
Health Workers ◽  
Care Model ◽  
Non Profit ◽  
Difference Analysis ◽  
Danger Signs ◽  
Rural Nepal

Abstract Background Reducing the maternal mortality ratio to less than 70 per 100,000 live births globally is one of the Sustainable Development Goals. Approximately 830 women die from pregnancy- or childbirth-related complications every day. Almost 99% of these deaths occur in developing countries. Increasing antenatal care quality and completion, and institutional delivery are key strategies to reduce maternal mortality, however there are many implementation challenges in rural and resource-limited settings. In Nepal, 43% of deliveries do not take place in an institution and 31% of women have insufficient antenatal care. Context-specific and evidence-based strategies are needed to improve antenatal care completion and institutional birth. We present an assessment of effectiveness outcomes for an adaptation of a group antenatal care model delivered by community health workers and midwives in close collaboration with government staff in rural Nepal. Methods The study was conducted in Achham, Nepal, via a public private partnership between the Nepali non-profit, Nyaya Health Nepal, and the Ministry of Health and Population, with financial and technical assistance from the American non-profit, Possible. We implemented group antenatal care as a prospective non-randomized, cluster-controlled, type I hybrid effectiveness-implementation study in six village clusters. The implementation approach allowed for iterative improvement in design by making changes to improve the quality of the intervention. We evaluated effectiveness through a difference in difference analysis of institutional birth rates between groups prior to implementation of the intervention and 1 year after implementation. Additionally, we assessed the change in knowledge of key danger signs and the acceptability of the group model compared with individual visits in a nested cohort of women receiving home visit care and home visit care plus group antenatal care. Using a directed content and thematic approach, we analyzed qualitative interviews to identify major themes related to implementation. Results At baseline, there were 457 recently-delivered women in the six village clusters receiving home visit care and 214 in the seven village clusters receiving home visit care plus group antenatal care. At endline, there were 336 and 201, respectively. The difference in difference analysis did not show a significant change in institutional birth rates nor antenatal care visit completion rates between the groups. There was, however, a significant increase in both institutional birth and antenatal care completion in each group from baseline to endline. We enrolled a nested cohort of 52 participants receiving home visit care and 62 participants receiving home visit care plus group antenatal care. There was high acceptability of the group antenatal care intervention and home visit care, with no significant differences between groups. A significantly higher percentage of women who participated in group antenatal care found their visits to be ‘very enjoyable’ (83.9% vs 59.6%, p = 0.0056). In the nested cohort, knowledge of key danger signs during pregnancy significantly improved from baseline to endline in the intervention clusters only (2 to 31%, p < 0.001), while knowledge of key danger signs related to labor and childbirth, the postpartum period, and the newborn did not in either intervention or control groups. Qualitative analysis revealed that women found that the groups provided an opportunity for learning and discussion, and the groups were a source of social support and empowerment. They also reported an improvement in services available at their village clinic. Providers noted the importance of the community health workers in identifying pregnant women in the community and linking them to the village clinics. Challenges in birth planning were brought up by both participants and providers. Conclusion While there was no significant change in institutional birth and antenatal care completion at the population level between groups, there was an increase of these outcomes in both groups. This may be secondary to the primary importance of community health worker involvement in both of these groups. Knowledge of key pregnancy danger signs was significantly improved in the home visit plus group antenatal care cohort compared with the home visit care only group. This initial study of Nyaya Health Nepal’s adapted group care model demonstrates the potential for impacting women’s antenatal care experience and should be studied over a longer period as an intervention embedded within a community health worker program. Trial registration ClinicalTrials.gov Identifier: NCT02330887, registered 01/05/2015, retroactively registered.

scholarly journals MENUJU KEHAMILAN YANG SEHAT DENGAN BEBAS ANEMIA DI ERA PANDEMI COVID-19

2021 ◽  
Vol 5 (1) ◽  
pp. 424
Author(s):  
Revinel Revinel ◽  
Aning Subiyatin
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Service Sector ◽  
Health Workers ◽  
Knowledge Score ◽  
District Health ◽  
Normal Delivery ◽  
Danger Signs ◽  
Interactive Education ◽  
The Government

ABSTRAKMasa pandemi  Covid-19 di Indonesia sangat berdampak di berbagai sektor layanan publik, terutama sektor layanan kesehatan khususnya pemanfaatan layanan Antenatal Care (ANC). Pemerintah merekomendasikan  menunda pemeriksaan kehamilan ke tenaga kesehatan kecuali ibu mengalami tanda – tanda bahaya kehamilan. Terkait dengan kondisi ibu hamil tetap harus mendapatkan informasi yang adekuat dan terpantau kesehatannya maka diperlukan kelas ibu hamil guna meningkatkan pengetahuan tentang kehamilan, persalinan, nifas dan parenting. Pengabdian kepada masyarakat  bertujuan untuk memberdayakan kelompok ibu hamil dalam meningkatkan pengetahuan dan merubah sikap dan perilaku ibu hamil agar  memahami tentang kehamilan yang sehat tanpa anemia agar dapat  mencegah komplikasi secara dini selama masa kehamilan  dan dapat mempersiapkan  persalinan normal,  mengikuti protokol kesehatan secara optimal. Metode yang diberikan melalui edukasi  interaktif, dengan pendekatan secara langsung, curah pendapat, ceramah, tanya jawab tentang pencegahan  anemia pada kehamilan, diikuti 19 ibu hamil dibagi 2 kelompok di Puskesmas kecamatan Tanah Abang. Hasilnya  menunjukkan bahwa terjadi peningkatan rata-rata skor pengetahuan sebesar dari 70,53±26,34 SD menjadi 88,94±14,48 SD. Kata kunci: anemia; ibu hamil; kelas ibu hamil.  ABSTRACTThe Covid-19 pandemic in Indonesia has greatly impacted various public service sectors, especially the health service sector, especially the use of Antenatal Care (ANC). The government recommends postponing Antenatal Care to health workers unless the mother experiences danger signs of pregnancy. Regarding the condition of pregnant women, they still have to get adequate information and their health is monitored, so a class for pregnant women is needed to increase knowledge about pregnancy, childbirth, postpartum and parenting. Community service aims to empower groups of pregnant women in increasing knowledge and changing attitudes and behavior of pregnant women in order to understand about a healthy pregnancy without of anemia in order to prevent complications early during pregnancy and be able to prepare for normal delivery, following health protocols optimally. The method provided was through interactive education, with a direct approach, brainstorming, lectures, questions and answers about preventing anemia in pregnancy, followed by 19 pregnant women divided into 2 groups at the Tanah Abang sub-district health center. The results showed that there was an increase in the average knowledge score from 70.53±26.34 SD to 88.94±14.48 SD. Keywords: anemia; pregnant women; class of pregnant women. 

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

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.

The Impact of Social Mobilization on Health Service Delivery and Health Outcomes

2018 ◽  
Author(s):  
Xavier Giné ◽  
Salma Khalid ◽  
Mansuri Ghazala
Keyword(s):  
Health Services ◽  
Service Delivery ◽  
Health Outcomes ◽  
Health Workers ◽  
Health Service Delivery ◽  
Health Providers ◽  
Child Health Outcomes ◽  
Rural Pakistan ◽  
Post Natal Care ◽  
The Impact

This chapter uses a randomized community development programme in rural Pakistan to assess the impact of citizen engagement on public service delivery and maternal and child health outcomes. The programme had a strong emphasis on organizing women, who also identified health services as a development priority at baseline. At midline, we find that the mobilization effort alone had a significant impact on the performance of village-based health providers. We detect economically large improvements in pregnancy and well-baby visits by female health workers, as well as increased utilization of pre- and post-natal care by pregnant women. In contrast, the quality of supra-village health services did not improve, underscoring the importance of community enforcement and monitoring capacity for improving service delivery.

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