Artificial Intelligence guided citizen-centric approach to enhance uptake of maternal health services among pregnant women living in urban slum settings in India. (Preprint)

2021 ◽  
Author(s):  
Rahul Shrivastava ◽  
Manmohan Singhal ◽  
Mansi Gupta ◽  
Ashish Joshi

BACKGROUND Pregnant women are considered to be a “high risk” group with limited access to health facilities in urban slums. Barriers to utilization of health services may lead to maternal and child mortality, morbidity, low birth weight, and children with stunted growth. Application of artificial intelligence (AI) can provide substantial improvements in all areas of healthcare from diagnostics to treatment. There have been several technological advances within the field of AI, however, AI not merely driven by what is technically feasible, but by what is humanly desirable is the need of the hour. OBJECTIVE The objective of our study is to develop and evaluate the AI guided citizen centric platform to enhance the uptake of maternal health services (antenatal care) amongst the pregnant women living in urban slum settings. METHODS A cross-sectional mixed method approach employed to collect data among pregnant women, aged 18-44 years, living in urban slums of South Delhi. A convenience sampling used to recruit 225 participants at the Anganwadi centres (AWC) after obtaining consent from the eligible participants. Inclusion criteria includes pregnant individuals residing in urban slums for more than 3 months, having smartphones, visiting AWC for seeking antenatal care. Quantitative and qualitative data will be collected electronically using Open Data Kit (ODK) based opensource tool from eligible participants. Data will be collected on clinical as well as socio-demographic parameters (based on existing literature). We aim to develop an innovative AI guided citizen centric decision support platform to effectively manage pregnancy and its outcomes among urban poor populations. The proposed research will help policymakers to prioritize resource planning, resource allocation and development of programs and policies to enhance maternal health outcomes. RESULTS The AI guided citizen centric decision support platform will be designed, developed, implemented and evaluated using principles of human centred design and findings of the study will be reported to diverse stakeholders. The tested and revised platform will be deployed for use across various stakeholders such as pregnant women, healthcare professionals, frontline workers, and policymakers. CONCLUSIONS With the understanding, use and adoption of emerging and innovative technologies such as AI, maternal health informatics can be at the forefront to help pregnant women in crisis. The proposed platform will potentially be scaled up to different geographic locations for adoption for similar and other health conditions.

2019 ◽  
Author(s):  
Ruth Atuhaire

Abstract Background Maternal health care and treatment services have a bearing on maternal mortality. Direct and Indirect factors affecting Maternal health outcomes therefore require understanding to enable well targeted interventions. This study, therefore, assessed the interrelationships between early antenatal care, health facility delivery and early postnatal care.Methods We investigated Maternal Health services using utilizing Antenatal care (ANC) within three months of pregnancy, Health facility delivery and utilizing postnatal care (PNC) within 48 hours after childbirth. The 2016 Uganda Demographic and Health Survey data was used. During analysis, a Generalized Structural Equation Model using logistic link and binomial family option was used. The interrelated (Endogenous) outcomes were timely ANC, health facility delivery and timely PNC.Results Timely ANC (aOR=1.04; 95% CI=0.95-1.14) and(aOR=1.1; 95% CI=1.00-1.26) was directly related to increased odds of health facility delivery and timely PNC respectively. Factors that increased the odds of timely ANC as a mediating factor for health facility delivery and timely PNC were women age 35-39 (aOR=1.18; 95% CI=0.99-1.24) compared to women age 15-19, completing primary seven (aOR=1.68; 95% CI=1.58-1.81) compared to some primary, available health workers (aOR=1.06; 95% CI=0.97-1.18), complications (aOR=2.04; 95% CI=1.89-2.26) and desire for pregnancy(aOR=1.15; 95% CI=1.03-1.36). Factors that reduced the odds of timely ANC were being married (aOR=0.93; 95% CI=0.89-1.20), distance and cost of service being problematic (aOR=0.97; 95% CI=0.85-1.1) (aOR=0.5; 95% CI=0.37-0.82) respectively. Factors that significantly influenced health facility delivery through timely ANC were; unmarried (OR=1.03; (=1.04*0.99)), distance being problematic ((aOR=1.0; (=1.04*0.97)) and complications (aOR=2.02; (=1.04*1.94)). Factors that significantly influenced timely PNC through timely ANC were; women age 35-39 (aOR=1.3; (=1.18*1.1)) compared to 15-19, completing primary seven (aOR=1.68; (=1.68*1.1))compared to some primary and service cost being problematic (aOR=0.55; (=0.5*1.1)). Surprisingly, health facility delivery was not statistically significant as a mediator for timely PNC.Conclusion Attending antenatal care within first trimester was a mediating factor for health facility delivery and early postnatal care. Interventions in maternal health should focus on factors that increase antenatal care first trimester attendance in resource limited settings. Furthermore, Government should reduce on costs of attaining all maternal health services and emphasize girl education completion.


BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e036211
Author(s):  
Clara C Natai ◽  
Neema Gervas ◽  
Frybert M Sikira ◽  
Beatrice J Leyaro ◽  
Juma Mfanga ◽  
...  

BackgroundMale involvement in antenatal care (ANC) is among interventions to improve maternal health. Globally male involvement in ANC is low and varies in low-income and middle-income countries including Tanzania where most maternal deaths occur. In Sub-Sahara, men are chief decision makers and highly influence maternal health. In Tanzania information is limited regarding influence of male involvement during ANC on utilisation of maternal health services.ObjectivesTo determine the effect of male involvement during ANC on use of maternal health services in Mwanza, Tanzania.DesignA cross-sectional study conducted from June to July 2019.SettingThis study was conducted at seven randomly selected health facilities providing reproductive, maternal and child health (RCH) services in Mwanza City.ParticipantsIncluded 430 postpartum women who delivered 1 year prior to the study and attending for RCH services (growth monitoring, vaccination, postpartum care).Outcome measures4 or more ANC visits, skilled birth attendant (SBA) use during childbirth and postnatal care (PNC) utilisation 48 hours after delivery.MethodsInterviews and observation of the women’s ANC card were used to collect data. Data was entered, cleaned and analysed by SPSS.ResultsThe mean age of participants was 25.7 years. Of 430 women, 54.4% reported their partners attended ANC at least once, 69.7% reported they attended for four or more ANC visits during last pregnancy, 95% used SBAs during childbirth and 9.2% attended PNC within 48 hours after delivery. Male involvement during ANC was significantly associated with four or more ANC visits (Crude Odds Ratio (COR): 1.90; 95% CI: 1.08–3.35) but not with SBA use or PNC utilisation.ConclusionMale involvement in ANC is still low in Mwanza, as 46% of the partners had not attended with partners at ANC. Alternative strategies are needed to improve participation. Studies among men are required to explore the barriers of participation in overall RCH services.


Author(s):  
Nitin A. Lodha

Background: Antenatal care is the care of a woman during pregnancy. The primary aim of antenatal care is to achieve at the end of pregnancy a healthy mother and a healthy baby. To improve maternal health, barriers which limit access to quality maternal health services must be identified and addressed at all levels of health system. Objectives were to determine demographic and obstetric factors affecting utilization of ANC service and prevalence of anaemia among pregnant women.Methods: This is cross-sectional descriptive study carried out in tertiary care hospital, using structured questionnaire, interviews were conducted with married pregnant women age between 18-45 years, who visited ANC clinic. Total 170 pregnant women visited hospital during a period was included in study. Data was analysed using MS excel and Epi info. Chi –square test was applied.Results: Maximum number of study subjects (42.9%) from age 23-27 years. 66.5% were Hindu, 56.5% study subjects from joint family. 14.7% were illiterate. 45.3% were primigravida, 54.7% were multigravida. 71.1% study subjects were from third trimester of pregnancy. 94.7% were taken at least one dose of Tetanus Toxoids. Iron folic acid tablets were taken by 87.6%. Prevalence of anaemia was 55.8%.Conclusions: Majority of pregnant women came for antenatal check-up, but regularity was not seen in most of cases. The presence study has brought out no significant socio-cultural barrier like women’s literacy, socio economic class and parity of women affecting the utilization of services.


PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246237
Author(s):  
Berhan Tsegaye ◽  
Elsabet Shudura ◽  
Amanuel Yoseph ◽  
Alemu Tamiso

Background Maternal health services are affected by complex factors from one setting to another. Consequently, health planners should prioritize different interventions and design appropriate programs to enhance maternal health services utilization. Results of prior studies are conflicting. Furthermore, only few studies were done from antenatal to postnatal continuum of care in Ethiopia. Objectives This study aimed to assess prevalence and predictors of skilled maternal health services utilization at Dale-Wonsho health and demographic surveillance site of the Hawassa University, South Ethiopia, in 2019. Methods A community based cross sectional study was conducted from January 1–30; 2019. A total of 682 women who gave birth in the last twelve months were selected by using a two stage sampling technique. Data were collected through face to face interview. Data were entered into Epidata version 3.1. Then, they were exported and analyzed by SPSS version 22. Bi-variable logistic regression analysis was done and variables with p-value less than 0.05 were considered as candidate for multivariable logistic regression analysis. Adjusted Odds Ratios (AOR) with 95% CI were computed, and p-value less than 0.01 was computed to determine the level of significance. Result Prevalence of antenatal care, institutional delivery and postnatal care utilizations were 69.1%, 52.1% and 32.7% respectively. Educated women (AOR = 4.72, 95%CI,2.82,7.9), household training (AOR = 8.52,95%CI = 5.5,13.1), middle wealth quantile(AOR = 0.8,95%CI,0.4–0.7), being richest wealth quantile (AOR = 0.16;95%CI = 0.06,0.41) and pregnancy plan (AOR = 3.65,95%CI,1.67–8.0) were factors positively associated with antenatal care utilization. Husband education (AOR = 4.96,95CI,3.08–8.0), and antenatal care (AOR = 5.9; 95%CI,3.87,9.1) were factors associated with institutional delivery. Maternal education (AOR = 2.5,95CI,1.4–4.4), information about postnatal care service utilization (AOR = 3.6,95CI,2.1,6.2) and women autonomy(AOR = 6.1,95CI,3.8,9.7) were positively associated with postnatal care service. Conclusion Prevalence of antenatal care, institutional delivery and postnatal care services were lower than the targeted plan. Policy makers should focus on capacity building of women both economically and academically. So, women should be more autonomous to utilize health services effectively. Moreover, awareness creation among women should be enhanced about maternal health service.


2021 ◽  
Vol 10 (2) ◽  
pp. 44-50
Author(s):  
Nigus Bililign Yimer ◽  
◽  
Misgan Legesse Liben

Background: A skilled birth attendance for every pregnant woman during childbirth is the most crucial intervention for improving maternal health. This study aimed to assess institutional delivery service utilization and associated factors among mothers who gave birth in the last 12 months in Raya Kobo district, Ethiopia. Methods: A community-based cross-sectional study was carried out in the Raya Kobo district of Amhara Regional State during March 2016. Logistic regression analysis was performed to assess the association between each independent variable and the outcome variable. Variables with a p-value <0.05 were considered significant. Results: A total of 493 mothers were included in the study, with a response rate of 95.4%. The mean (+SD) age of the study participants was 29.13 (±6.93) years. About 73% of the study participants had attended at least one antenatal care follow up for their last pregnancy, and 56.6% (95% CI: 52.0, 61.0%) gave birth at health institutions. Travelling for 30 minutes and less [AOR=2.95(1.89, 4.58)], attending antenatal care [AOR=6.0(3.55, 10.13)], having knowledge about intrapartum danger signs [AOR=2.48(1.44, 4.24)] and getting information from health extension workers (HEWs) regarding maternal health services were positively associated. Conclusion: The district health office should strengthen its effort to provide free ambulance accessibility and provide information on danger signs of intrapartum complications and the importance of using institutional delivery service to every mother who came to the antenatal clinic. Furthermore, the district health officials should focus on strengthening the capacity of HEWs in relation to maternal health services.


PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257032
Author(s):  
Ni Ketut Aryastami ◽  
Rofingatul Mubasyiroh

Background Maternal Mortality Ratio (MMR) in Indonesia is still high, 305, compared to 240 deaths per 100,000 in South East Asian Region. The use of Traditional Birth Attendance (TBA) as a cascade for maternal health and delivery, suspected to be the pocket of the MMR problem. The study aimed to assess the influence of traditional practices on maternal health services in Indonesia. Methods We used two data sets of national surveys for this secondary data analysis. The samples included 14,798 mothers whose final delivery was between January 2005 and August 2010. The dependent variables were utilization of maternal healthcare, including receiving antenatal care (ANC≥4), attended by skilled birth attendance (SBA), and having a facility-based delivery (FBD). The independent variables were the use of traditional practices, type of family structure, and TBA density. We run a Multivariate logistic regression for the analysis by controlling all the covariates. Results Traditional practices and high TBA density have significantly inhibited the mother’s access to maternal health services. Mothers who completed antenatal care were 15.6% lost the cascade of facility-based delivery. The higher the TBA population, the lower cascade of the use of Maternal Health Services irrespective of the economic quintile. Mothers in villages with a high TBA density had significantly lower odds (AOR = 0.30; CI = 0.24–0.38; p<0.01) than mothers in towns with low TBA density. Moreover, mothers who lived in an extended family had positively significantly higher odds (AOR = 1.33, CI = 1.17–1.52; p<0.01) of using maternal health services. Discussion Not all mothers who have received proper antenatal delivered the baby in health care facilities or preferred a traditional birth attendance instead. Traditional practices influenced the ideal utilization of maternal health care. Maternal health care utilization can be improved by community empowerment through the maternal health policy to easier mothers get delivery in a health care facility.


2019 ◽  
Vol 6 ◽  
pp. 233339281983513 ◽  
Author(s):  
Achamyelesh Gebretsadik ◽  
Million Teshome ◽  
Mekdes Mekonnen ◽  
Akalewold Alemayehu ◽  
Yusuf Haji

Background: Health extension workers (HEWs) are primarily been assigned in rural areas of Ethiopia to provide maternal and child health services. Few studies have been done to investigate HEWs’ contributions towards maternal health services. This study describes HEWs involvement in the utilization of focused antenatal care (FANC). Methods: A population-based cross-sectional survey was conducted between January 21 and February 4, 2017. Mothers (2300) who gave birth in the last 6 months (0-6 months) in randomly selected 30 kebeles in the rural Sidama zone, participated in the study. A face-to-face interview was done using a structured questionnaire adapted from the Saving Newborn Lives Program. The main outcome variable was FANC utilization. Descriptive statistics and multivariate logistic regression analysis were used using SPSS statistical software. Results: The FANC was used by 525 (24.36%; 95% confidence interval [CI]: 22.5%-26.2%) women. Health extension workers accounted for 244 (46.47%; 95% CI: 43.5-47.7%) of mothers. The FANC utilization was less likely among those who were illiterate (adjusted odds ratio [AOR]: .32; 95% CI: .18-.57) and those who attended first cycle (AOR: .41; 95% CI: .23-.74), those who attended secondary cycle (AOR: .47; 95% CI: .27-.82), primipara (AOR: 0.53; 95% CI: .35-.83), and those who gave birth at home (AOR: .66; 95% CI: .51-.84). Mothers who had knowledge of pregnancy danger signs (AOR: 1.42; 95% CI: 1.2-1.7) and exposure to mass media (AOR: 1.35; 95% CI: 1.1-1.66) were more likely to utilize FANC. Conclusions: FANC utilization in this study was low compared to other studies. The HEWs had a major contribution to the services. However, it is low when compared to the plan set by the state ministry of health. The existing health extension program could be strengthened by increasing the number of HEWs. Empowering rural mothers through continuous education program to enhance the utilization of maternal health services.


2019 ◽  
Vol 34 (10) ◽  
pp. 752-761
Author(s):  
Soyoon Weon ◽  
David W Rothwell ◽  
Shailen Nandy ◽  
Arijit Nandi

Abstract In low- and middle-income countries (LMICs), many women of reproductive age experience morbidity and mortality attributable to inadequate access to and use of health services. Access to personal savings has been identified as a potential instrument for empowering women and improving access to and use of health services. Few studies, however, have examined the relation between savings ownership and use of maternal health services. In this study, we used data from the Indonesian Family Life Survey to examine the relation between women’s savings ownership and use of maternal health services. To estimate the effect of obtaining savings ownership on our primary outcomes, specifically receipt of antenatal care, delivery in a health facility and delivery assisted by a skilled attendant, we used a propensity score weighted difference-in-differences approach. Our findings showed that acquiring savings ownership increased the proportion of women who reported delivering in a health facility by 22 percentage points [risk difference (RD) = 0.22, 95%CI = 0.08–0.37)] and skilled birth attendance by 14 percentage points (RD = 0.14, 95%CI = 0.03–0.25). Conclusions were qualitatively similar across a range of model specifications used to assess the robustness of our main findings. Results, however, did not suggest that savings ownership increased the receipt of antenatal care, which was nearly universal in the sample. Our findings suggest that under certain conditions, savings ownership may facilitate the use of maternal health services, although further quasi-experimental and experimental research is needed to address threats to internal validity and strengthen causal inference, and to examine the impact of savings ownership across different contexts.


2020 ◽  
Author(s):  
Peninah Agaba ◽  
Cyprian Misinde

Abstract Introduction Inadequate use of maternal health services among the youth remains a serious health challenge in Uganda. The low use of maternal health services among youth partly explains the persistence high maternal mortality rate in the country. Yet, improved use of maternal health services by the youth would help reduce maternal deaths in the country. Therefore, this study examines predisposing and enabling factors associated with the timing and the number of antenatal care visits among unmarried compared to married youth aged 15-24 years between 1995 and 2011 in Uganda. Methodology Two-level binary logistic and linear regression models with district as a second level of analysis were conducted on pooled data of the 1995, 2000/01, 2006 and 2011 Uganda Demographic and Health Surveys. This analysis was among 581 unmarried, compared to 5,437 married youth, aged 15-24 years. Results Only 16% of unmarried youth and 18% of married youth had ANC in the first trimester. Education was the only factor that was significantly associated with early use of antenatal care among unmarried youth. Whereas high education was associated with higher odds of using antenatal care in the first trimester among married youth (OR=1.30, 95%CI=1.08-1.57), it was associated with late start among unmarried youth (OR=0.56, 95%CI=0.31-0.98). Higher parity, protestant membership and residence in eastern region were associated with late start of antenatal care, while access to radio and television, and education level of the husband were associated with higher odds of early use of antenatal care among married youth. Overall, married youth were more likely to have more frequent antenatal care visits than unmarried youth. Among both groups, higher educational attainment and greater access to radio were associated with frequent antenatal care use. Residing in western region was associated with fewer antenatal care visits among both married and unmarried youth. Access to newspaper was associated with more antenatal care visits among married youth only. Conclusion This study presents the individual level predisposing and enabling factors that are important predictors of the use of antenatal health care services among youth that will guide policy to reduce maternal deaths among youth in Uganda.


2021 ◽  
Vol 2 ◽  
Author(s):  
Siri Aas Rustad ◽  
Helga Malmin Binningsbø ◽  
Haakon Gjerløw ◽  
Francis Mwesigye ◽  
Tony Odokonyero ◽  
...  

Introduction: Uganda is one of the largest refugee-hosting nations in the world, with the majority of the refugees having fled South Sudan. In the early 2000's the local government and refugee health systems were merged to create a more equal and integrated system for refugees and the host population. Our aim is to investigate whether mothers from the two groups experience the same access to and quality of maternal health services, and whether refugee- and host-community mothers perceive the maternal health services differently.Methods: In November–December 2019, we conducted a household survey of 1,004 Ugandan nationals and South Sudanese refugee mothers aged 15–49 in the West Nile region covering the districts of Arua, Yumbe, and Adjumani, and elicited information on access to maternal health care services, perceptions of the quality of services, and feelings of discrimination. The data was then analyzed using Ordinary Least Squares and logistic regression.Results: Our analyses do not reveal large differences between refugees and the host community in terms of access to and the quality of maternal health services. Results from bivariate models indicate that refugee mothers are 6% points less likely to receive antenatal care (p-value &lt; 0.05) but are 8% points more likely to give birth at a health facility (p-value &lt; 0.05). Refugee mothers are generally less satisfied with how they were treated during antenatal care (0.132 lower average value on a Likert scale, p-value &lt; 0.01). Refugee mothers are also 4% points more likely to feel discriminated against during ANC compared to their counterparts in the host community (p-value &lt; 0.05).Discussion: The way women feel treated at the health facility during maternal health care is an important aspect of quality care. While there seems to be equal access to resources between refugees and host community mothers in Northern Uganda in terms of access to and quality of care, there is still a discrepancy between the two groups in terms of how the women feel treated. Policymakers and practitioners in the health sector should pay attention to these perceived inequalities between refugees and women from the host communities to ensure equally inclusive treatment across groups.


Sign in / Sign up

Export Citation Format

Share Document