Birth plans and health insurance enrolment of pregnant women: a cross-sectional survey at two secondary health facilities in Lagos, Nigeria

Abstract Background Anaemia during pregnancy is a major public health concern. Despite its wide scope and adverse effects including increased maternal and perinatal morbidity and mortality, and long-term adverse effects in the new born, extensive interventions using upstream approaches to public health have largely not been implemented. This study investigated the prevalence and associated factors of anaemia in pregnant women in four health facilities in the Kwabre East Municipality of Ghana.Method A cross-sectional survey with a two-stage sampling technique was conducted on 220 pregnant women who attended antenatal care at the selected health facilities. Interview-based structured questionnaires were used. Bivariate and multivariate logistic regression were used to identify predictors.Results The prevalence of anaemia was 11.4%. Few women (25) were anaemic and morphologically, 14 had normocytic normochromic (56%) anemia and 9 had Microcytic hypochromic (36) anaemia. Iron deficiency was reported in 19 (8.6%) pregnant women. Iron sulphate intake (AOR [95% CI] = 3.16 [1.15, 7.37], ANC follow-up during pregnancy (AOR [95% CI] = 3.07 [1.59, 7.99], household size of ≥ 5 (AOR [95% CI] = 3.58 [1.75, 9.52], folic acid intake (AOR [95% CI] = 5.29 [2.65, 12.39] and the period in pregnancy AOR [95% CI]= ≥36 weeks 3.2 (1.3–4.5) were independent predictors of anemia.Conclusion Though anaemia prevalence has been low in urban areas as previously reported, collaborated healthcare measures that aim at eradicating the menace are encouraged. Maternal health care interventions including the administration of folic acid, regular iron sulphate intake and intensive education on early ANC are recommended.

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The bypassing of healthcare facilities among National Health Insurance Scheme enrollees in Ibadan, Nigeria

International Health ◽

10.1093/inthealth/ihaa063 ◽

2020 ◽

Author(s):

Adetola O Oladimeji ◽

David A Adewole ◽

Folashayo Adeniji

Keyword(s):

Health Insurance ◽

National Health Insurance ◽

National Health ◽

National Health Insurance Scheme ◽

Health Facilities ◽

Health Insurance Scheme ◽

Insurance Scheme ◽

Cross Sectional Survey ◽

Additional Time ◽

Cross Sectional

Abstract Background Bypassing occurs when patients knowingly visit a health facility other than the one they live nearest to. In Ibadan, southwest Nigeria, the majority of enrollees in the National Health Insurance Scheme (NHIS) receive medical care in just 12% of the available NHIS-accredited facilities. Given that enrollees access healthcare services at highly subsidized rates under the scheme, this study aimed to determine the factors responsible for the observed distribution of enrollees across these health facilities. Methods The study was a descriptive cross-sectional survey conducted among NHIS enrollees receiving care at outpatient departments of five randomly selected accredited health facilities in Ibadan. A total of 311 NHIS enrollees were consecutively recruited and a semistructured, pretested, interviewer-administered questionnaire was used to elicit information from respondents. Descriptive and inferential statistics were used to present results at 5% level of significance. Distance traveled by patients from their residence to the facilities was measured using Google maps. Results The mean age of respondents was 37.1±16.1 y. There were 167 (53.7%) males and 224 (72.3%) were married. The bypassing rate was 174 (55.3%). More than a third of enrollees, 127 (41.0%), reported that their hospital choice was made based on physician referral, 130 (41.8%) based on personal choice, 26 (8.4%) based upon the recommendation of the Health Management Organization (HMO), while 27 (8.7%) were influenced by friends/family/colleagues. Bypassing was positively associated with educational status (X2 = 13.147, p=0.004). Respondents who bypassed expended additional time and money traveling to the farther away hospitals, 35.1 (±34.66) min and 389.51 (±545.21) naira per visit, respectively. Conclusion The level of bypassing among enrollees was fairly high. Enrollees should be properly guided regarding the need to access healthcare in facilities closer to them by their HMOs and physicians in the case of referrals. This will reduce bypassing and the cost of travel leading to better outcomes among enrollees.

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The PROMISES study: a mixed methods approach to explore the acceptability of salivary progesterone testing for preterm birth risk among pregnant women and trained frontline healthcare workers in rural India

BMJ Open ◽

10.1136/bmjopen-2020-040268 ◽

2021 ◽

Vol 11 (1) ◽

pp. e040268

Author(s):

Danielle Ashworth ◽

Pankhuri Sharma ◽

Sergio A Silverio ◽

Simi Khan ◽

Nishtha Kathuria ◽

...

Keyword(s):

Mixed Methods ◽

Preterm Birth ◽

Pregnant Women ◽

Barriers And Facilitators ◽

Rural India ◽

Structured Interviews ◽

Framework Analysis ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Thematic Framework

IntroductionIndia has an overall neonatal mortality rate of 28/1000 live births, with higher rates in rural India. Approximately 3.5 million pregnancies in India are affected by preterm birth (PTB) annually and contribute to approximately a quarter of PTBs globally. Embedded within the PROMISES study (which aims to validate a low-cost salivary progesterone test for early detection of PTB risk), we present a mixed methods explanatory sequential feasibility substudy of the salivary progesterone test.MethodsA pretraining and post-training questionnaire to assess Accredited Social Health Activists (ASHAs) (n=201) knowledge and experience of PTB and salivary progesterone sampling was analysed using the McNemar test. Descriptive statistics for a cross-sectional survey of pregnant women (n=400) are presented in which the acceptability of this test for pregnant women is assessed. Structured interviews were undertaken with ASHAs (n=10) and pregnant women (n=9), and were analysed using thematic framework analysis to explore the barriers and facilitators influencing the use of this test in rural India.ResultsBefore training, ASHAs’ knowledge of PTB (including risk factors, causes, postnatal support and testing) was very limited. After the training programme, there was a significant improvement in the ASHAs’ knowledge of PTB. All 400 women reported the salivary test was acceptable with the majority finding it easy but not quick or better than drawing blood. For the qualitative aspects of the study, analysis of interview data with ASHAs and women, our thematic framework comprised of three main areas: implementation of intervention; networks of influence and access to healthcare. Qualitative data were stratified and presented as barriers and facilitators.ConclusionThis study suggests support for ongoing investigations validating PTB testing using salivary progesterone in rural settings.

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31. Influenza Vaccination During Pregnancy: A Descriptive Cross-sectional Survey of the Knowledge, Beliefs, and Attitudes of Mexican Gynecologists and Family Physicians

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.076 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S39-S39

Author(s):

Erika Z Lopatynsky-Reyes ◽

Sue Ann Costa-Clemens ◽

Enrique Chacon-Cruz ◽

Michael Greenberg

Keyword(s):

Influenza Vaccination ◽

Pregnant Women ◽

Latin American ◽

Vaccine Coverage ◽

Family Physicians ◽

Morbidity And Mortality ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Beliefs And Attitudes ◽

In Pregnancy

Abstract Background Influenza in pregnancy is associated with elevated morbidity and mortality. Influenza vaccines are both safe and effective in pregnancy, supporting routine use in this population. Even though influenza vaccination in Mexico is recommended for pregnant women, there are no publications of influenza vaccine coverage in pregnancy. This is the first Latin American survey done only in physicians aiming to assess the knowledge, beliefs, and attitudes that Mexican Obstetrics-Gynecologists (OBG) and Family Physicians (FP) have towards influenza and influenza immunization during pregnancy. Methods A cross-sectional survey was conducted, both paper-based and online. The questionnaire was composed of 35 questions, which addressed general knowledge of influenza, recommendations for vaccination during pregnancy, and beliefs and attitudes concerning the acceptability of the vaccine in pregnant women. Results A total of 206 completed surveys were available, 98 (47.6%) from OBG, 108 (52.4%) from FP. Regarding current practicing medical institutions, 76 (37%), 69 (34%), 31 (14.5%), 30 (14.5%) reported working for the Mexican Institute of Social Security, Private Sector, Secretariat of Health, or a combination of all respectively, representing an estimated 2,472 daily pregnancy consultations. About a quarter (26.2%) reported not having a notion that influenza is more severe among pregnant women. More than half (51.5%) ignored the potential side effects of influenza infection on the fetus. The majority (56.8%) did not know when vaccination during pregnancy should occur. Pregnancy as a risk factor for developing influenza complications was known only in 48.1%. Also, 46.1 % believed that vaccination only confers protection to the mother, but not to the fetus. Nevertheless, 96.1% considered that immunization against influenza during pregnancy is a safe and effective preventive intervention. A results’ summary is shown in Figure-1. Conclusion Based on this survey, current knowledge of OBG and FP for influenza morbidity and mortality during pregnancy, and the importance of influenza vaccination in pregnant women, is poor. Mandatory recommendations to educate medical providers regarding influenza vaccination during pregnancy in Mexico are necessary, even as imperative for CME credits. Disclosures All Authors: No reported disclosures

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Maternal adherence to micronutrient supplementation before and during pregnancy in Northwest China: a large-scale population-based cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2018-028843 ◽

2019 ◽

Vol 9 (8) ◽

pp. e028843 ◽

Cited By ~ 6

Author(s):

Danmeng Liu ◽

Yue Cheng ◽

Shaonong Dang ◽

Duolao Wang ◽

Yaling Zhao ◽

...

Keyword(s):

Pregnant Women ◽

Large Scale ◽

Northwest China ◽

Population Based ◽

Shaanxi Province ◽

Micronutrient Supplementation ◽

Cross Sectional Survey ◽

Start Time ◽

Cross Sectional ◽

Scale Population

ObjectivesTo report the situation of maternal micronutrient supplementation before and during pregnancy in Northwest China and to examine the rates of and factors related to the adherence to micronutrient supplementation among pregnant women in this region, where dietary micronutrient intake is commonly insufficient.DesignA large-scale population-based cross-sectional survey.SettingTwenty counties and ten districts of Shaanxi Province.ParticipantsA sample of 30 027 women were selected using a stratified multistage random sampling method. A total of 28 678 women were chosen for the final analysis after excluding those who did not provide clear information about nutritional supplementation before and during pregnancy.Main outcome measuresMaternal adherence to micronutrient supplementation (high and low) were the outcomes. They were determined by the start time and duration of use according to Chinese guidelines (for folic acid (FA) supplements) and WHO recommendations (for iron, calcium and multiple-micronutrient (MMN) supplements).ResultsIn total, 83.9% of women took at least one kind of micronutrient supplement before or during pregnancy. FA (67.6%) and calcium (57.5%) were the primarily used micronutrient supplements; few participants used MMN (14.0%) or iron (5.4%). Adherence to supplementation of all micronutrients was low (7.4% for FA, 0.6% for iron, 11.7% for calcium and 2.7% for MMN). Higher educational levels, higher income levels, urban residence and better antenatal care (including pregnancy consultation and a higher frequency of antenatal visits) were associated with high adherence to micronutrient supplementation.ConclusionMaternal micronutrient supplementation before and during pregnancy in Northwest China was way below standards recommended by the Chinese guidelines or WHO. Targeted health education and future nutritional guidelines are suggested to improve this situation, especially in pregnant women with disadvantaged sociodemographic conditions.

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Utilization of key preventive measures for pregnancy complications and malaria among women in Jimma Zone, Ethiopia

BMC Public Health ◽

10.1186/s12889-019-7727-8 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Mariame Ouedraogo ◽

Jaameeta Kurji ◽

Lakew Abebe ◽

Ronald Labonté ◽

Sudhakar Morankar ◽

...

Keyword(s):

Health Services ◽

Pregnant Women ◽

Malaria Infection ◽

Preventive Measures ◽

Health Sector ◽

Maternal Health Services ◽

Cross Sectional Survey ◽

Wealth Status ◽

Cross Sectional ◽

Jimma Zone

Abstract Background In Ethiopia, malaria infections and other complications during pregnancy contribute to the high burden of maternal morbidity and mortality. Preventive measures are available, however little is known about the factors influencing the uptake of maternal health services and interventions by pregnant women in Ethiopia. Methods We analyzed data from a community-based cross-sectional survey conducted in 2016 in three rural districts of Jimma Zone, Ethiopia, with 3784 women who had a pregnancy outcome in the year preceding the survey. We used multivariable logistic regression models accounting for clustering to identify the determinants of antenatal care (ANC) attendance and insecticide-treated net (ITN) ownership and use, and the prevalence and predictors of malaria infection among pregnant women. Results Eighty-four percent of interviewed women reported receiving at least one ANC visit during their last pregnancy, while 47% reported attending four or more ANC visits. Common reasons for not attending ANC included women’s lack of awareness of its importance (48%), distance to health facility (23%) and unavailability of transportation (14%). Important determinants of ANC attendance included higher education level and wealth status, woman’s ability to make healthcare decisions, and pregnancy intendedness. An estimated 48% of women reported owning an ITN during their last pregnancy. Of these, 55% reported to have always slept under it during their last pregnancy. Analysis revealed that the odds of owning and using ITNs were respectively 2.07 (95% CI: 1.62–2.63) and 1.73 (95% CI: 1.32–2.27) times higher among women who attended at least one ANC visit. The self-reported prevalence of malaria infection during pregnancy was low (1.4%) across the three districts. We found that young, uneducated, and unemployed women presented higher odds of malaria infection during their last pregnancy. Conclusion ANC and ITN uptake during pregnancy in Jimma Zone fall below the respective targets of 95 and 90% set in the Ethiopian Health Sector Transformation Plan for 2020, suggesting that more intensive programmatic efforts still need to be directed towards improving access to these health services. Reaching ANC non-users and ITN ownership and use as part of ANC services could be emphasized to address these gaps.

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Determinants of Antenatal Care Attendance among Pregnant Women Living in Endemic Malaria Settings: Experience from the Democratic Republic of Congo

Obstetrics and Gynecology International ◽

10.1155/2016/5423413 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 12

Author(s):

Célestin Ndosimao Nsibu ◽

Célestin Manianga ◽

Serge Kapanga ◽

Esther Mona ◽

Philippe Pululu ◽

...

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

Male Partner ◽

First Trimester ◽

Reproductive Age ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Republic Of Congo

Background. Antenatal care (ANC) attendance helps pregnant women to benefit from preventive and curative services.Methods. Determinants for ANC attendance were identified through a cross-sectional survey in the Democratic Republic of Congo. Sociocultural bottlenecks were assessed via focus groups discussion of married men and women.Results. In this survey, 28 of the 500 interviewed pregnant women (5.6%) did not attend ANC services and 82.4% booked over the first trimester. The first visit is positively influenced by the reproductive age (OR: 0.52, 95% CI(0.28–0.95),p<0.04), the educational level (OR: 0.41,95% CI(0.17–0.97),p<0.04), the nearby health center (OR: 0.43, 95% CI(0.2–0.92),p<0.03), and the presence of a male partner (OR: 10.48, 95% CI(2.1–52.23),p<0.001). The barriers to early booking were (i) the cost of service; (ii) the appearance or individual income; (iii) the geographical inaccessibility or distance to health facilities; (iv) social and religious prohibitions; (v) the stigmatization from other women when conceiving in the late ages or young or while still lactating (parity); (vi) the time for waiting for services.Conclusion. The early ANC attendance is delayed among poor women with little education and living alone.

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Prevalence and Correlates of Pregnancy Self-Testing Among Pregnant Women Attending Antenatal Care in Western Kenya

10.21203/rs.3.rs-78174/v1 ◽

2020 ◽

Author(s):

Nina Njeri Nganga ◽

Julia Dettinger ◽

John Kinuthia ◽

Jared Baeten ◽

Grace John-Stewart ◽

...

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

Sub Saharan Africa ◽

Future Research ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Western Kenya ◽

Self Testing ◽

Sub Saharan ◽

Exposure Prophylaxis

Abstract In sub-Saharan Africa little is known about how often women use pregnancy self-tests or characteristics of these women despite evidence that pregnancy self-testing is associated with early antenatal care (ANC) attendance. Understanding the characteristics of women who use pregnancy self-tests may facilitate early access to ANC and preventive interventions in pregnancy. We conducted a cross-sectional survey on an ongoing pre-exposure prophylaxis (PrEP) implementation study which enrolled pregnant women to determine the prevalence and factors associated with pregnancy self-testing among women in western Kenya. Overall in our study population, the prevalence of pregnancy self-testing was 22% and higher among women who were employed, currently in school, had previous pregnancy complications, received services from urban health facilities, and had partners who had at least attended secondary school. The most reported reasons for non-use of pregnancy self-tests included not thinking it was necessary, lack of knowledge, and lack of money to pay for the test. Future research should focus on understanding the knowledge and attitudes of women toward pregnancy self-testing.

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Hubungan Karakteristik dan Pengetahuan Ibu Hamil dengan Perilaku Hygiene Tentang Keputihan (Flour Albus) di Puskesmas Kalumpang Kota Ternate Tahun 2013

Jurnal Kesehatan Poltekkes Ternate ◽

10.32763/juke.v7i1.72 ◽

2018 ◽

Vol 7 (1) ◽

pp. 1

Author(s):

Nuzliati T Djama ◽

Amira BSA

Keyword(s):

Statistical Analysis ◽

Pregnant Women ◽

Vaginal Discharge ◽

Health Workers ◽

Vaginal Secretion ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Correlational Design ◽

Hygiene Behavior ◽

Abstract Knowledge

Abstract : Knowledge relations of pregnant women with the hygiene behavior about flour albus in Puskesmas Kalumpang Ternate Oktober 2013 Whiteness or Flour Albus is an abnormal vaginal secretion in women. Many women are not aware that they regard whitish vaginal discharge as common and trivial. Survey of health workers at the Puskesmas Kalumpang Ternate Incidence of Flour Albus / Whitish in pregnant women and pregnant women about the knowledge of flour albus / whiteness, from 100% of pregnant women around 55% of women do not know flour albus / discharge is physiological and pathological. The purpose of this study is to reveal Knowledge relations of pregnant women with the hygiene behavior about flour albus in Puskesmas Kalumpang Ternate Oktober 2013. The study design was descriptive correlational, design is cross sectional survey, with 30 samples of working mothers. The statistical analysis use in this study was bivariate.The results Relations knowledge of pregnant women with the hygiene behavior about flour albus in Puskesmas Kalumpang Ternate Oktober 2013, Based on the results showed a significant association (p = 0.036 ). Based on the Knowledge relations of pregnant women with the hygiene behavior about flour albus in Puskesmas Kalumpang Ternate Oktober 2013, can be considered in an effort to increase knowledge and awareness of the importance of maintaining the cleanliness of the area of sex organs.

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Malaria Preventive Practices among Pregnant Women in Akwa Ibom State, Southern Nigeria

Archives of Current Research International ◽

10.9734/acri/2019/v19i330158 ◽

2020 ◽

pp. 1-8

Author(s):

T. Kasso ◽

I. L. Oboro ◽

O. Maduka ◽

A. T. O. Awopeju ◽

N. I. Paul ◽

...

Keyword(s):

Pregnant Women ◽

Intermittent Preventive Treatment ◽

Open Data ◽

Public Health Problem ◽

Preventive Treatment ◽

Health Facilities ◽

Bed Nets ◽

P Value ◽

Cross Sectional ◽

Preventive Practices

Background: Malaria is a serious public health problem in developing countries with Africa bearing most of its burden. Pregnant women are more susceptible to malaria and it is one of the leading causes of maternal and perinatal mortality/morbidity. Use of effective malaria preventive measures during pregnancy reduces its burden and complications. Aim: This was to determine malaria preventive practices used by pregnant women in Akwa Ibom state, Nigeria. Materials and Methods: It was a cross sectional study of pregnant women attending public and private health facilities in Akwa Ibom state. An informed written consent was obtained from the participants. Stratified sampling method was used in selecting the health facilities and the study participants. Information was obtained with pretested questionnaires by trained personnel with the aid of Open Data Kit (ODK) on android phones. Data was managed with SPSS 22.0 and P-value of <0.05 was considered statistically significant. Results: There were 935 participants in the study. Their mean age was 28.52 ± 5.09 years with 879 (94.0%) being married. Most had secondary and tertiary degrees: 451(48.2%) and 440(47.1%). Majority of them were traders/business women and self-employed (58.2%) while 7% were unemployed. Malaria preventive practices were use of window net, bed net and insecticides accounting for 659(71%), 447(48.2%) and 207(22.3%) respectively. There were 612 (65.5%) participants that received malaria drugs for prevention with 452(73.9%) receiving Intermittent Preventive Treatment in Pregnancy (IPTp) with Sulfadoxine-Pyrimethamine (SP). Only 296 (31.7%) of them slept under bed nets the night before the interview. Conclusion: Common preventive practices employed by pregnant women were IPTp with SP, window nets, ITNs and modified IRS. Majority of the women utilized widow nets, though not as effective as ITNs. Efforts should be intensified concerning awareness creation about the benefits of ITN use during pregnancy.

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