Spatial Pattern and Determinants of Institutional Delivery in Ethiopia: Spatial and Multilevel Analysis Using 2019 Ethiopian Mini Demographic and Health Survey.

Background: In Ethiopia, despite the progress that has been made to improve maternal and child health, the proportion of births occurring at health institutions is still very low (26%), Which significantly contribute to a large number of maternal death 412 deaths/100,000 live births. Therefore, this study intended to determine spatial pattern and factors affecting institutional delivery among women who had live birth in Ethiopia within five years preceding survey.Method: Data from 2019 Ethiopian mini demographic and health survey were used. Taking into account the nested structure of the data, multilevel logistic regression analysis has been employed to a nationally representative sample of 5753 women nested with in 305 communities/clusters.Result: A significant heterogeneity was observed between clusters for institutional delivery which explains about 57% of the total variation. Individual-level variables: primary education (OR= 1.8: 95% CI: 1.44-2.26), secondary education (OR= 3.65: 95% CI: 2.19- 6.1), diploma and higher (OR= 2.74: 95% CI: 1.02 – 7.34), women who had both Radio and Television were 4.6 times (OR= 4.6; 95% CI: 2.52, 8.45), four and above Antenatal visit (AOR=2.72 ,95% CI:2.2, 3.34), rich wealth index (OR= 2.22; 95% CI: 1.62- 2.99), birth interval for 18 to 33 months (OR= 1.8; 95% CI: 1.19, 2.92), and women who space birth for 33 and above months (OR= 2.02; 95% CI: 1.3, 3.12) were associated with institutional delivery. Community level variables, community high proportion of antenatal visit (OR= 4.68; 95% CI: 4.13- 5.30), and Region were associated with institutional deliveryConclusion: A clustered pattern of areas with low institutional delivery was observed in Ethiopia. Both individual and community level factors found significantly associated with institutional delivery theses showed the need for community women education through health extension programs and community health workers. And the effort to promote institutional delivery should pay special attention to antenatal care, less educated women and interventions considering awareness, access, and availability of the services are vital for regions.

The prevalence of unintended pregnancy and its association with HIV status among pregnant women in South Africa, a national antenatal survey, 2019

To describe the prevalence of unintended pregnancy and its association with HIV status among pregnant women in South Africa. A cross-sectional survey was conducted between October and mid-November 2019 among pregnant women aged 15–49 years in 1589 selected public antenatal care facilities. Pregnancy intention was assessed using two questions from the London Measure of Unplanned Pregnancy. Survey logistic regression examined factors associated with unintended pregnancy. Among 34,946 participants, 51.6% had an unintended pregnancy. On multivariable analysis, the odds of unintended pregnancy was higher among women who knew their HIV-positive status before pregnancy but initiated treatment after the first antenatal visit (adjusted odds ratio [aOR], 1.5 [95% confidence interval (CI):1.2–1.8]), women who initiated treatment before pregnancy (aOR, 1.3 [95% CI:1.2–1.3]), and women with a new HIV diagnosis during pregnancy (aOR, 1.2 [95% CI:1.1–1.3]) compared to HIV-negative women. Women who were single, in a non-cohabiting or a cohabiting relationship, and young women (15–24 years) had significantly higher risk of unintended pregnancy compared to married women and women aged 30–49 years, respectively. A comprehensive approach, including regular assessment of HIV clients’ pregnancy intention, and adolescent and youth-friendly reproductive health services could help prevent unintended pregnancy.

Hubungan Pengetahuan Mengenai Tanda Perdarahan dengan Kunjungan Antenatal pada Ibu Hamil Trimester III

Knowledge is an important factor for pregnant women to be able to adapt to physiological and psychological changes during pregnancy. Failure to adapt causes several health problems for pregnant women, one of which is bleeding. Bleeding events can be prevented by obediently carrying out antenatal visits. To determine the relationship between respondent’s characteristics and knowledge of signs of bleeding during pregnancy with antenatal visit compliance in third trimester pregnant women. Quantitative research with a cross sectional approach and purposive sampling technique on 30 third trimester pregnant women, in October-November 2020. Using a questionnaire and data analysis using Chi-Square. Characteristics of respondents aged 20-35 years (93.3%), primigravida (56.7%), secondary education (60%), less knowledgeable (60%), obedient to antenatal visits (76.7%). The p-value=1,000. There is no significant relationship between the knowledge of third trimester pregnant women about signs of bleeding during pregnancy and compliance with antenatal visits at the Cipayung District Health Center, East Jakarta. Nurses have a duty to provide counseling regarding the compliance of third trimester pregnant women in antenatal visits to prevent the risk of bleeding.

A COMPARATIVE STUDY OF THE ASSOCIATION OF SERUM FERRITIN LEVEL WITH GESTATIONAL DIABETES MELLITUS IN THE DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY AT SMS MEDICAL COLLEGE & ATTACHED GROUP OF HOSPITALS, JAIPUR

Background: The present study aimed to study the association of Serum Ferritin level with gestational diabetes mellitus Methods: All Pregnant Females in Gestational age of 16 to 32 weeks presenting to the Ante natal clinic of Department of Obstetrics and Gynaecology, SMS Medical College, Jaipur. Based on Oral Glucose tolerance test, study participants were divided into two groups, Pregnant female with Gestational Diabetes (GDM group) and Pregnant female without Gestational Diabetes (Controls) Results: Mean ferritin level was significantly higher in GDM group (33.51 ng/ml)) as compared to control group (24.97 ng/ml). This difference in mean ferritin level among the two groups was found to be statistically significant (p<0.001). This indicates that higher ferritin level is significantly associated with risk of GDM. Conclusion: Serum ferritin in this study had a significant correlation with development of GDM. High ferritin range was found in females with GDM. Routine use of monitoring of serum ferritin levels, during the antenatal visit in the mid trimester should be carried out, for early prediction of developing GDM. Keywords: GDM, Serum ferrtin, Metabolic conditions.

Collaborative maternity and newborn dashboard (CoMaND) for the COVID-19 pandemic: a protocol for timely, adaptive monitoring of perinatal outcomes in Melbourne, Australia

BackgroundThe COVID-19 pandemic has resulted in a range of unprecedented disruptions to maternity care with documented impacts on perinatal outcomes such as stillbirth and preterm birth. Metropolitan Melbourne has endured one of the longest and most stringent lockdowns in globally. This paper presents the protocol for a multicentre study to monitor perinatal outcomes in Melbourne, Australia, during the COVID-19 pandemic.MethodsMulticentre observational study analysing monthly deidentified maternal and newborn outcomes from births >20 weeks at all 12 public maternity services in Melbourne. Data will be merged centrally to analyse outcomes and create run charts according to established methods for detecting non-random ‘signals’ in healthcare. Perinatal outcomes will include weekly rates of total births, stillbirths, preterm births, neonatal intensive care admissions, low Apgar scores and fetal growth restriction. Maternal outcomes will include weekly rates of: induced labour, caesarean section, births before arrival to hospital, postpartum haemorrhage, length of stay, general anaesthesia for caesarean birth, influenza and COVID-19 vaccination status, and gestation at first antenatal visit. A prepandemic median for all outcomes will be calculated for the period of January 2018 to March 2020. A significant shift is defined as ≥6 consecutive weeks, all above or below the prepandemic median. Additional statistical analyses such as regression, time series and survival analyses will be performed for an in-depth examination of maternal and perinatal outcomes of interests.Ethics and disseminationEthics approval for the collaborative maternity and newborn dashboard project has been obtained from the Austin Health (HREC/64722/Austin-2020) and Mercy Health (ref. 2020-031).Trial registration numberACTRN12620000878976; Pre-results.

FACTORS RELATED TO FIRST ANTENATAL VISITS IN PREGNANT WOMEN

Background: Pregnancy is a physiological event but in its developmen it has risks. In Nagekeo district in 2018 and 2019 there were 6 cases of maternal death and 121 cases of infant mortality with 52 deaths occurring antepartum. There were 10 infant deaths at the Boawae Health Center in 2019 with 5 cases of death occurring antepartum. In addition, there is a gap in achieving the first antenatal visit target of 19% and 14.8% in 2018 and 2019 where not all pregnant women have had their first pregnancy examination in the first trimester. Several factors can influence the behavior of pregnant women in conducting the first antenatal visit such as education level and cost. The importance of carrying out a pregnancy check in the first trimester allows for early detection of disease, administration of folic acid, communication and health information as well as management of problems found. This study aims to analyze the factors associated with the first antenatal visit in pregnant women. Methods: This type of research is observational analytic with a cross sectional design. The sample in this study were all pregnant women in the 2nd and 3rd trimesters who were in the working area of the Boawae Health Center. Data collected through questionnaires were then processed and analyzed by frequency distribution and cross distribution as well as Multiple Logistics Regression analysis with a significance level of 5% (p = 0.05). The research sample size is 86 respondents. The sampling technique is non-probability sampling with consecutive sampling. Bivariate data analysis using chi square and multivariate test using multiple logistic regression. Results: The results showed that the factors associated with the first antenatal visit were maternal health status with a p-value of 0.001 (p < 0.005), husband's education with a p-value of 0.000 (p < 0.005), pregnancy complications with a p-value of 0.001 (p < 0.005), costs with a p-value of 0.002 (p < 0.005) and the presence of a companion with a p-value of 0.000 (p < 0.005). Multivariate analysis showed that the most dominant factor influencing was the cost and presence of a companion, so it can be concluded that pregnant women who have KIS and are supported by a companion are more likely to have their first visit in the first trimester of pregnancy. Conclusion: There is a relationship between health status, husband's education, costs, presence of companions, pregnancy complications with the first antenatal visit.

FACTORS THAT INFLUENCING THE AWARENESS OF THE FIRST ANTENATAL VISIT

ABSTRACTBackground : K1 antenatal care visits at gestational age less than 13 weeks has a very important meaning for pregnant women as well as maternal and child health programs because of their contribution to the prevention of maternal deaths. Coverage of K1 in Puskesmas Watukapu still has a gap of 28.05%.This study aims to determine the factors that influence the K1 antenatal care visit. Methode : The research method was analytic observational with cross sectional design. The sample in this study were all pregnant women trimesters 2 and 3 who came to visit the POLI KIA Puskesmas Watukapu.The sample size of 70 respondents was taken by non-probability sampling technique with consecutive sampling.The independent variable was K1 antenatal care visit, while the dependent variable were age, knowledge, education, parity, attitude, husband's support and family support.Research instrument with questionnaire. Bivariate data analysis used chi square test and multivariate test used multiple logistic regression test. Results:this study found that the proportion of K1 antenatal care visits was 62.4%. Bivariate statistical test results knowledge P = 0,000 (p <0,005), attitude P = 0,135 (P> 0,005), husband support P = 0,000 (P <0,005), family support P = 0,004 (P <0,005), age P = 0,331 (P> 0.005), education P = 0.004 (P <0.005), parity P = 0.015 (P <0.05). Multivariate test results with P value <0.005 was parity with a P value of 0.017.Conclusion: There is a correlation between knowledge, education, parity, husband's support and family support to the awareness of K1 antenatal care visits with the most dominant factor is parity.

Short interpregnancy interval: circumstance or choice?

IntroductionDespite the knowledge of pregnancy risks attributable to inadequate birth spacing, over one-third of pregnancies occur within 18 months of a preceding birth. In this qualitative study we sought to interview women with a short interpregnancy interval (sIPI) to explore their knowledge of contraception and birth spacing and their experience of counselling on these themes.MethodsWe conducted in-depth interviews with women with a sIPI (live-birth less than 18 months prior to conception of current pregnancy) at Royal Prince Alfred Hospital and Canterbury Hospital in Sydney, Australia. Women were recruited at the second antenatal visit or day 3 postpartum. Interviews were recorded and transcribed. The six-phase thematic analysis framework described by Braun and Clarke was used to perform qualitative data analysis.ResultsTwenty women were interviewed (IPI range: 3–18 months). The three central themes that arose were that perceptions of IPIs are shaped by individual circumstances, a lack of information from healthcare providers (HCPs) on IPI and contraception limited women’s ability to make informed decisions, and that reproductive life planning is an important element of pregnancy care.ConclusionsIn this study, women with a sIPI did not feel informed about birth spacing, had poor knowledge of reliable contraceptives, and remained at risk of further closely spaced pregnancies. There was a desire among women with a sIPI to receive clear and consistent education on these topics. HCPs need to do more to educate women in the antenatal and postnatal period to help them space their pregnancies appropriately.

Spatial Pattern And Determinants of Institutional Delivery in Ethiopia: Spatial and Multilevel Analysis Using 2019 Ethiopian Mini Demographic and Health Survey.

Background: In Ethiopia, despite the progress that has been made to improve maternal and child health, the proportion of births occurring at health institutions is still very low (26%), Which significantly contribute to a large number of maternal death 412 deaths/100,000 live births. Therefore, this study intended to determine spatial pattern and factors affecting institutional delivery among women who had live birth in Ethiopia within five years preceding survey.Method: Data from 2019 mini Ethiopian demographic and health survey were used. Taking into account the nested structure of the data, multilevel logistic regression analysis has been employed to a nationally representative sample of 5753 women nested with in 305 communities/clusters.Result: A significant heterogeneity was observed between clusters for institutional delivery which explains about 57% of the total variation. Individual-level variables: primary education (OR= 1.8: 95% CI: 1.44-2.26), secondary education (OR= 3.65: 95% CI: 2.19- 6.1), diploma and higher (OR= 2.74: 95% CI: 1.02 – 7.34), women who had both Radio and Television were 4.6 times (OR= 4.6; 95% CI: 2.52, 8.45), four and above Antenatal visit (AOR=2.72 ,95% CI:2.2, 3.34), rich wealth index (OR= 2.22; 95% CI: 1.62- 2.99), birth interval for 18 to 33 months (OR= 1.8; 95% CI: 1.19, 2.92), and women who space birth for 33 and above months (OR= 2.02; 95% CI: 1.3, 3.12) were associated with institutional delivery. Community level variables, community high proportion of antenatal visit (OR= 4.68; 95% CI: 4.13- 5.30), and Region were associated with institutional deliveryConclusion: A clustered pattern of areas with low institutional delivery was observed in Ethiopia. Both individual and community level factors found significantly associated with institutional delivery theses showed the need for community women education through health extension programs and community health workers. And the effort to promote institutional delivery should pay special attention to antenatal care, less educated women and interventions considering awareness, access, and availability of the services are vital for regions.

The relationship between markers of antenatal iron stores and birth outcomes differs by malaria prevention regimen—a prospective cohort study

Background Iron deficiency (ID) has been associated with adverse pregnancy outcomes, maternal anaemia, and altered susceptibility to infection. In Papua New Guinea (PNG), monthly treatment with sulphadoxine-pyrimethamine plus azithromycin (SPAZ) prevented low birthweight (LBW; <2500 g) through a combination of anti-malarial and non-malarial effects when compared to a single treatment with SP plus chloroquine (SPCQ) at first antenatal visit. We assessed the relationship between ID and adverse birth outcomes in women receiving SPAZ or SPCQ, and the mediating effects of malaria infection and haemoglobin levels during pregnancy. Methods Plasma ferritin levels measured at antenatal enrolment in a cohort of 1892 women were adjusted for concomitant inflammation using C-reactive protein and α-1-acid glycoprotein. Associations of ID (defined as ferritin <15 μg/L) or ferritin levels with birth outcomes (birthweight, LBW, preterm birth, small-for-gestational-age birthweight [SGA]) were determined using linear or logistic regression analysis, as appropriate. Mediation analysis assessed the degree of mediation of ID-birth outcome relationships by malaria infection or haemoglobin levels. Results At first antenatal visit (median gestational age, 22 weeks), 1256 women (66.4%) had ID. Overall, ID or ferritin levels at first antenatal visit were not associated with birth outcomes. There was effect modification by treatment arm. Amongst SPCQ recipients, ID was associated with a 81-g higher mean birthweight (95% confidence interval [CI] 10, 152; P = 0.025), and a twofold increase in ferritin levels was associated with increased odds of SGA (adjusted odds ratio [aOR] 1.25; 95% CI 1.06, 1.46; P = 0.007). By contrast, amongst SPAZ recipients, a twofold increase in ferritin was associated with reduced odds of LBW (aOR 0.80; 95% CI 0.67, 0.94; P = 0.009). Mediation analyses suggested that malaria infection or haemoglobin levels during pregnancy do not substantially mediate the association of ID with birth outcomes amongst SPCQ recipients. Conclusions Improved antenatal iron stores do not confer a benefit for the prevention of adverse birth outcomes in the context of malaria chemoprevention strategies that lack the non-malarial properties of monthly SPAZ. Research to determine the mechanisms by which ID protects from suboptimal foetal growth is needed to guide the design of new malaria prevention strategies and to inform iron supplementation policy in malaria-endemic settings. Trial registration ClinicalTrials.gov NCT01136850.