Comparing the timeliness and adequacy of antenatal care uptake between women who married as child brides and adult brides in 20 sub-Saharan African countries

Context Considering the persistent poor maternal and child health outcomes in sub-Saharan Africa (SSA), this study undertook a comparative analysis of the timing and adequacy of antenatal care uptake between women (aged 20–24 years) who married before age 18 and those who married at age 18 or above. Method Data came from Demographic and Health Surveys of 20 SSA countries. We performed binary logistic regression analysis on pooled data of women aged 20–24 (n = 33,630). Results Overall, the percentage of child brides in selected countries was 57.1%, with the lowest prevalence found in Rwanda (19.1%) and the highest rate in Chad (80.9%). Central and West African countries had the highest prevalence of child marriage compared to other sub-regions. Bivariate results indicate that a lower proportion of child brides (50.0%) had 4+ ANC visits compared to the adult brides (60.9%) and a lower percentage of them (34.0%) initiated ANC visits early compared to the adult brides (37.5%). After controlling for country of residence and selected socio-economic and demographic characteristics, multivariable results established significantly lower odds of having an adequate/prescribed number of ANC visits among women who married before age 15 (OR: 0.63, CI: 0.57–0.67, p<0.001), and women who married at ages 15–17 (OR: 0.81, CI: 0.75–0.84, p<0.001) compared to those who married at age 18+. Similar results were established between age at first marriage and timing of first ANC visit. Other interesting results emerged that young women who married earlier than age 18 and those who married at age 18+ differ significantly by several socio-economic and demographic characteristics. Conclusion Efforts to improve maternal and child health outcomes in SSA must give attention to address the underutilization and late start of antenatal care uptake among child brides.

Impact of COVID-19 Pandemic on Utilization of Facility-Based Essential Maternal and Child Health Services in North Shewa Zone, Ethiopia

Introduction: Ethiopia registered its first case of COVID-19 on March 13, 2020. We aimed to assess maternal, newborn, and child health care (MNCH) utilization during the first six months of the COVID-19 pandemic, as well as potential barriers and enablers of service utilization from health care providers and clients. Methods: Mixed study design was conducted as part of the Birhan Health and Demographic Surveillance System in Ethiopia. The trend of service utilization during the first six months of COVID-19 was compared to corresponding time and data points of the preceding year. Result: Service utilization of new family planning visits (43.2 to 28.5/month, p = 0.014) and sick under five child visits (225.0 to 139.8/month, P = 007) declined during the initial six months of the pandemic compared to the same period in the preceding year. Antenatal and postnatal care visits, facility delivery rates, and child routine immunization visits also decreased although this did not reach statistical significance. Interviews with health care providers and clients highlighted several barriers to service utilization during COVID-19, including fear of disease transmission, economic hardship, and transport service disruptions and restrictions. Enablers of service utilization included communities' decreased fear of COVID-19, and awareness-raising activities. Conclusion: Provision of essential MNCH services is crucial to ascertain favorable maternal and child health outcomes. In low- and middle-income country settings like Ethiopia, health systems might be fragile to withstand the caseloads and priority setting due to the pandemic. Our study presents early findings on the utilization of MNCH services that were maintained except sick child and new family planning visits. Government leaders, policy makers, and clinicians who wish to improve the resilience of their health system will need to continuously monitor service utilization and clients' evolving concerns during the pandemic to prevent increases in maternal and child morbidity and mortality.

Development of a Blueprint for Integrated Care for Vulnerable Pregnant Women

Purpose There has been increasing awareness of perinatal health and organisation of maternal and child health care in the Netherlands as a result of poor perinatal outcomes. Vulnerable women have a higher risk of these poor perinatal outcomes and also have a higher chance of receiving less adequate care. Therefore, within a consortium, embracing 100 organisations among professionals, educators, researchers, and policymakers, a joint aim was defined to support maternal and child health care professionals and social care professionals in providing adequate, integrated care for vulnerable pregnant women. Description Within the consortium, vulnerability is defined as the presence of psychopathology, psychosocial problems, and/or substance use, combined with a lack of individual and/or social resources. Three studies focussing on population characteristics, organisation of care and knowledge, skills, and attitudes of professionals regarding vulnerable pregnant women, were carried out. Outcomes were discussed in three field consultations. Assessment The outcomes of the studies, followed by the field consultations, resulted in a blueprint that was subsequently adapted to local operational care pathways in seven obstetric collaborations (organisational structures that consist of obstetricians of a single hospital and collaborating midwifery practices) and their collaborative partners. We conducted 12 interviews to evaluate the adaptation of the blueprint to local operational care pathways and its’ embedding into the obstetric collaborations. Conclusion Practice-based research resulted in a blueprint tailored to the needs of maternal and child health care professionals and social care professionals and providing structure and uniformity to integrated care provision for vulnerable pregnant women.

Maternal and Child Health Services in Rural Settings of The Gambia: Contextual Determinants of Postnatal Care from Mothers’ Perspectives—A Community-Based Analytical Cross-Sectional Study

Background. Maternal and child health in The Gambia is a trending public health burden. The postnatal period is critical and vital to the lives and health of the maternal mothers and their newborns, and pieces of evidence deduced that a majority of maternal and newborn deaths occur during this period. Hence, this research aimed to assess the prevalence and determinants of postnatal care utilization across women in rural Gambia. Methods. A community-based cross-sectional design was conducted in January 2020, with 265 women of childbearing age were recruited from the selected households in rural communities across the Upper River Region (URR), Gambia, using multistage sampling technique. A structured-interview questionnaire was developed to elicit contextual sociodemographic characteristics regarding the use of postnatal care. Percentages, chi-square/Fisher’s exact test for variables with p value ≤0.15 were considered for inclusion into the logistic regression model. The significance level was set at p < 0.05 . The adjusted odds ratios (aOR) with 95% confidence interval (CI) were computed to declare significance. Results. The study revealed that 90% of women utilize postnatal care (PNC) services in the rural settings of URR, Gambia. Factors such as women’s occupation, location, number of pregnancies, attending in last pregnancy, current uptake of family planning, and complication(s) in last labor were found to be associated with PNC utilization. Women who attended antenatal care (ANC) services in their last pregnancy were 10.8 times (aOR = 10.795, 95% CI: 1.025–113.694), current users of FP were 10.7 times (aOR = 10.708, 95% CI: 1.379–83.152), women’s number of pregnancies increases by a factor of 4.6 times (aOR = 4.649, 95% CI: 1.518–14.243) more likely to utilize PNC while women’s number of children alive were less likely by 76.1% (aOR = 0.239, 95% CI: 0.071–0.810) as compared to those who were not utilizing PNC services. Conclusion. The findings showed that attending ANC services, current uptake of FP, women’s number of pregnancies, and number of children alive were associated with PNC. Strengthening women empowerment and designing responsive ANC programs especially for rural women to improve PNC services are required.

Effect of Integrating Maternal and Child Health Services, Nutrition and Family Planning Services on Postpartum Family Planning Uptake at 6 Months Post-partum in Burkina Faso, Cote d’Ivoire and Niger: Protocol of a Longitudinal Quasi-experimental Study

Background : Although several interventions integrating maternal, neonatal, child health and nutrition with family planning have been implemented and tested, there is still limited evidence on their effectiveness to guide program efforts and policy action,on health services integration. This study aims to assess the effectiveness of a service delivery model integrating maternal and child health services, nutrition and family planning services, compared with the general standard of care in Burkina Faso, Cote d'Ivoire, and Niger. Methods: This is a quasi experimental study with one intervention group and one control group of 3-4 health facilities in each country. Each facility was matched to a control facility of the same level of care and that had similar coverage on selected reproductive health indicators such as family planning and post-partum family planning. The study participants are pregnant women (with a 6 months pregnancy at maximum) coming for their first antenatal care visit. They will be followed up to 6 months after childbirth, and will be interviewed at each antenatal visit and also during visits for infant vaccines.The analyzes will be carried out by intention to treat, using generalized linear models (binomial log or log Poisson) to assess the effect of the intervention on the ratio of contraceptive use prevalence between the two groups of the study at a significance level of 5%, while taking into account the cluster effect and adjusting for potential confounding factors (socio-demographic characteristics of women, unevenly distributed at inclusion). Discussion :This longitudinal study, with the provision of family planning services integrated into the whole maternal care continuum, a sufficiently long observation time and repeated measurements, will make it possible to better appreciate the timeline and the factors influencing women's decision-making on the use of post-partum family planning services. The results will help in increasing the body of knowledge regarding the impact of maternal and child health services integration on the utilization of post-partum family planning, taking into account the specific context of sub-Saharan Africa French speaking countries where such information is very needed.

The INFOGRAFIS KESEHATAN IBU HAMIL DI RUANG KESEHATAN IBU DAN ANAK PUSKESMAS JATINANGOR

Information about the health of pregnant women is one of the pregnant women’s needs. It is important for health centers to provide media that present health information for pregnant women as an education facilitator to increase health literacy for pregnant women. Moreover, the Public Health Center of Jatinangor has not provided information to the media that presents information about the health of pregnant women for pregnant women in Maternal and Child Health room. This study is conduct to provide information media that repackages health information for pregnant women in the form of an infographics in Maternal and Child Health room in the Public Health Center of Jatinangor. This study aims to know what kind of infographics that appropriate for Maternal and Child Health room, to find out the information, visual elements, and information/visual hierarchies that need to be presented in the infographics. This research uses action research method. Data collected by using observation, interview, questionnaire, and literature study technique. Interviews done with pregnant women patients, midwives, infographic expert, and the Public Health Center of Jatinangor officer. Through this research, it can be seen that the appropriate infographic to be placed in the Maternal and Child Health room of Jatinangor Health Center is a printed statistical infographic with a simple design; the room of information packaged in the infographic is information on the prevention of problems in pregnancy that often occur in Jatinangor; the visual elements used in the infographic is bright colors, simple geometric shapes, clear and large fonts, high-resolution and informational images, and proper white space composition; as well as information and visual hierarchies used in infographic is simple and straightforward hierarchies.

FACTORES ASOCIADOS A LA FALTA DE CONTROL PRENATAL EN AMÉRICA LATINA Y SU RELACIÓN CON LAS COMPLICACIONES OBSTÉTRICAS.

Introducción: El control prenatal es un conjunto de actividades y procedimientos que el equipo de salud ofrece a la embarazada, para la prevención de complicaciones, por medio del diagnóstico precoz de factores de riesgo en la gestante y enfermedades que puedan afectar el curso normal del embarazo y la salud del recién nacido. Objetivo: Identificar los factores asociados a la falta de control prenatal en América latina y su relación con las complicaciones obstétricas. Métodos: investigación de diseño documental con revisión bibliográfica en las bases de datos: PubMed, BVS, Scielo, Latindex, Lilacs y Google académico, con los descriptores de ciencias de la salud (DeCS) de Bireme y los Medical Subject Headings (MesH) de la National Library of Medicine: atención prenatal, embarazo, complicaciones del embarazo, salud materno-infantil, en idioma español e inglés durante el periodo 2015-2021. Resultados: La búsqueda inicial de información reportó un total de 1718 registros, de los cuales 86 eran elegibles, de estos 56 no fueron relevantes, por lo que quedan incluidos 30 que permitieron dar cumplimiento al objetivo de estudio con los cuales se procedió al meta-análisis. Conclusiones: Los factores asociados a la falta de control prenatal son: el bajo nivel de instrucción, ocupaciones del hogar y crianza, falta de empleo, escasos recursos económicos, ubicación geográfica, falta de afiliación, creencias y costumbres, estos factores se relacionan con complicaciones obstétricas como: infecciones, anemia, preeclampsia, hemorragias, desgarros perineales, alumbramiento incompleto, bajo peso y prematuridad. Palabras claves: atención prenatal, embarazo, complicaciones del embarazo, salud materno-infantil ABSTRACT Introduction: Prenatal control is a set of activities and procedures that the health team offers to the pregnant woman, for the prevention of complications, through the early diagnosis of risk factors in the pregnant woman and diseases that may affect the normal course of pregnancy. and the health of the newborn. Objective: To identify the factors associated with the lack of prenatal control in Latin America and its relationship with obstetric complications. Methods: documentary design research with bibliographic review in databases: PubMed, BVS, Scielo, Latindex, Lilacs and academic Google, with the descriptors of health sciences (DeCS) from Bireme and the Medical Subject Headings (MeSH) from the National Library of Medicine: prenatal care, pregnancy, pregnancy complications, maternal and child health, in Spanish and English during the period 2015-2021. Results: The initial search for information reported a total of 1718 records, of which 86 were eligible, of these 56 were not relevant, so 30 are included that allowed the fulfillment of the study objective with which the goal was carried out. analysis. Conclusions: The factors associated with the lack of prenatal control are: low level of education, home occupations and upbringing, lack of employment, scarce economic resources, geographic location, lack of affiliation, beliefs and customs, these factors are related to complications obstetrics such as: infections, anemia, preeclampsia, hemorrhages, perineal tears, incomplete delivery, low weight and prematurity.Keywords: prenatal care, pregnancy, pregnancy complications, maternal and child health

Construction and validation of the prognostic model for patients with neuroendocrine cervical carcinoma: a competing risk nomogram analysis

Purpose Neuroendocrine cervical carcinoma (NECC) is an uncommon malignancy of the female reproductive system. This study aimed to evaluate cancer-specific mortality and to construct prognostic nomograms for predicting the survival of patients with NECC. Methods we assembled the patients with NECC diagnosed between 2004 to 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. Meanwhile, we identified other patients with NECC from the Wenling Maternal and Child Health Care Hospital between 2002 to 2017. Fine and Gray’s test and Kaplan–Meier methods were used to evaluate cancer-specific mortality and overall survival (OS) rates, respectively. Nomograms were constructed for predicting cancer-specific survival (CSS) and OS for patients with NECC. The developed nomograms were validated both internally and externally. Results a total of 894 patients with NECC were extracted from the SEER database, then classified into the training cohort (n = 628) and the internal validation cohort (n = 266). Besides, 106 patients from the Wenling Maternal and Child Health Care Hospital served as an external validation cohort. Nomograms for predicting CSS and OS were constructed on clinical predictors. The validation of nomograms was calculated by calibration curves and concordance indexes (C-indexes). Furthermore, the developed nomograms presented higher areas under the receiver operating characteristic (ROC) curves when compared to the FIGO staging system. Conclusions we established the first competing risk nomograms to predict the survival of patients with NECC. Such a model with high predictive accuracy could be a practical tool for clinicians.