Assessing the effect of pregnancy intention at conception on the continuum of care in maternal healthcare services use in Bangladesh: Evidence from a nationally representative cross-sectional survey

Background The Continuum of Care (CoC; defined as accessing the recommended healthcare services during pregnancy and the early postpartum period) is low in lower-middle-income countries (LMICs). This may be a major contributor to the high rates of pregnancy-related complications and deaths in LMICs, particularly among women who had an unintended pregnancy. With a lack of research on the subject in Bangladesh, we aimed to examine the effect of unintended pregnancy on CoC. Methods Data from 4,493 mother-newborn dyads who participated in the cross-sectional 2014 Bangladesh Demographic and Health Survey were analysed. Women’s level of CoC was generated from responses to questions on the use and non-use of three recommended services during the course of pregnancy: four or more antenatal care (ANC) visits, skilled birth attendance (SBA) during delivery, and at least one postnatal care (PNC) visit within 24 hours of giving birth. Global recommendations of service use were used to classify CoC as high (used each of the recommended services), moderate (used at least two of the three recommended services), and low/none (no PNC, no SBA, and ≤3 ANC visits). Women’s pregnancy intention at the time of conception of their last pregnancy (ending with a live birth) was the major exposure variable, classified as wanted, mistimed, and unwanted. Unadjusted and adjusted (with individual-, household-, and community-level factors) multilevel multinomial logistic regression models were used to assess the association between unintended pregnancy and level of CoC. Results In Bangladesh, the highest level of CoC occurred in only 12% of pregnancies that ended with live births. This figure was reduced to 5.6% if the pregnancy was unwanted at conception. The antenatal period saw the greatest drop in CoC, with 65.13% of women receiving at least one ANC visit and 26.32% having four or more ANC visits. Following the adjustment of confounders, an unwanted pregnancy was found to be associated with 39% and 62% reduced odds of women receiving moderate and high levels of CoC, respectively, than those with a wanted pregnancy. Having a mistimed pregnancy was found to be associated with a 31% reduction in odds of women achieving a high CoC than women with a wanted pregnancy. Conclusion Almost nine in ten women did not achieve CoC in their last pregnancy, which was even higher when the pregnancy was unintended. Given that the ANC period has been identified as a critical time for intervention for these women, it is necessary for policies to scale up current maternal healthcare services that provide in-home maternal healthcare services and to monitor the continuity of ANC, with a particular focus on women who have an unintended pregnancy. Integration of maternal healthcare services with family planning services is also required to ensure CoC.

Quality of antenatal care and associated factors in a rural county in Kenya: an assessment of service provision and experience dimensions

Background This study aimed to assess the quality of antenatal care (ANC) women received in Migori county, Kenya—including both service provision and experience dimensions—and to examine factors associated with each dimension. Methods We used survey data collected in 2016 in Migori county from 1031 women aged 15–49 who attended ANC at least once in their most recent pregnancy. ANC quality service provision was measured by nine questions on receipt of recommended ANC services, and experience of care by 18 questions on information, communication, dignity, and facility environment. We summed the responses to the individual items to generate ANC service provision and experience of care scores. We used both linear and logistic regression to examine predictors. Results The average service provision score was 10.9 (SD = 2.4) out of a total of 16. Most women received some recommended services once, but not at the frequency recommended by the Kenyan Ministry of Health. About 90% had their blood pressure measured, and 78% had a urine test, but only 58 and 14% reported blood pressure monitoring and urine test, respectively, at every visit. Only 16% received an ultrasound at any time during ANC. The average experience score is 27.3 (SD = 8.2) out of a total score of 42, with key gaps demonstrated in communication. About half of women were not educated on pregnancy complications. Also, about one-third did not often understand the purposes of tests and medicines received and did not feel able to ask questions to the health care provider. In multivariate analysis, women who were literate, employed, and who received all their ANC in a health center had higher experiences scores than women who were illiterate (coefficient = 1.52, CI:0.26,2.79), unemployed (coefficient = 2.73, CI:1.46,4.00), and received some ANC from a hospital (coefficient = 1.99, CI: 0.84, 3.14) respectively. The wealthiest women had two times higher odds of receiving an ultrasound than the poorest women (OR = 2.00, CI:1.20,3.33). Conclusion Quality of ANC is suboptimal in both service provision and experience domains, with disparities by demographic and socioeconomic factors and facility type. More efforts are needed to improve quality of ANC and to eliminate the disparities.

Comparison of occupational accidents among staff of two educational hospitals of Medical Sciences University of Ahvaz in 2017

Introduction: Hospitals are one of the most important sources of health and medical services, with employees working in different parts that in touch with numerous Occupational harmful factors and Occupational Accidents. Through examining the accident occurring among employees, can do important action to reduce the Human and financial losses. Therefore, the current study aimed at comparing occupational accidents among the staff of the two educational hospitals of Medical Sciences University of Ahvaz. Methods: A cross-sectional analytical study was conducted in 2017 among laboratory staff, nurses and operating room personnel in two educational hospitals. 110 persons from each hospital (sample size based on Cochran formula) participated in the study and information about the experiences of accidents occurred for employees and the days of absence were collected through a questionnaire. Finally, data analysis was done by using SPSS 22 software. Findings: Over 85% of staff in educational hospitals No. 1 and No. 2 were female. The nurses had the highest frequency in terms of the organizational status of the staff employed in these two hospitals. The incident Crop with sharp objects in the hospital 1 and the incidence of skin contact with blood or other body fluids in the hospital 2 were the most frequent among other incidents. Results: Due to the fact that skin contact with blood or other body fluids has the highest rate of recurrence among other events, it can lead to an increase in absenteeism. Therefore, recommended services provided by professional health experts on the continued use of gloves and the selection of suitable gloves are helpful.

A Multi Criteria Recommendation Engine Model for Cloud Renderfarm Services

Cloud services that provide a complete platform for rendering the animation files using the resources in the cloud are known as cloud renderfarm services. This work proposes a multi criteria recommendation engine model for recommending these Cloud renderfarm services to animators. The services are recommended based on the functional requirements of the animation file to be rendered like the rendering software, plug-in required etc and the non functional Quality of Service (QoS) requirements like render node cost, time taken to upload animation files etc. The proposed recommendation engine model uses a domain specific ontology of renderfarm services to identify the right services that could satisfy the functional requirements of the user and ranks the identified services using the popular Multi Criteria Decision Analysis method like Simple Additive Weighting (SAW). The ranked list of services is provided as recommended services to the animators in the ranking order. The Recommendation model was tested to rank and recommend the cloud renderfarm services in multi criteria requirements by assigning different QoS criteria weight for each scenario. The ranking based recommendations were generated for six different scenarios and the results were analyzed. The results show that the services recommended for each scenario were different and were highly dependent on the weights assigned to each criterion.

Contributing Factors to Older Teen Mothers’ Academic Success as Very Young Mothers

This qualitative study explores the factors contributed to 13 older teen mothers’ academic success as very young mothers. The participants were older teen mothers who were pregnant and gave birth at the age of 16 years old or younger, and who have achieved a college degree from an accredited college or university while they raised their child(ren). In depth interviews were employed to document and analyze older teen mother experiences. One-on-one interviews with the participants revealed multiple factors assisted older teen mothers’ academic success, including family and other individuals support, teachers, early school attendance, personal drive, and responsibilities. While further research is needed, these findings suggest that developing holistic services for teen mothers is needed to assist in developing future academic success. A holistic approach includes mind, body and spirit (Arsenian, n.d.). These recommended services could be developed within existing programs and should include activities to promote self-awareness, health and some form of exploration of values, faith and family.

Use of recommended post-treatment services for adolescent and young adult Hodgkin lymphoma survivors.

107 Background: Adolescent and young adult (AYA) Hodgkin lymphoma survivors are at high risk for long-term and late effects. Post-treatment guidelines are available from the National Comprehensive Cancer Network (NCCN) and others; however, adherence to these guidelines is unknown. The purpose of this study was to identify AYA Hodgkin survivors from an integrated health care system and examine use of post-treatment services. Methods: We identified patients diagnosed between 2000 and 2010, ages 15 to 39. We identified use of NCCN recommended services (oncology visits, labs, CT) and non-recommended services (PET scan, CT after first year). Multivariate logistic regression was used to identify associations between receipt of recommended services within first 12 months post-treatment (oncology visits, labs, CT) and patient (gender, race/ethnicity) and cancer characteristics (stage, diagnosis age, diagnosis year). Results: We identified 354 patients (see table). Almost all had recommended oncology visits within the first 5 years (96%); 70% received recommended labs. Two-thirds received a recommended CT scan within 12 months post- treatment. However, 47% received a non-recommended CT in year 2 and 35% in year 3, and 33% received a non-recommended PETs. Overall, 48% received all recommended care within the first 12 months. Diagnosis year was significant in regression, with those diagnosed 2000-2005 less likely to receive recommended care than those diagnosed 2006-2010 (OR = 0.007, p < .0001). Conclusions: Less than half of patients received recommended care within the first year post-treatment. These results will inform development of effective programs to meet survivors’ needs. Next steps include exploring risk-stratified patterns of care in long-term survivors. [Table: see text]