Quality of Counselling Services for Pregnant Women in Community Clinics

Maternal health service had a potentially critical role in the improvement of reproductive health. This descriptive study was carried out in Tangail district, from 1st January to 31st December, 2019 to find out the quality of counselling of services for pregnant women in community clinics during pregnancy period. Data were collected among 289 respondents by face to face interview who had delivered within last 24 months and respondents were selected purposively. The majority (97.6%) of the respondents were housewife and maximum (72%) of the respondent were below SSC in this study monthly family income mean was taka 16124.00± 10065.480. Majority of the respondents (99.2%) had received antenatal check-up from different health care facilities and highest (87.2%) had received from the community clinic other hands (6.0%) pregnant women got antenatal care from non-government hospital among 250 respondents (94.0%) pregnant women received ANC from CHCP also (4%) pregnant women received ANC from HA. Out of 250 pregnant women (70%) of the respondents were problem suffer during pregnancy. Here majority (59.6%) pregnant women were suffer from nausea and vomiting and only (6.3%) were suffering from constipation. Majority (89.2%) of the respondents had preparation about danger sign during pregnancy. Most 245 (98%) of the respondents of pregnant women had information about ANC and most (85.7%) got information from CHCF on other hand ride got information (2.9%) from neighbour. half (4.8%) of the respondents choice of conduct delivery at upazila health complex followed by (48.8%) only choice of conduct clinics. Most (98%) of the respondents had received TT vaccine and maximum (95.1%) of the respondents had completed TT vaccine. Enough skilled manpower for patient care (98.4%). Health care provider perform ANC check-up (96.8%). Health care provider counselling during pregnancy (96.4%) physical examination (98.0%) explanation of health. (99.2%) health care provider give any advice before departure (70.4%). Continue to follow-up health status over phone (99.2%). Service providers in health care shows that 33.3% was BSc/BA, 42.9% of service providers were masters and above their professional training more than one third (38.1%) of the providers has basic training, 47.6% had basic & CSBA and rest 14.3% had ECT and nutritional training. Majority 100% of the provider’s designation had CHCP, number of staff in two health care had more than half (57.1%) providers.

Effect of checklist based box system interventions on improving institutional delivery among reproductive age women in Northwest Ethiopia: generalized structural equation modeling

Background Previous studies have shown that there is low utilization of institutional delivery in Ethiopia, as well as various factors contributing to this low utilization. Notably, there is paucity around interventions to improve institutional delivery. Hence, this study examines the effectiveness of checklist-based box system intervention on improving institutional delivery and to investigate the association through which the intervention is linked to institutional delivery. Method The study used data from a larger trial, on the effectiveness of checklist-based box system intervention on improving maternal health service utilization. In the intervention arm, mothers received regular community-level pregnancy screening and referral, service utilization monitoring boxes, drop-out tracing mechanisms, regular communication between health centers and health posts, and person-centered health education for mothers. This study used the existing government-led maternal health program as a control arm. A total of 1062 mothers who gave birth one-year before the survey were included in the final analysis. A difference-in-difference estimator was used to test the effectiveness of the intervention. Generalized structural equation modeling was used to examine the direct and/ indirect associations between the intervention and institutional delivery. Result Among participants, 403 (79.5%) mothers from intervention and 323 (58.2%) mothers from control clusters gave birth at health facilities. The result of the study revealed a 19% increase in institutional delivery in the intervention arm (19, 95%CI: 11.4-27.3%). In this study the pathway from checklist-based box system intervention to institutional delivery was mainly direct - (AOR = 3.32, 95%CI: 2.36-4.66), however, 33% of the effect was partially mediated by attendance of antenatal care four visits (AOR = 1.39, 95%CI: 1.02-1.92). The influence of significant others (AOR = 0.25, 95%CI: 0.15-0.43) and age (AOR = 0.03, 95%CI: 0.01- 0.09) had an inverse relation with institutional delivery. Conclusion The implementation of a checklist-based box system significantly increased institutional delivery utilization, both directly and indirectly by improving antenatal care four attendance. A larger-scale implementation of the intervention was recommended, taking the continuum of care approach into account. Trial registration ClinicalTrials.gov, NCT03891030, Retrospectively registered on 26 March, 2019.

Measurement and Mapping of Maternal Health Service Coverage Through a Novel Composite Index: A Sub-National Level Analysis in India

Background: Expansion of maternal health service coverage is crucial for the survival and wellbeing of both mother and child. To date, limited literature exists on the measurement of maternal health service coverage at the sub-national level in India. The prime objectives of the study were to comprehensively measure the maternal health service coverage by generating a composite index; map India by categorizing it into low, medium and high zones and examine its incremental changes over time. Methods: Utilising a nationally representative time series data of 15 key indicators spread across three domains of antenatal care, intranatal care and postnatal care, we constructed a novel ‘Maternal Health Service Coverage Index’ (MHSI) for 29 states and 5 union territories of India for the base (2017-18) and reference (2019-20) years. Following a rigorous procedure, MHSI scores were generated using both arithmetic mean and geometric mean approach. We categorized India into low, medium and high maternal health coverage zones and further generated geospatial maps to examine the extent and transition of maternal health service coverage from base to reference year.Results: India registered the highest mean percentage coverage (93.66%) for ‘institutional delivery’ and lowest for ‘treatment for obstetric complications’ (9.25%) among all the indicators. Depending on the usage of arithmetic mean and geometric mean approach, the maternal health service coverage index score for India exhibited marginal incremental change (between 0.015- 0.02 index points) in the reference year. West zone exhibited an upward transition in the coverage of maternal health service indicators, while none of the zones recorded a downward movement. States of Mizoram (east zone), Puducherry (south zone) showed a downward transition. Union territories of Dadra & Nagar Haveli (west zone) and Chandigarh (north zone) along with the states of Maharashtra (west zone), Assam, as well as Jharkhand (both from the east & north east zone), showed upward transition.Conclusion: Overall, maternal health service coverage is increasing across India. Our study offers a novel summary measure to comprehensively quantify the coverage of maternal health service, which can momentously help India to identify lagged indicators and low performing regions, thereby warranting the targeted interventions and concentrated programmatic efforts to bolster the maternal health service coverage at the sub-national level.

Disruptions in maternal health service use during the COVID-19 pandemic in 2020: experiences from 37 health facilities in low-income and middle-income countries

The COVID-19 pandemic has heterogeneously affected use of basic health services worldwide, with disruptions in some countries beginning in the early stages of the emergency in March 2020. These disruptions have occurred on both the supply and demand sides of healthcare, and have often been related to resource shortages to provide care and lower patient turnout associated with mobility restrictions and fear of contracting COVID-19 at facilities. In this paper, we assess the impact of the COVID-19 pandemic on the use of maternal health services using a time series modelling approach developed to monitor health service use during the pandemic using routinely collected health information systems data. We focus on data from 37 non-governmental organisation-supported health facilities in Haiti, Lesotho, Liberia, Malawi, Mexico and Sierra Leone. Overall, our analyses indicate significant declines in first antenatal care visits in Haiti (18% drop) and Sierra Leone (32% drop) and facility-based deliveries in all countries except Malawi from March to December 2020. Different strategies were adopted to maintain continuity of maternal health services, including communication campaigns, continuity of community health worker services, human resource capacity building to ensure compliance with international and national guidelines for front-line health workers, adapting spaces for safe distancing and ensuring the availability of personal protective equipment. We employ a local lens, providing prepandemic context and reporting results and strategies by country, to highlight the importance of developing context-specific interventions to design effective mitigation strategies.

Full immunization coverage and associated factors among children aged 12–23 months in Somali Region, Eastern Ethiopia

Objective Despite those efforts in expanded programs of immunization, nearly one fifth of children in developing countries miss out basic vaccines. Moreover, many children who started vaccination fail to complete immunization.Identifying associated factorswhich is scarce in the study area, is crucial for interventions. This study assessed full-immunization and associated factors among children aged 12–23 months in Somali region, Eastern Ethiopia. Methods A community-based cross-sectional study design was conducted from October 1–30, 2018, in selected rural and urban kebeles in Somali regionamong 612 children. Cluster sampling was employed and data was collected using structured questionnaire. Full-immunization was measured by maternal recall and vaccination card.Data entry and analysis was done by EpiData3.1 and SPSSversion.20 respectively. Binary logistic regression with Bivariate and Multivariable model was usedto identify predictors of full-immunization. Odd ratios were computed and P-value <0.05 was considered as statistically significant. Results Based on maternal recall plus vaccination card 249(41.4%) of children were completed immunization, while vaccination only by card was 87(29.7%). Only 238(39.5%) of participants had good knowledge about vaccination. Not knowing to come back for next visits 197(55.8%) were the major reason for dropout. Residing in urban (AOR = 2.0, 95%CI: 1.0, 3.9),primary educated mothers(AOR = 2.2, 95%CI: 1.0, 5.0), married mothers (AOR = 4.2, 95%CI:1.0, 18), higher average monthly income (AOR = 2.5, 95%CI 1.1, 5.2)and delivered at health facilities (AOR = 3.8, 95%CI 1.9, 7.3)were significantly associated with full-immunization. Conclusion Coverage of full immunization was found to be low compared to the targets set in the Global Vaccine Action Plan(2011–2020).Two-third of the participants has poor knowledge about vaccination. Urban residence, mother education, higher family income, male child and institutional delivery were factors. This study suggests that awareness creation, behaviour change on vaccination and enhancing utilization of maternal health service including delivery service, should be stressed.

Adopting Andersen’s behavior model to identify factors influencing maternal healthcare service utilization in Bangladesh

Background Equitable maternal healthcare service access and it’s optimum utilization remains a challenge for many developing countries like Bangladesh, and different predisposing, enabling, and need-based factors affect the level of maternal healthcare use. The evidently poor maternal healthcare service utilization and disparities among groups in Bangladesh are concerning considering its effect on maternal health outcomes. The study aimed to identify the factors that influence maternal healthcare service (MHS) utilization in Bangladesh by adopting Andersen’s behavior model of health service use as the theoretical framework. Methods The 2017–18 Bangladesh Demographic Health Survey (2017–18 BDHS) data were used which is nationally representative. The survey study used two-stage stratified sampling to select study households, and data were collected through face-to-face interviews. The desirable, moderate, and undesirable maternal health service (MHS) package was developed based on antenatal, and delivery care services use during pregnancy and childbirth. Multinomial logistic regression and discriminant analysis were performed to analyze the factors that affect MHS use. Results Out of 5,011 ever-married women, only 31.2% of women utilized the desirable level of MHS. The likelihood of using the desirable level of MHS package, relative to the undesirable category, was 9.38 times (OR: 9.38, 95% CI: 4.30–20.44) higher for women with a higher level of education compared to illiterate women, and the same trend was noticed for husband’s education. The wealth index had the highest standardized function coefficients (Beta coefficient: 0.49) in discriminatory function. Women with the richest wealth index were more than 23 times (OR: 23.27, 95% CI: 12.69–42.68) likely to have utilized desirable MHS than their poorest counterparts. The likelihood of service uses also varied according to the child’s birth order, administrative regions, and area of residence (rural vs. urban). Conclusions Policies and interventions directed towards poverty reduction, universal education, and diminishing geographical disparities of healthcare access might influence the desirable use of maternal healthcare services in Bangladesh.

Tetanus Toxoid Vaccination Coverage and Associated Factors among Childbearing Women in Ethiopia: A Systematic Review and Meta-Analysis

Background. Tetanus is a bacterial disease caused by the Clostridium tetani, which is a highly fatal, noncommunicable, and toxin-mediated disease. Globally, maternal and neonatal tetanus is a public health problem due to low maternal tetanus toxoid immunization. Ethiopia has the highest neonatal mortality and morbidity related to tetanus due to low tetanus toxoid immunization and the high number of home deliveries. The main objective of this systematic review and meta-analysis was to estimate the pooled coverage of at least two doses of tetanus toxoid immunization, and the pooled effect sizes of associated factors in Ethiopia. Methods. Primary studies for this review were searched from the PubMed/MEDLINE online, ScienceDirect, Hinari, Google, and Google Scholar databases. Primary articles published from 2010 up to August 30, 2020, were included in this meta-analysis. Data were extracted in Microsoft Excel format and exported to STATA Version 14.0. A random-effects meta-analysis model was used to estimate the pooled coverage of two or more tetanus toxoid immunizations and its associated factors. Heterogeneity was evaluated by the I 2 test. Egger’s weighted regression test was used to assess publication bias. Results. We retrieved 212 records; of these, 199 articles were excluded for reasons. Finally, 14 studies were included in this meta-analysis. The pooled estimate of receiving at least two doses of tetanus toxoid immunization coverage in Ethiopia was 52.2% (95% CI: 42.47-61.93, I 2 = 98.4 % ). Antenatal care ( OR = 7.8 (95% CI: 3.2, 19.2), I 2 = 96.3 % ), media exposure ( OR = 8.3 (95% CI: 2.1, 33.3), I 2 = 98.1 % ), distance from the health facility ( OR = 2.64 (95% CI: 1.1, 6.6), I 2 = 94.1 % ), educational status of women ( OR = 4.7 (95% CI: 2.07, 9.56), I 2 = 94.2 % ), and educational status of husbands ( OR = 2.995 (95% CI: 1.194, 7.512), I 2 = 92.5 % ) were factors significantly associated with receiving at least two doses of tetanus toxoid immunization coverage in Ethiopia. Conclusions. The coverage of tetanus toxoid immunization among childbearing women was low in Ethiopia. Strengthening maternal health service utilization (antinatal care and institutional delivery) to the nearest health facility even in health posts and empowering education for both women and their husbands is recommended to increase tetanus toxoid immunization coverage in Ethiopia.

Factors affecting utilization and satisfaction of maternal health care services among mothers of neonates in Paropakar maternity and women’s hospital

Background: Knowledge and use of maternal health service is an effectual way to reduce the risk of maternal morbidity and mortality which can be influenced by multiple factors. Maternal service utilization thus plays an important role during pregnancy, childbirth, and the postpartum period. The aim of the study was to analyse antenatal services as proxy indicator for study purpose.Methods: A descriptive cross-sectional study was conducted in post-natal ward of Paropakar maternity and women’s hospital after ethical approval from the Ethical Review Board of the Nepal Health Research Council and Institutional Review Committee of Paropakar maternity and women's hospital and 210 samples were collected by a simple random sampling method. Statistical analysis was done using SPSS 16.0.Results: Out of 210 participants, only 100 (47.6%) had antenatal care as per protocol. The median age of the women delivering in hospital was 25 years. Women having household income more than 10,000 (OR=2.125, 95% CI=1.065-4.241, p=0.032), impact of mass media for utilization of antenatal care service (OR=14.261, 95% CI=4.881-41.670, p value<0.001), and women’s taking an hour or less to reach health facility (OR=2.763, 95% CI=1.293-5.903, p value=0.009) were found to be statistically significant.Conclusions: Majority of women in the study didn’t utilized full antenatal care service as per protocol. There is a need for different community based maternal and child health programs targeting the reproductive aged women and adolescent groups.

Two-fifths of women are not autonomous in maternal health service utilization: A community-based cross-sectional study

Background: Autonomy of women in health care decision-making is tremendously crucial for improved maternal health outcomes and women’s empowerment. Women with greater freedom of movement are more likely to receive maternal health services. However, little has been investigated about women’s autonomy in maternal health care decision-making and contributing factors in Ethiopia. The aim of this study was to assess decision-making autonomy on maternal health care services utilization and associated factors among women.Methods: A community-based cross-sectional study was conducted in Mettu rural Woreda, Ilu Aba Bor zone, southwest Ethiopia from June 19 to August 20, 2021. Data was collected using a pretested interviewer-administered questionnaire from 541 randomly selected women. The collected data was entered into Epi-Data version 3.1 and exported to SPSS version 22 for analysis. Bivariate and multivariate logistic regression was used to identify factors associated with women's decision-making autonomy on maternal health service utilization. The significance of association was declared by using the odds ratio with a 95% confidence interval and a p-value less than 0.05 in the multivariable model.Results: Out of 522 women included in the analysis, 322 (60.5%) (95% CI: 56.2%-64.7%) were found to be autonomous on maternal health service utilization. Age category from 30-39 years, AOR=4.27 (95%CI: 1.59-11.43), attending primary education and above, AOR=3.87 (95%CI: 2.15-6.99), greater than five family size, AOR=0.25 (95%CI: 0.15-0.41), and distance from the health facility, AOR=5.33 (95%CI: 2.50-11.33) were significantly associated with women's decision-making autonomy on maternal health care services utilization.Conclusion: Even though every woman has the right to participate in her own health care decision-making, around two fifths of them have no role in making health care decisions about their own health. Socio-demographic factors like age and education were found to influence women’s autonomy. Special attention has to be given to women living in rural areas in order to reduce their dependency through education.

The Magnitude of Pre-lacteal Feeding Practice and its Influencing Factors Among Mothers with Children Under the Age of Two Years in Afar Region of Ethiopia: A Community based Quantitative and Qualitative Study

Background: Pre-lacteal feeding is a barrier to implement optimal breastfeeding practices and caused new-born disease. Pre-lacteal feeding is primarily practiced in developing countries, where cultural and social structures are based on descent and relationships. The aim of study was to determine the magnitude of pre-lacteal feeding practice and its influencing factors among mothers with children under the age of 2-years in Afar region of Ethiopia. Method: A community based cross sectional study supplemented by qualitative study was employed. In the quantitative study, 235 study participants were included, whereas seventeen study subjects participated in the qualitative study. Bivariate and multivariate logistic regression was used to determine factors associated with pre-lacteal feeding practice. The qualitative data was analyzed using thematic approach. Result: The magnitude of pre-lacteal feeding was 36.6%. Being a housewife (AOR=4.1, 95% CI: 1.4-12.2) and having male indexed child (AOR=4.9, 95% CI: 1.8-13.5) were more likely to practice pre-lacteal feeding than those of trade and female, respectively. However, pre-lacteal feeding practice decreased in those mothers with three and above ante natal care visits (AOR=0.31, 95% CI: 0.1-0.9), delivered at health institutes (AOR=0.1, 95% CI: 0.02-0.3), starting breastfeeding within one hour (AOR=0.04, at 95% CI: 0.01-0.1) and getting breast feeding counseling (AOR=0.21, at 95%CI: 0.06-0.7). Milk, plain water, sugar solution, honey, butter, dates (‘temir'), a leaf, and condo pepper were the most common pre-lacteal foods reported by study participants. Cultural beliefs and the assumption of cleaning new-born throat and bowel were the most common reason to practice pre-lacteal feeding. Conclusion: The magnitude of pre-lacteal feeding was high due to socio-cultural and maternal health service utilization factors. Water, milk products, sweet foods and some of plant types were the most common pre-lacteal foods. Key words: Pre-lacteal feeding, factors, mother, children