Health inequalities in timely antenatal care: audit of pre- and post-referral delays in antenatal bookings in London 2015–16

Background Antenatal booking has potential to reduce infant and maternal health inequalities; yet, those most in need are least likely to access timely care. This audit describes late referral and antenatal booking across London in 2015–16, according to maternal characteristics. Methods Referral < 8 weeks’ gestation, booking < 2 weeks after referral and booking < 10 weeks’ gestation were audited against maternal and referral characteristics. Results Of 122 275 antenatal bookings, 27.1% were before 10 weeks’ gestation and 72.8% by 12 + 6 weeks. Characteristics associated with late booking were living in more deprived areas, age < 20 years, higher parity, Black or Minority ethnicity (particularly Bangladeshi or Black African), birth in Somalia, Jewish religion, first language other than English, unemployment of self or partner, lack of social support, or single parent families. Women living in more deprived areas, with first language other than English, of Jewish religion, Black and Minority ethnicity or who were unemployed, waited longer from referral to booking, despite later referral. Conclusions Post-referral delays can compound late referral for some women, exacerbating health inequalities, but should be amenable to provider interventions. Different patterns of pre- and post-referral delay suggest that a tailored approach is needed to address inequalities in access to antenatal care.

Pattern of antenatal care among antenatal clinic attendees at Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria

Background: Antenatal care is a core component of safe motherhood initiative and it helps indirectly in reducing maternal and perinatal morbidity and mortality. Despite the obvious benefits of antenatal care, utilization of this service is very poor in our environment. Therefore, this study sought to assess the gestational age at booking, the reason for booking and determine the factors responsible for late booking among antenatal attendees at the Alex Ekwueme Federal University Teaching Hospital Abakaliki.Methods: This was a cross-sectional descriptive study conducted 5th May 2016 and 10th June 2016 among 258 consecutive pregnant women who presented for booking at the antenatal clinic of the hospital, using self-administered, pre-tested questionnaires. Statistical analysis was done using Epi Info 7.2.1.Results: The mean gestational age at booking was 21.5±4.8 weeks. The mean age of the respondents was 28.2±3.8 years while the mean parity was 1.5±1.6 years. Most of the women booked after the first trimester of pregnancy, only 61(24.8%) of the respondents booked in the first trimester of pregnancy. Majority of the women had no problem at booking 36.7%. Women aged 20-34 years booked late compared to women aged less than 20 years and those above 34 years and the difference was statistically significant. There was no statistically significant difference in maternal parity, education, marital status and religion with regards timing of booking. However, women who were sick during the first trimester were more likely to book early as well as women who booked early in their previous pregnancy.Conclusions: Late booking was common in our environment. There is an urgent need for increase awareness of the benefits of early booking to pregnancy outcome.

Exploring the pregnant women’s perspective of late booking of antenatal care services at Mbekweni Health Centre in Eastern Cape, South Africa

Background: Antenatal care (ANC) services are the gateway for integrated management of several conditions that adversely affect the mother and foetus. More stillbirths than neonatal deaths in South Africa are a reflection of poor quality ANC services. Aim: The primary aim of this study was to explore the reasons for late booking, and also to determine pregnant women’s knowledge, perceptions and attitude towards antenatal care services they receive in Mthatha area in Eastern Cape, South Africa. Setting: This was a qualitative study, conducted at Mbekweni Health Centre in the King Sabata Dalindyebo (KSD) subdistrict municipality of the Eastern Cape Province. Methods: This qualitative study consisted of selected pregnant women who presented after 19 weeks of gestation at Mbekweni Health Centre. Data were collected through two different methods, namely, semi-structured interviews and focus group discussions were used until saturation of the themes were reached. The interviews were transcribed verbatim and thematic analyses were undertaken. Results: Twenty women participated in the study. They were diverse in terms of age 18–41 years, gravidity 1–6 and time of ANC booking 20–28 weeks. The interviews identified a variety of personal, service and organisational reasons for late ANC booking. The themes identified for late ANC bookings were: health care system related issues, socio-economic factors, women’s perceptions and knowledge, and failure of family planning services. Conclusions: Women’s beliefs, knowledge and perceptions regarding antenatal services outweigh the perceived benefit of early ANC visit. The majority of women had lack of knowledge of contraception, early signs of pregnancy, purpose, timing and benefits of ANC visit.

Previous Early Antenatal Service Utilization Improves Timely Booking: Cross-Sectional Study at University of Gondar Hospital, Northwest Ethiopia

Background.Early booking of antenatal care (ANC) is regarded as a cornerstone of maternal and neonatal health care. However, existing evidence from developing countries indicate that lots of pregnant woman begin ANC booking lately.Objective.It was aimed to assess timing of ANC booking and associated factors among pregnant women attending ANC clinic at University of Gondar Hospital, 2013.Methods.An institution based cross-sectional study design was used to collect data with a face-to-face interview technique. Bivariate and multivariate analysis was used to identify associated factors for early ANC visit using SPSS version 20.Results.From total women (N = 369) interviewed, 47.4% were timely booked. Mothers with younger age (AOR = 3.83, 95% CI: 1.89, 10.53), formal education (AOR = 1.06, 95% CI: 1.03, −7.61), previous early ANC visit (AOR = 2.39, 95% CI: 2.23, 9.86), and perceived ANC visit per pregnancy of four and greater were significantly associated with early ANC visit.Conclusions.Although late booking is a problem in this study, previous early utilization of ANC visit favors current timely booking. This indicates that the importance of early booking was appropriately addressed from previous visits. Counseling of timely booking during ANC visit should be strengthened. Moreover, empowering through education is also recommended.

ANAEMIA IN PREGNANCY;

Background: Anaemia in pregnancy is an important public health problem especially in developing countries. It is a majorcause of maternal morbidity and mortality, and also has a significant impact on health of foetus .The causative factors vary in differentcommunities. Objectives and Methods: The purpose of study was to determine the prevalence and risk factors of anaemia amongpregnant women receiving antenatal care at Aziz Bhatti Shaheed Hospital Gujrat. The attending doctor filled a Proforma at the firstantenatal visit and blood sample was also drawn for complete blood counts. Results: Out of 560 women studied,419(74.8%) womenwere anaemic .Anaemia was more prevalent in multigravidae (77.6%) than in primigravidae (69.3%).Regarding severity 69.9%mild,26.7% moderate and 3.3% cases were of severe anaemia respectively. The severity increased with increasing parity. The prevalencealso increased with decreasing birth intervals (p=0.001) and late booking (p=0.002).Anaemia was more common among uneducated(78.6%) or those educated up to primary (72.7%). Intake of meat/chicken less than 2times/week (p=0.01) and PICA (p=0.005) werealso the risk factors for anaemia development in pregnancy. Conclusions: The prevalence of anaemia in antenatal care attendees of ABSHis very high. Frequent child birth with lack of birth spacing, late booking, low educational status and poor dietary habits are the major riskfactors that need urgent attention of health care providers.