Factors associated with changes in adequate antenatal care visits among pregnant women aged 15-49 years in Tanzania from 2004 to 2016

Background Antenatal care (ANC) is crucial for the health of the mother and unborn child as it delivers highly effective health interventions that can prevent maternal and newborn morbidity and mortality. In 2002, the World Health Organization (WHO) recommended a minimum of four ANC visits for a pregnant woman with a positive pregnancy during the entire gestational period. Tanzania has sub-optimal adequate (four or more) ANC visits, and the trend has been fluctuating over time. An understanding of the factors that have been contributing to the fluctuating trend over years is pivotal in increasing the proportions of pregnant women attaining adequate ANC visits in Tanzania. Methods The study used secondary data from Tanzania Demographic Health Survey (TDHS) from 2004 to 2016. The study included 17976 women aged 15-49 years. Data were analyzed using Stata version 14. Categorical and continuous variables were summarized using descriptive statistics and weighted proportions. A Poisson regression analysis was done to determine factors associated with adequate ANC visits. To determine factors associated with changes in adequate ANC visits among pregnant women in Tanzania from 2004 to 2016, multivariable Poisson decomposition analysis was done. Results The overall proportion of women who had adequate ANC visits in 2004/05, 2010 and 2015/16 was 62, 43 and 51% respectively. The increase in the proportion of women attaining adequate ANC from 2010 to 2015/16 was mainly, 66.2% due to changes in population structure, thus an improvement in health behavior. While 33.8% was due to changes in the mother’s characteristics. Early initiation of first ANC visit had contributed 51% of the overall changes in adequate ANC attendance in TDHS 2015/16 survey. Conclusion Early ANC initiation has greatly contributed to the increased proportion of pregnant women who attain four or more ANC visits overtime. Interventions on initiating the first ANC visit within the first twelve weeks of pregnancy should be a priority to increase proportion of women with adequate ANC visit.

Assessment of Women’s Experience of Care during Childbirth for Quality Improvement at Level 5 Health Facilities in Bungoma County, Kenya

High maternal and newborn mortality is a pressing problem in developing countries. Poor treatment during childbirth contributes directly and indirectly to this problem. Many women experience disrespectful and abusive treatment during childbirth worldwide which violates their rights. In Kenya, 20% of women report having experienced some form of disrespect and abuse (D&A). Bungoma County is among the 15 counties with the worst maternal and newborn health statistics in Kenya. The maternal mortality rate is 382 per 100,000 live births and newborn deaths 32 per 1,000 live births, while skilled birth attendance is 41.4%. This study was motivated by the poor maternal and newborn indicators, rising incidences of D&A, limited formal research on respectful maternity care. The study aimed at assessing women’s experience of care during childbirth at Level 5 health facilities in Bungoma County. The specific objectives were to determine the women’s experiences of care during childbirth, to determine factors contributing to disrespect and abuse during childbirth and to identify strategies for addressing issues affecting respectful maternity care for promoting quality of maternal and newborn care. A cross-sectional descriptive study design was used. It involved 360 mothers. Analysis of quantitative data was done using SPSS. Descriptive statistics were presented in graphs, tables, frequencies and percentages. Qualitative data was analysed thematically. The prevalence of D&A was 42.2%, younger age and lower education aggravated D&A. Autonomy, privacy and confidentiality, and absence of birth companionship were major aspects of D&A. Health workforce shortage, inadequate supervision, space and beds, poor provider-patient relationships were factors leading to D&A. It was concluded that there is a need for increased incorporation of Respectful Maternity Care (RMC) in routine care, deploy more staff, avail equipment and supplies, and enhance support supervision. The study information intends to assist stakeholders in prioritising policy actions for improving the quality of maternal and newborn health outcomes and indicators.

Prenatal PM2.5 Exposure in Relation to Maternal and Newborn Telomere Length at Delivery

Particulate matter with an aerodynamic diameter of 2.5 μm or less (PM2.5) is a ubiquitous air pollutant that is increasingly threatening the health of adults and children worldwide. One health impact of elevated PM2.5 exposure is alterations in telomere length (TL)—protective caps on chromosome ends that shorten with each cell division. Few analyses involve prenatal PM2.5 exposure, and paired maternal and cord TL measurements. Here, we analyzed the association between average and trimester-specific prenatal PM2.5 exposure, and maternal and newborn relative leukocyte TL measured at birth among 193 mothers and their newborns enrolled in a New-York-City-based birth cohort. Results indicated an overall negative relationship between prenatal PM2.5 and maternal TL at delivery, with a significant association observed in the second trimester (β = −0.039, 95% CI: −0.074, −0.003). PM2.5 exposure in trimester two was also inversely related to cord TL; however, this result did not reach statistical significance (β = −0.037, 95% CI: −0.114, 0.039), and no clear pattern emerged between PM2.5 and cord TL across the different exposure periods. Our analysis contributes to a limited body of research on ambient air pollution and human telomeres, and emphasizes the need for continued investigation into how PM2.5 exposure during pregnancy influences maternal and newborn health.

Continuum of Maternal and Newborn Health in Sierra Leone: a 2019 National Survey

IntroductionGlobally, Sierra Leone has some of the worst maternal and child health indicators. The situation is worsened by a dearth of evidence about the level of continuum of care, an evidence-based intervention aimed at reducing maternal and perinatal morbidity and mortality. Hence this study aimed to fill this gap in evidence in the level of and factors associated with continuum of maternal and newborn care.MethodThe study employed data from the 2019 Sierra Leone Demographic Health Survey (SLDHS). Analysis was restricted to women who had a live birth in the five years preceding the survey (n = 7,326). Bi-variable and multivariable logistic regression were performed using SPSS software version 25.ResultsOnly 17.9% (95% CI: 17.4-19.1) of the women utilized complete continuum of care (CoC) for maternal and newborn health services in Sierra Leone. About 22% (95% CI: 21.3-23.1) utilized 8 or more antenatal care (ANC) contacts, 88% (95% CI: 87.9-89.4) had skilled birth attendance (SBA) while 90.7% (95% CI: 90.2-91.5) and 90.4% (95% CI: 89.9-91.2) of mothers and neonates utilized postnatal care (PNC) respectively. Having started ANC within first trimester (aOR 1.71, 95% CI: 1.46-2.00), belonging to the Southern region (aOR 1.85, 95% CI: 1.23-2.80), belonging to richer wealth quintile (aOR 1.76, 95% CI: 1.27-2.44), using internet (aOR 1.49, 95% CI: 1.12-1.98) and having no big problems seeking permission to access healthcare (aOR 1.34, 95% CI: 1.06-1.69) were significantly associated with utilization of CoC.ConclusionThe overall completion of continuum of maternal care is low, with ANC being the lowest utilized component of continuum of care. The study findings further call for urgent attention for maternal health stakeholders to develop and implement tailored interventions prioritizing women empowerment, access to affordable internet services, timely initiation of ANC contacts, women in developed regions such as the Western and those from poor households.

Women’s experiences of maternal and newborn health care services and support systems in Buikwe District, Uganda: A qualitative study

Background Uganda continues to have a high neonatal mortality rate, with 20 deaths per 1000 live births reported in 2018. A measure to reverse this trend is to fully implement the Uganda Clinical Guidelines on care for mothers and newborns during pregnancy, delivery and the postnatal period. This study aimed to describe women’s experiences of maternal and newborn health care services and support systems, focusing on antenatal care, delivery and the postnatal period. Methods We used triangulation of qualitative methods including participant observations, semi-structured interviews with key informants and focus group discussions with mothers. Audio-recorded data were transcribed word by word in the local language and translated into English. All collected data material were stored using two-level password protection or stored in a locked cabinet. Malterud’s Systematic text condensation was used for analysis, and NVivo software was used to structure the data. Findings Antenatal care was valued by mothers although not always accessible due to transport cost and distance. Mothers relied on professional health workers and traditional birth attendants for basic maternal services but expressed general discontentment with spousal support in maternal issues. Financial dependency, gender disparities, and lack of autonomy in decision making on maternal issues, prohibited women from receiving optimal help and support. Postnatal follow-ups were found unsatisfactory, with no scheduled follow-ups from professional health workers during the first six weeks. Conclusions Further focus on gender equity, involving women’s right to own decision making in maternity issues, higher recognition of male involvement in maternity care and improved postnatal follow-ups are suggestions to policy makers for improved maternal care and newborn health in Buikwe District, Uganda.

Impact of the early COVID-19 pandemic on outcomes in a rural Ugandan neonatal unit: A retrospective cohort study

Background During the early COVID-19 pandemic travel in Uganda was tightly restricted which affected demand for and access to care for pregnant women and small and sick newborns. In this study we describe changes to neonatal outcomes in one rural central Ugandan newborn unit before and during the early phase of the COVID-19 pandemic. Methods We report outcomes from admissions captured in an electronic dataset of a well-established newborn unit before (September 2019 to March 2020) and during the early COVID-19 period (April–September 2020) as well as two seasonally matched periods one year prior. We report excess mortality as the percent change in mortality over what was expected based on seasonal trends. Findings The study included 2,494 patients, 567 of whom were admitted during the early COVID-19 period. During the pandemic admissions decreased by 14%. Patients born outside the facility were older on admission than previously (median 1 day of age vs. admission on the day of birth). There was an increase in admissions with birth asphyxia (22% vs. 15% of patients). Mortality was higher during COVID-19 than previously [16% vs. 11%, p = 0.017]. Patients born outside the facility had a relative increase of 55% above seasonal expected mortality (21% vs. 14%, p = 0.028). During this period patients had decreased antenatal care, restricted transport and difficulty with expenses and support. The hospital had difficulty with maternity staffing and supplies. There was significant community and staff fear of COVID-19. Interpretation Increased newborn mortality during the early COVID-19 pandemic at this facility was likely attributed to disruptions affecting maternal and newborn demand for, access to and quality of perinatal healthcare. Lockdown conditions and restrictions to public transit were significant barriers to maternal and newborn wellbeing, and require further focus by national and regional health officials.