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Mondal S, Anand A, Awasthi N, Singh B, Pradhan MR. Factors affecting pregnancy registration in India: does the pregnancy intention matter? BMC Pregnancy Childbirth 2023; 23:674. [PMID: 37726663 PMCID: PMC10507949 DOI: 10.1186/s12884-023-06002-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 09/14/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Pregnancy registration is one of the most critical components of women's reproductive health because it is the gateway to entering the continuum of care services such as antenatal care, institutional delivery, and postnatal care. There is a lack of studies exploring the relationship between pregnancy intention and pregnancy registration, especially in the Indian context. METHOD This study used the National Family Health Survey-5 (2019-21) data to explore the relationship between birth intention and failure of pregnancy registration. The bivariate and multivariate (binary logistic regression) analysis was carried out. RESULTS Adjusting the effects of socio-demographic and economic characteristics, compared with women with an intended pregnancy, the odds of failure of pregnancy registration were significantly high among women with a mistimed pregnancy (OR = 1.60, 95% CI = 1.47-1.73) and unwanted pregnancy (OR = 1.38, 95% CI = 1.26-1.52). The study found pregnancy intention as a significant predictor of pregnancy registration. CONCLUSIONS Results suggest strengthening the interaction of grassroots-level health workers with women, especially those with possibly lower healthcare autonomy and unintended pregnancy. Higher and earlier pregnancy registration will enhance maternal healthcare utilization and reduce adverse health consequences to mothers and children, thus ensuring better maternal and child health.
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Affiliation(s)
- Sourav Mondal
- International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India
| | - Abhishek Anand
- International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India
| | - Niharika Awasthi
- International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India
| | - Bharti Singh
- International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India
| | - Manas Ranjan Pradhan
- Department of Fertility and Social Demography, International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India.
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Nigatu SG, Birhan TY. The magnitude and determinants of delayed initiation of antenatal care among pregnant women in Gambia; evidence from Gambia demographic and health survey data. BMC Public Health 2023; 23:599. [PMID: 36997930 PMCID: PMC10061770 DOI: 10.1186/s12889-023-15506-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/23/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Despite gains throughout the 20th century, maternal health remains a major public health concern. Despite global efforts to enhance access to maternal and child healthcare services, women in low- and middle-income countries still have a high risk of dying during pregnancy and after birth. This study aimed to determine the magnitude and determinants of late antenatal care initiation among reproductive age women in Gambia. METHOD Secondary data analysis was conducted using the 2019-20 Gambian demographic and health survey data. All reproductive age women who gave birth in the five years preceding the survey and who had an antenatal care visit for the last child were included in this study. The total weighted sample size analyzed was 5310. Due to the hierarchical nature of demographic and health survey data, a multi-level logistic regression model was performed to identify the individual and community level factors associated with delayed first antenatal care initiation. RESULT In this study, the prevalence of delayed initiation of initial antenatal care was 56% ranged from 56 to 59%. Women with age 25-34 [Adjusted Odds Ratio = 0.77; 95% CI 0.67-0.89], 35-49 [Adjusted Odds Ratio = 0.77; 95% CI 0.65-0.90] and women reside in urban area [Adjusted Odds Ratio = 0.59; 95% CI 0.47-0.75] respectively had lower odds of delayed first antenatal care initiation. While women with unplanned pregnancy [Adjusted Odds Ratio = 1.60; 95% CI 1.37-1.84], no health insurance [Adjusted Odds Ratio = 1.78; 95% CI 1.14-2.76] and previous history of cesarean delivery [Adjusted Odds Ratio = 1.50; 95% CI 1.10-2.07] had higher odds of delayed initiation of antenatal care. CONCLUSION Despite the established advantages of early antenatal care initiation, this study revealed that late antenatal care initiation is still common in Gambia. Unplanned pregnancy, residence, health insurance, history of caesarian delivery, and age were significantly associated with delayed first antenatal care presentation. Therefore, focusing extra attention on these high-risk individuals could reduce delayed first antenatal care visit and this further minimizes maternal and fetal health concerns by recognizing and acting early.
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Affiliation(s)
- Solomon Gedlu Nigatu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Tilahun Yemanu Birhan
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
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Umeh CC, Okobi OE, Olawoye OI, Agu C, Koko J, Okoeguale J. Pyelonephritis in Pregnancy From the Lens of an Underserved Community. Cureus 2022; 14:e29029. [PMID: 36237795 PMCID: PMC9552702 DOI: 10.7759/cureus.29029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 11/25/2022] Open
Abstract
In pregnancy, early signs and symptoms of urinary tract infection, including cystitis or pyelonephritis, may overlap with pregnancy symptoms, making early detection challenging. Compounding this challenge is when it presents itself in resource-poor settings for several factors, including poverty, poor access to healthcare care, inadequate diagnostic facilities, low availability of insurance, education, and cultural limitations. In this case report, we present a case of a 33-year-old G3P2 with pyelonephritis in pregnancy that was compounded by issues related to access to care in resource-limited settings. Although this case was handled in a resource-poor country, fighting to improve access to better health care, the term "underserved" is not exclusive to such a place. Therefore, we reviewed some basic guidelines for managing pyelonephritis in pregnancy and the obstacles in most underprivileged populations.
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Rajvanshi D, Anthony J, Namasivayam V, Dehury B, Banadakoppa Manjappa R, Prakash R, Chintada DR, Khare S, Avery L, Crockett M, Isac S, Becker M, Blanchard J, Halli S. Association of identification of facility and transportation for childbirth with institutional delivery in high priority districts of Uttar Pradesh, India. BMC Pregnancy Childbirth 2021; 21:724. [PMID: 34706676 PMCID: PMC8549204 DOI: 10.1186/s12884-021-04187-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Timely and skilled care is key to reducing maternal and neonatal mortality. Birth preparedness involves preparation for safe childbirth during the antenatal period to reach the appropriate health facility for ensuring safe delivery. Hence, understanding the factors associated with birth preparedness and its significance for safe delivery is essential. This paper aims to assess the levels of birth preparedness, its determinants and association with institutional deliveries in High Priority Districts of Uttar Pradesh, India. Methods A community-based cross-sectional survey was conducted between June–October 2018 in the rural areas of 25 high priority districts of Uttar Pradesh, India. Simple random sampling was used to select 40 blocks among 294 blocks in 25 districts and 2646 primary sampling units within the selected blocks. The survey interviewed 9458 women who had a delivery 2 months prior to the survey. Descriptive statistics were included to characterize the study population. Multivariable logistic regression analyses were performed to identify the determinants of birth preparedness and to examine the association of birth preparedness with institutional delivery. Results Among the 9458 respondents, 61.8% had birth preparedness (both facility and transportation identified) and 79.1% delivered in a health facility. Women in other caste category (aOR = 1.24, CI 1.06–1.45) and those with 10 or more years of education (aOR = 1.68, CI 1.46–1.92) were more likely to have birth preparedness. Antenatal care (ANC) service uptake related factors like early registration for ANC (aOR = 1.14, CI 1.04–1.25) and three or more front line worker contacts (aOR = 1.61, CI 1.46–1.79) were also found to be significantly associated with birth preparedness. The adjusted multivariate model showed that those who identified both facility and transport were seven times more likely to undergo delivery in a health facility (aOR = 7.00, CI 6.07–8.08). Conclusion The results indicate the need for focussing on marginalized groups for improving birth preparedness. Increasing ANC registration in the first trimester of pregnancy, improving frontline worker contact, and optimum utilization of antenatal care check-ups for effective counselling on birth preparedness along with system level improvements could improve birth preparedness and consequently institutional delivery rates in Uttar Pradesh, India. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04187-5.
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Affiliation(s)
- Divya Rajvanshi
- India Health Action Trust, Lucknow, Uttar Pradesh/ New Delhi, India.
| | - John Anthony
- India Health Action Trust, Lucknow, Uttar Pradesh/ New Delhi, India.,Institute of Global Public Health, University of Manitoba, Winnipeg, Canada
| | | | - Bidyadhar Dehury
- India Health Action Trust, Lucknow, Uttar Pradesh/ New Delhi, India
| | | | - Ravi Prakash
- India Health Action Trust, Lucknow, Uttar Pradesh/ New Delhi, India.,Institute of Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Dhanunjaya Rao Chintada
- India Health Action Trust, Lucknow, Uttar Pradesh/ New Delhi, India.,Institute of Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Shagun Khare
- India Health Action Trust, Lucknow, Uttar Pradesh/ New Delhi, India
| | - Lisa Avery
- Institute of Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Maryanne Crockett
- Institute of Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Shajy Isac
- India Health Action Trust, Lucknow, Uttar Pradesh/ New Delhi, India.,Institute of Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Marissa Becker
- India Health Action Trust, Lucknow, Uttar Pradesh/ New Delhi, India.,Institute of Global Public Health, University of Manitoba, Winnipeg, Canada
| | - James Blanchard
- Institute of Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Shiva Halli
- India Health Action Trust, Lucknow, Uttar Pradesh/ New Delhi, India.,Institute of Global Public Health, University of Manitoba, Winnipeg, Canada
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Afrizal SH, Hidayanto AN, Handayani PW, Besral B, Martha E, Markam H, Budiharsana M, Eryando T. Evaluation of integrated antenatal care implementation in primary health care. JOURNAL OF INTEGRATED CARE 2020. [DOI: 10.1108/jica-07-2019-0031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis study was aimed to evaluate the implementation of an integrated antenatal care (ANC) scheme through a retrospective document study using a checklist for measuring the adequacy of the cohort ANC register documented by midwives in an urban area and to describe the barriers for the midwives during the ANC record process.Design/methodology/approachAn exploratory descriptive study using a sequential mixed method was utilised where a quantitative method was employed by collecting secondary data of 150 entries of the cohort ANC register and followed by in-depth interviews among midwives and community health workers.FindingsThe results show that the cohort registry indicators for integrated care such as laboratory and management were poorly recorded. Several barriers were found and categorised during the implementation of the integrated ANC, namely (1) governance and strategy, (2) process of care, (3) organisation and management support.Research limitations/implicationsThe contribution of this present research is that it provides empirical data of the integrated ANC implementation in primary health care (PHC) which has the responsibility to deliver an integrated level of care for ANC using a cohort registry for pregnancy registration monitoring which facilitates the continuity and quality of care.Practical implicationsPractical implication of the finding is that functional integration such as the clinical information system to facilitate an efficient and effective approach during the implementation of integrated ANC in primary care should be considered to support the clinical, professional, organisational, system and normative integration.Originality/valueSince only limited studies have been conducted to assess the quality of the cohort ANC registry and to investigate the barriers against integrated ANC implementation in Indonesia, the research findings are valuable information for the national and local governments to improve the ANC service in Indonesia.
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Patel A, Prakash AA, Das PK, Gupta S, Pusdekar YV, Hibberd PL. Maternal anemia and underweight as determinants of pregnancy outcomes: cohort study in eastern rural Maharashtra, India. BMJ Open 2018; 8:e021623. [PMID: 30093518 PMCID: PMC6089300 DOI: 10.1136/bmjopen-2018-021623] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To study the trend in the prevalence of anaemia and low BMI among pregnant women from Eastern Maharashtra and evaluate if low BMI and anaemia affect pregnancy outcomes. DESIGN Prospective observational cohort study. SETTING Catchment areas of 20 rural primary health centres in four eastern districts of Maharashtra State, India. PARTICIPANTS 72 750 women from the Nagpur site of Maternal and Newborn Health Registry of NIH's Global Network, enrolled from 2009 to 2016. MAIN OUTCOME MEASURES Mode of delivery, pregnancy related complications at delivery, stillbirths, neonatal deaths and low birth weight (LBW) in babies. RESULTS Over 90% of the women included in the study were anaemic and over a third were underweight (BMI <18 kg/m2) and with both conditions. Mild anaemia at any time during delivery significantly increased the risk (Risk ratio; 95% confidence interval (RR;(95% CI)) of stillbirth (1.3 (1.1-1.6)), neonatal deaths (1.3 (1-1.6)) and LBW babies (1.1 (1-1.2)). The risks became even more significant and increased further with moderate/severe anaemia any time during pregnancy for stillbirth (1.4 (1.2-1.8)), neonatal deaths (1.7 (1.3-2.1)) and LBW babies (1.3 (1.2-1.4)).,. Underweight at anytime during pregnancy increased the risk of neonatal deaths (1.1 (1-1.3)) and LBW babies (1.2;(1.2-1.3)).The risk of having stillbirths (1.5;(1.2-1.8)), neonatal deaths (1.7;(1.3-2.3)) and LBW babies (1.5;(1.4-1.6)) was highest when - the anaemia and underweight co-existed in the included women. Obesity/overweight during pregnancy increased the risk of maternal complications at delivery (1.6;(1.5-1.7)) and of caesarean section (1.5;(1.4-1.6)) and reduced the risk of LBW babies 0.8 (0.8-0.9)). CONCLUSION Maternal anaemia is associated with enhanced risk of stillbirth, neonatal deaths and LBW. The risks increased if anaemia and underweight were present simultaneously. TRIAL REGISTRATION NUMBER NCT01073475.
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Affiliation(s)
- Archana Patel
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
| | | | | | - Swarnim Gupta
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
| | | | - Patricia L Hibberd
- Boston University School of Public Health and Boston University School of Medicine, Boston, Massachusetts, USA
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Rogers AJ, Weke E, Kwena Z, Bukusi EA, Oyaro P, Cohen CR, Turan JM. Implementation of repeat HIV testing during pregnancy in Kenya: a qualitative study. BMC Pregnancy Childbirth 2016; 16:151. [PMID: 27401819 PMCID: PMC4940827 DOI: 10.1186/s12884-016-0936-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 06/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Repeat HIV testing in late pregnancy has the potential to decrease rates of mother-to-child transmission of HIV by identifying mothers who seroconvert after having tested negative for HIV in early pregnancy. Despite being national policy in Kenya, the available data suggest that implementation rates are low. METHODS We conducted 20 in-depth semi-structured interviews with healthcare providers and managers to explore barriers and enablers to implementation of repeat HIV testing guidelines for pregnant women. Participants were from the Nyanza region of Kenya and were purposively selected to provide variation in socio-demographics and job characteristics. Interview transcripts were coded and analyzed in Dedoose software using a thematic analysis approach. Four themes were identified a priori using Ferlie and Shortell's Framework for Change and additional themes were allowed to emerge from the data. RESULTS Participants identified barriers and enablers at the client, provider, facility, and health system levels. Key barriers at the client level from the perspective of providers included late initial presentation to antenatal care and low proportions of women completing the recommended four antenatal visits. Barriers to offering repeat HIV testing for providers included heavy workloads, time limitations, and failing to remember to check for retest eligibility. At the facility level, inconsistent volume of clients and lack of space required for confidential HIV retesting were cited as barriers. Finally, at the health system level, there were challenges relating to the HIV test kit supply chain and the design of nationally standardized antenatal patient registers. Enablers to improving the implementation of repeat HIV testing included client dissemination of the benefits of antenatal care through word-of-mouth, provider cooperation and task shifting, and it was suggested that use of an electronic health record system could provide automatic reminders for retest eligibility. CONCLUSIONS This study highlights some important barriers to improving HIV retesting rates among pregnant women who attend antenatal clinics in the Nyanza region of Kenya at the client, provider, facility, and health system levels. To successfully implement Kenya's national repeat HIV testing guidelines during pregnancy, it is essential that these barriers be addressed and enablers capitalized on through a multi-faceted intervention program.
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Affiliation(s)
- Anna Joy Rogers
- Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, Birmingham, USA.
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Zachary Kwena
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Patrick Oyaro
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco California, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, Birmingham, USA
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