Focused antenatal care utilization and associated factors in Debre Tabor Town, northwest Ethiopia, 2017

Assessment of quality of antenatal care services and associated factors in Malawi: Insights from a nationwide household survey

INTRODUCTION

Provision of quality antenatal care (ANC) to pregnant women is essential for reducing maternal and newborn mortality. ANC provides an opportunity for early identification of conditions that increase the risk of adverse pregnancy outcomes. However, there is limited evidence regarding the quality of ANC received by women in Malawi. This study aimed to assess the quality of ANC and associated factors in Malawi.

MATERIALS AND METHODS

National representative data from the 2019-2020 Malawi Multiple Indicator Cluster Survey was used for this cross-sectional study. A total of 6,287 weighted sample of women aged 15 to 49 years who had a live birth and received ANC at least once within two years preceding the survey were included in the analysis. Descriptive statistics were used to estimate the magnitude of quality ANC and multivariable logistic regression was computed to identify associated factors.

RESULTS

Of the 6,287 women, only 12.6% (95% CI: 11.4-13.9) received quality ANC. The likelihood of receiving quality ANC was significantly higher among women who had four to seven ANC contacts (AOR = 2.10; 95% CI: 1.79-2.49), made at least eight ANC contacts (AOR  =  3.40; 95% CI: 1.90-6.09) and started ANC within the first trimester (AOR  =  1.30; 95% CI: 1.10-1.53). On the other hand, women who had only primary education (AOR = 0.62; 95% CI:0.48-0.82) and had five or more births (AOR  =  0.56; 95% CI: 0.40-0.78) were less likely to receive quality ANC.

CONCLUSION

The findings reveal that quality of ANC in Malawi is low. These findings suggest the need for targeted interventions aimed at improving access to and utilization of ANC services among women with lower education and higher parity. Strengthening efforts to promote early ANC initiation and increasing the number of ANC contacts could significantly enhance the quality of ANC received by women in Malawi.

Effectiveness of trained religious leaders' engagement in maternal health education on improving maternal health service utilizations: Protocol of cluster randomized controlled trial in Hadiya Zone, Southern Ethiopia

BACKGROUND

Despite the many supply- and demand-side interventions aimed at increasing uptake of maternal health service utilizations, the maternal and new-born health service utilizations remains low. Religious leaders have the power to inhibit or facilitate effective adoption of maternal health service utilizations to promote maternal health. However, evidence on the roles of religious leaders in promoting maternal health in developing world is not fully known. Therefore this cluster-randomized trial is designed to evaluate the effects of trained religious leaders' engagement in maternal health education in improving maternal health service utilization and knowledge of obstetric danger signs.

METHODS

A community based cluster randomized control trial in which the study kebeles are randomly assigned into intervention and control groups will be conducted. The sample size is calculated using stata software. Three hundred six pregnant mothers will be enrolled in each group. A baseline study will be conducted before the intervention and post-intervention evaluation will be conducted after four months of intervention. Religious leaders will be selected and trained to lead participatory sessions on maternal health. Data on maternal health service utilizations, knowledge about obstetric danger signs, attitude towards skilled delivery service utilization and perception of pregnancy risk will be collected from a repeated cross sectional household survey. Effect of intervention will be assessed using multivariable logistic regression with generalized estimating equation model. Data will be analyzed using STATA software. For qualitative study, coded transcripts will be further analyzed and summarized in narratives for each theme and sub-themes.

DISCUSSION

This is one of the first trials to evaluate the effectiveness of trained religious leaders' engagement in maternal health education and will provide much needed evidence to policy makers about aspects of functionality and the religious leaders engagement required as they scale-up this programme in Ethiopia.

Gap identification for improvement in maternal and early infant health care practices among tribal pregnant women in an aspirational tribal district Sirohi, Rajasthan

Background

Sirohi is one of the aspirational districts of Rajasthan which is also tribal-dominated. The maternal and early infant health indicators are worrisome compared to regional or national statistics. First-trimester registration of pregnant women is 54% in district Sirohi, which is much less as compared to registration in the state of Rajasthan (63%) and India (59%). Four antenatal care (ANC) visits of pregnant women are 32% in district Sirohi, which is also much less as compared to ANC visits in the state of Rajasthan (39%) and India (51%). However, there was no tribal-specific data regarding maternal and early infant health.

Objective

The study aims to identify gaps for improvement in maternal and early infant health care practices among tribal pregnant women in an aspirational tribal district of Sirohi, Rajasthan.

Materials and Methods

It was a cross-sectional study conducted among 560 tribal pregnant women to assess the existing maternal, and early infant health care knowledge and practices through a pre-validated questionnaire in the tribal population of district Sirohi Rajasthan.

Result

Nineteen per cent (19.5%, n = 109) of tribal pregnant women got married between the age of 10 and 17 (less than the legal age of marriage of 18 years). There is a significant relationship between early age at marriage and low educational status P < 0.001, r = 0.241 among participants. Measurement of weight, blood pressure and urine examination was done in 32.5% (n = 181), 19.5% (n = 109) and 7.1% (n = 39), respectively, among tribal pregnant women. The majority (94.6%) of the pregnant tribal women (385/407) were anaemic. Approximately 60% (n = 337) of mothers were unaware of thermal protection (skin-to-skin care). Sixty per cent (n = 334) of tribal pregnant women preferred to seek consultation regarding antenatal and infant health care from doctors, while 40.1% (n = 224) were more comfortable seeking advice from traditional birth attendants (TBAs).

Conclusion

The study finds inadequate knowledge and practice towards maternal and early infant care among tribal pregnant women. As TBAs influence tribal pregnant women, systematic training and involvement of TBAs in maternal and child health are indispensable.

Antenatal care coverage in a low-resource setting: Estimations from the Birhan Cohort

Antenatal care (ANC) coverage estimates commonly rely on self-reported data, which may carry biases. Leveraging prospectively collected longitudinal data from the Birhan field site and its pregnancy and birth cohort, the Birhan Cohort, this study aimed to estimate the coverage of ANC, minimizing assumptions and biases due to self-reported information and describing retention patterns in ANC in rural Amhara, Ethiopia. The study population were women enrolled and followed during pregnancy between December 2018 and April 2020. ANC visits were measured by prospective facility chart abstraction and self-report at enrollment. The primary study outcomes were the total number of ANC visits attended during pregnancy and the coverage of at least one, four, or eight ANC visits. Additionally, we estimated ANC retention patterns. We included 2069 women, of which 150 (7.2%) women enrolled <13 weeks of gestation with complete prospective facility reporting. Among these 150 women, ANC coverage of at least one visit was 97.3%, whereas coverage of four visits or more was 34.0%. Among all women, coverage of one ANC visit was 92.3%, while coverage of four or more visits was 28.8%. No women were found to have attended eight or more ANC visits. On retention in care, 70.3% of participants who had an ANC visit between weeks 28 and <36 of gestation did not return for a subsequent visit. Despite the high proportion of pregnant women who accessed ANC at least once in our study area, the coverage of four visits remains low. Further efforts are needed to enhance access to more ANC visits, retain women in care, and adhere to the most recent Ethiopian National ANC guideline of at least eight ANC visits. It is essential to identify the factors that lead a large proportion of women to discontinue ANC follow-up.

Determinants of fetomaternal complication of instrumental vaginal delivery among women who gave childbirth in Southern Ethiopia: a facility-based cross-sectional study

BACKGROUND

In Ethiopia, one in five instrumental deliveries among women giving birth resulted in an unfavourable outcome. This study aimed to assess the determinants of feto-maternal complications of instrumental delivery in selected public hospitals of Gamo and Gofa zones, Southern Ethiopia.

METHODS

An institution-based cross-sectional study was conducted among 399 women attending selected public hospitals in the Gamo and Gofa zones. Data were collected using data extraction tools using a systematic random sampling technique. The collected data was entered into Epi-data version 3.1 and then analyzed using SPSS version 25. Logistic regression analysis was conducted to determine an association.

RESULTS

One hundred eighty-three (45.9%, n = 183/399) instrumental deliveries were found to be complicated. Primigravida women (AOR: 95% CI: 2.21 (1.35, 3.63), infant birth weight (AOR: 95% CI: 2.56 (1.37, 4.77), post-term pregnancy (AOR: 95% CI: 12.77 (2.92, 55.78), and maternal age (AOR: 95% CI: 7.00 (2.16, 22.64) were associated with fetomaternal complications in instrumental delivery among women who gave birth.

CONCLUSIONS AND RECOMMENDATION

A high proportion of women developed fetomaternal complications when compared to local studies. Promotion of antenatal care services, increasing women's education and empowerment as well as working on capacity building of health care professionals through education and training is cost-effective to reduce the occurrence of fetomaternal complications.

Factors associated with first antenatal care (ANC) attendance within 12 weeks of pregnancy among women in Lira City, Northern Uganda: a facility-based cross-sectional study

OBJECTIVE

This study aimed at assessing factors associated with first antenatal care (ANC) attendance within 12 weeks of pregnancy among women in Lira City.

DESIGN

A cross-sectional study.

SETTINGS

The study was conducted in health facilities offering ANC services in Lira City, Northern Uganda.

PARTICIPANTS

The study was among 368 pregnant mothers attending their first ANC in the three selected facilities (Lira Regional Referral Hospital, Ober Health Center IV and Pentecostal Assembly of God Mission Health Center IV) in Lira City.

PRIMARY AND SECONDARY OUTCOME MEASURES

Level of first ANC attendance within 12 weeks of pregnancy and associated factors.

RESULTS

Early ANC attendance was 36.1%. Women who were: unmarried (adjusted OR (aOR): 0.40, 95% CI: 0.16 to 0.99), took >2 hours to reach a health facility (aOR: 0.21, 95% CI: 0.07 to 0.62), or not visited by village health teams or healthcare workers at home (aOR: 0.33, 95% CI: 0.12 to 0.92) were less likely to attend their first ANC early. On the other hand, women who were: not knowing first that ANC guides parents on infant care (aOR: 2.22, 95% CI: 1.06 to 4.67); pregnant without consent of spouse (aOR: 4.29, 95% CI: 1.75 to 10.55); attending ANC from a private facility (aOR: 2.89, 95% CI: 1.27 to 6.15); and having two to three healthcare workers present at the ANC clinic (aOR: 1.79, 95% CI: 1.03 to 3.13) were more likely to attend ANC early.

CONCLUSIONS

Despite the fact that the WHO recommends that all women begin ANC within 12 weeks after conception, Lira City in Northern Uganda had a low overall incidence of timely ANC initiation. Being unmarried, distance to reach a health facility, and being visited by village health teams or healthcare workers at home were all linked to timely ANC commencement. As a result, intervention efforts should concentrate on the highlighted determinants in order to promote ANC initiation in Lira City, Northern Uganda. This can be accomplished by providing information and education to the community on the timing and necessity of ANC in Northern Uganda.

Multilevel Count Regression Analysis of Factors Associated with the Desired Number of Antenatal Care Service Visits in Ethiopia

BACKGROUND

Visiting the desired number of antenatal care services improve the success of maternal health programs in terms of mother and child health. The study aimed to identify the factors associated with differences in the number of antenatal care service visits across and within regions of Ethiopia by using the 2019 Ethiopian Mini Demographic Health Survey (EMDHS).

METHODS

A total of 3979 women who were pregnant or gave birth within 5 years preceding the survey from the 2019 Ethiopian Mini Demographic Health Survey were included in the analysis. A multi-level Hurdle negative binomial regression model was selected to consider the hierarchical nature of the data in determining the factors associated with the barriers to the desired number of antenatal care service visits.

RESULTS

About one-fourth (26.2%) of mothers did not visit any antenatal care, and only 137 (3.4%) women visited the service eight times and above. The random intercept with the fixed coefficient of multilevel Hurdle negative binomial model results has shown that women in the age group between 25 and 34 (AOR = 1.057), in the age group between 35 and 49 (AOR = 1.108), protestant religion follower women (AOR = 0.918), Muslim women (AOR = 0.945), other religion follower women (AOR = 0.768), mothers in primary educational level (AOR = 1.123), secondary and higher education level (AOR = 1.228), rich mothers (AOR = 1.134), and mothers living in rural (AOR = 0.789) were statistically associated with regional variation regarding the frequency of ANC service visits.

CONCLUSIONS

The majority of pregnant women did not visit antenatal care services according to the findings of this study. This study's results revealed that the predictor variables such as mother's age, education level, religion, place of residence, marital status, and wealth index were significant, and the findings revealed that there were regional differences in ANC visits in Ethiopia. Women's economic and educational interventions should be a top priority.

Impact of COVID-19 on the antenatal care services utilization in the region of Guelmim Oued Noun, Morocco

Background

The COVID-19 pandemic has seriously impacted access to healthcare facilities across the world, but there is little evidence of how the pandemic influences the use of essential healthcare in the world.

Objective

This study aimed to evaluate the impact of the COVID-19 pandemic on antenatal indicators in the region of Guelmim Oued Noun, Morocco.

Methods

The aggregated data was delivered by regional health authorities covering the period from January 2017 to December 2020. The interrupted time series was mobilized to conduct statistical analysis.

Results

The descriptive results revealed a steady decline after the COVID-19 pandemic in antenatal indicators. The results of the regression model showed a negative impact of the pandemic on the antenatal recruitment rate (β₂=-16.14; P<0.01), recruitment rate of women in antenatal visits during the 1st quarter of pregnancy (β₂=- 2.09; P<0.01), antenatal visit completion rate (β₂=-18.10; P>0.05), and average number of visits/pregnancies (β₂=-15.65, P<0,05).

Conclusion

The effect of the COVID-19 pandemic on antenatal rates was significant for almost all the indicators studied. Future studies should focus on the impact of the pandemic on postnatal and immunization services on a national scale.

Utilization of optimal antenatal care, institutional delivery, and associated factors in Northwest Ethiopia

Optimal antenatal care visits (ANC4+) and institutional delivery are essentials to save lives of the women and the baby during pregnancy and delivery. Though focused antenatal care visits and institutional delivery is recommended by World Health Organization, Ethiopia has sub-optimal antenatal care and lagged facility delivery. A community-based cross-sectional study was conducted among 811 lactating women in Northwest Ethiopia. Multivariable logistic regression analysis was performed using 95% confidence level and p < 0.05. The prevalence of optimal antenatal care visits and institutional delivery were 39.6% (95%CI: 36.2-43) and 62.6% (95%CI: 59.2-66), respectively. Maternal education (AOR = 2.05; 95%CI: 1.14, 3.69), home visiting by health extension workers (AOR = 1.57; 95%CI: 1.01, 2.29), and early antenatal care booking (AOR = 11.92; 95%CI: 8.22, 17.31) were significant predictors of optimal antenatal care. Exposure to mass media (AOR = 1.65; 95% CI: 1.02, 2.65); intended pregnancy(AOR = 1.68; 95%CI:1.12, 3.63); parity of one (AO = 3.46; 95% CI: 1.73, 6.89); 1-3 antenatal care visits (AOR = 2.17; 95% CI: 1.29, 3.63); and ANC4 + (AOR = 3.57; 95% CI: 2.07, 6.14); history of pregnancy-related complications(AOR = 1.63; 95%CI: 1.04, 2.57), and access to transportation to reach a health facility(AOR = 1.58; 95%CI: 1.00, 2.45) were significant predictors of institutional delivery. Addressing the modifiable factors identified in this study could improve optimal antenatal care visit and institutional delivery.

Disclosure of HIV status to sexual partner and its associated factors among pregnant women living with HIV attending prenatal care in Amhara Regional state Referral Hospitals, Ethiopia

BACKGROUND

Disclosure of Human Immunodeficiency Virus (HIV) status to sexual partners plays a significant role in the successful prevention and care of HIV infection. Pregnant women who did not reveal their HIV status to their sexual partners make the prevention and control efforts challenging. Therefore, this study was aimed to assess HIV status disclosure to sexual partners and associated factors among pregnant women living with HIV attending prenatal care in Amhara Regional state referral Hospitals, Ethiopia in 2021.

METHODS

An institution-based cross-sectional study was conducted from October 17th, 2020 to March 1st, 2021. A total of 423 pregnant women living with HIV were participated in this study. A systematic random sampling technique was used to select all eligible women. Data was collected using a semi-structured, pretested, and interviewer-administered questionnaire. EPI INFO version 7 and SPSS version 21 were used for data entry and analysis, respectively. Both univariable and multivariable logistic regression analyses were performed to find factors associated with women's disclosure status to a sexual partner. Statistical association was decided based on the adjusted odds ratio (AOR) with its 95% Confidence Interval (CI) and p-value of ≤ 0.05.

RESULTS

The prevalence of disclosure of their HIV status to their sexual partners was 73% (95% CI: 68.9%, 77.3%). Being an urban resident (AOR = 5.04, 95% CI: 2.14, 11.81), diagnosed HIV before pregnancy (AOR = 7.77, 95% CI: 3.09, 19.52), disclosing their HIV status to others (AOR = 7.01, 95% CI: 3.78, 13.25), planned pregnancy (AOR = 2.46, 95% CI: 1.32, 4.57), and having good knowledge on HIV/AIDS prevention (AOR = 2.19, 95% CI:1.22, 3.94) were found to be statistically significant with women's disclosure of their HIV status to their sexual partner.

CONCLUSION

In this study, nearly three-fourth of pregnant women disclosed their HIV status to their sexual partner. Thus, setting strategies in preventing unplanned pregnancy, HIV diagnosed before pregnancy, and increasing knowledge of HIV prevention will have significant role in escalating women's disclosure status.

The uptake of key Essential Nutrition Action (ENA) messages and its predictors among mothers of children aged 6-24 months in Southern Ethiopia, 2021: A community-based crossectional study

BACKGROUND

Essential nutrition action(ENA) is a framework for managing advocacy, establishing a foundation, and implementing a comprehensive package of preventive nutritional activities. Essential Nutrition Actions study studies provide current information on each nutrition action, allowing health systems to focus more on nutrition, which is critical in tackling the "double burden" of malnutrition: underweight and overweight. Hence, this study aimed at assessing the level of ENA practice and its predictors among mothers of children aged 6 to 24 months in southern Ethiopia.

METHODS

A community-based cross-sectional study was conducted from May 1 to 30, 2021 among randomly selected 633 mothers of children aged 6-24 months. A multi-stage sampling technique was used to access study participants. Data were collected by using a pretested, structured interviewer-administered questionnaire. To identify predictors of ENA practice, bivariable and multivariable logistic regression were used. The strength of the association was measured using an adjusted odds ratio with 95 percent confidence intervals. The statistical significance was declared at a p-value less than 0.05.

RESULTS

A total of 624 participants took part in the study, with a response rate of 98.6%. The uptake of key ENA messages among mothers was measured using 27 items, and it was found to be 47.4% (95% CI: 43.8, 51.4). Complementary feeding was the commonest ENA message practiced by 66.7% of respondents, while prevention of iodine deficiency disorder was practiced by only 33.7% of respondents. Variables namely, mother's education level of college and above [AOR: 3.90, 95% CI: 1.79, 8.51], institutional delivery [AOR: 2.75, 95% CI: 1.17,6.49], having PNC service [AOR: 2.95, 95% CI: 1.91, 4.57], being knowledgeable on ENA message [AOR: 2.37, 95% CI: 1.81, 3.26] and being a model household [AOR: 3.83,95% CI: 2.58, 5.69] were positively associated with a good uptake of key ENA messages. On the other hand, primiparity [AOR: 0.32, 95% CI: 0.21,0.56] was identified as a negative predictor.

CONCLUSION

The overall practice of key Essential nutrition action messages in the study area was low as compared to studies. Stakeholders must step up their efforts to improve and hasten the utilization of maternal and child health services, especially institutional delivery and Postnatal care by focusing on uneducated women to promote compliance to key ENA messages. Furthermore, health workers need to focus on awareness-raising and model household creation.

Factors associated with comprehensive knowledge of antenatal care and attitude towards its uptake among women delivered at home in rural Sehala Seyemit district, northern Ethiopia: A community-based cross-sectional study

Background

Despite the current sustainable development goal period (i.e. SDG 3), the prevention of maternal and neonatal mortality is not satisfactory in Ethiopia. Keeping women knowledgeable about antenatal care and maintaining a positive attitude towards its uptake, particularly in the marginalized rural community is crucial. However, evidence regarding the knowledge and attitude of women towards antenatal care uptake is scarce. Therefore, this study aimed to assess factors affecting comprehensive knowledge of antenatal care and attitude towards its uptake among women delivered at home in rural Sehala Seyemit district, northern Ethiopia.

Methods

A community-based cross-sectional study was conducted from September 1^st to October 15^th, 2020. A multi-stage sampling technique was used to select 653 women. The data were collected using a semi-structured interview guide. Data were entered into EPI INFO 7.1.2 and analyzed by SPSS version 25. Both bivariable and multivariable logistic regression analyses were undertaken to identify factors associated with women’s knowledge of antenatal care and attitude towards its uptake. The level of significant association in the multivariable analysis was determined based on a p-value of < 0.05.

Results

Women’s knowledge of antenatal care and positive attitude towards its uptake was 56.5% and 75.2%, respectively. Older age (AOR = 7.2; 95% CI: 3.43, 15.1), media exposure (AOR = 3.69; 95% CI: 2.41, 5.65), history of abortion (AOR = 11.6; 95% CI: 3.3, 14.6), time to reach health facility (AOR = 4.58; 95% CI: 3.05, 6.88), and history of obstetric danger signs (AOR = 7.3; 95% CI: 3.92, 13.64) were factors significantly associated with knowledge of antenatal care. Furthermore, higher decision-making power (AOR = 8.3; 95% CI: 4.8, 13.83), adequate knowledge of antenatal care (AOR = 2.2; 95% CI: 1.26, 3.71), delivery attended by health extension workers (AOR = 2.3; 95% CI: 1.1, 5.1), and media exposure (AOR = 2.27; 95% CI: 1.30, 3.97) were predictors of a favorable attitude towards antenatal care utilization.

Conclusion

Although the majority of women in the present study had a favorable attitude towards antenatal care uptake, their knowledge level was inadequate. Strengthening access to transportation, mass media, involvement in household decision-making, and encouraging women to deliver at a health facility by a skilled provider may increase women’s knowledge and attitude towards antenatal care uptake, thereby improving maternal healthcare service uptake.

Levels and associated factors of the maternal healthcare continuum in Hadiya zone, Southern Ethiopia: A multilevel analysis

BACKGROUND

The continuity of care throughout pregnancy, birth, and after delivery is an effective strategy to avert maternal and newborn deaths. A low proportion of mothers have achieved the continuum of maternal care in Ethiopia. This study aimed to assess the rate and factors associated with the completion of a continuum of maternal healthcare services in Hadiya Zone, Southern Ethiopia.

METHODS

A community-based, cross-sectional study was conducted over two months (from September to October 2021) in 18 kebeles of the Hadiya zone, southern Ethiopia. Multistage cluster sampling was carried out to select the required study subjects, and data were collected using a structured, interviewer-administered questionnaire. A multilevel binary logistic regression model was used to examine the effects of individual and community-level factors on key elements of the care continuum. The measure of fixed effects was expressed as an odds ratio with a 95% confidence interval (CI).

RESULTS

In this study, only 11.3% of women completed all components of the care continuum, which included four or more antenatal visits, skilled birth attendance, and postnatal care. The factors that are significantly associated with the completion of maternal care include higher maternal education [AOR = 4.1; 95%CI: 1.3-12.6], urban residence [AOR = 1.8; 95%CI: 1.1-3.0], time of first antenatal care follow-up [AOR = 2.7; 95% CI: 1.6-4.6], knowledgeability regarding postnatal danger signs [AOR = 1.9, 95% CI: 1.1-3.3], being in the highest wealth quintile [AOR = 2.8; 95%CI: 1.2-6.6] and primipara [AOR = 3.6; 95%CI: 1.4-9.4].

CONCLUSION

The rate of continuum of maternal healthcare services utilization was low in the study area. The findings indicated that higher maternal education, urban residence, time of first antenatal care follow-up, knowledgeability regarding postnatal danger signs, being in the highest wealth quintile and primipara were the factors associated with the completion of the continuum of maternal care. As a result of this study's findings, program planners and ministry of health and non-governmental organizations working on maternal health should prioritize continued and strengthened health education in order to increase the completion level of the continuum of maternal healthcare services.

The Magnitude of Optimal Antenatal Care Utilization and Its Associated Factors among Pregnant Women in South Gondar Zone, Northwest Ethiopia: A Cross-Sectional Study

Background. Adequate antenatal care is essential for the health of the mother and the development of the fetus. The World Health Organization recommends at least four antenatal care (ANC) visits during pregnancy. In Ethiopia, only 32% of women of childbearing age attend four or more ANC visits. This figure is significantly lower than the average for least developed countries. This study is aimed at calculating the magnitude and identifying the factors associated with optimal antenatal care utilization in the South Gondar Zone, Northwest Ethiopia. Methods. A community-based cross-sectional study was conducted in the South Gondar Zone of Northwest Ethiopia from September 2020 to May 2021. A total of 434 participants were selected using multistage cluster sampling. Data were gathered through face-to-face interviews using a structured questionnaire. A multivariate binary logistic regression model was used to determine the factors associated with the optimal use of antenatal care. Result. The magnitude of optimal antenatal care utilization was 59% (95% CI; 54.20, 63.65). The study showed that mothers who completed their secondary school ( $\text{AOR}=8.205$ ; 95% CI: 3.406, 19.767), women who completed their tertiary school ( $\text{AOR}=6.406$ ; 95% CI: 2.229, 18.416), women whose husbands’ level of education is secondary school ( $\text{AOR}=5.967$ ; 95% CI: 2.753, 12.936), those with a planned pregnancy ( $\text{AOR}=1.912$ ; 95% CI: 1.117, 3.271), those with a wanted pregnancy ( $\text{AOR}=2.341$ ; 95% CI: 1.366, 4.009), women whose husbands work in the government or nongovernment sector ( $\text{AOR}=3.736$ ; 95% CI: 2.093, 6.669), those not being exposed to the media ( $\text{AOR}=0.520$ ; 95% CI: 0.345, 0.783), and rural women ( $\text{AOR}=0.267$ ; 95% CI: 0.164, 0.435) were significantly associated with optimal ANC utilization. Conclusion. The findings suggest that more emphasis should be placed on education-based programs for women and their husbands that highlight the benefits of a planned pregnancy, desired pregnancy, and maternal health care. Meanwhile, the government and other concerned bodies should focus on expanding road accessibility, health institutions, and ambulance distribution to improve optimal ANC utilization in the area.

Irregular Antenatal Care Attendance among Pregnant Women during COVID-19 Pandemic in a Tertiary Care Centre: A Descriptive Cross-sectional Study

INTRODUCTION

The coronavirus disease 2019 pandemic has made access to antenatal care services difficult, which could lead to serious implications for the health of mothers and fetus. There is limited study regarding its impact on pregnant women. This study aimed to find out the prevalence of irregular antenatal care attendance among pregnant women during the COVID-19 pandemic in a tertiary care centre.

METHODS

A descriptive cross-sectional study was carried out among pregnant women attending antenatal care visits at the Department of Gynaecology and Obstetrics in a tertiary care centre from 23 July 2021 to 5 September 2021. Ethical approval was granted by the Institutional Review Committee (Reference number: 077/078/67). Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated.

RESULTS

Among 196 pregnant women, 49 (25%) (18.96-31.06, 95% Confidence Interval) had irregular antenatal care attendance during the COVID-19 pandemic.

CONCLUSIONS

The prevalence of irregular antenatal care attendance during the COVID-19 pandemic was lower than other studies done in similar settings. Antenatal care is crucial to prevent maternal, fetal morbidity and mortality, hence uninterrupted antenatal care services should be provided even during crisis situation like COVID-19 pandemics.

Quality of Antenatal Care Service and Factors Associated with Client Satisfaction at Public Health Facilities of Bele Gasgar District

Background: Quality of service and client satisfaction are crucial to increase services utilization. However, there is a paucity of data in this study area. Consequently, this study aimed to assess “Quality of Antenatal Care (ANC) and client satisfaction in Public Health Facilities”. Method: Facility-based cross-sectional study was conducted from March 11 to April 19, 2019. Systematic random sampling was used to select 366 women. Data were collected through the exit interview, data extraction, and observation. Result: Quality of ANC was 30% (95% CI = 25–35). About 55% (95% CI = 50–60) of women were satisfied with the services. Iron/folic acid supplementation (AOR = 2.23, 95% CI;1.30–4.79), measuring weight (AOR = 3.61, 95% CI = 1.40–9.31), travel time >60 min (AOR = 4, 95% CI;2.3–8.16) and 60–120 min (AOR = 3.68, 95% CI = 1.61–8.38), and consultation time (AOR = 2.89, 95% CI = 1.14–7.31) were positively associated with client satisfaction, while health professional initiation to ask question never (AOR = 0.20, 95% CI = 0.08–0.43) and to ask sometimes (AOR = 0.32, 95% CI = 0.16–0.65) were negatively associated. Conclusion: Quality of ANC was low while clients’ satisfaction was moderately low. Therefore, improvement in the area of input, process, and output is recommended.

Association of Higher Educational Attainment on Antenatal Care Utilization Among Pregnant Women in East Africa Using Demographic and Health Surveys (DHS) from 2010 to 2018: A Multilevel Analysis

Introduction

The use of antenatal care (ANC) plays a major role in minimizing maternal and child mortality through effective and appropriate screening, preventive, or treatment intervention. Even though almost all pregnancy-related mortalities are largely preventable through adequate use of ANC, sub-Saharan Africa (SSA), particularly East African Countries, continues to share the largest share of global maternal, and newborn mortality. Therefore, this study assesses if educational attainment is associated with optimal ANC utilization in East Africa.

Methods

A secondary data analysis was done based on Demographic and Health Surveys (DHS) from 2010 to 2018 in the 11 East African Countries. A total weighted sample of 84,660 women who gave birth in the 5 years preceding each country’s DHS survey and had ANC visits were included in this study. Data processing and analysis were performed using STATA 15 software. A multilevel mixed-effect logistic regression model was fitted to examine the association of educational attainment and ANC utilization. Variables with a p-value <0.05 were declared as significant factors associated with ANC utilization. Model comparison was done based on Akaike and Bayesian Information Criteria (AIC and BIC).

Results

The magnitude of optimal ANC utilization in East African Countries was 56.37% with 95% CI (56.03, 56.69) with the highest optimal ANC utilization in Zimbabwe (80.96%) and the lowest optimal ANC utilization in Rwanda (44.31%). Women who had higher education levels were more likely to have optimal ANC utilization, compared to those with no education (AOR = 2.34; 95 and CI; 2.11–2.59). Women who had media exposure were more likely to have optimal ANC utilization than those who have no media exposure (AOR = 1.07; 95% CI; 1.03, 1.10).

Conclusion

Antenatal care utilization was low in East African countries. Educational attainment, maternal age, wealth index, birth order, media exposure, and living countries were factors associated with ANC utilization. Efforts to improve antenatal care and other maternal health service utilization in East Africa must take into account these factors. Specifically, working on the access to mass media by women may also improve antenatal care utilization.

Prevalence and factors affecting the utilization of antenatal care in rural areas of Southwestern Ethiopia

BACKGROUND

Antenatal care (ANC) is a health care intervention intended to ensure the safety of pregnancy. According to the World Health Organization, at least four ANC visits are recommended for a healthy pregnancy. However, whether this recommended number of visits was followed or not in the rural areas of Southwestern Ethiopia is not known. Therefore, the study aimed to investigate the prevalence of, and the associated factors of ANC utilization by pregnant women in the rural areas of Southwestern Ethiopia.

METHODS

A community-based cross-sectional study design was used in three rural zones. The data were collected from n = 978 women through a structured questionnaire with face-to-face interview. The collected data were analyzed using descriptive statistics and a multiple binary logistic regression model.

RESULTS

The results showed that 56% of women made the recommended minimum number of ANC visits and the remaining 44% of them underutilized the ANC service. The multiple binary logistic regression model identified zone, marital status of the woman, educational level of the husband, occupation of the husband, knowledge of danger signs of pregnancy, birth interval, source of information, timely visits, and transportation problem to be statistically significant factors affecting the prevalence of ANC visit utilization of women. Bench Maji zone had smaller odds ratio of ANC visit prevalence as compared to Kaffa zone. Women who lived in the rural area of Sheko zone are 2.67 times less likely to utilize ANC visit than those who lived in the rural area of Kaffa zone keeping other variables constant.

CONCLUSION

The study results highlight the need to increase the number of ANC visits, and the importance of using an appropriate model to determine the important socio-demographic factors that ANC service providers shall focus on to improve the health of the unborn baby and the mother during pregnancy.

Late antenatal care utilization in Ethiopia: The effect of socio-economic inequities and regional disparities

Antenatal care (ANC) is one of the most crucial components of maternal health care services. However, less than two-third of pregnant women receive ANC at least once and only 32% had at least 4 ANC visits in Ethiopia. There is dearth of nationally representative data that indicate changes in utilization of ANC services at the end of health sector transformation plan I period (HSTP I) in the country. Therefore, the present study aimed to investigate utilization of ANC the effect of socio-economic inequities and regional disparities in Ethiopia. The 2019 Ethiopian Mini Demographic and Health Survey data were used. A total of 5753 women in the reproductive age who gave live births in the five years preceding the survey were used for this study. Multivariable logistic regression model was fitted to identify factors associated with ANC booking. This study indicated that 74% women had at least one ANC visit during their last pregnancy of which four out of ten did not receive the recommended 4+ visits. The proportion of women who had late ANC booking (i.e., first ANC visit to health facility after 4 months of pregnancy) was found to be 32% and significant disparities were observed across regions. Rural residency (adjusted OR (AOR): 1.62, 95% CI (1.28, 2.05)), being wealth (AOR: 0.69, 95% CI (0.55, 0.85)), education (AOR: 0.25, 95% CI (0.15, 0.40)) and being grand multi-parity (AOR: 1.35, 95% CI (1.005, 1.83)) were significantly associated with late ANC booking. ANC services utilization is far behind its targets and the proportion of pregnant women entering ANC late is high. It is necessary to intensify efforts to raise awareness about the need of early ANC initiation, particularly in rural areas.

Quality of antenatal care and associated factors among pregnant women attending government hospitals in Sidama Region, Southern Ethiopia

Background:

Good-quality antenatal care improves maternal health in the least developed countries. This study was aimed at assessing the quality of antenatal care and associated factors among pregnant women attending hospitals in the Sidama Region, Southern Ethiopia.

Method:

A facility-based cross-sectional study was conducted from 1 February to 30 April 2020 among 372 pregnant women. A two-stage sampling technique—the first stage, selection of health facilities; the second stage, selection of respondents—was used. Trained data collectors administered exit interviews. Data were entered into EPI Info 7 and analyzed using IBM SPSS version 25. Quality of care was assessed using a validated questionnaire containing 68 attributes of quality. Good quality of care was determined by the proportion of respondents who scored ⩾80% of 68 variables. Bivariable and multivariable logistic regressions were used in the analysis. The outputs were presented using an adjusted odds ratio with 95% confidence intervals.

Results:

This study revealed that 41.2% (95% confidence interval: 36.2%–46.2%) of pregnant women had received good-quality antenatal care. Increased odds of the utilization of quality antenatal care were observed among women who lived in urban areas (adjusted odds ratio = 4.32, 95% confidence interval: 2.58–7.21), attained primary education and more (adjusted odds ratio = 2.68, 95% confidence interval: 1.60–4.48), earned a monthly income >3000 Ethiopia Birr (US$93.3) (adjusted odds ratio = 3.86, 95% confidence interval: 2.28–6.51), and visited hospitals for antenatal care ⩾4 times (adjusted odds ratio = 3.68, 95% confidence interval: 2.21–6.10).

Conclusions:

The proportion of women who received good-quality antenatal care was low. Good quality care was associated with residence, education status, income level, and frequency of antenatal care visits. Training care providers, strengthening counseling, and promoting women’s economic empowerment to improve the utilization of quality antenatal care are recommended.

Prevalence and associated factors of caesarian section in Ethiopia: a multilevel analysis of the 2019 Ethiopia Mini Demographic Health Survey

BACKGROUND

Caesarian section is a vital emergency obstetric intervention for saving the lives of mothers and newborns. However, factors which are responsible for caesarian section (CS) were not well established in the country level data. Therefore, this study aimed to assess the prevalence and associated factors of caesarian section in Ethiopia.

METHODS

Data from the Ethiopian Mini Demographic and Health survey 2019 were used to identify factors associated with the caesarian section in Ethiopia. We applied multi-level logistic regression and a p-value of <0.25 to include variables before modeling and a p-value<0.05 with 95% confidence interval (CI) for final results.

RESULT

The prevalence of caesarian section in Ethiopia was 5.44% (95% CI; 0.048-0.06) in2019. Women in age group of 30-39 and 40-49 years had a higher odd of caesarian section (AOR = 2.14, 95%CI = 1.55-2.94) and (AOR = 2, 95%CI = 1.20-3.97) respectively compared to women in age group of 15-29 years. Women with secondary and higher educational level had higher odds of caesarian section (AOR = 2.15, 95%CI = 1.38-3.34) and (AOR = 2.8, 95%CI = 1.73-4.53) compared to those in no education category. Compared to Orthodox, Muslims and Protestant religions had lower odds of caesarian section with AOR of 0.50 (0.34-0.73) and 0.53 (0.34-0.85). Having <2 births was also associated with the low caesarian section 0.61(0.52-1.22). Using modern contraceptive methods, having ANC visits of 1-3, 4th, 5 plus, and urban residence were associated with higher odds of caesarian section as 1.4 (1.05-1.80]), 2.2 (1.51-3.12), 1.7 (1.12-2.46), and 2.4 (1.65-3.44) 1.6(1.04-2.57) respectively.

CONCLUSION

Although evidence indicates that the caesarian deliveries increased both in developed and underdeveloped countries, the current magnitude of this service was very low in Ethiopia which might indicate missing opportunities that might costing lives of mothers and newborns. Women's age, religion, educational status, parity, contraceptive method, and ANC visit were individual level factors influenced caesarian section. whereas, region and place of residence were community level factors affected caesarian section in the country. Depending on these factors, the country needs policy decisions for further national level interventions.

Adequacy of prenatal care services and associated factors in Southern Ethiopia

BACKGROUND

Prenatal care is an important component for the continuum of care in maternal and child health services. Despite increased attention on prenatal care service coverage, the adequacy of service provision has not been well addressed in Ethiopia. Therefore, this study aimed to describe the status of the adequacy of prenatal care and its associated factors in Southern Ethiopia.

METHOD

A longitudinal study done by the Performance care Monitoring and Accountability (PMA2020) project was used. The study was conducted from August 2016 to January 2017 in Southern Ethiopia. A multistage stratified cluster design in which all enumeration areas were randomly selected using probability proportional to size and all households were screened to identify 324 pregnant women of six or more months. Questions regarding early attendance of prenatal care, enough visits, and sufficient services were asked to measure the adequacy of prenatal care. Finally, an ordered logistic regression analysis was employed to assess factors associated with the adequacy of prenatal care services.

RESULTS

Of the total pregnant women 44.21 % attended enough visits, 84.10 % had early visits, and 42.03 % received sufficient services. The women residing in urban areas had 2.35 odds of having adequate prenatal care in reference to rural areas (adjusted odds ratio (aOR) 2.35 [95 % CI 1.05-5.31]). Women who attended primary and secondary education had 2.42(aOR 2.42 [95 % C.I. 1.04, 5.65]), and 4.18 (aOR 4.18 [95 % CI 1.32, 13.29]) odds of adequate prenatal care in reference with those who never attended education respectively. The women participating in one to five networks have 2.18 odds of adequate prenatal care in reference to their counterparts (aOR 2.78 [95 % CI 1.01, 7.71]).

CONCLUSIONS

The adequacy of prenatal care services in Southern Ethiopia is very low. The Ethiopian health care system should strengthen one to five networks to discuss on family health issues. Further research, should validate the tools and measure the adequacy of the services in different contexts of Ethiopia using a mixed method study for an in-depth understanding of the problem.

Determinants of practice of preconception care among women of reproductive age group in southern Ethiopia, 2020: content analysis

Background

Preconception care (PCC) is a series of biomedical, mental, and psycho-social health services provided to women and a couple before pregnancy and throughout subsequent pregnancies for desired outcomes. Millions of women and new-borns have died in low-income countries due to impediments that arise before and exaggerate during pregnancies that are not deal with as part of pre-conception care. To the best of our knowledge, however, there is a lack of information about preconception care practice and its determinants in southern Ethiopia, including the study area. This study was therefore planned to assess the practice of preconception care and its determinants among mothers who recently gave birth in Wolkite town, southern Ethiopia, in 2020.

Methods

A community-based cross-sectional study was conducted from February 1 to 30, 2020. A total of 600 mothers who have given birth in the last 12months have been randomly selected. A two-stage sampling technique was employed. For data collection, a pre-tested, semi-structured questionnaire was used. The data was encoded and entered into Epi-Data version 3.1 and exported for analysis to SPSS version 23. Household wealth status was determined through the application of principal component analysis(PCA). The practice PCC was considered as a count variable and measured as a minimum score of 0 and a maximum of 10. A bivariable statistical analysis was performed through analysis of variance (ANOVA) and independent t-tests and variables with a p-value of<0.05 were eligible for the generalized linear regression model. To see the weight of each explanatory variable on PCC utilization, generalized linear regression with a Poisson link was done.

Results

Of the sampled 600 participants, 591 took part in the study, which yielded a response rate of 98.8%.The mean (SD) score of the practice of PCC was 3.94 (1.98) with minimum and maximum scores of 0 and 10 respectively. Only 6.4% (95%CI: 4.6, 8.6) of mothers received all selected items of PCC services. Thecommonest item received by 67.2% of mothers was Folic acid supplementation, while 16.1% of mothers received the least item of optimizing psychological health. Education status of mother[AOR 0.74, 95%CI 0.63, 0.97], time spent to access nearby health facilities [AOR 0.69, 95%CI 0.58, 0.83], availability of PCC unit [AOR1.46; 95%CI 1.17, 1.67], mothers knowledge on PCC [AOR 1.34, 95%CI 1.13, 1.65], being a model household [AOR 1.31, 95%CI 1.18, 1.52] and womens autonomy in decision making [AOR 0.75, 95%CI 0.64, 0.96] were identified as significant predictors of practice of PCC.

Conclusion

The uptake of WHO-recommended PCC service elements in the current study area was found to be unsatisfactory. Stakeholders must therefore increase their efforts to align PCC units with existing MNCH service delivery points, improve women's decision-making autonomy, and focus on behavioral change communication to strengthen PCC practice.

Plain language summary

Preconception care (PCC) is a series of biomedical, mental, and psycho-social health services provided to women and a couple before pregnancy and throughout subsequent pregnancies for better endings. The main goal of the PCC is to improve maternal and child health outcomes, by-promoting wellness and providing preventive care. It can also be seen as an earlier chance for teenage girls, mothers, and children to live a better and longer-term healthy life. Pieces of PCC service packages suggested by the World Health Organization(WHO) are, micronutrient supplementation (Folate supplementation), infectious disease (STI/HIV) screening and testing, chronic disease screening and management, healthy diet therapy, vaccination, prevention of substance use (cessation of cigarette smoking and too much alcohol consumption), optimizing psychological health, counseling on the importance of exercise and reproductive health planning and implementation. Millions of women and new-borns have died in low-income countries due to impediments that arise before and exaggerate during pregnancies that are not deal with as part of pre-conception care. To the best of our knowledge, however, there is a lack of information about preconception care practice and its determinants in southern Ethiopia, including the study area. This study was therefore planned to evaluate the practice of preconception care and its determinants among mothers who recently gave birth in Wolkite town, southern Ethiopia, in 2020.

Mothers who have given birth in the last 12months have been randomly selected Household wealth status was determined through the application of principal component analysis(PCA). To see the weight of each explanatory variable on PCC, generalized linear regression with a Poisson type was done. Accordingly, the Education status of the mother, time spent to access nearby health facilities, availability of PCC unit, mothers knowledge on PCC, being a model household, and womens autonomy in decision making were identified as significant predictors of practice of PCC. Stakeholders must therefore increase their efforts to align PCC units with existing MNCH service delivery points, improve women's decision-making autonomy, and focus on behavioral change communication to strengthen PCC practice.

Magnitude of antenatal care service uptake and associated factors among pregnant women: analysis of the 2016 Ethiopia Demographic and Health Survey

Objective

Antenatal and postnatal cares are crucial for the survival and well-being of both the mother and the child. WHO recommends a minimum of four antenatal care (ANC) visits during a pregnancy. In Ethiopia, only 38% of women in the reproductive age make a minimum of first ANC visits. This value is far below the typical rates of least developed countries. This study aimed to calculate the magnitude and identify associated factors of ANC service utilisation among pregnant women in Ethiopia.

Design

Cross-sectional study design.

Setting

Ethiopia.

Participants

A total of 7913 pregnant women participated in the study.

Primary outcome measures

Antenatal care service uptake among pregnant women.

Result

Only 35.5% of the pregnant mothers have used ANC services at least four times and 64.5% of the pregnant mothers have used less than three times during their periods of pregnancy. The study showed that rich women (PR=1.077, 95% CI: 1.029 to 1.127), having access to mass media (PR=1.086, 95% CI: 1.045 to 1.128), having pregnancy complications (PR=1.203, 95% CI: 1.165 to 1.242), secondary education and above (PR=1.112, 95% CI:1.052 to 1.176), husbands’ having secondary education and above (PR=1.085, 95% CI: 1.031 to 1.142) and married (PR=1.187; 95% CI: 1.087 to 1.296), rural women (PR=0.884, 95% CI: 0.846 to 0.924) and women>30 years of age (PR=1.067, 95% CI: 1.024 to 1.111) significantly associated with the ANC service uptake.

Conclusion

The magnitude of ANC service uptake was low. This low magnitude of ANC service utilisation calls for a need to improve community awareness about maternal health. More importantly, intensive health education is required for pregnant women to have better ANC service uptake and follow-up adherence.

Determinants of completing recommended antenatal care utilization in sub-Saharan from 2006 to 2018: evidence from 36 countries using Demographic and Health Surveys

Background

Every day in 2017, approximately 810 women died from preventable causes related to pregnancy and childbirth, with 99% of these maternal deaths occurring in low and lower-middle-income countries. Sub-Saharan Africa (SSA) alone accounts for roughly 66%. If pregnant women gained recommended ANC (Antenatal Care), these maternal deaths could be prevented. Still, many women lack recommended ANC in sub-Saharan Africa. This study aimed at determining the pooled prevalence and determinants of recommended ANC utilization in SSA.

Methods

We used the most recent standard demographic and health survey data from the period of 2006 to 2018 for 36 SSA countries. A total of 260,572 women who had at least one live birth 5 years preceding the survey were included in this study. A meta-analysis of DHS data of the Sub-Saharan countries was conducted to generate pooled prevalence, and a forest plot was used to present it. A multilevel multivariable logistic regression model was fitted to identify determinants of recommended ANC utilization. The AOR (Adjusted Odds Ratio) with their 95% CI and p-value ≤0.05 was used to declare the recommended ANC utilization determinates.

Results

The pooled prevalence of recommended antenatal care utilization in sub-Saharan Africa countries were 58.53% [95% CI: 58.35, 58.71], with the highest recommended ANC utilization in the Southern Region of Africa (78.86%) and the low recommended ANC utilization in Eastern Regions of Africa (53.39%). In the multilevel multivariable logistic regression model region, residence, literacy level, maternal education, husband education, maternal occupation, women health care decision autonomy, wealth index, media exposure, accessing health care, wanted pregnancy, contraceptive use, and birth order were determinants of recommended ANC utilization in Sub-Saharan Africa.

Conclusion

The coverage of recommended ANC service utilization was with high disparities among the region. Being a rural residence, illiterate, low education level, had no occupation, low women autonomy, low socioeconomic status, not exposed to media, a big problem to access health care, unplanned pregnancy, not use of contraceptive were determinants of women that had no recommended ANC utilization in SSA. This study evidenced the existence of a wide gap between SSA regions and countries. Special attention is required to improve health accessibility, utilization, and quality of maternal health services.

Utilizing a Minimum of Four Antenatal Care Visits and Associated Factors in Debre Berhan Town, North Shewa, Amhara, Ethiopia, 2020

Background

Receiving a minimum of four antenatal care, as per the World Health Organization recommendation, enhances the possibility of utilizing effective maternal health care during antenatal follow-up. Hence, this study aimed to identify the level of a minimum of 4 ANC usage and factors associated with Debre Berhan town.

Methods

A community-based cross-sectional study was employed from February 20 to March 10/2020 among women who gave birth in the last 6 months before the data collection period in Debre Berhan town. Data were collected using face-to-face interviews with the pre-tested tool by trained data collectors from randomly selected participants. After entering the data into Epi-data software version 3.1, it was further processed using SPSS version 23 statistical package. Both bivariate and multivariable Logistic regressions were fitted to identify the determinants for the utilization of a minimum of 4 antenatal care. A significance level of 0.05 was used to decide the significance of statistical tests.

Results

A total of 390 women were interviewed giving a response rate of 99.2%. In this study, 78.5% (95% CI: 74.4-82.6) of women received a minimum of four antenatal care visits. Maternal educational status, initiation of antenatal visit at ≤16 weeks of gestation, and husband support/partner involvement were identified predictors of utilization of minimum 4 antenatal visits.

Conclusion and Recommendations

Use of at least four antenatal visits in Debre Berhan town was found to be good. Health promotion programs targeting mothers with no education and lower educational level are important to increase their awareness about the importance of antenatal services. Male partner involvement during care related to pregnancy and promoting early initiation of antenatal care is important to overcome challenges towards a minimum of 4 antenatal visits in Debre Berhan town.

Antenatal Care Service Utilization of Pregnant Women Attending Antenatal Care in Public Hospitals During the COVID-19 Pandemic Period

BACKGROUND

The recent coronavirus disease (COVID-19) pandemic has had a disastrous effect on the health-care delivery system, of mainly pregnancy-related healthcare. In order to fill the information gap in the scientific literature and in response to the limited evidence in the country, this study aims to assess the impact of the COVID-19 pandemic on antenatal care utilization among pregnant women attending public facilities in Northeast Ethiopia. Therefore, the result will be beneficial to design strategies for prioritizing maternal healthcare even with the COVID-19 pandemic period.

METHODS

A facility-based cross-sectional study was conducted from February 2 to August 30, 2020 among pregnant women attending ANC services at public hospitals in Northeast Ethiopia. Thus, a total of 389 women were included in the study with a simple random sampling technique. The bi-variable and multi-variable logistic regression models were employed to identify factors significantly associated with ANC utilization. Adjusted odds ratio (AOR) with 95% CI was estimated to show the strength of association. Finally, a P-value of <0.05 in the multivariable logistic regression analysis was used to identify predictors of antenatal care utilization.

RESULTS

Overall, 114 (29.3%) pregnant women had fully utilized antenatal care services during the pandemic period. Mother age ≥35 years (AOR=11.79, 95% CI=1.18- 117.8), secondary education and above (AOR=4.74, 95% CI=1.04- 21.61), history of stillbirth before recent pregnancy (AOR=0.007, 95% CI=0.001-0.12), interruption and diversion of services due to COVID-19 response (AOR=0.675, 95% CI=0.142-0.742), fear of COVID-19 (AOR=0.13, 95% CI=0.06-0.31), and lack of transport access (AOR=4.15, 95% CI=1.04-16.54) were predictors of full antenatal care service utilization.

CONCLUSION

Three of every ten pregnant women who attended the obstetric outpatient clinics have fully utilized the antenatal care services. Encouraging women's educational status, prioritizing maternal health services during COVID-19, and improving the quality of ANC service should be emphasized more.

Spatial Pattern and Associated Factors of ANC Visits in Ethiopia: Spatial and Multilevel Modeling of Ethiopian Demographic Health Survey Data

Background

Although there is an increase in having antenatal care (ANC), still many women lack recommended ANC contacts in Ethiopia. Therefore, this study was aimed at determining spatial patterns and associated factors of not having ANC visits using the Ethiopian Demographic and Health Survey (EDHS) 2016 data.

Methods

A two-stage stratified cluster sampling technique was employed based on EDHS data from January 18 to June 27, 2016. A total of 7,462 women were included in the study. ArcGIS version 10.7 software was used to visualize the spatial distribution. The Bernoulli model was applied using Kilduff SaTScan version 9.6 software to identify significant purely spatial clusters for not having ANC visits in Ethiopia. A multivariable multilevel logistic regression model was used to identify individual- and community-level determinants of not having antenatal care. Model comparison was checked using the likelihood test and goodness of fit was assessed by the deviance test.

Results

The primary clusters' spatial window was located in Somalia, Oromia, Afar, Dire Dawa, and Harari regions with the log-likelihood ratio (LLR) of 133.02, at p < 0.001 level of significance. In this study, Islam religion (adjusted odds ratio (AOR) = 0.7 with 95% confidence interval (CI) (0.52,0.96)), mother education being primary (AOR = 0.59, 95% CI (0.49,0.71)), distance from health facility being a big problem (AOR = 0.76, CI (0.65,0.89)), second birth order (AOR = 1.35, CI (1.03, 1.76)), richer wealth index (AOR = 0.65, CI (0.51,0.82)), rural residence (AOR = 2.38, CI (1.54,3.66)), and high community media exposure (AOR = 0.68, CI (0.52,0.89)) were determinants of not having antenatal care in Ethiopia.

Conclusion

The spatial distribution of ANC in Ethiopia is non-random. A higher proportion of not having ANC is found in northeast Amhara, west Benishangul Gumuz, Somali, Afar, north, and northeast SNNPR. On the other hand, a low proportion of not having ANC was found in Tigray, Addis Ababa, and Dire Dawa. In Ethiopia, not having antenatal care is affected by both individual- and community-level factors. Prompt attention by the Federal Ministry of Health is compulsory to improve ANC especially in rural residents, uneducated women, poor households, and regions like Oromia, Gambella, and Somalia.

Women's knowledge and its associated factors regarding optimum utilisation of antenatal care in rural Ghana: A cross-sectional study

INTRODUCTION

Improving maternal health is a global public health challenge especially in sub-Saharan Africa. The optimum utilisation of antenatal care (ANC) by pregnant women is known to improve maternal health outcomes. Maternal morbidity and mortality rates in Ghana remain unacceptably high, particularly in rural settings where skilled delivery care often times is disproportionally low. This study assessed factors associated with optimum utilisation of antenatal care in rural Ghana.

METHODS

A cross-sectional design was applied to collect data among eligible participants between October 2018 and January 2019. A total of 322 women who gave birth and attended the postnatal clinic were recruited for the study. Consecutive sampling was employed in recruiting participants. The associations between the dependent variables (ANC service utilisation and knowledge of ANC) and independent variables (socio-demographic characteristics) were examined using ordinary least squares logistic regression at 95% confidence interval in STATA version 14.0.

RESULTS

Of the 322 participants, 69.0% reported utilising at least four or more times ANC services. Determinants of women attending ANC for four or more times was significantly associated with age [OR = 4.36 (95%CI: 2.16-8.80), p<0.001], educational level [OR = 10.18 (95%CI: 3.86-26.87), p<0.001], and insured with National Health Insurance Scheme [OR = 3.42 (95%CI: 1.72-6.82), p<0.001]. Not married [OR = 0.65 (0.39-1.09), p = 0.011] or divorced [OR = 0.33 (95%CI: 0.13-0.83), p = 0.019] was negatively associated with utilisation of four or more ANC services. The majority (79.0%) of the participants had a good level of knowledge regarding antenatal care.

CONCLUSION

Although the majority of women in this study had good knowledge of ANC services, a significant number of them did not complete the recommended number of ANC visits for at least four times during a normal pregnancy. Awareness and further education to reproductive-age women on the significant role adequate ANC attendance plays in advancing health and well-being require further investments, particularly among rural women in Ghana.

Determinants of antenatal care utilisation in sub-Saharan Africa: a systematic review

OBJECTIVES

To identify the determinants of antenatal care (ANC) utilisation in sub-Saharan Africa.

DESIGN

Systematic review.

DATA SOURCES

Databases searched were PubMed, OVID, EMBASE, CINAHL and Web of Science.

ELIGIBILITY CRITERIA

Primary studies reporting on determinants of ANC utilisation following multivariate analysis, conducted in sub-Saharan Africa and published in English language between 2008 and 2018.

DATA EXTRACTION AND SYNTHESIS

A data extraction form was used to extract the following information: name of first author, year of publication, study location, study design, study subjects, sample size and determinants. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist for reporting a systematic review or meta-analysis protocol was used to guide the screening and eligibility of the studies. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess the quality of the studies while the Andersen framework was used to report findings.

RESULTS

74 studies that met the inclusion criteria were fully assessed. Most studies identified socioeconomic status, urban residence, older/increasing age, low parity, being educated and having an educated partner, being employed, being married and Christian religion as predictors of ANC attendance and timeliness. Awareness of danger signs, timing and adequate number of antenatal visits, exposure to mass media and good attitude towards ANC utilisation made attendance and initiation of ANC in first trimester more likely. Having an unplanned pregnancy, previous pregnancy complications, poor autonomy, lack of husband's support, increased distance to health facility, not having health insurance and high cost of services negatively impacted the overall uptake, timing and frequency of antenatal visits.

CONCLUSION

A variety of predisposing, enabling and need factors affect ANC utilisation in sub-Saharan Africa. Intersectoral collaboration to promote female education and empowerment, improve geographical access and strengthened implementation of ANC policies with active community participation are recommended.