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

Adequate antenatal care service utilizations after the onset of COVID-19 pandemic in Ethiopia: a systematic review and meta-analysis

Background

The world faces great difficulty in continuing to provide essential maternity health care after the onset of COVID-19 pandemic Many women have trouble accessing maternity healthcare due to fear of infection. A decline in the utilization of maternity health services is suggested to worsen adequate antenatal care service utilization. Thus, this study aimed to determine the pooled estimate of adequate antenatal care service utilization after the onset of COVID-19 in Ethiopia.

Methods

The searching of articles was carried out on Web of Science, Scopus, PubMed, CINHAL, Google Scholar, African journals online, and the institutional repository of Ethiopian universities. Using a Microsoft Excel standardized spreadsheet, the data were extracted. A random effect model was used to determine a pooled estimate of adequate antenatal care utilization. I 2 statistics were used to quantify the amount of heterogeneity. The evidence of publication bias was examined using Egger's regression test and a visual inspection of the funnel plot. Subgroup and sensitivity analyses were also carried out.

Results

Finally, this systematic review and meta-analysis included 11 eligible articles. The overall pooled estimate of adequate antenatal care service utilization after the onset of COVID-19 pandemic in Ethiopia was 46.28% (95% CI: 35.32%-57.26%). There is a substantial amount of heterogeneity between studies (I 2 = 99.07%, p < 0.001). Pregnant women who visited antenatal care early were 10.9 times more likely to have adequate antenatal care utilization than those without early visits (AOR = 10.93, 95% CI: 7.2-14.66).

Conclusion

In this review, the percentage of women who utilized adequate antenatal care after the onset of COVID-19 pandemic in Ethiopia was less than half. Early antenatal care visit is an important factor to achieve adequate antenatal care service utilizations.

Systematic review registration

: CRD42023495279.

Experiences of Midwestern obstetric clinicians during the Coronavirus disease 2019 pandemic

Background

The Coronavirus disease 2019 (COVID-19) pandemic led to healthcare system changes aimed at minimizing disease transmission that impacted experiences with obstetric healthcare.

Objective

To explore experiences of clinicians providing obstetric care during the COVID-19 pandemic.

Study Design

Qualitative, in-depth, semi-structured interviews were conducted with five nurse practitioners and 16 obstetrical physicians providing a mix of outpatient and inpatient obstetric care during the COVID-19 pandemic in a mid-sized, Midwestern city in the United States. Interviews elucidated challenges and facilitators of obstetric care provision and vaccination of pregnant patients against COVID-19 during the pandemic. Transcripts were coded inductively then deductively using the Health Equity Implementation Framework (HEIF), which integrates a disparities framework and implementation framework to highlight multilevel factors that influence obstetric care. Thematic analysis was conducted, and thematic saturation was reached.

Results

We interviewed 21 clinicians. Clinicians recounted personal challenges such as social isolation and burnout that could be countered by social support. Challenges within the clinical encounter included implementation of infection mitigation efforts, vaccine counseling, and limitations of telehealth. However, when successfully implemented, telehealth facilitated care and circumvented barriers. Clinicians cited challenges at the healthcare system level such as rapidly evolving knowledge and recommendations, restrictive visitor policies, personnel shortage, and inadequate institutional resources to support pandemic-related stressors. However, interdisciplinary care and guidelines available for clinicians facilitated care. Clinicians reported that challenges at the societal level included financial strain, lack of childcare, medical mistrust, politicization of medicine, misinformation, and racism. Societal-level facilitators included insurance access, community outreach, positive policy changes, and fostering trust in medicine.

Conclusion

The pandemic produced unique stressors and exacerbated existing challenges for clinicians providing obstetric care. Applying the HEIF to the findings emphasizes the influence of societal factors on all other levels. Identified facilitators can inform interventions to address stressors in obstetric care that have resulted from the changed sociopolitical landscape of the pandemic.

Provision and utilization of basic maternal healthcare during the pandemic in Ecuador: The health workers' perspective

Context

Ecuador was one of the most affected counties in Latin America during coronavirus disease 2019 (COVID-19). Its health system already faced financing and organizational problems before the pandemic.

Aims

To analyze the effects of the pandemic on the provision and utilization of maternal health services in units of the Public Health of Ecuador as perceived by the health personnel.

Material and Methods

This is a mixed methods study with two rapid evaluation cycles. The first cycle collected information during January-March and the second one during April-June, 2021. An online questionnaire and semistructured interviews were applied to professionals involved in the management and provision of maternal health programs. Both instruments explored provision and utilization of maternal health services. Questionnaires were processed using SPSS and descriptive statistics. Interviews were exported to Atlas-Ti and were codified using the explored categories.

Results

A total of 207 health workers participated in the first cycle, and 200 in the second one. They recognized that during the pandemic, healthcare personnel were reduced by more than 30% due to the presence of risk factors among them as well as the lack of budget for new contracts. The availability of materials and supplies was also reduced by nearly 50%, mainly due to the lack of budget. The demand for maternal healthcare in public health units was reduced because people feared being infected by COVID-19 and nearly 25% goes to the private sector.

Conclusions

The pandemic has had a negative effect on the provision as well as utilization of maternal healthcare services. Nevertheless, health professionals implemented diverse strategies to reduce this negative effect on maternal care.

Investigation of usage of antenatal care services by Syrian immigrant pregnant women and the frequency of anaemia and hypertension during the pandemic

During the pandemic period, the use of health services by disadvantaged groups such as immigrants has deteriorated. The study aims to evaluate the use of antenatal care services by Syrian pregnant women during the pandemic. It is a cross-sectional type of study. The population consisted of 495 pregnant women who applied to the Extended Migrant Health Center (EMHC) between August 2020 and December 2022. Demographic data and pregnancy-related health records were examined through the system records, without any contact with the pregnant women. The percentage of pregnant women who had timely follow-up for each antenatal visit were 11.5% (n=56), 17.2% (n=80), 20.0% (n=88), and 17.4% (n=73), respectively. Only 17.7% (n=87) of the pregnant women made the recommended number of visits during their pregnancy period. The recommended number of follow-ups was statistically significantly higher in women with high-risk pregnancies (p=0.045). Of the pregnant women, 27.4% had anaemia and 2.4% had hypertension. The use of antenatal care in immigrant pregnant women is very low. Interventions are needed in this regard. Increasing the utilization of antenatal care services by immigrant pregnant women is extremely important for both the health of the pregnant woman and the health of the baby.

Factors associated with COVID-19 infection in pregnant women: Focusing on maternal anxiety

OBJECTIVE

Given the critical importance of maternal mental health for the well-being of both the mother and fetus, it is essential to thoroughly investigate the impact of COVID-19 infection on mental health. This study aims to identify the factors associated with COVID-19 infection and mental health, underscoring the necessity of effective mental health management for pregnant women.

METHODS

Data were analyzed from 97 pregnant women who visited Gachon University Gil hospital in South Korea. Coronavirus 2019 (COVID-19) infection status was categorized based on whether the infection occurred during pregnancy. Maternal anxiety, the dependent variable, was measured using the state anxiety scale of the Spielberger State-Trait Anxiety Inventory. Multiple logistic regression analysis was performed to examine the association between COVID-19 infection and anxiety.

RESULTS

Among the 97 pregnant women, 50 (51.5%) experienced anxiety. Of those infected with COVID-19, 31 (64.6%) experienced anxiety. The mean anxiety score was significantly higher in pregnant women with COVID-19 infection compared to those without infection (Infected: Mean = 46.35, SD = 13.85; Non-infected: Mean = 39.59, SD = 10.58, p-value:0.008). Maternal depression, and posttraumatic stress disorder were significantly higher in pregnant women with COVID-19 infection, while fetal attachment showed no significant difference. Pregnant women infected with COVID-19 during pregnancy were more likely to experience anxiety compared to non-infected women (Adjusted OR = 9.37; 95% CI = 1.39-63.12).

CONCLUSION

This study highlights that pregnant women infected with COVID-19 are more likely to experience elevated levels of anxiety, emphasizing the critical importance of addressing mental health among pregnant women. The insights from this study could provide valuable guidance for policymaking, underscoring the need for targeted interventions to manage mental health in pregnant women and mitigate the risk of adverse outcomes.

Risk perception increase due to COVID-19 impacted antenatal care utilization among women in an indigenous community

BACKGROUND

Risk perception varies greatly among individuals, affecting their behavior and decision-making in risky situations. The COVID-19 pandemic affected worldwide, but the role of risk perception related to COVID-19 in ethnic minorities in Mexico is unclear. This study quantifies the impact of COVID-related risk perception (susceptibility and severity) and perceived fear on the utilization of antenatal care services among indigenous women in San Cristobal de las Casas, Chiapas, Mexico.

METHODS

We conducted a retrospective crossover study between June and December 2021, interviewing 98 women from San Cristóbal de las Casas, Chiapas. In a crossover design, each subject acts as their own control, so we required the participants to have a previous pregnancy experience. A logistic model was used to calculate the odds ratio for the outcome of having an adequate number of antenatal care visits. The analysis considered the period (during or before the pandemic) as well as perceived severity and susceptibility levels as independent variables.

RESULTS

COVID-19 reduced antenatal care utilization by 50%. During the pandemic, the adjusted odds ratio for attending health antenatal care services was 0.83 (95% CI: 4.8, 14.5) compared to pre pandemics. Adjusted for fear of contagion, the mother's perception of severity was associated with an increased likelihood of an insufficient number of antenatal visits. OR = 0.25 (95% CI: 0.10, 0.65).

CONCLUSION

The risk perception for COVID-19 decreased the likelihood of receiving an adequate number of antenatal care visits.

COVID-19 related barriers to institutional childbirth during the early phase of the pandemic in rural Arsi zone, Ethiopia, 2022: A qualitative study

Introduction

Global, national, and local studies revealed that the COVID-19 pandemic has significantly reduced institutional childbirth. However, it is not well understood how the COVID-19 epidemic affected institutional childbirth service utilization. Therefore, this study aimed to evaluate COVID-19 related impediments to institutional childbirth service uptake during the early phase of the COVID-19 pandemic (March 20/2020-June 20/2020) in the rural Arsi zone of Ethiopia.

Methods

A community-based Phenomenological study was conducted from January 10-25/2022, among mothers who gave birth in the Arsi zone during the early phase of the COVID-19 epidemic (March 20/2020-June 20/2020) in Ethiopia. Data was collected by the primary author and a university graduated Midwives with experience in qualitative data collection. Eight focus group discussions and six in-depth interviews were conducted among mothers who gave birth in selected rural areas of the Arsi zone during the early phase of the COVID-19 pandemic. Nine key informant interviews were also conducted among Midwives, Maternity Ward Heads, and Community Health Extension Workers. Data was transcribed, translated, and analyzed thematically using Atlas Ti.7 version.

Results

Four major themes and eleven sub-themes emerged regarding the barriers to institutional childbirth during the early phase of COVID-19 pandemic. The COVID-19 related fear was a reason for avoiding institutional childbirth for almost all participants. COVID-19 restrictions such as transportation bans, market bans and public transport price doubling were also critical concerns to seeking institutional childbirth. Perceived Poor quality of institutional childbirth care during the curfew was also an impeding factor. Poor communication, incomplete care components and absenteeism were mentioned under this theme. Unbalanced mass media tragedies and rumors of unknown sources were COVID -19 related infodemics found affecting the practice of institutional childbirth.

Conclusions

COVID-19 related fears, COVID-19 restrictions, Perceived Poor quality of care during the COVID-19 pandemic and the COVID-19 Infodemic were the main reasons for reduced institutional childbirth service utilization during the early phase of the COVID-19 pandemic in Ethiopia. Therefore, strategies must be designed proactively to maintain essential maternal health services, particularly institutional childbirth, during pandemics like COVID-19 and similar future epidemics.

Impact of the COVID-19 pandemic on perinatal care and outcomes: A retrospective study in a tertiary hospital in Northern Ghana

BACKGROUND

Perinatal mortality remains a global challenge. This challenge may be worsened by the negative effects of the COVID-19 pandemic on maternal and child health.

OBJECTIVES

Examine the impact of the COVID-19 pandemic on perinatal care and outcomes in the Tamale Teaching Hospital in northern Ghana.

METHODS

A hospital-based retrospective study was conducted in the Tamale Teaching Hospital. We compared antenatal care attendance, total deliveries, cesarean sections, and perinatal mortality before the COVID-19 pandemic (March 1, 2019 to February 28, 2020) and during the COVID-19 pandemic (March 1, 2020 to February 28, 2021). Interrupted time series analyses was performed to evaluate the impact of the COVID-19 pandemic on perinatal care and outcomes at TTH.

RESULTS

A total number of 35,350 antenatal visits and 16,786 deliveries were registered at TTH from March 2019 to February 2021. Antenatal care, early neonatal death, and emergency cesarean section showed a rapid decline after the onset of the pandemic, with a progressive recovery over the following months. The total number of deliveries and fresh stillbirths showed a step change with a marked decrease during the pandemic, while the macerated stillbirths showed a pulse change, a temporary marked decrease with a quick recovery over time.

CONCLUSION

The COVID-19 pandemic had a negative impact on perinatal care and outcomes in our facility. Pregnancy monitoring through antenatal care should be encouraged and continued even as countries tackle the pandemic.

Pregnancy outcomes before and during COVID-19 pandemic in Tamale Metropolis, Ghana: A retrospective cohort study

BACKGROUND

The COVID-19 pandemic affected expectant mothers seeking maternal health services in most developing countries. Access and utilization of maternal health services including antenatal care (ANC) attendance and skilled delivery declined drastically resulting in adverse pregnancy outcomes. This study assessed pregnancy outcomes before and during COVID-19 pandemic in Tamale Metropolis, Ghana.

METHODS/DESIGN

A retrospective cohort study design was employed. A random sampling technique was used to select 450 women who delivered before or during the COVID-19 pandemic in Tamale Metropolis, Ghana. The respondents were interviewed using structured questionnaire at their homes. In this study, the data collected were socio-demographics characteristics, ANC attendance, before or during pandemic delivery, place of delivery and birth outcomes. Chi-square test and bivariate logistic regression analyses were performed under significant level of 0.05 to determine factors associated with the outcome variables.

RESULT

Of the 450 respondents, 51.8% were between 26 and 30 years of age. More than half (52.2%) of the respondents had no formal education and 93.3% were married. The majority (60.4%) of the respondents described their residence as urban setting. About 31.6% of the women delivered before the pandemic. The COVID-19 pandemic influenced place of delivery. The proportion of women who attended at least one ANC visit (84.5% before vs 70.5% during), and delivered at a hospital (76.8% before vs 72.4% during) were higher before the pandemic. More women were likely to deliver at home during COVID-19 (OR: 2.38, 95%CI: 1.52-3.74, p<0.001). Similarly, there was statistically significance difference between before and during COVID-19 delivery on at least one ANC attendance (OR: 2.72, 95%CI: 1.58-1.67, p<0.001). Women who delivered during COVID-19 were about twice more likely to develop complications (OR: 1.72, 95%CI: 1.03-2.87, p = 0.04).

CONCLUSION

ANC attendance and health facility delivery decreased while pregnancy complications increased during COVID-19. During disease outbreaks, outreach engagement strategies should be devised to increase access and utilization of maternal health services for marginalized and underserved populations. The capacity of health workers should be strengthened through skills training to manage adverse birth outcomes.

Exploring the interplay between food security and antenatal care utilization among pregnant women in Southern Ethiopia: Insights from an institution-based cross-sectional study

Background

Ensuring the satisfaction of pregnant women with antenatal care is crucial for positive pregnancy outcomes and their engagement with emerging technologies and alternative care models. Maintaining high satisfaction during the antenatal period significantly impacts the well-being of both the expectant mother and the unborn child. Despite the recognized importance of antenatal care satisfaction, comprehensive information on satisfaction levels and influencing factors in the specific study area is lacking. Therefore, this study aims to assess antenatal care service satisfaction and associated factors among pregnant women in Arba Minch town, southern Ethiopia.

Methods

We conducted an institution-based cross-sectional study among 418 pregnant women from December 2022 to January 30, 2023, using a systematic sampling method. Data were collected using the Kobo Toolbox and analyzed with SPSS Version 26. The threshold for statistical significance was set at a p-value of less than 0.05.

Results

Out of 418 participants, 54.3% (95% CI=49.4-60.4) expressed satisfaction with antenatal care services. Factors significantly associated with women's satisfaction included: being unable to read and write (AOR=2.37; 95% CI: 1.97-3.80), being aged 25-29 years (AOR=3.20; 95% CI: 1.65-6.22), receiving antenatal care at a hospital (AOR=1.81; 95% CI: 1.05-3.12), having a previous history of antenatal visits (AOR=2.59; 95% CI: 1.26-5.30), a monthly income of 2500-5000 ETB (AOR=1.44; 95% CI: 1.21-3.94), waiting times of less than 30 min (AOR=2.59; 95% CI: 1.52-4.41), maintaining a positive attitude towards antenatal care (AOR=2.50; 95% CI: 1.05-3.65), and having a secure food source (AOR=2.06; 95% CI: 1.13-3.78).

Conclusion

Over 54% of participants were satisfied with antenatal care services. To improve satisfaction levels, recommended strategies include enhancing healthcare infrastructure, establishing maternity waiting areas, reducing waiting times, and expanding services to remote areas.

The COVID-19 Pandemic's Impact on Health Service Utilization Among Pregnant Women in Three Nigerian States: A Mixed Methods Study

OBJECTIVE

COVID-19 disrupted health service delivery and weakened global and national health systems. The objective of this study was to describe the changes in health service utilization in three local government areas (LGAs) in Nigeria and examine factors involved.

METHODS

A cross-sectional mixed-methods approach was used. A total of 315 pregnant women seen for antenatal care in 80 health facilities in three LGAs between October 1 and November 30, 2020, participated in exit interviews; 93 women participated in focus group discussions (FGDs). Descriptive analyses and a multivariable logistic analysis were conducted to examine associations between characteristics and decreased service utilization. Content analysis was used to identify the emerging themes related to health service utilization during the pandemic.

RESULTS

One quarter of women reported that they reduced or ceased health service. The biggest reported changes were in immunization (47 to 30%, p < 0.001) and a small but statistically significant decline in antenatal care (98.7 to 93.8%, p < 0.001) was observed. Qualitative findings show that lockdowns, transportation issues, increased costs and fear of contracting COVID-19 or being labeled as COVID-positive were the most common reasons for not seeking care during this period of the pandemic.

CONCLUSIONS

The pandemic negatively impacted health service utilization amongst pregnant women in Nigeria. A better understanding of differences in state response could help inform future actions. The findings highlight the need for health systems to consider how to facilitate service utilization during a pandemic, such as providing safe transport or increasing outreach, and to minimize stigma for those seeking care.

Impact of the COVID-19 pandemic and policy response on access to and utilization of reproductive, maternal, child and adolescent health services in Kenya, Uganda and Zambia

Global health crises can negatively impact access to and utilisation of essential health services. Access to and utilisation of reproductive health services were already challenged in Sub-Saharan Africa with the COVID-19 pandemic further complicating the critical situation. This cross-sectional qualitative study aimed to assess the impact of the COVID-19 pandemic and policy responses to it on the access to, and utilization of reproductive, maternal, child and adolescent health services in Kenya, Uganda, and Zambia. It sought to explore the perspectives of women of reproductive age (18-49), frontline health workers and government representatives, all from geographies that are under-researched in this context. Using purposive sampling, key informant and in-depth interviews were carried out with 63 participants across the three countries between November 2020 and February 2021. The study population included women of reproductive age (18-49 years), front-line health service providers, and government representatives We established that COVID-19 and the policy response to it affected access to and utilization of services in the three countries, the most affected being antenatal care, delivery, family planning, and immunization services. Women reported not accessing the health facilities for various reasons. Barriers to access and utilization of services cut across all the socioecological levels. Movement restrictions, particularly in Uganda where they were most severe, and fear of contracting COVID-19 at health facilities were the most reported barriers. Weak structures at community level and inadequate supply of commodities in health facilities exacerbated the situation. Mitigation factors were put in place at different levels. There is need to strengthen the health system, particularly the supply chain and to have services closer to the community to enhance access to and utilisation of services at all times and particularly during crises such as the Covid-19 pandemic.

Antenatal care utilization on low birth weight children among women with high-risk births

Background

Low birth weight (LBW) is a major public health problem in Indonesia, and is a leading cause of neonatal mortality. Adequate antenatal care (ANC) utilization would help to prevent the incidence of LBW babies. This study aims to examine the association between ANC utilization and LBW children among women with high-risk birth criteria. High-risk birth criteria consisted of 4T which were too young (mother's age <20 years old), too old (mother's age >35 years old), too close (age gap between children <2 years), and too many (number of children >2 children).

Methods

This study utilized calendar data from the women's module from the 2017 Indonesia Demographic and Health Survey (IDHS), with the unit of analysis only the last birth of women of childbearing age (15-49), which numbered 16,627 women. From this number, analysis was done by separating the criteria for women with high-risk birth. Multivariate logistic regression analyses were employed to assess the impact of ANC and socio-demographic factors on LBW among women with high-risk birth criteria.

Results

This study revealed that only among women with too many children criteria (>2 children), adequate ANC utilization was significantly associated with LBW of children, even after controlling for a range of socio-demographic factors (p < 0.05). In all four women criteria, preterm birth was more likely to have LBW than those infants who were born normally (above and equal to 2500 grams) (p < 0.001).

Conclusions

According to WHO, qualified ANC standards have not been fully implemented, including in the case of ANC visits of at least eight times, and it is hoped that ANC with health workers at health facilities can be increased. There is also a need for increased monitoring of pregnant women with a high risk of 4T to keep doing ANC visits to reduce LBW births.

The impact of COVID-19 and national pandemic responses on health service utilisation in seven low- and middle-income countries

BACKGROUND

The COVID-19 pandemic has disrupted health services worldwide, which may have led to increased mortality and secondary disease outbreaks. Disruptions vary by patient population, geographic area, and service. While many reasons have been put forward to explain disruptions, few studies have empirically investigated their causes.

OBJECTIVE

We quantify disruptions to outpatient services, facility-based deliveries, and family planning in seven low- and middle-income countries during the COVID-19 pandemic and quantify relationships between disruptions and the intensity of national pandemic responses.

METHODS

We leveraged routine data from 104 Partners In Health-supported facilities from January 2016 to December 2021. We first quantified COVID-19-related disruptions in each country by month using negative binomial time series models. We then modelled the relationship between disruptions and the intensity of national pandemic responses, as measured by the stringency index from the Oxford COVID-19 Government Response Tracker.

RESULTS

For all the studied countries, we observed at least one month with a significant decline in outpatient visits during the COVID-19 pandemic. We also observed significant cumulative drops in outpatient visits across all months in Lesotho, Liberia, Malawi, Rwanda, and Sierra Leone. A significant cumulative decrease in facility-based deliveries was observed in Haiti, Lesotho, Mexico, and Sierra Leone. No country had significant cumulative drops in family planning visits. For a 10-unit increase in the average monthly stringency index, the proportion deviation in monthly facility outpatient visits compared to expected fell by 3.9% (95% CI: -5.1%, -1.6%). No relationship between stringency of pandemic responses and utilisation was observed for facility-based deliveries or family planning.

CONCLUSIONS

Context-specific strategies show the ability of health systems to sustain essential health services during the pandemic. The link between pandemic responses and healthcare utilisation can inform purposeful strategies to ensure communities have access to care and provide lessons for promoting the utilisation of health services elsewhere.

Measuring supply-side service disruption: a systematic review of the methods for measuring disruption in the context of maternal and newborn health services in low and middle-income settings

OBJECTIVES

During the COVID-19 pandemic, most essential services experienced some level of disruption. Disruption in LMICs was more severe than in HICs. Early reports suggested that services for maternal and newborn health were disproportionately affected, raising concerns about health equity. Most disruption indicators measure demand-side disruption, or they conflate demand-side and supply-side disruption. There is currently no published guidance on measuring supply-side disruption. The primary objective of this review was to identify methods and approaches used to measure supply-side service disruptions to maternal and newborn health services in the context of COVID-19.

DESIGN

We carried out a systematic review and have created a typology of measurement methods and approaches using narrative synthesis.

DATA SOURCES

We searched MEDLINE, EMBASE and Global Health in January 2023. We also searched the grey literature.

ELIGIBILITY CRITERIA

We included empirical studies describing the measurement of supply-side service disruption of maternal and newborn health services in LMICs in the context of COVID-19.

DATA EXTRACTION AND SYNTHESIS

We extracted the aim, method(s), setting, and study outcome(s) from included studies. We synthesised findings by type of measure (ie, provision or quality of services) and methodological approach (ie, qualitative or quantitative).

RESULTS

We identified 28 studies describing 5 approaches to measuring supply-side disruption: (1) cross-sectional surveys of the nature and experience of supply-side disruption, (2) surveys to measure temporal changes in service provision or quality, (3) surveys to create composite disruption scores, (4) surveys of service users to measure receipt of services, and (5) clinical observation of the provision and quality of services.

CONCLUSION

Our review identified methods and approaches for measuring supply-side service disruption of maternal and newborn health services. These indicators provide important information about the causes and extent of supply-side disruption and provide a useful starting point for developing specific guidance on the measurement of service disruption in LMICs.

Antenatal care booked rural residence women have home delivery during the era of COVID-19 pandemic in Gidan District, Ethiopia

BACKGROUND

World Health Organization (WHO) recommends that every pregnant woman receive quality care throughout pregnancy, childbirth, and the postnatal period. It is estimated that institutional delivery could reduce 16% to 33% of maternal deaths. Despite the importance of giving birth at a health institution, in Ethiopia, according to the Ethiopian Demographic Health Survey report, nearly half of the ANC-booked mothers gave birth at home. Therefore, this study aimed to determine the prevalence and associated factors of home delivery among antenatal care-booked women in their last pregnancy during the era of COVID-19.

METHODS

A community-based cross-sectional study was conducted from March 30 to April 29, 2021. A simple random technique was employed to select 770 participants among women booked for antenatal care. Interviewer-administered questionnaires were used to collect the data. A binary logistic regression model was fitted. Adjusted odds ratios with its respective 95% confidence interval were used to declare the associated factors.

RESULTS

The prevalence of home delivery was 28.8% (95% CI: 25.7, 32.2). Rural residence (AOR = 2.02, 95% CI: 1.23, 3.34), unmarried women (AOR = 11.16, 95% CI: 4.18, 29.79), husband education (AOR = 2.60, 95% CI: 1.72, 3.91), not being involved in the women's development army (AOR = 1.64, 95% CI: 1.01, 2.65), and fear of COVID-19 infection (AOR = 3.86, 95% CI: 2.31, 6.44) were significantly associated factors of home delivery.

CONCLUSION

Even though the government tried to lower the rate of home delivery by accessing health institutions in remote areas, implementing a women's development army, and introducing maternal waiting home utilization, nearly one in every three pregnant women gave birth at home among ANC booked women in their last pregnancy. Thus, improving the husband's educational status, providing information related to health institution delivery benefits during antenatal care, and strengthening the implementation of the women's development army, particularly among rural and unmarried women, would decrease home childbirth practices.

Accessibility and utilization of antenatal care services in sub-Saharan Africa during the COVID-19 pandemic: A rapid review

Control measures for the COVID-19 pandemic brought unprecedented challenges to health care delivery. Some countries in sub-Saharan Africa (SSA) stopped the provision of essential health care except for those services that were deemed emergencies or life-threatening. A rapid review was conducted on March 18, 2022, on the accessibility and utilization of antenatal care services in sub-Saharan Africa during the COVID-19 pandemic. PubMed, Google Scholar, SCOPUS, and the World Health Organization library databases were searched for relevant studies. A modified Population, Intervention, Control, and Outcomes (PICO) framework informed the development of the search strategy. The review included studies conducted within Africa that described the availability, access, and utilization of antenatal services during the COVID-19 pandemic. Eighteen studies met the inclusion criteria. This review revealed a reduction in access to ANC services, an increase in the number of home deliveries, and a reduction in the number of women attending ANC visits during the COVID-19 pandemic. A decrease in ANC service utilization was reported in some studies in the review. Barriers to ANC access and utilization during the COVID-19 pandemic included movement restrictions, limited transport access, fear of contracting COVID-19 at the health facilities, and facility barriers. The use of telemedicine needs to be improved in African countries to allow for the continued provision of health services during pandemics. In addition, there should strengthening of community involvement in the provision of maternal health services post-COVID-19 so that services may be able to better withstand future public health emergencies.

Utilisation of ANC services before and after the COVID-19 pandemic in selected resource-poor blocks of India: role of community health workers in Swabhimaan programme area

INTRODUCTION

COVID-19 has disrupted maternal and child health services. Community Health Workers (CHWs) supported the women by visiting pregnant women's homes and providing the MCH services as required. This study attempts to understand the role of CHW and its impact on the Ante-Natal Care (ANC) services pre-pandemic and post-Pandemic in the poor resource setting.

METHODS

The Swabhimaan programme interventions were carried out in the selected blocks in the Indian States of Bihar, Odisha and Chhattisgarh with the objective to improve the nutritional status of mothers, pregnant women and adolescents living in resource-poor blocks of three selected states during 2016-2022. Cross-sectional surveys, namely pre-pandemic (2018-19) and post-pandemic (2021-22) of pregnant and mothers of under two children, utilised to fulfil the objectives of this study. These surveys are part of Swabhimaan evaluation, a community-based non-randomised controlled study.

RESULTS

The ANC services received by women have increased over time from 2015 to 2022. Our findings confirm that the ground-level community and health systems were active during the pandemic, and the results show significant improvement. Additionally, the women supported by the CHW have substantially improved pregnancy registration, first ANC, Tetanus injection, consumption of Iron Folic Acid, Calcium and deworming tablets than those who did not. Propesnsity Score Matching analysis shows that the average treatment effect on the various ANC services of having the support of CHW is significant.

CONCLUSION

This study shows the vital role of CHWs in utilising various Maternal and Child Health services. Better linkage and networking of the CHWs with the community will ensure health service delivery regularly and in an emergency like a pandemic and develop resilience.

Self-reported delays in care-seeking in West Africa during the first wave of the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic caused delays in care-seeking due to fears of infection and decreased healthcare access globally. These delays have been linked in some countries to COVID-19 perceptions, decreased income, and food insecurity, but little is known about patient-level factors for decreased care-seeking specifically at the beginning of COVID-19 in West Africa. Understanding these factors is important to identify those at highest risk and address healthcare-related barriers.

METHODS

This study used self-reported data from telephone surveys in a population-based sample in Burkina Faso (n = 1352), Ghana (n = 1621), and Sierra Leone (n = 1301) in May-June 2020. Questions assessed delays in care-seeking, sociodemographic variables, COVID-19 beliefs, and food insecurity. Bivariate analyses using chi-square and multivariate analyses using logistic regression were used to explore associations between factors and delays in care-seeking by country. Independent variables were chosen based on prior research suggesting that financial insecurity, older age, female sex, rural location, and COVID-related concerns are associated with delays.

RESULTS

Between March-June 2020, 9.9%, 10.6%, and 5.7% of participants in Burkina Faso, Ghana, and Sierra Leone, respectively, delayed care-seeking. Food insecurity was prevalent (21.8-46.1%) and in bivariate analyses was associated with delays in care-seeking in Burkina Faso and Ghana. Concern about risk of household contraction of COVID-19 was common (18.1-36.0%) and in Ghana and Sierra Leone was associated with delays in care-seeking in both bivariate and multivariate analyses. In bivariate analyses, females showed more delays in Burkina Faso, while age above 30 and urban location were associated with delays in Ghana. In multivariate analyses, food insecurity was associated with increased delayed care-seeking in Burkina Faso.

CONCLUSIONS

Multiple factors were associated with delays in care-seeking early in the COVID-19 pandemic, with food insecurity and concerns about infection showing significant associations in multiple countries. These findings highlight the need to invest in clinic accessibility, community education, and financial assistance to address barriers in healthcare. While many delays have subsided since the initial phase of the COVID-19 pandemic, understanding factors associated with early disruptions of care-seeking at the patient and household level will inform strategies for maintaining healthcare access during future pandemics in West Africa.

COVID-19 impacts on healthcare access in sub-Saharan Africa: an overview

This overview aimed to describe the situation of healthcare access in sub-Saharan Africa, excluding South Africa, during the COVID-19 pandemic. A PubMed^® search from March 31, 2020, to August 15, 2022, selected 116 articles. Healthcare access and consequences of COVID-19 were assessed based on comparisons with months before its onset or an identical season in previous years. A general reduction of healthcare delivery, associated with the decline of care quality, and closure of many specialty services were reported. The impact was heterogeneous in space and time, with an increase in urban areas at the beginning of the pandemic (March-June 2020). The return to normalcy was gradual from the 3^rd quarter of 2020 until the end of 2021. The impact of COVID-19 on the health system and its use was attributed to (a) conjunctural factors resulting from government actions to mitigate the spread of the epidemic (containment, transportation restrictions, closures of businesses, and places of entertainment or worship); (b) structural factors related to the disruption of public and private facilities and institutions, in particular, the health system; and (c) individual factors linked to the increase in costs, impoverishment of the population, and fear of contamination or stigmatization, which discouraged patients from going to health centers. They have caused considerable socio-economic damage. Several studies emphasized some adaptability of the healthcare offer and resilience of the healthcare system, despite its unpreparedness, which explained a return to normal activities as early as 2022 while the COVID-19 epidemic persisted. There appears to be a strong disproportion between the moderate incidence and severity of COVID-19 in sub-Saharan Africa, and the dramatic impact on healthcare access. Several articles make recommendations for lowering the socioeconomic consequences of future epidemics to ensure better management of health issues.

Access to Maternal and Child Health Services during the COVID-19 Pandemic: An Explorative Qualitative Study in Odisha, India

Background

Maternal and child health (MCH) care is one of the essential routine healthcare services, which got affected during the coronavirus disease 2019 (COVID-19) pandemic. Modeled projections had anticipated an 8.3%-38.6% rise in maternal mortality from different countries globally. In view of limited studies pertaining to issues related to accessing MCH services in the event of a pandemic, this study was carried out on pregnant and postnatal mothers in Odisha, India.

Methods

An explorative qualitative study through 36 in-depth interviews (IDIs) was conducted among 16 (44.4%) antenatal and 20 (55.5%) postnatal mothers in six of thirty districts of Odisha, India, from February to April 2021. The districts and blocks were randomly selected for better representativeness. The IDIs were conducted using a predesigned and pretested guide among mothers who had undergone delivery or availed of antenatal, postnatal, or child health services from October 2020 to April 2021. The IDIs were conducted till data saturation. The data were analyzed using MAXQDA software.

Results

The average age of mothers was 27.6 (+/- 2.2) years. Among the participants, 16 (44.4%) were antenatal and 20 (55.6%) were postnatal mothers; 19 (52.8%) were primipara and 17 (47.2%) were multipara. The majority explained that they received enormous support including door-to-door services from the community health workers (CHWs) even during the difficult times of the pandemic. Reduced transportation facility and fear of contracting the infection were reasons behind the unwillingness to visit health facilities and preference for home delivery. Furthermore, the pandemic had physical, mental, social, and financial impacts among pregnant and postnatal women.

Conclusion

The unprecedented COVID-19 pandemic has affected access to MCH services by antenatal and postnatal mothers. Health system preparedness and appropriate strategies including better community engagement and participation could avert such challenges in the future.

Assessing the Quality of Antenatal Care in King Abdulaziz University Hospital: A Retrospective Study

BACKGROUND

Antenatal care is vital for pregnant women and fetuses. However, the coronavirus disease 2019 (COVID-19) pandemic has hindered access to care worldwide, resulting in missed appointments. Therefore, assessing the quality of antenatal care during the pandemic is crucial. This study evaluated the care provided at King Abdulaziz University Hospital in Saudi Arabia and suggested areas for improvement.

METHODS

This retrospective medical records review involved 400 pregnant patients who received antenatal care at King Abdulaziz University Hospital in the past two years. A checklist was used to collect patient data, including demographics, antenatal care visits, ultrasounds, gestational age at first visit and ultrasound, prior cesarean section and preterm delivery, and virtual clinic attendance during the COVID-19 pandemic. Statistical analyses were performed using SPSS version 25 (Armonk, NY: IBM Corp.).

RESULTS

The sample had a mean age of 30±6 years, and most participants (87.8%) were Saudi women. Over half of the participants did not attend any antenatal follow-up visits, and the majority had only one ultrasound. Only a small proportion of mothers attended virtual clinics during the pandemic. Having a prior cesarean section and a parity of 1-3 were positively associated with ultrasound attendance, while prior preterm delivery was positively associated with antenatal visits and virtual clinic attendance.

CONCLUSION

This study highlighted the importance of improving antenatal care quality at King Abdulaziz University Hospital, especially during COVID-19. To achieve this, strategies such as increasing visits, ultrasound attendance, and virtual clinic access should be considered. By implementing these recommendations, the hospital can enhance care and promote maternal and fetal health.

An investigation of factors affecting the utilization of antenatal care services among women in post-natal wards in two Namibian hospitals in the Khomas region

Background

Antenatal care (ANC) services are the care provided by skilled healthcare professionals to pregnant women to ensure the best health for both mother and baby during pregnancy and after delivery. In Namibia, utilization of antenatal care services has been reported to be dropping from 97% in 2013 to 91% in 2016.

Objectives

The objectives of this study were to investigate the factors affecting the utilization of ANC services.

Methods

A quantitative approach and a cross-sectional analytical design were used to carry out the study. The study population was all mothers who delivered and were admitted to the postnatal ward of Intermediate Hospital Katutura and Windhoek Central Hospital during the time of the study. Data were collected from 320 participants using self-administered structured questionnaires. The data were analyzed using the Statistical Package for Social Science (SPSS) Version 25 software.

Results

Participants were aged between 16 and 42 years with a mean age of 27 years. The results show that 229 (71.6%) utilized ANC while 91(28.4%) did not utilize ANC services. Factors such as the negative attitude of health care workers, long distance to and from health facilities, lack of transport money to travel to and from the health facilities, lack of knowledge regarding antenatal care, attitude towards pregnancy, and others, were found as hindrances to the utilization of antenatal care services. Participants also indicated motivators for ANC utilization such as preventing complications, knowing their HIV status, getting health education, knowing the estimated date of delivery, and identifying and treatment of medical conditions. The study reveals the higher knowledge of participants on ANC utilization, most participants have the right to make decisions and had positive attitudes toward the quality of ANC services. The level of attitude toward pregnancy was associated with the utilization of antenatal care services with an odd ratio OR=2.132; and P=0.014.

Conclusions

The study identified factors that affect utilization of ANC services such as age, marital status, mother's education, partner's formal education, negative attitude toward health providers, long distance to and from ANC health care facilities, fear of HIV test and results, Covid-19 regulations, inability to determine the pregnancy at the earlier stages and financial constraints Based on this study findings, it is recommended that the utilization of ANC might be improved through effective community mobilization and outreach maternity services to educate and improve awareness on the importance of ANC.

Uptake of prevention of mother-to-child transmission cascade services in Burkina Faso between 2013 and 2020: are we on the right track?

BACKGROUND

The use of services to prevent mother-to-child transmission (PMTCT) of the human immunodeficiency virus (HIV) remains a serious challenge in sub-Saharan Africa. In the last decade, Burkina Faso has implemented numerous policies to increase the use of PMTCT services by pregnant women and their partners, as well as children. This study assesses trends in the uptake of PMTCT services in Burkina Faso from 2013 to 2020 in order to study the progress and gaps in achieving the national and international targets set for 2020.

METHODS

A repeated cross-sectional analysis was performed using data extracted from district health information software version 2. Percentages were computed for each PMTCT indicator and comparisons between the years were made using a chi-square test for trends with a significance threshold of 5%. Regions were not compared with each other.

RESULTS

The proportion of pregnant women who were tested and received their results significantly increased from 47.9% in 2013 to 84.6% in 2020 (p value < 0.001). Of the 13 regions in the country, only 1 region met the 95% national targets whereas, 6 regions met the 90% international targets for this indicator. The proportions of HIV-positive women receiving antiretroviral therapy (ART) increased from 90.8% in 2013 to 100% in 2020. In the same period, the proportion of exposed infants who received antiretroviral prophylaxis increased from 64.3% in 2013 to 86.8% in 2020. Only 3 regions reached the national and international targets for this indicator. A positive trend was also observed for the indicator related to screening at 2 months or later of exposed infants using Polymerase Chain Reaction (PCR) technic; with the rate rising from 7.4% in 2013 to 75.7% in 2020. However, for this indicator, the national and international targets were not achieved considering the national and regional settings. Concerning the women's partners, the proportion of those who tested for HIV increased from 0.9% in 2013 to 4.5% in 2020, with only 1 region that fully met the national target of 10% in 2020. The prevalence of HIV in this particular group was 0.5% in 2020.

CONCLUSIONS

PMTCT indicators show an increase from 2013 to 2020 but with a strong disparity between regions. National and international targets have not been achieved for any indicator; except for those related to women receiving ART. Strengthening strategies to effectively engage women and their partners on the use of PMTCT cascade services could help reduce mother-to-child transmission in Burkina Faso.

Exploring the antenatal care challenges faced during the COVID-19 pandemic in rural areas of Indonesia: a qualitative study

INTRODUCTION

The COVID-19 pandemic affected almost all healthcare services in Indonesia, including antenatal care (ANC). Pregnant women were a vulnerable group during the pandemic since the Indonesian government's policies at the time influenced the delivery of ANC services, particularly in rural areas. Investigating the ANC challenges faced during the pandemic from the perspectives of pregnant women and healthcare providers is important for our understanding of ANC provision. This study, therefore explores barriers to ANC appointments faced during the COVID-19 pandemic in rural areas of Indonesia from the perspectives of pregnant women and health care providers.

METHODS

This was a qualitative exploratory descriptive study involving 31 participants, consisting of 25 pregnant women and six healthcare providers who were selected via a purposive sampling method. Thadeus and Maine's Three Delays Model was used as the theoretical framework. Data were collected between March and August 2021, through two focus group discussions (FGDs), ten in-depth interviews, and field notes. Data were analyzed using a thematic analysis method.

RESULTS

Three themes describing barriers to ANC during the COVID-19 pandemic in rural areas of Indonesia emerged from this study. Those themes were: (1) The fear of being infected with COVID-19, related to anxiety, perceived vulnerability, and the desire to protect oneself and loved ones; (2) The stay-at-home policy, related to transport barriers and restricted social activity; and (3) Re-designed ANC services, related to ANC adjustments, high-risk pregnancies, insufficient information, and adherence to COVID-19 preventive behaviors.

CONCLUSION

Based on the Three Delays Model, several challenges to carrying out ANC during the COVID-19 pandemic in rural areas of Indonesia were identified. These findings demonstrate the need to formulate and implement ANC packages to facilitate pregnant women's access to health care services.

Impact of COVID-19 pandemic on utilization of essential maternal healthcare services in Ethiopia: A systematic review and meta-analysis

BACKGROUND

The COVID-19 pandemic has a significant challenge for countries to maintain the provision of essential maternity services. Many women could experience difficulties in accessing maternal healthcare due to transport problems, anxiety, and fear of infection. A reduction in the utilization of maternity services has been suggested as a possible cause of worsened maternal health outcomes. Thus, this study aimed to determine the impact of the COVID-19 pandemic on the utilization of maternal healthcare services in Ethiopia.

METHODS

Searching of articles was conducted from PubMed, Science Direct, Cochrane Library, Web of Science, Scopus, and Google scholar. The quality of studies was evaluated using the Newcastle-Ottawa scale. Inspection of the Funnel plot and Egger's test were used to evaluate the evidence of publication bias. Heterogeneity was evaluated using Cochran's Q statistic and quantified by I2. A random-effects model was used to determine pooled estimates using STATA 14.

RESULTS

After reviewing 41,188 articles, 21 studies were included in this systematic review and meta-analysis. The pooled reduction was 26.62% (95% CI: 13.86, 39.37) for family planning, 19.30% (95% CI: 15.85, 22.76) for antenatal care, 12.82% (95% CI: 7.29, 18.34) for institutional delivery, 17.82% (95% CI: 8.32, 27.32) for postnatal care, and 19.39% (95% CI: 11.29, 27.49) for abortion care. This study also demonstrated that maternal perception of poor quality of care and fear of infection, lack of transport, cultural events, diversion of resources, lack of essential drugs, and lack of personal protective equipment and sanitizer were identified as the main challenges faced during the pandemic.

CONCLUSION

This study revealed that the utilization of maternal healthcare services in Ethiopia significantly decreased during the COVID-19 pandemic. Government measures, health facility-related barriers, and maternal-related factors were identified as challenges faced during the pandemic. Thus, service providers, policy-makers, and other relevant stakeholders should prioritize maternity care as an essential core healthcare service. Besides, increasing awareness of women through mass media, and making maternity services more accessible and equitable would likely increase the utilization of maternal healthcare services.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021293681.

[Impact of COVID-19 on public health in sub-Saharan Africa]

Objective

This work aimed to assess the impact of COVID-19 on healthcare supply in sub-Saharan Africa except South Africa.

Method

A search through PubMed® between April 2020 and August 2022 selected 135 articles. The impact of COVID-19 was assessed on comparisons with the months prior to the onset of COVID-19 or an identical season in previous years.

Results

The decline of health services, associated with a reduction in their quality, and the closure of specialized health units have been reported. Many control programs and public health interventions have been interrupted, with the risk of an increase of the corresponding diseases. Social disorganization has generated mental health issues among the population, including health personnel. The impact was heterogeneous in space and time. The main causes were attributed to containment measures (transport restrictions, trade closures) and the lack of human and material resources. The increase in costs, in addition to the impoverishment of the population, and the fear of being contaminated or stigmatized have discouraged patients from going to health centres. The studies mention the gradual return to normal after the first epidemic wave and the resilience of the healthcare system.

Conclusion

Several articles make recommendations aimed at reducing the impact of future epidemics: support for community workers, training of health workers and reorganization of services to improve the reception and care of patients, technological innovations (use of telephones, drones, etc.) and better information monitoring.

Determinants of maternal satisfaction with focused antenatal care services rendered at public health facilities in the West Shewa Zone, Central Ethiopia: A multicentre cross-sectional study

Background

Every woman has the right to receive quality care during pregnancy. It is proven that antenatal care (ANC) reduces maternal and perinatal morbidity and mortality. The government of Ethiopia is also making intense efforts to increase the coverage of ANC. However, among pregnant women, the levels of satisfaction with the care provided are overlooked, as the percentage of women who complete all ANC visits is below 50. Therefore, this study aims to assess maternal satisfaction with ANC services rendered at public health facilities in the West Shewa Zone, Ethiopia.

Methods

A facility-based cross-sectional study was conducted among women who were receiving ANC in public health facilities in Central Ethiopia between September 1 and October 15, 2021. A total of 411 women were selected using the systematic random sampling method. The questionnaire was pretested and the data were collected electronically using CSEntry. The collected data were exported to SPSS version 26. The characteristics of the study participants were described using frequency and percentage. Bivariate and multivariate logistic regression were used to identify the factors associated with maternal satisfaction with focused ANC service.

Result

This study revealed that 46.7% [95% confidence interval (CI) (41.7%-51.6%)] of women were satisfied with ANC service. Factors such as the quality of the health institution [adjusted odd ratio (AOR) = 5.10, (95% CI: 3.33-7.75)], place of residence [AOR = 2.38, (95% CI: 1.21-4.70)], history of abortion [AOR = 0.19, (95% CI: 0.07-0.49)], and previous mode of delivery [AOR = 0.30, (95% CI: 0.15-0.60)] were significantly associated with women's satisfaction with focused ANC service.

Conclusion

More than half of pregnant women who received ANC were dissatisfied with the service they received. This should be a cause for concern, as the level of satisfaction is lower than that of the findings of previous studies conducted in Ethiopia. Institutional variables, interactions with patients, and previous experiences of pregnant women have an impact on the level of satisfaction. Due attention should be paid to primary health and communication of health professionals with pregnant women to improve the levels of satisfaction with focused ANC service.

Prevalence and risk predictors of childhood stunting in Bangladesh

BACKGROUND

The child nutritional status of a country is a potential indicator of socioeconomic development. Child malnutrition is still the leading cause of severe health and welfare problems across Bangladesh. The most prevalent form of child malnutrition, stunting, is a serious public health issue in many low and middle-income countries. This study aimed to investigate the heterogeneous effect of some child, maternal, household, and health-related predictors, along with the quantiles of the conditional distribution of Z-score for height-for-age (HAZ) of under five children in Bangladesh.

METHODS AND MATERIALS

In this study, a sample of 8,321 children under five years of age was studied from BDHS-2017-18. The chi-square test was mainly used to identify the significant predictors of the HAZ score and sequential quantile regression was used to estimate the heterogeneous effect of the significant predictors at different quantiles of the conditional HAZ distribution.

RESULTS

The findings revealed that female children were significantly shorter than their male counterparts except at the 75th quantile. It was also discovered that children aged 7-47 months were disadvantaged, but children aged 48-59 months were advantaged in terms of height over children aged 6 months or younger. Moreover, children with a higher birth order had significantly lower HAZ scores than 1st birth order children. In addition, home delivery, the duration of breastfeeding, and the BCG vaccine and vitamin A received status were found to have varied significant negative associations with the HAZ score. As well, seven or fewer antenatal care visits was negatively associated with the HAZ score, but more than seven antenatal care visits was positively associated with the HAZ score. Additionally, children who lived in urban areas and whose mothers were over 18 years and either normal weight or overweight had a significant height advantage. Furthermore, parental secondary or higher education had a significant positive but varied effect across the conditional HAZ distribution, except for the mother's education, at the 50th quantile. Children from wealthier families were also around 0.30 standard deviations (SD) taller than those from the poorest families. Religion also had a significant relationship with the conditional HAZ distribution in favor of non-Muslim children.

CONCLUSIONS

To enhance children's nutritional levels, intervention measures should be designed considering the estimated heterogeneous effect of the risk factors. This would accelerate the progress towards achieving the targets of Sustainable Development Goals (SDGs) related to child and maternal health in Bangladesh by 2030.

Fear of COVID-19 and poor accessibility of comprehensive care has caused delay in initiation of antenatal care among pregnant women in Southwest Ethiopia: the need for disaster resilient and accessible maternal health care

Background

Antenatal care (ANC) is care provided to pregnant women in order to ensure positive health outcomes for both mother and baby. Late ANC contact lacks the opportunity to provide interventions that are effective early in the pregnancy. A huge proportion of pregnant women present late. The aim of this study was to identify determinants of late enrollment in the ANC among pregnant women in public health centers in Ilu Ababor Zone, South-West Ethiopia.

Design and methods

A facility-based case-control study was conducted on 270 randomly selected pregnant women (135 cases and 135 controls). A pretested interviewer-administered questionnaire was used to collect data. Multi-variable logistic regression was run to identify the determinants of late ANC initiation. The adjusted odds ratio (AOR) and its 95% confidence interval (CI) were used to determine statistical significance at a P-value of 0.05.

Result

A total of 270 pregnant women were interviewed, making a response rate of 97%. Unplanned pregnancy [AOR: 2.8; 95% CI: (1.3, 6.0)], lack of information on time of ANC initiation [AOR: 2.7; 95% CI:(1.02, 5.0)], older age [AOR: 2.2; 95% CI:(1.01, 4.7)], not attending ANC in the previous pregnancy [AOR: 4.07; 95% CI: (1.8, 9.5)], and fear of COVID-19 were determinants of late initiation of ANC in the study area.

Conclusion

Age, pregnancy and care-related factors, and fear of COVID-19 were determinants of late initiation of ANC. Community-based provision of comprehensive information on planned pregnancy and the ANC is important. A resilient system has to be built to deliver essential health services during emergencies like COVID-19.

An integrative literature review on the impact of COVID-19 on maternal and child health in Africa

Africa has the highest rates of maternal deaths globally which have been linked to poorly functioning health care systems. The pandemic revealed already known weaknesses in the health systems in Africa, such as workforce shortages, lack of equipment and resources. The aim of this paper is to review the published literature on the impact of the COVID-19 pandemic on maternal and child health in Africa. The integrative review process delineated by Whittemore and Knafl (2005) was used to meet the study aims. The literature search of Ovid Medline, CINAHL, PubMed, WHO, Google and Google scholar, Africa journals online, MIDIRS was limited to publications between March 2020 and May 2022. All the studies went through the PRISMA stages, and 179 full text papers screened for eligibility, 36 papers met inclusion criteria. Of the studies, 6 were qualitative, 25 quantitative studies, and 5 mixed methods. Thematic analysis according to the methods of Braun and Clark (2006) were used to synthesize the data. From the search the six themes that emerged include: effects of lockdown measures, COVID concerns and psychological stress, reduced attendance at antenatal care, childhood vaccination, reduced facility-based births, and increase maternal and child mortality. A review of the literature revealed the following policy issues: The need for government to develop robust response mechanism to public health emergencies that negatively affect maternal and child health issues and devise health policies to mitigate negative effects of lockdown. In times of pandemic there is need to maintain special access for both antenatal care and child delivery services and limit a shift to use of untrained birth attendants to reduce maternal and neonatal deaths. These could be achieved by soliciting investments from various sectors to provide high-quality care that ensures sustainability to all layers of the population.

Analysis of Causes of Maternal Death in East Java Province, Indonesia

BACKGROUND: The maternal mortality rate is an indicator that reflects the mother’s health status, especially the risk of death for the mother during pregnancy and childbirth. Measles, Mumps, and Rubella (MMR) has a close relationship with efforts to increase human development. Therefore, efforts are needed to reduce MMR by identifying the factors that influence MMR. AIM: The aim of the study was to analyze the factors causing the incidence of Maternal Death in East Java Province. METHODS: The research design used in this research is a quantitative research using descriptive-analytical. The population of this research is districts/cities in East Java Province, with a sample of 38 districts/cities. The research period starts from August to September 2021. Data analysis using grouping and percentage of cases. RESULTS: The results of the study found that cases of maternal death in East Java due to postpartum hemorrhage in 2021 were 131 cases. Cases due to hypertension as many as 115 cases. Cases due to infection as many as 25 cases. The incidence of maternal death due to abortion is 1 case. There were 13 cases of maternal death due to blood disorders. There were 6 cases of maternal death due to metabolic disorders — cases of maternal death due to Heart as many as 54 cases. Maternal deaths due to COVID-19 were 793 cases. CONCLUSION: Factors causing maternal death in East Java Province, namely, hypertension bleeding, infection, abortion, blood disorders, heart metabolic disorders, and COVID-19. The most influential factor in maternal mortality in 2021 is COVID-19.

Factors Influencing the Antenatal Care Attendance of Pregnant Women During the First COVID-19 Wave Lockdown in Thailand

Background

The coronavirus disease 2019 (COVID-19) outbreak impacted healthcare service management worldwide. Thailand had limited healthcare resources. During the pandemic, several medical supplies were in high demand and expensive. The Thai government needed to declare a lockdown to reduce the unnecessary use of medical supplies. Antenatal care (ANC) services have adapted to the outbreak situation. However, information about the potential impact of COVID-19 lockdown on pregnant women and the reduction of disease exposure risk in this population remains unclear. Thus, this study aimed to assess the percentage of ANC attendance and factors affecting the scheduled ANC attendance of pregnant women during the first COVID-19 wave lockdown in Thailand.

Methods

This retrospective cross-sectional study included Thai women who were pregnant between 1 March and 31 May 2020. An online survey was conducted among pregnant women who had first ever ANC attendance before 1 March 2020. A total of 266 completed responses were returned and analysed. Statistically, the sample size was representative of the population. The predictors of scheduled ANC attendance during the lockdown were identified through logistic regression analysis.

Results

Overall, 223 (83.8%) pregnant women had scheduled ANC attendance during the lockdown. The predictive factors of ANC attendance were non-relocation (adjusted odds ratio [AOR] = 2.91, 95% confidence interval [CI]: 1.009-8.381) and access to health services (AOR = 2.234, 95% CI: 1.125-4.436).

Conclusion

During the lockdown, ANC attendance slightly declined, and the extended duration of each ANC or reduced face-to-face interactions with healthcare professionals. For pregnant women with non-relocation, healthcare providers must provide opportunities to contact them directly if they had doubts. The limited number of pregnant women who access health services allowed the clinic to be less crowded and therefore easy to ANC attendance.

Antenatal care utilization during the COVID-19 pandemic: an online cross-sectional survey among Filipino women

BACKGROUND

The COVID-19 pandemic resulted in unprecedented challenges to healthcare systems worldwide, including interruption of antenatal care services. The study aimed to determine the utilization of antenatal care services of Filipino women during the COVID-19 pandemic.

METHODS

A cross-sectional study was conducted among postpartum women using an online self-administered survey in the Philippines from January 1 to March 31, 2022. The questionnaire used to assess health-seeking behavior was validated before the survey proper. Women aged 18 to 45 years who delivered in 2021 were recruited. The participants answered a structured questionnaire to assess their access, perceptions, and utilization of antenatal care. Utilization of antenatal care was evaluated using standard measures, including the timing of initiation of antenatal care, number of subsequent visits, and place of consults. The factors affecting the adequacy of antenatal care were determined for each variable through simple logistic regression.

RESULTS

A total of 318 women were enrolled in the study. All the respondents agreed on the necessity of antenatal care. However, only 46.37% had six or more in-person antenatal visits, with the majority attended to by midwives at community health centers. Most respondents (71.38%) initiated antenatal care during the first trimester. Almost half reported deferrals of visits mainly due to lockdown restrictions, transportation problems, and financial issues. Positive predictors of adequate antenatal care were prior pregnancies (OR 1.80, 95% CI 1.11-9.20 for 2-3 prior pregnancies; OR 3.02, 95% CI 1.45-6.29 for 4 or more prior pregnancies), live births (OR 1.67, 95% CI 1.04-2.69 for 2-3 prior live births; OR 2.46, 95% CI 1.17-5.16 for 4 or more prior live births), having living children (OR 1.74, 95% CI 1.09-2.79), spousal support (OR 1.75, 95% CI 1.01-3.03 for married women; OR 1.89, 95% CI 1.09-3.28 for women with common-law partners), history of obstetric complications (OR 2.82, 95% CI 1.33-5.97), and use of private vehicles (OR 2.65, 95% CI 1.05-6.68). Negative predictors were employment (OR 0.37, 95% CI 0.22-0.63) and medical examination prior to pregnancy (OR 0.36, 95% CI 0.23-0.58).

CONCLUSION

Despite an overall positive perception of the necessity of antenatal care, utilization has been inadequate in more than half of the respondents. Various individual, facility, and policy-level factors affected the utilization of services during the pandemic. There is a need to augment antenatal care services in the country by mitigating barriers to access. The public health response should strengthen collaborative efforts with primary-level healthcare to increase service provision, especially to more vulnerable populations.

Essential maternal health service disruptions in Ethiopia during COVID 19 pandemic: a systematic review

INTRODUCTION

COVID 19 pandemic has challenged the resilience of the most effective health systems in the world. The Ethiopian Ministry of health tried to ensure the continuation of essential maternal health services during the pandemic. Despite several individual studies conducted on the impact of COVID 19 on maternal health services, no evidence can summarize the extent of impact as a nation and which essential maternal health service is most affected.

METHOD

A systematic review was conducted to summarize the extent of disruption of essential maternal health services and identify the most affected service in the era of the COVID pandemic in Ethiopia. Preferred Reporting Items for Systematic Review and Meta-analysis guidelines were followed. Comprehensive literature was searched using international databases PubMed, Google scholar, and African Online Journal to retrieve related articles. Descriptive analysis was made to answer the review objective.

RESULT

Overall, 498 articles were retrieved using our search strategy and finally 8 articles were included in the review. We found, ANC (26.35%), skilled birth attendance (23.46%), PNC (30%), family planning (14%), and abortion care (23.7%) maximum disruption of service utilization due to the pandemic. PNC service was the most significantly affected service unit followed by the ANC unit.

CONCLUSION

Essential maternal health services have been significantly disrupted due to COVID 19 pandemic in Ethiopia. It is expected from all stakeholders to prioritize safe and accessible maternity care during the pandemic and the aftermath and take lesson to reduce maternal and infant morbidity and mortality.

Fears and uncertainties of expectant mothers during the COVID-19 pandemic: trying to reclaim control

Purpose

The novel coronavirus disease (COVID-19) outbreak has exponentially spread across the globe and formed one of the greatest health threats in history. Pregnant women are vulnerable, and their vulnerability is amplified by the associated containment measures of the pandemic. In this study, we aim to explore and describe expectant mothers’ experiences during the lockdown of COVID-19.

Method

A qualitative descriptive design was used. Eighteen pregnant and postpartum women were recruited through purposive and snowball sampling. Semi-structured phone call interviews were conducted by a female researcher. Braun and Clarke’s thematic data analysis was followed.

Results

Three main themes are developed: (1) Living with fears and uncertainties amid the COVID-19 pandemic, (2) Lockdown disrupting the normalcy of pregnancy, (3) Trying to control the chaos of life. Five subthemes underlined the three themes.

Conclusion

Findings portrayed expectant mothers’ uncertainties, fears, and the fragility of the healthcare systems in responding to mothers’ needs during the COVID-19 pandemic. Although the pandemic has resulted in disruption of the normalcy of pregnancy, mothers sought adaptive means to protect themselves and maintain control. Governmental authorities and healthcare providers are directly responsible to maintain considerate perinatal care services for expectant mothers during lockdown and crises.

Factors affecting delayed and non-receipt of healthcare during the COVID-19 pandemic for women in rural Maharashtra, India: Evidence from a cross-sectional study

Background

Pathways to low healthcare utilisation under the COVID-19 pandemic are not well understood. This study aims to understand women's concerns about the health system's priorities and their increased burden of domestic responsibilities during COVID-19 as predictors of delayed or non-receipt of needed care for themselves or their children.

Methods

We surveyed married women in rural Maharashtra, India (N = 1021) on their health and economic concerns between Feb 1 and March 26, 2021. This study period was when India emerged from the first wave of the pandemic, which had severely impacted the health systems, and before the second-even more devastating wave had started. We captured if women were concerned about access to non-COVID health services due to healthcare being directed solely to COVID-19) (exposure 1) and whether their domestic responsibilities increased during the pandemic (exposure 2). Our outcomes included women's reports on whether they delayed healthcare seeking (secondary outcome and mediator) and whether they received healthcare for themselves or their children when needed (primary outcome). We conducted adjusted regression models on our predictor variables with each outcome and assessed the mediation effects of delayed healthcare seeking for each of the exposure variables.

Findings

We found that women who were concerned that healthcare was directed solely towards COVID-19 were more likely not to receive healthcare when needed (Adjusted Risk Ratio [ARR] = 1.49, 95% CI = 1.14, 1.95). We also found that women whose domestic care burden increased under the pandemic were more likely to delay healthcare seeking (ARR = 1.84, 95% CI = 1.05, 3.21). Delayed healthcare seeking mediated the associations between each of our exposure variables with our outcome variable, non-receipt of needed healthcare.

Interpretation

Our findings suggested that women's perceptions of healthcare systems and their domestic labour burdens affected healthcare seeking during the pandemic in India, even before the second wave of COVID-19 incapacitated the health system. Support for women and health systems is needed to ensure healthcare uptake during crises.

Funding

Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, USA (grant numbers: R01HD084453- 01A1 and RO1HD61115); Department of Biotechnology, Government of India (grant #BT/IN/US/01/BD/2010); the EMERGE project (Bill and Melinda Gates Foundation Grants: OPP1163682 and INV018007; PI Anita Raj), and Bill and Melinda Gates Foundation Grant number INV-002967.

Experiences of Urban Slum-Dwelling Women With Maternal and Child Health Services During COVID-19 Pandemic: A Multi-City Qualitative Study From India

Objectives: The COVID-19 pandemic containment necessitated the diversion of substantial health care resources thus affecting the routine essential care, and posing barriers to achieving the Sustainable Development Goals (SDGs). We explored the experiences of vulnerable communities—urban-slum-dwelling women regarding maternal and child health services during COVID-19.

Methods: We conducted 48 in-depth interviews in four Indian states—12 in each state among urban-slum antenatal, intra-natal, and postnatal women. We used framework analysis.

Results: Amidst the implementation of the mandatory stay-at-home, many women acknowledged that routine immunization services and antenatal check-ups remained uninterrupted, and were mostly provided at the community level. To prevent transmission, the family members and relatives had restricted visits to the health facility during labor or post-delivery. Women preferred to have a shorter hospital stay post-delivery and reduced routine postnatal check-ups for fear of infection.

Conclusion: India has a variety of national and state-level programs focused on improving MCH indicators to achieve the SDGs. COVID-19 inadvertently interrupted some components of health services, insinuating the need for a disaster or pandemic-resilient MCH services delivery system.

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.

Analyzing delay in referral of pregnant women and children under five years old during the COVID-19 pandemic: Fars Province, Iran

The researchers assessed the delay in referral of pregnant women and children under five years old during the COVID-19 pandemic that they require regular healthcare. This cross-sectional study was conducted in 2021 in Fars, Iran. A total of 591 households with pregnant women and children under five years old were recruited, then having delay and the number of their delays in regular visits during the COVID-19 outbreak was asked. A total of 153 children under five years old (51.7%) and 93 pregnant women (31.5%) reported delays in referral. In children, higher age and referral to the family physician and private clinic, and in pregnant women, higher gestational age and pregnancy rank and having health problems (e.g., preeclampsia in the current pregnancy) significantly enhanced the number of delays. Due to the vulnerability of these groups, it is necessary to consider active care for them as a priority at the primary care level.

The direct and indirect impact of COVID-19 pandemic on maternal and child health services in Africa: a scoping review

Introduction

The novel coronavirus disease 2019 (COVID-19) continues to disrupt the availability and utilization of routine and emergency health care services, with differing impacts in jurisdictions across the world. In this scoping review, we set out to synthesize documentation of the direct and indirect effect of the pandemic, and national responses to it, on maternal, newborn and child health (MNCH) in Africa.

Methods

A scoping review was conducted to provide an overview of the most significant impacts identified up to March 15, 2022. We searched MEDLINE, Embase, HealthSTAR, Web of Science, PubMed, and Scopus electronic databases. We included peer reviewed literature that discussed maternal and child health in Africa during the COVID-19 pandemic, published from January 2020 to March 2022, and written in English. Papers that did not focus on the African region or an African country were excluded. A data-charting form was developed by the two reviewers to determine which themes to extract, and narrative descriptions were written about the extracted thematic areas.

Results

Four-hundred and seventy-eight articles were identified through our literature search and 27 were deemed appropriate for analysis. We identified three overarching themes: delayed or decreased care, disruption in service provision and utilization and mitigation strategies or recommendations. Our results show that minor consideration was given to preserving and promoting health service access and utilization for mothers and children, especially in historically underserved areas in Africa.

Conclusions

Reviewed literature illuminates the need for continued prioritization of maternity services, immunization, and reproductive health services. This prioritization was not given the much-needed attention during the COVID-19 pandemic yet is necessary to shield the continent’s most vulnerable population segments from the shocks of current and future global health emergencies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41256-022-00257-z.

Effective interventions to ensure MCH (Maternal and Child Health) services during pandemic related health emergencies (Zika, Ebola, and COVID-19): A systematic review

INTRODUCTION

Ensuring accessible and quality health care for women and children is an existing challenge, which is further exacerbated during pandemics. There is a knowledge gap about the effect of pandemics on maternal, newborn, and child well-being. This systematic review was conducted to study maternal and child health (MCH) services utilization during pandemics (Zika, Ebola, and COVID-19) and the effectiveness of various interventions undertaken for ensuring utilization of MCH services.

METHODOLOGY

A systematic and comprehensive search was conducted in MEDLINE/PubMed, Cochrane CENTRAL, Embase, Epistemonikos, ScienceDirect, and Google Scholar. Of 5643 citations, 60 potential studies were finally included for analysis. The included studies were appraised using JBI Critical appraisal tools. Study selection and data extraction were done independently and in duplicate. Findings are presented narratively based on the RMNCHA framework by World Health Organization (WHO).

RESULTS

Maternal and child health services such as antenatal care (ANC) visits, institutional deliveries, immunization uptake, were greatly affected during a pandemic situation. Innovative approaches in form of health care services through virtual consultation, patient triaging, developing dedicated COVID maternity centers and maternity schools were implemented in different places for ensuring continuity of MCH care during pandemics. None of the studies reported the effectiveness of these interventions during pandemic-related health emergencies.

CONCLUSION

The findings suggest that during pandemics, MCH care utilization often gets affected. Many innovative interventions were adopted to ensure MCH services. However, they lack evidence about their effectiveness. It is critically important to implement evidence-based appropriate interventions for better MCH care utilization.

Effect of restrictions imposed due to COVID-19 pandemic on the antenatal care and pregnancy outcomes: a prospective observational study from rural North India

OBJECTIVES

To assess the difficulties faced by the pregnant women in seeking appropriate antenatal care due to the restrictions imposed during the COVID-19 pandemic; assess the difficulties encountered during delivery and postpartum period; the suitability of the teleconsultation services offered; effect of COVID-19 infection on pregnancy outcomes and the effect of restrictions on the nutrition profile of the pregnant women.

DESIGN

Prospective observational study.

SETTING AND PARTICIPANTS

We included 1374 pregnant women from the rural areas of three districts of Punjab, India registered at government health centres before the implementation of lockdown due to the COVID-19 pandemic on 24 March 2020.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the difficulties faced by the women during their pregnancies due to restrictions imposed during the lockdown. The secondary outcomes included the effect of COVID-19 infections on pregnancy outcomes, satisfaction from the telemedicine services and restrictions on the nutrition profile of the pregnant women.

RESULTS

One-third of the women (38.4%) considered their last pregnancy unplanned. Women faced difficulties due to the restrictions in getting adequate nutrition (76.5%), accessing transportation facilities (35.4%), consultations from doctors (22.4%) or getting an ultrasonography scan (48.7%). One-fifth (21.9%) of women could not access safe abortion services. Only 3.6% of respondents ever took any teleconsultation services offered by the government. Most of them felt unsatisfied compared with routine visits (77.5%). COVID-19-infected women were primarily asymptomatic (76.1%), but there was a high incidence of preterm birth (42.8%). Frontline workers could visit 64.3% of the women in the postpartum period despite restrictions.

CONCLUSIONS

Lockdown compromised the antenatal care in our study area while the frontline workers attempted to minimise the inconvenience. Telemedicine services did not prove to be of many benefits to pregnant women and should only work as a supplement to the existing protocols of antenatal care.

Intention to use maternal health services and associated factors among women who gave birth at home in rural Sehala Seyemit district: a community-based cross-sectional study

BACKGROUND

Low maternal healthcare service utilization contributes to poor maternal and newborn health outcomes in rural Ethiopia. 'Motivational factors influence women's intention to perform a specific health behavior, and the intention of subsequent home delivery and related risks that may contribute to women's death is less known. Therefore, this study aimed to assess the intention of maternal health service utilization among women who gave birth at home in the rural Sehala Seyemit district.

METHODS

A community-based cross-sectional study was conducted from September 1st to October 15th, 2020, among 653 women. A two-stage sampling technique was used to select the study participants. First, a semi-structured, pretested, and interviewer-administered questionnaire were used. The mean of the sum score was also used to categorize the intention as intended and not intended. Second, multivariable logistic regression analysis was computed to identify factors associated with women's intention to use maternal health services. Adjusted odds ratio (AOR) with a 95% confidence interval at a p-value of ≤ 0.05 were used to declare statistical association.

RESULTS

Of the women who gave birth at home the intention to use maternal health service was 62.3% (95% CI; 59, 66). Women's age of > 30 years (AOR = 6.04; 95%CI: 2.34, 15.60), short time to reach health facility (AOR = 2.52; 95% CI: 1.57, 4.10), media exposure (AOR = 2.10; 95% CI: 1.16, 3.65), history of obstetric danger signs (AOR = 4.60; 95% CI: 2.33, 9.10), positive subjective norms (AOR = 11.20; 95% CI; 6.77, 18.50) and last delivery assisted by traditional birth attendants (AOR = 0.15; 95% CI: 0.06, 0.33) were factors associated with women's intention to use maternal health services.

CONCLUSION

In this study, maternal health service utilization intention is still unsatisfactory compared to the national target plan. Maternal age, media exposure, obstetric danger signs, distance to a health facility, positive subjective norms, and delivery assistant at delivery were predictors of women's intention to use maternal healthcare services. Improving women's awareness of maternal healthcare services and developing strategies to increase women's access to mass media, skilled birth attendants, and transportation for rural women may enhance their intention to use maternal healthcare services.

Individual-level and community-level factors associated with eight or more antenatal care contacts in sub-Saharan Africa: evidence from 36 sub-Saharan African countries

OBJECTIVE

To reduce maternal mortality, the WHO has been introducing several antenatal care (ANC) measures. Pregnancy-related preventable morbidity and mortality, on the other hand, remain alarmingly high. This study was conducted to estimate the magnitude and the factors associated with eight or more ANC visits in sub-Saharan Africa.

DESIGN

A population-based, cross-sectional investigation was conducted.

SETTING

Sub-Saharan African countries.

PARTICIPANTS

A total of 300 575 women from recent Demographic and Health Surveys (DHS) conducted in 36 sub-Saharan African countries from 2006 to 2018 were included in this study.

METHODS

The data were sourced from sub-Saharan African countries' recent DHS data set from 2006 to 2018. A multilevel logistic regression model was fitted to identify factors associated with ANC use. Adjusted OR, with 95% CI and a p value of less than 0.05, was employed to determine parameters linked to ANC use.

RESULTS

The pooled magnitude of eight or more ANC visits in sub-Saharan African countries was 6.8% (95% CI 6.7% to 6.9%). Residence, maternal education, husband's education, maternal occupation, wealth index, media exposure, contraceptive use and desired pregnancy were all positively associated with eight or more ANC visits in the multilevel logistic regression analysis, whereas birth order was negatively associated with eight or more ANC visits.

CONCLUSIONS

Compliance with the WHO guidelines on the minimum number of ANC contacts in sub-Saharan Africa is poor. We recommend that mother and child health programmes review existing policies and develop new policies to adopt, execute and address the obstacles to maintaining the WHO-recommended minimum of eight ANC interactions. Women's education, economic position, media exposure and family planning uptake should be prioritised and improved. Urgent intervention is required to meet the minimum of eight ANC contacts in sub-Saharan Africa.

Leaving no woman or girl behind? Inclusion and participation in digital maternal health programs in sub-Saharan Africa

Across sub-Saharan Africa where access to adequate maternal healthcare is fraught with myriad challenges, especially for hard-to-reach populations, digital health technologies offer opportunities to improve maternal health outcomes. Digital health can circumvent inefficiencies in the traditional healthcare system and address challenges such as limited access to in-person medical consultations, and poor access to skilled birth attendants and health promotion activities. These benefits notwithstanding, digital health can be exclusionary. Too often, digital maternal health programs are not designed with a focus on equity in distribution nor are they designed from a gender equity standpoint. In this paper, we illustrate exclusionary practices of digital health programs through an extensive literature review of digital maternal health programs across sub-Saharan Africa. Taking an intersectional approach, we discuss how women are most vulnerable and excluded at the intersection of gender, literacy, and disability. Tackling exclusionary practices in digital health is crucial to ensure that no woman or girl is left behind.

Adequacy of Antenatal Care during the COVID-19 Pandemic: Observational Study with Postpartum Women

OBJECTIVE

 The present study aimed to evaluate the antenatal care adequacy for women who gave birth at the University Hospital of Santa Catarina in Florianopolis (Brazil) during the COVID-19 pandemic, and to evaluate the association of adequacy with sociodemographic, clinical, and access characteristics.

METHODS

 Data were collected between October and December 2020, including 254 patients who delivered in the University Hospital from Federal University of Santa Catarina and answered our questionnaires. Additional data were obtained from patients' antenatal booklets. Antenatal care was classified as adequate, intermediate, or inadequate according to the number of appointments, gestational age at the beginning of follow-up, and tests results. We carried out a descriptive statistical analysis and a bivariate/with odds ratio analysis on maternal sociodemographic, clinical and health access variables that were compared with antenatal adequacy.

RESULTS

 Antenatal care was considered adequate in 35.8% of cases, intermediate in 46.8%, and inadequate in 17.4%. The following maternal variables were associated with inadequate prenatal care (intermediate or inadequate prenatal care): having black or brown skin colour, having two or more children, being of foreign nationality, not being fluent in Portuguese, and using illicit drugs during pregnancy; the clinical variables were more than 6 weeks between appointments, and not attending high-risk antenatal care; as for access, the variables were difficulties in attending or scheduling appointments, and attending virtual appointments only.

CONCLUSION

 In a sample of pregnant women from a teaching hospital in Florianópolis during the COVID-19 pandemic, antenatal care was considered adequate in 35.8%, intermediate in 46.8%, and inadequate in 17.4% of cases.

Assessment of maternal and child health care services performance in the context of COVID-19 pandemic in Addis Ababa, Ethiopia: evidence from routine service data

Background

In many settings, health care service provision has been modified to managing COVID-19 cases, and this has been affecting the provision of maternal and child health services. The aim of this study was to assess trends in selected maternal and child health services performance in the context of COVID-19 pandemic.

Methods

A cross-sectional data review was conducted in Addis Ababa, Ethiopia from April to May 2021. Routine health management information system database was reviewed from Addis Ababa Health Bureau for the period from July 2019 to March 2021 across all quarters. Proportion and mean with standard deviation were computed. T-test was used to assess statistically significant differences in services mean performance.

Results

Postnatal care  visit, new contraceptives accepters, safe abortion care and number of under-5 years old children treated for pneumonia significantly decreased by 9.3% (p-value 0.04), 20.3% (p-value 0.004), 23.7% (p-value 0.01) and 77.2% (p-value < 0.001), respectively during the first 8 months of the COVID-19 pandemic compared to the previous 8 months’ average performance. The trends in Antenatal care first visit, new contraceptive accepters, pentavalent-3 vaccination and under-five children treated for pneumonia began to decline in January to  March 2020, a quarter when the COVID-19 pandemic began; with accelerated declines in April to June 2020 following national lockdown. The trends for the stated services began to increase during July–September 2020, the last quarter of national lockdown. Contraceptive accepters and pentavalent-1 vaccination continued to decline and showed no recovery until January–March 2021 when this study was completed.

Conclusions

Most of the maternal and child health services performance declined following the onset of COVID-19 pandemic and national lockdown, and most of the services began recovering during July–September 2020, the last quarter of national lockdown. However, new and repeat contraceptive accepters and pentavalent-1 recipients continue to decline and show no recovery during end of the study period. Implementing COVID-19 prevention measures and assuring the community about the safety of service delivery is imperative to ensure continuity of the maternal and child health services. Regular monitoring and evaluation of services performance is required to identify slowly recovering services and respond to potentially volatile changes during the COVID-19 pandemic.

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

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

Antenatal care services utilization during COVID-19 second wave attack in Pasuruan, Indonesia

Indonesia is currently experiencing the second wave of the COVID-19 pandemic, impacting maternal health services and maternal mortality. This research aims to investigate the use of antenatal care (ANC) during the COVID-19 second wave and the factors that play a role in this situation. A cross-sectional study was conducted during July 2021 on 344 pregnant women in primary, secondary, and tertiary maternal health care facilities in Pasuruan Regency, Indonesia. The data collection technique was simple random sampling, with face-to-face interviews assisted by questionnaires. Logistic regression and adjusted odds ratio with 95% CI and p<0.05 were performed to identify a significant relationship. 136 (39.5%) pregnant women did not use ANC services during the second wave of the COVID-19 outbreak. Husband’s support (AOR=13.814, 95% CI: 8.090–23.588), believing that pregnant women are not afraid of contracting COVID-19 (AOR=6.501, 95% CI: 3.904–10.825), easy access to transportation (AOR=12.145, 95% CI: 6.186–23.846), ease of ANC fees (AOR=4.105, 95% CI: 2.424–6.950), no lockdown policy (AOR=3.130, 95% CI: 1.983–4.940), knowledge regarding COVID-19 (AOR=2.975, 95% CI: 1.793–4.938), COVID-19 information on social media (AOR=3.035, 95% CI: 1.179–7.815), COVID-19 prevention protocols in health facilities (AOR=8.478, 95% CI: 3.611–19.903) were predictors of ANC utilization. This encourages the importance of prioritizing health services for pregnant women during the pandemic, overcoming the fear of contracting COVID-19 through maternal education, husband support, easy access to ANC, and improving the quality of ANC service facilities.