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Rochel-Perez EA, Martin-Dorantes MA, Mendez-Dominguez N. Estimation of the Incidence of Congenital Syphilis in Mexico Between 2019 and 2023. Cureus 2024; 16:e63913. [PMID: 39099895 PMCID: PMC11298237 DOI: 10.7759/cureus.63913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2024] [Indexed: 08/06/2024] Open
Abstract
Introduction Congenital Syphilis (CS) is considered the second leading cause of preventable death in developing countries. The last report of the incidence rate of CS was made in 2017. Objective The objective of the study was to estimate the incidence of CS between 2019-2023. Materials and methods This is a retrospective study for which data were obtained from the new cases of CS reported in the Epidemiological Bulletin for 2019-2023 and from the newborn population records reported in the National Institute of Statistics and Geography and the National Population Council. Results In Mexico, the incidence rate of CS is 3.20 per 10,000 births. An increment of CS cases was observed between 2019-2023, with a higher number of cases in 2022. Conclusion A democratization of detection and prompt management is needed to reduce transmission, particularly among the most vulnerable population.
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Affiliation(s)
- Erick A Rochel-Perez
- Departamento de Investigación, Hospital Regional de Alta Especialidad de la Península de Yucatán-IMMS BIENESTAR, Mérida, MEX
| | - Mario A Martin-Dorantes
- Departamento de Investigación, Hospital Regional de Alta Especialidad de la Península de Yucatán-IMSS BIENESTAR, Mérida, MEX
| | - Nina Mendez-Dominguez
- Research and Learning, Hospital Regional de Alta Especialidad de la Peninsula de Yucatan-IMSS BIENESTAR, Mérida, MEX
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Aguilar-Rodríguez MA, Castro-Porras LV. COVID-19 and the adequacy of antenatal care among Indigenous women: A retrospective crossover analysis. Birth 2024; 51:432-440. [PMID: 38037260 DOI: 10.1111/birt.12799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Often marginalized and disadvantaged by systems of oppression, Indigenous populations commonly face significant barriers to accessing adequate antenatal care (ANC). The COVID-19 pandemic had an unprecedented impact on healthcare systems worldwide, including on the provision of antenatal care; this was especially so for Indigenous communities in many regions. As such, our study aimed to estimate the association between the COVID-19 pandemic and adequate ANC received by Indigenous women in Chiapas, Mexico. METHODS We conducted a retrospective crossover analysis with data collected between June and December 2021 from Indigenous women who attended at least one ANC appointment at one of two health centers in San Cristóbal de las Casas, Chiapas. We used a multinomial logistic regression model considering the time frame (before and during the pandemic) as the primary independent variable. Adequate antenatal care comprised four dimensions: attendance by qualified personnel, timely first visit, sufficient frequency of visits, and adequacy of the content provided during the visits. RESULTS During the COVID-19 pandemic, there was a significant drop in ANC adequacy, with 12.7% (95% CI: 8.3, 18.9) of Indigenous women receiving ANC, compared with the pre-pandemic rate of 52.5% (95% CI: 44.7, 60.3), among the 158 participants. The pandemic resulted in a reduction of 75.8% in the adequacy of ANC. Considering the four dimensions of adequacy, we found that having only one dimension was associated with a relative risk ratio (RRR) of 12.45 (95% CI: 6.40, 24.23), while having two or three dimensions was associated with a RRR of 5.23 (95% CI: 2.83, 9.65) when using adequate ANC as the category of reference. CONCLUSIONS According to our results, Indigenous women's ANC adequacy was negatively affected by the COVID-19 pandemic. In light of these findings, we emphasize the importance of developing healthcare systems that are prepared to adapt consultation schemes by implementing virtual visits and incorporating community health workers.
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Affiliation(s)
| | - Lilia V Castro-Porras
- Politics, Population and Health Research Center, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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Aboagye RG, Okyere J, Seidu AA, Ahinkorah BO, Budu E, Yaya S. Does women's empowerment and socio-economic status predict adequacy of antenatal care in sub-Saharan Africa? Int Health 2024; 16:165-173. [PMID: 36916325 PMCID: PMC10911537 DOI: 10.1093/inthealth/ihad016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/13/2023] [Accepted: 02/20/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Quality and adequate antenatal care (ANC) are key strategies necessary to achieve Sustainable Development Goal 3.1. However, in sub-Saharan Africa (SSA), there is a paucity of evidence on the role women's empowerment and socio-economic status play in ANC attendance. This study aimed to examine whether women's empowerment and socio-economic status predict the adequacy of ANC in SSA. METHODS Data from the recent Demographic and Health Surveys (DHSs) of 10 countries in SSA were used for the study. We included countries with a survey dataset compiled between 2018 and 2020. We included 57 265 women with complete observations on variables of interest in the study. Frequencies and percentages were used to summarize the results of the coverage of adequate ANC services across the 10 countries. A multivariable binary multilevel regression analysis was employed to examine the association between women's empowerment and socio-economic status indicators and the adequacy of ANC. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were used to present the findings of the regression analysis. RESULTS The average prevalence of adequate ANC in SSA was 10.4%. This ranged from 0.2% in Rwanda to 24.5% in Liberia. Women with medium (aOR 1.24 [CI 1.10 to 1.40]) and high (aOR 1.24 [CI 1.07 to 1.43]) decision-making power had higher odds of adequate ANC compared to those with low decision-making power. Women with higher levels of education (aOR 1.63 [CI 1.36 to 1.95]) as well as partners with higher education levels (aOR 1.34 [CI 1.14 to 1.56]) had the highest odds of adequate ANC compared to those with no formal education. Additionally, those working (aOR 1.35 [95% CI 1.23 to 1.49]) and those in the richest wealth category (aOR 2.29 [CI 1.90 to 2.76]) had higher odds of adequate ANC compared to those who are not working and those in the poorest wealth category. Those with high justification of violence against women (aOR 0.84 [CI 0.73 to 0.97]) had lower odds of adequate ANC compared to those with low justification of violence against women. CONCLUSIONS Adequacy of ANC was low across all 10 countries we included in this study. It is evident from the study that women's empowerment and socio-economic status significantly predicted the adequacy of ANC. As such, promoting women's empowerment programs without intensive improvements in women's socio-economic status would yield ineffective results. However, when women's empowerment programs are combined with active improvements in socio-economic status, then women will be encouraged to seek adequate ANC.
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Affiliation(s)
- Richard Gyan Aboagye
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Faculty of Built and Natural Environment, Department of Estate Management, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Australia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Eugene Budu
- Research Unit, Korle Bu Teaching Hospital, P.O. Box 77, Accra, Ghana
| | - Sanni Yaya
- University of Parakou, Faculty of Medicine, Parakou, Benin
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
- George Institute for Global Health, Imperial College London, London, UK
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Soni S, Aparna Sharma K, Yadav K, Singhal S, Kaur R. Bridging gaps in antenatal care: Implementation of the WHO ANC model using a web-based mobile application at different levels of the healthcare system. Int J Med Inform 2023; 180:105277. [PMID: 37944274 DOI: 10.1016/j.ijmedinf.2023.105277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/14/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Antenatal care (ANC) is crucial for ensuring positive maternal and perinatal outcomes. The World Health Organization (WHO) has released comprehensive guidelines on ANC with the aim of providing a "positive pregnancy experience". While mobile health (mHealth) technology shows immense potential in improving healthcare services, evidence of its effectiveness remains limited. OBJECTIVES This study aimed to develop a mobile application aligned with the WHO antenatal care model and follow a group of antenatal women using that and compare it to the conventional care provided. METHODS A prospective open-label study was carried out at three health centers, where patients with singleton/twin pregnancies and access to smartphones were recruited after obtaining informed consent. The study group was followed using the mobile application, while the control group received conventional care. A recall-based questionnaire was used to assess the content of care, including comprehensive history, examination, and patient counselling. Patient satisfaction and the feasibility of using the application were also evaluated. RESULTS A total of 85 patients in the study group and 73 controls were followed until delivery. Baseline demographic details were comparable, while the number of antenatal visits were higher in the intervention group. Patients in the study group had significantly higher mean scores compared to the controls in terms of comprehensive history (8.26 ± 2.26 vs 3.58 ± 2.30; p < 0.001), physical examination (4.26 ± 1.03 vs 3.66 ± 1.09; p = 0.001) and patient counselling (6.09 ± 1.65 vs 4.33 ± 1.69; p < 0.001). Among the recommended investigations, a hemogram (100 % vs 93.2 %; p = 0.02) and ultrasound prior to 24 weeks (89.4 % vs 56.2 %; p < 0.001) were carried out in a larger number of patients in the study group. Patient satisfaction scores, calculated using the PreMAPeQ questionnaire, were higher in the intervention group. CONCLUSION This study highlights the effectiveness of an m-health application in enhancing the quality of antenatal care and facilitating standardized ANC visits. Further research is necessary to establish mHealth technology as a cost-effective intervention in this area.
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Affiliation(s)
- Snigdha Soni
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - K Aparna Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Kapil Yadav
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Seema Singhal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Ravneet Kaur
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi 110029, India.
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Medina-Ranilla J, Espinoza-Pajuelo L, Mazzoni A, Roberti J, García-Elorrio E, Leslie HH, García PJ. A systematic review of population and patient perspectives and experiences as measured in Latin American and Caribbean surveys. Health Policy Plan 2023; 38:1225-1241. [PMID: 37803966 DOI: 10.1093/heapol/czad083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/20/2023] [Accepted: 09/11/2023] [Indexed: 10/08/2023] Open
Abstract
High-quality health systems must provide accessible, people-centred care to both improve health and maintain population trust in health services. Furthermore, accurate measurement of population perspectives is vital to hold health systems accountable and to inform improvement efforts. To describe the current state of such measures in Latin America and the Caribbean (LAC), we conducted a systematic review of facility and population-based assessments that included patient-reported experience and satisfaction measures. Five databases were searched for publications on quantitative surveys assessing healthcare quality in Spanish- or Portuguese-speaking LAC countries, focusing on the domains of processes of care and quality impacts. We included articles published since 2011 with a national sampling frame or inclusion of multiple subnational regions. We tabulated and described these articles, identifying, classifying and summarizing the items used to assess healthcare quality into the domains mentioned earlier. Of the 5584 publications reviewed, 58 articles met our inclusion criteria. Most studies were cross-sectional (95%), assessed all levels of healthcare (57%) and were secondary analyses of existing surveys (86%). The articles yielded 33 unique surveys spanning 12 LAC countries; only eight of them are regularly administered surveys. The most common quality domains assessed were satisfaction (in 33 out of 58 articles, 57%), evidence-based/effective care (34%), waiting times (33%), clear communication (33%) and ease of use (31%). Items and reported ratings varied widely among instruments used, time points and geographical settings. Assessment of patient-reported quality measures through population- and facility-based surveys is present but heterogeneous in LAC countries. Satisfaction was measured frequently, although its use in accountability or informing quality improvement is limited. Measurement of healthcare quality in LAC needs to be more systematic, regular, comprehensive and to be led collaboratively by researchers, governments and policymakers to enable comparison of results across countries and to effectively inform policy implementation.
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Affiliation(s)
- Jesús Medina-Ranilla
- School of Public Health and Administration, Epidemiology, STD and HIV Unit, Cayetano Heredia University (UPCH), Honorio Delgado Av. 430, San Martín de Porres, Lima 150135, Peru
| | - Laura Espinoza-Pajuelo
- School of Public Health and Administration, Epidemiology, STD and HIV Unit, Cayetano Heredia University (UPCH), Honorio Delgado Av. 430, San Martín de Porres, Lima 150135, Peru
| | - Agustina Mazzoni
- Health Care Quality and Patient Safety Department, Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires C1414CPV, Argentina
| | - Javier Roberti
- Health Care Quality and Patient Safety Department, Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires C1414CPV, Argentina
| | - Ezequiel García-Elorrio
- Health Care Quality and Patient Safety Department, Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires C1414CPV, Argentina
| | - Hannah Hogan Leslie
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th St., Floor 4, San Francisco, CA 94143, United States
| | - Patricia Jannet García
- School of Public Health and Administration, Epidemiology, STD and HIV Unit, Cayetano Heredia University (UPCH), Honorio Delgado Av. 430, San Martín de Porres, Lima 150135, Peru
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Masoi TJ, Kibusi SM, Bintabara D, Lilungulu A. The effectiveness of interactive mobile health technologies in improving antenatal care service utilization in Dodoma region, Tanzania: A quasi-Experimental study. PLOS DIGITAL HEALTH 2023; 2:e0000321. [PMID: 37585393 PMCID: PMC10431653 DOI: 10.1371/journal.pdig.0000321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/08/2023] [Indexed: 08/18/2023]
Abstract
Antenatal care (ANC) provides a platform for important health care during pregnancy, including health promotion, screening, diagnosis and disease prevention. Timely and appropriate utilization of antenatal care can prevent complications as well as ensure optimal maternal and newborn health care. This study assessed the effectiveness of interactive (two way communication) mobile health technologies during antenatal period to improve maternal and newborn service utilization in Dodoma region, Tanzania. Using quasi-experimental design, participants were randomly selected to achieve a sample size of 450 pregnant women (Intervention = 150 and Control = 300) in Dodoma city from January to November, 2018. Interventions were matched to controls by gravidity, education level and gestational age at a ratio of 1 to 2. The intervention group received health education messages through their mobile phones, while the control group continued with standard antenatal care services offered in local clinics. Pregnant women were followed from their initial visit to the point of delivery. The Chi-square test was used to establish the association and regression analysis were used to test the effect of the intervention. The median age of participants was found to be 25 years that ranged from 16 to 41 years. Generally, 77.3 percent of participants in the intervention group utilized adequate (i. ANC care provided by skilled health personnel, ii. Sufficient number of ANC visits (4 or more visits during pregnancy), iii. Appropriate ANC contents provided (visits included at least 13 out of 15 of the recommended basic care procedures or contents) ANC services compared to 57.7 percent in the control group. Interactive mobile health technology system was observed to be effective on improving antenatal care service utilization (AOR = 2.164, P<0.05, 95% CI = 1.351-3.466) compared to conventional antenatal care health education given in local health facilities. Use of interactive mobile health technologies during antenatal period has the potential of improving access to information and antenatal care service utilization in the study setting. Trial Registration: PACTR202008834066796 "Retrospectively registered".
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Affiliation(s)
- Theresia J. Masoi
- Department of Clinical Nursing, the University of Dodoma, Dodoma, Tanzania
| | - Stephen M. Kibusi
- Department of Public Health and Community Nursing, the University of Dodoma, Dodoma, Tanzania
| | | | - Athanase Lilungulu
- Department of Obstetrics and Gynecology, the University of Dodoma, Dodoma, Tanzania
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Abebe GF, Birhanu AM, Alemayehu D, Girma D, Berchedi AA, Negesse Y. Spatial distribution, and predictors of late initiation of first antenatal care visit in Ethiopia: Spatial and multilevel analysis. PLoS One 2023; 18:e0288869. [PMID: 37490460 PMCID: PMC10368282 DOI: 10.1371/journal.pone.0288869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 07/06/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Despite the proven benefit of early initiation of first antenatal care visits as a means to achieve good maternal and neonatal health outcomes through early detection and prevention of risks during pregnancy, shreds of evidence showed that most of the women in Ethiopia start their ANC visits lately. OBJECTIVE To determine the spatial distribution and predictors of late initiation of first antenatal care visits among reproductive-age women in Ethiopia. METHOD The 2019 Ethiopian Mini Demographic and Health Survey (EMDHS) data were used. A total weighted sample of 2,935 reproductive-age women who gave birth in the five years preceding the survey and who had antenatal care visits for their last child was included. To check the nature of the distribution of late initiation of ANC visits, the global Moran's I statistics were applied. Gettis-OrdGi statistics and spatial interpolation using the Ordinary Kriging method were done to identify the spatial locations and to predict unknown locations of late initiation of first ANC visits, respectively. For the predictors, a multilevel mixed-effect logistic regression model was applied. Finally, statistical significance was declared at a p-value < 0.05. RESULTS The prevalence of late initiation of first ANC visits in Ethiopia was 62.6%. The spatial analysis showed that the late initiation of first ANC visits significantly varied across regions of Ethiopia. The spatial interpolation predicted the highest rates of late initiation of first ANC visits in the eastern SNNPRs, southern and western Oromia, and some parts of the Somalia region. Being rural residents, attending higher education, having medium wealth status, richer wealth status, richest wealth status, having ≥ 5 family size, a household headed by male, living in SNNPRs, and Oromia regions were significant predictors of late initiation of first ANC visits. CONCLUSION A clustered pattern of areas with high rates of late initiation of the first ANC visit was detected in Ethiopia. Public health intervention targeting the identified hotspot areas, and women's empowerment would decrease the late start of the first ANC visit. Furthermore, the identified predictors should be underscored when designing new policies and strategies.
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Affiliation(s)
- Gossa Fetene Abebe
- Department of Midwifery, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Anteneh Messele Birhanu
- School of Medicine, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Dereje Alemayehu
- School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Desalegn Girma
- Department of Midwifery, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Ashenafi Assefa Berchedi
- Department of Nursing, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Yilkal Negesse
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Bermudez Rojas MDLL, Medina Jimenez V, Manzanares Cuadros JI, Diaz Martínez DA, Padilla Raygoza N, Lara Lona E. Universal prenatal screening: a initiative from Guanajuato, Mexico to improve equity in perinatal healthcare. Front Med (Lausanne) 2023; 10:1127802. [PMID: 37275376 PMCID: PMC10233497 DOI: 10.3389/fmed.2023.1127802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/28/2023] [Indexed: 06/07/2023] Open
Abstract
The prenatal approach from a preventive perspective is necessary to reduce perinatal complications. A perinatal care model with a holistic and horizontal approach is required. Mexico is currently considered an emerging market economy with inequality and an economic gap that impacts the accessibility and distribution of healthcare services. Guanajuato is one of the 32 states of Mexico and represents 1.6% of the country's surface. Strategies during the prenatal approach allow prediction, diagnosis, and anticipation of the principal causes of morbidity and mortality. Combining data from maternal characteristics and history with findings of biophysical and biochemical tests at 11 to 13 weeks of gestation can define the patient-specific risk for a large spectrum of complications that include miscarriage and fetal death, preterm delivery, preeclampsia, congenital disorders, and fetal growth abnormalities. We aim to describe the care model designed and implemented in the State Center for Timely Prenatal Screening of the Maternal and Child Hospital of Leon, Guanajuato, Mexico. Previous research showed there is a lack of information for low and middle-income countries regarding how to integrate prenatal screening strategies in the absence of resources to perform cell-free fetal DNA or biochemical serum markers in countries with emergent economies. This care model is carried out through horizontal processes where the screening is provided by trained and certified general practitioners who identify the population at risk in a timely manner for specialized care, and could help guide other Mexican states, and other countries with emergent economies with limited financial, professional, and infrastructural resources to improve prenatal care with a sense of equity, equality, and social inclusion as well as the timely evaluation of specialized perinatal care of high-risk patients.
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Affiliation(s)
- Ma de la Luz Bermudez Rojas
- State Center for Timely Prenatal Screening, Maternal and Child Hospital of Leon Guanajuato, Maternal-Fetal Unit, Institute of Public Health, Leon, Guanajuato, Mexico
| | - Virginia Medina Jimenez
- State Center for Timely Prenatal Screening, Maternal and Child Hospital of Leon Guanajuato, Maternal-Fetal Unit, Institute of Public Health, Leon, Guanajuato, Mexico
| | - Javier Ivan Manzanares Cuadros
- State Center for Timely Prenatal Screening, Maternal and Child Hospital of Leon Guanajuato, Maternal-Fetal Unit, Institute of Public Health, Leon, Guanajuato, Mexico
| | | | - Nicolas Padilla Raygoza
- Department of Research and Technological Development, Directorate of Teaching and Research Institute of Public Health, Leon, Guanajuato, Mexico
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Reis-Muleva B, Vilela Borges AL, Simões Duarte L, da Silva Dos Santos CC, de Castro Nascimento N. Assessment of the quality of antenatal care in Mozambique. Midwifery 2023; 118:103598. [PMID: 36706649 DOI: 10.1016/j.midw.2023.103598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/21/2022] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To assess the quality of antenatal care and its covariates among postpartum women in Mozambique. DESIGN Cross-sectional study. SETTING The study was undertaken either at the maternity hospital or at home, in Mozambique, in 2019. PARTICIPANTS A total of 393 women aged 18 to 49 years were interviewed immediately after giving birth. MEASUREMENTS The quality of antenatal care was analysed based on the guidelines of the Ministry of Health of Mozambique: antenatal appointment in the first 16 weeks of gestation, 4 or more antenatal appointments, at least one laboratory test, at least 4 or more clinical-obstetric procedures, 3 doses of the prophylactic intermittent treatment for malaria, 2 doses of the tetanus vaccine, and counselling related to general health care. Women who reported all of these situations were classified as having had quality antenatal care. FINDINGS All women reported at least one antenatal care visit, but only 13.0% were classified as having had quality antenatal care. Women who underwent antenatal care in previous pregnancies (aOR=4,28; 95% CI=1,45-12,62) and whose current pregnancy was planned (aOR=2,51; 95% CI=1,11-5,68) were more likely to have quality antenatal care than those who had never had access to antenatal care in previous pregnancies and those who currently had an unplanned pregnancy. It was observed that the criteria recommended by the Ministry of Health were not followed during antenatal care, especially regarding the gestational age at the beginning of antenatal care, the minimum number of consultations, performing blood tests (complete blood count, blood glucose, blood typing and Rh factor) and guidance on signs of risk in pregnancy and childbirth. KEY CONCLUSIONS In general, the criteria recommended for quality antenatal care are not incorporated into clinical practice in Mozambique. IMPLICATIONS FOR PRACTICE While quality antenatal care is essential to reduce maternal morbidity and mortality, many sub-Saharan countries still have low-quality antenatal care services, which is one of the reasons why these countries have the highest maternal mortality rates worldwide.
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Affiliation(s)
- Belarmina Reis-Muleva
- Lúrio University of Nampula, Mozambique, Bairro de Marrere, R Nr. 4250, Km 2,3 - Nampula, Mozambique.
| | - Ana Luiza Vilela Borges
- Public Health Nursing Department, School of Nursing, University of São Paulo, São Paulo, Brazil. School of Nursing. University of São Paulo. Avenida Doutor Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil.
| | - Luciane Simões Duarte
- Chronic Noncommunicable Diseases Division of Disease Control Coordination of São Paulo State Department of Health. Avenue Doutor Arnaldo, 351, 01246-000, São Paulo, SP, Brazil.
| | - Carolina Cavalcante da Silva Dos Santos
- Public Health Nursing Department, School of Nursing, University of São Paulo, São Paulo, Brazil. School of Nursing. University of São Paulo. Avenida Doutor Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil.
| | - Natália de Castro Nascimento
- Public Health Nursing Department, School of Nursing, University of São Paulo, São Paulo, Brazil. School of Nursing. University of São Paulo. Avenida Doutor Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil.
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Determinants of early initiation of first antenatal care visit in Ethiopia based on the 2019 Ethiopia mini-demographic and health survey: A multilevel analysis. PLoS One 2023; 18:e0281038. [PMID: 36877686 PMCID: PMC9987803 DOI: 10.1371/journal.pone.0281038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 01/16/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Early initiation of the first antenatal care visit provides a critical opportunity for health promotion, disease prevention, and curative care for women and their unborn fetuses. However, in developing countries, including Ethiopia, it is underutilized and most of the pregnant women didn't attend antenatal care visits during the first trimester (early). Therefore, the objective of this study was to estimate the prevalence of early initiation of antenatal care visits and its determinants among reproductive-age women in Ethiopia. METHODS A secondary data analysis was done based on the 2019 intermediate Ethiopian demographic health survey. The data were weighted by sampling weight for probability sampling and non-response to restore the representativeness of the data and have valid statistical estimates. Then, a total weighted sample of 2,935 women aged 15-49 years who gave birth in the five years preceding the survey and who had antenatal care visits for their last child was included. A multilevel mixed-effects logistic regression model was fitted to examine the determinants of early initiation of first antenatal care visits. Finally, statistical significance was declared at a p-value < 0.05. RESULTS In this study, the overall magnitude of early initiation of the first antenatal care visit was 37.4% (95%CI: 34.6-40.2%). Women who attend higher education (AOR = 2.26: 95%CI; 1.36-3.77), medium wealth status (AOR = 1.80: 95%CI; 1.17-2.76), richer wealth status (AOR = 1.86: 95%CI; 1.21, 2.85), richest wealth status (AOR = 2.34: 95%CI; 1.43-3.83), living in Harari region (AOR = 2.24: 95%CI; 1.16-4.30), and living at Dire-Dawa city (AOR = 2.24: 95%CI; 1.16-4.30) were higher odds of early initiation of first ANC visits. However, women who were rural resident (AOR = 0.70: 95%CI; 0.59-0.93), household headed by male (AOR = 0.87: 95%CI; 0.72, 0.97), having ≥ 5 family size (AOR = 0.71: 95%CI; 0.55-0.93), and living in SNNPRs (AOR = 0.44: 95%CI; 0.23-0.84) were lower odds of early initiation of first ANC visits. CONCLUSION The prevalence of early initiation of first antenatal care remains low in Ethiopia. Women's education, residence, wealth status, household head, having ≥ 5 family sizes, and region were determinants of early initiation of first antenatal care visits. Improving female education and women's empowerment through economic transitions with special attention given to rural and SNNPR regional state residents could maximize the early initiation of first antenatal care visits. Furthermore, to increase early antenatal care uptake, these determinants should be considered when designing new policies or updating policies and strategies on antenatal care uptake to help increase early attendance, which can help in the reduction of maternal and neonatal mortality and to achieve sustainable development goals 3 by 2030.
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Input, process, and output factors contributing to quality of antenatal care services: a scoping review of evidence. BMC Pregnancy Childbirth 2022; 22:977. [PMID: 36577961 PMCID: PMC9795647 DOI: 10.1186/s12884-022-05331-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND High-quality antenatal care (ANC) provides a lifesaving opportunity for women and their newborns through providing health promotion, disease prevention, and early diagnosis and treatment of pregnancy-related health issues. However, systematically synthesised evidence on factors influencing the quality of ANC services is lacking. This scoping review aims to systematically synthesize the factors influencing in provision and utilisation of quality ANC services. METHODS We conducted a scoping review of published evidence on the quality of ANC services. We searched records on four databases (PubMed, Scopus, Embase, and Google scholar) and grey literature from 1 to 2011 to 30 August 2021. We analysed data using Braun and Clarke's thematic analysis approach. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guideline for the review. We explained themes using the Donabedian healthcare quality assessment model (input-process-output). RESULTS Several inputs- and process-related factors contributed to suboptimal quality of ANC in many low and lower- or middle-income countries. Input factors included facility readiness (e.g., lack of infrastructure, provision of commodities and supplies, health workforce, structural and intermediary characteristics of pregnant women, and service delivery approaches). Processes-related factors included technical quality of care (e.g., lack of skilled adequate and timely care, and poor adherence to the guidelines) and social quality (lack of effective communication and poor client satisfaction). These input and process factors have also contributed to equity gaps in utilisation of quality ANC services. CONCLUSION Several input and process factors influenced the provision and utilization of optimum quality ANC services. Better health system inputs (e.g., availability of trained workforces, commodities, guidelines, context-specific programs) are essential to creating enabling facility environment for quality ANC services. Care processes can be improved by ensuring capacity-building activities for workforces (training, technical support visits), and mentoring staff working at peripheral facilities. Identifying coverage of quality ANC services among disadvantaged groups could be the initial step in designing and implementing targeted program approaches.
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Receiving quality antenatal care service increases the chance of maternal use of skilled birth attendants in Ethiopia: Using a longitudinal panel survey. PLoS One 2022; 17:e0279495. [PMID: 36548352 PMCID: PMC9778501 DOI: 10.1371/journal.pone.0279495] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Evidence has suggested that maternal use of skilled birth attendant is the most important factor to reduce maternal mortality because of more than three-fourths of maternal deaths occur during child delivery or within 24 hours after delivery due to hemorrhage, hypertension, ruptured uterus and sepsis. In Ethiopia, more than 42% of pregnant women with 4+ antenatal care (ANC) visit did not deliver by skilled birth attendant. The factors for women not using skilled birth attendant after any ANC visit is not well-studied yet. Therefore, the aim of this study was to assess effect of quality antenatal care service on maternal use of skilled birth attendant after any antenatal care visit. METHODS This study was initiated using performance monitoring for action Ethiopia longitudinal panel survey datasets. A total of 1,511 postnatal women were included in the analysis. Generalized estimating equation Poisson regression model was used to assess the effect of quality ANC service on maternal use of skilled birth attendant by accounting the clustering nature of the data using Stata vers.16 software. RESULTS This study showed that about 54% of women used skilled birth attendant during the current baby delivery (rate = 53.6%, 95% UI = 51-56%). Nearly, 39% of the women received quality (more than 75th percentile) ANC service (rate = 39.05%, 95% UI = 36-42%). The highest and the lowest antenatal care service the women received, respectively, were blood pressure measure (91.9%) and syphilis test (12.4%). Women who received better quality ANC service were 20% higher more likely to use skilled birth attendant compared to women who received low quality ANC service (adjusted IRR = 1.20, 95% UI = 1.11, 1.31). CONCLUSION Maternal use of skilled birth attendant can be improved by providing quality ANC service during subsequent ANC visits. Improving ANC service delivery may encourage or positively reinforce women's and partner's decision to use skilled birth attendant.
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Woldeamanuel BT. Factors associated with inadequate prenatal care service utilization in Ethiopia according to the WHO recommended standard guidelines. Front Public Health 2022; 10:998055. [PMID: 36408015 PMCID: PMC9670123 DOI: 10.3389/fpubh.2022.998055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
Background Adequate maternal health care could prevent 54% of maternal deaths in low- and middle-income countries. In Ethiopia, the maternal mortality rate was reduced from 817 to 412 deaths per 100,000 live births between 2000 and 2016. Thus, the current study focuses on the adequacy of prenatal care (PNC) services rather than the mere prenatal contacts available to assess compliance with the WHO recommended standard guidelines. Methods A nationally representative cross-sectional dataset from the Ethiopian Mini Demographic and Health Survey 2019 was analyzed. Risk factors for prenatal care adequacy were assessed using a multilevel ordinal logistic regression model. Results About 43% of women met the old WHO recommendation of at least four prenatal contacts, while only 3.5% of women met the new WHO recommended minimum of eight prenatal contacts. The overall adequacy of prenatal care based on the four prenatal care utilization indicators was 52.1% no PNC, 37.4% received inadequate PNC and 10.5% received adequate PNC. Being a rural resident [AOR = 0.694 (95% CI: 0.557, 0.865)] and wanting no more children [AOR = 0.687 (95% CI: 0.544, 0.868)] are associated with inadequate prenatal care. Higher educational attainment of women and spouses, exposure to the media, upper wealth quintile, and a perceived shorter distance to a health facility were significantly associated with adequate prenatal care. Conclusion The prevalence of adequate prenatal care was lower. Multi-sectoral efforts are needed to improve maternal health targets by reducing maternal mortality through improved health care services.
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Abebe GF, Belachew DZ, Girma D, Aydiko A, Negesse Y. Multilevel analysis of the predictors of completion of the continuum of maternity care in Ethiopia; using the recent 2019 Ethiopia mini demographic and health survey. BMC Pregnancy Childbirth 2022; 22:691. [PMID: 36071407 PMCID: PMC9450293 DOI: 10.1186/s12884-022-05016-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background Despite the significant benefit of the continuum of care to avert maternal and neonatal mortality and morbidity, still the dropout from the continuum of care remains high and continued to become a challenge in Ethiopia. Therefore, this study aimed to assess the level of completion along the continuum of maternity care and its predictors among reproductive-age women in Ethiopia. Methods A secondary data analysis was done using the 2019 mini Ethiopian demographic health survey. A total weighted sample of 2,905 women aged 15–49 years who gave birth in the last five years preceding the survey and who had antenatal care visits was included. A multilevel mixed-effects logistic regression model was used to examine the predictors that affect the completion of the continuum of maternity care services. Finally, statistical significance was declared at a p-value < 0.05. Results In this study, the overall prevalence of completion along the continuum of maternity care was 12.9% (95%CI: 11.1 – 14.9%). Attending higher education (AOR = 2.03: 95%CI; 1.14 - 3.61), belonged to medium wealth status (AOR = 1.69: 95%CI; 1.07 - 2.66), belonged to rich wealth status (AOR = 2.05: 95%CI; 1.32, 3.17), and informed about danger signs during pregnancy (AOR = 2.23: 95%CI; 1.61, 3.10) were positively associated with the completion of the maternity continuum of care. However, late initiaton of first antenatal care visits (AOR = 0.66: 95%CI; 0.49, 0.89), being rural resident (AOR = 0.67: 95%CI; 0.42 - 0.93), lived in the Afar (AOR = 0.36: 95%CI; 0.12 – 0.83) and Gambella (AOR = 0.52: 95%CI; 0.19 – 0.95) regional states were negatively associated with the completion of the continuum of maternity care. Conclusion Despite most of the women using at least one of the maternity services, the level of completion along the continuum of care after antenatal care booking remains low in Ethiopia. Therefore, enhancing female education and economic transitions with special consideration given to rural, Afar, and Gambella regional state residents. Counseling towards the danger signs of pregnancy and its complications during antenatal care follow-upshould be strengthened. . Furthermore, the identified predictors should be considered when designing new policies or updating policies and strategies on maternity services uptake to step-up its full utilization, which in turn helps in the achievement of the sustainable development goals of ending preventable causes of maternal, neonatal, and child death by 2030.
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Affiliation(s)
- Gossa Fetene Abebe
- Department of Midwifery, College of Medicine and Health Sciences, Mizan-Tepi University, P.O.Box-260, Mizan Teferi, Ethiopia.
| | - Dereje Zeleke Belachew
- Department of Midwifery, College of Medicine and Health Sciences, Mizan-Tepi University, P.O.Box-260, Mizan Teferi, Ethiopia
| | - Desalegn Girma
- Department of Midwifery, College of Medicine and Health Sciences, Mizan-Tepi University, P.O.Box-260, Mizan Teferi, Ethiopia
| | - Alemseged Aydiko
- Department of Midwifery, College of Medicine and Health Sciences, Mizan-Tepi University, P.O.Box-260, Mizan Teferi, Ethiopia
| | - Yilkal Negesse
- Department of Public health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Khatri RB, Durham J, Karkee R, Assefa Y. High coverage but low quality of maternal and newborn health services in the coverage cascade: who is benefitted and left behind in accessing better quality health services in Nepal? Reprod Health 2022; 19:163. [PMID: 35854265 PMCID: PMC9297647 DOI: 10.1186/s12978-022-01465-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antenatal care (ANC) visits, institutional delivery, and postnatal care (PNC) visits are vital to improve the health of mothers and newborns. Despite improved access to these routine maternal and newborn health (MNH) services in Nepal, little is known about the cascade of health service coverage, particularly contact coverage, intervention-specific coverage, and quality-adjusted coverage of MNH services. This study examined the cascade of MNH services coverage, as well as social determinants associated with uptake of quality MNH services in Nepal. METHODS We conducted a secondary analysis of data derived from the Nepal Demographic and Health Survey (NDHS) 2016, taking 1978 women aged 15-49 years who had a live birth in the 2 years preceding the survey. Three outcome variables were (i) four or more (4+) ANC visits, (ii) institutional delivery, and (iii) first PNC visit for mothers and newborns within 48 h of childbirth. We applied a cascade of health services coverage, including contact coverage, intervention-specific and quality-adjusted coverage, using a list of specific intervention components for each outcome variable. Several social determinants of health were included as independent variables to identify determinants of uptake of quality MNH services. We generated a quality score for each outcome variable and dichotomised the scores into two categories of "poor" and "optimal" quality, considering > 0.8 as a cut-off point. Binomial logistic regression was conducted and odds ratios (OR) were reported with 95% confidence intervals (CIs) at the significance level of p < 0.05 (two-tailed). RESULTS Contact coverage was higher than intervention-specific coverage and quality-adjusted coverage across all MNH services. Women with advantaged ethnicities or who had access to bank accounts had higher odds of receiving optimal quality MNH services, while women who speak the Maithili language and who had high birth order (≥ 4) had lower odds of receiving optimal quality ANC services. Women who received better quality ANC services had higher odds of receiving optimal quality institutional delivery. Women received poor quality PNC services if they were from remote provinces, had higher birth order and perceived problems when not having access to female providers. CONCLUSIONS Women experiencing ethnic and social disadvantages, and from remote provinces received poor quality MNH services. The quality-adjusted coverage can be estimated using household survey data, such as demographic and health surveys, especially in countries with limited routine data. Policies and programs should focus on increasing quality of MNH services and targeting disadvantaged populations and those living in remote areas. Ensuring access to female health providers and improving the quality of earlier maternity visits could improve the quality of health care during the pregnancy-delivery-postnatal period.
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Affiliation(s)
- Resham B Khatri
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia. .,Health Social Science and Development Research Institute, Kathmandu, Nepal.
| | - Jo Durham
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Rajendra Karkee
- School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Yibeltal Assefa
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Ferreira FM, Venâncio KCMP, Narchi NZ. Network care: relationship between prenatal care adequacy and hospital obstetric care in a cross-sectional study. Rev Esc Enferm USP 2022; 56:e20220011. [PMID: 35802658 PMCID: PMC10081621 DOI: 10.1590/1980-220x-reeusp-2022-0011en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/10/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the relationship between prenatal care adequacy and the demand for hospital obstetric care. METHOD A cross-sectional, quantitative study, conducted in a Brazilian capital, at six basic units and a hospital unit, from 2017 to 2020. Pregnant women who met the predefined inclusion and exclusion criteria participated in the study. Data were collected by structured questionnaire, and follow-up of participants was in person, by phone and by application. Descriptive and analytical statistics were performed using a statistical program. RESULTS A total of 224 women were investigated. Prenatal care was adequate in 42.4% of cases, and the mean percentage of adequacy was 76.7% of assessed indicators. Of the 1,067 hospital visits, 63.1% were inopportune. The regression model showed that the variable "prenatal care adequacy" was statistically relevant (0.043), with a 2.2 times higher Odds Ratio (OR) of women who had inadequate prenatal follow-up seeking the hospital inanely. CONCLUSION Prenatal care inadequacy was related to the inopportune search for emergency room care, with care overload for this point in the care network.
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Affiliation(s)
| | | | - Nádia Zanon Narchi
- Universidade de São Paulo, Escola de Artes, Ciências e Humanidades, São Paulo, SP, Brazil
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Hailu GA, Weret ZS, Adasho ZA, Eshete BM. Quality of antenatal care and associated factors in public health centers in Addis Ababa, Ethiopia, a cross-sectional study. PLoS One 2022; 17:e0269710. [PMID: 35687552 PMCID: PMC9187099 DOI: 10.1371/journal.pone.0269710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 05/26/2022] [Indexed: 12/01/2022] Open
Abstract
Background Potentially, the risk of morbidity and mortality during pregnancy and child birth can be prevented through comprehensive, quality antenatal care services. The high maternal mortality rate in developing countries, including Ethiopia, is related to poor quality of antenatal care services and is still a major public health problem. The aim of this study is to assess the quality of antenatal care and associated factors in public health centers in Addis Ababa, Ethiopia. Methods An institution-based cross-sectional study was conducted using a quantitative method from December 10 to January 30, 2020. A total of 616 study participants were selected by a systematic random sampling technique. Data was collected using pre-tested structured interview administered questionnaires. The data was entered into Epi-info version 7.2.1 and analyzed by SPSS version 24. Bivariate and multivariable logistic regressions were performed to identify the presence and strength of the association between the outcome and predictor variables. Results Overall, 33% of pregnant women received good-quality antenatal care. Satisfaction with antenatal care service, antenatal care initiation time, maintaining confidentiality, and waiting time become significant predictors of the quality of antenatal care. As a result, a lack of confidential care (AOR = 0.37; 95% CI, (0.40, 0.88)), a long waiting time (AOR = 0.6, 95% CI, (0.48, 0.88)), and no satisfaction with ANC services (AOR = 0.26; 95% CI, (0.109, 0.36)) were identified as factors impeding the quality of antenatal care. While starting ANC later than four months of pregnancy was found to be a positive predictor of the quality of antenatal care (AOR = 1.9, 95% CI: (1.21, 3.12)). Conclusion Only one-third of pregnant mothers received good quality antenatal care. Lack of confidential care, long waiting time and no satisfaction with antenatal care services were factors hindering the quality of antenatal care. While initiation of antenatal care after four months of pregnancy was a positive predictor of the quality of antenatal care.
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Affiliation(s)
- Genet Atlabachew Hailu
- Department of Midwifery, Menelik II Medical and Health Science College, Kotebe Metropolitan University, Addis Ababa, Ethiopia
| | - Zewdu Shewngizaw Weret
- Department of Psychiatry, Menelik II Medical and Health Science College, Kotebe Metropolitan University, Addis Ababa, Ethiopia
| | - Zerihun Adraro Adasho
- Department of Neonatal Nursing, Menelik II Medical and Health Science College, Kotebe Metropolitan University, Addis Ababa, Ethiopia
- * E-mail:
| | - Belete Melesegn Eshete
- Department of Psychiatry, Menelik II Medical and Health Science College, Kotebe Metropolitan University, Addis Ababa, Ethiopia
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McCauley H, Lowe K, Furtado N, Mangiaterra V, van den Broek N. What are the essential components of antenatal care? A systematic review of the literature and development of signal functions to guide monitoring and evaluation. BJOG 2022; 129:855-867. [PMID: 34839568 DOI: 10.1111/1471-0528.17029] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/29/2021] [Accepted: 11/22/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Antenatal care (ANC) is one of the key care packages required to reduce global maternal and perinatal mortality and morbidity. OBJECTIVES To identify the essential components of ANC and develop signal functions. SEARCH STRATEGY MESH headings for databases including Cinahl, Cochrane, Global Health, Medline, PubMed and Web of Science. SELECTION CRITERIA Papers and reports on content of ANC published from 2000 to 2020. DATA COLLECTION AND ANALYSIS Narrative synthesis of data and development of signal function through 7 consensus-building workshops with 184 stakeholders. MAIN RESULTS A total of 221 papers and reports are included from which 28 essential components of ANC were extracted and used to develop 15 signal functions with the equipment, medication and consumables required for implementation of each. Signal functions for the prevention and management of infectious diseases (malaria, HIV, tuberculosis, syphilis and tetanus) can be applied depending on population disease burden. Screening and management of pre-eclampsia, gestational diabetes, anaemia, mental and social health (including intimate partner violence) are recommended universally. Three signal functions address monitoring of fetal growth and wellbeing, and identification and management of obstetric complications. Promotion of health and wellbeing via education and support for nutrition, cessation of substance abuse, uptake of family planning, recognition of danger signs and birth preparedness are included as essential components of ANC. CONCLUSIONS New signal functions have been developed which can be used for monitoring and evaluation of content and quality of ANC. Country adaptation and validation is recommended.
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Affiliation(s)
- H McCauley
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - K Lowe
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - N Furtado
- The Global Fund for Aids Tuberculosis and Malaria, Geneva, Switzerland
| | - V Mangiaterra
- The Global Fund for Aids Tuberculosis and Malaria, Geneva, Switzerland
- Department of Government, Health and Not for Profit, SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | - N van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Alamneh A, Asmamaw A, Woldemariam M, Yenew C, Atikilt G, Andualem M, Mebrat A. Trend change in delayed first antenatal care visit among reproductive-aged women in Ethiopia: multivariate decomposition analysis. Reprod Health 2022; 19:80. [PMID: 35346248 PMCID: PMC8962488 DOI: 10.1186/s12978-022-01373-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 03/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background Early first antenatal care visit is a critical health care service for the well-being of women and newborn babies. However, many women in Ethiopia still start their first antenatal care visit late. We aimed to examine the trend in delayed first antenatal care visit and identify the contributing factors for the trend change in delayed first antenatal care visits in Ethiopia over the study period 2000–2016. Method We analyzed the data on reproductive-aged women from the four consecutive Ethiopian Demographic and Health Surveys to determine the magnitude and trend of delayed first antenatal care visit. A weighted sample of 2146 in 2000, 2051 in 2005, 3368 in 2011, and 4740 women in 2016 EDHS were involved in this study. All statistical analysis was undertaken using STATA 14. Multivariate logistic decomposition analysis was used to analyze the trends of delayed first antenatal care visit over time and the contributing factors to the change in delayed first antenatal care visit. Results The prevalence of delayed first antenatal care visit in Ethiopia decreased significantly from 76.8% (95% CI 75.1−78.6) in 2000 to 67.3% (95% CI 65.9−68.6) in 2016. Decomposition analysis revealed that 39% of the overall change in delayed first antenatal care visit overtime was due to differences in women’s composition, whereas 61% was due to women’s behavioral changes. In this study, residence, husband's education, maternal occupation, ever told about pregnancy complications, cesarean delivery and family sizes were significantly contributing factors for the decline in delayed first antenatal care visit over the study periods. Conclusion The prevalence of delayed first antenatal care visit in Ethiopia among women decreased significantly over time. More than halves (61%) decline in delayed first antenatal care visits was due to women’s behavioral changes. Public health interventions targeting rural residents, poor household economic status and improving awareness about pregnancy-related complications would help to reduce the prevalence of delayed first antenatal care visit. Antenatal care visits during the first trimester of the pregnancy stage provide opportunities for women to improve their health, prevent disease, and identify and manage pregnancy and childbirth complications. However, delayed first antenatal care visit is a major leading cause of pregnancy and childbirth complications, and many women in Ethiopia still start ANC visits late. Hence, we aimed to examine the trends in delayed first antenatal care visits and identify the contributing factors for the trend change in delayed first antenatal care visits in Ethiopia over the study period (2000–2016). We obtained data on women aged 15–49 years from four consecutive Ethiopian Demographic and Health Surveys (EDHSs) conducted in 2000, 2005, 2011, and 2016. We extracted both response and independent variables for this study from the Kids Record (KR file) data set. The prevalence of delayed first ANC visit has significantly decreased from 76.8% [95% CI 75.1, 78.6] in 2000 to 67.3% [95% CI 65.9, 68.6] in 2016 over the last sixteen years in Ethiopia. The overall trend change in delayed first antenatal care visits over the study periods was due to the difference in women's composition of selected characteristics and women's behavioral changes on ANC initiation. More than halves (61%) decline in delayed first ANC visits among reproductive-aged women was due to women's behavioral change, and 39% was due to change in women's composition over time. The significant contributing factors for the decline in delayed first antenatal care visits over the study period were residence, husband's educational level, mass media exposure, ever told about pregnancy complications, cesarean delivery and family sizes. Changes in the composition of women's characteristics according to residence areas, media exposure, ever told about pregnancy complications, cesarean delivery and family sizes were statistically significant variables for the decline in delayed first ANC visit over time. Only husbands who had secondary and above education were attributable to women’s behavioral change on ANC services.
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Affiliation(s)
- Asaye Alamneh
- Department of Social and Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Achenef Asmamaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mehari Woldemariam
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Chalachew Yenew
- Department of Social and Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getaneh Atikilt
- Department of Social and Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Minwuyelet Andualem
- Department of English Language and Literature, Faculty of Social Science and Humanities, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare Mebrat
- Department Epidemiology and Biostatistics, Institute of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
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Fetene G, Alie MS, Girma D, Negesse Y. Prevalence and its predictors of intimate partner violence against pregnant women amid COVID-19 pandemic in Southwest Ethiopia, 2021: A cross-sectional study. SAGE Open Med 2022; 10:20503121221079317. [PMID: 35223032 PMCID: PMC8873970 DOI: 10.1177/20503121221079317] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/21/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Preventive measures like staying-at-home and social distancing are among the top strategies on the list to avert the spread of coronavirus disease 2019 and its consequences. However, this strategy brings off another shadow pandemic of intimate partner violence against women, and no study has been done to assess the magnitude of intimate partner violence against pregnant women during the pandemic in Ethiopia. Therefore, this study was aimed to determine the prevalence of intimate partner violence and its predictors in Southwest Ethiopia amid the coronavirus disease 2019 pandemic. METHODS A community-based cross-sectional study was conducted, from 15 June 2021 to 15 August 2021, on a total of 590 pregnant women recruited by systematic random sampling techniques. Pretested structured questionnaires were used to collect data, and the data were entered using EpiData version 3.1 and analyzed by SPSS version 24. Logistic regression analysis was used to identify predictors of intimate partner violence. Finally, statistical significance was declared at a p-value <0.05. RESULTS The prevalence of intimate partner violence was 39.2%. Of this, 29.8%, 26.8%, and 22.2% of the pregnant women had experienced physical, sexual, and emotional intimate partner violence, respectively. Being illiterate (adjusted odds ratio = 2.36, 95% confidence interval: 1.33-4.19), having illiterate husbands (adjusted odds ratio = 4.79, 95% confidence interval: 2.69-8.55), household decisions made by the husband alone (adjusted odds ratio = 4.91, 95% confidence interval: 3.74-9.33), and pandemic-induced economic downturns (adjusted odds ratio = 9.03, 95% confidence interval: 5.18-15.98) were the predictors that were significantly associated with intimate partner violence. CONCLUSION The prevalence of intimate partner violence against pregnant women during the coronavirus disease 2019 pandemic has been found to be high in the study area. Thus, more efforts should be tried to integrating intimate partner violence screening in maternal and child healthcare services, and early identification of high-risk individuals, and continuous community-based awareness creation activities are recommended.
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Affiliation(s)
- Gossa Fetene
- Department of Midwifery, College of Medicine and Health Sciences, Mizan–Tepi University, Mizan, Ethiopia
| | - Melsew Setegn Alie
- Department of Reproductive Health and Nutrition, College of Medicine and Health Sciences, Mizan–Tepi University, Mizan, Ethiopia
| | - Desalegn Girma
- Department of Midwifery, College of Medicine and Health Sciences, Mizan–Tepi University, Mizan, Ethiopia
| | - Yilkal Negesse
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Mizan–Tepi University, Mizan, Ethiopia
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Tsega D, Admas M, Talie A, Tsega TB, Birhanu MY, Alemu S, Mengist B. Maternity Continuum Care Completion and Its Associated Factors in Northwest Ethiopia. J Pregnancy 2022; 2022:1309881. [PMID: 35223099 PMCID: PMC8872697 DOI: 10.1155/2022/1309881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/07/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Continuum care is a basic package approach for women to receive essential services throughout pregnancy, childbirth, and postpartum, and it is critical for women and their infants' survival and well-being. Although it is an effective strategy for improving maternal and child health, it has not been implemented adequately in less developed countries, primarily in sub-Saharan Africa, including Ethiopia, where 55% of women have been dropped out from the continuum of care. Therefore, this study is aimed at assessing maternity continuum care completion and its associated factors within northwest Ethiopia, 2020. MATERIALS AND METHODS A community-based cross-sectional study design was considered among 504 women from March 10 to March 30, 2020, using pretested and structured questionnaires administered via face-to-face interviews. To select study participants, a simple random sampling technique was used. Data were coded, checked, and entered into EpiData software (V. 4.2), then transferred to SPSS (V. 25) for further analysis. A bivariable analysis with 95% CI was performed, and variables with P 0.25 during binary logistic regression were entered into a multivariable analysis to assess predictors' independent effect. RESULTS About 177 (37.6%) women completed maternal continuum care. Women with secondary education and above (AOR = 2.75, 95% CI 1.42-5.32), urban residence (AOR = 2.45, 95% CI 1.35-4.45), using ambulance transport (AOR = 3.96, 95% CI 2.19-7.19), mass media exposure (AOR = 3.64, 95% CI 2.02-6.56), and distance from health facilities (AOR = 3.22, 95% CI 1.84-5.63) showed significant positive associations with completion of maternity continuum care. CONCLUSION However, a higher proportion of mothers completed the continuum of maternity care in the district than Ethiopian Demographic and Health Survey 2016 (9.1%); further interventions are compulsory to reach the acceptable level. Hence, comprehensive awareness-raising, education, and promotion activities at the community and health facility levels and empowering women in health care and decision-making backing to expand the completion of maternity continuum of care are necessary.
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Affiliation(s)
- Daniel Tsega
- Department of Midwifery, Medicine and Health Science College, Wolkite University, Wolkite, PO Box 07, Ethiopia
| | - Melaku Admas
- Department of Midwifery, Medicine and Health Science College, Debre Markos University, Debre Markos, PO Box 269, Ethiopia
| | - Asmare Talie
- Department of Midwifery, Medicine and Health Science College, Debre Markos University, Debre Markos, PO Box 269, Ethiopia
| | - Tesfa Birlew Tsega
- Department of Public Health, Medicine and Health Science College, Debre Markos University, Debre Markos, PO Box 269, Ethiopia
| | - Molla Yigzaw Birhanu
- Department of Public Health, Medicine and Health Science College, Debre Markos University, Debre Markos, PO Box 269, Ethiopia
| | - Simegn Alemu
- Department of Public Health, Medicine and Health Science College, Debre Markos University, Debre Markos, PO Box 269, Ethiopia
| | - Belayneh Mengist
- Department of Public Health, Medicine and Health Science College, Debre Markos University, Debre Markos, PO Box 269, Ethiopia
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Pre-pregnancy body mass index and gestational weight-gain predict maternal hemoglobin levels and are jointly associated with neonatal outcomes in a Mexican birth cohort. NUTR HOSP 2022; 39:852-862. [DOI: 10.20960/nh.03999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Ferreira FM, Venâncio KCMP, Narchi NZ. Cuidado em rede: relação entre a adequação pré-natal e os atendimentos obstétricos hospitalares em um estudo transversal. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2022-0011pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: Avaliar a relação entre a adequação do pré-natal e a demanda de atendimentos obstétricos hospitalares. Método: Estudo transversal, quantitativo, conduzido em uma capital brasileira, em seis unidades básicas e uma unidade hospitalar, de 2017 a 2020. Participaram gestantes que atenderam aos critérios de inclusão e exclusão pré-definidos. Os dados foram coletados por questionário estruturado e o seguimento das participantes foi presencial, telefônico e por aplicativo. Procedeu-se à estatística descritiva e analítica, utilizando um programa estatístico. Resultados: Foram investigadas 224 mulheres. O pré-natal foi adequado em 42,4% dos casos, e o percentual médio de adequação foi de 76,7% dos indicadores avaliados. Dos 1.067 atendimentos hospitalares, 63,1% foram inoportunos. O modelo de regressão mostrou que a variável “adequação do pré-natal” foi estatisticamente relevante (p 0,043), com razão de chance (OR) 2,2 vezes maior de as mulheres que tiveram um acompanhamento pré-natal inadequado buscarem o hospital de forma inoportuna. Conclusão: A inadequação do pré-natal teve relação com a procura inoportuna por atendimentos em pronto-socorro, com sobrecarga assistencial para este ponto na rede de cuidado.
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Sámano R, Chico-Barba G, Flores-Quijano ME, Godínez-Martínez E, Martínez-Rojano H, Ortiz-Hernandez L, Nájera-Medina O, Hernández-Trejo M, Hurtado-Solache C. Association of Pregestational BMI and Gestational Weight Gain with Maternal and Neonatal Outcomes in Adolescents and Adults from Mexico City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:280. [PMID: 35010540 PMCID: PMC8750657 DOI: 10.3390/ijerph19010280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/13/2021] [Accepted: 12/24/2021] [Indexed: 06/14/2023]
Abstract
During pregnancy, adolescents experience physiological changes different from adults because they have not concluded their physical growth. Therefore, maternal and neonatal outcomes may not be the same. This paper aimed to analyze the association between pregestational BMI (pBMI) and gestational weight gain (GWG) with maternal and neonatal outcomes in adolescent and adult pregnant women. The authors performed an observational study that included 1112 women, where 52.6% (n = 585) were adolescents. Sociodemographic information, pBMI, GWG, neonatal anthropometric measures, and maternal and neonatal outcomes were obtained. Adolescent women had a mean lower (21.4 vs. 26.2, p ≤ 0.001) pBMI than adults and a higher gestational weight gain (12.3 vs. 10.7 kg, p ≤ 0.001). According to Poisson regression models, gestational diabetes is positively associated with insufficient GWG and with pregestational obesity. Furthermore, the probability of developing pregnancy-induced hypertension increased with pBMI of obesity compared to normal weight. Preeclampsia, anemia, and preterm birth were not associated with GWG. Insufficient GWG was a risk factor, and being overweight was a protective factor for low birth weight and small for gestational age. We conclude that pBMI, GWG, and age group were associated only with gestational diabetes and low birth weight.
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Affiliation(s)
- Reyna Sámano
- Coordinación de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud, Mexico City 11000, Mexico; (M.E.F.-Q.); (E.G.-M.)
- Programa de Posgrado Doctorado en Ciencias Biológicas y de la Salud, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Mexico City 04960, Mexico; (L.O.-H.); (O.N.-M.)
| | - Gabriela Chico-Barba
- Coordinación de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud, Mexico City 11000, Mexico; (M.E.F.-Q.); (E.G.-M.)
- Escuela de Enfermería, Facultad de Ciencias de la Salud, Universidad Panamericana, Mexico City 03920, Mexico
- Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de la Salud, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - María Eugenia Flores-Quijano
- Coordinación de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud, Mexico City 11000, Mexico; (M.E.F.-Q.); (E.G.-M.)
| | - Estela Godínez-Martínez
- Coordinación de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud, Mexico City 11000, Mexico; (M.E.F.-Q.); (E.G.-M.)
| | - Hugo Martínez-Rojano
- Sección de Posgrado e Investigación de la Escuela Superior de Medicina del Instituto Politécnico Nacional, Mexico City 11340, Mexico;
| | - Luis Ortiz-Hernandez
- Programa de Posgrado Doctorado en Ciencias Biológicas y de la Salud, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Mexico City 04960, Mexico; (L.O.-H.); (O.N.-M.)
- Departamento de Atención a la Salud, Universidad Autónoma Metropolitana Xochimilco, Mexico City 04960, Mexico
| | - Oralia Nájera-Medina
- Programa de Posgrado Doctorado en Ciencias Biológicas y de la Salud, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Mexico City 04960, Mexico; (L.O.-H.); (O.N.-M.)
- Departamento de Atención a la Salud, Universidad Autónoma Metropolitana Xochimilco, Mexico City 04960, Mexico
| | - María Hernández-Trejo
- Departamento de Neurobiología del Desarrollo, Instituto Nacional de Perinatología, Secretaría de Salud, Mexico City 11000, Mexico;
| | - Cristopher Hurtado-Solache
- Escuela de Ciencias de la Salud, Universidad del Valle de México-Chapultepec, Mexico City 11810, Mexico;
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Feng XL, Wang Y, Chen Z, Carine R. Factors affecting the frequency and contents of routine antenatal care in remote rural China in 2009-2016: an observational study. BJOG 2021; 129:1062-1072. [PMID: 34860444 DOI: 10.1111/1471-0528.17037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 08/27/2021] [Accepted: 09/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We assessed factors associated with frequency and contents of antenatal care (ANC) in remote rural China, including province of residence and individual level factors. DESIGN Survey-based cross-sectional study. SETTING Remote rural China, Five provinces- Jilin, Shaanxi, Hunan, Guizhou, and Ningxia. SAMPLE 3,918 women with a live birth in 2009-2016. METHODS Poisson regression. MAIN OUTCOME MEASURES ANC frequency- 5+ visits starting in the first trimester. ANC contents- co-coverage of six care components, and overuse of ultrasound. MAIN RESULTS Three quarters (72.9%) of women had 5+ visits starting in the first trimester, 68.8% received all six care components, and 94.5% had 3+ ultrasounds. Only 30.9% women sought ANC from township hospitals, paying between $3.8 and 25.8 per-visit. ANC frequency and contents were associated with women's socio-economic characteristics, but provincial effects were much stronger, even after adjusting for individual factors. Women living in Guizhou and Ningxia, the two poorest provinces with high proportions of ethnic minorities, were particularly underserved. Compared to women in Shaanxi, women in Guizhou were 33% (adjusted RR 0.67, 95%CI 0.61-0.74) less likely to receive 5+ ANC starting in the first trimester; women in Ningxia were 17% less likely (adjusted RR 0.83, 95% CI 0.76-0.90) to receive all six care components. CONCLUSION The province of residence was a stronger predictor of ANC frequency and contents than women's individual characteristics in China, suggesting that strengthening the decentralised system of financing and organisation of ANC at province level is crucial to achieving success. Future efforts are warranted to engage sub-regional administrations.
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Affiliation(s)
- Xing Lin Feng
- Department of Health Policy and Management, School of Public Health, Peking University, UK
| | - Ying Wang
- Department of Health Policy and Management, School of Public Health, Peking University, UK
| | - Zhengchao Chen
- Department of Health Policy and Management, School of Public Health, Peking University, UK
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Serván-Mori E, Orozco-Núñez E, Heredia-Pi I, Armenta-Paulino N, Wirtz VJ, Meneses-Navarro S, Nigenda G. Public health insurance and ethnic disparities in maternal health care: the case of vulnerable Mexican women over the last 25 years. Health Policy Plan 2021; 36:1671-1680. [PMID: 34557904 DOI: 10.1093/heapol/czab119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 09/14/2021] [Accepted: 09/23/2021] [Indexed: 11/13/2022] Open
Abstract
This article examines the coverage in the continuum of antenatal-postnatal care for vulnerable women in Mexico according to indigenous status and assesses the influence of public health insurance strategies on the evolution of coverage over the last 25 years. We studied a total of 19 613 567 Mexican women, aged 12-54 years at last birth, based on a pooled cross-sectional analysis of data from the 1997, 2009, 2014 and 2018 waves of the National Survey of Demographic Dynamics. After describing sociodemographic characteristics and maternal-health coverage by indigenous status, we constructed a pooled fixed-effects and interaction multivariable regression model to assess the influence of the Seguro Popular programme on continuum of care. We estimated adjusted continuum of care coverage between 1994 and 2018 according to Seguro Popular affiliation and indigenous status. Prior to the Seguro Popular programme, crude coverage in the continuum of care for non-indigenous women stood at 14.5% [95% confidence interval (CI): 13.2-15.8%] or 11 percentage points higher than for indigenous women. During the last period of the programme, it rose to 46.5% [95% CI: 45.6-47.5%] and 34.1% [95% CI: 30.7-37.4%], respectively. Our regression analysis corroborated findings that, on average, indigenous women faced lower odds of benefiting from continuum of care [adjusted odds ratio (aOR) = 0.48, 95% CI: 0.40-0.57] than did their non-indigenous counterparts. It also revealed that coverage for indigenous women without Seguro Popular affiliation was 26.7% [95% CI: 23.3-30.1%] or 12 percentage points lower than for those with Seguro Popular affiliation (38.6%, 95% CI: 35.7-41.4%). Our regression results confirmed that the latter benefited from higher odds of continuum of care (aOR = 1.67, 95% CI: 1.36-2.26). Gaps between those of indigenous and non-indigenous status have persisted, but the Seguro Popular clearly contributed to reducing the coverage gaps between these two groups of women. Strategies yielding better outcomes are required to improve the structural conditions of indigenous populations.
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Affiliation(s)
- Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico
| | - Emanuel Orozco-Núñez
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico
| | - Ileana Heredia-Pi
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico
| | - Nancy Armenta-Paulino
- International Center for Equity in Health, Federal University of Pelotas, Pelotas 96020-220, Brazil
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA
| | - Sergio Meneses-Navarro
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico
| | - Gustavo Nigenda
- National School of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City 14370, Mexico
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Bobo FT, Asante A, Woldie M, Hayen A. Poor coverage and quality for poor women: Inequalities in quality antenatal care in nine East African countries. Health Policy Plan 2021; 36:662-672. [PMID: 33822943 DOI: 10.1093/heapol/czaa192] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/12/2022] Open
Abstract
The use of quality antenatal care (ANC) improves maternal and newborn health outcomes. Ensuring equity in access to quality maternal health services is a priority agenda in low- and middle-income countries. This study aimed to assess inequalities in the use of quality ANC in nine East African countries using the most recent Demographic and Health Surveys. We used two outcome variables to examine ANC service adequacy: four or more ANC contacts and quality ANC. We defined quality ANC as having six of the recommended ANC components during follow-up: blood pressure measurement, urine sample test, blood sample test, provision of iron supplements, drug for intestinal parasite and tetanus toxoid injections. We used the concentration index (CCI) to examine inequalities within and across countries. We fitted a multilevel regression model to assess the predictors of inequalities in the contact and content of ANC. This study included 87 068 women; among those 54.4% (n = 47 387) had four or more ANC contacts, but only 21% (n = 15 759) reported receiving all six services. The coverage of four or more ANC and receipt of all six services was pro-rich within and across all countries. The highest inequality in four or more ANC contacts was in Ethiopia with a CCI of 0.209, while women in Burundi had the highest inequality in coverage of all six services (CCI: 0.318). Higher education levels and media exposure were predictors of service uptake, while women who had unintended pregnancies were less likely to make four or more ANC contacts and receive six services. Interventions to improve access to quality ANC require rethinking the service delivery mechanisms in all countries. Moreover, ensuring equity in access to quality ANC requires tailoring service delivery modalities to address the social determinants of service uptake.
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Affiliation(s)
- Firew Tekle Bobo
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.,School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Augustine Asante
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia.,Fenot Project of Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia
| | - Andrew Hayen
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Fene F, Serván-Mori E, Ángel Mendoza M, Chivardi C, Reyes-Morales H, Nigenda G. Measuring and analysing social efficiency in the production of maternal health services in Mexico, 2008-15. Health Policy Plan 2021; 35:889-899. [PMID: 32588053 DOI: 10.1093/heapol/czaa055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 11/12/2022] Open
Abstract
'Social efficiency' (SE) denotes the capacity of health systems to ensure equitable access to quality health services at no financial risk to users. Mexico and other low- and middle-income countries have rarely studied the performance of their health systems from an SE perspective. We propose a metric for assessing SE in the production of maternal health services in the public sector among populations without social security, analysing contextual correlates of the demand for these services. Analysis was based on administrative data collected from the 243 health jurisdictions (HJs) in Mexico for the period 2008-15. We defined production inputs as the availability of physical and human resources and social product as the unweighted sum of social sub-products, including an equitable distribution of maternal health resources, the provision of quality maternal health care and financial protection for users. We described the SE scores, the main contextual characteristics as well as those related to the demand for maternal health services. We then performed a variance decomposition analysis of the SE score by component and estimated the SE territorial concentration patterns. Finally, we identified the structural characteristics modelling SE by means of a spatial autoregressive panel data model with fixed effects by year. The SE score rose from 57.7% in 2008 to 71.9% in 2015 (P < 0.01), with its quality component accounting for the largest proportion of variance (30%). SE peaked in HJs with low social marginalization and rurality, and with service demand characterized by low parity and older populations. Different SE levels demonstrated territorial concentration patterns. Analysing SE as a metric for health system performance offers elements that contribute to the achievement of UHC as well as to the design and implementation of effective maternal health interventions intended particularly for the most socially vulnerable sectors of the population.
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Affiliation(s)
- Fato Fene
- School of Public Health of Mexico at the National Institute of Public Health of Mexico, Av. Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico
| | - Edson Serván-Mori
- Center for Health System Research, National Institute of Public Health of Mexico, Av. Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico
| | - Miguel Ángel Mendoza
- School of Economics, National Autonomous University of Mexico, Interior S/N, C.U., Coyoacán, 04510 Mexico City, Mexico
| | - Carlos Chivardi
- Center for Health System Research, National Institute of Public Health of Mexico, Av. Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico
| | - Hortensia Reyes-Morales
- Center for Health System Research, National Institute of Public Health of Mexico, Av. Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico
| | - Gustavo Nigenda
- National School of Nursing and Obstetrics, National Autonomous University of Mexico, Camino Viejo to Xochimilco and, Viad. Tlalpan, Huipulco, 14370 Mexico City, Mexico
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Omidakhsh N, von Ehrenstein OS. Improved Water, Sanitation and Utilization of Maternal and Child Health Services in South Asia-An Analysis of Demographic Health Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147667. [PMID: 34300122 PMCID: PMC8303440 DOI: 10.3390/ijerph18147667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 01/21/2023]
Abstract
Globally, many millions of people still lack access to safe drinking water and sanitation facilities. Here, we examined associations between household availability of improved drinking water and sanitation, respectively, and use of maternal and child health (MCH) services in South Asian countries. Demographic and Health Survey population-based data from Bangladesh, Nepal, India, and Pakistan were used, restricted to women with a child aged 0-36 months (n = 145,262). Types of households' water source and sanitation facilities were categorized based on the World Health Organization and UNICEF's definitions of "improved" and "unimproved". We applied logistic regressions to estimate odds ratios (OR) and 95% confidence intervals (CI) for improved water and sanitation, respectively, and reported antenatal care visits, having a skilled attendant at birth, and infant vaccination coverage, stratified by maternal education. Among lower educated women, access to improved water source was associated with greater ORs for presence of a skilled attendant at delivery and their children having up-to-date immunizations (OR: 1.29; 95% CI: 1.17, 1.42). Among lower and higher educated women, improved sanitation (vs. unimproved) was associated with greater ORs for having had adequate antenatal care visits (OR: 1.74; 95% CI: 1.62, 1.88; OR: 1.71; 95% CI: 1.62, 1.80), and similarly for having had a skilled attendant at birth, and children with up-to-date immunizations. Approaches addressing water/sanitation and MCH services across sectors could be a suggested public health strategy.
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Tadele A, Teka B. Adequacy of prenatal care services and associated factors in Southern Ethiopia. Arch Public Health 2021; 79:94. [PMID: 34099020 PMCID: PMC8183068 DOI: 10.1186/s13690-021-00614-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 05/21/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Prenatal care is an important component for the continuum of care in maternal and child health services. Despite increased attention on prenatal care service coverage, the adequacy of service provision has not been well addressed in Ethiopia. Therefore, this study aimed to describe the status of the adequacy of prenatal care and its associated factors in Southern Ethiopia. METHOD A longitudinal study done by the Performance care Monitoring and Accountability (PMA2020) project was used. The study was conducted from August 2016 to January 2017 in Southern Ethiopia. A multistage stratified cluster design in which all enumeration areas were randomly selected using probability proportional to size and all households were screened to identify 324 pregnant women of six or more months. Questions regarding early attendance of prenatal care, enough visits, and sufficient services were asked to measure the adequacy of prenatal care. Finally, an ordered logistic regression analysis was employed to assess factors associated with the adequacy of prenatal care services. RESULTS Of the total pregnant women 44.21 % attended enough visits, 84.10 % had early visits, and 42.03 % received sufficient services. The women residing in urban areas had 2.35 odds of having adequate prenatal care in reference to rural areas (adjusted odds ratio (aOR) 2.35 [95 % CI 1.05-5.31]). Women who attended primary and secondary education had 2.42(aOR 2.42 [95 % C.I. 1.04, 5.65]), and 4.18 (aOR 4.18 [95 % CI 1.32, 13.29]) odds of adequate prenatal care in reference with those who never attended education respectively. The women participating in one to five networks have 2.18 odds of adequate prenatal care in reference to their counterparts (aOR 2.78 [95 % CI 1.01, 7.71]). CONCLUSIONS The adequacy of prenatal care services in Southern Ethiopia is very low. The Ethiopian health care system should strengthen one to five networks to discuss on family health issues. Further research, should validate the tools and measure the adequacy of the services in different contexts of Ethiopia using a mixed method study for an in-depth understanding of the problem.
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Affiliation(s)
- Afework Tadele
- Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Bekelu Teka
- Population and Family Health, Jimma University, Jimma, Ethiopia
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Anik AI, Islam MR, Rahman MS. Do women's empowerment and socioeconomic status predict the adequacy of antenatal care? A cross-sectional study in five South Asian countries. BMJ Open 2021; 11:e043940. [PMID: 34083327 PMCID: PMC8183191 DOI: 10.1136/bmjopen-2020-043940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Relative to the attention given to improving the measurement of adequacy of antenatal care (ANC) in South Asian (SA) region, the influence of women's empowerment and socioeconomic status (WESES) on adequate ANC services has hardly received any attention. This study aimed to investigate the present scenario of adequacy of ANC in SA and how its adequacy was associated with WESES. SETTING AND PARTICIPANTS Using the Demographic and Health Survey data set of five SA countries, that is, Afghanistan, Bangladesh, India, Nepal and Pakistan, 48 107 women were selected in this study who received at least one ANC component and had at least one live birth in the 3 or 5 years preceding the survey. ANALYSIS Multilevel logistic regression models were used to investigate the relationship between adequacy of ANC and WESES. RESULTS Only 30% women received adequate ANC in SA, ranging from 8.4% (95% CI 7.1% to 9.9%) in Afghanistan to 39.8% (95% CI 37.4% to 42.2%) in Nepal. The poor utilisation of adequate ANC services was most prevalent among the women residing in rural areas and that of poor families as well as low empowerment status in SA countries. Different levels of WESES, that is, highly empowered but poor (adjusted OR (AOR): 1.33; 95% CI 1.18 to 1.49), lowly empowered but rich (AOR: 2.07; 95% CI 1.84 to 2.32) and highly empowered and rich women (AOR: 3.07; 95% CI 2.75 to 3.43), showed significant positive association with adequate ANC services than the poor and low empowered women, after adjusting the potential covariates. CONCLUSION As unsatisfactory level of adequate ANC services has been observed in SA region, this study suggests a nationwide comprehensive improvement of women's empowerment status as well as establishment of necessary healthcare centres in remote areas is essential to ensure long-term and sustainable adequacy of ANC services.
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Affiliation(s)
- Asibul Islam Anik
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Md Rashedul Islam
- Department of Global Health Policy, Faculty of Medicine, The University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Division of Prevention, Center for Public Health Science, National Cancer Center Japan, Chuo-ku, Tokyo, Japan
| | - Md Shafiur Rahman
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Osaka, Japan
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Tello-Torres C, Hernández-Vásquez A, Dongo KF, Vargas-Fernández R, Bendezu-Quispe G. Prevalence and Determinants of Adequate Compliance with Antenatal Care in Peru. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:442-451. [PMID: 34318469 PMCID: PMC10411206 DOI: 10.1055/s-0041-1732463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 05/27/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To determine the adequacy of compliance with antenatal care (ANC) by pregnant women in Peru and to identify the associated factors. METHODS An analytical cross-sectional study of data from the 2019 Peruvian Demographic and Family Health Survey (Encuesta Demográfica y de Salud Familiar, ENDES, in Spanish) was conducted. The dependent variable was adequate compliance with ANC (provided by skilled health care professionals; first ANC visit during the first trimester of pregnancy; six or more ANC visits during pregnancy; ANC visits with appropriate content) by women aged 15 to 49 years in their last delivery within the five years prior to the survey. Crude and adjusted prevalence ratios and their 95% confidence intervals were calculated using a log-binomial regression model. RESULTS A total of 18,386 women were analyzed, 35.0% of whom adequately complied with ANC. The lowest proportion of compliance was found with the content of ANC (42.6%). Sociodemographic factors and those related to pregnancy, such as being in the age groups of 20 to 34 years and 35 to 49 years, having secondary or higher education, belonging to a wealth quintile of the population other than the poorest, being from the Amazon region, not being of native ethnicity, having a second or third pregnancy, and having a desired pregnancy, increased the probability of presenting adequate compliance with ANC. CONCLUSION Only 3 out of 10 women in Peru showed adequate compliance with ANC. Compliance with the content of ANC must be improved, and strategies must be developed to increase the proportion of adequate compliance with ANC.
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Affiliation(s)
| | - Akram Hernández-Vásquez
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
| | - Karla F. Dongo
- Facultad de Medicina Humana, Universidad Científica del Sur, Lima, Peru
| | | | - Guido Bendezu-Quispe
- Universidad Privada Norbert Wiener, Centro de Investigación Epidemiológica en Salud Global, Lima, Peru
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Association between Maternal Dietary Diversity and Low Birth Weight in Central India: A Case-Control Study. J Nutr Metab 2021; 2021:6667608. [PMID: 34194827 PMCID: PMC8181120 DOI: 10.1155/2021/6667608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/25/2021] [Indexed: 11/28/2022] Open
Abstract
Low birth weight (LBW) is one of the major public health challenges in India. LBW etiology is multifactorial and linked to multiple determinants, including maternal undernutrition and sociodemographic characteristics. The objective of the present endeavor was to assess how maternal dietary diversity and other sociodemographic factors among marginalized populations are associated with the incidence of LBW. The study was a part of the community-based intervention that aimed to improve maternal and child health in the Morena district of Madhya Pradesh, a state in central India. In this case-control study, cases were defined as mothers with an LBW child (<2500 grams) and controls as mothers without an LBW child. A quantitative survey was done with women of reproductive age, having at least one child aged 0–24 months. We calculated the dietary diversity based on the number of food groups consumed during pregnancy by women on a daily basis. Stepwise logistic regression models were built to test for associations between sociodemographic and dietary diversity variables and LBW incidence. There were 157 mothers with and 214 without an LBW child. Women's diets mainly consisted of grains, such as wheat, rice, maize, and roots and tubers. Eggs and meat were consumed by less than 1% of the women. There were 20% lesser chances of an LBW child with increasing maternal dietary diversity scores (odds ratio: 0.79; 95% CI: 0.65, 0.96). The poor maternal diet quality during pregnancy may result in adverse birth outcomes with long-term consequences in a child.
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Mugo NS, Mya KS, Raynes-Greenow C. Country compliance with WHO-recommended antenatal care guidelines: equity analysis of the 2015-2016 Demography and Health Survey in Myanmar. BMJ Glob Health 2021; 5:bmjgh-2019-002169. [PMID: 33298468 PMCID: PMC7733101 DOI: 10.1136/bmjgh-2019-002169] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Early access to adequate antenatal care (ANC) from skilled providers is crucial for detecting and preventing obstetric complications of pregnancy. We aimed to assess factors associated with the utilisation of the new WHO ANC guidelines including the recommended number, on time initiation and adequate components of ANC contacts in Myanmar. Methods We examined data from 2943 mothers aged 15–49 years whose most recent birth occurred in the last 5 years prior to the 2015–2016 Myanmar Demographic and Health Survey. Factors associated with utilisation of the new WHO recommended ANC were explored using multinomial logistic regression and multivariate models. We used marginal standardisation methods to estimate the predicted probabilities of the factors significantly associated with the three measures of ANC. Results Approximately 18% of mothers met the new WHO recommended number of eight ANC contacts. About 58% of the mothers received adequate ANC components, and 47% initiated ANC within the first trimester of pregnancy. The predicted model shows that Myanmar could achieve 70% coverage of adequate components of ANC if all women were living in urban areas. Similarly, if ANC was through private health facilities, 63% would achieve adequate components of ANC. Pregnant women from urban areas (adjusted risk ratio (aRR): 4.86, 95% CI 2.44 to 9.68) were more than four times more likely to have adequate ANC components compared with women from rural areas. Pregnant women in the highest wealth quintile were three times more likely to receive eight or more ANC contacts (aRR: 3.20, 95% CI 1.61 to 6.36) relative to mothers from the lowest wealth quintile. On time initiation of the first ANC contact was fourfold for mothers aged 30–39 years relative to adolescent mothers (aRR: 4.07, 95% CI 1.53 to 10.84). Conclusion The 2016 WHO ANC target is not yet being met by the majority of women in Myanmar. Our results highlight the need to address health access inequity for women who are from lower socioeconomic groups, or are younger, and those living in rural areas.
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Affiliation(s)
- Ngatho Samuel Mugo
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kyaw Swa Mya
- Department of Biostatistics and Medical Demography, University of Public Health, Yangon, Myanmar
| | - Camille Raynes-Greenow
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Bintabara D, Basinda N. Twelve-year persistence of inequalities in antenatal care utilisation among women in Tanzania: a decomposition analysis of population-based cross-sectional surveys. BMJ Open 2021; 11:e040450. [PMID: 33879479 PMCID: PMC8061846 DOI: 10.1136/bmjopen-2020-040450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study was undertaken to assess the trend and contributors of socioeconomic inequalities in antenatal care (ANC) utilisation among women of reproductive age in Tanzania from 2004 to 2016. DESIGN Population-based cross-sectional surveys. SETTING This study analysed nationally representative data for women of reproductive age obtained from the 2004-2016 Tanzania Demographic Health Surveys. PRIMARY OUTCOME MEASURE The outcome variables analysed in this study are: (1) attendance of ANC and (2) accessing adequate antenatal care. ANALYTICAL METHODS The concentration curve and the concentration index were used to measure socioeconomic inequality in attending and accessing adequate ANC. The concentration index was decomposed to identify the factors explaining the observed socioeconomic inequality of these two outcomes. RESULTS The concentration index for attending at least four ANC visits increased from 0.169 in 2004 to 0.243 in 2016 (p<0.01). Similarly, for accessing adequate care, the index increased from 0.147 in 2004 to 0.355 in 2016 (p<0.01). This indicates the significant increase in socioeconomic inequalities (favouring wealthier women) for these two outcomes over time. Furthermore, the results show that wealth status was the largest contributor to inequality in both attending at least four visits (71%, 50% and 70%) and accessing adequate ANC (50%, 42% and 51%) in 2004, 2010 and 2016, respectively, in favour of wealthier women (p<0.05). The other contributors to socioeconomic inequalities in ANC utilisation were maternal education and type of residence. CONCLUSION Over the 12 years of surveys, there was no reduction in socioeconomic inequalities in ANC utilisation in Tanzania. Therefore, the efforts of achieving universal health coverage should focus on reducing wealth-related inequality and improving women's education from poor households.
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Affiliation(s)
| | - Namanya Basinda
- Department of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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Serván-Mori E, Heredia-Pi I, García DC, Nigenda G, Sosa-Rubí SG, Seiglie JA, Lozano R. Assessing the continuum of care for maternal health in Mexico, 1994-2018. Bull World Health Organ 2021; 99:190-200. [PMID: 33716341 PMCID: PMC7941105 DOI: 10.2471/blt.20.252544] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 10/07/2020] [Accepted: 10/19/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe the temporal and geographical patterns of the continuum of maternal health care in Mexico, as well as the sociodemographic characteristics that affect the likelihood of receiving this care. METHODS We conducted a pooled cross-sectional analysis using the 1997, 2009, 2014 and 2018 waves of the National Survey of Demographic Dynamics, collating sociodemographic and obstetric characteristics of 93 745 women aged 12-54 years at last delivery. We defined eight variables along the antenatal-postnatal continuum, both independently and conditionally. We used a pooled fixed-effects multivariable logistic model to determine the likelihood of receiving the continuum of care for various properties. We also mapped the quintiles of adjusted state-level absolute change in continuum of care coverage during 1994-2018. FINDINGS We observed large absolute increases in the proportion of women receiving timely antenatal and postnatal care (from 48.9% to 88.2% and from 39.1% to 68.7%, respectively). In our conditional analysis, we found that the proportion of women receiving adequate antenatal care doubled over this period. We showed that having social security and a higher level of education is positively associated with receiving the continuum of care. We observed the largest relative increases in continuum of care coverage in Chiapas (181.5%) and Durango (160.6%), assigned human development index categories of low and medium, respectively. CONCLUSION Despite significant progress in coverage of the continuum of maternal health care, disparities remain. While ensuring progress towards achievement of the health-related sustainable development goal, government intervention must also target underserved populations.
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Affiliation(s)
- Edson Serván-Mori
- Center for Health System Research, National Institute of Public Health, Avenida Universidad #655, 62100, Cuernavaca, Morelos, Mexico
| | - Ileana Heredia-Pi
- Center for Health System Research, National Institute of Public Health, Avenida Universidad #655, 62100, Cuernavaca, Morelos, Mexico
| | - Diego Cerecero García
- Center for Health System Research, National Institute of Public Health, Avenida Universidad #655, 62100, Cuernavaca, Morelos, Mexico
| | - Gustavo Nigenda
- National School of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
| | - Sandra G Sosa-Rubí
- Center for Health System Research, National Institute of Public Health, Avenida Universidad #655, 62100, Cuernavaca, Morelos, Mexico
| | - Jacqueline A Seiglie
- Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America (USA)
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
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Arroyave L, Saad GE, Victora CG, Barros AJD. A new content-qualified antenatal care coverage indicator: Development and validation of a score using national health surveys in low- and middle-income countries. J Glob Health 2021; 11:04008. [PMID: 33692892 PMCID: PMC7916319 DOI: 10.7189/jogh.11.04008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Good quality antenatal care (ANC) helps reduce adverse maternal and newborn outcomes, especially in low and middle-income countries (LMICs). Most of the currently used ANC indicators only measure contact with services. We aimed to create and validate a new indicator measured as a score, considering both contact and content, that can be used for monitoring. Methods We used data from national surveys conducted in LMICs. Information on ANC was used to build an adequacy score (ANCq) that would be applicable to all women in need of ANC. Cronbach's alpha and factor analysis were used to assess the proposed indicator. We also used a convergent validation approach, exploring the association of our proposed indicator with neonatal mortality. Results The ANCq score was derived from seven variables related to contact with services and content of care ranging from zero to ten. Surveys from 63 countries with all variables were used. The validity assessment showed satisfactory results based on Cronbach's alpha (0.82) and factor analysis. The overall mean of ANCq was 6.7, ranging from 3.5 in Afghanistan to 9.3 in Cuba and the Dominican Republic. In most countries, the ANCq was inversely associated with neonatal mortality and the pooled for all surveys Odds Ratio was 0.90 (95% CI = 0.88-0.92). Conclusions ANCq allows the assessment of ANC in LMICs considering contact with services and content of care. It also presented good validity properties, being a useful tool for assessing ANC coverage and adequacy of care in monitoring and accountability exercises.
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Affiliation(s)
- Luisa Arroyave
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil.,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Ghada E Saad
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil.,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Aluisio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil.,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
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The Bangladesh Maternal Health Voucher Scheme: impact on completeness of antenatal care provision. J Biosoc Sci 2021; 54:217-224. [PMID: 33487188 DOI: 10.1017/s0021932020000784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study aimed to assess completeness of antenatal care coverage following implementation of a voucher scheme for maternal health in Bangladesh. The investigation used interview data from a survey conducted in Bangladesh in 2017 of 2400 randomly selected women aged 15-49 with children aged 0-23 months in four geographical areas where voucher scheme implementation was underway. Of these women, 1944 had attended at least one antenatal clinic visit so were included in the analysis. A 'completeness index' for antenatal visits was constructed as an outcome variable based on recall of thirteen elements of care. Bivariate analysis against independent variables of interest was carried out and multivariate linear regression models developed to examine the influence of voucher scheme participation on completeness of antenatal care adjusting for socio-demographic characteristics. Voucher scheme membership was associated with higher 'completeness index' scores, with a mean score of 185.2±101.0 for voucher recipients and 139.6 ± 93.3 for non-recipients (p<0.001). Scheme membership reduced the differentials associated with health facility type and socioeconomic status. Women from the lowest socioeconomic group who were voucher recipients received substantially more components of antenatal care (mean score: 159.6±82.1) compared with non-recipients (mean score: 115.7±83.0). This favourable effect of voucher scheme membership on the most vulnerable socioeconomic group remained significant after adjusting for educational status. The Bangladesh voucher scheme model has the potential to maximize gains in maternal and newborn health through enhancing the completeness of service provision.
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Kim C, Tappis H, Natiq L, Fried B, Lich KH, Delamater PL, Weinberger M, Trogdon JG. Travel time, availability of emergency obstetric care, and perceived quality of care associated with maternal healthcare utilisation in Afghanistan: A multilevel analysis. Glob Public Health 2021; 17:569-586. [PMID: 33460359 DOI: 10.1080/17441692.2021.1873400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Limited understanding of factors such as travel time, availability of emergency obstetric care (EmOC), and satisfaction/perceived quality of care on the utilisation of maternal health services exists in fragile and conflict-affect settings. We examined these key factors on three utilisation outcomes: at least one skilled antenatal care (ANC) visit, in-facility delivery, and bypassing the nearest public facility for childbirth in Afghanistan from 2010 to 2015. We used three-level multilevel mixed effects logistic regression models to assess the relationships between women's and their nearest public facilities' characteristics and outcomes. The nearest facility score for satisfaction/perceived quality was associated with having at least one skilled ANC visit (AOR: 2.02, 95% CI: 1.21, 3.36). Women whose nearest facility provided EmOC had a higher odds of in-facility childbirth compared to women whose nearest facility did not (AOR: 1.24, 95% CI: 1.04, 1.48). Nearest hospital travel time (AOR: 0.95, 95% CI: 0.93, 0.98) and nearest facility satisfaction/perceived quality (AOR: 0.34, 95% CI: 0.14, 0.82) were associated with lower odds of women bypassing their nearest facility. Afghanistan has made progress in expanding access to maternal healthcare services during the ongoing conflict. Addressing key barriers is essential to ensure that women have access to life-saving services.
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Affiliation(s)
- Christine Kim
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hannah Tappis
- Technical Leadership and Innovations Department, Jhpiego, Baltimore, MD, USA
| | - Laila Natiq
- Silk Route Training and Research Organization, Kabul, Afghanistan
| | - Bruce Fried
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paul L Delamater
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Banchani E, Tenkorang EY. Determinants of Low Birth Weight in Ghana: Does Quality of Antenatal Care Matter? Matern Child Health J 2020; 24:668-677. [PMID: 32026325 DOI: 10.1007/s10995-020-02895-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Low birth weight is a public health issue that contributes to perinatal and infant mortality, especially in limited-resource settings, but there is limited understanding of the determinants of low birth weight and the contributions of quality antenatal care to maintaining healthy birth weights for newborns in such settings. This study aims at establishing links between birthweight and quality antenatal care in Ghana. METHODS We used data collected from the recent 2017 Ghana Maternal Health Survey and applied complementary log-log models to investigate relationships between the quality of antenatal care (screening/diagnostic procedures, clinical interventions, type of health provider) and low birth weight in Ghana. RESULTS The results reveal that compared to women who received low quality clinical interventions, those who received high quality interventions were significantly less likely to have a low birth weight baby. Similarly, women who made the recommended number of antenatal visits (at least eight) were significantly less likely to have a baby with low birth weight than women making fewer visits. CONCLUSION Our findings suggest that while the number of antenatal visits is important, the quality of care received during such visits is equally relevant to reducing low birth weight in Ghana.
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Affiliation(s)
- Emmanuel Banchani
- Department of Sociology, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada
| | - Eric Y Tenkorang
- Department of Sociology, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada.
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Ibañez-Cuevas M, Heredia-Pi IB, Fuentes-Rivera E, Andrade-Romo Z, Alcalde-Rabanal J, Cacho LBB, Guzmán-Delgado X, Jurkiewicz L, Darney BG. Group Prenatal Care in Mexico: perspectives and experiences of health personnel. Rev Saude Publica 2020; 54:140. [PMID: 33331532 PMCID: PMC7703532 DOI: 10.11606/s1518-8787.2020054002175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 04/08/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Identify barriers and facilitators to implementing the Group Prenatal Care model in Mexico (GPC) from the health care personnel's perspective. METHODS We carried out a qualitative descriptive study in four clinics of the Ministry of Health in two states of Mexico (Morelos and Hidalgo) from June 2016 to August 2018. We conducted 11 semi-structured interviews with health care service providers, and we examined their perceptions and experiences during the implementation of the GPC model. We identified the barriers and facilitators for its adoption in two dimensions: a) structural (space, resources, health personnel, patient volume, community) and b) attitudinal (motivation, leadership, acceptability, address problems, work atmosphere and communication). RESULTS The most relevant barriers reported at the structural level were the availability of physical space in health units and the work overload of health personnel. We identified the difficulty in adopting a less hierarchical relationship during the pregnant women's care at the attitudinal level. The main facilitator at the attitudinal level was the acceptability that providers had of the model. One specific finding for Mexico's implementation context was the resistance to change the doctor-patient relationship; it is difficult to abandon the prevailing hierarchical model and change to a more horizontal relationship with pregnant women. CONCLUSION Analyzing the GPC model's implementation in Mexico, from the health care personnel's perspective, has revealed barriers and facilitators similar to the experiences in other contexts. Future efforts to adopt the model should focus on timely attention to identified barriers, especially those identified in the attitudinal dimension that can be modified by regular health care personnel training.
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Affiliation(s)
- Midiam Ibañez-Cuevas
- Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, MOR, México
| | - Ileana Beatriz Heredia-Pi
- Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, MOR, México
| | - Evelyn Fuentes-Rivera
- Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, MOR, México
| | - Zafiro Andrade-Romo
- Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, MOR, México
| | - Jacqueline Alcalde-Rabanal
- Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, MOR, México
| | | | - Xochitl Guzmán-Delgado
- Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, MOR, México
| | - Laurie Jurkiewicz
- University of California San Francisco. San Francisco General Hospital. Department of ObGyn & Reproductive Sciences. San Francisco, CA, USA
| | - Blair G Darney
- Oregon Health & Science University. Department of Obstetrics & Gynecology. Portland, OR, USA
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Abstract
Objective: The WHO and UNICEF recommend home visits to improve health outcomes for mothers and newborns. We evaluated the effect of home visits by community volunteers during pregnancy and postpartum on breast-feeding practices, women’s knowledge about benefits, beliefs and myths of breast-feeding, obstetric and neonatal warning signs, preparation for childbirth and initial care for newborns, and diarrhoea and respiratory diseases in children. Design: Community quasi-experimental design. We estimated difference-in-difference models with fixed effects at the community level weighted by propensity score and investigated implementation barriers through focus groups and semi-structured interviews. Setting: Poor rural communities in Mexico; 48 intervention and 29 control. Participants: Baseline and follow-up information were reported from two independent cross-sectional samples of women with babies aged between 6 and 18 months (baseline: 292 control, 320 intervention; follow-up: 292 control, 294 intervention). Results: The intervention increased reports of exclusive breast-feeding in the first 6 months by 24·4 percentage points (pp) (95 % CI: 13·4, 35·4), mothers’ knowledge of obstetric warning signs by 23·4 pp (95 % CI: 9·2, 37·5) and neonatal warning signs by 26·2 pp (95 % CI: 15·2, 37·2) compared to the control group. A non-linear dose–response relation with the number of home visits was found. Diarrhoea and respiratory diseases among children decreased in the intervention v. control group but were not statistically significant. Conclusions: Home visits should be implemented as a complementary strategy to the provision of prenatal and postnatal care in rural communities due to their potential positive effects on the health of mothers and their children.
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Mota-Sanhua V, Suárez-Hesketh CI, Velázquez-Hernández B, Ruiz-Speare O. [Mexican pregnant women's environment, knowledge and attitudes on prenatal care]. ACTA ACUST UNITED AC 2020; 21:258-264. [PMID: 33027338 DOI: 10.15446/rsap.v21n2.78496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 02/16/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To explore the barriers and facilitators to prenatal care, as well as the knowledge about healthy pregnancy and the attitude towards pregnancy. MATERIALS AND METHODS Mixed-methods study in pregnant women with social and economic vulnerability. Barriers and facilitators for prenatal care were examined using ethnographic methods, while structured and semi-structured interviews were used to assess knowledge and attitudes. Data were categorized during the qualitative analysis, and frequencies, ratios, average and standard deviation were calculated in the quantitative analysis. RESULTS Ten women aged between 18 and 33 years were interviewed; 50% sought prenatal care during their first trimester. Facilitators included partner role and family support, and barriers were unsafe neighborhood and home, and lack of funds to cover transportation to the clinic. Most women did not receive information related to weight gain. Almost none knew about depression or abuse. Half of them did not know about risks of addictive substances, nor did they know about prevention of infectious diseases. Finally, attitudes towards pregnancy were: environmental stressors; chaotic homes; fears about pregnancy; and interest in knowing more about pregnancy. CONCLUSION The interviewed women were open to learn about their pregnancy and they have family and spouse support. Prenatal care should be strengthened with topics related to mental health, domestic abuse, healthy weight gain, risk of addictive substances, and prevention of infectious diseases. They can be enhanced by including safety in unsafe areas, as well as techniques for better time and family economy management.
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Affiliation(s)
- Vanessa Mota-Sanhua
- VM: Nutrióloga Clínica. M. Sc.; Ph.D. Ciencias de la Salud. Centro Médico ABC. México, México.
| | | | - Blanca Velázquez-Hernández
- CV: MD. Especialidad en Patología Clínica y Maestra en Administración de Instituciones. Centro Médico ABC. Colonia Las Américas. México, México.
| | - Octavio Ruiz-Speare
- OR: MD. M. Sc. Ciencias y FACS. Centro Médico ABC. Colonia Las Américas. México, México.
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Emiru AA, Alene GD, Debelew GT. Women's satisfaction with the quality of antenatal care services rendered at public health facilities in Northwest Ethiopia: the application of partial proportional odds model. BMJ Open 2020; 10:e037085. [PMID: 32948558 PMCID: PMC7500293 DOI: 10.1136/bmjopen-2020-037085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The study was aimed: (1) to describe the quality of antenatal care (ANC) at public health facilities in Northwest Ethiopia, including dimensions of the structure, process and outcome; and (2) to assess the relationship between ANC satisfaction and structure and process dimension of ANC quality. DESIGN Cross sectional. SETTING Healthcare facilities providing ANC services in Northwest Ethiopia. PARTICIPANTS 795 pregnant women attending the antenatal clinics at 15 public health facilities and 41 health workers working for the surveyed facilities. OUTCOME MEASURES The outcome variable, women's satisfaction with ANC, was constructed from multiple satisfaction items using principal component analysis on an ordered, categorical and three-point Likert scale. The key hypothesised factors considered were structural and process aspects of care. Data were analysed using the partial proportional odds model with 95% CI. RESULTS The result revealed that only 30.3% of the pregnant women were highly satisfied, whereas 31.7% had a lower satisfaction level. The findings showed that process quality indicators better predicted client satisfaction. In relation to this, better scores in history taking (aOR1=aOR2; 1.81 (95% CI 1.25 to 2.60)), counselling (aOR1 = aOR2; 1.89 (95% CI 1.33 to 2.69)) and screening (aOR1= aOR2; 18.10 (95% CI 11.52 to 28.39)) were associated with achieving higher satisfaction. We also observed a significant but lower satisfaction among women in the late trimester of pregnancy (aOR1 = aOR2; 0.87 (95% CI 0.78 to 0.97)). However, we did not see any significant relationship between structural variables and client satisfaction. CONCLUSIONS The study demonstrated that women's satisfaction with ANC was low. The contents of ANC services covered during client-provider interaction were the main factors affecting client satisfaction. This suggests that efforts are required to improve the competencies of health professionals to make them more effective while dealing with clients.
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Affiliation(s)
- Amanu Aragaw Emiru
- Reproductive Health and Population Studies, Bahir Dar University, Bahir Dar, Ethiopia
| | - G D Alene
- Epidemiology and Biostatistics, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gurmesa Tura Debelew
- Department of Population and Family Health, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
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Assessment of Quality of Antenatal Care Services and Its Determinant Factors in Public Health Facilities of Hossana Town, Hadiya Zone, Southern Ethiopia: A Longitudinal Study. ADVANCES IN PUBLIC HEALTH 2020. [DOI: 10.1155/2020/5436324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Antenatal care is a care that links the woman and her family with the formal health system, increases the chance of using a skilled attendant at birth, and contributes to good health through the life cycle. Inadequate care during this time breaks a critical link in the continuum of care and affects both women and babies. Therefore, the main aim of this study was to determine the quality of ANC in Hadiya Zone, Southern Ethiopia. Method. A longitudinal facility-based study design was conducted among 1123 mothers whose gestational age of less than 16 weeks was identified and followed until birth and 40 days after birth to detect whether they gained the acceptable standard of quality of ANC from July 2017 to June 2018. A structured, predefined, and pretested observation check list and Likert scales were employed to obtain the necessary information after getting both written and verbal consent from the concerned bodies and study participants. Data was entered into Epi Info version 3.5 and transferred to STATA Version 14 software and cleaned by reviewing frequency tables, logical errors, and checking outliers. Generalized estimating equation (GEE) analysis was applied to get the average response observation of each visit of quality of ANC in the health facilities. Result. This study showed that the overall magnitude of good quality of antenatal care service that was provided in the whole visit at Hosanna Town’s public health facilities was 1230 (31.38%). The most frequently identified problems were inability to take full history, lack of proper counseling, poor healthcare provider and client interaction, and improper registration and there was a variation in providing quality of care in each visit. Quality of antenatal care was significantly associated with residence, educational status gravidity, parity, and visit. In conclusion, the overall quality of antenatal care is low, so the health facilities need further modification on the identified problems.
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Serván-Mori E, Chivardi C, Fene F, Heredia-Pi I, Mendoza MÁ, Nigenda G. Tackling maternal mortality by improving technical efficiency in the production of primary health services: longitudinal evidence from the Mexican case. Health Care Manag Sci 2020; 23:571-584. [PMID: 32720200 DOI: 10.1007/s10729-020-09503-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 02/06/2020] [Indexed: 10/23/2022]
Abstract
Ensuring regular and timely access to efficient and quality health services reduces the risk of maternal mortality. Specifically, improving technical efficiency (TE) can result in improved health outcomes. To date, no studies in Mexico have explored the connection of TE with either the production of maternal health services at the primary-care level or the maternal-mortality ratio (MMR) in populations without social security coverage. The present study combined data envelopment analysis (DEA), longitudinal data and selection bias correction methods with the purpose of obtaining original evidence on the impact of TE on the MMR during the period 2008-2015. The results revealed that MMR fell 0.36% (P < 0.01) for every percentage point increase in TE at the jurisdictional level or elasticity TE-MMR. This effect proved lower in highly marginalized jurisdictions and disappeared entirely in those with low- or medium-marginalization levels. Our findings also highlighted the relevance of certain social and economic aspects in the attainment of TE by jurisdictions. This clearly demonstrates the need for comprehensive, cross-cutting policies capable of modifying the structural conditions that generate vulnerability in specific population groups. In other words, achieving an effective and sustainable reduction in the MMR requires, inter alia, that the Mexican government review and update two essential elements: the criteria behind resource allocation and distribution, and the control mechanisms currently in place for executing and ensuring accountability in these two functions.
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Affiliation(s)
- Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Carlos Chivardi
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Fato Fene
- School of Public Health, National Institute of Public Health of Mexico, Cuernavaca, Morelos, Mexico
| | - Ileana Heredia-Pi
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Miguel Ángel Mendoza
- School of Economics, National Autonomous University of Mexico, Mexico City, Mexico
| | - Gustavo Nigenda
- National School of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico.
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Emiru AA, Alene GD, Debelew GT. Individual, Household, and Contextual Factors Influencing the Timing of the First Antenatal Care Attendance in Northwest Ethiopia: A Two-Level Binary Logistic Regression Analysis. Int J Womens Health 2020; 12:463-471. [PMID: 32606998 PMCID: PMC7308146 DOI: 10.2147/ijwh.s250832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 06/09/2020] [Indexed: 11/23/2022] Open
Abstract
Background Early antenatal visit is critical for the health and well-being of mothers and babies. However, various individual, family level, and contextual factors influence the timely initiation of antenatal care. Objective The aim of this study was to examine individual, household, and community-level factors associated with the timing of first ANC visit among mothers who gave birth in the last twelve months before the survey. Methods A community-based cross-sectional study was conducted in June 2018. A multistage cluster sampling technique was applied, and a sample of 898 women was considered. Data were collected using a questionnaire and checklist. The analysis was made using SPSS. A multilevel logistic regression with random effects at the kebele level was developed to assess the predictors of late initiation of antenatal care. Odds ratio with 95% confidence intervals was used to measure association while the intra-class correlation coefficient and the median odds ratio were used to measure variations. Results Overall, 78.4% (95% CI: 75.6, 80.9) of women started their first ANC in 4 months of gestation or later and significant heterogeneity was observed between clusters. At level 1, women with intended pregnancy (aOR=0.31; 95% CI: 0.12, 0.79), and being knowledgeable about the timing (aOR=0.43; 95% CI: 0.25, 0.75) and pregnancy-related complications (aOR=0.16; 95% CI: 0.10, 0.26) were less likely to delay their first ANC visit. Conversely, the odds of late ANC visit was higher among women with no formal education (aOR=4.08, 95% CI: 2.20, 7.55). Distance to the health facility (aOR=1.04; 95% CI, 1.01-1.08) was the only level-2 significant predictor. Conclusion The study revealed that late ANC initiation was rampant. Several factors operating at different levels were associated with late ANC visits; yet, the role of individual-level factors was relatively stronger. Hence, awareness creation is essential to the underprivileged community using the available communication networks.
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Affiliation(s)
- Amanu Aragaw Emiru
- Department of Reproductive Health and Population Studies, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Getu Degu Alene
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Bahir Dar University, Bahir, Ethiopia
| | - Gurmesa Tura Debelew
- Department of Population and Family Health, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
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Sauer SM, Pullum T, Wang W, Mallick L, Leslie HH. Variance estimation for effective coverage measures: A simulation study. J Glob Health 2020; 10:010506. [DOI: 10.7189/jogh.10.010506] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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49
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Women's retention on the continuum of maternal care pathway in west Gojjam zone, Ethiopia: multilevel analysis. BMC Pregnancy Childbirth 2020; 20:258. [PMID: 32349687 PMCID: PMC7191802 DOI: 10.1186/s12884-020-02953-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 04/16/2020] [Indexed: 11/25/2022] Open
Abstract
Background The continuum of maternal care has been one of the effective approaches for improving the health of mothers and newborns. Although large numbers of Ethiopian women do not use maternal health services, points of drop out along the continuum are not understood well. Understanding of a particular point of maternal care dropout on the continuum, however, helps governments make effective interventions. This study aimed to assess the extent of women’s service utilization and the factors affecting retention on the continuum of care in West Gojjam Zone, Ethiopia. Methods A community-based study linked to health facility data was conducted in June 2018. Data were obtained from 1281 mothers who gave birth to their last baby within the preceding 12 months from a two-stage cluster sampling. Data were collected via face-to-face interviews using a pretested questionnaire. Multilevel logistic regression models were used to examine the effects of individual and cluster-level factors on key elements of the continuum of care. The measure of fixed effects was expressed as Odds Ratio with 95% confidence interval. Results The study revealed that only 12.1% of women completed the continuum of maternal care services (ANC4+, SBA, and PNC within 2 days after birth); while 25.1% of them did not receive any care during their recent births. There were commonalities and differences in the predictors of the three indicators of maternal health service utilization. Variables related to services received during antenatal care such as early initiation of ANC (AOR = 7.53, 95%CI, 2.94, 19.29) and receiving proper contents (AOR = 3.31, 95%CI, 1.08, 10.16) were among the predictors significantly associated with the completion of the continuum of care. Conclusions The continuum of maternal care completion rate was extremely low, indicating that women were not getting the maximum possible health benefit from existing health services. The results also revealed that maternal health service utilization was influenced by factors operating at various levels-individual, household, community, and health facility. Since antenatal care is considered an entry point for the subsequent use of maternal services, strategies that aimed to improve maternal health service utilization should target early initiation and antenatal care quality.
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50
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Sauer SM, Pullum T, Wang W, Mallick L, Leslie HH. Variance estimation for effective coverage measures: A simulation study. J Glob Health 2020. [PMID: 32257160 PMCID: PMC7101480 DOI: 10.7189/jogh-10-010506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Effective coverage research is increasing rapidly in global health and development, as researchers use a range of measures and combine data sources to adjust coverage for the quality of services received. However, most estimates of effective coverage that combine data sources are reported only as point estimates, which may be due to the challenge of calculating the variance for a composite measure. In this paper, we evaluate three methods to quantify the uncertainty in the estimation of effective coverage. Methods We conducted a simulation study to evaluate the performance of the exact, delta, and parametric bootstrap methods for constructing confidence intervals around point estimates that are calculated from combined data on coverage and quality. We assessed performance by computing the number of nominally 95% confidence intervals that contain the truth for a range of coverage and quality values and data source sample sizes. To illustrate these approaches, we applied the delta and exact methods to estimates of adjusted coverage of antenatal care (ANC) in Senegal. We used household survey data for coverage and health facility assessments for readiness to provide services. Results With small sample sizes, when the true effective coverage value was close to the boundaries 0 or 1, the exact and parametric bootstrap methods resulted in substantial over or undercoverage and, for the exact method, a high proportion of invalid confidence intervals, while the delta method yielded modest overcoverage. The proportion of confidence intervals containing the truth in all three methods approached the intended 95% with larger sample sizes and as the true effective coverage value moved away from the 0 or 1 boundary. Confidence intervals for adjusted ANC in Senegal were largely overlapping across the delta and exact methods, although at the sub-national level, the exact method produced invalid confidence intervals for estimates near 0 or 1. We provide the code to implement these methods. Conclusions The uncertainty around an effective coverage estimate can be characterized; this should become standard practice if effective coverage estimates are to become part of national and global health monitoring. The delta method approach outperformed the other methods in this study; we recommend its use for appropriate inference from effective coverage estimates that combine data sources, particularly when either sample size is small. When used for estimates created from facility type or regional strata, these methods require assumptions of independence that must be considered in each example.
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Affiliation(s)
- Sara M Sauer
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Thomas Pullum
- The Demographic and Health Surveys (DHS) Program, Division of International Health and Development, ICF, Rockville, Maryland, USA
| | - Wenjuan Wang
- The Demographic and Health Surveys (DHS) Program, Division of International Health and Development, ICF, Rockville, Maryland, USA.,Division of AIDS, Behavioral, and Population Sciences; Center for Scientific Review, National Institutes of Health; Bethesda, Maryland, USA
| | - Lindsay Mallick
- The DHS Program, Avenir Health; Glastonbury, Connecticut, USA
| | - Hannah H Leslie
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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