Primary health care nursing students' knowledge of and attitude towards the provision of preconception care in KwaZulu-Natal

Training in preconception care focused on primary health care providers: Effects on preconception care knowledge and provision

Objective

To assess the effect of a rapid training intervention on the knowledge of health providers and the provision of preconception care in primary health care services.

Methods

Randomized community trial in eight primary health care facilities (four were randomly allocated to the intervention group and four to the control group) in 2020 in Brazil. The intervention consisted of rapid training in preconception health for all health providers in the intervention group. Health providers who had medicine and nursing backgrounds answered structured questionnaires about their knowledge and practices of preconception health-related topics, and reproductive-age women attending the services completed a questionnaire about their experience with preconception care in pre- and postintervention (three months after the intervention) periods.

Findings

The level of knowledge among health providers increased after the intervention, but providing information about preconception care and prescribing folic acid showed no significant change, with the exception of screening for future pregnancy intention.

Key conclusions and implications for practice

Although the knowledge of health providers on preconception care is a fundamental requirement for its provision in primary health care settings, rapid training focused on preconception health topics was not sufficient to change their practices, with the exception of pregnancy intention screening, which experienced a slight increase after the training. It appears that additional elements, such as the reorganization of primary health care services to prioritize non-pregnant women, the development and implementation of specific guidelines, along with strategies for the dissemination of preconception care awareness, may also play crucial roles for full preconception care implementation in addition to health providers' knowledge of such issues.

Preconception Care Recommendations, Training, and Competency of Primary Healthcare Nurses in South Africa: A Quantitative Descriptive Study

Introduction

There has been a growing interest in preconception care (PCC) as a primary means of tackling the high maternal and child mortality rates, as evidence has shown that the state of maternal health before conception can have a direct impact on the health of the mother and baby. Primary care nurses have been recognized as the highest providers of sexual and reproductive healthcare to the vulnerable population in resource-constrained settings.

Objective

This study aimed to examine and describe the PCC recommendations, training, and competency of primary healthcare (PHC) nurses in South Africa.

Methods

A cross-sectional descriptive study was conducted among 196 PHC nurses to examine the PCC recommendations, training, and competency. A self-administered survey tool was used for data collection.

Results

The self-reported PCC recommendations, training, and competency of PHC nurses were 63.3%, 88.3%, and 94.9%, respectively, in each aspect. The PCC training among the respondents was mainly in-service training. The only training that was indicated to have been done primarily at a pre-service level was training about reproductive life plan screening and brief counseling. Over 20% of the respondents indicated that they did not receive any training on how to provide alcohol, drug, or tobacco cessation services and how to conduct preconception risk assessments.

Conclusion

Although PHC nurses reported a high level of recommendation, training, and competency, their level of reported PCC practice is not equivalent to their provision, as they rendered PCC services to fewer women, and they also reported fewer women seeking PCC. A future longitudinal study is required to examine the reason for low PCC-seeking habits among those at high risk of adverse pregnancy outcomes and contextual factors influencing the provision of PCC services among healthcare workers.

“We Are Having a Huge Problem with Compliance”: Exploring Preconception Care Utilization in South Africa

Background: Preconception care (PCC), a policy directive from the World Health Organisation (WHO), comprises all the health interventions offered to women and couples before conception and is intended to improve their overall health status and the pregnancy outcomes. Although PCC should be an essential part of maternal and child health services in most African countries, its provision and utilization are not widely documented. Hence, this study aimed to explore the factors influencing preconception care utilization among high-risk women in South Africa. Methods: A descriptive qualitative study of 29 purposively selected women and healthcare workers was conducted through individual in-depth interviews using a semi-structured interview guide. The interviews were transcribed verbatim, and the analyses were performed using Nvivo version 12. The Social-Ecological Model (SEM) guided the data analysis. Four levels of factors (the individual, the interpersonal, the community and social, and the policy and institutional) were used to assess what can influence PCC utilization. Findings: The availability of PCC services, the intrahospital referral of women, the referral practices of other healthcare workers, the underutilization of the PCC facility, and resources emerged at the institutional levels, while compliance with PCC appointments, socioeconomic factors, pregnancy planning, assumptions, and knowledge was at the individual levels. Conclusion: The utilization of the preconception care services was inadequate. The primary influencer of preconception care utilization was at the individual, policy, and institutional levels. The availability of preconception care services and the intrahospital referral of women at high risk of adverse pregnancy outcomes positively influenced the women’s PCC utilization, while poor pregnancy planning, and unavailability of PCC policies and guidelines negatively influenced preconception care utilization. Therefore, interventions to improve PCC utilization should focus on the four SEM levels for effectiveness. There is a need to raise PCC awareness and develop policy and guidelines to ensure consistent, standardized practice among healthcare workers.

Current state of preconception care in sub-Saharan Africa: A systematic scoping review

Background

Preconception care (PCC) utilisation is essential to extend and complete the health continuum. However, these services are not yet incorporated into many low-income countries’ existing maternal health services.

Aim

This study aims to review the current literature on the knowledge, utilisation and provision of PCC.

Setting

This included women and healthcare workers (HCWs) in Sub-Saharan African (SSA) countries.

Methods

Arksey and O’Malley’s scoping review methodology framework is used in this study. The following databases, Google Scholar, Science Direct, PubMed, Scopus and Dissertation via ProQuest, were searched. Articles that met the eligibility criteria were included in this study.

Results

Out of the 451 retrieved articles, 39 were relevant. In most studies, women’s utilisation and HCW’s provision of PCC were considered limited. Their knowledge, however, varies between studies, and there were a few studies conducted among women with chronic conditions. Several factors influenced women and HCWs’ knowledge, utilisation and provision of PCC, including age, level of education, employment, practice area, resources and knowledge. Preconception care interventions most commonly identified, utilised and provided were HIV testing, counselling and family planning, while preconception folic acid supplementation was the least.

Conclusion

The estimates of knowledge and utilisation were suboptimal among women, while provision was the worst affected among HCWs. Gaps exist between the HCW knowledge and practice of PCC. There is a need to promote, prioritise, integrate and optimise the opportunistic provision of PCC in SSA. There is also a need for more studies on PCC provision and utilisation among women with chronic medical conditions.

Knowledge of preconception care and associated factors among maternal health care providers working in urban public health institutions of Eastern Ethiopia

Background:

Provision of preconception care is significantly affected by the health care provider’s knowledge of preconception care. In Ethiopia, preconception care is rare, if even available, as part of maternal health care services. Thus, this study aimed to determine the level of knowledge of preconception care and associated factors among health care providers working in public health facilities in Eastern Ethiopia.

Methods:

A multicenter cross-sectional study was conducted from 1 March to 1 April 2020. A simple random sampling technique was used to select a total of 415 maternal health care providers. We utilized a structured, pretested, and self-administered questionnaire to collect data. Data were entered into EpiData (version 3.1) and exported to STATA (version 16) for analysis. Descriptive statistics and bivariate and multivariate logistic regression analyses were performed. All covariates with a p value ⩽0.20 in bivariate logistic regression were entered into a multivariate logistic regression analysis to control the confounding variables; variables with a p value <0.05 were considered statistically significant.

Results:

Out of 410 respondents, 247 (60.2%; 95% confidence interval: 55.4–65.1) had good knowledge of preconception care. Having an educational level of Bachelor of Science degree and above (adjusted odds ratio: 6.97, 95% confidence interval: 3.85–12.60), 5 or more years work experience (adjusted odds ratio: 2.60, 95% confidence interval: 1.52–4.49), working in a hospital (adjusted odds ratio: 2.50, 95% confidence interval: 1.25–4.99), reading preconception care guidelines (adjusted odds ratio: 3.06, 95% confidence interval: 1.40–6.68), and training on preconception (adjusted odds ratio: 2.90, 95% confidence interval: 1.37–6.15) were significantly associated with good knowledge of preconception care.

Conclusions and Recommendations:

Three out of five maternal health care providers in this study had good knowledge of preconception care. Facilitating continuous refreshment training and continuous professional development for health workers, preparing comprehensive preconception care guidelines for health institutions, and reading preconception care guidelines were highly recommended.